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Applying lessons learned from the USAID family planning graduation experience to the GAVI graduation process.
Health Policy and Planning. 2015 Jul; 30(6):687-95.As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds $1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success. Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.
The USAID population program in Ecuador: a graduation report. [El Programa de USAID para la población de Ecuador aprueba su examen final. Informe]
Washington, D.C., LTG Associates, Population Technical Assistance Project [POPTECH], 2001 Oct.  p. (POPTECH Publication No. 2001–031–006; USAID Contract No. HRN–C–00–00–00007–00)For nearly 30 years, the United States Agency for International Development (USAID) provided assistance for population, family planning, and reproductive health programs in Ecuador. Throughout the early years, USAID worked with both private and public sector institutions to establish a broad base for national awareness of and support for family planning and for the introduction of contraceptive services. USAID led all other donors in this sector in terms of financial, technical, and contraceptive commodity assistance. Upon reflection of the accomplishments of the USAID population program during these years and considering its most recent Strategic Objective of “increased use of sustainable family planning and maternal child health services,” it is apparent that the Agency was successful in this endeavor and has adequately provided for the graduation of its local partners, particularly those in the private sector, where USAID had directed the major focus of its assistance over the past decade. During the last and final phase of assistance, 1992–2001, the USAID strategy focused primarily on assuring the financial and institutional sustainability of the two largest local nongovernmental organizations (NGOs) that provide family planning services. USAID/Ecuador worked in partnership with the Asociación Pro-bienestar de la Familia Ecuatoriana (APROFE), which is the Ecuadorian affiliate of the International Planned Parenthood Federation (IPPF), and the Centro Médico de Orientación y Planificación Familiar (CEMOPLAF)—institutions that provide contraceptive and other reproductive health services. At the same time, in order to assure that the necessary tools were in place for future program monitoring, planning, and evaluation, USAID assistance was provided to the Centro de Estudios de Población y Desarrollo Social (CEPAR). (excerpt)
Population and Development Review. 2002 Dec; 28(4):707-733.We begin by briefly describing the shift in population policies. We then set out two theoretical frameworks expected to account for national reactions to the new policy: first, the spontaneous spread of new cultural items and the coalescence of a normative consensus about their value, and second, the directed diffusion of cultural items by powerful Western donors. We then describe our data and evaluate its quality. Subsequently, we analyze the responses of national elites in our five study countries to the Cairo agenda in terms of discourse and implementation. In our conclusion, we evaluate these responses in terms of the validity of the two theoretical frameworks. (excerpt)
Population assistance and family planning programs: issues for Congress. Updated February 13, 2003. Programas de asistencia a la población y de planificación familiar: temas para el Congreso. Actualización al 13 de febrero de 2003.
Washington, D.C., Library of Congress, Congressional Research Service, 2003 Feb 13.  p. (Issue Brief for Congress)Since 1965, United States policy has supported international population planning based on principles of voluntarism and informed choice that gives participants access to information on all methods of birth control. This policy, however, has generated contentious debate for over two decades, resulting in frequent clarification and modification of U.S. international family planning programs. In the mid-1980s, U.S. population aid policy became especially controversial when the Reagan Administration introduced restrictions. Critics viewed this policy as a major and unwise departure from U.S. population efforts of the previous 20 years. The “Mexico City policy” further denied U.S. funds to foreign non-governmental organizations (NGOs) that perform or promote abortion as a method of family planning, regardless of whether the source of money was the U.S. government Presidents Reagan and Bush also banned grants to the U.N. Population Fund (UNFPA) because of its program in China, where coercion has been used. During the Bush Administration, a slight majority in Congress favored funding UNFPA and overturning the Mexico City policy but failed to alter policy because of presidential vetoes or the threat of a veto. President Clinton repealed Mexico City policy restrictions and resumed UNFPA funding, but these decisions were frequently challenged by some Members of Congress. On January 22, 2001, President Bush revoked the Clinton Administration population policy position and restored in full the terms of the Mexico City restrictions