FAMILY PLANNING SERVICES

 Family planning is defined as the ability of

individuals and couples to anticipate and
attain their desired number of children
 and the spacing and timing of their births.
 It is achieved through use of contraceptive
methods and the treatment of involuntary
infertility.
 Family planning is a means of promoting the
health of women and families and
 part of a strategy to reduce the high maternal,
infant and child mortality.
 Service Eligibility
Any reproductive age person, male or female
regardless of
marital status is eligible for
Family Planning services
including information, education and
counseling .
 Range of Services to be offered In
Family Planning Services
The following services shall be offered at each level of
the health system
• Counseling
• Provision of contraceptives
• At levels above a health post Screening for
reproductive organ cancers
• Prevention, screening and management for sexually
transmitted infections including HIV
• Prevention and management of infertility
 Counseling
 Counseling is an important task of service
providers.
 All clients have to be counseled to assist them
make an informed voluntary choice and
decision regarding fertility andcontraception.
 Information should be provided regarding all
available methods of contraception used.
 Counseling.......
 Advantages and expected contraceptive side
effects as well as the steps to be taken if and
when the clients have side effects.
 Knowledge of the common misconceptions
about each method is an added advantage to
the counselor and
 efforts should be made to address clients
concerns and fears about specific methods.
FP workers should ensure confidentiality and
privacy to potential clients.
 Provision of Contraceptives
1.Natural Family Planning Methods,
2.Modern Family Planning Methods
 1.Natural Family Planning
Methods,
•
Abstinence
•
Standard Days Method
•
Calendar Method,
•
Cervical mucus (Billings)
•
ovulation method,
•
Sympto-thermal method
•
Lactation amenorrhea method ,
•
Withdrawal method
 2.Modern Family Planning Methods
•
Condoms methods
•
Vaginal Contraceptive Foam Tablet and jellies
•
Emergency Contraceptives
•
Progestin-Only Pills
•
Combined Oral Contraceptives
•
Injectables contraceptives
•
Implants
•
Intra-Uterine Contraceptive Devices
•
Bilateral tubal ligation
 Referral Systems -

An effective referral system means a close
relationship between all levels of the health
system and helps to ensure people receive the
best possible care closest to home.

It also assists in making cost-effective use of
hospitals and primary health care services.
 Definition of terms

•
A referral can be defined as a process in which a
health worker at a one level of the health
system,

having insufficient resources (drugs,
equipment, skills)

to manage a clinical condition,

seeks the assistance of a better or
differently resourced facility at the same or
higher level to assist in,

or take over the management of, the client’s
case.
 Definition of terms cont.……

Key reasons for deciding to refer
either an emergency or routine case
include:

to seek expert opinion regarding the client

to seek additional or different services for the client

to seek admission and management of the client

to seek use of diagnostic and therapeutic tools
•
 Defition of terms…..

The facility that starts the referral process is
called the initiating facility.

prepare an outward referral to communicate the client
condition and status.

The facility that accepts the referred case is
called the receiving facility and at the end of
their involvement.

prepare a back referral on the lower part of the forms to let
the initiating facility know what has been done.
 Definition of terms………
•
A referral register is a means of maintaining a
list of all outward and inward referrals for one
facility or service provider.
•
Information registered includes client
referred,
–
to where, when and why, whether the case is closed or
continuing (the retuning referral form has been received with
any necessary rehabilitation or follow-up), and whether it was
an appropriate referral or if there were any issues.
 Components of a referral system
components of referral system contain five
system:
1.Health System
2.Initiating facility
3.Referral practicalities
4.Receiving Facility
5.Supervision and capacity building
6.Continuous quality improvement
 Description of components of the
referral system
•
1. Health system issues
The health system issues includes:
a. Service providers and quality of care
b. Performance expectations and
c. Involvement of organizations
  
1. Health System

a. Service providers (public and private sector) and quality of care

For a referral system to work at its best, relationships between service providers


are formalized and referral procedures agreed.

All levels of the health system, including primary health care services, need to be


functioning appropriately.
This includes each facility:



being clear about their role, responsibilities and limitations

•
Strengthened primary health care services
•
Clarity of level and role of each facility
•
Availability of protocols of care for conditions for each level of facility
•
Availability of communication and transport
 Health System………
b. Performance expectations
A referral system will function effectively if all


service providers are expected to adhere to the

•
referral discipline,
•
to refer appropriately, and
•
to follow the agreed protocols of care .

facility supervisors to monitor referral statistics and
to provide feedback as appropriate.
Expectation to refer appropriately and follow


protocols of care
Expectations that health workers and clients adhere


to the referral discipline

Regular supervision and capacity building


19
 Health System………
C. Involvement of organizations
The national health authorities must expect the


supervisors to regularly take action to ensure that

the referral system progressively improves.
Ministry of Health


Medical and nursing schools



Medical and nursing professional associations


 2.Initiating facility

a. The client and their condition

b. Protocol of care for that condition at that level of
service
c. Treat and stabilize client – document treatment
provided
d. Decision to refer
 2.Initiating facility……
a. The client and their condition
When a client visits the health post, it is important
that the health worker attends to them

promptly ,treats them with respect,

privacy and confidentiality,

acknowledging their cultural beliefs,

and identify their needs.
 2.Initiating facility

b. Protocol of care for that condition at that level of

service
•
If protocols of care are used in this country, the
health workers need to have ready access to, and be
very familiar with, the agreed regional or national
protocols for that level of facility.
•
Protocols need to include likely circumstances for
referral and details of the information and
documents that should be sent with the client.
 2.Initiating facility……
c. Treat and stabilize client – document treatment
provided.

