Promoting Reproductive Health Services in Rural Communities in Honduras

The opinions expressed herein are those of the authors and do not necessarily reflect the view of USAID. SUMMARY Using the results of a previous operations research study, the Ministry of Health of Honduras recently changed the National Women's Health Service Delivery Guidelines to explicitly authorize nurse auxiliaries to insert IUDs, deliver Depo-Provera and take Pap smears. These services are new to the rural communities served by rural health centers (RHCs). The objective of this project was to test whether the demand for these newly introduced services would increase at the rural health centers (RHCs) if a promotional brochure was distributed in the surrounding communities by the RHC's clients. The nurse auxiliaries gave ten-minute talks at the RHCs and asked clinic clients to distribute the brochures among potentially interested friends in their communities. Twelve rural health centers (RHCs) participated in the study: six in the experimental group where brochures were distributed, and six in the control group, where no special activity was conducted. The twelve RHCs were randomly selected from 180 in which the nurse auxiliaries had been trained in the provision of these services as part of a FRONTIERS intermediate result 2 project. To assess the intervention, we compared the services delivered three months before and three months after the intervention in both the experimental and the control groups. New IUD users increased from 2.8 to 4.5 per month in the experimental group, while in the control group they decreased from 1.4 to 0.9. New injectable users increased an average of 1.8 users per month in the experimental group, compared to 0.6 new users in the control group. Finally, Pap smears increased by 1.6 samples per month in the experimental group, and decreased by 0.1 samples per month in the control group. However, mean tests showed that the only statistically significant differences in both groups were the increases in the number of injectable users. A t-test to compare the service delivery differences between the experimental and the control groups found that the experimental group had significantly higher change rates than the control group. We recommend the use of this strategy for all sites where RHCs have recently introduced the three new services. It is estimated that in the expansion period, the cost per additional user generated by the strategy would only be about US $ 0.13.