Bangladesh 1993-1994 Demographic and Health ... - Measure DHS

11.2 Family Planning Services IssuesHousehold Visitation by Field WorkersField workers are a key component in the family planning program service delivery system. Theirdirect contact with clients through household visitation remains a key strategy in the program's educationaland motivational efforts. The BDHS data show that despite impressive coverage by family planning fieldworkers, the household visitation rate remains low. In 1993-94, only 38 percent of currently married womensaid they had been visited by a family planning field worker during the previous six months (see Table 4.30).It should be noted that visits to the household may underestimate the actual frequency of contact betweenfield workers and couples.The patterns of visits according to characteristics of the women are as expected. Very young women,old women without children, women in Chittagong Division, and sterilized couples, are all less likely to bevisited. It is of concern that only one in four couples who were not currently using any method of contraceptionwere visited. Clearly, this group must be reached if use of contraception is to increase further.Despite the small proportion of households visited, it is encouraging that among those visited, themean number of visits during the preceding six months was 3.0, indicating that the normal bimonthlyvisitation schedule was being followed in these cases (see Table 4.30). Questions may be asked about whysuch frequent visits are made to sterilization acceptors, and what supplies are provided to current users oftraditional methods, but overall the pattern is satisfactory.Currently married women who were visited by a field worker had a contraceptive prevalence ratealmost double that of those who were not visited by a field worker. This pattern has also been observed inother studies; however, it cannot be assumed that such visits necessarily cause the higher rate of contraceptiveuse. There may be a selection bias by the field workers to avoid determined nonusers, and to favor visitinglikely users.Consideration should be given to a review of just how realistic the targets are for field workervisitation. Currently, field workers are supposed to visit 20 households a day, or to complete the visitationcycle in two month's time. It is necessary to determine the optimum number of households a field workercan visit daily, as well as the length of the visitation cycle based on the current workload. If the present forceof field workers cannot be increased, or current workloads reduced, alternative approaches should bedeveloped. Current pilot approaches such as satellite clinics, the Depotholder Program, the block system ofvisitation, or the cluster mode of visitation need to be properly evaluated to determine which aspects are mostconducive to increased client contact. In many cases, nonusers decline to use family planning due to matterswhich could be effectively addressed by IEC. For example, about half of nonusers under 30 years (and onein four, overall) gave reasons for nonuse related to health concerns or knowledge issues that could be due toinadequate information (see Table 4.24).National planning must focus not only on providing services for around 12 million currentcontraceptive users, but must also anticipate a doubling of that number within a decade if the Government'scontraceptive prevalence goals are to be approached in the context of the large and rapidly increasing numberof eligible couples. There can be no doubt that the private sector will need to take a greater role in provisionof services.137