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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
maternal and child health (MCH) and family planning services at different levels of facility. Some have services for the prevention, diagnosis, and treatment of sexually transmitted diseases (STDs), though these are typically weak and poorly coordinated with other health services. Most countries also have health education or communication programs, though again the quality and funding is often low, and these efforts are poorly coordinated with other prevention and treatment services. Hence, organizing delivery for reproductive health services does not typically start from a zero base; rather, it requires strengthening coordination, linkage, or integration and diversifying existing services, as well as adding new ones.
Table 6-1 presents information on existing MCH and family planning service capacity obtained through the Demographic and Health Surveys (DHS) service availability module (SAM) administered either through direct facility visits or to key informants in sample clusters (communities). 1 In the eight countries, services are reasonably accessible to most clusters, at a facility within 30 kilometers. Coverage of basic services ranges varies widely across countries: for example, residents in 93 percent of the sampled clusters in Thailand have access to immunization services at a hospital, compared with only 35.2 percent of the Nigerian DHS clusters. In approximately one-half of the 624 clusters in Bolivia, residents have access to a constellation of six types of MCH services, as well as contraception, from a nearby hospital.2 These aggregate data only show availability of services at the community level, of course; they do not show the great variation in quality of services (Fisher et al., 1994) or in barriers to access that may exist.
The availability of contraceptive services is highly associated with the availability of MCH services. This pattern reflects the common practice of integration of contraceptive with MCH services in health facilities. These
The DHS SAM (Wilkinson, Njogu, and Abderrahim, 1993), as well as the situation analysis tool used in several regional operations research programs (Fisher et al., 1994), obtains information about services at the nearest facility of four to five main types, located within a specified radius of the sampled cluster. Although not a probability sample of facilities, the information from the DHS SAM is presently the most standardized and systematic available for a cross-national comparison of MCH and family planning services. Often the SAM is restricted to rural areas. The DHS SAM has not yet included data on STD diagnosis and treatment services. Some include information on information, education, and communication activities and other community-based services carried out in sample clusters. To monitor and evaluate the effectiveness of reproductive health programs, the content of existing facility-level surveys would need to be modified.
These data are not weighted or linked to the individuals interviewed; thus, one cannot generalize about the areas or population covered by the clusters.