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Field structures in family planning.

Field activity in Pakistans national family planning program from 1966 to 1969 was carried out primarily by "dais" (midwives) who worked part-time and were paid by commission for women they referred to clinics for IUDs and by 80% of the value of contraceptives they sold. Most were illiterate and had little previous experience as midwives. A review of the effectiveness of the dais during this 5-year period indicated that the level of involvement among these women was low (with only 37% of the eligible population having been contacted) and that they focused on new acceptors rather than on maintaining a high level of use among women already practicing family planning. It was also observed that they were operating unsystematically with inadequate guidelines to determine their effectiveness. These observations led to suggestions for a new field structure which was implemented in July 1969. The new system was based on male-female teams responsible for a target of 1300-1500 couples (based on the national ratio of 16.5 fertile couples per 100 population). The team was to be literate from the locality over 25 years of age and qualified to introduce innovation effectively. Salary was designed to provide incentives for the team to promote qualitative as well as quantitative family planning and to avoid false reporting and other problems inherent in incentive programs. A record-keeping system to be maintained by the team was developed and greater emphasis placed on group contacts and long-term follow-up. In effect in 1 district so far the field system has operated for 1 year in the district of Sialkot Punjab province and evaluation now in process should indicate what failures exist and why as well as provide information to allow the system to be modified early enough in the next 5-year period to achieve target goals.