Integration of Reproductive Health Services for Men in Health and Family Welfare Centers In Bangladesh

This 38-page document includes details from an operations research (OR) study meant to explore how to increase men's access to and acceptance of reproductive health services at Health and Family Welfare Centers (HFWCs) in Bangladesh. The study was conducted in collaboration with the National Institute of Population Research and Training (NIPORT), the Directorate of Family Planning, and the Population Council. These collaborators were motivated by their observation that, during recent decades, despite the extensive development of behavioural change communication (BCC) materials on family planning, including condoms and vasectomy, in Bangladesh, very few of these materials focus on men's responsibilities in family planning and the reproductive health of couples.

The study activities began in November 2000 and were completed in December 2002. Interventions included training for service providers regarding reproductive tract infections (RTIs) and sexually transmitted infections (STIs), awareness raising about male RTIs and STIs, group discussions, BCC materials, and RTI and STI services using the syndromic approach. Carried out in the 4 major divisions of Bangladesh (Dhaka, Khulna, Rajshahi, and Sylhet), the interventions were tested in 12 government health facilities, focusing primarily on men of reproductive age and grassroots-level service providers. Specifically, evaluators used a quasi-experimental non-equivalent control group design, with 8 HFWCs as intervention sites and 4 HFWCs as control sites. Service provider interviews, focus group discussions, inventory surveys, male and female exit client interviews, and client registers were used to collect the data.

According to this report, the interventions resulted in an increase in male clients (ages 15 years and above) in the experimental clinics from 131 clients to 337 clients per clinic per month. "Analysis revealed, however, that nearly all of the male clients seeking services from HFWCs came for the treatment of general health problems. Only a small number of male RTI and STI clients sought services from the clinics. The number of RTI and STI clients increased from a monthly average of less than one client per clinic prior to the intervention to more than five during the intervention period. There was also an unexpected substantial rise in the number of female clients (15 years and above) including those seeking treatment for RTIs and STIs....Because of limitations in the study, an increase in condom use could not be assessed."

An excerpt from the document follows:

• "Service providers’ technical knowledge about male reproductive health problems and syndromic management of RTIs and STIs increased as a result of training.
• If male reproductive health services are included within the female focused HFWCs, and men know about them, then they will use the services.
• Inclusion of reproductive health services for men at HFWCs will not have an adverse effect upon the number of female clients who seek treatment from the same clinics.
• Interventions will lead to an increase in the number of male clients with RTIs and STIs at experimental clinics.
• There is no need to alter the working hours of HFWCs to accommodate male clients, particularly those seeking treatment for RTIs or STIs.

The study concluded that reproductive health services for men could easily be integrated into the HFWCs without affecting the clinics’ focus on serving women and children. Men were found to be willing to use the existing services within the routine service hours of the clinics. Women did not show any apprehension in using the health services because of the presence of male clients. Service providers, however, need practical training to diagnose and treat RTI and STI cases. To meet the requirements of the additional clients, extra medicines should be supplied. Finally, the rise in the total number of male and female clients at HFWCs will lead to more effective use of resources with increased use of health facilities and decreased cost of treatment per patient.

...Thus, the findings indicate that enhanced use of HFWCs by men and the introduction of services for RTIs and STIs at the clinics can be achieved without imposing a heavy burden on government resources....Further, findings indicate that including male clients will require very little modification in the delivery system as neither different hours nor separate facilities are needed at HFWCs...

...However, theoretical training alone is insufficient for the effective delivery of RTI and STI services. Good clinical training and demonstration are essential for case management of RTIs and STIs in clients using the syndromic approach. The practical training should be conducted at a place where providers would have enough RTI and STI cases to observe and practice the syndromic approach for managing both male and female clients....[S]ervice providers require training in communication skills to make them more effective counselors and more able to discuss sex and sexuality. Providers will need several short refresher courses and supportive supervision, rather than one short training course that covers several topics, to carry out effective communication and counseling sessions.

Since HFWCs continue to focus mainly on mothers and children, the inclusion of male clients in these centers requires targeted BCC materials. Likewise, the availability of the new services has to be publicized in the community. The materials can provide information about the services and raise awareness about the signs and symptoms of RTIs and STIs among men, their consequences, and necessary interventions. The study confirmed that focused awareness-raising activities were successful in increasing the number of male clients who went to HFWCs seeking treatment for both general health and problems related to RTIs and STIs..."