that were in effect on January 19, 1993. Foreign NGOs and international organizations, as a condition for receipt of U.S. funds, now must agree not to perform or actively promote abortions as a method of family planning in other countries. Subsequently, in January 2002, the White House placed a hold on the transfer of $34 million appropriated by Congress for UNFPA and launched a review of the organization’s program in China. Following the visit by a State Department assessment team in May, Secretary of State Powell announced on July 22 that UNFPA was in violation of the “Kemp-Kasten” amendment that bans U.S. assistance to organizations that support or participate in the management of coercive family planning programs. For FY2003, the President proposes no UNFPA funding, although there is a “reserve” of $25 million that could be used if the White House determines that UNFPA is eligible for U.S. support in FY2003. The Administration further requests $425 million for bilateral family planning programs, a reduction from the $446.5 million provided in FY2002. H.J.Res. 2, as passed by the Senate on January 23, 2003, includes the FY2003 Foreign Operations Appropriations. It provides $435 million for bilateral family planning aid and $35 million for UNFPA. Last year, the Senate Appropriations Committee (S. 2779) had recommended $450 million for bilateral activities and $50 million for UNFPA. The Senate bill further would have modified the Kemp-Kasten amendment and partially reversed the President’s Mexico City policy for some organizations. The House bill (H.R. 5410) last year provided $425 million for family planning and $25 million for UNFPA, but made no modifications to Kemp-Kasten or to the Mexico City policy. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 1994. x, 122 p. (Technical Report No. 17)In 1989, the UN Population Fund (UNFPA) began its "Global Initiative" to estimate "Contraceptive Requirements and Logistics Management Needs" throughout the developing world in the 1990s. After the initial study was completed, 12 countries were chosen for the preparation of more detailed estimates with information on program needs for logistics management of contraceptive commodities, options for local production, the involvement of nongovernmental organizations (NGOs) and the private sector in the supply of contraceptives, condom requirements for sexually transmitted disease (STD)/HIV/AIDS prevention, and financing issues. The fact-finding mission to the Philippines took place in 1993. In the introductory chapter of this technical report, the Global Initiative is described and the Philippine Population Program is presented in terms of the demographic picture, the population policy framework, the Philippine Family Planning (FP) Program, STD/AIDS control and prevention efforts, and an overview of donor assistance from 1) the UNFPA, 2) USAID, 3) the World Bank, 4) the Asian Development Bank, 5) the Australian International Development Assistance Bureau, 6) the Canadian International Development Agency, 7) the Commission of the European Community, 8) the International Planned Parenthood Federation, 9) the Japanese International Cooperation Agency, and 10) the Netherlands. The second chapter presents contraceptive requirements including longterm forecasting methodology, projected longterm commodity requirements, condom requirements for STD/AIDS prevention, total commodity requirements for 1993-2002, short-term procurement projections, and projections and calculations of unmet need. Chapter 3 covers logistics management for 1) the public sector, 2) condoms for STD/AIDS preventions, 3) NGOs, and 4) the commercial sector. The fourth chapter is devoted to a consideration of private practitioners and a detailed look at the ways that NGOs relate to FP groups. This chapter also covers the work of NGOs in STD/AIDS prevention and coordination and collaboration among NGOs. Chapter 5 is devoted to the private commercial sector and includes information on social marketing, the commercial sector, and duties and taxes. The issues addressed in chapter 6 are contraceptive manufacturing and quality assurance, including the potential for the local manufacture of OCs, condoms, IUDs, injectables, and implants. The national AIDS prevention and control program, the forecasting of condom requirements for STD/AIDS prevention, and policy and managerial issues are considered in chapter 7. The last chapter provides a financial analysis of the sources and uses of funds for contraceptives including donated commodities, the private commercial sector, cost recovery issues, and regulations and policies, such as taxes and duties on donated contraceptives, which affect commodities. 5 appendices provide additional information on contraceptive requirements, logistics management and costs, the private commercial sector, condoms for STD/AIDS prevention, and a financial analysis. Information provided by the texts and appendices is presented in tables and charts throughout the report.
Final report of an operations research project: "A Study to Increase the Availability and Price of Oral Contraceptives in Three Program Settings", Contract CI90.59A.
