7 TH SEMINAR OF THE EUROPEAN SOCIETY OF CONTRACEPTION

1. 7TH SEMINAR OF THE EUROPEAN SOCIETY OF CONTRACEPTION Contraception Practice in Europe: Differences in Availabilityand Accessibility 12-13 September, 2003 Budapest, Hungary

2. Community-based Health Service Approach For Effective Family Planning Prof. Dr. S. Sinan ÖZALP Osmangazi University Faculty of Medicine Department of Obstetrics and Gynecology Eskisehir,Turkey

3. CBHSPrograms These programs should focus on: • Common and important health problems of the community • Health problems for which there are effective remedies • Services and supplies that are relatively safe and easy to deliver

4. CBHSPrograms In these programs: • Lay workers from the community provide important services and supplies with minimal reliance on clinics, professional medical personnel,or complex diagnostic, screening, and record-keeping procedures.

5. CBHSApproach For Effective FP • FP is one of several primary health measures that can be delivered safely, effectively, and cheaply through CBHS.

6. CBHSApproach For Effective FP This method increases access to services and supplies in four ways: • By overcoming geographical barriers • By overcoming cost barriers • By eliminating bureaucratic problems • By overcoming cultural and communication barriers

7. CBHSApproach For Effective FP • The aim of this presentation is to discuss CBHS model for effective FP • Two projects that were implemented by using the CBHS model are discussed.

8. CBHSApproach For Effective FP • The aim of the first project was to inform men on FP and sexually transmitted diseases and therefore to contribute to the improvement of family health by exhibiting a model of well established relationship between the volunteers and governmental organizations • The project was designed by the FPAT and submitted to the Ministry of Health. Within the framework the protocol signed upon the approval of the MH and with the financial support of GTZ) • Ozalp S., Hassa H., Koral S., Cevikbilen T., Satiroglu H.: The project on health education of men on family planning and sexually transmitted diseases in the province of Balikesir, Turkey. 7th Congress of the European Society of Contraception, 10-13 April, 2002, Genoa, Italy).

9. CBHSApproach For Effective FP • Education was given by 24 male community workers who were trained by conferences, group meetings and panels. • Information, education and communication materials were developed and distributed. • The members of the local and national mass media were informed on the project activities as well as reproductive and sexual health and their support was ensured.

10. CBHSApproach For Effective FP • Total of 12.945 men were informed through personal talks by the male community workers. • At the end of the project, the ratio of those who reported to use the FP methods were increased from 57.8 to 79.2%.

11. CBHSApproach For Effective FP • From this project, it was found that well-organized man to man education was very effective in male involvement for family planning and STD prevention

12. CBHSApproach For Effective FP • The aim of the second project was to mobilize the community’s own resources, and women leaders and field supervisors were selected and trained to take part in fieldwork • This project was a part of ‘Safe Motherhood Project’ of FPAT and received financial support from UNFPA and was implemented under a sub-contract to the Ministry of Health ‘Global Safe Motherhood Project’. • There were 10.557 married women in the area and %98.4 were reached. • Ozalp S., Koral S., Topkara N.: The influence of community-based health service approach on effective contraceptive choice in a slum area of Ankara, Turkey. Contraceptive Choices and Realities, eds, van Lunsen RHW, Unzeitig V, Creatsas G. The Parthenon Publishing Group, New York. 2000, p. 221-227).

13. CBHSApproach For Effective FP • As a result of information/motivation during house visits, 36% of women using modern methods were raised to 74.6%. • Majority of the women were educated on family planning, motivated to use an effective method and change of behavior was accomplished.

14. CBHSApproach For Effective FP • How the system works: • Most CBHS programs are started by voluntary agencies,often with support from the International Voluntary Organisations • Contributions from the local community, including fees for service • Governments may provide medical backupand partial funding • Some programshave substantial research components

15. CBHSApproach For Effective FP Difficulties in a CBHS programs • Recruiting and training workers • Providing continued supervision • Coordinating backup with the existing medical systemkeeping supplies flowing • Evaluating the program and revising it as needed.

16. CBHSApproach For Effective FP • What happens when the financialsupportceases in CBHS system • Effect of the project may continue (how long and how effective?) • The continuation and evaluation of the activities may become a problem (when and at what degree?)

17. CBHSApproach For Effective FP • Conclusions • Research is needed to evaluate the effect of the previous projects after the financial support ceases • For the new projects, continuity of the services after the project ends, must be a part of the project