Evaluation of the Micro Planning activity for Family Planning in Gorkha district to decrease the unmet need for Family Planning.

Research Report.

SUMMARY: Introduction Nepal has managed to show substantial improvements in increasing the Contraceptive Prevalence Rate(CPR) over the past two decades, with an increase of the CPR from 2.40 percent in 1976 to 48 percent in 2006. However, between the last two Nepal Demographic Health Surveys (NDHS) of 2006 and 2011, the use of family planning has shown stagnation. The innovative micro-planning initiative has successfully been implemented through the "District Strengthening in Family Planning Program" which focuses on the family planning needs in rural and marginalized communities. The program was a part of the Family Health Division's (FHD) efforts to revitalize the family planning program in Nepal, with focus on scaling up efforts to improve utilization of family planning methods in low CPR districts and disadvantaged communities. Evaluation Objectives The overall objective of the evaluation was to assess the effectiveness of the microplanning initiative in the "District Strengthening in Family Planning Program" in Gorkha district. Evaluation Methodology Descriptive study was applied to measures the evaluation of FP micro-planning program (before and after the intervention) in Gorkha District and the paradigm of change in utilization of FP among the people who have necessities. The evaluation study was carried out in health facility and its catchment area of selectedVDC (Aarughat,Baddada,Bunkot, Asrang,Harmi and Tandrang)of Gorkha District. DHO, In charge of health facility, ANM, FCHV, WRA adolescents and HFOMC members of each selected VDC were targeted group of study. All together 26 KII, 4 FGD and 6 Facilityassessment was conducted. Before data collection began, ethical approval was sought from FHD approval and communication was made with District Authorities. Before starting an interview, field researcher informed all of the respondents ofthe purpose of the survey. The qualitative data analysis plan was developed. The grid table and summarization was made after the translation and transcribing of qualitative information. The questions were coded prior to data management. Completed questionnaires were assigned unique ID codes Finding Relevancy of Micro Planning This allows identification of strategies and interventions to reach the most marginalised and unreached segments of the population with appropriate and quality family planning services.The National health policy 2071 also encompassed the one of major policy as developmental agenda to ensure the quality FP services to all people who has necessities. Similarly the NHSSP II also have targeted to availability of five FP services in every health facility and increase in met need of FP also. Again, it immense to keeps the continuation of micro planning to focus on raising the prevalence rate in low CPR districts.The Nepal Demographic Health Survey 2011 showed that to remain high (35 percent). It reveals that the micro planning of FP would help to increase of utilization of FP among those populations who have high-unmet need. Efficiency of Micro Planning of FP Micro planning is not an additional task to be generated to staffs of health facilities. This is only a proxy activities of FP to implement the minutely by receiving of ownership of community people as well. The stakeholder also realize that the there is no any extra burden to implement the micro planning however necessity to give priority to deputation of staff, training to staffs, proper monitoring evaluation and record keeping. The estimated per cost to change the CPR from existing level (If the constant of other regular budget of family planning) is 783,604.00 NRs per unit change of CPR of district level. (CPR was increased by 2.72 in 2070/71 as compare to 2069/70). During the study, almost all budget were spend to develop VDC wise micro planning, orientation about MP on FP. No additional capacity building activities were conducted except regular. The achievement in CPR and increase in current user could able to base on existing resources. This implies that the capacity-building programme and increase in the sanctioned post of health worker could able tosupport increase in CPR in following days. Effectivenessof MicroPlanning of FP The Achievements of increase in CPR was found satisfactory but difficult to achieve target to set by micro planning for each health facility catchment area (VDC). The total frequency status of both type FP users was found in increasing order in all selected health facility including district except slight decrease in Aaruchaunate PHCC and Bunkot. The data reveals that therewas increasein utilization of temporary methods. At district level, condom, pills were in increasing order where as utilization of implant was almost stable. Similarly, in selected VDC, the utilization of FP device was also found in increasing trend among the current user at district level. The overall status of user of FP device in selected VDC also almost in increasing order except some disorder in utilization of Depo. The participation of male was found higher percentage than female in sterilization. This shows that higher the male participation in sterilization increase to promote the family planning as responsibility and equality among the couple. The increasing status of percentage of utilization of FP services as compare to WRA population relay the increase in CPR and supports to decreasethe unmet need. The status of CPR was found increase at district and selected health facility except Aaruchanaute PHCC. Sustainability of Micro Planning of FP The family planning programme is itself government priority programme in health planning. Theseparate budget heading is allocated for family planning programme. So that, micro planning also necessary to initiate as one part of family planning programme. The micro planning activities is necessary to indicate regular programme of FP and necessary tomake effective monitoring and evaluation mechanism of micro planning status for sustainability. Impact of Programme of Micro Planning of FP The increasing of new acceptor, current user of both temporary methods and permanent methods indicate the micro planning has good effect on PF programme. Similarly, the status of CPR also found increase from 36.44 (FY 2069/70) to 39.16(FY 2070/71) is appreciative outcome of micro planning. The positive increase signal in sterilization (But proportion of female sterilization still high than male) Micro planning was known only among the participants of workshop. Poor practice of sharing of micro planning and strategy to other health worker of facility level. Poor practice of monitoring and supervision, no any evidenceof hard copy micro planning was found at health facility and Poor reactivation of FCHV and mother group High proportion of spousal separation (Due to overseas employment), Cultural thought (Not recorded about the real status of WRA of Muslim families), taking abortion as means of FP among new generation, Increase of using emergency contraception (Not properly recorded), and a lack of innovative approaches to cater services to difficult-to-reach or special sub-groups are possible reasons. Recommendation The initiation of micro planning had found good effect, so that need to initiate in other districts of Nepal as regular activities. Establishment the strong mechanism to fulfil the target set by micro planning through supportive supervision and monitoring from central to district level and district level to facility level.