A serious obstacle that has to be overcome in setting up a permanent community organization for the provision of health services including family planning, is the world shortage of health manpower, especially in developing countries (WHO Official Records, 1971, No. 194, pp. 559-579).
Health manpower planning is needed to help governments estimate the
quantity and type of knOWledge, skills and abilities required to implement their health programmes.
Every country undertaking the introduction or expansion of family planning activities faces the problem of determining the type, quali-fication, number, recruitment, and training of health and other workers reqUired for the programme. Because of the acute shortage of qualified personnel, large-scale training programmes are often initiated before answers to these basic questions have been found.
Some instruction in family planning should be given to all health personnel, indicating the need for the inclus··on of family planning in the regular curricula of school of medicine, nursing and midwifery, and other health sciences. As a long-term objective, all personnel should
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unaerstand that family plannins is a part of ~eneral health care ~nd
therefore part of their responsibilities (WHO Technical Report Series, 476, 1971). In add.it i cn , the introduction of family pl.anni.ng in health services necessitates a clear definition of the duties of all categories and levels of health personnel; the orientation of staff already in
service or available for employment; and the inclusion of family planning in the basic education ef all relevant personnel to ensure that they will have sufficient knowledee and skill to be employed by the health services.
An integrated approach to the teaching of family plannin~ involves the subjects of physiology, obstetrics and eynaecology, paediatrics, and social and preventive medicine. Until recently comparatively little use was made in medical teachin2 of the rapidly increasing ranee of audio-visual media which can help teachers to improve the speed and effectiveness of student learning. Complicated equipment is not necessary to achieve innovation in teaching methods, and even simple audiovisual aids may help offset teaching staff shortages in developing countries (~owlinp" 1971).
The teachmg of management skills has been almost totally negl ect ed in education and trainin~ programmes for health personnel. One of the fundamental tasks of management, whether in the national health service or in a peripheral health post, is to adapt rationally to changes as
they occur. The purpose is to minimize the disrupting effect of unforeseen developments and to maximize opportunities for the achievement of shifting obj ective (UNESCO, 1970, editor, Teaching and Learndng ) , tlanagement skills are especially pertinent to the introduction and intecration of family planning into the health services and should be included in the training given to all health personnel. The development of managerial and
administrative skills and specializations is equally important for
administration and training. This, however, has not received sufficient attention in most countries, and this deficiency is one of the most important deterrents to the development of effective family planning
programmes. Trained personnel are required for manpower planninr, functions,
fo~ the design of manpower training and development strategies and for the administration, operation and evaluation of service programmes.
There is also the need to orient teaching to the work to be performed and recommend the development of field training areas that focus on the provision of comprehensive health care for the family and community. The strengthening of teaching activities should not concentrate on family planning in a narrow sense, but be broadened in order to train staff better than at present to provide comprehensive care.
All personnel engaged in health progrmnmes involvinr, family planning preparation in health education. Well-qualified health education staff are required to help make a systematic and detailed study of the educational needs of different groups of people in the community, in particular
adolescents and future parents, as well as to identify, strengthen and give support to the educational functions and tasks of staff at each level of the family planninr- programme.
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The general education and tramm« requirements outlined above must be sup?lemented by consideration of specific categories of personnel and their particular needs.
1. Medical Education
.The inclusion of hUITk~n reproduction. family planning and population dynamics in curri~ula is of relatively recent origin and is still in the initial star,es of development in many countries having family planning programmes. Some studies undertaken on medical students' knowledge of, and. attitude towards, family planning indicate little awareness of its objectives and the role they themselves might have to play in this regard, in their future careers. However, increasing awareness of the need for such education in recent years is procucing efforts to include this area in.me4ical school curricula.
The formulation of appropriate courses of study in medical schools, the.integration of new subject matter in existin~ curricula, the development of resources and new methods of teaching should give priority to the
advanced training of the teaching staff of relevant disciplines, in particular preventive and social medicine, gynaecology and obst erics, and paediatrics; to the introduction of inter-disciplinary teaching; to the iinprovement and expansion of medical faculties and teaching
institutions; and to the development of rural and urban field practice areas in which students can acquire knowledge and skill in the delivery of maternal and child health care, includinr: family p l annino .
Paediatric ians , obstetricians and general practitioners already employed in the health services or in private practice should receive orientation or refresher courses. Various medical associations in
collaboration with governments could organize the training. The content of such training would be: a IIeneral review of various aspects of human reproduction and population dynamics, 'government policy concerning the
in~lusion of family planninz activities in its regular heaith programme, the health benefits and promotional aspects of family planni~g, the . integration of family planning into the daily work of educatin~ patients and their fmhilies, and clinical training in neWlY developed co~traceptive
techniques. ' . .
