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  1. 1
    318962

    The potential of private sector midwives in reaching Millennium Development Goals.

    White P; Levin L

    Bethesda, Maryland, Abt Associates. Private Sector Partnerships-One [PSP-One], 2006 Dec. 48 p. (Technical Report No. 6; USAID Contract No. GPO-I-00-04-00007-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-754)

    Government health sectors in many countries face an uphill battle to reach the Millennium Development Goals (MDGs) set for 2015. In the last six years, Ministries of Health (MOHs) in many less developed countries (LDCs) have been unable to invest sufficiently in their health systems. To achieve the MDGs despite inadequate resources, new approaches for delivering critical clinical services must be considered. This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in LDCs' ability to reach MDGs. This paper examines factors that support or constrain private practice midwives' (PPMWs') ability to offer expanded services in order to inform the policy and donor communities about PPMWs' potential. Data was collected through literature reviews, stakeholder interviews, and field-based, semi-structured interviews in Ghana, Indonesia, Peru, Uganda, and Zambia. Ghana, Indonesia, and Uganda were chosen because they are countries where PPMWs provide expanded services. Peru and Zambia were selected as examples where midwives have struggled to develop private practices or they provide expanded services despite issues about midwives' roles and legal sanctions for private practices. (excerpt)
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  2. 2
    113716

    Midterm review of the Tanzania Family Planning Services Support (FPSS) Project (621-0173).

    Shutt MM; Fleuret A; Kapiga S; Kirkland R; Magnani R; Mandara N; Mpangile G; Olson C; Omari CK; Pressman W

    Arlington, Virginia, Population Technical Assistance Project [POPTECH], 1994 Dec. xix, 84, [40] 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).
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  3. 3
    099406

    Country report: Bangladesh. International Conference on Population and Development, Cairo, 5-13 September 1994.

    Bangladesh

    [Unpublished] 1994. iv, 45 p.

    The country report prepared by Bangladesh for the 1994 International Conference on Population and Development begins by highlighting the achievements of the family planning (FP)/maternal-child health (MCH) program. Political commitment, international support, the involvement of women, and integrated efforts have led to a decline in the population growth rate from 3 to 2.07% (1971-91), a decline in total fertility rate from 7.5 to 4.0% (1974-91), a reduction in desired family size from 4.1 to 2.9 (1975-89), a decline in infant mortality from 150 to 88/1000 (1975-92), and a decline in the under age 5 years mortality from 24 to 19/1000 (1982-90). In addition, the contraceptive prevalence rate has increased from 7 to 40% (1974-91). The government is now addressing the following concerns: 1) the dependence of the FP and health programs on external resources; 2) improving access to and quality of FP and health services; 3) promoting a demand for FP and involving men in FP and MCH; and 4) achieving social and economic development through economic overhaul and by improving education and the status of women and children. The country report presents the demographic context by giving a profile of the population and by discussing mortality, migration, and future growth and population size. The population policy, planning, and program framework is described through information on national perceptions of population issues, the evolution and current status of the population policy (which is presented), the role of population in development planning, and a profile of the national population program (reproductive health issues; MCH and FP services; information, education, and communication; research methodology; the environment, aging, adolescents and youth, multi-sectoral activities, women's status; the health of women and girls; women's education and role in industry and agriculture, and public interventions for women). The description of the operational aspects of population and family planning (FP) program implementation includes political and national support, the national implementation strategy, evaluation, finances and resources, and the role of the World Population Plan of Action. The discussion of the national plan for the future involves emerging and priority concerns, the policy framework, programmatic activities, resource mobilization, and regional and global cooperation.
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  4. 4
    081692

    Graduating NGOs to self-sustaining status and stagnating national family planning programs.

    AmaraSingham S

    [Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. [6] 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.
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  5. 5
    084230

    Study of sustainability for the National Family Planning Board in Jamaica.

    Clyde ME; Levy TD; Bennett J

    [Unpublished] 1992 Apr 2. iv, 37, [24] 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.
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  6. 6
    075783

    Family planning programme sustainability: a review of cost recovery approaches.

    Ashford LS; Bouzidi M

    London, England, International Planned Parenthood Federation [IPPF], 1992 Mar. iv, 81 p.

