Evaluation of A.I.D. family planning programs : Tunisia case study

This report analyzes the effects of that contribution. Section II reviews Tunisia's social and economic climates and their relationship to family planning from the 1950s to the present. Section III provides a component-specific review of the national program, while its overall effectiveness, efficiency, sustainability and long-term impact are discussed in Sections IV and V. Among the successes of the program, detailed in Section VI, are that it: dramatically reduced fertility and abortion rates, as well as government expenditures on health and education; effectively expanded use of modern contraceptive methods (especially IUDs and female sterilization), the access of poor women to modern methods, and overall program coverage; and was cost-effective. A.I.D.'s contribution to this effort focused on: (1) diversifying the modes of service delivery through mobile units and a social marketing campaign, thereby increasing program access; (2) supporting training and TA in highly effective clinical methods, thereby enhancing contraceptive prevalence; (3) improving health outreach via extensive training of professionals and field workers in clinical methods, management, and service delivery, including IUD provision; and (4) enhancing institutional capacities by supporting the establishment of training centers. Less positively, as of 1990, when A.I.D. funding terminated, the Agency had not contributed to the program's financial sustainability. A price increase was needed for the contraceptive social marketing program to increase profits and reflect real costs, and the program had not been privatized; nor had A.I.D. supported analyses or pilot programs to test cost-recovery schemes. However, A.I.D. assistance may have reduced the budget necessary for the public program in the future.