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[A guide to providing reproductive health services] Guia para prestacao de services em saude reprodutiva.
Fortaleza, Brazil, Secretaria da Saude, 1998. xxvi, 432 p.The Viva Mulher [Healthy Woman] Program developed by the Secretariat of Health of the State of Ceará (SESA-CE), in partnership with several local, national and international institutions, was conceived after recognition of the unfavorable health situation of women throughout the State. Sensitized by the size of the problem and encouraged by other successful initiatives, such as the Community Health Agent program and the Healthy Child program, the results of which were translated into a reduction in infant mortality and an increase in the coverage of Basic Health Actions, the State Government resolved to promote a broad mobilization of institutions interested in the problems so as to develop intensive joint efforts involving society as a whole in an attempt to make a significant change in the health profile of women in Ceará. The first concrete act was the holding of the "Woman, Health, Life" seminar in Fortaleza in August 1992, which had more than 1,000 participants, to launch the Healthy Woman program on the basis of directives from the Ministry of Health (PAISM). The Healthy Woman program was associated from the beginning with the United Nations Population Fund (FNUAP), which proposed to offer technical assistance and financial resources through a four-year cooperation project with the State Government. The Pan American Health Organization (PAHO), collaborating agencies of the U.S. Agency for International Development (AID) and other international entities later joined in the process and have been cooperating in various complementary manners. (excerpt)
[Unpublished] 1993. , 23,  p.In 1993 in Tanzania, the Association for Voluntary Surgical Contraception (AVSC) helped the Tanzania organization UMATI and the Ministry of Health (MOH) evaluate the 5-year Permanent and Long-Term (P<) Contraception Program. The program planned to use the findings to develop action workplans to address the issues and to expand services. The assessment team visited sits in Dar es Salaam, Iringa and Mbeya, and Arusha and Moshi. In 4 years, the program had expanded from 2 sites to 35 sites nationwide. It trained 250 family planning providers in tubal ligation. P< providers performed more than 9000 tubal ligations (90,000 couple years of protection). The program has surpassed all its service objectives, which contributed to a lack of resources. It established a national network of interested health providers and administrators. Demand for services outpaces the supply countrywide. Since clients and providers have accepted tubal ligation, the government has incorporated sexual sterilization into its national family planning program. It is now preparing to introduce the contraceptive implant Norplant. USAID/AVSC and UMATI/IPPF, (International Planned Parenthood Federation) support 3 full-time staff positions and plan on adding staff in area offices. Other than the 3 AVSC-funded positions in UMATI, UMATI, and MOH have provided all staff time. Other donors to the P< Contraception Program include the development agencies of the UK and Germany and perhaps the World Bank. The MOH has requested future goods from UNFPA for the Interim Norplant Expansion Program. The 2 major outcomes of the assessment were realization of the need to support full-time physician-nurse teams in each UMATI area office and MOH agreement to integrate training for P< methods into the national training strategy. UMATI and USAID planned to add 2 more area offices. Service obstacles were insufficient trained staff, expendable supplies, and equipment to expand to the 35 sites (25 were planned). The key management problem was failure to completely integrate the P< program into the UMATI mainstream.
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%.
Latin American and Caribbean Region health care financing activities, 1982-1988. An annotated compilation. Draft.
[Unpublished] 1989 Mar. , 87 p. (USAID Contract No. DPE-5927-C-00-5068-00)The Resources for Child Health Project (REACH) presents an overview of health care financing (HCF) activities in the Latin American and Caribbean regions for the period 1982-88. REACH is compiling regional health care financing initiatives, preparing detailed case studies of USAID health financing experiences in 3 countries, and developing a set of general guidelines to be used by health officers to identify opportunities for HCF activities. A draft version of the first of these components is presented and includes an updated annotated list of health finance activities, studies, and projects conducted in the region since 1982. The USAID approach to HCF as put forth in policy statements and other official documents is summarized; World Bank, Inter-American Development Bank, and Pan American Health Organization viewpoints are reviewed as well as social security issues and their relationships to HCF; and country overviews are provided under Caribbean, Central America, South America, and North America subheadings. Brief overviews of HCF activities for each country are given followed by summaries of individual activities funded by USAID and other organizations. Summaries indicate whether activities are public or private sector, main areas of emphasis, and describe content. Activity costs are also given for USAID-funded initiatives.
