Evaluation of the Zaire family planning services project (project no. 660-0094) : final report

Interim evaluation covers the period 9/82-12/90 (against a 9/91 PACD), with a focus on activities since the 8/88 project amendment. The project has made many positive contributions to Zaire's FP program, which is well advanced in comparison with other French- speaking African countries. The Zairian National Population Committee (CONAPO) has devised a population policy which will be an integral part of the government's next 5-year development plan. Support to Projet de Services des Naissances Desirables (PSND), the government's FP agency, has resulted in several notable achievements; specifically, this component has: established 140 operating FP units (vs. a target of 125); opened 3 regional training centers, 2 of which are still functioning; encouraged the integration of FP into the curricula at several secondary-level nursing schools (but not at university-level nursing schools or medical schools); and provided in-country training for 849 people, and overseas training for 148 more, ranging from courses in the basics of FP to full MPH degree programs. The project has also provided management TA to both CONAPO and PSND, and helped increase sales of condoms through the social marketing program from less than 1 million in 1988 to a projected 9 million in 1990. On the negative side, PSND's logistics and supply system are functioning poorly, and there is an urgent need for in-service retraining of service providers. Additionally, codified medical standards or referral guidelines for FP providers are lacking; national FP goal setting is unrealistic, ad hoc, and "top-down;" there are too many staff and supervisors at headquarters, and too few at the field and regional levels; the definitions of terms used in reporting service statistics to PSND headquarters are not understood in the field; and FP services in clinics are generally underutilized, indicating that community-based distribution (CBD), contraceptive social marketing, and particularly IEC activities need improvement. Besides recommendations aimed at correcting the problems mentioned above, it is recommended that USAID/Z: (1) collect data on contraceptive prevalence prior to project termination; (2) strengthen and coordinate with the A.I.D./GOZ Rural Primary Health Project (SANRU) and the Zairian Association of Family Well-Being (AZBEF) to enable them to play lead roles in implementing IEC and CBD; and (3) involve the private sector (including industrial and commercial firms) more closely in FP activities.