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  1. 1

    Understanding programme costs as a pre-requisite for cost effectiveness.

    Bouzidi M; Ashford LS

    In: Family planning. Meeting challenges: promoting choices. The proceedings of the IPPF Family Planning Congress, New Delhi, October 1992, edited by Pramilla Senanayake and Ronald L. Kleinman. Carnforth, England, Parthenon Publishing Group, 1993. 163-71.

    The costs of family planning programs was discussed by the International Planned Parenthood Federation in 1991-92 highlighting demand and resources. They proposed a strategy to review methodologies used by the World Bank, USAID, and UNFPA; and to develop cost analysis methodologies. Expenditures in 25 family planning associations (FPAs) worldwide were also reviewed in this presentation. The results showed that worldwide the average IPPF commodity grant represented only 5.7% of all grants and income. Most FPAs had personnel costs that were 30-50% of total expenditure, although Korea and Malaysia had personnel costs of about 60%. Lebanon, Indonesia, Nepal, Sri Lanka, and Mexico had lower personnel costs because they relied heavily on volunteer labor. The variation in average cost per couple year of protection (CYP) could be explained by the differences in programs in terms of clinic and nonclinic service delivery; information, education, and communication (IEC), and other development projects. Therefore, FPA expenditures by type consisted of these categories. The IEC category included males, youth, and women-in-development projects. Tanzania reported very low cost per CYP (less than $5), but a very high cost per visit (more than $14) because a large proportion of its commodities were distributed through non-FPA channels. In contrast, Madagascar had a lower clinic service delivery cost ($1.29), compared with a cost per CYP of $18 because it distributed all the contraceptives through clinics. The cost per CYP was high in Liberia (about $32), followed by Kenya (about $20), Madagascar (about $19), Ethiopia (about $16), and Tanzania (about $4). Most of these CYP costs were derived from grants. In the future FPA might investigate some other issues: the measurement of demand and need, the projecting of future costs, and the role of FPAs in filling the gap between public expenditures and community needs.
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  2. 2

    The use of service statistics in PROFAMILIA.

    Ojeda G

    [Unpublished] 1993. Presented at the Expert Meeting on Information Systems and Measurement for Assessing Program Effects, Washington, D.C., September 9-10, 1993. Sponsored by National Academy of Sciences Committee on Population. [4] p.

    Profamilia has been affiliated with the International Planned Parenthood Federation since 1967, and it objectives are to promote family planning (FP) in Colombia with information and services. 70% of couples using modern methods obtained them from Profamilia. 69% of Colombian women of reproductive age are current users of FP. There are 47 Profamilia clinics, 8 of which offer FP only to men. Surgical contraception was offered to men starting since then. The 1990 Demographic and Health Survey indicated that female sterilization led the way in FP methods, followed by oral contraceptives and the IUD. About 80% of new acceptors choose sterilization and the IUD, and they have become progressively younger. In 1970 Profamilia started community-based distribution of OCs and condoms and inaugurated social marketing in 1974. OCs and condoms donated by foreign agencies are sold in pharmacies at low prices. The Evaluation and Research Department comprises the Service Statistics, Evaluation, and Research Sections. Monthly reports are produced on FP services provided, based on total number of new acceptors per clinic and per method, total number of follow-ups, sociodemographic characteristics of new acceptors, number of male and female sterilizations, number of couple years of protection per program and per clinic, educational activities, finances, and supplies used. Service statistics are used for client care, program operation, administrative monitoring, measurement of program activity, supervision, evaluation, and research. Volume indicators measure services rendered and the number of clients served; coverage indicators measure the extent of services provided to various groups; quality indicators include measures of comprehensiveness, timeliness, continuity, and satisfaction; effectiveness indicators measure the achievement of objectives; and efficiency indicators relate to inputs such as cost and facilities.
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  3. 3

    Second International Congress, IFFLP.

    Flynn A

    International Review of Natural Family Planning. 1981 Spring; 5(1):83-90.

    The second International Congress of the International Federation of Family Life Promotion (IFFLP) held in Ireland in September 24 to October 1, 1980 was conducted to provide a forum for issues relating to natural family planning (NFP). The Congress was divided into 3 components: 1) scientific status, program development, and NFP programs in their cultural contexts; 2) the IFFLP general assembly; and 3) trainer's workshop. 2 NFP effectiveness studies (Los Angeles study and Colombia study) both comparing the ovulation method and the sympto-thermal method were discussed in terms of recruitment, training, dropouts, and conclusions. Recruitment in both studies was very low (2-3% of population in the Los Angeles study, and less for the Colombia study), raising questions relating to the measure of acceptability of natural methods in the population concerned and the nature of the constraints of the study. Dropout rate reached an alarming 70% at the end of a year in both studies, raising the questions of the validity of the life-table analysis presented. The Pearl Index values for both studies were very high: for the LA study, 18.5/100 woman-years for the sympto-thermal method and 32/100 woman-years for the ovulation method; for the Colombia study, 33/100 for the sympto-thermal method and 35/100 for the ovulation method. The following were deemed as important scientific advances in NFP: 1) clarification of the concept of "basic infertile" pattern of preovulatory mucus (unchanged pattern day after day means continuing infertility); 2) use of cervical mucus as one of the most important indices in infertile/subfertile patients and also during lactation and premenopause; and 3) development of methods for measuring levels of estrone-3-glucuronide and pregnanediol-3-alpha-glucuronide to predict start and end of fertile phase. A paper presented on the use of the Billings Ovulation Method by 82 postpartum women followed up for an average of 16 months showed that only 4 unplanned pregnancies occurred (2 method and 2 user failures), and 97.8% of the women learned to recognize their postpartum mucus pattern. The Pearl Index was 7.3/100 woman-years and overall method failure rate was 3.6. Other topics discussed were NFP program services and developments in NFP by zonal groups.
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