Evaluation of the Centre for Development and Population Activities (CEDPA) access to family planning through women managers project (936-3059)

Interim evaluation covers the period 1991-12/95. The project is implemented by the Centre for Development and Population Activities (CEDPA). ACCESS has met or exceeded all but one objective listed in the project amendment: the objective of training 75-100 ACCESS alumnae as a Consultant Corps was not achieved due to problems in the design. However, plans have been developed to train an additional 40-50 alumnae over the next 18 months, and in Nigeria, ACCESS trained over 50 master trainers to serve as trainers for other country subprojects. In addition, CEDPA/ACCESS has made noteworthy progress in management and financial systems, monitoring and evaluation, quality of care, integration of reproductive health systems, and institutional and financial sustainability. All USAID Missions contacted during the evaluation commended ACCESS for excellence, flexibility, and responsiveness. ACCESS has trained 2,773 women in 7 countries as community-based distribution (CBD) workers; there is abundant evidence that the training has served to empower the women to improve their economic status, knowledge, skills, and role in the family. At the managerial level, ACCESS has trained 82 women as CBD supervisors, 76 in subproject management, and 54 in administrative areas. ACCESS has provided quality, timely TA to its subprojects. In Kenya, for example, TA along with staff training substantially improved the performance of the Kabiro Kawangware Community Health Project, which had been supported by other donors for many years with little success. This subproject, about 80% completed, has now achieved 355% of targeted new acceptors. ACCESS has established effective and often innovative strategies for delivering quality FP services to disadvantaged groups in hard to reach geographic areas and challenging environments. In 1995, ACCESS had 19 subprojects underway in India, Nepal, Kenya, Nigeria, and one beginning in Tanzania. ACCESS has developed several promising service delivery models. Two of its models -- one which adds FP to an ongoing urban social services program, another adding FP to a dairy cooperatives program -- are being successfully replicated in Uttar Pradesh, India, under Project 3860527. However, ACCESS has not yet systematically examined continuation rates, an important indicator of quality of care, and only recently began to collect drop out data. ACCESS"s knowledge of service delivery issues at the local level, coupled with its expanding alumnae base of trained, articulate leaders, gives it a unique comparative advantage in the area of FP advocacy. In considering which types of advocacy groups to support, USAID should consider recent research findings that policy reform is more likely to occur when local groups understand the issues, feel they have a stake in the process, and are mobilized to undertake advocacy on their own. Policy reform at the national level is greatly facilitated by support at the local level. ACCESS works with its partners to encourage financial sustainability by developing management systems, preparing long-range strategies for sustainability, and diversifying funding (cost recovery, social marketing, fee for service, multiple donors, community contributions). Of eight service delivery subprojects (excluding Nigeria), six have multiple options for funding diversification, two have revolving drug funds, four charge a fee for service or a registration fee, and two participate in social marketing of condoms. The Association for Health and Population Activities Project in Mali, which has now graduated, has had income generation activities for several years and now charges to provide training to other NGOs. All projects which generate funds have developed suitable accounting systems. At the same time, however, only two current subprojects have assessed the full costs of service delivery. This area of sustainability will require ACCESS"s greatest attention. ACCESS has honored its commitment to partners even when subproject funding was cut due to changing USAID policy and priorities, in all cases leveraging alternative funding to enable partners to continue activities; of 12 projects, only the Turkish Municipal project has closed due to changes in political support. ACCESS has developed several models for partnerships with other organizations to support sustainable development. The traditional approach involves ACCESS channeling CEDPA resources to NGOs while simultaneously training women in the organization in leadership and management. In response to criticism that this model yields minimal effects at state, provincial, and regional levels, ACCESS has developed several other models, e.g., working with consortia of NGOs, working with training centers, and working through other organizations" infrastructures (these include the Red Cross in Nepal, trading and religious associations in Nigeria, and dairy cooperatives in India).