Program planning for family planning services

This exchange of opinions was occasioned by an article which appeared in the October 1969 Perspectives under the title Family Planning Services in the U.S.: a National Overview, 1968. Mr. Sieverts criticizes the article as follows. The ratio of unmet need claimed to available facilities is considered not properly stated in that all indigent girls and women from their midteens through their midforties do not need such services every year and that clinic services do not represent the total of such services available. Many have no such need. The private physician and hospital clinic provide much service. Development of new services should also consider demands, resources, and alternative solutions. Other health services must also be coordinated. Mr. Jaffe's defense follows. The stated need is an approximation by applying the Dryfoos-Pulgar-Varky (DPV) formula to the 1966 census figures. The need figure which results is about 5 million out of a total of over 8 million poor and near-poor women in the age group 15-44. This estimate is considered reasonably accurate. The number included but not in need is partially offset by some below the age of 18 who are also in need. Poor families have relatively less access to private physicians than others. This is shown by the number of women who deliver their babies on the ward service of hospitals without the presence of a private physician. Also, private physicians tend to give less attention to contraception for low income patients than do clinics. Many women depend on nonmedical and unreliable birth control measures. Family planning is not a one-time educational process. Revisits, continuing supervision, and check-up examinations are advocated particularly for IUD users and those taking pills. With current contraceptive technology adequate family planning services contemplates care extending for most of the patient's reproductive years. Resources require allocation. The study rests on the findings that the poor have a higher incidence of unwanted fertility than the nonpoor with significant adverse health and social consequences for both the individual and society. The study was a systematic attempt to achieve a national goal of providing modern family planning services to all who need and want them but cannot afford private care.     

Pandemic planning

During the previous century, three influenza A pandemics occurred with a variable severity. The two latter were explained by a genetic re-assortment and false alarms without pandemic spread were observed later by the same mechanism or by direct animal infection. The likelihood that such an event occurs again is high and each country has to be prepared for facing what could be a catastrophe. The last event in Hong Kong in 1997 where six persons died, has allowed refining the definitions and phasing a pandemic threat from the moment that a novel virus is discovered. WHO implemented 50 years ago a large network of surveillance with five collaborating centres, including the animal influenza centre of Memphis, and 110 national influenza centres. These centres are encouraged to prepare or improve a national contingency plan that could reduce importantly medical and socio-economic consequences of an influenza A pandemic. Countries or regions are recommended to use these guidelines that provide a framework for preparing an appropriate and proportionate response.     

Needs-based planning: Evaluation of a level-of-care planning model

With the closure of a number of provincial psychiatric hospitals planned, the Ministry of Health of Ontario has commissioned a series of planning projects to identify alternative placements for current hospital patients. The goal is to match need to care in the least restrictive setting. A systematic, clinically driven planning process was implemented that involved three steps: development of a continuum of levels of care representing increasingly intensive and more restrictive supports, development of criteria and decision rules for placement, and comprehensive needs assessment of current patients using the Colorado Client Assessment Record. Results showed that only 10% of current inpatients need to remain in the hospital, and over 60% could live independently in the community with appropriate supports. Evidence supports concurrent validity of the planning model, but further work is needed to assess whether recommended levels of care effectively meet consumer needs in the least restrictive setting.     

disaster planning—

Whether it's fire, flood, or thermonuclear explosion, disasters are a constant threat. When large numbers of people are injured in a single catastrophe, the only consideration is that the greatest number be made well and productive in the shortest time. To meet this need, planned preparedness is vital. The simplest way to stress the importance of a plan is to say that someday it may save your life.     

