TCI University Toolkit: Services & Supply
Fixed-Day Service Provision
What Is It?
Family planning services are provided at a fixed facility, on a fixed day, at a fixed time – often for free. The special days can offer a specific contraceptive method or a full range of methods (see examples from India and Senegal in the boxes below).
The special days can complement routine family planning service provision by offering a method that is typically not provided at the facility, or by guaranteeing availability of a routine family planning service on a specific day.
It is accompanied by community mobilization to raise awareness of these days so the community can expect to receive family planning services at the particular location and time.
What Are the Benefits?
- Facilities can galvanize their quality improvement efforts around a specific day, service and time.
- Individuals are guaranteed to receive the family planning services they come for after screening for medical eligibility.
- Clients’ waiting time is minimal.
- Clients may appreciate a schedule of specific services, for example, that intrauterine devices (IUDs) are offered on the third Thursday of every month, to help them plan in advance when to get the specific method they want. The scheduled days also assure to clients that they are guaranteed to get the specific service they want that day.
- As facilities demonstrate reliability of service delivery on the special days, clients’ confidence in the facilities and providers improves, in turn improving their chances of returning for other services.
- Geographic and financial access to family planning for underserved populations increases. In Francophone West Africa, family planning services were often combined with other services such as breast and cervical cancer screenings, infertility care, and HIV/AIDS care, further serving the health needs of underserved populations.
In India, the government endorses the fixed-day service provision approach – which it calls the Fixed-Day Static (FDS) approach – to provide quality intrauterine device, no-scalpel vasectomy and female sterilization services. The FDS approach is a component of the national family planning guidelines, and all health facilities are required to conduct FDS.
In some sites, this approach was so successful that every day became an FDS day where particular methods were made available on specific days to ensure community members could plan ahead to obtain their desired method.
Senegal refers to the fixed-day service provision approach as Special Free Family Planning Days, in which the full spectrum of contraceptive methods is offered to individuals free of charge.
These days are held in existing health facilities or in other sites close to underserved populations, either in a mobile clinic or in government buildings. Community health workers conduct household visits to inform the community about upcoming special days. Each special day serves, on average, about 30 new contraceptive acceptors, based on 6-month implementation data from two districts.
How to Implement
Select a date
The date chosen should make sure that the appropriate medical team and support staff will be available to handle the volume of clients, which will likely be higher than normal. In India, a typical team for Fixed-Day Service consists of:
- Anesthetist (if available and necessary, for example, to provide female sterilization)
- Paramedical staff
- Lab technician
- Ward boy
If the fixed-service day for a particular facility is part of a longer series of fixed-service days or if a group of facilities are conducting fixed-service days, prepare a consolidated schedule that shows all facilities’ planned service days. This calendar example from India shows on what day of the week that 11 facilities in Aligarh district plan to offer fixed family planning service days. Once the dates are fixed, the calendar should be widely circulated among facility staff.
Prepare the facility
Ensure ahead of time that the following items, at a minimum, will be available on the special service day to meet the needs of a higher-than-usual volume of clients: commodities, supplies, equipment, manpower, reporting forms and other relevant materials. To minimize waiting times, you may want to consider setting up a separate registration counter for clients who are at the facility for the fixed-day service than for those who are there for other services.
Recruit and prepare a list of available medical and non-medical staff who will be implicated in the service day. In places where a facility does not have appropriately trained medical/paramedical staff to assist with provision of the family planning services, qualified staff from another facility should be recruited for that day. Ensure availability of commodities and supplies; this includes both contraceptive stock as well as medical equipment and other consumables. Make sure you have infection prevention supplies available as well. You can develop or adapt a checklist from India to make sure the facility is ready for the service day.
Engage the community
Use a multitude of communication channels to inform the community about the services that will be available on the fixed day. Use community health workers to help mobilize the community and publicize the date and location of the service. You can also collaborate with local midwives and nurses in the target area. Inform other development partners and NGOs about the fixed-day service so they can publicize it through their networks.
Provide quality services on the fixed day
Make sure clients are satisfied with the quality of care from the moment they enter the health facility to when they leave. When clients arrive at the facility, they should be greeted and their necessary information recorded into a register. If appropriate, a counselor can offer preservice counseling to clients. During the consultation, the provider should provide client-centered care and services to the client.
The client should be offered the method of choice unless the client is not medically eligible for that method. In that case, the provider should offer appropriate counseling to help the client choose another suitable method. The client should receive any post-procedure counseling, if appropriate, such as counseling about possible side effects and early warning signs that require medical attention and scheduling any necessary follow-up appointments.
Data from fixed-day services should be collected separately from routine service days in order to better monitor effectiveness of this approach. However, the data should feed into other public health information systems. Client exit interviews may be used to monitor quality of services provided at these days. Possible indicators:
- Number of fixed days planned compared with number of fixed days held
- Number of new family planning acceptors recruited through such days
- Number of women who switch from short-acting methods to long-acting reversible contraceptives or permanent methods
- Number of women continuing family planning methods due to these special days
- Total number of women benefiting from family planning services at these special days
- Number of family planning clients served through fixed-day services, by method mix distribution
- Percentage of family planning clients served through fixed-day services to the total family planning clients served, by method and/or by month
What Is the Evidence?
India’s experience under the Urban Health Initiative (UHI) revealed that when fixed-day services for family planning were regularly organized in a facility, the quality and utilization of routine family planning services in that facility improved. In fact, in one facility, one fixed day of providing the intrauterine device (IUD) resulted in the same number of new IUD clients that day as the entire previous quarter when IUDs were in theory provided alongside other family planning services.
The following graph shows that an increase in the number of fixed service days conducted in selected facilities across 11 cities of UHI resulted in corresponding increases in the number of acceptors of long-acting and permanent methods (LAPMs).
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In Francophone West Africa, fixed-day family planning services were often combined with other services such as breast and cervical cancer screenings, infertility care, and HIV/AIDS care, further serving the health needs of underserved populations.CorrectIncorrect
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- Preplanning is key to the success of the service day. Make sure you have reviewed and addressed all possible complications that could happen on the day, such as the registration process and stocking all necessary supplies and equipment.
- Designating a team to organize the day or days can distribute the responsibilities and make sure nothing gets missed. In India, specific roles and responsibilities are outlined for every member of the team.
- The day can be organized to provide either a range of contraceptive methods or specific methods.
- Ensure community awareness of the day by publicizing the service schedule widely and using communication reminders like handbills and newspaper inserts or ads.
- Make sure that demand generated can be met with the services provided.
- The cost of providing free services may be prohibitive to the program and should be planned far in advance with the appropriate authorities within the health system.
- Follow-up for women benefitting from this service may be challenging. One solution is to transfer the medical files to the woman’s facility of choice.