Jordan Private Doctors Family Planning and Breast Cancer Survey, May 2008

As part of the Private Sector Project for Women’s Health (PSP) monitoring and evaluation, PSP conducted a survey in May 2008 to measure the following: 

1. Knowledge and behavior of physicians in FP/BC. 
2. Number of clients coming to doctors for FP or BC services. 

The results of the survey would enable PSP to: 

• Identify gaps in the knowledge and behavior of physicians in FP/BC, and find ways to improve it. 
• Identify women’s major concerns regarding the use of oral contraceptives according to doctors. 
• Identify reasons that make women stop using oral contraceptives according to doctors. 
• Identify what makes a woman ask about breast cancer, according to doctors. 
• Identify future messages for our communications for the change of behavior component of our communication activities. 

PSP-Jordan Evaluation Report

One of the main activities of the Private Sector Project (PSP) for Women’s Health is to address provider bias and negative attitudes and behaviors towards hormonal family planning (FP) methods and to increase knowledge of modern contraceptive methods among physicians providing family planning (FP) services to Jordanian women. To do this, PSP enacted an Evidence Based Medicine (EBM) in which PSP collaborated with Bayer Schering Pharma to organize seminars for 247 physicians to disseminate best research evidence on combined oral contraception (COC) methods through a Critically Appraised Topic (CAT) format. PSP then reinforced knowledge though individual visits to doctors, providing specific messages and materials on key COC topics.

PSP conducted an assessment of knowledge, attitudes, and practices of physicians participating in its 2009/2010 EBM program both before and after participation in the program.

The assessment found that the PSP-Jordan EBM program was an effective method for improving private sector provider knowledge, attitudes, and practices on FP. Following participation in the EBM program, participating physicians: 

• Improved reported FP discussion practices. 
• Improved reported COC pill prescription practices 
• Improved reported attitudes on the importance of patient preferences 
• Increased knowledge of COC pills. 

Based on assessment results, it is recommended that PSP: 

PSP-Jordan Outreach Mid-Term Evaluation

A major project activity, and the focus of this mid-term evaluation, is outreach to women in their homes by community health workers (CHWs) to generate and increase demand for reproductive health and family planning (RH/FP) services and to refer them to the appropriate service points.

Evaluation of Pilot Personal Data Assistance Devices Program for Community Outreach

One of the major activities of the Private Sector Project for Women’s Health (PSP) is to implement a home-based outreach program with hard to reach population groups, implemented by community health workers (CHW). 

Part III Training Needs Assessment for Jordan Medical Council

One objective of the Private Sector Project for Women’s Health (PSP) is to improve the quality of women’s health services delivered through the private sector. Toward that end, PSP commissioned a review of the status of Continuing Medical Education (CME) for physicians in Jordan. The complete report for the whole review of CME has three parts:

• Part I: Technical Report: Continuing Medical Education (CME), Role of Jordan Medical Council (JMC) and the Way Forward
• Part II: Legal Report: The Legislative Status of the Jordan Medical Council and Continuing Medical Education
• Part III: Jordan Medical Council Capacity Building Report: Organizational Structure, Job Descriptions, and Training Needs Assessment

This report addresses part III only, i.e., the Training Needs Assessment for Jordan Medical Council (JMC).

Organizational:

• Adopt the proposed organizational structure
• Adopt new job descriptions 
• Map the work flow and develop Standard Operating Procedures
• Develop an employee annual appraisal system
• Use individual development plans
• Develop the personnel division to become an HR dept.

Capacity:

• Develop a capacity building plan.
• Allocate money for capacity building.
• Integrate technology and encourage the use of computers.
• Conduct the following trainings:
  • Computer Training had the highest demand.
  • English Language ( Business )
  • Team building and team work, required to all managerial levels.
  • Personal Communication skills for employees and customers service.
  • Conflict management skills
  • Internal communication.
  • Management and leadership
  • Financial Analysis

Part II Technical Report: Legal Report The Legislative Status of the Jordan Medical Council and Continuing Medical Education

One objective of the Private Sector Project for Women’s Health (PSP) is to improve the quality of women’s health services delivered through the private sector. Toward that end, PSP commissioned a review of the status of Continuing Medical Education (CME) for physicians in Jordan. The complete report for the whole review of CME has three parts:

• Part I: Technical Report: Continuing Medical Education (CME), Role of Jordan Medical Council (JMC) and the Way Forward
• Part II: Legal Report: The Legislative Status of the Jordan Medical Council and Continuing Medical Education
• Part III: Jordan Medical Council Capacity Building Report: Organizational Structure, Job Descriptions, and Training Needs Assessment

This report addresses part II only, i.e., the Legal Report: The Legislative Status of the Jordan Medical Council (JMC) and Continuing Medical Education (CME).

