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Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence.
Health Services Research. 2017 Oct 20;OBJECTIVE: To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. DATA SOURCES: Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. STUDY DESIGN: Interviews addressed organizational capacities to expand family planning and integrate services with primary care. DATA EXTRACTION: Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. PRINCIPAL FINDINGS: Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. CONCLUSIONS: Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. (c) Health Research and Educational Trust.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016. 24 p.This evaluation focuses on how UNFPA performed in the area of family planning during the period covered by the UNFPA Strategic Plan 2008-2013. It provides valuable insights and learning which can be used to inform the current UNFPA family planning strategy as well as other relevant programmes, including UNFPA Supplies (2013-2020). All the countries where UNFPA works in family planning were included, but the evaluation focuses on the 69 priority countries identified in the 2012 London Summit on Family Planning as having low rates of contraceptive use and high unmet needs. The evaluation took place in 2014-2016 and was conducted by Euro Health Group in collaboration with the Royal Tropical Institute Netherlands. It involved a multidisciplinary team of senior evaluators and family planning and sexual and reproductive health and rights specialists, which was supervised and guided by the Evaluation Office in consultation with the Evaluation Reference Group. The outputs include a thematic evaluation report, an evaluation brief and country case study notes for Bolivia, Burkina Faso, Cambodia, Ethiopia and Zimbabwe.
Measuring the achievements and costs of reproductive health programs. Report of a meeting of the Working Group on Reproductive Health and Family Planning, the World Bank, June 24-25, 1996.
[Unpublished] 1996.  p.The Working Group on Reproductive Health and Family Planning is a joint project of the Health and Development Policy Project and the Population Council. On June 24, 1996, members of the Working Group met to discuss ways of measuring the achievements and costs of family planning and reproductive health programs. It is particularly important to revise family planning program evaluation methods so that they are consistent with a client-centered, reproductive health approach, and to develop ways of evaluating the costs and effectiveness of the components of comprehensive reproductive health care. This report is comprised of papers on the following topics: performance indicators with regard to making the transition from a demographically-oriented family planning program to a client-centered reproductive health paradigm; monitoring and evaluating reproductive health and family planning programs; incorporating indicators into reproductive health projects; disability adjusted life years and reproductive health; assessing the costs of reproductive health programs; and the cost of reproductive health. A summary is presented of the technical group meeting discussion.
Lancet. 1995 Jul 29; 346(8970):301.The World Bank, in "India's Welfare Programme: Towards a Reproductive and Child Health Approach," a review done with the Ministry of Health and Family Welfare, makes the following recommendations: 1) eliminate method-specific contraceptive targets and incentives, and replace them with broad reproductive and child health goals and measures; 2) increase the emphasis on male contraceptive methods (which account currently for only 6% of contraceptive use); 3) improve access to reproductive and child health services; 4) increase the role of the private sector by revitalizing the social marketing program; and 5) encourage experimentation with an expanded role for the private sector in implementing publicly funded programs. Since the launch of the family planning program in 1951, mortality has fallen by two-thirds, and life expectancy at birth has almost doubled. However, the population has almost doubled since 1961. By 2025, it is expected to be 1.5-1.9 billion. By 1992, India had achieved 60% of its goal for replacement fertility (2.1 births per woman), decreasing from 6 births per woman in 1951-1961 to 3-4 births per woman. Meeting India's unmet need for family planning would allow the replacement fertility goal to be reached. Female education and employment would add to the demand for smaller families and assure continuing declines in fertility and population growth rate. The report also highlights problems in implementation of the program, including program accessibility and quality of care. The report cites National Family Health Survey data which shows that only 35% of children under 2 received all six vaccines in the program, while 30% received none. The bank's "1993 World Development Report" recommended spending $5.40 per head for maternal and child health and family welfare programs; India spends $0.60. Massive borrowing will be required.
PUBLIC HEALTH REPORTS. 1980 Sep-Oct; 95(5):422-6.The implications of the eradication of smallpox in the context of epidemiology are presented. Eradication of disease has been conceived since the 1st smallpox vaccination was developed in the 18th century. Since then, attempts to eradicate yellow fever, malaria, yaws and smallpox have been instituted. Most public health professionals have been rightfully skeptical. Indeed, the success with smallpox was fortuitous and achieved only by a narrow margin. It is unlikely that any other disease will be eradicated, lacking the perfect epidemiological characteristics and affordable technology. The key to success with smallpox was the principle of surveillance. This concept has a vigorous developmental history in the discipline of epidemiology, derived from the work of Langmuir and Farr. It involves meticulous data collection, analysis, appropriate action and evaluation. In the case of smallpox, only these techniques permitted the key observations that smallpox vaccination was remarkably durable, and that effective reporting was fundamental for success. The currently popular goal of health for all, through horizontal programs, is contrary to the methods of epidemiology because its objective is vague and meaningless, no specific management structure is envisioned, and no system of surveillance and assessment is in place.
