FAMILY PLANNING

TERMINAL PAR. STUDIES COULD NOT BE CARRIED OUT TO VERIFY GOAL ACHIEVEMENT OF A 40/1000 CRUDE BIRTH RATE. HOWEVER, IT WAS ESTIMATED THAT TO ACHIEVE A 40/1000 CRUDE BIRTH RATE (IN 1977) WOULD REQUIRE AN ACCEPTOR RATE OF 15% - 17% OF WOMEN, 15 TO 44 YEARS OLD, OR 87,000 ACCEPTORS. WITH A 12% ACCEPTOR RATE THROUGH THE ORGANIZED PROGRAM (50,989 ACTIVE ACCEPTORS) IN 1976 AND AN ESTIMATED 30,000 COUPLES USING COMMERCIALLY PURCHASED CONTRACEPTIVES, THE 87,000 TARGET FOR 1977 WAS ALMOST ACHIEVED IN 1976. THE PLAN TO INTEGRATE FAMILY PLANNING INTO GENERAL HEALTH SERVICES HAS BEEN SUCCESSFUL. THERE ARE ABOUT 125 MOH HEALTH CENTERS IN NICARAGUA WITH 86 OFFERING FAMILY PLANNING SERVICES. OF THESE 86, 31 HAVE PERSONNEL RECEIVING SALARIES EXCLUSIVELY TO PERFORM FAMILY PLANNING SERVICES, WHILE THE OTHER 55 OFFER INTEGRATED (FAMILY PLANNING AND HEALTH) SERVICES. IN SOME HEALTH CENTERS, THE DEMAND FOR REGULAR SERVICES IS SO GREAT THAT THE LIMITED STAFF HAS NOT BEEN ABLE TO PROVIDE FAMILY PLANNING SERVICES. HEALTH CENTERS, ESPECIALLY THOSE FURTHEST FROM MANAGUA, ARE HARDLY EVER FULLY STAFFED BECAUSE PERSONNEL MANY TIMES ARE RELUCTANT TO SERVE IN REMOTE AREAS. MANY HEALTH CENTERS HAVE ONLY A NURSE, OR AN AUXILIARY NURSE. MORE PARA-MEDICS WILL BE ALLOWED TO PERFORM DUTIES PREVIOUSLY RESERVED FOR DOCTORS OR NURSES. THE NICARAGUA DEMOGRAPHIC ASSOCIATION (ADN), WITH USAID FUNDING, TRAINED 500 DOCTORS IN 3 TO 5 DAY PRE-SERVICE OR IN-SERVICE TRAINING COURSES. ADN ALSO TRAINED 550 NURSES, AUXILIARY NURSES, SOCIAL WORKERS, AND HEALTH EDUCATORS. ADN CONDUCTED FAMILY PLANNING MOTIVATION/EDUCATION SESSIONS FOR 600 PEOPLE. "KAP" STUDIES CONDUCTED BY CDN WERE VERY USEFUL IN ASSESSING TARGET POPULATION KNOWLEDGE, ATTITUDES, AND PRACTICES ABOUT FAMILY PLANNING. THE CLIENT RECORD SYSTEM IN NICARAGUA IS THE BEST IN CENTRAL AMERICA. THE LIMITED STAFF OF THE MOH STATISTICS AND EVALUATION DEPARTMENT PREPARES QUARTERLY REPORTS OF HEALTH CENTER ACTIVITIES BUT HAS LITTLE TIME TO CONDUCT SURVEYS AND EVALUATIONS.