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Bolivia: A Gender Focus in Service Delivery Improves Quality of Care
OR Summary no. 68

Background

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs), has long promoted gender sensitivity as a necessary component of high-quality care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs.

In 2005, FRONTIERS collaborated with PROCOSI to test the feasibility and costs of a system for certifying that its member organizations provided gender-sensitive reproductive health services. The two-year project followed a 2000 intervention to incorporate gender perspectives in PROCOSI clinics, which led to improved client satisfaction, a significant reduction in unmet need, and improved communication between partners (see box). The 2005 intervention was designed to create a cost-effective certification system. Participating service-delivery facilities were required to comply with 80 percent of a set of 65 quality of care and gender indicators modified from a set of standards developed by the IPPF. The standards included categories related to institutional policies and practices, provider practices, personnel knowledge of reproductive health, client comfort, use of gendered language, information, education, communication and training, client satisfaction, and monitoring and evaluation.

The certification process begins with an assessment by the service delivery staff of their compliance with the 65 indicators; continues with the development and implementation of workplans to satisfy unmet standards; and concludes when an external evaluation certifies that the clinic meets at least 80 percent of the indicators. When this process is completed, the clinic receives a certificate as a "gender-sensitive quality health center” in a public ceremony. The certification is valid for only two years, thus the facility has to repeat the procedure periodically.

Of the 18 service-delivery facilities invited, eight participated (most reasons for declining had to do with resource availability), and seven completed the certification process. The baseline and endline assessments included observations of provider–client interactions, interviews with clients, interviews with providers, an assessment of conditions, and a review of institutional guidelines.

Findings

• The initial diagnostic assessment showed that the NGO facilities complied with an average of 14 percent of the gender- and quality-related standards. At the endline assessment, the facilities met 94 percent of the proposed standards. Thus all seven clinics that completed the process achieved certification as a gender-sensitive and quality service provider.

• The seven facilities completing certification proposed an average of 72 actions to solve compliance problems with the gender and quality standards. They were most likely to target provider practice, provider knowledge, and institutional policies.

• Changes made by individual units ranged from simple to major, and included reorganizing space to improve client flow, creating cleanliness campaigns, designating a staff cafeteria within the unit, systematically screening clients’ needs for a list of services, and hiring both male and female physicians to offer clients the provider of their preferred gender.

• Average costs for the certification across the seven facilities were US$4,004, almost half of which was due to opportunity costs (staff time). Excluding staff time the average cost was $2,039, with the majority of expenses due to meetings, workshops, and infrastructure improvements in the three facilities that made infrastructure changes.

• There was no relationship between the cost of incorporating a gender perspective and compliance with standards or number of activities.

Utilization

• Following dissemination of the project results, arrangements were made to extend the strategy to other NGOs in and outside the network. In June 2007, representatives of organizations from eight countries attended a workshop on the gender-certification strategy.

Sources: Palenque de la Quintana, Erica, Patricia Riveros Hamel, and Ricardo Vernon. 2007. “Consolidating a gender perspective in the PROCOSI network,” FRONTIERS Final Report. Washington, DC: Population Council. (PDF)

Palenque, Erica, Lizzy Montaño, Ricardo Vernon, Fernando Gonzales, Patricia Riveros, and John H. Bratt. 2004. “Effects and costs of implementing a gender-sensitive reproductive health program,” FRONTIERS Final Report. Washington, DC: Population Council. (PDF)

This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. HRN-A-00-98-00012-00. The contents are the responsibility of the FRONTIERS program and do not necessarily reflect the views of USAID or the United States Government.
 

For more information contact:
Frontiers in Reproductive Health (FRONTIERS)
Population Council
4301 Connecticut Ave. N.W., Suite 280
Washington, DC 20008 USA
Telephone: +1 202 237 9400
Facsimile: +1 202 237 8410
E-mail: frontiers@popcouncil.org

 

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This page updated 18 January 2008

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