Will hiring more FWA affect contraceptive prevalence in rural Bangladesh? -- analytical evidence from the MCH-FP Extension Project.

The International Centre for Diarrhoeal Disease Research/Bangladesh and the Ministry of Health/Family Planning (MOHFP) conducted a study of the system of health and family planning (FP) work in 4 Upazilas (countries) 2 of which were intervention areas of the Maternal-Child Health and Family Planning Extension Project. The justification for a policy to hire 10000 new family welfare assistants (FWAs) based on research findings from this project is examined. Statistical analysis of longitudinal Extension Project data corroborated work previously presented to the MOHFP by Phillips and Koblinsky in 1984 and Koblinsky in 1986. It was ascertained that worker-client exchanges had an important effect on contraceptive use behavior; in particular Was influenced this behavior. This effect varied by management condition; where management conditions had been improved the FWA contract effect was enhanced. FP services meet existing damage for contraception while FWA services generate demand for contraceptives thus Was act as service providers and not only as communicators and motivators. Their expertise in offering contraceptive care in the clients home made the Was effective workers. The effect of hiring more Was will be independent of efforts to improve management. The increase in the ratio of FWA workers to population density will have a substantial impact even if contact rates increase by only 1/3 as a result of hiring 10000 new Was. Careful operational planning of the new FWA recruitment posting training and supervision is needed.