Proceedings of the Caribbean Regional Conference "Operations Research: Key to Management and Policy", Dover Convention Centre, St. Lawrence, Barbados, May 31 - June 2, 1989.
[New York, New York], Population Council, 1989. 19,  p.Objectives, proceedings, and conclusions of a Caribbean regional conference on operations research (OR) in maternal-child health and family planning programs (FP/MCH) are summarized. Sponsored by the Population Council, USAID, and UNICEF, participants included policy makers, program managers, service providers, and representatives from international agencies in health and family planning from Antigua and Barbuda, Barbados, Dominica, Grenada, Jamaica, Mexico, St. Kitts-Nevis, St. Lucia, St. Vincent and the Grenadines, Trinidad and Tobago, and the U.S. The conference was held with hopes of contributing to the legitimization of OR as a management tool, and helping to develop a network of program directors and researchers interested in using OR for program improvement. Specifically, participants were called upon to review the progress and results of recent regional OR projects, analyze the utilization of these projects by policy makers and program managers, highlight regional quality of care, and establish directions for future projects in the region. Overall, the conference contributed to the dissemination and documentation of OR, and provided a forum in which to identify important service, research, and policy issues for the future. OR can improve FP/MCH services, and make positive contributions to the social impact of these programs. The unmet need of teenagers and men and structural adjustment were identified as issues of concern. Strategies will need to be developed to maintain currently high levels of contraceptive prevalence, while responding to the needs of special groups, with OR expected to focus on the quality of care especially in education and counseling, and screening and user follow-up. The technical competence of service providers and follow-up mechanisms are both in need of improvement, while stronger institutional and management capabilities should be developed through training and human resource development.
Proposal to USAID for funding WHO Regional Office for Africa AIDS Control Programme for the WHO African Region.
[Unpublished] 1986 May 7. 6 p.Representatives of the 45 Member States in the African Region of the World Health Organization (WHO) met in March 1986 and approved a plan of action for acquired immunodeficiency syndrome (AIDS) control. It was stressed that lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) infection is a potential barrier to the goal of health for all by the year 2000. The plan calls upon each Member State to create a National AIDS Committee responsible for overall coordination of AIDS-related research and prevention-control activities. The national strategy should consist of 3 parts: 1) initial assessment of the LAV/HTLV-III situation and available resources; 2) strengthening of the health infrastructure in order to support epidemiologic, laboratory, clincal, and preventive activities; and 3) information and education programs directed toward the general public, high-risk groups, and health care workers regarding AIDS and its prevention. The proposal approved includes 5 principal components: 1) to strengthen the capability of the African Region of WHO to coordinate AIDS-related activities and provide assistance to Member States; 2) to conduct initial assessments in 4 countries in collaboration with the WHO Control Program on AIDS; 3) to strengthen the health infrastructure at the national level in 4 states, including initiation of AIDS surveillance, laboratory support, and education; 4) to assist Member States in educational activities through the provisionof liaison staff; and 5) to ensure liaison with the Global WHO Control Program on AIDS. It was further proposed that a medical epidemiologist be assigned to the Communicable Disease Bureau at the Regional Office in Brazzaville, as well as a laboratory advisor. A total of US$1 million has been allocated for this plan of action.
Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.
Washington, D.C., Family Health, 1980 July 23. 162 p.The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
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.
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).
