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Reproductive women health services in Rural Honduras
– Reported, February 29, 2012
Currently, 50% of married women in Honduras are using a contraceptive method. However, there are marked differences between urban (66.9%) and rural areas (40.4%) Rural Health Centers (RHCs) are the most accessible health services for women in rural areas in Honduras. RHCs are staffed by nurse auxiliaries, who attain this degree by completing a two-year technical course after junior high school.
Until recently, one of the main problems faced by women in rural areas was that long-term contraceptive methods were not easily accessible, since service delivery guidelines did not authorize nurse auxiliaries to insert IUDs and provide Depo-Provera. Therefore, INOPAL III conducted a project to determine if nurse auxiliaries could successfully provide these services, as well as take Pap smears. Results showed that most of the 60 nurses who participated in the study delivered quality services in terms of information given to users, compliance with service delivery guidelines, and follow-up with users. Study participants inserted a total of 2,030 IUDs. Furthermore, a study that took place in five RHCs showed that the costs per new IUD user varied from US$2.90 to $18.60, while costs for each cytology varied from $1.50 to $9.40. Given this experience, the MOH changed the Womens Health Service Delivery Guidelines and authorized nurse auxiliaries to provide these services.
In the Rural Health Centers where nurse auxiliaries gave daily ten-minute talks and distributed brochures, the number of services provided increased from 631 to 767 (22%). The corresponding increase at the RHCs where no promotion took place was only 12% (from 193 to 216 services).
The number of IUD insertions at experimental RHCs increased from 50 to 75, while at the control group RHCs they decreased from 26 to 16. The relative increase in the number of Depo-Provera users at the experimental group units was 36%, versus 19% at the control group units. And while nurse auxiliaries in the experimental group took 22% more Pap smears after the intervention, those at the control group took 4% less than before the intervention. The total number of new users of longterm contraceptive methods (IUD and DMPA) increased by 41% in the experimental group and decreased by 2% in the control group.
The average monthly number of services provided in the experimental and in the control group health centers in the three pre-intervention months and the three post-intervention months. We first compared the mean number of services provided in the three months before the intervention and found that the health centers in the experimental group had had a statistically significant higher output even before the intervention. Since the relative number of services provided increased more in the experimental sites, it was not surprising to observe significant differences in the mean number of services provided in the experimental and control groups after the intervention.
A second analysis consisted of observing whether there were significant changes in the productivity of each group between the pre and post intervention periods. In general terms, there were more substantial increases in the experimental group than in the control group. However, t-tests showed that the only statistically significant increase was the number of new injectable users in the experimental group, and of new and follow-up injectable visits in the control group.
The intervention that was tested can be replicated on a larger scale and is both low-cost and effective in the short term, as shown by the increase in demand for the three new services by 11% after implementing the promotion strategy. The strategy was particularly effective in bringing in new IUD and Depo-Provera users, the long-term contraceptive options introduced to the rural communities where the intervention took place. Therefore, we recommend that the MOH conduct promotional activities in the communities where these services have recently been introduced.
Credits: Irma Mendoza,Ricardo Vernon & U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)
More Information:
http://www.popcouncil.org/pdfs/frontiers/FR_FinalReports/Honduras_Nurse_roles.pdf
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