WORLD HEALTH. 1988 Jan-Feb; 3-4.40 years have elapsed since people of goodwill and foresight laid the foundations of the World Health Organization. For the 1st time in history there would be a truly global cooperative enterprise to protect and promote human health. Health which is rightly defined in the WHO Constitution as not merely the absence of disease or infirmity but as a state of complete physical, mental and social well-being. Remarkable progress had been made in science, technology and medicine. This was consolidated in the course of the 1st 30 years of WHO's existence. Sufficient know-how and expertise became available to ensure health care for all the inhabitants of the planet. There is however a wide gulf between the health haves and the health have nots. Within WHO, 166 Member States are now unanimously committed to Health for All: a strategy firmly anchored on 4 basic pillars: 1) technology--not necessarily sophisticated but appropriate technology, and by appropriate it is meant not only scientifically sound but socially acceptable and economically affordable, 2) political will to improve health so as to enable people to lead economically productive and socially rewarding lives, 3) health sector cooperation with other key development areas such as education, agriculture, industry and information, and 4) community and individual participation in the quest for better health; All for Health by the Year 2000.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xii, 39,  p.Most family life education (FLE) projects included in this evaluation have the longterm objectives of reducing the incidence of teenage prognancy, and promotion of self-reliance and positive, responsible behavior among youth. The immediate objectives and project strategies are also very similar across projects, e.g., in-school and out-of-school FLE, comprehensive youth services, including family planning (FP) and training. The evaluation shows that project design has improved over the years (clearer and measurable formulation of objectives, more comprehensive workplans and better explanation of budgetary items) and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. However, the Evaluation Mission in concerned that due to the similarities in project design, country-and-time-specific factors have not always been adequately taken into consideration. Other concerns include the lack of systematic needs assessment and use of baseline data to guide implementation. All the projects evaluated have contributed to the training in FLE/FP of a large number of family life educators, teachers and nurses and have thus significantly strengthened professional national capability. Nevertheless, training needs still exist in motivational/attitudinal variables, sex roles, teaching/learning technics. The projects have made a significant contribution to the introduction of FLE into schools and teacher training institutions. The focus at present should be the institutionalization of FLE within the in-school sector, including the development of a policy approving FLE in schools. The development of community-based health centers was often the central activity of the out-of-school FLE component of the projects. These centers have contributed to shaping the countries' attitudes by creating an awareness of teenage pregnancy, by developing an acceptable strategy, by providing a focal point for discussing sensitive issues, and by becoming a mechanism for community mobilization. The projects have also contributed to making FP services available and specialized services for adolescents are being established. The emphasis has been more on education and awareness creation than on contraceptive distribution to adolescents. At present the need is to strengthen the service delivery components. The limited availability of data suggests that adolescent pregnancy remains an urgent problem in the region. Sustained and more focused FLE/FP program efforts directed to adolescents continue to be needed in the region. The most important general lesson learnt from the programs is that programs in adolescent fertility can be started and implemented in countries even prior to declaration of policy by governments. However, at a certain stage of implementation the programs cannot be carried further without explicit government policies and control.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: country reports.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xiv, 89 p.UNFPA has provided funding for various family life education (FLE) projects with particular emphasis on youth in the English-speaking Caribbean since the mid-1970s; this report is an independent evaluation of the projects in Antigua, Barbados, Dominica, Jamaica, St. Lucia, and St. Christopher and Nevis. Although birth rates are relatively low in the English-speaking Caribbean, the incidence of adolescent pregnancy and the number of births to women under the age of 20 is an important problem in the region. The Mission concluded overall that the projects have contributed to pioneering and groundbreaking efforts demonstrating that it is possible to initiate and make considerable progress in the implementation of FLE/FP programs for adolescents even when adolescent pregnancy and births are still highly sensitive and controversial issues and when there are no official policies in favor of such programs. The Mission concluded also that project design had improved over the years and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. All the projects included in the evaluation have contributed to the training in FLE/FP of a large number of family life educators, teachers, and nurses and, as a result, have significantly strengthened professional national capability. The projects have shown that despite the lack of official policy approving FLE in schools and generally overcrowded curricula, FLE can be introduced into schools. In the area of FP service delivery, the projects included in the evaluation have contributed to making FP services generally available through integration with the government maternal and child health services. The main management issues across the projects were similar and included staffing, coordination, supervision, monitoring and evaluation. There is a need to adjust project design so that gender separation is minimized and that the FLE content deals better with issues such as self-awareness, sex roles, and self-esteem. The wider impact of the projects included in this evaluation, to be reflected, for example, in reduced incidence of teenage pregnancy, reduced maternal and infant/child morbidity and mortality, and more generally in the life patterns of women, cannot yet be measured.
Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38,  p.The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
Report on the evaluation of UNFPA assistance to the maternal and child health programme of Malawi: project MLW/78/P03 (February 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. xi, 36,  p.The 3 initial objectives of the Maternal and Child Health Program of Malawi were health and nutrition education, training of traditional midwives, and immunization against measles and polio. The Evaluation Mission found that the strong points of the project are: the Government's commitment to improve the status of maternal and child health by its expansion of services and its recent acceptance of child spacing as part of its program in maternal child health; the high level of dedication of the personnel in the Ministry of Health; the attention given to strengthening the Health Education section; and the establishment of a good management information framework upon which planning, supervision and monitoring can be further developed. Factors which seem to have hindered the project have been the lack of trained staff at the supervisory and service delivery level caused in large part by the lack of accomodation at the various national training institutions; the failure to appoint international staff to key positions within the project; and the lack of adequate transportation for project personnel. As child spacing will soon be included in project activities, the present organization of the Central Medical Stores to procure and distribute contraceptives and other needed supplies will adversely affect project performance. In total, the evaluation Mission made 19 recommendations addressed mainly to the Government and a number to the World Health Organiation and the United Nations Fund for Population Activities for project management decisions.
Joicfp Review. 1985 Oct; 10:44.The primary health care program in the Philippines today officially includes only the control of parasites which cause malaria and schistomiasis. Dr. Solon suggests that equal emphasis should be given to the control of all types of parasites. This paper presents excerpts from an interview with Dr. Solon. He expresses his opinion that in the past 20 years infant mortality has decreased markedly. In 1985, it was reduced to 58/1000 live births. He attributes this to a political will to support the health ministry in the implementation of its programs. The efforts to implement primary health care (PHC) has resulted in receiving the Kawaski Award given by Japan and the World Health Organization (WHO) to a country successfully implementing PHC. JOICFP has demonstrated the approaches used in the integration of family planning, nutrition and parasite control. Dr. Solon hopes that the integrated project would pave the way for the control of parasites other than schistostomiasis and malariasis. Less attention has been paid to the control of helminths such as ascaris, bookworm, trichuris t. and roundworm, which are common in the Philippines. Worms may cause deadly diseases such as pneumonia and bronchitis. JOICFP has shown that in several project areas in the country, use of the right personnel, equipment and anthelmintics can result in controlling these parasites.
Methodological problems in evaluation of family planning impact of programmes that are integrated with other development sectors.
In: Studies to enhance the evaluation of family planning programmes by United Nations Department of International Economic and Social Affairs. Population Division [DIESA] New York, New York, United Nations, 1985. 108-110. (Population Studies No. 87 ST/ESA/SER.A/87)Governments of developing countries began to undertake family planning in the 1960s thanks to a sudden availability of funds for programs exaggerating an already existing cleavage between program and general demography professionals. Discussion at the World Population Conference (WPC) in Bucharest recognized social and economic factors as an important element in the use of family planning and attempted to encourage better cooperation between program evaluators and demographers. Separation of family planning effects from development effects has been difficult. The WPC's World Population Plan of Action (WPPA) reiterated that population and population policies were interrelated with and should not be considered substitutes for socioeconomic development policies. Increasingly, governments have been integrating family planning with education and health programs as recommended by the WPPA. Family planning being a relatively new venture, it is necessary to develop a theoretical framework to justify assumptions that family planning and development are productively integrable and synergistic, determining demographic effects and their causal mechanisms, whether social or program related. A careful record of program inputs must be kept. Important issues in education, which generally speaking has an inverse effect on fertility, are: in which sex and age group of the population is education most effective for fertility control allowing for lag time; and what are the intervening effects--age at marriage, better knowledge, or change of attitudes? Some of the simplest integrated programs combine family planning with educational programs in schools, health programs, and agricultural programs. Thus teachers are trained to educate pupils in population problems; health workers educate family health consumers a logical diversity of function that is however limited by the scope of the health program. The benefits of small family size may be incorporated into rural development ideology. Critical evaluation will necessitate demonstration of integration's beneficial effects.