Arlington, Virginia, Partnership for Child Health Care, 1994. , 10,  p. (BASICS Trip Report; BASICS Technical Directive: 000 IN 00 011; USAID Contract No. HRN-6006-C-00-3031-00)A World Bank-supported BASICS project will respond to the government of Indonesia's request to improve the public provision of health care. An informal agreement existed between BASICS, the World Bank, and the Indonesian Ministry of Health to conduct a joint visit to Indonesia during the preparation of the Bank's Health Project IV. That visit was conducted between September 21 and October 8, 1994, and included several field trips to East Java, East Nusa Tengara, West Kalimantan, and Central Java. The technical note included in this report considers some possibilities of the expansion of the private sector in modern Indonesia. The provision of specialized health services to remote areas, the support of training activities, the stimulation of behavioral changes, and ensuring quality assurance for the private sector are discussed. The technical note also emphasizes the need to look beyond the health center especially since the current systems often fail to address basic health needs. Many opportunities exist for BASICS to play an important role in Indonesia, but it is unclear how many resources USAID/Jakarta will have to invest in child survival activities. The anticipated modest size of resources will probably restrict BASICS activities to the private sector, the district level, and potentially operations research activities. Ongoing research into urban health is a promising area. Most of the possible lines of action concerning support to the private sector are outlined in the technical note.
[Unpublished] 1979 Jul 16. 23, , 5 p. (EGY-02)Building on previous AID-supported research by the American University in Cairo, specifically a study of household contraceptive delivery, the Social Research Center (SRC) expanded a household distribution system tested in Shanawan to 38 rural villages in the Menoufia Governorate. The project, which cost US $919,440, was designed to test the effectiveness of the household-based approach to delivery of family planning (FP) services. Like the earlier project, this study was based on the assumptions that there was an unmet demand for contraceptives and that this demand could be systematically identified and met in a culturally acceptable way, using lay women as distributors. Once a community is systematically exposed to FP information and services, a community-based resupply system can effectively meet the ongoing demand for services. The project tests 4 different FP systems, where a first round of free household distribution is followed by: 1) free resupply at the clinic; 2) free resupply in the village; 3) resupply sold at the clinic; and 4) resupply sold at a village depot. Distribution and resupply agents were local women. The study employed a quasi-experimental design. Villages were matched as far as possible on sociodemographic characteristics and contraceptive usage and were randomly assigned to one of the 4 types of delivery systems. Data were collected through a baseline survey conducted at the same time as the household distribution of contraceptives to assess contraceptive behavior. A follow-up survey conducted 9 months later with eligible women only (married, fecund, and age 15-44) was designed to evaluate the household delivery system and focused on contraceptive and fertility behavior. Prevalence increased from 19.1% at the baseline to 27.7% 8 months after the distribution (relative increase of 45%). The delivery system proved to be culturally, logistically, and administratively feasible. There was no significant difference in prevalence between those groups who were charged for a resupply of contraceptives and those who were not. Prevalence increased from 19.5 to 28.5% in the former group and from 18.7 to 26.9% in the latter. Based on this study, a modified version of the tested delivery system was implemented in collaboration with the Governorate of Menoufia among the entire rural population of 1.4 million. The modified system included a wider range of contraceptive methods as well as health and community development components.
[Unpublished] 1989. , 16,  p. (USAID Contract No. DPE-5927-C-00-5068-00)The Ministry of Public Health (MSP) and external agencies participating in Ecuador's Expanded Program on Immunization (EPI) decided in 1987 that a field-oriented supervisor was needed to help improve the implementation of immunization service delivery at operational levels. Dr. Jose Litardo was therefore retained as EPI Field Coordinator to offer technical support including 2 short-term visits annually from REACH headquarters. The 1st visit was January 11-22, 1989, during which detailed discussions were had with USAID, the Ministry of Public Health (MSP), PAHO, and UNICEF staff; a 3-day field trip within Cotopaxi Province also took place so that EPI supervisory techniques could be demonstrated, strengths and weaknesses in the EPI identified, and recommendations formulated. It was found that the MSP needs technical, managerial, administrative, and logistic support for its EPI at provincial and canton health area levels as it continues to extend its regionalization of health services. More personnel like the REACH EPI Field Coordinator will be needed. It was also found that the program has been slack in meeting routine demand for immunization services; the prevention of neonatal tetanus has been overlooked relative to other EPI target diseases; many norms in use Ecuador do not reflect internationally accepted WHO EPI policies; third doses of vaccine are not completed before age 12 months in many areas; and training in the management and supervision of the cold chain is needed. REACH supports the MSP's decision to assign Litardo to Esmeraldas in 1989. Recommendations are provided on regionalization, delivery strategies, EPI norms, monitoring immunization coverage, supervision, the cold chain, and research.