[Unpublished] 1991 Oct 10. , 32,  p. (PER-19; USAID Contract No. DPE-3030-Z-00-9019-00)In an effort to reach more clients while increasing self-sufficiency, a group of private and public agencies in Peru collaborated in 2 operations research (OR) studies. This OR project, which cost US $62,040, was affected by the action of the newly elected government which ended price controls and subsidies in August 1990 and resulted in changes in the spending habits of most Peruvian families. Sales of all oral contraceptives (OCs) fell from an average of 141,400 to 73,400 cycles/month, and sales of Microgynon in pharmacies fell from 76,400 to 38,000 cycles/month. The first OR study tested the use of community-based distributors (CBDs), Ministry of Health (MOH) facilities, and private midwives as contraceptive social marketing (CSM) outlets by adding the OC Microgynon (sold at pharmacy prices) to CBD programs and raising the price of the donated OC, Lo-Femenal, over time. Specific objectives were to determine 1) if total CBD sales increased with the method mix, 2) whether CBD from homes of small businesses was more effective, 3) if the new distribution of Microgynon would increase sales of the OC as a whole, and 4) the impact of Lo-Feminal price increases on sales and user characteristics. The study was carried out in 44 experimental and 44 control groups in Lima and 20 experimental and 21 control groups in Ica. Baseline data were obtained for December 1989-April 1990, and monthly sales were monitored during the 12 months from May 1990 to April 1991. Data were also obtained from surveys of dropouts and new Microgynon acceptors. It was found that the August 1990 price increase effectively destroyed the significant market penetration exhibited by Microgynon in the first 4 months of the study. Adding an affordable CSM brand to CBD programs will, however, increase sales and self-sufficiency, although the sale of donated OCs for around $0.30/cycle will reduce sales of the new brand by 20-40%. It was also found that most clients who dropped out because of side effects were less likely to be contracepting than those who dropped out because of cost, indicating a need for improved distributor counseling. The second study tested the price elasticity of demand for OCs in CBD programs by measuring the demand for Microgynon. Specific objectives were to determine 1) the level of Microgynon sales in MOH facilities, 2) the level of sales by nurse-midwives, 3) the number of Microgynon users who formerly used Lo-femenal from the MOH, and 4) the number of Microgynon users in MOH and nurse-midwife facilities who formerly obtained the OC from pharmacies. A demonstration project was carried out in the rural departments of Ayacucho and Huancavelica, the poorest areas of Peru. 4 MOH hospitals in 4 cities and 17 nurse-midwives participated. The hope was that the CSM products would mitigate the effect of stock-outs in the hospitals. It was found that no Microgynon was sold because of a reluctance to recommend it and other unfavorable study conditions (the necessity for separate accounting, the lack of stock-outs, the reluctance of the midwives to sell a contraceptive, and the decline in client purchasing power). Cost recovery in the MOH would be better served by charging a modest amount for donated contraceptives.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (PHI-01)In 1975, a USAID-Commission on Population (POPCOM) planning team reported that the key problem facing the National Family Planning (FP) Program in the Philippines was extending the program beyond its existing network of municipal-based clinics to the surrounding barrios. At that time, the number of new FP acceptors was declining, and there was a shift to less effective methods among current users. Because most clinics were urban-based, rural acceptors could not easily access FP services. The report recommended that supply depots be established in barrios and that motivators be used to distribute contraceptives and hygiene information and materials. An operations research project, which cost US $77,313, was developed to test the feasibility and cost-effectiveness of delivering FP/hygiene materials directly to households in rural areas. The Barrio Supply Point (BSP) operators were to visit and make available to every household free FP and hygiene materials. After the initial visit, BSP operators were to continue to serve as resupply agents. Although contraceptives were resupplied free, a nominal charge was required for hygiene materials. A quasi-experimental study design was employed. Pilot tests were conducted to determine what materials might be effectively distributed in addition to contraceptives. Project support was terminated in December 1978, before the project was fully implemented, because of the evolution of a national outreach program. Results of the pilot test showed that over 90% of households offered free condoms and oral contraceptives, or free contraceptives and bars of soap, accepted them. No data on use of these items were collected.
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (EGY-01)Egypt's family planning (FP) program, active since 1966, has been facilitated by the country's population density, flat terrain, and extensive health infrastructure. Nevertheless, by the early 1970s, a substantial proportion of couples were still not using contraception because of minimal clinic outreach; high dropout rates for oral contraceptive (OC) users; lack of knowledge about side effects among clinic staff and clients; disruptions in clinical supplies; and unavailability of other methods, such as the IUD, especially in rural areas. In 1971, USAID supported the American University in Cairo's (AUC) FP research activities in rural Egypt, in which household fertility survey data, a follow-up of women attending FP clinics, the cultural context of FP, communication and education, and the implementation of services were studied. In 1974, AUC initiated a demonstration project (which cost US $224,000) of a low-cost way to provide FP services to all married women in a treatment population through a household contraceptive distribution system. The interventions were implemented in the Shanawan (rural) and Sayeda Zeinab (city of Cairo) communities of Menoufia Governorate. During an initial canvas in November 1974, married women 15-49 years of age, who were living with their husbands and were not pregnant or less than 3 months postpartum and breast feeding, were offered 4 cycles of OCs or a supply of condoms. During a second canvas in February 1975, acceptors were provided with an additional 4 cycles of OCs and referred to a local depot for resupply. Each distribution area was mapped, and each housing unit numbered. Data collected through canvassing consisted primarily of eligibility screening items and provided numbers of acceptors, refusals, ineligibles, not at homes, etc. To increase coverage, 2 attempts were made to reach women not at home. Of the 2,493 women canvassed in Sayeda Zeinab, 1713 (69%) were eligible to receive contraceptives. Of these, 58% accepted 4 to 6 cycles of OCs. At the time of initial household distribution, 45% of eligible women were already using OCs. As a result of the canvass, an additional 5% of the women became acceptors. The AUC did not expand the household distribution of contraceptives to other urban areas of Cairo, because women there evidently already had adequate access to FP information and supplies. In the 6,915 households canvassed in Shanawan, 1156 of the 1820 women (64%) were eligible to receive contraceptives. Of these, 45% accepted 4 to 6 cycles of OCs. 21% of eligible women were already using OCs at the time of initial household distribution. Although condoms were offered, few were accepted, apparently because it was not culturally acceptable for women to either distribute or accept condoms. One year after the initial household distribution, contraceptive use among married women of reproductive age had increased 69% from 18.4 to 31% among all age and parity groups and at all educational and occupational levels, and the incidence of pregnancy declined from 19.3 to 14.9%.
