The “U” technique: A new method for Norplant implants removal

The standard technique for Norplant implants removal was compared with a new technique called the “U” technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. Seventy-six women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 (“U” removal technique). Variables measured included: (a) time required for complete removal, (b) number of capsules not broken or damaged during removal, and (c) number of incisions required for removal of all six capsules. In clients with visible or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the “U” technique (19 versus 7 minutes, p < 0.001); also more capsules were damaged during removal (5.6 undamaged versus 6.0,p < 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules while none of the clients required more than one incision with the “U” technique. Our conclusion is that the “U” technique is a quicker and easier method of removing Norplant capsules than the standard technique.     

Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia

ABSTRACT: BACKGROUND: Allocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system. METHODS: A standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country. FINDINGS: Substantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population, particularly numbers of births, infants and children and also key diseases with high cost/prevalence and variation, most notably the level of malnutrition. The approach to resource allocation was implemented using existing data sources and permitted the rapid construction of a needs based formula that is highly specific to the package mandated across the country. Refinement could focus more on resources required to finance demand side costs and expansion of the service package to include priority non-communicable services.     

‘U’ technique and standard technique of Norplant removal

Objectives To compare the side effects and time required for Norplant removal between the U technique (using the no-scalpel vas deferens holding forceps) and the standard technique.Materials and methods A randomized controlled clinical trial was carried out of acceptors in family planning clinics in Dr Kariadi Hospital, Semarang, who wanted to have Norplant removal. The Norplant was removed by experienced doctors who had been trained for both the U technique and the standard technique. Removal time, capsule condition and complications were examined.Results From 41 clients in the U technique group and 41 clients in the standard technique group, the removal times were 2.75±1.28 and 6.57±2.93 minutes, respectively (p<0.01). One week after Norplant removal, complications were found in 5 clients, 1 from the U technique group (2.44%) and 4 from the standard technique group (9.76%). Two weeks after Norplant removal no complications were found.Conclusion The U technique was quicker and less complicated compared with the standard technique.

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ResumenObjectivos Comparar los efectos secundarios y el tiempo requerido para el retiro de Norplant con la técnica U y la técnica estándar.Materiales y métodos Un ensayo clínico controlado aleatorizado de aceptadoras en la clínica de planificación familiar Dr. Kariadi Hospital Semarang que deseaban que se retirase el Norplant. El Norplant fue retirado por médicos experimentados que habían sido adiestrados tanto en la técnica U como en la estándar. Se examinaron el tiempo de retiro, el estado de las cápsulas y las complicaciones.Resultados En 41 clientas en la técnica U y 41 clientas en la técnica estándar, el tiempo de retiro fue 2,75±1,28 y 6,57±2,93 minutos (p<0,01) respectivamente. Se detectaron complicationes después de una semana del retiro de Norplant en 5 clientas, 1 caso (2,44%) en la técnica U y 4 (9,76%) en la técnica estándar. Dos semanas después no se detectaron complicaciones.Conclusión La técnica U fue más rápida y señaló menos complicaciones que la técnica estándar.

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ResumèObjectifs Comparer les effets secondaires et le temps nécessaire pour le retrait du Norplant, entre la technique en U et la technique standard.Matériels et méthodes Un essai clinique randomisé a été effectué sous contrôle à la clinique de planning familial de l'hôpital Dr. Kariadi de Semarang sur des patientes sollicitant le retrait du Norplant. Celui-ci a été retiré par des médecins expérimentés qui avaient, été formés à la technique de retrait dite en U et à la technique standard. On a relevé les temps de retrait, l'état des implants et les complications survenues.Résultats Pour 41 patientes soumises à la technique en U et 41 patientes à la technique standard, les temps de retrait ont été respectivement de 2,75±1,28 et 6,57±2,93 minutes (p<0,01). Des complications ont été observées une semaine après le retrait de Norplant chez 5 femmes, soit 1 cas (2,44%) pour la technique en U et 4(9,76%) pour la technique standard. Deux semaines plus tard, aucune complication n'a été constatée.Conclusion La technique en U est plus rapide et entraîne moins de complications que la technique standard.