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Manual of National Standards for Family Planning Services

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Manual of National Standards for Family Planning Services Manual of National Standards for Family Planning Services December 2009 Title: Manual of National Standards for Family Planning Services Published by: FALAH project for Ministry of Population Welfare, Government of Pakistan First Edition: 1,500 copies—August 1995 Second Edition: 3,000 copies—August 1998 Third Edition: 1,550 copies—October 2007 Fourth Revised Edition: 1,500 copies—December 2009 Graphics and other contraceptive information included in this document are adapted with permission from: World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), INFO Project. 2007. Family Planning: A Global Handbook for Providers. CCP and WHO: Baltimore and Geneva. The publication may be reproduced and excerpts from it may be quoted without permission, provided the material is distributed free of charge and the publisher is acknowledged. Table of Contents ABBREVIATIONS AND ACRONYMS ix ACkNOwlEDgEMENTS xi PREface xiii Chapter 1 | fAMIlY PlANNINg SERVICE DElIVERY IN PAkISTAN Introduction 1 Country Profile 1 Pakistan’s Populationw elfare Programme: History 2 Population Policy 2002 3 The Millennium Development goals 5 Pakistan Population Sector Initiatives 7 Population welfare Programme—Service Delivery Infrastructure 8 Components of National RHS Package of Pakistan 12 list of Quality of Care Indicators 13 Checklists on QoC for Service Delivery Points 15 Emergency Medicine list 19 Chapter 2 | COUNSEllINg AND INfORMED CHOICE IN fAMIlY PlANNINg Introduction 21 Three kinds of family Planning Communication 21 Principles of good Counselling 22 The Counselling Process 22 Benefits of Counselling 24 Qualities of ag ood Counsellor 24 Standards of a good Counsellor 27 Instructions ot the Counsellor 27 Informed Choice 28 Informed Consent 28 Client Assessment 29 Counselling of Clients with Special Needs 30 Counselling Men 33 Rumours and Misconceptions 34 Relationship between Contraceptive Methods and Sexual life 35 The Rights of family Planning Clients 35 page iii Chapter 3 | HEAlTHY TIMINg AND SPACINg Of PREgNANCY Introduction 39 key Research findings about the Risks of Closely Spaced Pregnancies 39 Three Components of Healthy Timing and Spacing of Pregnancy 40 Country Profile: Pakistan and Birth Spacing 40 Policy 40 Standards 41 Rationale 41 The Difference between “Birth Interval” and “Interpregnancy Interval” 41 Benefits of HTSP for Newborns and Infants 42 Benefits of HTSP for Mothers 42 Benefits of HTSP for Delaying Early Childbearing among Adolescents 42 Counselling Skills for HTSP 44 The SAHR Approach for HTSP 45 Chapter 4 | ASEPSIS/INfECTION PREVENTION IN fAMIlY PlANNINg Introduction 47 Standard Precautions 47 Hand Hygiene 49 gloves 51 Personal Protective Equipment and Drapes 52 Use of Antiseptic 54 Skin Preparation prior to Surgical Procedures 55 Instructions orf Cervical or Vaginal Preparation 56 Skin Preparation for Injections 56 Safe Practices in Operating Rooms 56 Instruments Causing Injuries 57 Safe Handling of Hypodermic Needles and Syringes 58 Infection Prevention Techniques 60 Instrument Processing 61 waste Management 68 Chapter 5 | MEDICAl ElIgIBIlITY CRITERIA Introduction 73 Barriers to Contraceptive Use 73 Addressing Medical Barriers: world Health Organization Medical Eligibility Criteria 75 Identification of Conditions 75 page iv Chapter 6 | NATURAl METHODS Introduction 87 lactational Amenorrhoea Method (lAM) family Planning Method Based on Breastfeeding 88 Counselling for Breastfeeding 93 Contraception for Non-lactating Mothers 94 Suitable Methods of Contraception during lactation 94 fertility Awareness-Based Methods 94 Calendar-Based Methods 97 Symptoms-Based Methods 101 withdrawal Method (Coitus Interruptus) 105 Chapter 7 | BARRIER AND PROTECTIVE METHODS Introduction 109 Policy 109 Standards 109 Male Condoms 109 female Condoms 114 Chapter 8 | ORAl CONTRACEPTIVE PIllS Introduction 119 Policy 119 Standards 120 Combined Oral Contraceptive Pills 120 Progestin-Only Pills 130 Chapter 9 | INJECTABlES Introduction 137 Policy 137 Standards 137 Progestin-Only Injectables 137 Combined Injectable Contraceptives 144 Chapter 10 | INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD) Introduction 151 Policy 151 Standards 151 Copper-Bearing Intrauterine Contraceptive Devices 152 Hormone-Containing Intrauterine Contraceptive Devices 169 giving Advice on Side Effects 173 page v Chapter 11 | IMPlANTS Introduction 175 Types of Implants 175 Policy 176 Standards 176 Mode of Action 176 Effectiveness 176 Advantages 177 limitations 177 Indications 178 when to Start 179 Equipment and Supplies Needed for Norplant Insertion 180 Technique for Insertion of Norplant-6 Rods 180 Technique for Removal of