Science and Technology for Development: Prospects Entering the Twenty-First Century. A symposium in commemoration of the twenty-fifth anniversary of the U.S. Agency for International Development, Washington, D.C., June 22-23, 1987.
Washington, D.C., National Academy Press, 1988. 79 p.This Symposium described and assessed the contributions of science and technology in development of less developed countries (LDCs), and focused on what science and technology can contribute in the future. Development experts have learned in the last 3 decades that transfer of available technology to LDCs alone does not bring about development. Social scientists have introduced the concepts of local participation and the need to adjust to local socioeconomic conditions. These concepts and the development of methodologies and processes that guide development agencies to prepare effective strategies for achieving goals have all improved project success rates. Agricultural scientists have contributed to the development of higher yielding, hardier food crops, especially rice, maize, and wheat. Health scientists have reduced infant and child mortalities and have increased life expectancy for those living in the LDCs. 1 significant contribution was the successful global effort to eradicate smallpox from the earth. Population experts and biological scientists have increased the range of contraceptives and the modes for delivering family planning services, both of which have contributed to the reduction of fertility rates in some LDCs. Communication experts have taken advantage of the telecommunications and information technologies to make available important information concerning health, agriculture, and education. For example, crop simulation models based on changes in temperature, humidity, precipitation, wind, solar radiation, and soil conditions have predicted outcomes of various agricultural systems. An integration of all of the above disciplines are necessary to bring about development in the LDCs.
St. John's, Antigua, CFPA, 1987. 39 p.In the 1920s 1/3 of the children in the Caribbean area died before age 5, and life expectancy was 35 years; today life expectancy is 70 years. In the early 1960s only 50,000 women used birth control; in the mid-1980s 500,000 do, but this is still only 1/2 of all reproductive age women. During 1987 the governments of St. Lucia, Dominica and Grenada adopted formal population policies; and the Caribbean Family Planning Affiliation (CFPA) called for the introduction of sex education in all Caribbean schools for the specific purpose of reducing the high teenage pregnancy rate of 120/1000. CFPA received funds from the US Agency for International Development and the United Nations Fund for Population Activities to assist in its annual multimedia IEC campaigns directed particularly at teenagers and young adults. CFPA worked with other nongovernmental organizations to conduct seminars on population and development and family life education in schools. In 1986-87 CFPA held a short story contest to heighten teenage awareness of family planning. The CFPA and its member countries observed the 3rd Annual Family Planning Day on November 21, 1987; and Stichting Lobi, the Family Planning Association of Suriname celebrated its 20th anniversary on February 29, 1988. CFPA affiliate countries made strides in 1987 in areas of sex education, including AIDS education, teenage pregnancy prevention, and outreach programs. The CFPA Annual Report concludes with financial statements, a list of member associations, and the names of CFPA officers.
Status of family planning activities and involvement of international agencies in the Caribbean region [chart].
[Unpublished] 1970. 1 p.Add to my documents.
[Unpublished] 1981 Aug 28. 222 p. (AID/LAC/P-085)The background, goals, projected activities and beneficiaries, financial requirements, and implementation plans for a Family Planning Outreach Project in Haiti are detailed. The project is intended to assist the Government of Haiti to establish a cost-effective national family planning program. Population growth continues to accelerate in Haiti, despite high infant and child mortality, significant emigration, and declining fertility. The government does not have an articulated population policy. Although family planning and maternal and child health services have been in existence since 1971, there is no effective access to these services. This project is viewed as a means of achieving a substantial and sustained reduction in family size and improving health status. It is also a means of strengthening the Haitian family so it can participate more directly in the national development process. The purpose of the project will be accomplished through the following activities: 1) improvement of the organization and management of the national family planning program; 2) improvement of the quality and quantity of maternal and child health and family planning services; 3) expansion of the participation of private and voluntary organizations, other governmental, and local community groups in service provision; 4) increase in the availability of contraceptives at reasonable prices through rural and urban commercial channels; and 5) formulation of appropriate population and family planning policies. By the end of the project, all government health facilities and 75% of private facilities will actively counsel and provide family planning services; integrated models of community health and family planning services will have been developed to serve 60% of the population; basic drugs and contraceptives will be available at reasonable subsidized prices throughout the country; and 25% of women ages 15-45 at risk of pregnancy will be continuing users of effective contraceptive methods. The project will be implemented by the existing infrastructure of private and public organizations, primarily by the Department of Public Health and Population and its Division of Family Hygiene. The US Agency for International Development (USAID) is providing US$9.615 million (54%) toward the estimated US$17.980 million cost of the 5-year project. An additional US$6.555 million (36%) will be provided by the Government of Haiti.
