Making Your Program Sustainable

Creating Client Demand And Expanding The Client Base
How to ...
Improve the quality of family planning services
Improve the marketing of family planning services

		Creating Client Demand And Expanding The Client Base The second step in developing a strategy that leads to sustainability is generating client demand for family planning services and expanding the client base to include the poor and underserved. When couples believe that the use of modern contraceptives will benefit them as individuals, they will make an effort to obtain and use contraceptives effectively. Convincing clients that it is in their own best interest to use contraceptives correctly is the key to increasing client demand and is based on three fundamental marketing principles: Understanding client needs and trying to meet them; Providing high-quality services; Marketing services effectively.
Understanding client needs and trying to meet them		Perhaps the greatest lesson that family planning managers can learn from the private commercial sector is to listen to the consumer. People who use family planning services want: The largest choice of methods possible Does your program provide methods that women and men in your service area most commonly ask for? If not, can you expand your services to provide these methods, or refer clients to a provider who does? An explanation of the benefits, risks, and side effects of all methods Do you check to see whether the clients have received complete information on contraceptive methods by conducting exit interviews from time to time? Do your service providers record whether clients received this information, and do you check periodically to see that this has been recorded? Short waiting times Have you conducted a clinic flow analysis to see if there are ways to reduce waiting times for you clients? Is the protocol for resupply visits designed to keep waiting times short? Have you considered providing client education during the time that clients spend waiting for services? To be treated with respect and courtesy Have you tried to observe, casually and unobtrusively, the way clients are treated by all members of your staff? Have you conducted exit interviews with clients to determine how they feel about the way staff members have treated them? Services delivered in clean and tidy surroundings Would you like to come to your clinic yourself for services? If not, what needs to be changed? Family planning program managers can pay careful attention to their clients, anticipate their needs, and get an insight into the concerns of both current and potential family planning users by using survey techniques like focus groups and exit interviews. A suggestion box placed in the waiting room will also let you know the clients' opinions.
Providing high-quality services		Another lesson that family planning managers can learn from the private commercial sector is that the investment in quality is worthwhile. Quality sells products, and satisfied customers will keep coming back. People are more willing to pay for services when they know they are of good quality. For these reasons, attention to the quality of family planning services will yield important results in increased demand and increased willingness to pay for services. Improve the quality of family planning services Set quality standards which are appropriate to the situation, and enforce them. The first step in developing a quality product or service is setting appropriate standards. Standards should take into consideration the real environment that the client faces and the medical or social consequences of standards that are too lax or too stringent. In many family planning programs, inappropriately stringent medical standards act as a barrier to obtaining services, while standards of service delivery are ignored. To ensure high-quality family planning program standards, managers must place an equal emphasis on medical standards and on those related to providing clients with counseling and information. Consider both perceived and technical quality. Managers can improve the technical quality of their programs as well as the client perception of service quality. Improving technical quality if fairly straightforward, for example, checking an IUD to make sure it has not deteriorated and is in its sterile package, or ensuring that a midwife has the ability to insert an IUD in a sterile and painless way. Technical quality is best evaluated by technical experts. It is more difficult to assess how the client perceives the quality of family planning services. Research has shown that a client's view of quality is influenced by the following factors: The choice and availability of different methods The provision of complete and accurate information on methods and services The perceived technical competence of service providers Whether, in their interactions with staff, the clients feel they have been treated with respect and courtesy and that their concerns have been taken seriously Whether the program follows up with clients The availability of other related services Managers need to review each of these elements of perceived quality to determine how each can be improved. In addition, managers must ensure that the family planning services are of the highest possible technical quality. For example, equipment must be sterilized before use, and the clinic must have the ability to obtain and use sterilized equipment. All clinic staff must be trained and have the skills to follow the clinical protocols of the program. Ensure that incentives do not interfere with quality. While incentives may be useful to build demand for family planning, if they are improperly implemented they can jeopardize the quality of services. Several examples of inappropriate incentives follow: A program offers a choice of contraceptive methods (which is often considered a component of program quality), but gives its providers an incentive to promote one method over others. While attempting to recruit a certain number of family planning acceptors in order to reach a target, a provider is unwilling to inform possible acceptors the potential side effects, for fear that this will scare them off. A program offers a prize to the family planning provider who performs the most sterilizations, which encourages the providers to emphasize the quantity of sterilizations performed over their quality. Monitor quality. Quality is difficult to measure. However, it can be monitored by using management information reports, exit interviews, and focus groups. Once you are aware of all of the factors influencing both technical and perceived quality, it is important to select the indicators that will help you to monitor the quality of the services your program provides.
Marketing services effectively		Social marketing has become a key component of almost all family planning programs today. The use of mass media and of targeted face-to-face communications has proved to be of great value in disseminating family planning information. The service delivery system in the public sector can benefit from the experience of the private sector, which has been very successful at marketing services. Improve the marketing of family planning services Know the client. Even experienced family planning managers can have misconceptions about the popular beliefs and needs of their clients. Professional marketing begins with a comprehensive study on the characteristics of the target group that is to be reached. In developing and maintaining a high demand for family planning, managers should consider the income levels of potential clients, their access to different contraceptives and services, their preferences regarding sources of information and family planning services, and the best ways of communicating with the clients. Although market research can be expensive, it is a prerequisite for understanding the needs of the client. Identify the product clearly. Family planning programs should be promoting action to space births or limit family size, not specific contraceptive. While it is important to provide information about the various methods of contraception that are available, the marketing campaign should emphasize the concept of family planning and its potential benefits. Use clear, consistent messages that address consumers directly. The purpose of marketing is to influence consumers' thinking so they will make a decision. In the case of a soft drink, the decision is to buy and drink that particular soft drink. In the case of family planning, the decision to use contraceptives. If we are to influence consumers' thinking with a marketing message, the consumer must be able to understand that message and act accordingly. Messages must be clear, using language which the target group understands and relates to. Messages must be consistent, so that each component in the information campaign reinforces the previous idea. Messages should deal directly with fears and concerns about contraceptive use. An honest and supportive approach may persuade non-users to try the product. Messages must be carefully designed and pretested, and should have extensive follow-up to ensure that they are effective in positively motivating clients to practice family planning. Provide clients with real choices. A major determinant of demand for contraceptive services is the client's perception that there is an appropriate contraceptive method conveniently available, that matches her or his needs and life-style. For this reason, family planning programs must offer the widest possible array of contraceptive products and services to their clients. The choices should include not only all the methods available, but also different brands within each method and different sources for receiving services. To reach the widest possible audience, contraceptives should be offered through government clinics, private clinics, private doctors, midwives, pharmacies, field workers, private and government hospitals, and religious organizations. The wider the choice, the greater the likelihood of having satisfied acceptors. This in turns leads to more successful contraceptive use, lower fertility, and a more sustainable program. Present a professional image. One of the ways to encourage people to practice contraception is to present the target group with an image of a high-quality and professionally responsible program. Brochures should be designed to be accurate, attractive, and informational. A professional approach to promotion gives the consumer confidence in the quality of the product that is being offered. The program's services, however, must live up to the high-quality image projected in the marketing approach. The family planning programs must have technically competent and committed professional staff, clean facilities which ensure privacy, and high-quality services.