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Programme evaluations maybeeitherprocess evaluation what age does erectile dysfunction usually start discount super levitra online amex, which examines theappropriate execution of programmecomponents erectile dysfunction vs impotence cheap 80 mg super levitra with visa, or outcome evaluation erectile dysfunction fatigue purchase cheap super levitra on-line, whichexaminesthe bene? Keepingrecordsand preparingand analysingreports areeffectivewaystodetermine clients? needs andtheir usepatterns, without doing aformalprogramme evaluation. It providesadaily log of thenumberofclient visits,subdividedbythe typesand quantitiesof 18 Study Session2 FamilyPlanningService Delivery andProgramme Management contraceptives dispensed to each client on amonthlybasis. It is usually themonthlyaverage of thequantity of that productthat hasbeen dispensed to usersduringthe past threeorsix months. Ifthe months of supplyinyour stocks areless than thetimeremaining before your next delivery of supplies, then you mayneed to arrange foranemergency delivery (see Table2. Almost allmedia areused to promotefamily planning communications,including radio, television, billboardsand brochures. In theEthiopian context, asuccessful modelhouseholdcan be used to communicatethe messagetotheir peers. Part of your future role will be to identify allpotentialmeansof communicationavailableinyour localities, so that you will be able to make useofthemincommunicatingaspectsofthe family planning programmes in yourcommunity. For more details,refer to your Health Education, Advocacy and Community Mobilisation Module. Summary of StudySession In Study Session2,you have learnedthat: 1 The family planning service includeseducationaland comprehensive medical or social activitieswhich enable individuals andcouples to determinefreelythe numberand spacing of theirchildren, andtoselect the meansbywhich this maybeachieved. Theystate theexpected results and/or theintended activitiesofeach service delivery component of theprogramme overa shorttimeperiod, such as aquarter,amonth, or aweek. Keepingrecordsand preparingand analysingreports areeffectivewaystodetermine clients? needsand usepatterns, without doing aformalprogramme evaluation. Mediaand traditionalforms of entertainmentcan be useful for transmittingthisinformation to thecommunity. Write your answersinyour Study Diaryand discuss them with your Tutoratthe next Study SupportMeeting. Inaddition, women of the kebele,onaverage,are estimated to have seven livebirthsintheir lifetime. Months of supply=500/50 =10 So,based on current stockinhand, theprovidercan safelyprovide Lo femenalpillsfor 10 more months before running out of stock. You can help them to choose acontraceptive method that is personally andmedically appropriate. Through your counselling sessions with them,you will make sure that they understand how to usetheir chosen method correctly,toensuresafeand effectivecontraceptiveprotection. In this study session, you will learnabout thegeneral concepts andprinciples of family planning counselling, thesteps forconducting family planning counselling, andthe factorsaffectingcounsellingoutcomes. Learning Outcomesfor StudySession When you have studied this session, youshouldbeableto: 3. In ordertoallowpeopletomakeaninformedchoice about family planning, you must make them awareofall theavailablemethods,and theadvantages and disadvantages of each. Theyshould know how to usethe chosen method safely andeffectively, as well as understanding possibleside-effects. Always remember that family planning counsellingisnot atype of lecture from you to thosewho have come to you forhelp. Youshouldshow respect to theclientwho hascometosee you, anddealwith theirproblems andconcerns about contraceptioninastraightforwardway. For example, theway you wouldapproach asessionwith agroup wouldbedifferent from theway you wouldworkwithanindividual. Themostcommonsettings in which family planning counsellingcan take place aredescribed below. Thisisparticularly commonwhentheyare thinking of usingirreversiblefamily planning measures, such as voluntary surgical methods. In this situation, aftergreetingeveryone in afriendly manner, you wouldexplaintothemthe bene? It is acost effectiveway of informationsharingand answeringgeneral questions,but Figure 3.

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G Past contraceptive use protects women after they reach menopause where reduced risk of low bone mineral density was documented G Reduction in acne Contraceptive Updates 2 Reference Manual for Doctors G Decreased incidence of rheumatoid arthritis Side effects G Nausea erectile dysfunction commercial bob purchase cheap super levitra, vomiting erectile dysfunction doctors in houston tx cheap super levitra 80mg without a prescription, decreased appetite; usually subsides after 2 to causes of erectile dysfunction young males generic super levitra 80mg mastercard 3 months of use G Breakthrough bleeding common with low dose progesterone pills due to low or absent estrogen. Common with women who had menstrual problems before starting oral contraceptive pills. There is an increase in the risk of myocardial infarction with the increasing number of cigarettes per day. In women having a history of high blood pressure, evaluation of cause and level of hypertension should be done as soon as possible. Among women with migraine, women who had aura had a higher risk of stroke than those without aura. Contraceptive Updates 2 Reference Manual for Doctors Chart 1: When to start combined oral contraceptives Phase Recommended Guidelines Having a menstrual cycle Within 5 days after the start of her menstrual bleeding. If it has been more than 5 days since menstrual bleeding started, she will need to abstain from sex or use additional contraceptive protection for the next 7 days. She can also start immediately or at any other time, if it reasonably certain that she is not pregnant. Running out of stock of pills is one of the major reasons for unintended pregnancy. G Plan for return visit G Invite the client to come back any time if she has any questions, problems or opts for another method Explaining how to use the pill 1. Show her what kind of pill packet you are giving her, whether 21 pills or 28 pills. Explain that if she forgets to take the reminder pills she is still protected from pregnancy. Show how to follow the direction or arrows on the packet for the rest of the pills, one each day (first hormonal pills and then reminder pills?). Give her instructions on how to start the first packet, then the next packet and what to do in case she misses a pill. Ask her to repeat the most important instructions and show how she will take the pill, using the pill packet. Give specific instructions Starting the first packet See chart 1 above for details on when to start. G If she starts beyond day 5 after the start of her menstrual bleeding, she may have irregular menstrual bleeding for a few days. G Taking the pill at the same (fixed) time of the day might help her to remember taking them. G Starting the 28-pill packets: When she finishes one packet, she should take the first pill from the next packet on the very next day. G 21-pill packets: After she takes the last pill from one packet, she should wait for 7 days and then take the first Contraceptive Updates 2 Reference Manual for Doctors pill from the next packet. G Mention common side-effects for instance, nausea, mild headaches, tender breasts, spotting between periods, irregular bleeding, moodiness etc. They usually become less or stop within 3 months after starting the combined oral contraceptives. Figure 4: What to do if you miss one or more pills Contraceptive Updates 3 Reference Manual for Doctors. Dealing with some common problems of combined oral contraceptives G Invite the client to come back if she has any problems in using the pill or has any complications. Let her know that she can switch to another contraceptive method any time she so wishes. Chart 2: Common problems and remedies Problems Remedies Common side-effects such as nausea, mild G Keep taking her pills. Skipping pills may make these side headaches, tender breasts, spotting effects worse and also increases the risk of pregnancy between periods, irregular bleeding, moodiness G For spotting or irregular bleeding, she can try taking each pill at the same time of day. G Reassure her that these are not signs of more serious problems, and they usually disappear. Vomiting (for any reasons) within 2 hours G She should take another active pill of taking an active (hormone) pill Severe diarrhoea and vomiting for more than G She should continue taking pills (if she can) despite her 24 hours discomfort G If severe vomiting or diarrhoea continues for 2 or more days, she should follow the procedure for missed pills G Describe the symptoms of problems that require medical attention.

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Considering the high levels of infant mortality erectile dysfunction treatment in kuala lumpur buy cheap super levitra 80mg online, especially in rural areas erectile dysfunction exercise video purchase super levitra 80 mg, a family of two seemed absurd erectile dysfunction pills super levitra 80mg on-line. No local staff members involved in the program, let alone foreign technical assistance personnel, appeared to have anticipated such opposition to their propaganda. Beginning in the early 1960s, a variety of research centers in India engaged in sys tematic attempts to measure family planning knowledge, attitudes, and practice. As part of its family planning efforts, the government supported a variety of demographic and communication action research projects coordinated by the Cen tral Family Planning Institute, a government-financed autonomous body. The Demo graphic Training and Research Center, established by the United Nations (later renamed as the International Institute for Population Studies) was a notable center for such research, as well as for training in demography (Narain 1968, p. Throughout the 1960s and 1970s, Indian social scientists at universities and free standing research institutes were reluctant, for the most part, to engage in research on family planning. Senior social scientists interviewed in 1971 reported that family planning operations were in the hands of physicians and that policy was set by senior civil servants, nei ther of which were particularly interested in contributions by social scientists. Ashok Mitra, head of the Planning Commission and himself a distinguished social scientist, ruefully noted that the bureaucracy viewed academics as troublemakers. For their part, academic social scientists avoided research on the national family planning pro gram, leaving it to those officially responsible for implementing family planning programs and employed by the Ministry of Health and Family Planning. Social Science Research Social science contributions to population issues were substantially enhanced by the formation of the Population Foundation of India (formerly known as Family Plan ning Foundation) was established in 1970 by a dedicated group of industrialists and population activists led J. The Population Foundation of India funded a number of high-quality social sci ence research studies directly relevant to the national family planning program, including an essay on the consequences of population growth by Ashok Mitra and an examination of family planning strategies by M. Renaming the Ministry of Health and Family Planning as the Ministry of Health and Family Welfare formalized this strategic transition (personal correspon dence with Ronald Ridker 2006). Neither of these two styles of colonialism were sufficiently respectful of the traditional culture that gov erned the lives of the majority of Indians, 80 percent of whom lived in rural villages. Nor were they willing to let Indians assume ownership of even their own initiatives. The Ford Foundation In the earliest days of the Indian family planning effort, the Ford Foundation took the lead in assisting, if not shaping, the emerging enterprise. Much of this can be attrib uted to the close association of their representative, Ensminger, with Prime Minister Nehru, who encouraged the foundation to take a leading role. While Freymann, King, Segal, Southam, and Wilder made significant contribu tions, as described earlier, many other technical assistance people whom Ensminger brought to India found themselves less useful. The collapse of the intensive family planning scheme in the late 1960s left foreign experts recruited to work in those dis tricts without Indian counterparts. Furthermore, the prominent role of foreign advisers in devising a variety of initiatives tended to discourage Indian ownership of some such projects. His toric monsoon failures in 1965?66 and 1967?68 raised fears of massive starvation in the following decade. In 1973, relations between the governments of India and the United States cooled, caused, among other things, by a perceived U. Prime Minister Indira Gandhi had embarked on a program of national self-reliance that affected the Ford Foundation as well. Das, secretary of the Ministry of Health and Family Planning, broke off arrangements with foundation-supported consultants to the ministry and refused to meet with foundation officials. Over the years, the United Nations Population Fund and the Danish, Japanese, and Norwegian assistance agencies donated smaller sums for a variety of family planning?related activities. The effect of all such investments was proportionate to the extent to which the donors understood the traditional values and cultural traits of the Indian population. Experimentation with a variety of approaches adapted to specific populations rarely occurred. Furthermore, hundreds of thousands of family planning workers were recruited without sufficient training or supervision. In rural areas, workers faced formidable obstacles in traveling to villages to which they were assigned.