Target-specific home-based motivation: test case with family planning

Abstract

Objective: Develop systematic approach toward targeting of non-users of family planning (FP) methods and provide motivation at their homes, and examine the effects on acceptance of modern FP method. Methodology: Motivation of non-users of FP method through targeted home visits was carried out as a component of the operations research intervention on Alternative Strategies for Delivery of MCH-FP Services (ASDS) tested in two sites of Dhaka city during January 1996-May 1997. This strategy was experimented to affect focused outreach activities, in place of door-to-door delivery of services, to attain maximum effectiveness within fund constraints. To assess the effects of the approach and acquire insights of the providers' and clients' perspectives, an evaluation was conducted during March-May 1997. The service records of the fieldworkers on the non-users of modem FP methods among slum and non-slum households were analyzed; 40 observations of fieldworker-women encounters were made, 48 in-depth interviews of the target clients, and in-depth interviews with the seven fieldworkers of the intervention sites were conducted. Results: Despite a major change in the two-decade-old conventional service-delivery system relating to withdrawal of home distribution of contraceptives, target-specific home-based motivation resulted in the high acceptance of modern FP methods among the non-users. A third of the non-slum and a fourth of the slum non-users in one intervention area (at Hazaribagh), and little more than a fourth of both non-slum and slum non-users in another (at Gandaria) became acceptors of modem FP methods. The systematic approach of addressing the non-users developed in participatory workshops with the fieldworkers was found effective by both fieldworkers and target clients. The changed role of the fieldworkers, from FP commodity suppliers to case-workers, resulted in more time allocated for motivation, and more effective need-based motivation and counselling. Conclusion: Focused home visits for providing motivation to the target population led to higher effectiveness of programmes with fewer fieldworkers, hence with reduced costs. Although target-specific home-based motivation was applied for FP in this study, this approach may be adapted for other health programmes loo.