Evaluation of the Family Health International cooperative agreement

The evaluation covers the period 1984-12/89 and was prepared in preparation for an expected 5-year extension of the cooperative agreement. In general, FHI's work is innovative, useful, and of high quality. In every avenue pursued, FHI has been able to document observable impact. The clinical trials division (which absorbs about half the project budget) has shifted emphasis from evaluating existing methods to developing and introducing new ones. This change was appropriate since, in the case of several methods (e.g., IUD's and pills), the most useful avenues of research had been well explored. Some of the new products under development appear very promising, including NET-90 injectable, plastic condoms, D-propranolol, and iodine delivery for non- surgical female sterilization. The field development and training division (25% of the project budget) manages a unique network of some 200 clinical centers in more than 50 countries and provides support to family health research centers in nine developing countries. The division also coordinates the introduction of new methods, disseminates research findings, and provides monitoring and support to the other divisions. An expected expansion of responsibilities is causing some concern, however, since the division's staff is already stretched too thin. The program evaluation division has done some excellent project- specific work. However, its overall portfolio, which is divided into eight loosely related categories, could be better focused. This dispersion of efforts is the result of FHI's attempts to respond to Mission requests. The reproductive epidemiology and sexually transmitted disease division has made important contributions, particularly in responding to fears about a possible relationship between the pill and cancer. The organization is smoothly run, with high staff morale and good internal communication. There is concern, however, whether FHI will be able to maintain its high standards as it continues to grow. Although few funding constraints have been evident to date, some of the new activities (e.g., the introduction of NORPLANT) are potentially of such a size and scale that FHI may have to begin making difficult choices as to what activities to pursue.