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Final report of an operations research project: "A Study to Increase the Availability and Price of Oral Contraceptives in Three Program Settings", Contract CI90.59A.
[Unpublished] 1991 Oct 10. , 32,  p. (PER-19; USAID Contract No. DPE-3030-Z-00-9019-00)In an effort to reach more clients while increasing self-sufficiency, a group of private and public agencies in Peru collaborated in 2 operations research (OR) studies. This OR project, which cost US $62,040, was affected by the action of the newly elected government which ended price controls and subsidies in August 1990 and resulted in changes in the spending habits of most Peruvian families. Sales of all oral contraceptives (OCs) fell from an average of 141,400 to 73,400 cycles/month, and sales of Microgynon in pharmacies fell from 76,400 to 38,000 cycles/month. The first OR study tested the use of community-based distributors (CBDs), Ministry of Health (MOH) facilities, and private midwives as contraceptive social marketing (CSM) outlets by adding the OC Microgynon (sold at pharmacy prices) to CBD programs and raising the price of the donated OC, Lo-Femenal, over time. Specific objectives were to determine 1) if total CBD sales increased with the method mix, 2) whether CBD from homes of small businesses was more effective, 3) if the new distribution of Microgynon would increase sales of the OC as a whole, and 4) the impact of Lo-Feminal price increases on sales and user characteristics. The study was carried out in 44 experimental and 44 control groups in Lima and 20 experimental and 21 control groups in Ica. Baseline data were obtained for December 1989-April 1990, and monthly sales were monitored during the 12 months from May 1990 to April 1991. Data were also obtained from surveys of dropouts and new Microgynon acceptors. It was found that the August 1990 price increase effectively destroyed the significant market penetration exhibited by Microgynon in the first 4 months of the study. Adding an affordable CSM brand to CBD programs will, however, increase sales and self-sufficiency, although the sale of donated OCs for around $0.30/cycle will reduce sales of the new brand by 20-40%. It was also found that most clients who dropped out because of side effects were less likely to be contracepting than those who dropped out because of cost, indicating a need for improved distributor counseling. The second study tested the price elasticity of demand for OCs in CBD programs by measuring the demand for Microgynon. Specific objectives were to determine 1) the level of Microgynon sales in MOH facilities, 2) the level of sales by nurse-midwives, 3) the number of Microgynon users who formerly used Lo-femenal from the MOH, and 4) the number of Microgynon users in MOH and nurse-midwife facilities who formerly obtained the OC from pharmacies. A demonstration project was carried out in the rural departments of Ayacucho and Huancavelica, the poorest areas of Peru. 4 MOH hospitals in 4 cities and 17 nurse-midwives participated. The hope was that the CSM products would mitigate the effect of stock-outs in the hospitals. It was found that no Microgynon was sold because of a reluctance to recommend it and other unfavorable study conditions (the necessity for separate accounting, the lack of stock-outs, the reluctance of the midwives to sell a contraceptive, and the decline in client purchasing power). Cost recovery in the MOH would be better served by charging a modest amount for donated contraceptives.
Sexually transmitted diseases research needs: report of a WHO consultative group, Copenhagen, 13-14 September 1989.
[Unpublished] 1991. Presented at the 1st International Course on Planning and Managing STD Control Activities in Developing Countries, Antwerp, Belgium, September 9-21, 1991. 31 p.In response to the growing needs for research into sexually transmitted diseases (STDs), the STD Program of the World Health Organization (WHO) in September 1989 convened a small interdisciplinary consultative group of scientists from both developing and more developed countries to review STD research priorities. The consultation was organized based upon the belief that a joint consideration of global STD research priorities and local research capabilities would increase overall research capacity by coordinating the efforts of scientists from around the world to get the job done. Participants considered the areas of biomedical research, clinical and epidemiological research, behavioral research, and operations research. However, research needs directly related to HIV were not considered except where they interfaced with research on other STDs. The above areas of research, as well as the expansion of interregional and interdisciplinary collaborations, the strengthening of research institutions, developing and strengthening research training, and facilitating technology transfer and the use of marketing systems are discussed.
[Unpublished] . 15,  p.The purpose was to summarize lessons learned from operations research (OR) for quality of care in family planning (FP) programs. OR refers to the use of scientific methods to solve managerial practices among FP programs. The OR database, compiled for the FP/OR project database and currently managed by The Population Council, includes descriptions of 243 projects conducted since the USAID/Office of Population OR program began in 1973. The database contains information of each of the FP/OR subprojects including: country and region, type of project, contractor, cost, dates of initiation and termination, purpose, design of the study, major issue, delivery system analyzed, contraceptive methods involved, and type of data and reports available. The results indicate that: 1) More than 90% of research funds allocated during the past 20 years had been for enhancing services to integrate contraceptive services with other reproductive health services (such as breast feeding, AIDS, and primary care). FP was complemented with breast feeding to improve maternal and child health in Indonesia, Honduras, and Peru. FP workers were engaged in AIDS prevention campaigns in Colombia, Mexico, Peru, Thailand and Zaire. FP services were provided to underserved populations such as indigenous groups, young adults, and high risk populations. Postpartum projects strove to increase the acceptance of contraceptive use to space births or to conclude childbearing. 2) Less than 2% of research funds had been directed to projects to enhance continuity and follow-up clients. 3) 53% of the research projects examined standard solutions such as community-based distribution systems. Only 21 projects had the aim of developing unique or alternative procedures to enhance a component of quality of care. Based on the above results, future OR could investigate new solutions to enhance quality of care, such as mechanisms to ensure continuity of use or tests to increase the contraceptive choice of heterogeneous populations.
