Service delivery at family welfare centres: the clients perspective

Abstract

The Family Welfare Centre (FWC) are the primary fixed centres for the provision of maternal and child health and family planning services at grass root level. Two paramedics are posted of which one is female. The objectives of this study was to evaluate the types and quality of services and determine client satisfaction of these services. Six hundred and fifty exit interviews were conducted with FWC clients using a structured questionnaire between July and September 1993 in Abhoynagar and Sirajgonj Thanas, the field sites of the MCH-FP Extension Project (Rural) of ICDDR.B. Client were asked about the services they had received that day. Most clients were married women, aged 20 to 40 years, living less than one kilometre away from FWC. They had an average of 3.75 previous pregnancies and 55 percent of them were using a contraceptive method. At least one paramedics was present on 94 percent of the working days while interviews were conducted at the FWCs. Illness of the women (68%) and child care (51%) were the most common reasons for seeking services. Only 8 percent clients received antenatal care while 6 percent got family planning services. Over ninety percent clients received at-least two drugs that day. Half of the family planning complications were found among the IUD users, who make up only 6% of all users. Discrepancies were found between the drugs recorded in the register and those actually dispensed. Many clients did not remember or were not told the dosage of drugs. A quarter of the clients received antibiotics of which 70% percent did not know the proper dosage of drugs. Thirty percent of the clients were aot satisfied about privacy, clinical examination, availability of drugs, and counselling. Their knowledge about services offered at FWC indicates that, majority of the clients (80%) knew about curative care offered at FWC and over a half of the respondents were aware of family planning and child care services where as only 20 percent know about antenatal care. The study shows that curative care is the most frequent service provided at FWC. Family planning services, antenatal and post natal care represent at very smalt proportion of the activities. Clients are not fully aware of other services available. Treatment practices and communication between clients and providers arc not satisfactory. The study recommends refresher training for the paramedics. Technical guidelines should be available for them. Furthermore, the community should be motivated to utilize the MCH-FP services.