Arlington, Virginia, John Snow [JSI], Resources for Child Health [REACH], 1988 Sep. , 99,  p. (USAID Contract No. DPE-5927-C-00-5068-00)Building upon smallpox and measles immunization campaigns originally supported by USAID, the Centers for Disease Control, and the World Health Organization, the African region Combatting Childhood Communicable Diseases (CCCD) Project began providing immunizations, oral rehydration therapy for children with diarrhea, and malaria prophylaxis services in 1982. The project was approved in September, 1981, for spending of $47 million through fiscal 1988, and was designed to be implemented through existing publicly operated health service delivery systems with recipient CCCD project countries helping to finance recurrent costs and providing human resources for project implementation. Accordingly, almost all country project agreements were written to ensure that country governments would provide financial support for activities through direct budget allocations, user fees, or some combination of the 2. Regular analyses of service provision were also agreed upon. The development and implementation of user fees have taken place, but the overall theoretical financial strategy has yet to be met in any country project. This document discusses financing achievements and what more is needed to ensure longer term project financial sustainability. Sections review country-specific agreements to spell out original USAID/country terms on financing components; consider the capacity of CCCD project governments to finance recurrent costs in their respective macroeconomic contexts; present highlights of a review of CCCD project financing activities; summarize an evaluation of alternative health financing options; give conclusions of analyses on the financial sustainability of CCCD project activity; and make recommendations for future USAID CCCD project support with respect to financing and economics.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The US Agency for International Development (USAID) and the Institute for International Studies in Natural Family Planning are at work to find ways to remove barriers to family planning breastfeeding promotion efforts. Barriers include lack of or conflicting measures of program success along with lack of information on the breastfeeding/fertility relationship. The 2 organizations have taken the following steps to assist family planning organizations to increase their promotion and support of breastfeeding: identify current activities and potential barriers to breastfeeding promotion; develop guidelines for breastfeeding support and promotion; assess feasibility and impact of the guidelines; and disseminate the guidelines. Much remains to be done to integrate family planning and breastfeeding. The keys to success are: generating and communicating information which can be used readily by both the population and health policymakers in family planning programs; developing and disseminating guidelines and prototype materials which can be adapted to program needs; identifying, implementing, and evaluating programmatic ways to promote breastfeeding in community and clinical settings; and involving the population community -- at the local, national, and international levels, and in research, service delivery, policy, and training -- in an ongoing dialogue about the relationship of family planning and breastfeeding.
Draft team member contributions to mid-term evaluation of the Population and Family Planning Project (608-0171) in Morocco.
[Unpublished] 1988 Mar. 13 p.The draft team member contributions to the mid-term evaluation of the population and family planning project in Morocco examine current progress and address future needs. Increased awareness of at least 1 method of family planning was attributed to a USAID-funded project. But, problems of access, religious constraints, and lack of method-specific media campaigns need to be addressed. An increased effort to direct promotion efforts toward men is needed, as a prior immunization program showed that the husband was a key factor in encouraging mothers to bring their children to be vaccinated. Because the local health worker plays a critical role at the community level, training and support for these workers should be emphasized. Media-specific and audience-specific campaigns, by the government and private sector, should focus on the most cost-effective means of reaching the provincial level population. Donor organizations (such as UNICEF, UNFPA and USAID) should address the IEC needs identified by the central health education office, whose role and supporting functions need to be strengthened. Content of family planning materials must be method-specific, using a systematic methodology to address problems of inappropriateness, inadequate contraceptive mix, and lack of field worker training materials. Improved distribution methods for existing materials, as well as increased use of television and mass media are viable options. Using the community more effectively by encouraging leader motivation and instituting incentives could help to improve promotional and distributional activities at the provincial level. An evaluation of training needs revealed that the workshop method of training may be overemphasized, and most health workers expressed a desire for lengthened training. The private sector could be sensitized to public health issues and needs and, in conjunction with out of country technical assistance, produce effective social marketing of contraceptives within the Moroccan context. Coordination with other donors would be beneficial, with the exchange of documents and meetings between the groups.
