Evaluation of the FPPS project (family planning private sector)

Interim evaluation covers the period 12/84-5/90. The project's approach of working through private organizations is a sound one; currently, about 10% to 13% of all modern FP use in Kenya flows through such arrangements. An estimated 238,000 couple years of protection (CYP) have been provided under FPPS subprojects (SP's) to date, at an overall average cost per CYP of about $25; however, costs tended to decline dramatically after SP startup, and in 1990 average CYP cost was $12.52. Most numerical goals have been met or surpassed: SP's have been completed or are currently in operation in 54 institutions, with 60 planned by the 9/91 PACD; approximately 88,300 Kenyans are using FPPS services, surpassing the goal of 85,000; an estimated 828 mid-level workers have been trained in FP service delivery, far more than the target of 525; and 6 of 7 planned operations research projects have been completed. While a data and evaluation system was established, its outputs were not published or disseminated as proposed; also, 2 planned workshops on data management and evaluation have not been conducted. The clinical training program was in limbo due to a dispute with the training provider. SP sustainability is encouraging but faces certain limitations. FPPS policy is to discontinue assistance to SP's after 2 years, but smaller and nonprofit organizations (e.g., nursing homes and religious organizations) often cannot sustain the full range of FP activities after assistance is withdrawn, and must continue to depend on FPPS for contraceptives, IEC, and training. All 44 SP's which have passed the 2 year point continue to provide FP services. Apparently, even some unaffiliated organizations have been motivated by project educational activities to start their own FP programs. Some of the most important recommendations are: (1) conduct a survey of unmet FP needs in Kenya before designing possible follow-on project(s); also, review the role of child survival in future FPPS activities; (2) consider a more flexible policy for SP support based on the character of the organization; e.g., extend assistance to religious organizations beyond the 2 year cutoff date; (3) resume training, possibly under direct FPPS guidance; (4) immediately begin work on publishing technical reports to share the experience and results of this project with FP planners throughout Africa and the world; (5) use the eight determinants of project success identified in this evaluation as a guide when planning or evaluating SP's; (6) to the full extent possible, incorporate voluntary surgical contraception (VSC) as a standard part of FPPS activities; and (7) place less emphasis on operations research. Some of the lessons learned are: (1) SP's which provided integrated care were more successful than those with solely FP interventions; (2) local IEC subcommittees increased SP success; (3) contraceptives should be promoted and distributed by non- threatening persons such as subunit heads, rather than senior managers; and (4) better contraceptive supply and logistics systems are needed.