Guidelines require comprehensive steps. Effective use of national family planning guidelines includes dissemination and regular updating.
Network. 1998 Fall; 19(1):6 p..Nearly 50 developing countries have begun developing new or revised national guidelines on family planning (FP) services. This is a collaborative process, involving providers, government officials, technical experts, and others. In developing guidelines for contraception, many national health officials have relied on recommendations developed by the WHO and US Agency for International Development. These recommendations are designed to make services more accessible, more uniform, and of higher quality. Studies also indicate that guidelines affect provider practices. However, effective use of FP guidelines includes dissemination and regular updating. It is noted that significant improvement in the process of care has been found after the introduction of guidelines. Nevertheless, successful introduction of clinical guidelines is dependent on many factors, including the methods of developing, disseminating and implementing these guidelines. Despite the challenges faced in the effective use of national FP guidelines, progress has been made in standardizing national policies that have the potential to improve access and quality.
Washington, D.C., USAID, 2000 Apr. 12 p.This paper documents the US global leadership in family planning in response to the challenge of saving women’s lives and protecting women’s health. Backed by a strong bipartisan consensus in Congress, the US support for voluntary family planning and related health programs in developing countries began in the 1960s. Since then, profound changes have occurred in reproductive behavior throughout most of the world. The other programs include enabling couples to make reproductive choices and enhancing quality of life and development. In addition, the US government provides family planning assistance to developing countries through the Agency for International Development, and the UN Population Fund. These partnerships seek to: provide comprehensive assistance; integrate family planning and other reproductive health services; expand access to services through partnerships with nongovernmental organizations; focus on quality care and the battle against HIV/AIDS; save women's lives by replacing abortion with contraception; and empower women through integrated approaches. Despite the above initiatives, special efforts are needed to expand access to those needing the family planning services in both public and private sectors.
Quality of care in family planning service delivery. A survey of cooperating agencies of the Family Planning Services Division, Office of Population, U.S. Agency for International Development.
[Unpublished] 1992 Apr. v, 39,  p.The purpose of this report was to provide information to the Family Planning Services Division of the Office of Population, Agency for International Development on approaches to the quality of care of eight of its cooperating agencies (CAs); namely, Association for Voluntary Surgical Contraception, Cooperative Assistance Relief Everywhere, Center for Development and Population Activities, Enterprise, International Planned Parenthood Federation/Western Hemisphere Region, Pathfinder, Family Planning Services Expansion and Technical Support project, and Social Marketing for Change project. The report addresses questions on the following areas: CA definition of quality of care, approaches to assessing quality, success stories, constraints to quality of care, future activities, and their recommendations regarding quality of care. The overall approaches of quality assurance fall into four categories: grass roots, medical/management monitoring, information and training, and method/stage of program approach. The approaches to assessing quality of care that are developed by each CA are often complementary. Some of the major constraints to quality of care include lack of understanding of client-oriented services, provider bias, and restrictive government policies. Estimated resources devoted for quality of care was between 5 and 30%. In terms of the future of the quality of care, all CAs would like to increase levels and approaches, and try new approaches and activities in the area of quality of care.
Sustainability of the FP-MCH program of NGOs in Bangladesh. Future Search Workshop, July 15-18, 1995, Centre for Development Management, Rajendrapur, Bangladesh.
