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The level of effort in the national response to HIV / AIDS: the AIDS Program Effort Index (API), 2003 round.
Washington, D.C., USAID, 2003 Dec.  p.The success of HIV/AIDS programs can be affected by many factors, including political commitment, program effort, socio-cultural context, political systems, economic development, extent and duration of the epidemic , and resources available. Many programs track low-level inputs (e.g., training workshops conducted, condoms distributed) or outcomes (e.g., percentage of acts protected by condom use). Measures of program effort are generally confined to the existence or lack of major program elements (e.g., condom social marketing, counseling and testing). To assist countries in such evaluation efforts, several guides have been developed by the Joint United Nations Program on HIV/AIDS (UNAIDS), the World Health Organization (WHO), the United States Agency for International Development (USAID) and other organizations (see, for example, “Meeting the Behavioural Data Collection Needs of National HIV/AIDS and STD Programmes” and “National AIDS Programs: A Guide to Monitoring and Evaluation of HIV/AIDS Programs”). However, information about the policy environment, level of political support, and other contextual issues affecting the success and failure of national AIDS programs has not been addressed previously. (excerpt)
Measuring the level of effort in the national and international response to HIV / AIDS: The AIDS Programme Effort Index (API). Summary report.
Geneva, Switzerland, UNAIDS, . 24 p.UNAIDS, USAID and the POLICY Project have developed the AIDS Programme Effort Index (API) to measure programme effort in the response to the HIV/AIDS epidemic. The index is designed to provide a profile that describes national effort and the international contribution to that effort. The API was applied to 40 countries in 2000. The results show that programme effort is relatively high in the areas of legal and regulatory environment, policy formulation and organizational structure. Political support was somewhat lower but increased the most from 1998. Monitoring and evaluation and prevention programmes scored in the middle range, about 50 out of 100 possible points. The lowest rated components were resources and care. The API also measured the availability of key prevention and care services. Overall, essential services are available to about half of the people living in urban areas but to only about one-quarter of the entire population. International efforts to assist country programmes received relatively high rating in all categories except care. The results presented here will be supplemented later in 2001 with a new component on human rights. (excerpt)
Washington, D.C., LTG Associates, Monitoring, Evaluation and Design Support Project, 2002 Mar.  p. (PD-ABW-468; USAID Contract No. HRN-I-00-99-00002-00)The Nutrition Results Package is a ten-year program framework authorized in 1998. Under this authorization, The Food and Nutrition Technical Assistance (FANTA) project was awarded competitively in September 1998 to the Academy for Educational Development (AED) as the prime contractor, with Cornell University and Tufts University as subcontractors. The FANTA proposal included a memorandum of understanding with Food Aid Management (FAM), a consortium of Private Voluntary Organizations (PVOs), referred to as Cooperating Sponsors (CS), implementing Title II food aid development and emergency programs. The overall purpose of FANTA is "improved food and nutrition policy, strategy, and program development". Three Intermediate Results (IRs) were identified to achieve this purpose: USAID's and Cooperating Sponsors' nutrition and food security-related program development, analysis, monitoring, and evaluation improved, USAID, host country governments, and Cooperating Sponsors establish improved, integrated nutrition and food security-related strategies and policies, and Best practices and acceptable standards in nutrition and food security-related policy and programming adopted by USAID, Cooperating Sponsors, and other key stakeholders. (excerpt)
Measuring the level of effort in the national and international response to HIV / AIDS: The AIDS Program Effort Index (API).
