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Belize City, Belize, Ministry of Health, 1984. , 54 p. (EPI/84/003)An evaluation of the Expanded Program on Immunization (EPI) in Belize was conducted by the Pan American Health Organization/World Health Organization at the request of the country's Ministry of Health. The evaluation was undertaken to identify obstacles to program implementation, and subsequently provide national managers and decision makers with viable potential solutions. General background information is provided on Belize, with specific mention made of demographic, ethnic, and linguistic characteristics, the health system, and the EPI program in the country. EPI evaluation methodology and vaccination coverage are presented, followed by detailed examination of study findings and recommendations. Achievements, problems, and recommendations are listed for the areas of planning and organizations, management and administration, training, supervision, resources, logistics and the cold chain, delivery strategies, the information and surveillance system, and promotion and community participation. A 23-page chronogram of recommended activities follows, with the report concluding in acknowledgements and annexes.
Civil registration and vital statistics in the Africa region: lessons learned from the evaluation of UNFPA-assisted projects in Kenya and Sierra Leone.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. viii, 25 p.To review the experience of vital statistics and civil registration in the Africa Region, projects in 2 countries were evaluated in-depth: the Civil Registration Demonstration in Kenya and the Strengthening of the Civil Registration and Vital Statistics System in Sierra Leone. Based on these project evaluations and on experience in the area of data collection and project implementation in other parts of the Africa Region, specific observations/conclusions and recommendations are made in 5 areas. 1) United Nations Fund for Population Activities (UNFPA) support for civil registration is justified if and when it can be expected to produce vital statistics which are not less reliable than estimates derived from censuses and surveys. 2) Regarding project strategy, a gradually expanding registration area is preferable in countries in the Africa Region which have extensive rural areas. 3) A thorough assessment of the registration hierarchy is required when establishing new methods and procedures for civil registration. In deciding upon the topics to be included in the region records, usefulness, collectability and neutrality of the inputs are important criteria. 4) Regarding project inputs, Governments may wish to choose an existing organization which has a large field staff and a bureaucratic hierarchy to undertake civil registration activities. In this way these activites could then be added on as new functions of existing posts. The careful selection of types of equipment and supplies greatly affects the implementation of civil registration activities and external resources are required in many projects for vehicles and paper for registration forms. 5) While the projects evaluated have followed the procedures for monitoring through the submission of Project Progress Reports and the holding of Tripartite Review Meetings, the monitoring system has not served as a triggering mechanism for actions. This is mainly due to the lack of follow-up by the governments, and executing and finding agencies of the monitoring reports, and at times, the absence of key technical and administrative persons at Tripartite Review Meetings. Recommendations made concerning these conclusions are addressed to the governments of the Region to improve their civil registration systems; some are addressed specifically to UNFPA and the United Nations Department of Technical Cooperation for Development to improve their assistance to governments.
General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.
New York, New York, UNFPA, 1984 Dec. iv, 41 p.4 maternal-child health/family planning (MCH/FP) projects were evaluated by the United Nations Fund for Population Activities (UNFPA) in the Southern Africa Region between 1981-1984. The projects were in Botswana, Malawi, Swaziland and Zambia. An overriding finding at the time of the Evaluation Missions was the acceptance of family planning (child spacing) by all 4 governments, when at the onset of the projects, family planning was either not included in the project documents or was included only as a minor contributant to the MCH programs. The intervention by UNFPA was very important for the acceptance and promotion of family planning activities by the governments. The Evaluation Missions concluded that there were 3 primary reasons for the successful intervention: UNFPA has a broad mandate to provide assistance in MCH and FP, a commitment to development projects in line with the governments' priorities, and the ability to fund projects very quickly, facilitating project implementation. Each of the 4 projects is assessed in terms of population policy changes, MCH/FP program strategy and serive delivery, organization of the MCH/Fp unit, health education, training, evaluation and research systems, and administration and management. Essential factors affecting the project are outlined and recommendations made. The last section discusses general lessons derived from the MCH/FP projects evaluated. 