Evaluation of AID family planning programs : Philippine case study

through three projects were virtually identical. The effectiveness of these efforts, a major aim of which was to support an outreach program initiated in 1976, is assessed herein. On the positive side, the FP program established a delivery system which provided easy access to affordable FP services, while the outreach effort, although it fell into disarray in the late 1980's, transformed an urban, clinic-based program into a national community-based delivery system. Costs were quite high (especially for outreach), but analysis reveals a break-even by 1985 and a 5:1 benefit-cost ratio by the year 2000. However, declines during in population growth rates and in total fertility rates were not a result of the methods in which A.I.D. made its greatest investment. The outreach program was unable to increase demand for reversible methods (despite massive promotional efforts), apparently due to lack of appeal, a fact reflected in higher discontinuation rates for these methods in the Philippines than in neighboring countries. The only methods evidencing increasing use and demand -- voluntary surgical contraception (VSC) and the various forms of rhythm -- were not especially promoted by the program, though A.I.D. did play a major role by training doctors and nurses in VSC. The increased demand for these two methods was due in large part to the promotional efforts of nongovernmental organizations (NGO's), who served as a major force for innovation and training for the FP program. Over and above individual weaknesses (e.g., inadequate training of field workers in contraceptive methods, failure to develop a long-term strategic plan and establish realistic targets), the program lacked financial sustainability; from the outset it was largely dependent on external assistance, most of it provided by A.I.D., whose too early withdrawal of funds for training further undermined sustainability. This teaches the importance of developing a financial strategy systematically. It also shows that developing countries cannot shoulder an increasing part of huge FP programs without sustained economic growth.