Below are the main recommendations:

• Make CME in Jordan mandatory and develop a clear mechanism for this mandate.
• State clear authorities for JMC.
• Abolish the specialized committee and re-instate the role of the national committee.
• Adopt the proposed amended law or the articles and provisions that directly bestow the mandatory nature of fulfilling CME and its role in re-licensing for all physicians.
• No amendment to the Law of Public Health is required.
• Follow the expedited route by enacting the proposed amended law during the vacation of parliament to develop a temporary law.
• Issue by laws and instructions based on the new proposed amended law of JMC that are at par with international by-laws and instructions.

Part I Technical Report: Continuing Medical Education (CME) Role of Jordan Medical Council

One objective of the Private Sector Project for Women’s Health (PSP) is to improve the quality of women’s health services delivered through the private sector. Toward that end, PSP commissioned a review of the status of Continuing Medical Education (CME) for physicians in Jordan. The complete report for the whole review of CME has three parts:

• Part I: Technical Report: Continuing Medical Education (CME), Role of Jordan Medical Council (JMC) and the Way Forward
• Part II: Legal Report: The Legislative Status of the Jordan Medical Council and Continuing Medical Education
• Part III: Jordan Medical Council Capacity Building Report: Organizational Structure, Job Descriptions, and Training Needs Assessment

This report addresses part I only, i.e., the Technical Report: Continuing Medical Education, Role of Jordan Medical Council and the Way Forward.

The review and analysis found that the JMC does not meet expectations when benchmarked against the regional and international CME standards. Specifically, the review found the following:

• The JMC does not provide CME activities.
• CME is not necessary for re-licensing.
• The CME credit system is non-specific.
• Guidelines are rudimentary and subjective.
• There is no provider accreditation.
• Collaboration among the private sector is not prominent.
• CME is does not follow unified plans or standards.
• The JMC is both provider of CME and an accreditation body.

A number of recommendations are critical for advancement of CME:

• Make CME legally mandatory for relicensing.
• Relinquish the provider role from the JMC mandate.
• Review regulations and guidelines to meet international best practices.
• Change the organizational structure.

Jordan Association for Family Planning and Protection: Needs Assessment

The objectives of the JAFPP assessment were to develop recommendations to maintain and improve service quality; expand family planning/reproductive health services and clientele; increase access to quality reproductive health services; and improve JAFPP’s financial stability and cost efficiency.

The most important challenges to enhance JAFPP service delivery include:

• Governance issues that result in too many management/administrative roles and responsibilities resting at board level
• Demand for a narrow range of services is flat even though excess capacity is available
• Access limited by a lower number of fixed clinics and limited clinic hours
• Quality of care and ability to expand access is threatened by low staff morale
• Growing financial gap where current costs are exceeding current revenues

The report includes recommendations for addressing these challenges.

Rapid Market Assessment in Jordan

Through this rapid assessment, the PSP-One project sought to analyze business conditions and the strategies and practices of the pharmaceutical industry in Jordan. The assessment focused on the private sector, particularly the market potential for generic contraceptive products whose presence on a market can contribute to significantly reducing contraceptive prices. Another area of focus was the willingness of private sector supppliers to increase the range of products available in Jordan and participate in market-building efforts.

Jordan’s high entry barriers and price control limit access to both product innovation and low-cost generic contraceptives. Multinational companies selling contraceptives in Jordan cite high marketing costs and low price ceilings as disincentives for introducing new brands or investing in this market. Asian generic producers are subject to cumbersome and costly procedures that limit their presence in Jordan. Local manufacturers reportedly have no interest in producing contraceptives because their export potential is extremely limited. As a result, generic products are relatively absent from the Jordanian market, which contributes to keeping drug prices high across most therapeutic areas.

Assessment of the Role of Private Pharmacies in Provision of Family Planning Information and Services in Jordan

The purpose of the study was to evaluate knowledge, attitudes and practices of attending pharmacy staff towards family planning after elapse of 4 years on a previous program aimed at enhancing knowledge and skills of pharmacy staff in the area of family planning.

The study concluded that:

• Pharmacy Staff are willing to provide family planning products to “walk-ins” requesting them over-the-counter, but little counseling and probing accompanies this interaction and personal convictions and beliefs of pharmacy staff sometimes affect the final sale of oral contraceptives or family planning products in general
• There are significant gaps in knowledge of pharmacy staff in the area of family planning products and their optimal use suggesting the previous training in this field did not have a carry-on effect
• The pharmacy still plays no significant role in the decision to adopt a contraceptive method or to continue to use it

In view of these findings, the starting point for adoption of family planning products will always be the physician. But, the role of the pharmacist remains significant if not crucial in maintaining proper use as oral contraceptives are classified as a repeat prescription product and actual practice confirms this where more than two-thirds of oral contraceptive business is repeat. To this end, dissipating some prevailing misconceptions and myths amongst pharmacy staff (and clients) regarding use of oral contraceptives is crucial to increase user retention rates and maintanence of propor oral contraceptive use. Furthermore, provision of information to both clients and pharmacy staff on the “extra” benefits of OCs to women’s health is needed alongside of correction of misconceptions.