5 areas are identified where similar problems exist to varying degrees in all the projects evaluated. These are: training of medical personnel in FP (the main MCH/FP service provider in these projects was the nurse/midwife); supervision of personnel and the supply and distribution of contraceptives; research and evaluation, especially regarding the sociocultural setting of target populations and the inadequacy of existing service statistics and other sources of data; project monitoring (technical and financial) and finally project execution by the World Health Organization (WHO). Specifically in regard to the recruitment of experts, the provision of supplies and equipment, and the provision of funds for local costs, WHO execution has been deficient.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xii, 39,  p.Most family life education (FLE) projects included in this evaluation have the longterm objectives of reducing the incidence of teenage prognancy, and promotion of self-reliance and positive, responsible behavior among youth. The immediate objectives and project strategies are also very similar across projects, e.g., in-school and out-of-school FLE, comprehensive youth services, including family planning (FP) and training. The evaluation shows that project design has improved over the years (clearer and measurable formulation of objectives, more comprehensive workplans and better explanation of budgetary items) and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. However, the Evaluation Mission in concerned that due to the similarities in project design, country-and-time-specific factors have not always been adequately taken into consideration. Other concerns include the lack of systematic needs assessment and use of baseline data to guide implementation. All the projects evaluated have contributed to the training in FLE/FP of a large number of family life educators, teachers and nurses and have thus significantly strengthened professional national capability. Nevertheless, training needs still exist in motivational/attitudinal variables, sex roles, teaching/learning technics. The projects have made a significant contribution to the introduction of FLE into schools and teacher training institutions. The focus at present should be the institutionalization of FLE within the in-school sector, including the development of a policy approving FLE in schools. The development of community-based health centers was often the central activity of the out-of-school FLE component of the projects. These centers have contributed to shaping the countries' attitudes by creating an awareness of teenage pregnancy, by developing an acceptable strategy, by providing a focal point for discussing sensitive issues, and by becoming a mechanism for community mobilization. The projects have also contributed to making FP services available and specialized services for adolescents are being established. The emphasis has been more on education and awareness creation than on contraceptive distribution to adolescents. At present the need is to strengthen the service delivery components. The limited availability of data suggests that adolescent pregnancy remains an urgent problem in the region. Sustained and more focused FLE/FP program efforts directed to adolescents continue to be needed in the region. The most important general lesson learnt from the programs is that programs in adolescent fertility can be started and implemented in countries even prior to declaration of policy by governments. However, at a certain stage of implementation the programs cannot be carried further without explicit government policies and control.
Report on the evaluation of UNFPA assistance to the civil registration demonstration project in Kenya: project KEN/79/P04.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. xi, 36 p.Kenya established a compulsory vital statistics and civil registration system in 1963 and it was extended nationwide in phases until it covered the whole country by 1971. Serious under-registration of births and deaths however, has persisted. In order to improve registration coverage, the government submitted a proposal to UNFPA to support experimentation with ways to promote registration in some model areas. The original project document included 4 immediate objectives: the strengthening of the civil registration system in the model areas including the creation of a new organizational structure, the training of project personnel and the decentralization of registration activities; the improvement of methods and procedures of registration through experimentation; the collection of reliable vital statistics in the model areas; and, the establishment of a public awareness program on the need for civil registration to ensure the continuation and extension of the new system. Of the 4 objectives of the project, 2 have been achieved--the strengthening of civil registration in the model areas and the improvement of methods and procedures of registration. The major deficiency during the project period was the lack of required staff in the field. The primary feature which distinguishes the project is that traditional birth attendants and village elders become key persons at the village level and act as registration informants after receiving training. The strong points of the project are the high quality of technical assistance provided by the executing agency, the close collaboration among various government departments, and the choice of project strategy and model area. Recommendations have been made to correct the problems of a lack of key personnel at the head office and in the field, and the expansion of registration to new areas before consolidation was completed in the old areas.
