QUALITY OF CARE IN FAMILY PLANNING SERVICES FROM CLIENTS’ AND PROVIDERS’ PERSPECTIVE: AN ASSESSMENT STUDY IN PUNJAB, PAKISTAN

Objectives: This study examines the clients’ rights and providers' needs in the provision of family planning services. Pakistan is one of the first developing countries which adopted a policy of reducing population in early 1950s, but the success of the program remained from poor to modest. In family planning services provision of quality of care is an important task to enhance the utilization and coverage of such services, but little is known about this dimension of family planning services. Now there is growing realization that everyone in the community who is in need of FP services has a right to good quality services. So the present study attempts to assess the clients' rights and providers' needs in the provision of family planning services.\ud \ud Data Source: This study uses a framework developed by International Planned Parenthood Federation (IPPF) as a guideline. This framework consists of ten clients' rights including information, access, choice, safety, privacy, confidentiality, dignity, comfort, continuity of care and opinion and ten providers' needs in training, information, infrastructure, supplies, guidance, backup, respect, encouragement. feedback and self expression. Government of Pakistan has established a network of Family Welfare Centres through Ministry of Population Welfare in the country, So this study was conducted at Family Welfare Centres in the urban and rural areas of district Gujranwala.\ud \ud Methodology: In the present study, for clients' rights quantitative approach and for providers' needs qualitative approach is used. Total sample size was 600 ever married women aged (15-45) years with at least one surviving child using any contraceptive method. Data were collected through exit interview and follow up approaches. Present study was conducted at 11 Family Welfare Centres which were selected proportionally from total 51 FWCs. Data were analyzed by appropriate statistical technique including univariate, bivariate and multiple linear regression analysis through Statistical Package for Social Science (SPSS). For providers' needs qualitative approach is used and for this purpose a guideline was prepared. Four focus group discussions were conducted with service providers in the whole district. In each FGD five in charges of FWCs participated.\ud \ud Results: The results indicate many weaknesses in clients' rights including information, access, choice, safety, privacy, comfort, continuity of care and opinion rights. According to respondents, they were not informed properly about use for FP methods, had low economic access to FP services as service providers demanded the charges of FP services and clients’ preferred method were not selected by them. Service providers were not technically competent as respondents mentioned side effects or FP methods. Service providers counseled the clients in the presence of other clients but privacy during physical examination was completely provided. Different facilities were not provided properly at FWCs. Clients were not followed up and services providers did not take their opinion 10 improve the quality of services. Service providers mentioned gaps in their support including training, information, infrastructure, supply, guidance, encouragement, feedback and self expression, There was lack of any new training courses, no technical information was provided to clients. Supply of contraceptive was not regular, no permanent buildings, service providers not encouraged, no feedback, only they were forced to complete the targets, Service providers could not express freely.\ud \ud Recommendations: It is suggested that a Complete Client Centered (CCC) approach is required urgently in which client’s rights are properly addressed. Practical rather than theoretical training programmes, information on technical issues, regular supplies, permanent and better infrastructure, encouragement and a target free approach was needed for service providers to perform their duties in a satisfactory manner