Client relations in South Asia: programmatic and societal determinants

Abstract

Client relations constitute a neglected area of research in family planning. Findings from studies in northern India and Bangladesh reveal considerable variation in both the quantity and quality of contacts in programs that function under roughly comparable socioeconomic conditions. Client relations are determined by a complex set of forces in which both programmatic factors and conditions pertaining to the societal environment play a key role. Worker-client exchanges have a net, incremental effect on contraceptive use. PIP:

Despite their considerable importance, client relations constitute a neglected area of research in family planning (FP). This paper analyzes research findings on the nature of client relations and their determinants from northern India programs: 1) the Kanpur study, on FP in 1 division of Uttar Pradesh; 2) another from a smaller Uttar Pradesh project, on interactions between male and female workers and villagers; and Bangladesh: 3) a maternal-child health (MCH) and FP project of the International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Matlab; and 4) an ICDDR,B study of a MCH-FP extension project in 2 subdistricts. Additional information is reported from an earlier survey of 6 Bangladesh subdistricts. Important aspects of client encounters are initiation, medium, and setting of contact, and degree of dependence. Determinants of client relations are expressed in diagram form. Some survey studies of the quantity of FP contacts with villages reveal variation between villages, and between northern India and Bangladesh. Not only coverage but also degree of follow-up are shown to affect program performance. Worker density and work effort, as well as village accessibility, affect coverage. The managerial context and societal conditions are also important. Female workers are generally more effective because women are more responsive to the FP message and female to female communication is more culturally appropriate. Females are also less likely to be affected by political influences, lacking political connections, and are less likely to have alternative employment. Females with high status and access to patronage are more likely to be successful, and workers' integration into networks of status and influence lends social credibility to program activities. But aside from personnel characteristics, policy formulation and program implementation are constrained by patronage politics, dependence and poverty economics, and bureaucratic structures