Report on the evaluation of UNFPA assistance to the strengthening of the civil registration and vital statistics system in Sierra Leone: project SIL/79/P03.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. x, 28 p.While Sierra Leone has a long tradition in registering births and deaths, dating back to the mid-1880s, registration has remained low. In order to improve registration coverage, the original project formulated in 1979 by the government included 3 immediate objectives; the strengthening of the civil registration system in a model area, the experimentation with field organization procedures most suitable for the registration system in the country, and the production of estimates of demographic variables in the model area and in the rest of the country. In the Tripartite Project Review held in 1981, 2 additional objectives were added to the project; the unification of the civil registration laws, including the provision of a uniform and universal legislation for the entire country, and the reorganization and training of the registration hierarchy. While the strategy to use a model area for the development was a sound one, without the law being enacted, new forms and registers could not be printed and thus few of the planned activities could take place. Of the 5 immediate objectives of the project, only one has been achieved--the passage of the Act of 1983 which provides the legal framework for registration to take place nationwide under the new system. Little progress has been made in the achievement of the 4 remaining objectives. The Evaluation Mission made recommendations concerning the need to reformulate the extension document early in 1985, taking into account the results of the Evaluation Mission, the concentration of government action on registration in the non-model areas, and thereafter the gradual expansion of registration to adjacent areas where more complete coverage is possible.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: country reports.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xiv, 89 p.UNFPA has provided funding for various family life education (FLE) projects with particular emphasis on youth in the English-speaking Caribbean since the mid-1970s; this report is an independent evaluation of the projects in Antigua, Barbados, Dominica, Jamaica, St. Lucia, and St. Christopher and Nevis. Although birth rates are relatively low in the English-speaking Caribbean, the incidence of adolescent pregnancy and the number of births to women under the age of 20 is an important problem in the region. The Mission concluded overall that the projects have contributed to pioneering and groundbreaking efforts demonstrating that it is possible to initiate and make considerable progress in the implementation of FLE/FP programs for adolescents even when adolescent pregnancy and births are still highly sensitive and controversial issues and when there are no official policies in favor of such programs. The Mission concluded also that project design had improved over the years and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. All the projects included in the evaluation have contributed to the training in FLE/FP of a large number of family life educators, teachers, and nurses and, as a result, have significantly strengthened professional national capability. The projects have shown that despite the lack of official policy approving FLE in schools and generally overcrowded curricula, FLE can be introduced into schools. In the area of FP service delivery, the projects included in the evaluation have contributed to making FP services generally available through integration with the government maternal and child health services. The main management issues across the projects were similar and included staffing, coordination, supervision, monitoring and evaluation. There is a need to adjust project design so that gender separation is minimized and that the FLE content deals better with issues such as self-awareness, sex roles, and self-esteem. The wider impact of the projects included in this evaluation, to be reflected, for example, in reduced incidence of teenage pregnancy, reduced maternal and infant/child morbidity and mortality, and more generally in the life patterns of women, cannot yet be measured.
Report on the evaluation of the UNFPA-supported women, population and development projects in Indonesia (INS/79/P20 and INS/83/P02) and of the role of women in three other UNFPA-supported projects in Indonesia (INS/77/P03, INS/79/P04, and INS/79/P16).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Apr. vi, 52 p.The Evaluation Mission analyzes and assess the 2 United Nations Fund for Population Activities (UNFPA)-supported Women, Population and Development Projects and the role of women in 3 other UNFPA-assisted projects in Indonesia. The Mission concluded that the family planning and cooperative/income generation scheme as evolved in the 2 projects has contributed to increasing contraceptive acceptance and continuation and to a shift from the less reliable to the more reliable contraceptive methods. The projects have also assisted women and their families to expand their income generating activities, raise their incomes, and improve the family's standard of living. The Mission recommends that: 1) more diversified income producing activities be encouraged; 2) product outlets be identified and mapped and appropriate marketing strategies devised; 2) loan repayment schedules be carefully examined; 4) data collection, monitoring and evaluation be streamlined and strenghthened; and 5) the process of the entire rural cooperatives/income generation scheme be more comprehensively documented. In the 3 other projects, which are addressed to both men and women, the needs and concerns of women have not been adequately taken into account and/or the participation of women in all phases of the projects and their access to project benefits have not been equal to men. The Mission therefore recommends that special consideration be given to women's concerns in the design and formulation of all projects. The Mission ascertained that non-women specific projects tend to perpetuate existing discriminatory or unequal access to, and control of, resources by women unless specific consideration is accorded to them.