2. Nursing and Midwifery
As in medical education, the subjects of human reproduction,' family planning and population dyn~~ics can and should be incorporated in
curricula of schools of nursing and midwifery. Staff who will be expected to inclUge family planning in their daily work in health centres, clinics and hospitals must be well informed, understand the tasks they are
to
undertake, especially the supervision and training of auxiliary starf and receive some ori.ent ation on the role played by each member of an inter-disciplinarx health team. In addit i.on to competence in their own
professional field, they must have a thorough knowledre of human
reproduction, family planning and population dynamics; of the principles and methods of health education; and of the variables of demographic and helath statistics as they relate to biological, social and cultural factors that condition the health of the individual, the family, and the community as a whole (WHO/NURS/69.79). In traditional communities, where only
female health personnel are acceptable in MCH and family planning care and where women doctors are in short supp ly, certain technical procedures such as the insertion of intrauterine devices may be deler,ated to the nurse-midwife. For this purpose special training courses and supervision have to be organized.
3. Training of Administrators, Managers and Manpower Specialists The special skills required to plan, execute, administer and
evaluate family planning pr03rammes must be devel(~ed by the establishment of appropriate training programmes. Such programmes should provide
training for top and middle level managerial personnel with emphasis on:
personnel supervision and supervisory staff and networks; modern managerial techniques; programme evaluation and operation research, and the basics of manpower planninp; utilization, training and development. Training for manpower development specialists should include: manpower planning and the design of manpower training and develop~ent strategies; task performance and analysis, personnel management £nd supervision; training needs and assessment and training evaluation; and design of training curricula and materials.
4. Training in Health Education
Staff at all levels need to know and be able to use the skills of health education in r,iving family planning information and education, so that they can encourage people to make their own decisions and take action for the improvement of their family's health. Unfortunately, few countries have enough professionally qualified health educators to form a health
education unit capable of guiding and assi~ting in the planning, implementa-tion and evaluaimplementa-tion of family planning educaimplementa-tional actiVities. There is also an acute shortage of teachers of health education, not only for the preparation of health educators and other health workers, but also for the training of teachers in primary and second~ry schools, teacher-training institutions and functional literacy classes.
Staff engaged in the education and training of others, i.e.
the educators, should be given highest priority for preparation in health education, health aspects of family planning, and related matters for importance to the health care and well-being of individuals, families, and community groups.
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5. Health Auxiliaries
The need to improve the training of auxiliaries, especially auxiliary nurses and midwives, to render services to families, particularly to
mothers and children, has been discussed. The traininr; of sufficient numbers of auxiliaries to render service in maternal and child care and family planning in the rural areas is given hi~h priority.
fulxiliary staff in the outposts of the health services play a key role in the total health service system. They are generally the first to be called upon in times of need. Their integrity, attitudes,
knowledge and skills may determine whether the people will accept or reject mcdern medicine when it is extended to the villages. It is of utmost importance that they obtain all the support they require from professicnal staff.
If the activities of auxiliaries are to be effective, the following must be assured; clearly defined responsibilities; supervision that
includes continuing in-service training; guidance and encouragement; the support of a multi-disciplinary team; an effective system of referral to appropriate services; max inum community participation in the health programme; and the regular ~rovision of adequate supplies.
Continuing in-service trnining should include further preparation in family health care, including family planning; the principles and methods of individual counselling; methods of working with groups to help create an atmosphere conducive to the acceptance of new ideas such as family planning; and ways of involVing the whole community in the planning and delivery of an improved health service.
6. Workers in Other Sectors·
Personnel in such fields a3 social work, home economics, teaching, community development and agriCUlture have an important role to play in increasing community and individual awareness and improving the availability of health services, including iamily planning. Before such personnel
can play an effective role, they must be aware of the relevance of the benefits of family planning to the goals of their own disciplines. Only then can family planning be effectively integrated into work at the field level.
Encouragement should be given for the integration of the health aspects of family planning into toe basic curricula of schools of public administration, social work and home economics, teaCher-training colleges, community development and agricultural institutes and similar institutions that prepare personnel who may come into contact with health programmes or be involved in aspects of family planning.
Orientation courses for these groups should consist of information on factors influencing maternal and child health and family health,
including the health benefits of family planning for families, government policy on family planning, organization and delivery of family planning through community health services, methods of contraception, the attitude of the community towards child-bearing, child-rearing and family planning, and the counselling of individuals and groups in matters related to
family health and family p.larmdng , These workers can contribute to the acceptance in their Ol~ fields of family planning as a means of improving family and community health.
VII. EVALUATION OF FAMILY PLANNING PROGRAMMES IN HEALTH SERVICES