Evaluation of the Africa operations research/technical assistance project

Since its inception in 1988, the project has carried out more than 60 subprojects (SP's) in 16 countries, exceeding contract stipulations. Overall, implementation has been of high quality. SP's have had significant policy relevance for both national and international audiences. PC staff were resourceful in identifying SP opportunities and in responding to host country and USAID Mission interests and concerns. In carrying out SP's, PC collaborated with public and private national and regional institutions, frequently including other A.I.D. cooperating agencies; collaboration with International Planned Parenthood Federation affiliates was particularly notable. According to both USAID Missions and host country institutions, the TA provided by both core staff and resident advisors was timely, fully collaborative, and generally of high quality. There were several SP's, however, that would have benefitted from more frequent and more intensive TA and supervision by PC staff. The project has successfully built on prior OR activities funded by A.I.D.'s Bureau for Research and Development, notably in adapting the PRICOR Thesaurus approach for service diagnostics in developing the situation analysis, and in capitalizing on groundwork laid in host countries by Columbia and Tulane Universities in previous OR contracts. The standardization of the situation analysis methodology is a significant contribution to helping program managers improve service delivery and the quality of care offered to clients. SP results indicate that OR remains an important way to introduce and test the feasibility of various approaches to service delivery in new contexts, particularly with respect to integrated health programs and workplace-based programs. Overall, with about half the SP's completed, the project appears to be having a fairly impressive impact. It has already begun to leave a legacy of qualitative change, documented in revised procedures, upgraded training, and different supervision strategies, in several countries. It is also likely that services will expand in several countries as a result of SP activities. Finally, as a result primarily of training and TA, the project has begun to institutionalize OR capabilities in several countries. The project has also had a broader impact on the field of family planning OR, mainly through the development or revision of materials and methodologies. This project has provided a number of insights on OR. It has shown that situation analyses, which provide a comprehensive assessment of the functioning of FP subsystems, can help program managers improve service delivery and the quality of care. It has also shown that OR is most successful when carried out as an iterative process of problem identification, solution testing, results assessment, modification, and retesting. The project has also demonstrated that, while OR is extremely important in introducing new FP services in the face of opposition, it can be a more effective refining tool under conditions favorable to change. Such conditions exist when: (1) national programs are established with a comprehensive strategy, implementation plan, and institutional structure; (2) FP programs are dynamic and growing and actively looking for ways to expand and improve; (3) the institutional structure of the FP program permits effective utilization of results; and (4) donor financing and interest actively support implementation of alternative delivery approaches and improvements in established service delivery systems. (Author abstract, modified)