Report on the evaluation of CPR/80/P14: population education in the secondary schools and teachers training of the People's Republic of China.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. iv, 49 p.The objectives of the Population Education in Secondary Schools and Teachers Training of the People's Republic of China Projects were to provide the Chinese people, including young students, with the basic knowledge of population science and an understanding of why the Government considers family planning a fundamental national policy and why it is implementing the policy of controlling the number of the population and raising its quality. The 2 distinguishing features of this project are that the target group are middle school students rather than students of all grade levels, and that the existence of an established system for in-service training in the form of pedagogical institutes provides a fast and effective mechanism to introduce population education into the 2ndary school curriculum. The overall assessment of the Mission is that this project has been highly successful. The Mission's main recommendations are: 1) that the United Nations Fund for Population Activities and the Government increase their financial assistance; 2) future objectives be stated in terms that emphasize educational outcomes rather than operational tasks to permit objective monitoring and evaluation; 3) that a moratorium be place on the revision of population education curricula in order to concentrate on its diffusion; 4) that the posters and commentary be considered as a basis for instruction of junior middle school students as well as out-of-school youth and adults; 5) that questions on population content be included in the national examinations for university admission; 6) that a program for pre-service education in population education be initiated to supplement the in-service training; and 7) that substantial attention be given to different modes of training.
Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38,  p.The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
Report on the evaluation of UNFPA assistance to the maternal and child health programme of Malawi: project MLW/78/P03 (February 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. xi, 36,  p.The 3 initial objectives of the Maternal and Child Health Program of Malawi were health and nutrition education, training of traditional midwives, and immunization against measles and polio. The Evaluation Mission found that the strong points of the project are: the Government's commitment to improve the status of maternal and child health by its expansion of services and its recent acceptance of child spacing as part of its program in maternal child health; the high level of dedication of the personnel in the Ministry of Health; the attention given to strengthening the Health Education section; and the establishment of a good management information framework upon which planning, supervision and monitoring can be further developed. Factors which seem to have hindered the project have been the lack of trained staff at the supervisory and service delivery level caused in large part by the lack of accomodation at the various national training institutions; the failure to appoint international staff to key positions within the project; and the lack of adequate transportation for project personnel. As child spacing will soon be included in project activities, the present organization of the Central Medical Stores to procure and distribute contraceptives and other needed supplies will adversely affect project performance. In total, the evaluation Mission made 19 recommendations addressed mainly to the Government and a number to the World Health Organiation and the United Nations Fund for Population Activities for project management decisions.
Report on the evaluation of UNFPA-sponsored country programme in Democratic Yemen, 1979-1984 and role of women in it.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Apr. xiii, 101 p.The United Nations Fund for Population Activities (UNFPA)-sponsored Country Program was the 1st comprehensive effort in the field of population in Democratic Yemen, following earlier sub-sectoral interventions which benefitted from UNFPA assistance. This evaluation covers 1) the country program as such, focusing on the results achieved in terms of building national capacity for formulating and implementing population policies and programs; 2) the 7 component projects, one in data collection and analysis, a maternal child health/family planning project, and 5 in population education for different audiences; and 3) the women's dimension of the program. At the end of the 4th year of implementation, little had been done by the Country Program in terms of institution building and population policy. The program's achievements were hindered by factors such as an extreme shortage of national qualified staff, training facilities, poor program design, insufficient technical leadership and support, as well as unrealistic objectives. The 7 component projects were plagued with similar problems and made only modest acheivements. The Evaluation Mission expressed the view that long term international expertise to serve all projects would have been advisable as well as long term training abroad for a few people who could become leaders/advisors/administrators. In evaluating the role of women, the Mission found that women had participated in the implementation of all the projects evaluated but were mainly to be found in junior positions. The program as a whole contained a substantial portion of women among its direct beneficiaries comprising those who had been trained, employed and targeted as recipients of the services of the projects, although this varied considerably between projects. In general, the Mission was of the view that in the future a country program document should be prepared specifying the long term and immediate objectives for the population program as a whole.
Report on the evaluation of SEN/77/P04: population/socio-spatial/regional planning (population/amenagement du territoire).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. xiii, 34,  p.The Senegal population/socio-spatial/regional planning project illustrates a truly integrated approach to population and development planning. The evaluation Mission concluded overall that the project's achievements are positive. The project's main accomplishments have been the establishment of a sophisticated population data bank, the preparation of national and regional population projections, an analysis of migration movements, and the production of related maps and tables using primarily 2ndary data sources. The technical quality and detail of the work undertaken, as well as its potential usefulness, were high. However, the Mission also found that various constraints specific to this project have considerably limited its achievements. These include inadequately formulated project objectives and planned activities, poorly defined conceptual framework, low absorptive capacity of the implementing agency, and severe United Nations Fund for Population Activities budget reductions. The value of the work was found to be lessened because the data assembled have not yet been systematically integrated into other relevant data banks, properly disseminated or utilized. The Mission recommended measures which will help conserve the valuable data bank and other results of the project and will assist in the transfer to nationals of the knowledge and skills to update and utilize the data bank. Limited outside assistance--financial and technical--is needed for some of the recommended measures.
