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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.
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: 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.
[Unpublished] 1984. Presented at the Annual Meeting of the American Public Health Association [APHA], Anaheim, California, November 11-15, 1984. 43 p.This study analyzes infromation from 3 types of population specialists on how much effort is being applied in family planning programs in developing nations. In short, what and how well are these programs doing? As part of a study of the conditions of fertility decline in 1965-80, new data on family planning program efforts were collected in 1983 and early 1984 from some 425 population specialists around the world. They include 3 types: (1) country officials and senior staff working in public or private family planning programs; (2) staff in donor agencies such as the World Bank, AID, and UNFPA; (3) other observers, including researchers. The study analyzes the extent to which these 3 types differ on total program effort scores, and on 4 broad components of program effort: (a) policies; (b) services and service-related activities; (c) record-keeping and evaluation; (d) availability and accessibility of fertility-control supplies and services. Score differences on selected program items such as training programs and supervision are also examined. The analysis shows that country officials and public program staff believe that services and service-related activities are in better shape than do observers in the other 2 categories. The policy implications of this and other findings are discussed. (author's)
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.
New York, New York, United Nations, 1984. ix, 476 p. (International Conference on Population, 1984; Statements)The Expert Group on Fertility and Family was one of 4 expert groups assigned the task of examining critical, high priority population issues and, on that basis, making recommendations for action that would enhance the effectiveness of and compliance with the World Population Plan of Action. The report of the Expert Group consisted of 6 topics: 1) fertility response to modernization; 2) family structure and fertility; 3) choice with respect to childbearing, 4) reproductive and economic activity of women, 5) goals, policies and technical cooperation, and 6) recommendations. Contained in this report are also selected background papers with discuss in detail fertility determinants such as modernization, fertility decision processes, socioeconomic determinants, infant and child mortality as a ddeterminant of achieved fertility in some developed countries, the World Fertility Survey's contribution to understanding of fertility levels and trends, fertility in relation to family structure, measurement of the impact of population policies and programs on fertility, and techinical cooperation in the field of fertility and the family.