Family planning hotline

Since last March, a family planning hotline has been putting the caller in touch with the Family Planning Information Service. This is possibly the 1st centralized referral and information service for family planning in any major city in the U.S. Each months this fall 1400 New Yorkers called the hotline number to obtain information about family planning, infertility, abortion, and voluntary sterilization. Several major parallel developments made the creation of the Family Planning Information Service possible and strengthened its changes of success. The service is headed by a registered nurse who is assisted by 2 specially trained nonprofessional staff members. The unit is housed in Planned Parenthood's Manhattan headquarters. The Service has a special telephone number which is listed in all telephone directories. A number of promotional devices have been used to build and maintain the volume of inquiries. The results of the intensive work to develop and maintain the service have been dramatic. From a monthly volume of 300 calls in March, the figure in May had reached 670. In July there were 962 inquiries and in October the figure rose to 1421. About 90% of these calls are from women. By far the largest number of requests for information have concerned contraception and where such services can be obtained. Over 200 calls have been inquires about infertility problems, and 361 calls have concerned abortion. More than 100 calls have been about sterilization, with men outnumbering women 2:1.     

Family planning update

It is important that health visitors have a basic grasp of the main contraceptive methods, how they work, and the extent of family planning services available, for they will then be in the best position to advise and support patients. National Health Service (NHS) facilities are outlined and details are provided about the following main methods of contraception: combined oral contraceptive (OC) pill; progestogen only or minipill; IUD; diaphragm or cap and spermicide; condom and spermicide; "safe period;" and female and male sterilization. Motivation is a key factor in the successful use of birth control. Couples require information and guidance before they decide on a method and help if they are ambivalent about continuing with a method or concerned about possible side effects. Couples frequently will require continuing support to ensure that they are happy with their chosen method and using it correctly. As up to 2 million women in the UK use no regular or reliable contraception and are at risk of an unplanned pregnancy, much work remains to be done. The range of free NHS services includes: confidential advice; choice of birth control method; free supplies; male and female sterilization; postcoital contraception; special sessions for young persons; treatment for subfertility; psychosexual counseling; pregnancy testing and counseling; rubella screening; smear tests and breast checks; help for menopause problems; advice on premenstrual tension; and artificial insemination by husband and artificial insemination by donor. Although OCs have some possible risks and side effects, few women actually have serious problems. For most women the benefits outweigh the possible disadvantages. The more serious side effects, such as thrombosis, strokes, or raised blood pressure are rare, but the risks are greated in diabetics, cigarette smokers, those with high blood pressure, and those who have close relatives who have had heart attacks or strokes. The progestogen only or minipill can be used by women for whom estrogen containing pills are unsuitable. They are slightly less reliable than the combined pill, but are still approximately 98% effective. IUDs are 96-98% effective. The IUD is particularly useful for older women and for women who have already had children. Side effects such as irregular bleeding and heavy periods may occur in the 1st few months after insertion, and patients may require support and reassurance. If used carefully with a spermicide each time intercourse takes place, the diaphragm is 97% effective. Smaller devices which only cover the cervix are also available: the cervical cap; vault cap; or vimule cap. The condom, a reliable contraceptive method, is about 97% effective provided it is used with spermicide. In addition the condom provides some protection against sexually transmitted diseases. To use the "safe period" it is necessary to try to pinpoint ovulation, and the 4 ways to do this are outlined. The sympto-thermal method can be 85-93% effective if it is used carefully. Sterilization involves the cutting or blocking of the fallopian tubes in a woman or of the vas deferens in a man. The operation in either sex must be regarded as irreversible.     

Advance care planning

Advance care planning is the process of planning for future medical care, particularly for the event when the patient is unable to make his or her own decisions. It should be a routine part of standard medical care and, when possible, conducted with the proxy decision maker present. It is helpful to think of the process as a stepwise approach. The steps include the appropriate introduction of the topic, structured discussions covering potential scenarios, documentation of preferences, periodic review and update of the directives, and application of the wishes when needed. The steps can be integrated flexibly into routine clinical encounters by the physician and other members of the health care team. The process fosters personal resolution for the patient, preparedness for the proxy, and effective teamwork for the professionals. The process also has pitfalls of which to be aware. Arch Fam Med. 2000;9:1181-1187     

