Lubis F, Fajans P, Simmons R
Yayasan Kusuma Buana, Jakarta, Indonesia.
Contraception. 1994 May;49(5):527-41. doi: 10.1016/0010-7824(94)90008-6.
This paper discusses the technical dimensions of "quality of care" in contraceptive service delivery in both the Cyclofem Introductory Trial, as well as in routine service delivery of other injectables in Indonesia. Although the quality of care in the Cyclofem trial was generally acceptable, substantial weaknesses in screening, clinical technique, the management of side-effects, and knowledge concerning re-injection time frames were identified in the provision of injectable contraceptives in routine service delivery. The findings suggest that in order for Cyclofem and other injectables to be delivered in the routine program with an adequate standard of care, considerable managerial adaptation and strengthening of providers' technical capabilities would be necessary prior to actual introduction. This would include providing training and updated technical guidelines concerning both Cyclofem and other contraceptives to providers, with an emphasis on technical issues including contraceptive indications and contraindications, re-injection time frames, maintenance of asepsis and the management of side-effects. Strengthening the existing management information system and logistics systems to facilitate differentiation between injectable contraceptives provided by the program so as to ensure sufficient supplies of both contraceptives and associated materials such as needles and syringes will also be necessary.
本文讨论了在Cyclofem引入试验以及印度尼西亚其他注射用避孕药具常规服务提供过程中，避孕服务提供方面“护理质量”的技术维度。尽管Cyclofem试验中的护理质量总体上可以接受，但在常规服务提供中注射用避孕药具的供应方面，筛查、临床技术、副作用管理以及关于再次注射时间框架的知识存在重大缺陷。研究结果表明，为了使Cyclofem和其他注射用避孕药具在常规项目中以适当的护理标准提供，在实际引入之前，需要进行大量的管理调整并加强提供者的技术能力。这将包括向提供者提供有关Cyclofem和其他避孕药具的培训及更新的技术指南，重点是技术问题，包括避孕适应症和禁忌症、再次注射时间框架、无菌操作的维持以及副作用的管理。加强现有的管理信息系统和物流系统，以便区分项目提供的注射用避孕药具，从而确保避孕药具和相关材料（如针头和注射器）有足够的供应，这也是必要的。