A summary of the report on the evaluation of MEX/79/P04 "Integration of population policy with development plans and programmes".
New York, New York, UNFPA, 1984 Jul. 19,  p.The objective of this UNFPA project was to build the institutional and methodological base for integration of population policy into and its harmonization with national, sectoral and state policies or socioeconomic development in Mexico. More specifically, the project was to achieve integration of population policy with 6 sectoral plans, 24 state plans and the Master Development Plan within 3 years. Although the Mission considers it an achievement that the project signed agreements with all 31 states and the Federal District, no formal contacts had been made with the 6 sectors. Mexico's National Population Council (CONAPO) coordinated the project. The Mission recommended that support to integration activities be continued on the basis of the experience that has been acquired. Therefore it is necessary 1) to strengthen the activities at the state level; 2) to support the development of methodologies considering the impact of socioeconomic plans and programs on demographic variables and to provide a comprehensive program of international technical experience; 3) to recognize that responses to ad hoc support activities are an important integration instrument for both sectors and states; and 4) to exact greater clarity concerning the role of the project in the National Population Program. A lack of aedquately trained personnel proved to be a continual obstacle to implementation. The Mission recommends that at an early stage in the development of such projects a thorough assessment of the human resource requirements and existing capacity for integration of demographic and socioeconomic variables be made and that, based on this assessment, a specific training strategy be developed and incorporated in the project's design. In addition to training, the project also included research support activities; the outputs, however, were descriptive rather than analytical, which can be traced to both the design and execution of the work plan for research activities. The UNFPA's funding constraints and its management of reduced funds further complicated the project's execution, which suffered from high personnel turnover and lack of coordination of project activities.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
Washington, D.C., Heritage Foundation, 1984 Aug 27. 16 p. (Backgrounder No. 376)The United Nations' 2nd World Population Conference (Mexico City, 1984) called for greatly expanding funding for family planning assistance worldwide. The United Nations Fund for Population Activities (UNFPA), the conference's chief sponsor, will no doubt receive the largest portion of any assistance increase. UNFPA plays a critical role in population-related programs worldwide. The central debate on population policy should be over the extent and adequacy of the natural resources base and how countries can humanely and voluntarily change family size preferences. In countries like Singapore and South Korea, success has been achieved by combining social and economic incentives to discourage large families. Although couples in developing countries report wanting contraceptive service programs, they also want families of 4 to 6 children. So far UNFPA has been ineffective in changing the population situation. This overview of its activities reveals that UNFPA loses ultimate reponsibility for implementation of many of its own programs. UNFPA does not advocate a reduction in population growth within a single country, but rather helps couples have the number of children they desire. UNFPA's specific population and family programs are divided into functional areas: basic data collection, population change study, formulation and implementation of population policies, support for family planning/maternal child health programs and educational and communication programs. UNFPA stresses the importance of using contraceptives but not of achieving the small family norm. UNFPA's projects in some of the largest less developed nations are described, illustrating how the UN agency spends its assistance funds. From 1971 to 1982, the UNFPA spent almost US $230 million in the 10 largest less developed countries without any significant change in population growth. UNFPA program administrators are far from resolving the serious population problems facing developing countries and generally oblivious to new directions in which population policies should move. No progress will be made until UNFPA recognizes the need to approach the problem from a different perspective, working to change attitudes toward small families.