    Participants at the October 1991 IPPF seminar on Program Sustainability through Cost Recovery addressed the challenge of continuing to provide even more family planning (FP) services to the poorer segments of society while at the same time ensuring program survival. Field reports indicated a variety of funding sources, including user fees, social marketing programs, income generating schemes unrelated to FP, service agreements with the public sector, and private sources. Fees comprise the most common means of recovering FP program costs, but there is substantial diversity based on the income of the user, location of the service, and type of service provided. In view of field reports presented at the workshop, 6 broad recommendations were developed: 1) any approach to program sustainability must place the needs of the clients first; 2) sustainability should be an integral part of the organization's longterm strategic plan; 3) cost-effectiveness is a requirement; 4) periodic analyses of service costs, overhead costs, and costs per unit of output should be undertaken to monitor cost-effectiveness; 5) greater inter-IPPF cooperation and sharing of experiences should be encouraged; and 6) a business plan is essential for cost recovery. In countries where family planning acceptance is low and donor funds are available, FP associations are urged to focus on resource development rather than cost recovery from users. FP associations that provide health education services are encouraged to derive income from the sales of IEC materials or seminar fees. In some cases, higher fees can be charged for specialized services such as infertility counseling, but care must be taken to avoid diverting the program's emphasis from the primary task of managing the family planning program. The cost recovery schemes selected--fees, sales, insurance, or community fundraising--should always be consistent with the association's role in the national population program.
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  7. 7
    070873

    Report of the Seminar on Programme Sustainability through Cost Recovery, Kuala Lumpur, Malaysia, 21-25 October, 1991.

    International Planned Parenthood Federation [IPPF]

    London, England, IPPF, 1991. 15, [2] p.

    In the face of widespread user acceptance, rapidly growing demand, and developing country financial constraints, family planning associations must learn how to operate more efficiently and mobilize new resources with a view to ensuring greater long-term sustainability. Cost recovery was therefore identified as a means of maximizing the use of limited resources, improving program quality, strengthening management, and making service providers more accountable to clients. This document reports results from seminar participants organized to share the benefits of cost recovery with the international community, and to review policy and management issues. Reviewed in the seminar were country experiences with cost recovery, working group discussions on the definition of sustainability, the cost framework of family planning, determining user fees and clients' willingness to pay, preconditions for setting user fees, prerequisites for social marketing, models for cost sharing with the government and private sector, and country case studies from the Gambia, India, and Kenya. Those programs attaining highest self-sufficiency were aided by strong government commitment to either support family planning or to not impede program progress. Also helpful were a businesslike approach to service provision, a strong promotional campaign, organizational structure conductive to effective resource management, and resolve to try diverse approaches. In concluding, the importance of placing the customer first, cost-effectiveness, cost analysis, strategic planning, inter-FPA cooperation, and business plans are mentioned.
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  8. 8
    059872

    Private sector joins family planning effort.

    FRONT LINES. 1989 Dec; 6, 13.

    Projects supported by the Directorate for Population (S&T/POP) of the U.S. Agency for International Development and aimed at increasing for-profit private sector involvement in providing family planning services and products are described. Making products commercially available through social-marketing partnerships with the commercial sector, USAID has saved $1.1 million in commodity costs from Brazil, Dominican Republic, Ecuador, Indonesia, and Peru. Active private sector involvement benefits companies, consumers, and donors through increased corporate profits, healthier employees, improved consumer access at lower cost, and the possibility of sustained family planning programs. Moreover, private, for-profit companies will be able to meet service demands over the next 20 years where traditional government and donor agency sources would fail. Using employee surveys and cost-benefit analyses to demonstrate expected financial and health benefits for businesses and work forces, S&T/POP's Technical Information on Population for the Private Sector (TIPPS) project encourages private companies in developing countries to invest in family planning and maternal/child health care for their employees. 36 companies in 9 countries have responded thus far, which examples provided from Peru and Zimbabwe. The Enterprise program's objectives are also to increase the involvement of for-profit companies in delivering family planning services, and to improve the efficiency and effectiveness of private volunteer organizations in providing services. Projects have been started with mines, factories, banks, insurance companies, and parastatals in 27 countries, with examples cited from Ghana and Indonesia. Finally, the Social Marketing for Change project (SOMARC) builds demand and distributes low-cost contraceptives through commercial channels especially to low-income audiences. Partnerships have been initiated with the private sector in 17 developing countries, with examples provided from the Dominican Republic, Liberia and Ecuador. These projects have increased private sector involvement in family planning, thereby promoting service expansion at lower public sector cost.
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