Norplant-6 Rods 181 Technique for Insertion of Implanon Rod-1 181 Technique for Removal of Implanon Rod-1 182 Newer Implants 182 Method-Specific Counselling 184 Recordkeeping 185 Chapter 12 | VOlUNTARY SURgICAl CONTRACEPTION Introduction 187 Policy 187 Standards 188 female Sterilization 189 Techniques of female Sterilization 194 Vasectomy 200 Informed Consent 205 follow-Up 205 Reversal of Tubal ligation and Vasectomy 206 Recordkeeping 206 Standard facilities for a eproductiveR Health Service Centre 207 Staff Requirement 208 Other Material and Medicine Required for Minilaparotomy 209 Medical History Record Card for Tubal ligation/Vasectomy 211 Chapter 13 | EMERgENCY CONTRACEPTIVES Introduction 215 Policy 215 Standards 216 Mode of Action 216 Effectiveness 216 Advantages 217 limitations 217 Method of Use 217 Method-Specific Counselling orf Emergency Contraception 220 page vi Chapter 14 | ADVANCES IN CONTRACEPTIVE TECHNOlOgY Introduction 221 Policy 221 Standards 221 Barrier Methods 222 Combined Hormonal Contraceptives 222 Intrauterine Contraceptive Devices 227 Implants 229 female Sterilization 229 Male Methods 230 Chapter 15 | POSTPARTUM fAMIlY PlANNINg Introduction 231 Policy 231 Standards 232 Overview of Postpartum/Postnatal family Planning 232 family Planning Methods for Postpartum women 234 Integration of Postpartum family Planning Services: Missed Opportunities 238 Chapter 16 | RTIs/STIs, HIV/AIDS, AND HEPATITIS 247 Introduction 241 Reproductive Tract Infections 241 Sexually Transmitted Infections 241 Policy 241 Standards 242 Classification of RTIs/STIs 242 Strategies for Control 244 Role of the Health Care Provider 244 Protocol for Treatment 244 HIV/AIDS 259 Stages of HIV/AIDS Infection 259 Transmission of HIV/AIDS 260 Hepatitis 262 Contraceptives for Clients with STIS, HIV/AIDS 264 Chapter 17 | MAlE AND fEMAlE INfERTIlITY Introduction 265 Role and Responsibilities of family Planning Services 266 Definitions 266 fertility 266 Initial Approach ot an Infertile Couple at the family Planning Clinic 269 Secondary Evaluation of an Infertile Couple 269 goals of the Medical Evaluation of an Infertile Couple 270 follow-Up 272 Treatment Options 273 page vii Chapter 18 | CONTRACEPTIVE SECURITY Introduction 275 Definition 275 Elements of Contraceptive Security 275 Conclusion 277 working out Monthly Contraceptive Requirement— Replenishment for RHS-A Centre/MSU/fwC 279 Couple Year of Protection (CYP) 280 MoPw’s list of Contraceptive logistic Record/Reports (ClRS) 281 Chapter 19 | TRAININg/HUMAN RESOURCE DEVElOPMENT Introduction 283 Human Resource Development: goals and Objectives 283 Categories of Training Programmes under PwP 284 Qualities of a good Trainer 292 Trainee’s Certification 293 Chapter 20 | SUPERVISION, MONITORINg & EVAlUATION AND RECORDINg/REPORTINg Introduction 295 Supervision, Monitoring and Evaluation 295 Conceptual framework 299 Role and Responsibilities 301 Staff Position—RHS Centres 308 Staff Position—MSU 309 Staff Position—fwC 310 list of Monitoring formats and guidelines 311 REfERENCES 335 CONTRIBUTORS TO THE REVISED THE NATIONAl STANDARDS 339 page viii ABBREVIATIONS AND ACRONYMS ART Antiretroviral therapy ARV Antiretroviral BBT Basal body temperature BHU Basic Health Unit BTl Bilateral tubal ligation CBO Community-based organization CCSSC Cabinet Committee for Social Sector Coordination CIC Combined injectable contraceptive COC Combined oral contraceptive COPE Client-Oriented Performance Evaluation CPD Continued professional development CPR Contraceptive prevalence rate CRC Client clinical record card CS Contraceptive surgery DTC District Technical Committee DVT Deep venous thrombosis EC Emergency contraception ECP Emergency contraceptive pill ENg Etonorgestrel EPI Expanded Programme on Immunization fP family planning fPAP family Planning Association of akistanP fTO field Technical Officer fwA family welfare Assistant fwC family welfare Centre FWW family welfare worker HBV Hepatitis B virus HCV Hepatitis C virus HlD High-level disinfection HRD Human resource development HTSP Healthy Timing and Spacing of Pregnancy ICPD International Conference on Population and Development IEC Information, education and communication IPC Interpersonal communication IRC Institutionaleimbursement R Cost ISO International Standards Organization IUCD Intrauterine contraceptive device lAM lactational amenorrhoea method lHw lady Health worker lMP last menstrual period MCH Maternal and child health page ix MDG Millennium Development goal M&E Monitoring and Evaluation MEC Medical Eligibility Criteria MIS Management information system MO Medical Officer MoH Ministry of Health MoPw Ministry of Population welfare MSU Mobile Service Unit MSV Medical site visit NATPOw National rustT for Population welfare NfP Natural family planning NgO Nongovernmental organization NgO
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