The health workers assess the client, gather relevant
information and provide any necessary care possible at
that facility.

In an emergency situation, the health worker must
maintain all vital functions and minimize any further
damage.
 2.Initiating facility……
d. Decision to refer


Making the decision to refer the client comes after the
health worker has gathered and analyzed the relevant
information using the protocol of care as a guide.

Deciding to refer does not mean that the health worker
is inadequate or bad.
  
3.Referral practicalities
a. Outward referral form
A referral form that is standardized throughout the


network of service providers ensures that the same

essential information is provided whenever a
referral is initiated.
The referral form is designed to facilitate


communication in both directions - the initiating

facility completes the top part or the outward
referral.
Every patient referred out should be accompanied


by a written record of the clinical findings, any

treatment given before referral and specific reasons
for making the referral.
 a. Outward referral form………..


The referral form should accompany the client
(often carried by them) and give a clear designation
of to which facility the patient is being sent.

A carefully filled referral card cab help the client get



timely attention at the receiving facility.

 3.Referral practicalities…………..

b. Communication with receiving facility (make

arrangements as appropriate)

In some situations it will be possible and necessary to
communicate with the receiving facility to make an
appointment or other arrangements for the referral, or
to let them know of the pending arrival of an
emergency case.
If the client is very ill, it might be necessary for a health


worker to accompany them to the receiving facility.

 3.Referral practicalities…………..
c. Information to the client and their family/support
network

The decision to refer might be frightening or
distressing for the client and their family
so it is important that the health workers have empathy


and give the client relevant information such as:

Reasons and importance of the referral, risks associated with
•

not going
How to get to the receiving facility – location and transport
•

Who to see and what is likely to happen

•

The process of follow-up on their return

•
 Referral practicalities…………..


d. Empathy - understanding of implications
for client and family/support network

e. Empathy - understanding of implications
for client and family/support network
–
Overall fear
–
Cost of transport, treatment and family
accommodation

f. Referral register to monitor follow-up and
gather statistics
  
4. Receiving Facility

Receiving Facility

Anticipate arrival and receive client and referral
form

Provide care – document treatment provided

Plan rehabilitation or follow-up with client and
family/support network

Back referral form

Feedback to initiating facility on appropriateness
of referral

Referral register to monitor follow-up and
gather statistics
31
  

5. Supervision and capacity building

Supervision and capacity building:
1.Monitor outward and back referrals
i. Number and appropriateness of referrals – compliance
with protocols
ii. Quality of documentation
iii. Consistency of follow-up
2.Provide feedback, support and training for health
staff
3.Provide feedback to central level
 6. Continuous quality improvement

•
The referral system must be open to revision in
the light of practical experience, and in order to
meet the goals of the health system overall.
•
Periodically, there may be need to analyze the
functioning of the referral system, beyond
looking at the statistical patterns and trends.
 Referral System Tools

•
There are two sample tools to measure
referral system.

Sample tool 1

Sample tool 2
 Sample tool 1
Referral form
Prepare one copy to send with the client,
•

and keep one copy in the client notes.

•
•

Name of facility: Referral Form original / copy

Referred by: Name: Position:

Initiating Facility Name and Address:   Date of referral:

Telephone arrangements made: YES NO Facility Fax No.

Tel No.

Referred to Facility Name and Address:  

Client Name  
Identity Number   Age: Sex: M F

Client address  
Clinical history  
Findings  
Treatment given  
Reason for referral  
Documents accompanying referral  

Print name, sign & date Name: Signature Date:

:
Back referral from Facility Name   Tel No. Fax No.

Reply from Name: Date:

(person completing form)

Position: Specialty:

To Initiating Facility:  
(enter name and address)

Client Name  

Identity Number   Age: Sex: M F

Client address  
This client was seen by: on date:
(give name and specialty)

Patient history  

Special investigations and findings  

Diagnosis  

Treatment / operation  
Medication prescribed  

Please continue with: (meds, Rx, follow-  

up, care)

Refer back to: on date:

 Sample tool 2
Referral register

–
The register has a page for referrals made OUT
from a facility and referrals received IN to a facility.
–
Information on back referral of clients referred
out from the facility should be made on the same
line as information regarding the original referral
out. This facilitates follow-up.
 Date Client Identit Referred Referre Date Follo Follow Appro
referr Name (M y No. to d for Back w-up -up priate
al or F) (name of referr requir compl referr
made facility / al ed eted al
specialty) receiv YES / YES / YES /
ed NO NO NO

Register of Referrals OUT