Family planning expansion and regionalization

The International Planned Parenthood Federation (IPPF) will help PROFAMILIA to implement activities in community-based distribution (CBD), clinical services, public information and education, training, evaluation/investigation, and alternative distribution. PROFAMILIA will expand the number of its CBD posts, which provide easy access to orals, condoms, and spermicides, from 200 in 4 Pacific Coast Departments to 400 in 12 departments, including 5 in the mountainous central region. The number of users will average 150 per post. The CBD posts will be backstopped by 4 new regional clinics and 2 satellite clinics in 5 of Nicaragua"s 6 regions (in addition to the 2 existing regional clinics, both in Managua). Each with one operating room, the regional centers will provide voluntary surgical sterilization, gynecological services, family life education, and FP counseling. The satellite clinics will offer the same services, except for surgical sterilization. The Association for Voluntary Surgical Contraception will provide some TA for this component. PROFAMILIA will create a Social Communications Unit to expand community-level educational activities already carried out by PROFAMILIA"s Managua staff on a smaller scale. This will include maternal/child health education; sex education for adolescents; design, testing, and publication of new materials to support the CBD program; and mass media campaigns. A National Training Center will be established at PROFAMILIA headquarters under the aegis of the Social Communications Unit. Over the life of the project, the center will train: 90 physicians and 180 nurses from the Ministry of Health in contraceptive technology; 250 social workers from the Instituto Nicaraguense de Seguridad Social y Bienstar in FP promotion; and 370 CBD distributors. In addition, workshops will be held to familiarize 1,250 community leaders with PROFAMILIA activities. The most significant activities under the project"s evaluation/investigation component will be two contraceptive prevalence and maternal/child health surveys conducted by the U.S. Centers for Disease Control. Finally, PROFAMILIA will hire an expert to explore alternative contraceptive distribution systems. The expert will look for opportunities to increase cost recovery and will oversee marketing feasibility and demand studies. Amendment of 9/21/94 extends the PACD from 3/96 to 7/98 and revises project purpose. The new purpose is to increase access to a broader range of modern contraceptive methods, especially in rural and marginal urban areas through components in FP service delivery, communications, policy development and research, and institutional strengthening. Key output targets are that PROFAMILIA: (1) expand its FP service delivery network to encompass 800 CBD posts in the Pacific, Mountainous, and Atlantic Coast regions, backstopped by 11 full-service FP clinics; (2) establish a FP program on the Atlantic Coast; (3) expand its method mix to include one injectable, one progestin-only oral, and, subject to Government of Nicaragua approval, a subdermal implant; and (4) train 400 MOH and NGO personnel in modern contraceptive technology, including surgical contraception. (PD-ABL-588)