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[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992.  p.External donors provided plenty of funds to nongovernmental organizations (NGOs) in developing countries, hoping the governments would eventually support a national family planning (FP) policy. Lower levels of funding for population programs caused external donors to force NGO FP programs to become self-sustaining. Yet, it is likely to be difficult for them to improve the quality of services, expand coverage, and increase program sustainability all at the same time. External donors consider the 35-50% contraceptive prevalence rates that NGO FP programs are achieving to represent the early stages of sustainability at which time they divert funds to government programs. This loss of funds shifts the NGO program's focus from poor women to income-generation, made possible by targeting middle and upper income women. When diversion of funds resulted in a decline of contraceptive prevalence rates in Sri Lanka and stagnant rates in Pakistan and the Philippines. FP programs in Sri Lanka, Pakistan, and the Philippines first provided physician-controlled, reversible, clinical methods. Those in Sri Lanka and the Philippines next provided contraceptives through a widespread rural community-based distribution system. Pakistan held mass sterilization campaigns to address rapid population growth and high fertility. The management system of the national FP program in Sri Lanka is slow, and disruption of service delivery and supply systems is common Physician-trained nonphysician FP workers and the vertical national health and population sectors caused the stagnation in the public sector. The Philippines has trouble implementing public policy-based FP programs.
[Unpublished] 1992 Apr 2.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.
POPULI. 1993 Jun; 20(6):6-7.The UN Population Fund (UNFPA) assists population programs and activities in 140 countries, with field offices in 95 countries and country directors in 59. Its staff of 801 worked last year on a budget of US $225 million. An evaluation of the Fund's operations was sponsored by the official development agencies of Canada, Finland, and Germany in 1992 and early 1993. Conclusions are based upon reviewed documents, interviews, meetings, and case studies of programs in Bangladesh, Bolivia, Brazil, Egypt, Indonesia, Kenya, and Senegal. Generally, the Fund has succeeded in establishing credibility and promoting population as a critical development issue, but its close ties and dependence upon the sanctions and participation of host governments have kept the Fund from maximizing the potential of nongovernmental organizations (NGO) and the private sector to implement projects. Projects are either supported because of government pressure or are not executed by the best executing agencies; only very limited project execution is conducted through the private sector of NGOs. The Fund should instead encourage competition among UN agencies, NGOs, and private companies interested in executing projects. The Deputy Executive Director agrees with these findings, but holds that their relationship with governments is the result of the UN requirement that the Fund work at the invitation of and through host governments. UNFPA-supported country programs have also relied too heavily on other UN agencies to execute projects which have suffered from poor project management and inadequate and/or poor technical support. Moreover, the evaluation revealed that the UNFPA is overextended and should emphasize helping countries which have already tried to move forward with their population programs. Countries should demonstrate need for assistance in addiction to the proper attitude and practices.
Washington, D.C., World Bank, 1993. vii, 103 p.The World Bank has conducted an assessment of the performance of family planning (FP) programs in developing countries. The first part examines their contributions and costs. It concludes that FP programs have played a key role in a reproductive revolution in these countries. Specifically, all developing regions have experienced a transition to lower fertility (e.g., in the last 20 years, fertility has fallen 33%), resulting in lower infant, child, and maternal mortality. One chapter looks at experiences in East Asia, South Asia, Latin America, and sub-Saharan Africa. World Bank staff use research to present a broad summary of what methods and characteristics achieve effective programs. The book addresses other social development interventions that contribute to a lasting reproductive revolution. Despite the positive results of FP programs, maternal mortality in developing countries is still much higher (10 times) than it is in developed countries and 25% of married women in developing countries report an unmet need for FP. Government commitment to FP programs needs to be strengthened and donor support should keep up with needs to expand successful FP programs. FP programs can satisfy these needs if they provide quality services, including a solid client focus, effective promotion, and strong encouragement of the private sector to increase their participation. Indeed, program quality must be the top priority. Strategic management of FP programs is also crucial. Programs need to integrate and coordinate effective promotion of FP, e.g., social marketing, with other activities.
Evaluation of the regional advisory services in population education and communication in Sub-Saharan Africa of FAO, the ILO and UNESCO, 1978-1982.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Jun. iv, 64 p.This evaluation was conducted to assess alternative modes of providing regional population education and communication (PEC) advisory services in the African Region in the future, in addition to assessing past performance of existing projects. In the absence of specific and measurable project objectives, as well as uniform, reliable and comparative data for the different projects included in this evaluation, it was not possible to determine exactly the quantity and quality of the achievements of the regional advisory projects over the period under review. Nevertheless, it is concluded that the achivements had been relatively limited, partially because of inherent difficulties associated with the provision of advisory services in the region (e.g., distances, inter-and intra-country communication problems) but more so because of weaknesses in the formulation and implementation of the regional advisory projects. These weaknesses include: 1) differing views on the part of the Executing Agencies and the United Nations Fund for Population Activities (UNFPA) about the functions of the regional advisors which underlie the rather vaguely defined functions presented in the project documents; 2) insufficient planning of the regional advisory teams' activities; and 3) recruitment difficulties which led to vacancies and high turnover as well as to the hiring of partially qualified advisors. Furthermore, the present arrangement for the delivery of regional PEC advisory services, e.g., separate agency teams and advisors located in different countries, impedes the effective delivery of services because the advisors under this arrangement cannot function as 1 team. It is recommended that the functions of the regional PEC advisors in Africa be concentrated on assistance to country project formulation, advice on country project management and systemenatic particiaption in country project monitoring and evaluation. Recommended regional PEC advisory services are 1 team for PEC in the non-formal sector and another team for population education in the formal sector. Other recommendations deal with the role of Headquarters vis a vis regional follow-up and monitoring/supervision of regional advisors, other in-country activites and need for resident country advisors.