Dhaka, Bangladesh, Pathfinder International, 1995. , 38, 51 p. (USAID Cooperative Agreement No. 388-0071-A-00-7082-10)This report summarizes the activities of a workshop held July 15-18, 1995, in Bangladesh, on the sustainability of Bangladesh's family planning/maternal-child health (FP/MCH) program among nongovernmental organizations (NGOs). The workshop included representatives of the FP/MCH program, donor agencies, USAID cooperating agencies (CAs), NGOs, family planning clients, and technical experts (64 individuals). The aim was to determine a common vision of sustainability by 2010; to identify common features of this vision; and to identify Action Plans that stakeholders might adopt to ensure the actualization of the vision. The report includes a summary, introduction, objectives, inaugural session notes, technical presentations on USAID's vision, lessons learned from sustainability initiatives in Latin America, sustainability planning approaches and tools, and a future search workshop on sustainability. Stakeholders' evaluations of the workshop were listed in about 16 different statements. The appendices include the agenda, the list of participants, the national vision, USAID's vision, lessons learned from international settings and applicability to Bangladesh, tools to help plan for sustainability, and the workshop evaluation form. Many of the lessons learned were applicable to Bangladesh, with the exception of the question of appropriateness of charging all clients. The Quality-Expansion-Sustainability Management Information System and Management Development Assessment Tool were developed with staff from USAID's CAs in Bangladesh. Eight stakeholders participated in the Future Search Workshop and prepared Action Plans which are included in the appendix. The main features were lower donor dependency, community participation, and cost recovery. Promising features included quality of care, income generation, women's empowerment, collaboration, strengthening management skills, and endowment funds.
NEW YORK TIMES. 1996 Nov 17; 3.According to a UN survey covering 1990-1995, world population growth is 1.48%, significantly less than the 1.57% projected in the 1994 report. Fertility declined to an average of 2.96 children per woman; the projected figure was 3.1. The world's population could number 9.4 billion in 2050, nearly half a billion lower than the 1994 projection. World population now numbers 5.77 billion and will stabilize, sooner than expected, at 10.73 billion in 2200 (chart). Joseph Chamie, director of the UN Population Division, cites family planning programs of the 1960s and 1970s and recent programs improving women's status for creating a steady continuous fertility decline in every region. J. Brian Atwood, administrator of the United States Agency for International Development (USAID), called the gains heartening at a time when population and development assistance programs are being cut. International family planning program critic, Representative Christopher H. Smith (Republican, NJ), is concerned abortions will be funded. He believes that money would be better spent on improving children's lives and strengthening market economies to create better living standards and smaller families, and that Western family planning programs are culturally intrusive. Mr. Chamie responds that population declines are much slower if couples lack access to safe, culturally and religiously acceptable contraception. As seen in Bangladesh, Syria, and Turkey, where birth rates declined before living standards rose, socioeconomic growth is unnecessary to bring down fertility. Childbearing and marriage are being delayed, and people are being given the chance to choose better lives.
Summary report of: Updating Service Delivery Guidelines and Practices: a Workshop on Recent Recommendations and Experiences, Guatemala City, Guatemala, March 6, 1995.
Research Triangle Park, North Carolina, Family Health International [FHI], 1995 Aug. , 26 p. (MAQ: Maximizing Access and Quality)In March 1995, Family Health International (FHI), JHPIEGO Corporation, and seven collaborating agencies hosted an international workshop in Guatemala City so 60 family planning specialists from 23 countries could discuss how national guidelines for the use of contraceptives can be developed and implemented that are universally agreed upon and accepted. This workshop was held because a key obstacle of achieving high-quality family planning services is the lack of such guidelines. The participants reviewed the international recommendations developed by USAID and the World Health Organization (WHO). They also discussed the merits of the guidelines principle and learned from the pioneering countries in this initiative. The pioneering countries were presented in Session II as country case studies and included Mexico, Tanzania, and Turkey. The first session addressed the international initiative to update service delivery guidelines and practices, specifically how medical barriers stand in the way, and the WHO and USAID guidance documents. Session III involved working groups on contraception for young adults, contraception in postpartum care, contraception in postabortion care, progestin-only methods, and client perspectives. Participants suggested that the workshop be adapted into an easily replicated format to introduce the guidelines worldwide. The next step would be to translate the documents into national guidelines and convert them into changes in practice. One way would be to publish training materials for all levels of family planning providers. JHPIEGO has already published a user-friendly pocket guide in five languages to simplify the USAID and WHO documents. FHI has developed Contraceptive Technology Modules to educate policymakers and providers on the latest scientific information. JHPIEGO and FHI have created expert slides to accompany the modules.
