In the context of SRHR services, ‘Unmet need’ can be defined as “women/couples who want to avoid pregnancy (temporarily or indefinitely but are not using any method of contraception”. Causes of unmet need are usually explained on the basis of access to services, quality of care/services, cost barriers and social barriers. Among these, quality of care/services occupies a prime position in solving most of the unmet need questions. Respect for client’s rights and meeting provider’s needs are pre-requisites for the success of any quality of care initiative. Information given to client on choice of contraceptive methods, technical competence of staff, mechanism to ensure continuity, appropriate constellation of services and interpersonal relations at the health care facility are decisive in its success.

Research Summary: Bulletin of WHO has published a paper entitled Towards sustainable delivery of health services in Afghanistan: options for the future (September 2007). The authors observed that disruption caused by decades of war and civil strife in Afghanistan has led many international and national nongovernmental organizations (NGOs) to assume responsibility for the delivery of health services through contracts with donor agencies. Recently the Afghan Government has pursued the policy of contracting for a basic package of health services (BPHS) supported by funds from three major donors - the World Bank, the United States Agency for International Development (USAID) and the European Commission. With the gradual strengthening of the public health ministry, options for the future include pursuing the contracting option or increasing public provision of health services. Should contracting with NGOs be pursued, a clear strategy is required that includes developing accreditation instruments, better contracting mechanisms and a system for monitoring and evaluating the entire process. Should the government opt for an increasing role, problems to be solved include securing the transition to public provision, obtaining guarantees that appropriate financing will be provided and reconfiguration of the public health delivery system. Large-scale contracting with the private for-profit sector cannot be recommended at this stage, although this option could be explored via subcontracting by larger NGOs or small-scale trial contracts initiated by the public health ministry. Irrespective of the option chosen, an important challenge remaining is the recalcitrant problem of high out-of-pocket payments. Sustainable delivery of health services in Afghanistan can only be achieved with a clear national strategy in which all stakeholders have roles to play in the financing, regulation and delivery of services. (Courtesy: Pubmed)

Resources: FHI has launched a tool kit viz. Scaling Up the Continuum of Care for People Living with HIV in Asia and the Pacific. The toolkit provides HIV care service implementers and providers with guidance on establishing a local or national Continuum of Care program. Electronic copies of the Toolkit can be found at: http://www.fhi.org/en/HIVAIDS/country/Asia/index.htm

News: As part of establishing a Centre of Excellence on Access in Pakistan, RAHNUMA FPAP has conducted a policy advocacy round table in Islamabad, with active participation of its coalition partners. Three research papers, highlighting Sexual and Reproductive Health policy gaps in the country and recommendations were presented at the round table. For copies of the papers presented, write to: access@ippfsar.org.  

Events: Reproductive Health in Emergencies Conference 2008, coordinated by the Reproductive Health Access, Information and Services in Emergencies Initiative, in collaboration with the Reproductive Health Response in Conflict (RHRC) Consortium, will be held in Kampala, Uganda from June 18-20, 2008. Details are available at:  www.RHinEmergenciesConference.org/2008.