Geneva, Switzerland, UNAIDS, 2001 Feb. 31 p.UNAIDS, USAID and the POLICY Project have developed the AIDS Program Effort Index (API) to measure program effort in the response to the HIV/AIDS epidemic. The index is designed to provide a profile that describes national effort and the international contribution to that effort. The API was applied to 40 countries in 2000. The results show that program effort is relatively high in the areas of legal and regulatory environment, policy formulation and organizational structure. Political support was somewhat lower but increased the most from 1998. Monitoring and evaluation and prevention programs scored in the middle range, about 50 out of 100 possible points. The lowest rated components were resources and care. The API also measured the availability of key prevention and care services. Overall, essential services are available to about half of the people living in urban areas but to only about one-quarter of the entire population. International efforts to assist country programs received relatively high rating in all categories except care. The results presented here will be supplemented later this year with a new component on human rights and a score that compares countries on program effort. (excerpt)
Seattle, Washington, PATH, 2001 Dec 28.  p.For the past 24 years, PATH has been developing, adapting, transferring, and introducing appropriate new health technologies for resource-poor populations. In 1987, USAID started funding PATH’s work in this area through a cooperative agreement with PATH called the Technologies for Child Health: HealthTech program. This agreement was renewed in 1990 and then again in 1996 as the Technologies for Health program (HealthTech III). This report primarily summarizes the activities under the program during the last agreement, but also reflects work under the entire term of HealthTech since so much of the work is a continuum. The primary goal of HealthTech has been to identify health needs that can be met with technology solutions, and then either identify existing technologies that need adapting to be affordable and appropriate, or develop new ones. This research and development phase includes design, development, scale-up, evaluation in the laboratory and field settings, and finally introduction of technologies for health, nutrition, and family planning. Over the last ten years, HealthTech has effectively scaled up these activities and developed a critical mass of in-house expertise in product and diagnostic design, engineering, evaluation, and introduction of developing world technologies. Multiple collaborations with private industry and global and local agencies and nongovernmental organizations (NGOs) have been established. Under HealthTech and other similar programs, PATH to date has worked with 57 private-sector companies (21 U.S. firms, 14 additional industrial-world firms and 22 developing-world firms) and at least 40 public-sector partners (22 in the developed world and 18 in developing countries). The results of these collaborations have been to advance more than 30 economically sustainable technologies—17 of which are now in use in more than 25 developing countries. Six of these products are currently being (or have been) distributed worldwide by global agencies. (excerpt)
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 1997. , 38,  p. (Report; USAID Contract No. HRN-C-00-93-00031-00)An intergovernmental team visited Tanzania on June 17-26, 1997, to review the experience of the Expanded Program on Immunization (EPI) that received a grant from US Agency for International Development Africa Bureau to UN International Children Emergency Fund. During the visit, a series of interviews were conducted and the results are enumerated. The major finding of the visit was that health sector reform, recently initiated in Tanzania with an emphasis on decentralization and integration of certain functions at the central level, is leading to an reorganization in the management and delivery of immunization services. Moreover, the EPI was able to achieve and maintain high coverage rates despite severe challenges of economics, geography and infrastructure. However, the sustainability of the achievements of the EPI is challenged by three developments. First, the health reform sector is leading a substantially different role for EPI. Second, the introduction of special disease control initiatives requires intensified and highly organized activity for the successful implementation of National Immunization Days, as well as technical proficiency at all levels, creativity, and strong management for effective disease surveillance. Lastly, the assurance of a reliable supply of essential commodities remains an ongoing concern as donors shift their interests and modes of funding for supporting health activities. Team recommendations are enumerated.
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, John Snow, Inc., Resources for Child Health Project (REACH), 1989 Apr. , 102 p. (USAID Contract No. DPE-5927-C-00-5068-00)A review of 28 reports from the cost-effectiveness literature published between 1979 and 1987 which evaluated the Expanded Program on Immunization (EPI) was undertaken by the Resources for Child Health Project (REACH) for the Program and Policy Coordination Bureau of the USAID as part of the Immunization Sustainability Study. The objectives were to assess the quality of cost-effectiveness studies of the EPI and to determine whether these data were a sufficient basis for generalization relationships between program costs and coverage levels in the future. In 1985, the Pan American Health Organization (PAHO) committed itself to the eradication of polio virus from the region by 1990. PAHO's preliminary analysis for 19 countries showed that more than $450 million was committed to the Plans of Action was 85% financed by government resources. By 1988, worldwide immunization coverage reported for the third doses of DPT and polio vaccine has surpassed the 50% level in both developing and developed countries. UNICEF was accelerating the EPI to achieve Universal Childhood Immunization (UCI). USAID funding for immunization increased from $30 million in 1985 to $51 million in 1988, and the agency strove for universal immunization by 1990. USAID also funded efforts made by PAHO, the Rotary International, and UNICEF toward global eradication of polio and universal childhood immunization by 1990. The average cost per fully immunized child was $13 which was within the specified range of $5-$15 per child presented at the Bellagio Conference in 1984. Routine services through fixed facilities cost $11.74 per fully immunized child. Immunization campaigns cost $15.62 per fully immunized child. Immunization programs in Africa have lower average costs than those in Asia between $12.26 and $16.41 for all strategies. For routing services through fixed facilities, the proportion of government contribution was 55% of total; it diminished to 40% for campaign strategies. International organizations and donor agencies covered EPI costs (such as vaccines, syringes, cold chain equipment, vehicles, and local training costs). The Mauritania national campaign had a cost-effectiveness ratio of almost 1/2 that of the campaigns in Cameroon and Senegal because of a smaller urban target population, while greater numbers of doses of vaccine were administered in Senegal than in Mauritania. A cost- effectiveness study protocol is needed to standardize basic costing and effectiveness terminology and methods and to address the needs of program managers and policy makers.
National Program on the Control of Diarrheal Diseases. Report of the Joint MOH / WHO / UNICEF / USAID Comprehensive Program Review, 28 January to 11 February, 1985.
Manila, Philippines, Ministry of Health, 1985. v, 36 p.In early 1985, representatives of the Philippines Ministry of Health, WHO, UNICEF, and USAID visited health facilities (barangay health stations to hospitals) and used data from 9106 households (11,131 children under 5 years old) in the provinces of La Union, Bohol, and Bukidnon in the Philippines, to evaluate implementation and effect of the National Program on the Control of Diarrheal Diseases (CDD). 10.8% of the children had had diarrhea within the last 2 weeks. Mean diarrhea episode/child/year stood at 2.8. Mean infant mortality was 62.3/1000 live births (35.8 in La Union to 94 in Bukidnon). Diarrhea-related mortality for all children studied ranged from 3 in La Union to 18.3 in Bukidnon (mean = 8.6). Between 1978 and 1982, the diarrhea-related mortality rate for all of the Philippines fell from 2.1 to 1, presumably due to the CDD Program. Diarrhea was the leading cause of death in Bukidnon (21.3%), but in La Union and Bohol, it was the 5th leading cause of death (6.6% and 10.3%, respectively). 33% of children with diarrhea received oral rehydration solution (ORS), 12% did not receive any treatment, and 72% received herbs, antibiotics, or antidiarrheals. Many of the children receiving ORS also received other treatments. 86% of mothers were familiar with ORS and 73% of them had used it. 92% would use it again. 84% would buy it from stores, if sold. Government health facilities tended to use ORS and to prescribe it for diarrhea cases. Most facilities had successfully promoted breast feeding. The supply of ORS packets in most facilities was good. Almost all health personnel had received ORT training. Some recommendations included promotion of non-ORT strategies (e.g., hand-washing and food safety), conducting research (e.g., to identify suitable fluids and foods for home-based oral rehydration therapy, and regular monitoring and evaluation of the CDD Program.
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.
Washington, D.C., U.S. Agency for International Development, Center for Development Information and Evaluation, Bureau for Program and Policy Coordination, 1989 Aug. vi, 7 p. (A.I.D. Evaluation Occasional Paper No. 32)A comprehensive survey of social scientists who received financial support for overseas graduate training from an International Donor Agency focussed on the contribution of such training to the national building efforts in the social science discipline. A questionnaire was mailed to 1506 participants in Asian countries, which included 562 USAID trainees. The findings suggest that 1) trainees considered the social assistance provided by the agencies to be adequate, even though difficulty was experienced in travel and immigration arrangements, 2) problems encountered on return to their countries were mainly employment-related, due to either lack of equipment, institutional interest in research, or inadequate economic rewards. In addition, non-availability of professional books, lack of opportunities to attend overseas professional meetings and difficulty in getting information on developments in their major were factors which reduced further professional development. Most participants indicated that the knowledge and skills acquired from their training proved to be valuable. Furthermore, this data does not support the hypothesis that overseas trained participants gravitate to industrialized nations. It was found that in Asia such training provided the much needed expertise to lay the foundation for empirical research. Major concerns of the participants were the 1) underepresentation of women in such training programs, 2) lack of proficiency in English of participants, and 3) loss of contacts between participants and funding agencies.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care, 1988. 51,  p. (USAID Contract No. AID/DPE-5927-C-00-3083-00)Personal interview, site visits to Regions VII and VIII (Philippines), and record reviews were the principal methods used to evaluate the Oral Rehydration Therapy (ORT) component of the Primary Health Care Financing (PHCF) Project designed to increase the use of oral rehydration therapy as a primary preventive measure against diarrheal death among infants and young children. The project is designed to increase ORT utilization through a 2-pronged approach which creates demand for ORS products through training physicians, nurses, midwives, and health educators in the public and private sectors; and information, education, and communication campaigns to promote ORT among the public. The most serious concern regarding clinical training was the poor quality of case management observed in regional, provincial, and district hospitals. There seems to be no national plan or budget for the production of print materials to support IEC program activities. A wide disparity was found between projected demand and actual use of ORS, called ORESOL. The present distribution practices of the Department of Health translate to oversupply or nonavailability of ORS. Private sector pharmaceutical firms take a limited/traditional approach to product distribution, and commercial distributors capable of reaching the rural population should be identified and encouraged to market ORS.
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.
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.
Arlington, Virginia, International Science and Technology Insitute, Population Technical Assistance Project, 1987 Jul 15. ix, 66,  p. (Report No. 86-099-056)This evaluation of the village family planning program in Indonesia is prepared for USAID, which has supported the program for 15 years, and is to complete support in 1986. It is in general a positive evaluation, prepared by interviews, and visits to 7 out of 27 Provinces, 14 out of 246 Kabupatens (Districts), and 16 Villages. Village distribution centers have increased 38%, new acceptors by 38%, continuing user levels by 57%, and overall contraceptive prevalence by 38%. Access to varieties of contraceptives, especially longer acting methods, has improved, and costs per capita have decreased. Some problems were pointed out, generating several recommendations: physical conditions of the clinics need attention; motivation by consciousness raising has not been matched by better knowledge; the surgical program needs to be expanded; self-sufficiency in cost recovery should be fostered; operations research is needed on payment for field workers and volunteers; and social marketing should be expanded. USAID should continue support for the Outer Islands. In a final list of recommendations were the suggestions that USAID assist clinical programs further, support training of field workers, do more statistical review, continue to support the IEC program, operations research on community-based distribution, and program integration.
Evaluation of the USAID grant to the International Center for Diarrheal Disease Research, Bangladesh: Maternal and Child Health/Family Planning Extension Project.
Arlington, Virginia, International Science and Technology Institute, Population Technical Assistance Project, 1986 Sep 18. xi, 23,  p. (Report No. 85-68-039)This report evaluates a US Agency for International Development (AID) grant to the International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B), which supports the Maternal and Child Health/Family Planning Extension Project (EP). The EP operations research effort was initially designed to replicate the Matlab model in 2 upazilas, but shifted to an effort to initiate new approaches. Of the 13 major experiment undertaken during the project's 4-year history, over half have adopted by the Ministry of Health and Population Control, including a plan to add 10,000 female welfare assistants to the existing cadres. Considering the accomplishments of the EP to date, there is strong justification for continued funding of the project, at least until 1990 when the government's 5-year Plan concludes. It is recommended that the project's emphasis should continue to be to test various alternative strategies for improved implementation of family planning/maternal-child health programs within the overall framework of a limited number of clearly defined project objectives. The task of analyzing incremental costs should be given higher priority in the next 5 years and project documentation should be refined. The decision as to whether the project should be funded after 1990 or phased out should be deferred until a later date. Also presented in this report are specific recommendations regarding the selection of research topics, research procedures, dissemination of research results, addition of new staff, filling of staff vacancies, and Population Council involvement.
World Education Reports. 1985 Nov; (24):15-7.In the last decade we have come to radically redefine our understanding of how women fit into the socioeconomic fabric of developing countries. At least 2 factors have contributed to this realignment in our thinking. 1st, events around the UN Decade for Women dramatized women's invisibility in development planning, and mobilized human and financial resources around the issue. 2nd, the process of modernization underway in all developing countries has dramatically changed how women live and what they do. In the last decade, more and more women have become the sole providers and caretakers of the household, and have been forced to find ways to earn income to feed and clothe their families. Like many other organizations, USAID, in its current policy, emphasizes the need to integrate women as contributors to and beneficiaries of all projects, rather than to design projects specifically geared to women. Integrating women into income generation projects requires building into every step of a project--its design, implementation and evaluation--mechanisms to assure that women are not left out. The integration of women into all income generating projects is still difficult to implement. 4 reasons are suggested here: 1) resistance on the part of planners and practitioners who are still not convinced that women contribute substantially to a family's income; 2) few professionals have the expertise necessary to address the gender issue; 3) reaching women may require a larger initial investment of project funds; and 4) reaching women may require experimenting with approaches that will fit into their village or urban reality.
Washington, D.C., SOMARC, .  p.This document contains briefing materials for the participants of an upcoming meeting of the advisory council and working groups of Social Marketing for Change (SOMARC), an organizational network, funded by the US Agency for International Development (USAID) and composed of 5 firms which work together in helping agencies, organizations, and governments develop contraceptive social marketing programs. Social marketing is the use of commercial marketing techniques and management procedures to promote social change. The briefing materials include 3 background and 18 issue papers. The background papers provide brief summaries of USAID's population activities and of the history of social marketing programs, an overview of USAID sponsored contraceptive social marketing programs in 14 countries and of 3 major non-USAID programs, and a listing of the skills and resources needed to develop effective contraceptive social marketing programs. The issue papers provide a focus for the discussion sessions which are scheduled for SOMARC's working groups on marketing communication, management, and research. USAID's objective is to promote the development of family planning programs which are completely voluntary and which increase the reproductive freedom of couples. Contraceptive social marketing programs are consistent with this objective. USAID provides direct funding for family planning programs as well as commodity, technical, and training support. USAID's involvement in social marketing began in 1971, and USAID is currently sponsoring programs in Jamaica, Bangladesh, Nepal, El Salvador, Egypt, Honduras, Ecuador, the Caribbean Region, Costa Rica, Guatemala, and Peru. In the past, USAID provided support for programs in Mexico, Tunisia, and Ghana. The Mexican project is now functioning without USAID support, and the projects in Tunisia and Ghana are no longer operating. Major non-USAID contraceptive social marketing programs operate in India, Sri Lanka, and Colombia. These programs received only limited technical support from USAID. To ensure the success of social marketing programs, social marketers must have access to the knowledge and skills of commercial marketers in the areas of management, analysis and planning, communications, and research. Social marketers must also have expertise in social development and social research. In reference to the issue papers, the working groups and the advisory council were asked to develop suggestions for 1) overcoming social marketing program management problems, 2) motivating health professionals toward greater involvement in social marketing programs, 3) improving the media planning component of the programs, 4) improving management stability and training for management personnel, and 5) improving program evaluation. Areas addressed by the issue papers were 1) whether social marketing programs should be involved in creating a demand for contraceptives or only in meeting the existing demand, 2) the development of a methodology for assessing why some programs fail and others succeed, 3) the feasibility of using anthropological and questionnaire modules for conducting social marketing research, 4) techniques for overcoming the high level of nonsampling error characteristic of survey data collected in developing countries, 5) techniques for identifying contraceptive price elasticity, 6) the feasibility of using content analysis in social marketing communications, 7) the applicability of global marketing strategies for social marketing, and 8) how to select an an appropriate advertising agency to publicize social marketing programs.
Evaluation of the Population Council's International Awards Program on the Determinants of Fertility.
[Unpublished] 1984. 51 p.This evaluation of the effectiveness of the International Awards Program on the Determinants of Fertility, administered by the Population Council and funded by the US Agency for International Development, Office of Population, addresses 8 aspects of the Awards Program: the review process, solicitation and development proposals, orientation of approved projects, AID's role in the Awards Program, management, dissemination, and funding. Also considered is AID's potential role in population policy research. Recommendations are made about AID's role in social science research on population, the participation of the Population Council in such research, and specific aspects of the present program. It is concluded that AID should continue to support social science research which focuses on the determinants of fertility in developing countries and which is relevant to population policies in developing countries. This research should be administered by an independent organization. AID should also commission an account of social science research projects which have been important in providing direction for population policies. The Population Council is best suited to direct a program on the determinants of fertility in developing countries and a continuation of the present awards program should be administered by them. In order to improve the contribution of social science research, it is recommended that the Council take steps to increase the pool of applicants for the Awards Program and establish regular contact with AID regional population officers. The Council should also prepare plans for the dissemination of results of projects supported by the Awards Program. Finally, it is recommended that AID and the Council try to coordinate future data collection activities with the research activities supported by the Council's Awards Program.
Grass roots, herbs, promoters and preventions: a reevaluation of contemporary international health care planning. The Bolivian case.
Social Science and Medicine. 1983; 17(17):1281-9.In evaluating a United States Agency for International Development (USAID) project in Bolivia, the author argues that the program unwittingly contributed to the situation that created Bolivia's political problems. A 5-year pilot project which covered 39 villages and colonies in the Montero district in the state of Santa Cruz began in 1975 and was completed in 1980. In 1980 the project was "deobligated" when all but essential economic aid to Bolivia was halted following a political coup. The pilot project was based on 1) community participation through health care; 2) a referral system from health post of the promotor to the center with an auxiliary nurse midwife, to secondary and tertiary care in hospitals by physicians; 3) an emphasis on preventive medicine; and 4) the use of traditional medicine along with other therapy by the promotor. Although these concepts sound appropriate, they are in fact derived from contemporary thought in advanced industrial societies. The assumptions about social reality that are inherent in these plans actually misconstrue Bolivian society. The unintended consequences of the project actually diminish rural health care. A difference between the Western health planner's conception and the Bolivian conception--of community, of effective referral systems, of preventive and indigenous medicines--can have the effect of producing a health care program that has little resemblance to what was originally intended. The Bolivian elite actually manipulated the USAID health care programs through hegemony in the villages. The Jeffersonian concept of community is not applicable in Bolivia where resources are only exchanged through personal contacts. In villages of multiple class or ethnic groups or both or in villages with close ties or histories of ties with larger, more cosmopolitan groups, multiple different interests exist. These work against each other to prevent the very cooperation envisioned by the health care programs. The author suggests that developed countries should consider native ideologies, native social relations, and indigenous medicine more sensitively in design.
[Unpublished] 1981. 267 p. (Authorization: Ltr. AID/DS/POP: 2/12/81; Assgn. No. 582059)The major purposes of this evaluation were to assess Pathfinder's program of in-country assistance to family planning projects. A 2-part framework was followed. The general evaluation considered the organization's policy, including the composition and functions of the board, the project development strategy, and future planning; the management structure in Boston and in the field and program support; and project management. The country evaluation framework considered the country background in terms of demographics, overall family planning services, population policy, and laws and legislation; organizational structure and program support of Pathfinder management; several aspects of project management including project descriptions, design and selection, implementation and monitoring, and evaluation; and project effectiveness. Regional evaluations were separately prepared for Africa, Latin America, and Asia and the Middle East. Within the African region country reports and evaluations of specific projects in Nigeria, Kenya, and Zaire are presented; in Latin America reports are included for Brazil, Peru, Guatemala and Colombia; and in Asia and the Middle East reports were prepared for Indonesia, Bangladesh and Egypt. General recommendations are applicable to the overall program and recommendations and suggestions specific to a region, country or project are included in the individual regional reports. In general terms the team concluded that the Pathfinder Fund is using the USAID grant effectively. Specific projects are innovative, and no major insurmountable problems in the field were noted.
[Unpublished] 1978. 23 p. (Authorization: Ltr. POP/FPS: 6/7/78; APHA Assign. No. 1100-110)This report of a 1978 evaluation of the Pathfinder Fund focuses on the Fund's management structure and methods. 3 regional reports appear in separate documents. The evaluation team concluded that the Pathfinder programs have been administered effectively and have met assigned objectives over the past 2 years, but recommended some changes within the top management structure, especially a more balanced Board with greater representation of family planning and population professionals. The team recommended that Pathfinder continue its tradition of support for innovative, relatively small and high risk programs while also supporting longer term, larger scale efforts especially those with potential for innovation. The Pathfinder Fund should continue to seek private donor support to enable participation in projects not approved by AID. Pathfinder Fund projects in the 10 countries visited varied widely but generally appeared to be innovative, well-designed, and well-administered. Pathfinder Fund policy of recruiting regional and country administrators who are native to their area is believed to be 1 reason for its success.
[Unpublished] 1982. 19 p.The Integrated Population and Development Planning project (IPDP) has led to many diverse activities in 22 countries. The project consists of technical assistance, training, and research which have been evaluated insofar as each contributes to the objectives of the project. One part of the evaluation examines the Mauritania Human Resources Planning Model, Thailand Cost Benefit Analysis, the relationship between IPDP and The Futures Group, the role of the African Regional Office in Lome, Togo, and the quality of staffing of the IPDP; the 2nd part deals with project management issues. The following recommendations are made: 1) future activities should be concentrated in no more than 10 countries, 2) a special workshop should be convened to reexamine the entire issue of population and development policy, particularly as it related to sub-Saharan Africa, 3) future conferences should be planned as workshops or as short courses and be oriented towards mid-level staff, 4) no new research should be solicited, 5) technical assistance should be available not only to ministries of planning but to other ministries as well, 6) mini-courses should be developed in computer science, demography, statistics, and the economics of population in host countries, and individuals sent to short-term courses in the region or, if preferable, in the U.S., 7) the IPDP core staff should be maintained at its 1981/82 strength over the remaining term of the project, 8) present activities should be continued and adequately financed so that real impact on population policy may be achieved, and 9) the US Agency for International Development/Washington Contract Office should review internal procedures to expedite contractor requests for consultant approval.
Washington, D.C., U.S. Agency for International Development, Aug. 1983. 92 p. (U.S. Agency for International Development. Program Evaluation Report; No. 9)This paper presents the results of an independent evaluation of the initial US assistance for the new government of Zimbabwe. The evaluation team examined the major part of this assistance--a reconstruction program grant of US$20 million and a US$2 million project grant for the rebuilding of rural health clinics. The aid program had 3 objectives: 1) political; 2) macroeconomic--increasing limited foreign exchange and decreasing the budget deficit; 3) programming local currencies to meet the pressing needs of rural areas. On the most basic levels, USAID accomplished its goals, but with shortcomings. In the rural areas, recognition that US assistance had contributed to the reconstruction efforts was practically nonexistent. The rural health clinics, while rapidly reconstructed, suffered from a lack of drugs, equipment and adequate inspection. Both the project and cash grant modes of assistance as structured were appropriate in assuring speed and flexibility for delivery of aid. Implementation, monitoring and evaluation should rest with the government of Zimbabwe, with AID exercising sufficient oversight to assure the effectiveness of these processes. AID should shape its assistance along lines compatible with Zimbabwe procedures which have proven effective in the past. From this assistance program it was learned that AID has a range of foreign assistance tools available. AID can respond flexibly and quickly when political priorities are clear and sufficiently important. A strategy for achieving political benefits from the aid should be established and its progress regularly assessed. This program experience suggests the need for more flexible forms of assistance.
Summary of the expert meeting on AID demographic and family planning data collection and analysis needs (september 21-22, 1983).
[Unpublished] 1983. v, 37 p.The purpose of the meeting is identified as providing USAID with guidance on the collection, analysis, and use of demographic and family planning data. The context for the meeting was the cutbacks in USAID's demographic portfolio, and the resultant need to examine the tradeoffs involved in various areas of data collection and analysis assistance. 4 major donor organizations--USAID, the United Nations Fund for Population Activities, the World Bank, and the Rockefeller Founation--described their data collection and analysis programs and activities. Discussion focused on 3 areas of concern: 1)data collection methods; 2) data collection/analysis tools and techniques; and 3) types of data. In addition, a number of issues were raised, including the use of data to influence policy makers, the need for country of region-specific decisions about data collection and analysis, the need for training, the importance of an archive function to preserve the data from the World Fertility Survey (WFS) and other surveys, and the need for cost-effectiveness and cost-benefit analyses. Conclusions reached form a series of recommendations for USAID, 2 mechanisms were used to elicit recommendations on USAID priorities from participants. 1st, a list of points of general agreement was drawn up. These points were read to the group, discussed, and revised accordingly. They appear as Table ES-1, "Points of General Agreement on AID Priorities." The 2nd mechanism was a poll of particopants, asking them to assign priority rankings to a list of suggested potential areas of USAID activity. This list was discussed and revised by participants before the scoring took place. (author's modified)