Adoption of family planning: a process model and optimal pattern for the visit of a field worker

Abstract

In the context of the poor performance of the national family planning programme and the current paucity of resources, a major problem facing the programme administration is that of effective utilization of available resources. This dissertation tackles the problem of how to optimize the use of the most-important resource available to the programme administrator, i.e., the family planning worker. The resource utilization model used in this study related the pattern of field workers' visit to cost and effectiveness. This model overcame a general shortcoming of quantitative models in family planning in that it modeled the process of family planning adoption. In the proposed adopt ion model, the important stages through which a couple passes before adopting a family planning method were identified. A methodology was developed which validated an adoption model through non-recall data. The model was proved to be valid in both time and space. The stage model was able to explain the so-called KAP gap--the gap between attitude and practice. It clearly demarcated the flow paths of spacing vies-a-vies terminal use of family planning methods. The effectiveness of a field worker's visit was modeled through a stochastic model with Markovian assumption. The state space for the Markov chain we defined on the basis of the proposed mode1 of adoption. The transition matrices were estimated through a panel study of 200 couples under two alternatives -when they were visited by the family planning worker and when they were not visited by the worker. The Markov chain was shown to have high predictive validity. Next, the cost model was constructed to relate the total cost of operating a Primary Health Centre with the number of field Markers. To optimize the pattern of workers' field visits, the problem was formulated as a sequential decision problem and solved through dynamic programming. The relationship between acceptance of family planning methods and the visit effort was found to be non-linear. The suggested optimal policy recommends a selective strategy--visits to couples with only a certain kind of profile. The selective strategy is expected to .result in substantially higher rates of acceptance over a period of 20 quarters. Finally, some directions for future research are suggested and the implications of the finding of this dissertation for the national family planning programme are discussed.