Arlington, Virginia, Population Technical Assistance Project [POPTECH], 1994 Dec. xix, 84,  p. (POPTECH Report No. 94-011-015; USAID Contract No. CCP-3024-Q-00-3012)The Tanzania Family Planning Services Support Project (FPSS) aims to improve the health and welfare of women and children by providing women and couples the opportunity to choose freely the number and spacing of children. FPSS was implemented in 1991. The three interrelated project outputs are expanded delivery of quality family planning services, enhanced Tanzanian institutional capacity, and development of an institutional base. USAID/Tanzania requested a midterm evaluation, which was conducted in December 1994. It supports FPSS by directly providing funds to the government and cooperating agencies who provide technical assistance to the National Family Planning Program and the private sector. Other significant donors to the family planning sector include UNFPA, IPPF, Overseas Development Assistance, and German Association for Technical Cooperation. During 1991-94 modern contraceptive prevalence increased from 7% to 16%. New acceptors increased 40-50%. Monthly resupply clients increased 23%. In mid-1994, 79% of women and 90% of men were familiar with at least one modern contraceptive method. The proportion of facilities providing injectables, IUDs, and vaginal foam increased more than two-fold. Almost all the facilities provided oral contraceptives and condoms. The number of first attendances for family planning services increased 46%. FPSS supported a wide variety of training (e.g., 6 types of training courses), but the needs for more training were stifled by lack of trainers and of supervisors, weak distribution of training documents, failure to institutionalize family planning into the medical and nursing schools, and lack of equipment and supplies. There were solid improvements in contraceptive logistics and availability, strengthening of the family planning unit within the Ministry of Health, and flexibility by USAID/Tanzania's management in addressing changing country needs. Based on the findings, the team developed 12 major recommendations (e.g., development of a national strategy to achieve a sustainable family planning program).
NETWORK. 1995 Sep; 16(1):13.The United Nations Population Fund (UNFPA) estimates that US$17 billion will be needed to fund reproductive health care in developing countries by the year 2000. About US$10 billion of would go for family planning: currently, the amount spent on family planning is about US$5 billion. Donors are focusing on fewer countries because of limited resources. The United States Agency for International Development (USAID) is planning to phase out support for family planning in Jamaica and Brazil because the programs there have advanced sufficiently. Resources will be shifted to countries with more pressing needs. Dr. Richard Osborn, senior technical officer for UNFPA, states that UNFPA works with national program managers in allocating resources at the macro level (commodities, training). Currently, two-thirds of family planning funds spent worldwide come from developing country governments (mainly China, India, Indonesia, Mexico, South Africa, Turkey, and Bangladesh). Sustaining programs, much less adding new services, will be difficult. User fees and public-private partnerships are being considered; worldwide, consumers provide, currently, about 14% of family planning funds (The portion is higher in most Latin American countries.). In a few countries, insurance, social security, and other public-private arrangements contribute. Social marketing programs are being considered that would remove constraints on prescriptions and prices and improve the quality of services so that clients would be more willing to pay for contraceptives. Although governments are attempting to fit family planning into their health care budgets, estimates at the national level are difficult to make. Standards are needed to make expenditure estimates quickly and at low cost, according to Dr. Barbara Janowitz of FHI, which is developing guidelines. Studies in Bangladesh, Ecuador, Ghana, Mexico, and the Philippines are being conducted, with the assistance of The Evaluation Project at the Population Center at the University of North Carolina and in-country organizations, to determine the amounts from government resources spent on family planning services in general and by function (training, administration, service delivery, and information).
In: Partners against AIDS: lessons learned. AIDSCOM, [compiled by] Academy for Educational Development [AED]. AIDS Public Health Communication Project [AIDSCOM]. Washington, D.C., AED, 1993 Nov. 67-76. (USAID Contract No. DPE-5972-Z-00-7070-00)AIDSCOM's Resident Advisor to the WHO Caribbean Epidemiology Centre (CAREC) discussed partnerships with existing health institutions. These institutions included Ministries of Health, multilateral agencies (e.g., WHO and UNICEF), family planning associations, universities, international private voluntary organizations, bilateral agencies (e.g., Canadian International Development Agency), and indigenous nongovernmental organizations (NGOs). AIDSCOM helped them develop an appropriate and effective conceptual approach to HIV prevention, which generally meant integrating new HIV prevention skills and concepts into existing programs and activities. AIDSCOM technical assistance addressed issues of accessibility of health services, testing, counseling, policy and confidentiality. Technical assistance included improved planning and management, program design skills, materials development, training in prevention counseling and condom skills, and a model for personal and professional behavior regarding AIDS, sex and risk. A key factor contributing to a successful partnership with CAREC was continuity of AIDSCOM staff contact. AIDSCOM helped CAREC with social marketing and behavioral research. It helped CAREC and its national counterparts to develop a regional KABP protocol for all 19 countries. AIDSCOM helped implement the protocol and strategize how to develop programmatic activities based on the results. The identified activities were training health workers and HIV prevention counselors promoting condom skills, establishing 5 national AIDS hotlines, developing 3 national media campaigns, and developing music, theater, and radio dramas. AIDSCOM and CAREC became partners with local NGOs who had access to hard-to-reach groups. Lessons learned included: technical assistance helps heath projects shift program emphasis from information to behavior change; successful partnership result in innovative programs; and proven effectiveness can be replicated in parallel programs.
