Evaluation of the Africa operations research/technical assistance project II

The Population Council (PC) was the main implementing agency. The project has responded to USAID's request to diversify the project research portfolio to encompass a broad reproductive health (RH) agenda. Research is being carried out in a mix of countries, reflecting both USAID mission priorities and PC's willingness to optimize "windows of opportunity". Research topics clearly respond to new emphases in RH and build upon PC's strengths. Work with adolescents, postabortion care, integrated services, and female genital mutilation (FGM) is likely to yield important contributions to the field. To date, the project has initiated 47 OR subprojects, of which 22 were completed. Nearly half the studies are diagnostic or evaluative, and 12 of these are situation analyses (SAs). One-fifth of the studies are interventions, such as testing new methods of service delivery and improved quality of care, and linking FP services with postabortion care. Although USAID/Washington had expected more intervention studies, USAID missions are more interested in diagnostic or evaluative studies, particularly SAs. OR interventions are not always called for, in large part because the SAs so clearly identify weak service delivery functions that can be improved through direct intervention rather than through experimental testing. SAs responsibility for which has moved to the new MEASURE project -- also help service providers, program managers, NGOs, ministries of health (MOH), and donors understand components that contribute to high-quality programs and identify opportunities for change. USAID should ensure that follow-on activities to the SA, such as data interpretation workshops and national and regional seminars, which the present project does well, are continued. Among the large intervention studies, those in Burkina Faso and Ghana are testing different models of community- based service delivery and use of different levels of service providers. In Kenya, an experimental design examined different modes of delivering postabortion FP, and a study in Senegal is testing the effect of improved quality of services delivered at model clinics. A study in Zambia is comparing community-based strategies to improve RH among youth. About half of project activities consisted of TA to International Planned Parenthood Federation (IPPF) affiliates, regional research organizations, MOHs, and cooperating agencies. To cope with the growing demand for SAs, the project has trained a cadre of 40 professionals to serve as consultants to other countries. Local capacity was also enhanced through long- standing relationships and informal training derived from subproject implementation and the day-to-day presence of host- country social scientists (HCSS) and PC Fellows. Institutionalization, a project priority, has included: teaching administrators and decisionmakers the means to use OR; informing FP and RH agencies how to analyze and resolve problems, conduct OR, and apply OR results; providing TA and training for African researchers in OR protocols and implementing research with service delivery agencies; and providing TA to disseminate OR results. The project also provides support and TA to institutions and community health laboratories; has worked to strengthen Evaluation and Research Units (ERU) in Zimbabwe, Ghana, Zambia, Burkina Faso, and Senegal; and is providing support in OR research design and implementation to the newly established Center for Training and Research in RH (CEFOREP). However, there still is not a critical mass of sufficiently skilled researchers to implement OR without TA. Efforts to disseminate and use project information are detailed in the report.