Audit of USAID/Ecuador"s population and family planning project no. 518-0026

Audit covers the period 1981-12/89. Good progress is being made in achieving most objectives, and the overall project goal of decreasing Ecuador"s birth rate from 36.7% to 35% has almost been accomplished. In addition, private sector activities have been implemented effectively and efficiently, contributing to the overall positive attitude toward family planning found throughout the country. The audit did uncover certain shortcomings, however. (1) Community-based distributors are providing oral contraceptives to new users without first referring these users to medical personnel to evaluate the health risks involved. (2) More audiovisual (as opposed to written) educational materials are needed to effectively reach illiterate rural populations. (3) The public sector component, managed by the Ecuadorean Social Security Institute, is not accomplishing its objectives due to the project"s failure to provide adequate training and supplies. These problems originated in 1985 when change in the national government caused a negative attitude toward family planning; this attitude ended the public sector"s promotional activities and most of the contraceptives previously received had to be destroyed. in 1987 with another change in government, but project activities still lag. Lack of supplies has led to morale problems in rural areas, where FP personnel are unable to provide the services they have been promoting. (4) Statistics reported by participating agencies on new contraceptive users are overstated by 5%-10%. A clearer definition of a "new user" is needed to correct this problem and accurately reflect project accomplishments. (5) USAID/E and participating agencies had systems in place for verifying project expenditures. However, they did not require external audits, and USAID/E had not established an audit recommendation follow-up system.