[Unpublished] 1985. 78 p.A Population/Family Health Assessment was conducted in the Democratic Republic of Madagascar (GDRN) to review population and family planning activities and to make general recommendations for improvement, including the type of US Agency for International Development (USAID) population assistance that should be provided. Despite the fact that Madagascar's population of approximately 9 million is growing at a rate of 2.8% annually, meaning the population will double in less than 25 years, there is no official population policy. Yet, it is significant that the reduction of maternal and infant mortality and morbidity has been identified as an explicit goal in the health sector, and the country's actions long have reflected an attitude of acceptance and support of family planning. The private family planning association is recognized as a nongovernmental organization, which provides clinical and contraceptive services throughout Madagascar. The public health system offers no family planning services. Although the French law of 1920 forbidding the sale and use of contraceptives has not been rescinded, it is not enforced. The private family planning association now provides contraceptive services in 40 Ministry of Health facilities at the request of public health physicians, and the government has approved the participation of 35 medical and paramedical personnel in training courses as well as the installation of laparoscopic equipment in 8 medical facilities. Several other organizations provide child spacing services. Despite the efforts being made, the availability of contraceptive services remains limited, and contraceptive prevalence was estimated at 1% of women aged 15-49 in 1982. Several obstacles impede accessibility to contraceptive services and expansion of family planning programs, including a culture which favors large families, the strong influence of the Catholic Church, and a limited number of medical centers providing family planning services. Further, communication between the Office of Population and the Ministry of Health has not been the most favorable for the development of effective programs either area, but the recent naming of a physician to the position of Director of Population may facilitate closer collaboration. The recommendations made outline a general strategy for the initiation of population activities in the shortterm.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
Washington, D.C., International Science and Technology Institute, Population Technical Assistance Project, 1985 Aug 8. v, 7,  p. (Report No. 85-48-018; Contract No. DPE-3024-C-00-4063-00)The objectives of the consultation in Madagascar were to review existing policies and programs in population and family health, to assess government and nongovernment plans and capabilities to program implementation, to review other donor activities, to identify constraints impeding population and family planning activities, and to prepare recommendations for the US Agency for International Development (USAID) assistance to Madagascar. Although the government has no officially proclaimed population policy, there is increasing direct support of family planning. The private family planning association, Fianakaviana Sambatra (FISA) was officially recognized in 1967 and is permitted to import and distribute contraceptives. Sale of contraceptives in private pharmacies also is permitted. The major organization providing family planning services is FISA. The Ministry of Health (MOH) system does not include contraceptive services as part of its health care services, but at the request of MOH physicians, FISA provides services in 40 MOH facilities. Private pharmacies account for most of the contraceptive distribution, with oral contraceptives (OCs) being sold by prescriptions written by private physicians or, on occasion, by public health physicians. Contraceptive services also are provided in the medical centers of at least 3 organizations: JIRAMA, the water and electricity parastatal; SOLIMA, the petroleum parastatal; and OSTIE, a group of private enterprises that has its own health care system. A Catholic organization, FTK (Natural Family Planning Association) provides education and training in natural family planning. Demographic research has not been accorded a high priority in Madagascar. Consequently, the country's capabilities in the area are relatively limited. At this time, demographic research is carried out within several institutional structures. The major donor in the area of population/family planning is UN Fund for Population Activities (UNFPA). Activities of the UN International Children's Emergency Fund (UNICEF) in the area of health are relevant to the planned USAID assistance. For several years, USAID has provided population assistance to Madagascar through its centrally funded projects. Recommendations are presented in order of descending importance according to priorities determined by the consultation team: population policy; training/sensitization of the medical community; support to existing private voluntary organizations; demographic statistics and research; information, education, and communication; and collection and reinforcement of health statistics. In regard to population policy, assistance should be directed to 2 general objectives: providing guidance to the government in deciding which stance it ultimately wishes to adopt officially with regard to population; and encouraging the systematic incorporation of demographic factors into sectoral development planning.