GLIMPSE. 1994 Sep-Oct; 16(5):4.A workshop was held on 28 September 1994 at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) to share the lessons learned on door step delivery of injectable contraceptives in eight rural thanas in Bangladesh. The workshop was organized jointly by the Directorate of Family Planning, Government of Bangladesh (GOB) and the maternal-child health-family planning (MCH-FP) Extension Project (Rural) of ICDDR,B. A total of 150 participants from the Centre, the national family planning program, different NGOs, and donor agencies attended the workshop. The Minister for Health and Family Welfare, GOB, inaugurated the function as the chief guest. The director of the MCH-FP Extension Project (Rural) welcomed the guests. The Secretary of the Ministry thanked the Centre for its role in the national family planning program, and reiterated that the extension project is a collaborative project of the GOB and the Centre. The Minister emphasized that the population boom is a major problem of the nation. He thanked the Centre for helping the government in seeking solutions to this problem. The UNFPA Country Director expressed his happiness about the implementation and progress of the injectable contraceptive project. David Piet of USAID recommended that equal attention be given to all family planning methods, and not just to injectables. Also, he emphasized the quality of care and the sustainability of the method. The Director General of the Directorate of Family Planning thanked the implementors of this program at different levels for their contribution, and expressed his satisfaction over the activities of the project. The director of the Centre said that the Centre was proud to be involved in this project with the Bangladesh government. He thanked the donor agencies for supporting the Centre in providing family planning services to the nation.
FORUM. 1993 Dec; 9(2):38.The Board of Directors of the International Planned Parenthood Federation (IPPF) Western Hemisphere Region (WHR) met June 24-26, 1993, in New York to decide how much each of 38 family planning associations would receive as their budgets to fund programs in 1994. A total of $18,656,900 was allocated to grant receiving associations and the WHR regional office. The Board allocated funds on the basis of consideration of the following elements: the analysis of associations' input by program and financial advisors; comments from volunteers; group discussion of each association; and a detailed review of information provided by the IPPF regional office staff from its Red Book of 3-year working plans of all regional family planning association members. A series of options were also presented to mitigate the negative impact of expected funding reductions by the IPPF and USAID.
WASHINGTON POST. 1993 Nov 23; A12-3.On November 22, 1993, the administration of US President Clinton awarded $13.2 million to the International Planned Parenthood Federation (IPPF) as the first part of a 5-year USAID commitment of $75 million. The US also intends to resume funding in January to the UN Fund for Population Activities and other organizations that had been omitted from eligibility for the $430 million the US provides annually to foreign family planning (FP) programs. Eligibility had been withheld since 1984 during the Reagan and Bush administrations from organizations which performed or promoted abortion as a form of FP. US law continues to prohibit the use of US funds for abortion-related activities. USAID will enforce this restriction on use of the funds and on use of the money for coercive birth control practices in China. USAID Administrator, J. Brian Atwood, has determined that his agency's severely reduced budget will be targeted toward sustainable development with work in 4 basic areas: population and health, economic growth, the environment, and democracy. He stated that population problems are at the core of seemingly intractable problems in some developing countries and that the US must address the issue of population growth in order to meet any of its foreign policy objectives. He also stated that, in the view of the Clinton administration, access to FP information and services is a fundamental human right. The US grant will increase the IPPF's available funds for developing countries by about 20%.
[Unpublished] 1992 Apr 2. iv, 37,  p. (PN-ABL-448)The family planning (FP) program sponsored by the National Family Planning Board (NFPB) of Jamaica has proved a successful example to other countries in the Caribbean. New challenges, however, face the Board and the Jamaican government. Specifically, the government wishes to realize replacement fertility by the year 2000; USAID/Kingston will phase out assistance for FP over the period 1993-98, while the UNFPA and the World Bank will also reduce support; the high use of supply methods such as the pill and condom is less efficient than the use of longterm methods; and legal, economic, regulatory, and other operational barriers exist that constrain FP program expansion. A new implementation strategy is therefore needed to address these problems. The NFPB is the best suited body to develop and implement this strategy. Accordingly, it should work to garner the support of and a partnership with the public and private sectors to mobilize resources for FP. Instead of being the primary provider of FP for all consumers, the public sector must start providing for users who cannot pay for services and leave those who can pay to the private sector. This approach will diversify the burden of financing services while expanding the pool of service providers. Recommendations and next steps for the NFPB are offered in the areas of population targets to be served; the role and function of the NFPB to reach and serve various targets; and how to sustain beyond the cessation of donor inputs.