Evaluation of the family planning health and hygiene project of the community-based family planning services, Thailand

Evaluation covers the period 6/1/77-11/30/80 and is based on project records, interviews with project personnel, and a non-representative mini-survey of 2,463 project villages. Initial free distribution of contraceptives failed to increase long-term sales and the inclusion of household drugs increased program costs without generating more income. A new CBFPS strategy -- the project's fifth -- was therefore developed, in which village distributors (VD): (1) provide FP services by selling contraceptives (especially oral contraceptives -- OC) at subsidized prices and refer clients to the government for IUD and sterilization services; (2) sell and promote household drugs such as oral rehydration salts, vitamins, and anti-parasitics; and (3) promote breastfeeding, conduct certain economic development activities, and make referrals for immunization and curative care. The mini-survey revealed that while delivery of services in the second and third categories was fairly low, there has been much success with the first category. OC sales in 11/80 were at 440,000/year, and have increased 14%/year each of the last 2 years. The project, expending $7.87 per couple-year of protection, is cost-effective, although costs could be further reduced by using staff more effectively now that the project has passed the experimentation stage. It is recommended that a full-scale feasibility study of a national subsidized contraceptive retail sales program be conducted; that the project be kept intact until the role of government village health volunteers in distributing contraceptives is clarified; and that the program be re-evaluated in 2 years in the context of the National FP Program. To solve operational problems, it is recommended to increase VD stocks by as much as 50%; have district supervisors and field officers reactivate inactive accounts; reduce staff where possible; take steps to increase cost-recovery from 25% to 50% within 2 years; compensate district supervisors for fuel costs; and provide further training to VD's, stressing referrals in addition to female sterilization and vasectomy and allowing VD's to meet referral personnel.