FAMILY-PLANNING CLINICS THROUGH WOMENS EYES AND VOICES - A CASE-STUDYFROM RURAL BANGLADESH

Context: The voices and views of clients are an essential, but often n eglected aspect in initiatives to improve the quality of care provided by family planning and reproductive health programs. Methods: In anti cipation of an increased emphasis on clinic-based services in Banglade sh's national family planning program, a small qualitative study was u ndertaken in six villages in late 1996. In-depth interviews were condu cted with 34 clients of six government and two nongovernment clinics, and researchers spent one day at each clinic observing how providers a nd clients interacted. Results: Hierarchical modes of interaction and poor communication dominated many of the encounters, and women had to beg for services in some clinics. Providers appeared to selectively ap ply interpersonal skills and common courtesy; rudeness to clients was not merely a reflection of ignorance, since the paramedics appeared to know the basic principles of counseling. Limited access to medication and often arbitrary ways of determining when to dispense if created s uspicion and tension between providers and clients. Most clients expre ssed a willingness to overlook rode treatment, long waits and unhygien ic conditions, saying that because they were poor, they could not expe ct better care and had no service alternatives. Conclusions: Technical solutions, such as training in counseling, may not be enough to impro ve the quality of care provided in clinics in rural Bangladesh. Instit utional policies, norms and incentives need to become more client-orie nted if the transition from in-home delivery to clinics is to be a suc cess.