Influenza pandemic planning

Periodically, novel influenza viruses emerge and spread rapidly through susceptible populations, resulting in worldwide epidemics or pandemics. Three pandemics occurred in the 20th century. The first and most devastating of these, the "Spanish Flu" (A/H1N1) pandemic of 1918-1919, is estimated to have resulted in 20-50 million or more deaths worldwide, with unusually high mortality among young adults [C.W. Potter, Chronicle of influenza pandemics, in: K.G. Nicholson, R.G. Webster, A.J. Hay (Eds.), Textbook of Influenza, Blackwell Science, Oxford, 1998, p. 3]. Mortality associated with the 1957 "Asian Flu" (A/H2N2) and the 1968 "Hong Kong Flu" (A/H3N2) pandemics was less severe, with the highest excess mortality in the elderly and persons with chronic diseases [J. Infect. Dis. 178 (1998) 53]. However, considerable morbidity, social disruption and economic loss occurred during both of these pandemics [J. Infect. Dis. 176 (Suppl. 1) (1997) S4]. It is reasonable to assume that future influenza pandemics will occur, given historical evidence and current understanding of the biology, ecology, and epidemiology of influenza. Influenza viruses are impossible to eradicate, as there is a large reservoir of all subtypes of influenza A viruses in wild aquatic birds. In agricultural-based communities with high human population density such as are found in China, conditions exist for the emergence and spread of pandemic viruses. It is also impossible to predict when the next pandemic will occur. Moreover, the severity of illness is also unpredictable, so contingency plans must be put in place now during the inter-pandemic period. These plans must be flexible enough to respond to different levels of disease.     

The planning cycle

Information technology planning can be described as a continuous cyclical process composed of three phases whose primary purpose is optimum allocation of scarce resources. In the assessment phase, planners assess user needs, environmental factors, business objectives, and IT infrastructure needs to develop IT projects that address needs in each of these areas. A major goal of this phase is to develop a broad IT inventory. The prioritization phase seeks to ensure optimum allocation of scarce resources by prioritizing ITprojects based on: Costs--total life cycle costs. Benefits--both quantitative and non-quantitative, including support for the organization's strategic business objectives. Risks--subjective assessments of technological and non-technological risks. Implementation requirements--time and personnel requirements to implement the system. The scheduling phase incorporates sequencing considerations, personnel availability, and budgetary constraints to produce an IT plan in which project priorities are adjusted to meet organizational realities.     

Computer-assisted manpower planning

In the next year or two Newham Health District in London is to open phase I of its new nucleus development and close three existing hospitals. Robert Sloane, commissioning officer, describes how the IBM AS system was used to plan the manpower requirements and check the revenue consequences.     

Family planning in Uganda

Characteristics of child welfare clinics with family planning services, postnatal clinics with family planning services, and separate family planning clinics, all in Uganda, are discussed. During the years 1964-1967, growth was most rapid in and attendance was larger at separate family planning clinics. It is thought that this is the only way women in small villages will ever be reached. Whether a family planning clinic is a separate unit or is integrated with other clinics depends on the local situation. When women begin to learn that there are safe ways of controlling fertility, the government will probably begin offering these services along with other maternal and child health services. Until that time, the Family Planning Association has an important role to fill in offering these services in whatever manner the situation permits.     

Succeeding with succession planning

Succession planning is the process of identifying people who could presently move into key positions or could do so after specifically targeted development occurs. The process identifies the better people in the organization and takes a consistent approach to assembling, analyzing, and retaining information about potential leaders and planning for their further development. At its simplest level, it is the development of a backup and potential successor to each manager; at is most formal, it is a documented plan for management succession at all levels in the organization. Strongly supportive of a policy of development and promotion from within the organization, succession planning also represents a proactive posture in respect to inevitable management turnover. In these days of rapid change in health care, no modern organization that expects to keep up with increasing competition can afford to drift--or even to let a single department drift--while replacements are recruited for managers who resign, retire, or otherwise leave.     

