Community-based family planning services, family planning health and hygiene (FOHH) project

Special evaluation covers the period 1977-1979 and is based on interviews with key Royal Thai Government (RTG) and A.I.D. personnel, site visits, and document review. The project, implemented by the RTG's Community-Based Family Planning Services (CBFPS), has achieved most of its objectives -- although the the CBFPS will not be self-sufficient by late 1981 as planned -- and has shown that provision of family planning services reduces morbidity and mortality more than does provision of simple health care services. Based on a survey conducted by Mahidol University, the CBFPS selected 80 districts in which to test four models of contraceptive delivery-- low-priced pills and condoms were sold both with and without an initial 2 months free supply and with and without provision of household drugs and health orientation. Four districts served as a control. The CBFPS then trained 5,800 village distributors and 80 district supervisors in 29 provinces. Past weaknesses in the recruitment, training, and supervision of village distributors were overcome. A total of 65,072 new pill acceptors were recruited; overall acceptance in the four experimental areas was 80% of target. Results indicate that distribution of contraceptives alone is the most cost-effective approach (100% of target was achieved) and that the addition of household drugs does not promote contraception; however, once a delivery system is in place it is easy to include complementary basic health services. Free distribution of contraceptives has a mixed impact. While gaining a large number of acceptors, such a policy depletes limited national and local health care resources and leads consumers to assign little value to contraceptives. The RTG should consider charging for pills or phase in a new brand of low-priced pills, although instituting such a policy will be difficult.