Bethesda, Maryland, University Research Corporation, 1991 Apr. ix, 77,  p. (BAN-14; USAID Contract No. DPE-3030-C-00-5043-00; TvT No. BAN-SAS-04-10)Save the Children has a women's savings program (SAVE), which is an integral part of its comprehensive integrated rural development program. Women's savings groups were introduced in Bangladesh on an experimental basis in 1982. Over the years, these indigenous small groups have evolved from simple "savings" groups to dynamic forums to improve women's economic and social horizons and enable them to gain greater control over their lives and those of their children. An operations research study was undertaken, at a cost of US $35,874, to examine and document the impact of womens' savings groups on contraceptive use. The study was undertaken in 8 villages in Nasirnagar Upazila where SAVE programs were in operation: 5 villages where programs were initiated in 1982 (old villages) and 3 villages (new villages) where programs were begun in 1989. 2 comparison villages (without SAVE programs) were also selected at random from among the villages in the same geographic area. The experimental and comparison villages were similar in terms of household size, age, parity, and total fertility of the married women of reproductive age. The study employed a quasi-experimental design. Data were collected using a baseline survey and a mini-contraceptive prevalence survey conducted in both experimental and comparison villages as well as 2 rounds of individual and group interviews with selected savings group members and nonmembers in the experimental villages. Relevant cost data were obtained from SAVE/Dhaka. Selected variables from the SAVE project management information systems (PMIS) were also used for comparison with similar variables obtained in the baseline survey. Womens' savings groups, combined with family planning (FP) motivation, supplies, and services can be an effective strategy of raising contraceptive prevalence in rural Bangladesh. Contraceptive use, both ever and current, was higher in the experimental than in comparison villages and was higher in the old than in the new villages. Contraceptive use was higher among savings group members than among nonmembers, and contraceptive use was higher among the latter group than in the comparison villages, suggesting that the SAVE program helped raise contraceptive use among both members and nonmembers in the project villages. Current use at the baseline among members was 30.9 and 16.9% among members in old and new villages, respectively, and 7.3% in the comparison villages. Among nonmembers, current use was 17.9% in the old villages and 12.9% in the new villages. Current contraceptive use declined from 30.9 to 25.4% in the old villages over the life of the project. One of the main reasons reported for discontinuation was nonavailability of FP methods.
In: Operations research: helping family planning programs work better. Proceedings of an International Conference and Workshop on Using Operations Research to Help Family Planning Programs Work Better, held in Columbia, Maryland, June 11-14, 1990, edited by Myrna Seidman, Marjorie C. Horn. New York, New York, Wiley-Liss, 1991. 395-410. (Progress in Clinical and Biological Research Vol. 371)Systems analysis was adopted by the AID Office of Health, Primary Health Care Operations Research (OR) Project (PRICOR) for evaluating the process of delivery of child survival services. Actual performance is compared with an accepted standard. The rationale for examining the process of service delivery is provided along with an outline of the process evaluation methodology and an overall framework for examining the different systems. Illustrative examples of findings are given. Applications of this approach for routine management evaluation are discussed with particular reference to small, rapid, cheap and relatively simple OR studies. Outcome analysis screens for unsatisfactory performance, and process analysis specifies certain activities which require management action or improvements in a supervisor's performance. The PRICOR project objective was the development of practical methodologies for gathering information on service delivery and quality of care. The first task was the detailed identification of concrete activities necessary in providing effective services, which were drawn from the public health literature and a panel of outside experts. This thesaurus was used to examine staff performance in 12 countries: Thailand, Zaire, Haiti, Costa Rica, Colombia, Indonesia, Philippines, Peru, Niger, Pakistan, Senegal, and Togo. Although not a statistically representative sample, it was the first large scale, systematic effort. The following areas were evaluated by observation or review: service delivery, clinical and support facilities, home visits, records, informant interviews, role- playing, training courses, supervisory contacts, and population-based surveys. 6000 interviews and observations were addressed to immunizations, maternal health, child spacing, and growth monitoring and promotion. The systems analysis focused on 7 major systems (quality of care, outreach, primary supervision, secondary and higher levels of supervision, training, logistics, and management of information which were subdivided into approximately 40 issues areas which broke down into approximately 200 distinct and observable staff activities. The findings were that there are extensive and serious deficiencies in quality of care, that program mechanisms are poorly developed to detect and correct deficiencies, and that it is feasible to examine the process of service delivery and determine practical solutions.