Family planning in Pakistan

The Pakistan Family Planning Program functions as an autonomous body through the Ministry of Health. The Minister of Health is chairman of the Family Planning Council which is the main policy and planning unit. Each province has a Provincial Family Planning Board responsible for implementation. The District Family Planning Board functioning within the province is in charge of publicity and education, distribution and sale of supplies, and provision of clinical services and facilities. The District Board has about 1000 workers--medical and paramedical in the clinics, family planning officers for education and motivation, lady organizers (local motivator and agent of sale of conventional contraceptives), and agents (outlets for conventional contraceptives). There are full-time clinics for IUD insertions, follow-up, and medical and paramedical training; part-time clinics; and mobile clinics for IUD service in remote areas. In 1967-1968 there were 938 clinics: 361 urban and 577 rural. There were 46 full-time and 315 part-time urban clinics and 158 full-time and 419 part-time rural clinics. 65,000 IUD insertions are done a month.     

Family planning in India

The overall impact of the family planning movement on the Indian birth rate has been negligible so far, with only token areas of success. In 1961 there were 75 million couples of reproductive age; the present estimate is 84 million. Of these couples, 1.1 million have been sterilized and 400,000 fitted with IUDs, while 500,000 use other forms of contraception. Thus only 2.4% of reproductive age couples are contraceptive users, instead of the 65% who would have to use completely efficient contraceptive means in order to reduce the present birth rate of 40 per 1000 to 25 per 1000 by 1975: this indicates the vast size of the problem. Education and propaganda are needed, but the results of research into the best way of approaching the people about planning would come too late. An all-out communication and education programme would be launched in the field, together with an effective service programme. Communication experts, doctors, and demographers are all needed to formulate and carry out family planning policies. All the main methods of contraception should be offered. Sterilization, generally regarded as irreversible, is not attractive to younger couples; the IUD is becoming more and more popular and condoms are used quite extensively. No mention is made of oral contraception.     

Approaches to curriculum planning

This booklet describes different ways used to tackle the problem of curriculum planning. By studying these approaches teachers can get an insight into the process in their own school. First they must decide whether there should be a particular focus for curriculum planning and if so what it should be. In the light of this they can modify their school's approach. To what extent do they wish to focus on: aims and objectives (engineering approach), teaching methods (mechanics approach), content (cookbook approach), timetable (railway approach), problems (detective approach), one idea or strategy (religious approach), the regulations (bureaucratic approach), or a curriculum designed to attract sponsorship (public relations approach)? The magician approach, in which it is not clear how a curriculum is developed, is not recommended. Second, what should be the pattern of staff involvement—a representative group or committee (United Nations approach), all the teachers (people's congress approach), one individual (the dictator approach), a collaboration with students, patients and other professional colleagues (consumer approach), or a collaboration with an external consultant (consultant approach)? Whichever approach is adopted, advantages should be maximized and deficiencies minimized.     

Family planning in Britain

In Britain in 1968 there were 780 family planning clinics using all conventional methods except IUDs and 220 IUD clinics. In 1967 of 173,000 new patients, 77,000 chose oral contraceptives, 60,000 chose diaphragms, and 24,000 chose IUDs. A short training course is given to both nurses and doctors. The Family Planning Association is the private agency responsible for promoting birth control advice, information, and services. Since the Family Planning Act was passed in 1967, the National Health Service has the authority to provide family planning service to those who want it for free.     

Family planning in Egypt. A planning response to an Islamic environment

The problem of choosing the appropriate strategy to increase acceptance and use of modern contraceptives is very complex. Islamic fundamentalism is an increasingly important factor in the environment of Egyptian family planning programs. This article presents Egypt as a case example, illustrating the importance of external environmental analysis in planning for the operational implementation of family planning programs. Within the specifics of the Egyptian case, we additionally illustrate one practical tool for developing a planning response to that environment: Warren's (1977) typology of strategies for implementing social change.     

Performance-based planning for hospitals

It is time for health care planning to evolve through a new phase--from strategic planning to performance-based planning, writes Scott A. Mason, D.P.A., FACHE, president and CEO of eko systems inc.