POPULATION AND DEVELOPMENT REVIEW. 1986 Mar; 12(1):160-1.On September 25, 1985 M. Peter McPherson, administrator of the US Agency for International Development (USAID), announced that AID will reprogram $10 million originally earmarked for the UN Fund for Population Activities (UNFPA) to other family planning activities. Under recently enacted legislation, AID was required to withhold funding if UNFPA was found to "support or participate in the management of a program of coercive abortion or involuntary sterilization." McPherson concluded that sufficient evidence exists to indicate that UNFPA participates in the management of the China family planning program and also that implementation of China's 1-child per family policy has resulted in these abuses. The $10 million will be redirected to other voluntary bilateral population and family planning programs in Africa, Latin America and the Caribbean, Near East, and to US organizations that provide a variety of family planning services in developing countries. Reprogramming these funds reflects the Administration's policy to provide substantial support for voluntary family planning but firm opposition to abortion and coercive population control practices. AID's strategic plan includes providing 80% of the people in developing countries with access to a comprehensive range of family planning methods. AID currently spends $290 million on voluntary family planning programs in the developing world.
[Unpublished] 1986 Aug. 71,  p. (AID Contract No. DPE-3024-C-00-4063-00)The evaluation of the Resources for Awareness of Population in Development (RAPID II) Project was initiated on June 18, 1985, 25 months into the project operation, to determine if the results of actions undertaken thus far have been adequate to justify the time and money spent on them and to find ways to improve the efficiency and effectiveness of the program efforts. The objective of the 5-year RAPIDS II project is to assist those involved in development planning to better understand the relationship between population growth and socioeconomic development and thereby increase the less developed country (LDC) commitment to efforts designed to reduce rapid rates of population increase. This evaluation report discusses the development assistance context and then focuses on the following: RAPID II operations over the 1984-85 period; policy analyses and LDC subcontracting; the RAPID model and its presentation; visits by the evaluation team to the countries of the Dominican Republic, Ecuador, Cameroon, and Liberia; what works in terms of population policy development; some major problems and potential resolutions; and RAPID II activities over the 1985-88 period. US Agency for International Development (USAID) officials in Washington as well as in the field described RAPID II as being of continuing utility in helping to create a climate favorable to more effective population policies. The review of RAPID II activities was generally positive. The project was identified as useful in several countries of sub-Saharan Africa and Latin America. Due to the evidence of satisfactory performance in the field, the evaluation focused on differences between plan and midterm results with a view toward suggesting course corrections that can improve project performance. As population policy development is an inherently ambiguous field of activity, it has not been possible to draw clear lines between specific policy development activities and policy change in particular countries. Yet, there has been an improvement in the environment for population programs in LDCs. There were significant differences between planned and actual expenditures under the several subcategories of project expenditure. RAPID II total expenditures in the first 2 years of the project equalled budgeted expenditures when the contract was signed, but the distribution of expenditures by category was substantially different from what had been anticipated. It is recommended that emphasis in the project must shift predominantly to policy analyses (80% of remaining funds) and that that RAPID-style presentation resources (20%) be used carefully for only the highest priority requests. In regard to development of LDC subcontracts for policy analysis, efficiency has been low.
