Table 4 Facilitating factors and barriers to the implementation of thermal cautery in Asia

Technical aspects

Easiness to learn and to master thermal cautery

Need to modify FI technique when using cautery

Thermal cautery may be used alone with probably better efficacy than simple LE

Cautery alone is faster to perform than any technique combined with FI

Human resources

Interest in learning a new technique

Belief that current techniques are effective

Interest in improving efficacy and decreasing complications

Changing current behavior

Training

Training infrastructures already in place in South Asia

Need to retrain existing vasectomy providers

Need to train support staff (cautery device use and maintenance)

Supplies

"Low tech" supplies

Cost of new supplies (including batteries)

Most supplies already in place

Thermal cautery devices not currently available

Positive pilot field assessment of feasibility of processing and maintaining cautery devices

Processing and maintaining new material

AA alkaline batteries readily available

Policy and program

Program supporting sterilization (South Asia)

No program supporting sterilization (Thailand)

Cautery included in some national standards of practice

Cautery not included in most national standards of practice

Evaluation

Some infrastructure in place to conduct operational research

Low rates of follow-up and compliance to SA