ESET SysRescue

Collectively, data from the census of health facilities and pharmacies and the assessment of health facilities indicate that opportunities to support family planning use are being missed by the health sector at multiple levels.

13), which is confirmed by the findings of this study, male doctors have yet to step up to fill the need for male providers to counsel men. Present in much larger numbers than female doctors, especially in rural areas, non-providing male doctors represent a large missed opportunity to engage men in family planning.

The timings of facilities are also an important facet of their availability, especially where a part of their clientele has to invest considerable time and money to reach them. The presence of a female provider is crucial for dispensing female methods. It was found that more than 80 percent of public (except DHQs) and private health facilities had a female service provider present in the morning shift. However, only 39 percent of public and 42 percent of private facilities had a female provider available in the evenings, implying additional access difficulties for women who cannot travel in the daytime.

The second level of missed opportunities arises from the fact that the vast majority of SDPs only provides FP

services if the client specifically asks for them. This study found that 85 percent of clients who visited health facilities with reproductive health needs other than FP were not provided any counseling or information about family planning methods. Providers do not appear to recognize that they should proactively counsel clients regarding their need to space births to maintain maternal and child health. This is an important gap in the practices of providers and in facility management systems, especially since the majority of clients have low educational attainment and rely greatly on their providers to suggest any additional care they might need.

The third stage of missed opportunities relates to lack of choice of family planning methods. Less than 50

percent of public health facilities are providing all the basic methods—condoms, pills, emergency contraceptive pills, injectables, and IUDs or implants. Availability of implants is particularly low in both sectors. Although a high proportion of all public sector facilities offer IUDs, only about a tenth of private sector facilities are providing this method, and its availability at pharmacies is also negligible. Since the LARCs cannot be provided without the services of a skilled provider, it is particularly important that untapped private potential be harnessed for these methods. Non-involvement of private providers may also be a reason why pharmacies are not interested in keeping these methods.

Notably, even where public facilities are mandated to provide a larger range of methods, their capacity to do so can be restricted by stock-outs of contraceptives. On the day of the visit by the study team, about 80 percent of public health facilities had condoms, oral pills, injectables, and IUDs in stock, but only 6 percent had emergency contraceptive pills. Less than a third of private facilities had condoms, pills, and IUDs in stock, while 17 percent had ECPs. Moreover, while a large proportion of public facilities did have IUDs in stock, only 20 percent had the complete equipment for inserting/removing IUDs and a fourth did not have complete or essential kits for this purpose. Among private health facilities, a mere 11 percent had complete IUD kits and 66 percent did not have complete or essential kits. These issues translate into an even narrower range of options for family planning clients than the initial picture suggests, reducing their capacity to adopt new methods that suit their circumstances.

Gaps in the capacities and practices of service providers, linked to deficiencies in their training and knowledge, comprise the next tiers of missed opportunities to support potential and current FP clients. The

findings presented earlier in this section reveal large gaps in service providers’ knowledge about specific contraceptive methods as well as specific client rights. Only 26 percent have received any type of training related to family planning in the past three years, including only twelve doctors—three male and nine female. There are also weaknesses in provider practices related to communication with clients and ensuring their autonomy and privacy. It is pertinent to mention that most DoH facilities, except teaching hospitals and BHUs, are not giving much weightage to privacy, which is an important concern of clients. Arrangements for auditory

Most clients are leaving health facilities with inadequate information about how to use and what to expect while using their chosen contraceptive method. Many clients who are referred to other facilities for FP services are also not provided sufficient information to facilitate their access.

Overall, there is considerable scope for improving the quality of FP services and making the environment more client-centered. Investing in this area is likely to help reduce the current high levels of discontinuation of family planning.

Figure 5.15: Missed Opportunity