MethodMethodMixMix

CPR & TFR Comparison ChartCPR & TFR Comparison Chart

5

13.818.4

23.2

31.2

36.2

41.6 43.4

1975 1983 1985 1989 1991 1994 1997 2000

6.3

3.43.3

4.85.14.3

3.3

Source: BDHS 1999-2000 & MIS Report

CPR (modern methods)

TFR

Method Mix Changes Over TimeMethod Mix Changes Over Time

0

5

10

15

20

25

30

35

40

45

1975 1991 2000

VasectomyIUDTubectomyCondom

InjectablePill

Trends in Sterilization PerformanceTrends in Sterilization Performance1975 to 19991975 to 1999

-

100,000

200,000

300,000

400,000

500,000

74-75 78-79 82-83 86-87 90-91 94-95 98-99

Bangladesh Demographic and Health Survey, 1999-2000

Key findings fromKey findings from Review of Sterilization Review of Sterilization

Services -2000Services -2000

There is significant unmet demandThere is significant unmet demand

Infrastructure is adequateInfrastructure is adequate

Low performance factors:Low performance factors:

Lack of communication and information

Need for more trained personnel

Inadequate leadership and management

Poor quality of care

Strengthening Long Term Strengthening Long Term Clinical Family Planning Clinical Family Planning Services in BangladeshServices in Bangladesh

A Field Support Project A Field Support Project implemented by implemented by

EngenderHealthEngenderHealth Providing Technical Assistance to the Providing Technical Assistance to the

Government of Bangladesh and NGOsGovernment of Bangladesh and NGOs

Key Project ActivitiesKey Project ActivitiesJune 2001 – September 2002June 2001 – September 2002

District and sub-district workshops to provide District and sub-district workshops to provide information and plan for servicesinformation and plan for services

Topics: Topics:

Contraceptive UpdateContraceptive Update Introduction of NSV techniques Introduction of NSV techniques Addressing misconceptionsAddressing misconceptions BCC techniquesBCC techniques Organization and planning of sterilization servicesOrganization and planning of sterilization services

Example: August -- 3 DistrictsExample: August -- 3 Districts 52 workshops52 workshops 3095 participants3095 participants

Key Project ActivitiesKey Project ActivitiesJune 2001 – September 2002June 2001 – September 2002

Close collaboration with GovernmentClose collaboration with Government

Roving technical persons do training and provide Roving technical persons do training and provide services as neededservices as needed

Ex: August : 51 tubectomies and 32 NSVs performed as training,

demonstration, or request for services

Expand private sector servicesExpand private sector services

Research and BCC activitiesResearch and BCC activities

ResultsResults

Change in Sterilization PerformanceChange in Sterilization PerformanceJan to Sept 2001 Vs. Jan to Sept 2002

0

1000

2000

3000

4000

5000

6000

NSV Tubectomy

20012002

0200400600800

100012001400160018002000

NSV Tubectomy

20012002

District 1 (Jhenaidah) District 2 (Nilpharmari)

Performance ComparisonsPerformance Comparisons

2 GOB Districts2 GOB Districts comparable in demographicscomparable in demographics

Tubectomy-- 425 NSV-- 69

Total = 494

Total sterilization performance in all assisted Districts:Before and after/during project support

Total sterilization performance in all assisted Districts:Before and after/during project support

= 5,209

Control vs. Project: Performance July 2001 to June 2002Control vs. Project: Performance July 2001 to June 2002

Project Districts 1 & 2Project Districts 1 & 2

Tubectomy-- 3132 NSV-- 5033

Total = 8165

October 2000 to Sept. 2001

October 2001 to Sept. 2002

14,181=

Challenges AheadChallenges Ahead

Insuring informed choice and volunteerismInsuring informed choice and volunteerism

Broadening Scope Broadening Scope

Quality of care Quality of care

Replicating success for rapid expansion of Replicating success for rapid expansion of impactimpact