The Problem
In the face of a financial deficit, The XYZ organization noticed a sharp decline in the number of clients accessing critical sexual and reproductive health services in the low income and rural communities. The Outreach Department’s mobile clinic is responsible for increasing access to these services in low income, underserved communities. This stems from the organization’s mission to advance Sexual Reproductive Health and Rights, through advocacy and the provision of quality services to men, women and young people in Trinidad and Tobago. It also aligns with the Ministry of Health’s national and the United Nations Population Fund’s (UNFPA) international agenda of reducing unwanted pregnancies, increasing accesses to preventative screening for breast, cervical and prostate cancer, preventing the transmission of HIV/AIDS, and educating the public about reproductive health.
Services available on outreach includes pap smears, prostate and breast examinations, contraceptives, counseling on reproductive health issues (i.e. gender based violence), and voluntary counseling and testing (VCT) for HIV. There is also information sessions and literature about various reproductive health topics such as puberty and menopause. However these services are not reaching the target populations. The decline in clients accessing these critical services will have a negative impact on the health of the populations and will impact the performance based funding the organization receives from the International Planned Parent Hood Federation (IPPF), its parent body.
The residents in the communities that the mobile clinic serves did not have access to these services prior nor could they afford to pay for them privately. However, in the past three years The Ministry of Health noticed the lack of access to basic health services and constructed health centers in 4 of the 10 communities that the organization serves. Sexual and reproductive health services are among the cadre of services offered free of charge to the residents. There was a 15% decrease in clients on outreach following the opening of the clinics. However, many clients stated that they preferred to pay the low rates for services via outreach as opposed to having access for free at the health centers.
Nevertheless, the 30% price increases for services led to a 40% decrease in clients six months ago. Client exit interviews revealed that clients could no longer afford the services on outreach, even though they are 300% lower than the prices in private facilities.
With fewer clients accessing the services via outreach, there is no guarantee that they are going to the health centers. This is a major problem especially in light of the recent report that Trinidad and Tobago has the 3rd highest rate of cancer in the Americas as published by PAHO/WHO in 2013 (PAHO, 2013). The population is at risk.
The decrease in service also has a deleterious impact on the organization. The outreach department is unable to meet the service targets set by the organization and IPPF. They are not fulfilling the mandate, and less revenue is generated from services. In light of IPPF’s performance based funding policy, a decrease in clients means a decrease in funding and the organization cannot afford a budget cut.
It is evident that clients are not accessing services via outreach and that the public health sector is offering the same services for free. A gap remains we need to ensure that the women, young people and men in Trinidad and Tobago are accessing preventative sexual and reproductive health screening services, education and products. Lowering the prices is not an option as XYZ avoided raising the prices; it was its only recourse to remain fiscally sustainable. The health of the communities is most at stake.
Policy Options
Option 1: Increase Education and Awareness about the Importance of FPATT’s Services
The first option is to increase education outreach about the importance of preventative sexual and reproductive health screening services, safe sex practices to reduce spread of HIV/AIDS and STIs, the social benefits of planning families and avoiding unwanted pregnancies. The community health centers are offering the same services and products free to the public while we have to charge a fee. However, the public is not educated about the importance of these services. An option XYZ can explore is to have an educational outreach into rural and urban poor communities. This can be done in collaboration with local businesses in the community. The businesses can provide gifts as incentives to draw the public to the event, and they can cover the cost of adverting in the community that they operate. XYZ can also partner with the media to increase awareness about the educational caravan to ensure each one is effective and efficient. Through this educational outreach, we can be sure that people are aware of the importance of getting pap smears, prostate examinations, and using contraceptives including condoms. Regardless of where people access the services, they will know the importance of preventative sexual and reproductive health screening especially in light of the startlingly high cancer rates, HIV/AIDS rates, and unwanted pregnancies in the country. The outreach will also rebuild a relationship between the public and FPATT where the public feels that they can come to FPATT if they are in need of further information or want to access the confidential services.
Option 2: Conduct a Needs Assessments
There should be needs assessments conducted in the communities around the country to see if the residents need FPATT’s outreach services. This information can be used to determine which community FPATT should provide services to. The surveys will close the gap and identify if people are indeed continuing to access services in their community health centers or private hospitals. We can enlist the Ministry of Health to conduct this survey because it is addressing and analyzing the public health of the entire population. The information collected can be used to ensure that not only is the Family Planning Association is meeting the needs of communities but also ensure that the Ministry of Health is meeting the SRH needs of the country.
A best practice that can be explored is an article that evaluates the effectiveness of a staff administered survey in a sexual and reproductive health UK community clinic. The article reaffirms that life-style choices and social inequalities (e.g. income and gender inequalities) have a negative impact on a person’s health and well-being. The clinic implemented a staff administered survey to help identify the life-style and social issues their clients faced. Once unaddressed issues were identified, the staff offered support, information and referrals to the clients. The aim of the survey was to ensure the clinic effectively and efficiently met by the sexual and reproductive health of its clients.
Option 3: Partnerships and sponsorship from the private sector, the local government and international organizations
The organization should also seek corporate partnerships from companies and businesses to cover the cost of the services. This way, cost is no longer a barrier to services for our clients and people who prefer to access these quality confidential screening services at XYZ’s outreach department can continue to do so. If clients are accessing services via the outreach nursing staff then we know with certainty that they are proactive about their sexual and reproductive health.
International organizations such as United Nations, UNAIDS, UNICEF and UNFPA frequently have calls for project proposals that meet the health and social needs of underserved and low-income communities.
The national government of Trinidad and Tobago also has calls for project proposals to meet the social and health needs of residents in underserved communities. The national government has identified that the same underserved communities are the ones with the highest rates of violent crimes. Therefore, the Ministry of National Security also has call for project proposals that will meet the needs of these communities.
Private companies are also searching for organizations that can provide services to its staff and the surrounding community that the company operates as a way to increase the moral of its staff and improve the image of the company in the eyes of the residents. XYZ can partner with these private companies to provide its reproductive health services as health is always a major concern of every individual.