In India with a significant unmet need for family planning, compounded by access issues and a skewed method-mix, monitoring the quality of care especially in the public sector is a huge challenge. Sterilization focused approach mainly female sterilization in the family planning program has also been a point of concern as this is the easiest way to reduce TFR quickly. Moreover limited choice, non availability of spacing methods on demand and providers bias, puts the couple to resort to sterilization. The high unmet need coupled with limited public sector facilities and skilled personnel translate in heavy pressure for service delivery and can lead to lowered standards of quality of services.
These and other factors have resulted in diluting the standards at the facility level. Also, the community itself does not have very high expectation as they are not aware of the basic standards in health care and is satisfied with whatever services are available and accessible as per the Indian Public Health Standard (IPHS). In fact, in a context where there are no services available at all, the only hallmark of a high quality service is its availability, in whatever form.
The Civil Society has been very vibrant in India. It has been an active partner and the on-going programmes like the National Health Mission have carved out spaces for the role of civil society action right from the grass-roots (such as in form of the Rogi Kalyan Samitis) to the policy level. In fact, it has been civil society voice that has often resulted in programmatic change or innovation. The issues have ranged from sterilization insurance scheme to involvement of grassroots CSO in public hearings.
There is a further need for robust, well-informed and fair monitoring mechanisms that can strengthen the quality of services and also for creating demand from the community. The monitoring mechanisms must have competence of well-trained technical expertise along with the representation of civil society voices.
ARC, a coalition of organizations and individuals primarily working in the field of sexual and reproductive health has set up a national Technical standing committee on Quality of Care in Family Planning in India with an aim to review existing systems in priority intervention areas mandated by the Technical standing committee and recommend strategies to improve the quality of care in those areas, with special emphasis on choice, dignity, privacy and competency in service delivery.
Objectives of the Technical Standing Committee:
- To advocate for improving quality of care in family planning with a focus on sterilization services in camps as a priority as per the standards prescribed under different operational manual.
- To review other areas of intervention specially to provide choice, method specific counseling, follow up care etc. and work out an action plan for advocacy with timelines.
ARC proposes to undertake following tasks
- Ensure that the Guidelines are disseminated in the states up to the peripheral service providers. This can be immediately taken up where ARC has a presence in the form of State and district Chapters
- Advocate for establishing state/district District Quality Assurance Committees and help in strengthening the committees as required.
- To develop a set of ‘non-negotiables’ to assess sterilization service provision(facilities, infrastructure, site-readiness, competency of clinical and paramedical team, etc)
- To identify and prioritize components of quality care for taking up focused advocacy, (such as counseling, training needs, infrastructure strengthening, supply chain management, etc).
- Assign smaller groups from the Technical standing committee to look at specific issues
- Invite technical experts and government officials who may not be members of ARC but who may be able to provide critical inputs while consulting on specific issues.
- Conduct systematic assessment to identify constraints, shortfalls, deviations and gaps at various steps in the overall family planning service delivery.
- Prepare reports on various issues on the identified gaps and recommendations in specified areas of intervention.
Technical standing committee: