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Report of the evaluation of UNFPA assistance to the National Family Planning and Sex Education Programme of Costa Rica.
[Unpublished] 1980 Mar. 89 p.This report of the evaluation of UN Fund for Population Activities (UNFPA) assistance to Costa Rica's National Family Planning and Sex Education Program covers the following: 1) project dimension and purpose of the evaluation, scope and methodology of the evaluation, composition of the mission, and constraints; 2) background information; 3) 1974-77 family planning/sex education program (overview, immediate objectives, strategy, activities and targets, and institutional framework); 4) planned and actual inputs and rephasing in 1978-79; 5) family planning activities (physical facilities and types of services provided, recruitment of new users, continuation of users within the program, distribution of contraceptive supplies, sterilizations, and indicators of program impact); 6) training and supervision; 7) education, information, and communication (formal and nonformal education, educational activities in the clinics, and the impact of the nonformal educational program); 8) maternal and child health (maternal health indicators, cytological examinations, and infant mortality); 9) program evaluation and research; 10) population policy; 11) program administration; 12) some general conclusions regarding the performance of the program; and 13) the program beyond 1979. UNFPA evaluations are independent, in depth analyses, prepared and conducted by the Office of Evaluation, usually with the assistance of outside consultants. The process of analysis used in the evaluation follows a logical progression, i.e., that which underlines the original program design. Evaluation assessment includes an analysis of inputs and outputs, an investigation of the interrelationship among activities, an indication of the effectiveness of activities in achieving the objectives, and an assessment of duplication of activities or lack of coverage and the effect of this on realization of the objectives. The program was able to expand the coverage of family planning activities but has been unsuccessful in having a population policy established. The number of hospitals, health centers, and rural health posts providing family planning services was tripled in the 1974-77 period. The program could not achieve its targets in number of new users, and it recruited in 1977, only 11% of the total population of the country, against the 20% planned. It has been estimated that between 1973-77 around 231,200 births or 44.4% of those possible had been averted. Training and supervision has been a weak area of the program. A large number of professors have been trained in sex education, but no evaluation has been undertaken of the likely impact of this trained staff at the school level. The information, education, and communication (IEC) program has been successful in taking information and education to the population on family planning/sex education concerns but less successful in motivating the political groups to formulate a population policy.
In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 11-7. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)In developing countries systems of "bare-foot doctor" health care are being used. The goal is to provide a health service that is within the reach of each individual and family in the community, is acceptable to participants, that entails their full participation at a cost suitable to the individual and the nation. As opposed to hospital oriented Western medicine, there is usually a health officer from the local community, trained and provided with a dispensary, who returns to the home community. 2 projects in progress which were having negative results, 1 in Zaire and 1 in Senegal, were evaluated. The principles which redirected the programs are discussed. Problems such as mobile centers versus fixed sites for health centers, single aim projects and self-administration of the centers are explored. The acceptance of responsibility by the local public by using funding and resources of its own was judged to run the least risk of failing in the long term. In Senegal a new law on administrative reform was passed which allowed district health committees dealing with about 100,000 people to be set up. With a system of self-financing, more than 500,000 people were treated in 3 years. The fees were modest and 65% of the income from fees was used to keep drug supplies up to date. 3 dangers were identified and overcome: risk of embezzlement by district treasurers, overconsumption of drugs, and stocking excessively expensive products. The basic conditions necessary to provide an efficient network of health services in a rural environment (Zaire) and an urban environment (Senegal) are joint financing of activities through contractual financial participation, local administration, improved medical personnel, standardized medical procedure, and continuous supervision in collaboration with non-professional health workers.
[Unpublished] 1980. 30 p. (Authorization: Ltr. POP/FPS 11/19/1979; Assgn. No. 582-008)The authors assessed the International Planned Parenthood Federation assisted Community Based Family Planning Services Project, also known as the Contraceptive Retail Sales Project (CRS) for Greater Cairo. USAID wanted to determine the feasibility of expanding the project to other urban areas of Egypt, perhaps eventually linking up with family planning service programs and projects being developed in rural areas. The team evaluated such key project elements as product selection, branding, packaging, pricing, marketing research, promotion, distribution, and management. Concurrently, the team held extensive discussions with advertising specialists, commercial distributors, doctors, pharmacists, professors of medicine, government officials, members of the project staff, USAID officials, and the project Board of Directors. The team recommended unanimously that USAID support the Project's consolidation of Greater Cairo activities and the eventual expansion of the project to other urban areas of Egypt. The project has matured enough to warrant support in funding and technical expertise, and in the supply of commodities. The provision of such support would be consistent with the basic rationale for AID involvement with other similar projects. It was recommended that a U.S. contractor, nonresident in Egypt, be engaged to facilitate AID support. Use of the contractor vehicle seemed the only practical choice, given AID staff limitations, the intricate continuing relations with Egyptian Government officials, and the complicated coordination of activities with IPPF, the Egyptian Family Planning Association, and the Project's Board of Directors. The project requires rapid provision of expert technical services. Marketing research, advertising, promotion, volunteer operations, accounting, and management skills are among the types of expertise required. A major contractor responsibility would be to judge when and where to apply resources. The effectiveness of the investment would be greatly diminished if these skills were not applied appropriately. (Author's modified)