[Unpublished] 1984. Presented at the Union of National Radio and Television Organisations of Africa [URTNA] Family Health Broadcast Workshop (Nairobi, 19-23 November, 1984).  p.Statistical information on Zambia's population is provided, and the activities, goals, and achievements of the country's family health, maternal and child health (MCH), and expanded immunization programs are described. Zambia is a tropical country and has a 1-party participatory democratic form of government. The country is inhabited by 73 tribes speaking 62 languages. In 1983, the population size was 6,425,000, and 48.6% of the population was under 15 years of age. Population size, area, and density information for each province is provided. The general fertility rate was 220/1000 women of reproductive age. Life expectancy was 50 years for women and 46.7 years for men. The 6 major causes of death among women and children in 1979 were measles, malnutrition, pneumonia, malaria, diarrhea, and respiratory infection. The Ministry of Health is actively working to expand immunization and MCH services in the rural areas. The family health program is a training program charged with the task of providing training in family health for 600 enrolled nurses and midwives. Sessions include 6 weeks of classroom instruction followed by 6 weeks of clinical or field experience. Topics covered in the training sessions are health education, teaching and communication skills, management skills, child health, nutrition, immunization, prenatal and postnatal care, and child spacing. Graduates of the program are assigned to rural health facilities where they supervise the delivery of immunization and MCH services and initiate child spacing services. The family health program, initiated in 1980, is funded by the UN Fund for Population Activities and is guided jointly by the Ministry of Health and the World Health Organization. As of 1983, 19 registered nurse midwives and 442 enrolled nurse midwives were trained under the program. Information on the family health program is disseminated via radio, television, a Ministry of Health magazine, the World Health Day Exhibition, and agricultural shows. The development of MCH services in rural areas is emphasized by the 1980-84 national development plan. The major components of the MCH program are prenatal and postnatal care, family planning, children's clinics, vitamin and protein supplementation, immunization, and school health services. The Expanded Immunization Program (EIP) is integrated into the primary health care system and covers remote areas not as yet covered by MCH services. The specific goals of the program are to increase immunization coverage, establish a cold chain for vaccines, reduce vaccine wastage, and train health personnel to use and maintain cold chain equipment. The program is funded by various UN agencies and the national government. Family planning was introduced into Zambia by the Family Planning Association. The organization's name was later changed to the Planned Parenthood Association to overcome the mistaken impression that family planning meant the complete cessation of childbearing. In 1973, child spacing was integrated into the MCH program and family planning was assigned a high priority in the 1980-84 national development plan. Between 1980-84, the number of family planning acceptors increased from 49,412 to 101,803. In 1984, a number of evaluations were made of the MCH, EPI, and family health programs. The results of these evaluations will be available in the near future. Tables provide information on contraceptive usage, the Ministry of Health budget for 1983, the number and type of health staff in 1982, and the number and type of health facilities in the country.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
Report of the evaluation of UNFPA assistance to Colombia's Maternal, Child Health and Population Dynamic's Programme, 1974-1978.
New York, United Nations Fund for Population Activities, July 1981. 181 p.This report for UNFPA (United Nations Fund for Population Activities) on Colombia's Maternal and Child Health and Population Dynamics (MCH/PD) program was prepared by an independent team of consultants which spent 3 weeks in Colombia in February 1980 reviewing documents, interviewing key personnel and observing program services. The report consists of 8 chapters. The 1st describes the terms of references of the evaluation mission. The 2nd chapter provides background information on Colombia and identifies some of the principal environmental factors that affect the program. Chapter 3 describes the organizational context within which the program operates. The chapter also includes a discussion of the UNFPA funding and monitoring mechanism and how that affects program planning and operations. Chapter 4 is a description of the program planning process; goals, strategies and objectives, and of the UNFPA and government inputs to the program between 1974-1978, the period under review. A large part of the report is devoted to describing and assessing each program activity. Chapter 5 consists of descriptions of management information; maternal care; infant, child and adolescent care; family planning; supervision; training; community education; and research and evalutation studies. Chapter 6 is an analysis of the program's impact on: maternal morbidity and mortality; infant morbidity and mortality; and fertility. Chapter 7 summarizes the Mission's conclusions and lists its recommendations. The final chapter deals with the Mission's position in relation to the 1980-1983 proposal. Appendices provide statistical data on medical activities, contraceptive distribution and use, content of training courses, target population, total expenditures, and norms for care, as well as organizational charts, individuals interviewed, and UNFPA assistance to other agencies in Colombia. (author's modified)