Boston, Massachusetts, John Snow, Inc., 1988 Mar. 33 p. (Population Projects Database)This document contains, in looseleaf format, reports generated from the Office of Population's Population Projects Database (PPD) which is now maintained by John Snow's (JSI) Family Planning Logistics Management Project. JSI will issue "The Woldwide Report on A.I.D. and IPPF Funded Population Activities," also known as the "Subproject Activities Report," on a semi-annual basis. The fiscal year (FY) 1986 to FY 1987 is now available. Issued on an annual basis will be "The Country Funding Attribution Report"; the report for FY 1987 is included in the binder under the heading: CA Cost Report. Also provided is a list of current contracts, an acronym list, and an instruction manual for filling in the questionnaire on which the porject reports are based. A blank section is also provided for any special reports requested by the user from the Population Projects Database. Using the subproject activities report and the CA Cost Report together provides a full picture of population activities worldwide. Both reports are organized by country and both attempt to capture actual expenditures in prior years and expected expenditures in the current and future years. The reports differ in the following ways: the Subproject Activities Report focuses on in-country activities, including those carried out by A.I.D. Missions and Regional Bureaus, Cooperating Agencies and the International Planned Parenthood Federation (IPPF). It includes activities covered under host country contracts, but does not include certain US-based activities of Cooperating Agencies which support the Office of Population programs or those contracts that provide support solely in the form of technical assistance. Both descriptive and financial information is provided. The CA Cost Reports covers all contracts issued directly to Cooperating Agencies by the Office of Population as well as Mission "buy-ins" to those contracts. It does not cover other activities of A.I.D. Missions and Regional Bureaus, host country contract or activities of other international agencies. It is purely a financial report and focuses on the way total contract expenditures have been allocated among various cost categories. Both reports are prepared in tabular format. The PPD, wich was started in 1983, includes information on more than 2400 population assistance project activies funded by A.I.D. in over 100 countries; it also includes 600 projects funded by the United Nations Population Fund (UNFPA) and about 100 projects fund by IPPF. Reports on specific topics can be requested from JSI.
[Unpublished] 1988 May 21. 18 p. (NCIH 15th Annual International Health Conference; Papers)This address covers the 3 phases of National Primary Health Care (PHC) Implementation in Nigeria from 1975 to the present. The concept for the implementation of the 1st phase was to build and equip health centers, then train and post health workers to the facilities. No attempt was made to involve the community, use appropriate health technology, or set up management systems (such as referrals, supplies, monitoring, and evaluation of the delivery system). In short, at the end of the planned period, nowhere in the Federation were services, as described in the Alma Atta Declaration, being delivered. Between 1980 and 1985, because of the failure of the Basic Health Services Scheme, the Federal Ministry of Health abandoned any attempt to set up a PHC system and began the implementation of vertical systems of health care. Within the Ministry, groups attached themselves to particular agencies, leading to severe fragmentation of the Ministry. The Ministry as a whole had ceased to pursue the goals of PHC and adopted new objectives agreeable to each donor agency. Since 1985, the present Nigerian administration has aimed at establishing local government by local government, with the nation's PHC system incorporating the existing vertical programs. The considerable resources available through many AID agencies, international organizations, and governments need to be harnessed to achieve Nigeria's goals. Nigeria must therefore be clear as regards what these are and how to achieve them, bearing in mind that most of these agencies and organizations have their mandates and objectives limiting the activities in which they may engage.
FRONT LINES. 1987 Sep; 27(8):8-9, 11.The USAID's mission in Nepal is to assist development until the people can sustain their own needs: although the US contributes only 5% of donor aid, USAID coordinates donor efforts. The mission's theme is to emphasize agricultural productivity, conserve natural resources, promote the private sector and expand access to health, education and family planning. Nepal, a mountainous country between India and Tibet, has 16 million people growing at 2.5% annually, and a life expectancy of only 51 years. Only 20% of the land is arable, the Kathmandu valley and the Terai strip bordering India. Some of the objectives include getting new seed varieties into cultivation, using manure and compost, and building access roads into the rural areas. Rice and wheat yields have tripled in the '80s relative to the yields achieved in 1970. Other ongoing projects include reforestation, irrigation and watershed management. Integrated health and family planning clinics have been established so that more than 50% of the population is no more than a half day's walk from a health post. The Nepal Fertility Study of 1976 found that only 2.3% of married women were using modern contraceptives. Now the Contraceptive Retail Sales Private Company Ltd., a social marketing company started with USAID help, reports that the contraceptive use rate is now 15%. Some of the other health targets are control of malaria, smallpox, tuberculosis, leprosy, acute respiratory infections, and malnutrition. A related goal is raising the literacy rate for women from the current 12% level. General education goals are primary education teacher training and adult literacy. A few descriptive details about living on the Nepal mission are appended.