Evaluation of USAID/Honduras private sector population II project (522-0369)

The project was largely successful. Despite strong criticism from the Catholic Church, ASHONPLAFA provided family planning services at 1,963 rural and urban distribution points, and medical services at 6 ASHONPLAFA clinics and 7 private clinics in all geographic areas of the country. Additionally, through a contract with one of Honduras' largest pharmaceutical distributors, it provided contraceptives to over 600 pharmacies and stores throughout the country. In all, ASHONPLAFA achieved 82.5% of the project's couple years of protection (CYP) targets, with the Medical Clinical Program achieving 83.8% of target, the Community Services Program 81.3%, and the Social Marketing Program 78.2%. Also, CYP in 1993 was 19% higher than it was in 1991. ASHONPLAFA devoted considerable effort to cost recovery and income generation: it has steadily increased prices, significantly increased client volume and revenues, and improved the execution of its budget. The level of self-sufficiency is projected to be 27% in 1994, up from 21% in 1990. Levels of self-sufficiency increased significantly in five of the six regional offices, though falling in Tegucigalpa, the largest office. Continuing institutional needs include cost control, pricing strategies based on costs and a sliding fee scale, and generation of income in addition to program service charges. While some authority has been transferred from the central office to the regional offices, several problems still exist. The financial accounting and other management information systems (MIS) were not in use in all regions, did not provide cost accounting information, and did not provide regional and mid-level staff members with data about the programs so that corrective measures could be taken. Clinic underutilization is also a problem, and quality of medical attention requires additional attention. Lessons learned include the following. (1) When a project has potentially conflicting objectives (expanding geographic coverage and cost-recovery), clear guidance must be given as to which objective should receive greater emphasis. (2) Changing the structure and management policies of an institution is a long process that requires clear, agreed-upon steps as well as understanding and patience on the parts of the members of the organization and USAID. (3) Donors and grantees should establish agreed-upon plans and objectives for shifting financial responsibility to the grantee. (4) To measure impact, population-based data is necessary. USAID should attempt to carry out demographic and health surveys in time frames which would support bilateral population projects.