Evaluation of USAID/Peru project no. 527-0335 : private voluntary family planning service expansion project, April 19-May 8, 1993

The evaluation covers the period 10/90-5/93. The project is being implemented by Proyectos Informatica, Salud, Medicina, y Agricultura (PRISMA). None of the participating NGOs is either institutionally or financially independent: PLANFAMI-Puno and ATLF have very low survival prospects, APROSAMI, INPPARES, and PROFAMILIA have reasonably good prospects, and CENPROF and PLANIFAM, probably because of their geographical location, have higher institutional prospects, but severe economic limitations. However, all NGOs have a clear awareness of the need for growth and independence, as evidenced through their understanding of institutional vocabulary (e.g., strategic planning, costs analyses, market segmentation). Except for ATLF, the NGOs have significantly increased long-term contraceptive use among beneficiaries. Also, all NGOs have continued community-based distribution (CBD) activities on their own despite a reduction in funds for this purpose, and all provide natural family planning (NFP) information during counseling activities. However, NFP will not generate income, and will have to be supported by aggressive income-generating activities in both the health and non-health sectors. NGOs' attempts to expand into rural areas have been unsuccessful: because of Peru's poor economic situation, agencies that have worked with traditional campesinos have suffered net financial losses and have had to rely on financial subsidies from external sources. Likewise, NGOs have been unsuccessful in attempting to offer their services in underutilized public health facilities alongside public health service providers. On the one hand, health recipients were confused by the simultaneous provision of free and bought services; on the other, Ministry of health (MOH) doctors were resentful of private practitioners being paid on a fee-for-service basis. PRISMA has been effective in establishing good relationships with each of the six NGOs -- a difficult task given the heterogeneity of the group and the circumstances inherited from project's predecessor, the Private Sector Family Planning Project (5270269). PRISMA shortcomings that will have the most effect on participating NGOs are the initial involvement in and follow-up on studies and recommendations performed by private technical consultants. Additionally, there has been limited transfer of technology or methodology in the areas of cost analysis, marketing, and pricing (work done in the area of strategic planning was more successful).