Asked By:
Hanif
in
Education & Reference
-
434 days ago
admin's Answer
http://www.thedailystar.net/2004/08/04/d408041502120.htm
Population control: Reaching the remaining half
IREAD " population pro-grammes and directions" by Dr. Syed Jehangir Hyder (Daily Star July 24, 2004) with great interest. Dr. Hyder analyzed the progress and raised pertinent issues in the population programme of Bangladesh. As a person with some involvement in Bangladesh health and population programme during the decade of the seventies, this encouraged me to share some of my thoughts on a subject as important for the country as Population programme is.
Remarkable progress was made in creating awareness and raising use rate of contraceptives currently holding at over 50 per cent. Two things stand out at present. The quality, safety and acceptance of current services need considerable improvement. Second, reaching the remaining half and inducing many of them to use effective contraception of choice will require a different strategy and service delivery. Also, while reaching half the eligible population has been relatively easy,
raising the contraceptive prevalence rate to 65% and above will be harder. The demographic impact (impact on the size of the population and its age structure) of reaching those who have already "done the reproductive damage" that is those who have had two or more children so far has been relatively modest. Reaching the younger couples and those yet to enter reproductive cycle will yield a bigger impact.
On quality and safety, good clinical facilities and wider choice of contraceptives of tested quality will be first steps. This is linked with service delivery by knowledgeable and motivated staff. The time has perhaps come to move away from house visits and distribution and move to counseling, choice, and safe service delivery that is much more client/user centered and not target driven. This will require much "unlearning" by present staff but also induction of trained new staff.
Service delivery strategy may include first generating unmet demand from a relatively more sophisticated or choosey future acceptors; many of them will want and appreciate well-rounded information and services namely a wide choice of relevant and meaningful reproductive health services. The strategy should cover the long-term aspects by for example, reaching out to today's young adults and adolescents who will soon enter reproductive age. No doubt, the sustainability of optimum contraceptive prevalence rate and high impact on aggregate population fertility will come from the large younger age group especially the females in this group. And this group will know and demand valid information and high quality service.
As to coverage and scope of services, the programme must move well beyond contraception and limited maternal and child health towards a comprehensive package including adolescent health, safe sex and responsible pregnancy, post contraception care. A life cycle approach covering reproductive health will eventually improve programme performance, relevance, and sustainability. That is what was agreed in the Plan of Action adopted by the International Conference on Population and Development at Cairo in 1994.
Bangladesh population programme has made great strides. It is even cited as a model in certain aspects. But the strategy of extensive home distribution of standard contraceptives by an army of field workers has outlived its effectiveness. Now is the time for a strategic shift to timely and relevant information and advice, tailored -to -need service (individualized if you like) within a broad range of reproductive health coverage. So has the time come for viable quality and class of service albeit with a charge, which, many of future users will accept and be willing to pay if the service is safe, discreet, and perceived to be of good quality.
Time has come to embrace consumer-oriented service in tune with today's free market supply of consumer goods and services by choice. Contraception is not another item of consumption by choice; this choice has deep and long term bearing on health and well being of countless individuals and families; their right to know and choose is to be respected and not to be trifled with. This is one thing the Programme has to learn and learn very fast. Right to know should be combined with right things to know. Luckily, much is known already, both in science and technology of reproductive health including contraception and in means and methods of delivering population based services, in several countries (Thailand, Sri Lanka and Indonesia) in the region and beyond. That is waiting to be tapped and then tailored to suit local conditions and demands. Many of these lessons are not beyond the capacity of the Bangladesh programme to grasp and adapt. Bangladesh programme is mature enough with many successes and accumulated experience.
There is no substitute for validated truth; assumptions most likely valid but have to be tested and proven by evidence. Experience counts more than opinions, which are not sufficient guides to decisions. And in population programmes the world over sufficient experience exists waiting to be consulted and tested.
Research is key to new knowledge and generating fresh evidence. Therefore, the current research and field research in particular must be redesigned with a view to finding what might work better than others in motivation, education, and service quality; above all client needs and attitudes. Most behavioral research is difficult, time consuming and demands sophisticated methods. Yet, behavioral research is a key determinant of sophisticated strategy and successful induction and retention of tomorrow's users.
Bangladesh population programme faces two challenges; these are also great opportunities waiting to be seized. This is a not mere utopian or unrealistic dream. Reaching the remaining half (beyond the present 50% users) is the key to further and sustained decline of aggregate population fertility, which is the goal for the coming decade. Enlarging the scope of coverage, fine tuning the strategy to meet variations of needs and demands, and fresh research-cum-development into behavior and attitude are not options but are essential.
This article is primarily meant to open up the debate and discourse on some of the current challenges and to invite serious examination of viable options. What are wasteful are further seminars and workshops to enumerate the problems and engage in theoretical platitudes; enough of those are collecting dust on shelves and archives. And let us open the debate based on evidence and be ready to field test some new assumptions. Let us also create some welcome space for the many field workers of the population and health programme of the government and the non-governmental organisations who are usually sidelined in policy and programme debates.
Population programme's growth to adulthood under a strategic direction within broad reproductive health perspective has come. Reaching the remaining half is essential if the programme is to take off and reach the goal of reining in population dynamics and stabilize population. That will be a single major contribution to human resources development and poverty reduction.
Dr. Zakir Husain is former Chief, Health and Population, Planning Commission, Bangladesh.
Answered
433 days ago |
Read Comments (1)
Read answer