[Unpublished] 1984. v, 37,  p.This is an evaluation of the Rural Health Systems Project funded in 1979 through a contract between AID, the Rural Health Development Staff of the University of Hawaii and the government of Guyana. The goal of the project is to improve and expand primary care services to rural areas of Guyana through training community health workers and medexes, and utilizing them in an interlocking, tiered, supervisory and referral structure. The evaluation team was to assess the adequacy and relevancy of medex training; the performance of graduates, the adequacy of support and management systems for medexes, and the ability and commitment to continue the training by the government of Guyana. The evluation team visited a large number of health facilities staffed by medexes, interviewed key persons in the Ministry of Health, AID, and the Health Manpower Developement Staff of the University of Hawaii. The team's findings show that the Medex Training Program is of high quality. Medex are working effectively in medically underserved areas; progress is being made in financial information, 2-way radio and supply systems, this despite severe economic difficulties. The development of transportation systems has been extremely slow and difficult and contracts for building housing have not been completed. The team offers a number of recommendations which include the continuation of the Medex Training Program in order to maintain a steady supply of trained personnel; the need to develop a comprehensive career structure and professional incentive program; the regionalization of the expanded 2-way radio system as a continuing education medium; the immediate implementation and careful monitoring of the new financial managements information system; and the necessity for further action to improve the transportation systems. Furthermore, the team's recommendations emphasize that AID expedite its approval of documents necessary for housing contracts to be negotiated; that responsibility for supervisory medexes in rural health centers be gradually transferred to the regional health teams and that Medex headquarters and training staff be more closely integrated. The report includes various appendices: a map of the country, a list of persons interviewed by the team; training and education manuals for diabetes; samples of the system for teaching essentials to medex (e.g., clinical practice, history taking and physical examination) and the declaration of Alma Ata on primary health care.
[Unpublished] 1984. i, 15, 5 p.This report ist presented in response to a United States Agency for International Development (USAID) /Sri Lanka request for a review of the population and family planning program in the country and for recommentdations on the future role of UASID in support of the Sri Lanka program. It is intended to help the USAID Mission to make decisions regarding both the substance of population program assistance and the manner in which it is provided. The central recommendation is that the Mission undertake bilateral support of both public and private sector programs as soon as possible. This report is organized into 3 parts: 1)a brief overview of the demographic situation; 2) a review of the present national program, both public and private; and 3) recommendations for future program directions. The report was prepared during a 3-week visit to Sri Lanka. The relatively high rate of population growth will become an even greater factor in Sri Lanka's development equation than it has been in the past, and unless there is a significant and rapid decrease in fertility, population growth will diminish development prospeccts for the remainder of the century. USAID currently provides about US$0.5 to US$0.7 million of annual support to Sri Lanka family planning services programs through 9 intermediaries. This does not include the annual assistance provided by the United Nations Fund for Population Activites and International Planned Parenthood Federation which total approximately US$1.5 million. The Family Health Bureau of the Ministry of Health is responsible for managing the Government's family planning program. The Family Planning Association of Sri Lanka currently manages 2 large family planning service projects. USAID should begin high-level discussions in earnest with the Sri Lanka government.
Sex education and family planning services for adolescents in Latin America: the example of El Camino in Guatemala.
[Unpublished] 1984. ix, 54,  p.This report examines the organizational development of Centro del Adolescente "El Camino," an adolescent multipurpose center which offers sex education and family planning services in Guatemala City. The project is funded by the Pathfinder Fund through a US Agency for International Development (USAID) population grant from 1979 through 1984. Information about the need for adolescent services in Guatemala is summarized, as is the organizational history of El Camino and the characteristics of youngg people who came there, as well as other program models and philosophies of sex education in Guatemala City. Centro del Adolescente "El Camino" represents the efforts of a private family planning organization to develop a balanced approach to serving adolescents: providing effective education and contraceptives but also recognizing that Guatemalan teenagers have other equally pressing needs, including counseling, health care, recreation and vocational training. The major administrative issue faced by El Camino was the concern of its external funding sources that an adolescent multipurpose center was too expensive a mechanism for contraceptive distribution purposes. A series of institutional relationships was negotiated. Professionals, university students, and younger secondary students were involved. Issues of fiscal accountability, or the cost-effectiveness of such multipurpose adolescent centers, require consideration of the goals of international funding agencies in relation to those of the society in question. Recommendations depend on whether the goal is that of a short-term contraception distribution program with specific measurable objectives, or that of a long-range investment in changing a society's attitudes about sex education for children and youth and the and the provision of appropriate contraceptive services to sexually active adolescents. Appendixes are attached. (author's modified)
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.