Improving quality: one step at a time.

PIP: The notion that health care workers have the power to improve the quality of their services is a key to AVSC's efforts worldwide. The COPE process, AVSC's low-cost intervention for improving quality at service sites, brings together supervisors and staff at all levels to identify barriers to quality services and helps them find solutions they can implement with their own resources. For example, a hospital in Tanzania had tried unsuccessfully to obtain the funds to repair or replace broken equipment. Using the COPE process, the hospital used available funds to send a technician for training in maintenance and repair. Now everything from blood pressure equipment to bedsprings is repaired promptly, and quality has improved. Another hospital in Tanzania coped with the problem of broken bedsprings (patients were putting mattresses on the floor) by using readily available wire mesh to make repairs. In Kenya, the lack of running water forced staff to collect water from a cistern, taking time from their other responsibilities. During a COPE meeting to resolve the problem the staff bemoaned the fact that they did not have the funds to replace the water system. Then the gardener told the group that all they needed to do was fix a broken pipe. The repair was made at minimal cost, and the water supply was restored. The COPE process reveals that health care staff not only can identify obstacles to quality, they often know the cause of the problem and can offer the best solutions.^ieng

A comprehensive and efficient process for counseling patients desiring sterilization.

To optimize the time spent counseling a sterilization patient, this article presents a 10-step process that includes all steps necessary to ensure a comprehensive counseling session: (1) Discuss current contraception use and all available methods; (2) assess the client's interest in/readiness for sterilization; (3) emphasize that the procedure is meant to be permanent, but there is a possibility of failure; (4) explain the surgical procedure using visuals, and include a discussion of benefits and risks; (5) explain privately to the client the need to use condoms if engaging in risky sexual activity; (6) have the client read and sign an informed consent form; (7) schedule an appointment for the procedure and provide the patient with a copy of all necessary paperwork; (8) discuss cost and payment method; (9) provide written preoperative and postoperative instructions; and (10) schedule a postoperation visit, or a postoperation semen analysis.

Iran rebuilds family planning services.

PIP: After the revolution, the Islamic Republic of Iran instituted pronatalist policies which included lowering the minimum marriage age for girls to 9 years, abolishing some laws securing women's rights, and limiting availability of family planning (FP) services. By 1983, Iran's population growth rate was 3.9% which was among the highest worldwide. Before the revolution, Iran had 37 million people. About 2 million more people were added each year, resulting in a population size of 60 million by 1992. By the mid-1980s, economic development stood idle, there were not enough houses, children attended schools on 3 shifts, and malnutrition was spreading. In 1989, the government formed a population council and reestablished FP services. It also increased the minimum age of marriage for girls to 13 years, slightly improved women status, and eliminated fertility incentives for couples with at least 4 children. It also significantly increased funding for FP (from 560 million to 13 billion rials between 1990 and 1992). Government spending for FP will likely increase 2% annually until 2011. The government initiated a promotion of FP mass media campaign, emphasizing a 2-child family. Some posters showed a family with 2 girls. The mass media campaign promoted specific contraceptive methods (even tubal occlusion and vasectomy), a practice other Middle Eastern countries not do. 80% of sterilization acceptors claimed to learn about sterilization from the radio or newspapers. The Ministry of Health has invited the Association for Voluntary Surgical Contraception (AVSC) to help with its campaign to update sterilization techniques, including the non scalpel vasectomy technique. AVSC hopes to become even more involved in helping Iran update its national FP program.^ieng