Evaluation of mobile education and service units in increasing accessibility and acceptability of family planning methods -- India -- final report

Each MESU is designed to cover from 50,000 to 80,000 people in rural, semi-rural, or slum populations and provide maternal/child health (MCH) and family planning (FP) services. Data from a study of MESUs conducted by the Indian Institute for Health Management Research in four states (Bihar, Karnataka, Orissa, and Uttar Pradesh) provide some insight about their operation. (1) A range of acceptable MCH services are provided by each MESU, including vaccination for children and pregnant women, antenatal care for pregnant women, community education on the treatment of diarrhea, and FP messages, services, and referral. Some mobile teams provide sterilization services, while others refer users to government clinics. (2) A mobile team serves 1,300-1,900 new FP acceptors per year, about one-half to two-thirds of which are users of spacing methods. (3) While about 70% of the client population generally knows about the service, the irregularity of visits caused by problems with the vehicle (either maintenance or unavailability of a permanent vehicle) or changes in programming reduce the potential for increased utilization, as do problems with lack of follow-up care. (4) While the population is familiar with MESU family welfare services, other services are less well known and understood. (5) There is great variability in the coverage and effectiveness of the teams, with some providing largely clinical services like tubectomy and the IUD, and others providing largely pills and condoms. This is due in part to the availability of medically trained personnel in the MESU team. In half of the areas served by mobile teams, no differences are observed in terms of contraceptive knowledge or use when compared with neighboring areas serviced by the public health system. (6) The cost of operation of a MESU per year is generally less than US$10,000, with salaries of staff accounting for about 80% of the costs. The composition of staff varies, however, between MESUs in terms of training and gender. Overall, there is no consistent pattern emerging to show that all MESU units perform better than public health services. With the increasing demand for clinical reproductive health services, particularly from female physicians, the mobile clinic may have another role, that of increasing the outreach for clinic laboratory and reproductive health examinations. Mobile units may also be employed by FPAI to help other NGOs provide clinical backup to community-based distribution efforts. However, program strategies and management have to improve to make these services more cost-effective. (Author abstract, modified)