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Transcript of Ensuring Informed and Voluntary Decision Making MODULE 4 Facilitative Supervision for Quality...
Ensuring Informed and Voluntary Decision
Making
MODULE 4
Facilitative Supervision for Quality Improvement Curriculum
2008
Essential Elements of Informed and Voluntary Decision Making
Service and method options are available.
The decision-making process is voluntary.
People have appropriate information.
Good client-provider interaction, including counseling, is ensured.
The social and rights context supports autonomous decision making.
Why Do We Care about Informed and Voluntary Decision Making?
It is a human right.
It is an essential element of quality of care and client satisfaction.
It significantly contributes to program effectiveness.
It is a policy requirement.
Informed Choice as a Reproductive and a Human Right
Individuals and couples have the right:
To decide about the number, spacing, and timing of their children
To have the information, education, and necessary services to achieve their desired number and spacing of births
ICPD, 1994
Clients’ Rights
Information Access to services Informed choice Safe services Privacy and confidentiality Dignity, comfort, and expression of opinion Continuity of care
Adapted from: Huezo, C., and Diaz, S. 1993. Quality of care in family planning: Clients’ rights and providers’
needs. Advances in Contraception 9(2):129-139.
Client-Provider Interaction
Client-provider interactions (CPIs) are all exchanges, both verbal and nonverbal, that clients have with health care providers at all levels, regarding any health care service.
nonverbalClientClient
ProviderProvider nonverbalverbal
verbal
Informed Consent and Counseling
Informed Consent: Agreement by the client to receive medical treatment, to use an FP method, or to take part in a study
Counseling: Two-way, one-on-one communication between a health care provider and a client, to facilitate or confirm a decision by the client
Client-Centered Communications Make a Difference!
Research tells us that... The interpersonal communication and information
provided are the key issues to clients’ perception of the quality of services.
Client-oriented communication that tailors information to the individual has positive impact on method adoption, continuation, and client satisfaction.
Abdel-Tawab, N., and Roter, D. 1996. Provider-client relations in family planning clinics in Egypt. Paper presented at the annual meeting of the Population
Association of America, New Orleans, LA, USA, May 9-11, 1996; and Koenig, M. A., et al. 1997. The influence of quality of care upon contraceptive
use in rural Bangladesh. Studies in Family Planning 28(4):278-289
Giving People a Choice Makes a Difference!
Research tells us that...
Use of contraception is highest when people have access to a range of contraceptive methods. Ross, J., et al. 2002. Contraceptive method choice in developing countries.
International Family Planning Perspectives 28(1):32-40
Clients who receive the method they want are more likely to continue use.
Pariani, S., et al. 1991. Does choice make a difference to contraceptive use? Evidence from East Java. Studies in Family Planning 22(6):384-390
Quality Counseling Makes a Difference
Research also tells us that... A major reason that clients discontinue pills and
injectables is that they are not adequately informed about side effects.
EngenderHealth studies in Cambodia, 2000, and in Nepal, 2001
Conversely, counseling about side effects significantly increases continuation.
Lei et al, 1996, FHI Network, 1991
What Are the Consequences of Not Assuring Informed and Voluntary Decision Making ?
Situation ConsequencesClient does not fully understand the method (vasectomy).
Client fails to use another method for three months, resulting in pregnancy.
Client is given an incentive (e.g., travel money or food).
Client may be induced to accept the method rather than choosing it based on real need or preference, which can lead to regret. When incentives are discontinued, interest in the method may wane.
Factors Affecting Informed and Voluntary Decision Making
Barriers to informed and voluntary client decision making persist in many programsaround the world, due to the following
factors:
Individual/community/cultural factors
Service-delivery factors
Policy factors
Community/Cultural Factors That Affect Informed and Voluntary Decision Making
Sociocultural factors, beliefs, and norms
Rights context, status of women, and individual status
Availability and accessibility of services
Literacy level
Awareness of reproductive health and rights
Sources and quality of information
Service-Delivery Factors That Affect Informed and Voluntary Decision Making
Provider attitudes, knowledge, and skills
Counseling: quality and allocated personnel and time
Supervision
Client information/education materials
Method mix and access
Informed consent
Policy Factors That May Challenge Informed and Voluntary Decision Making
Targets or quotas
Per-case referral or provider payments
Client payments or noncash incentives
Limited method mix and “camp” services
Fees
Eligibility criteria
Informed and Voluntary Decision Making as a Good Program Strategy
Ensuring informed choice leads to:
Better method use and client compliance with treatment regimens
Continued method use
Satisfied clients, who are good promoters
Some Safeguards
Inform the public of their right to make informed FP/RH decisions.
Strengthen communications and counseling training and supervision.
Orient providers and managers to the benefits of ensuring informed choice (IC) and voluntary decision making.
Make protecting IC a performance indicator.
More Safeguards
Increase service-delivery points and method options.
Remove policy restrictions that limit access to information, services, or methods.
Increase male involvement to inform men and gain their support for partners’ decisions and method use.
Practice QI approaches that emphasize client-centered care.