Improvements in the constellation of services in the African context are largely addressed through attaining better measures of service integration, which can be achieved through improved referral across categories of health programs. The use of an unobtrusive referral message that linked family planning and the Expanded Program of Immunizations (EPI) services was tested in an operations research study in Togo. The introduction of the referral message was accompanied by an 18-percent increase in awareness of available family planning services and an increase in the average monthly number of new family planning clients of 54 percent. These positive results indicate that the use of referral can have a significant and dramatic impact on family planning services in a relatively short time. In Togo, no evidence existed of a negative impact on EPI services, and a majority of the EPI providers reported satisfaction with the effect of the referral message at the close of the study.
PIP: Quality of care is currently construed to mean matching population needs with service provision. Improvements in African services are valued when there is a constellation of multiple services provided in a fixed center. In Togo, a simple intervention was developed to link childhood immunization and family planning services. Before immunizing each child, the service provider would make 3 family planning statements to the child's mother. The statements were salient and easy to remember: "Madame, your child is still young, and you should be concerned about having another pregnancy too soon." "This clinic provides family planning services that can help you delay your next pregnancy." And, "You should visit the family planning services after the immunization today for more information." Clinic staff were trained in a day and a half orientation session. The referral message was evaluated with a quasi-experimental design. Impact was measured in terms of knowledge of family planning methods and availability of family planning in the clinic, intention to use a contraceptive method, and the history of contraceptive use. 16 urban and rural clinics were involved. The sample included 1000 randomly selected women who has just had their children immunized. The pretest was conducted in January, 1992, and the post test was conducted in August, 1992, 6 months after the intervention in the study. Service statistics were also collected from 9 months prior to the intervention until September, 1992. Pretest and post test women were similar demographically. Recall levels were also similar. The results indicated that control group persons did not show any change in their awareness of family service availability in the clinic. The increase in the study group was from 40% to 58%. Differences between awareness in the control and study groups was 8% before the intervention and 22% after. Women desiring a longer birth-spacing period were more likely to be aware of service availability. The mean number of acceptors in the study group increased significantly from 200 to 307; average monthly number of family planning users also increased significantly from 1035 to 1311, which was a significant difference from control group users. Both groups showed significant increases in number of vaccines administered monthly in the study period.