Family planning maternal and child health, phase V

The Ministry of Public Health"s (MOPH) Directorate of Preventive Services and Health Training and a U.S. contractor will implement the project. The project will increase the use of FP, diarrheal disease control, and safe motherhood (e.g., breastfeeding) services, and provide limited support for other services such as immunization and AIDS and respiratory disease control. (1) To increase access to FP/MCH services the project will modify client eligibility policies; increase the categories of professionals authorized to provide FP/MCH services; and introduce new contraceptive methods, and expand long-term and permanent methods, including Norplant, injectables, laparoscopy, and IUDs. Client records, a referral mechanism, and changes in staffing patterns, will help to integrate generalized health services with specialized health facilities. Integrated delivery strategies to be tested will include provision of postpartum FP within maternities. A data base on underserved populations will be developed to better target these groups. To improve service quality, the project will develop protocols, increase training (including that in interpersonal communications for health workers) and develop new curricula and materials, and upgrade supervision. Health facilities will be renovated to increase client privacy and provided with new equipment and supplies. The project will develop guidelines for the provision of IEC; provide training in the use of these IEC guidelines; train trainers in interpersonal communication and counseling; test FP/MCH messages; develop and disseminate educational materials for providers and clients and provide training for use of the materials; and provide public education through video programs, radio spots, etc. Opinion leaders will be educated about FP/MCH issues, using RAPID-style presentations. Efforts to increase program sustainability -- as USAID phases out its FP/MCH assistance -- will focus on policy, decentralization, and the private sector. The MOPH will develop a policy reform agenda, test alternative policies and practices, and engage in policy dialogue; policy issues to be addressed include health financing reforms and regulations concerning health workers and the role of the private sector. To strengthen decentralized management of FP/MCH services, the project will help the MOPH to develop institutions that incorporate regional structures and to improve provincial level capacities to plan and manage service delivery, IEC, training, logistics, and supervision. MOPH officials will be trained in decentralized program planning, include budgeting; the capacity of central, regional, and provincial staff to evaluate FP/MCH programs will be enhanced; and the MOPH will increase its training capacities and test a decentralized training plan, including trainer training modules. Managerial and technical expertise will be improved at all levels through the use of quality management approaches in at least five provinces, through managerial training, and by helping managers to develop linkages with U.S. firms. The Ministry will develop its capacity to procure and manage contraceptive supplies; A.I.D. support for these activities will terminate in 1998. In addition, the Health Education Division will develop a decentralized national IEC program. Finally, to increase financial and personnel resources for FP/MCH services, the MOPH will promote greater private sector involvement in FP/MCH. The project will train pharmacists and other private sector professionals, promote contraceptive marketing by private companies, analyze the policy implications of social marketing, develop a pilot employer-based program for service delivery and referral, and test several approaches to private sector FP/MCH service delivery, including the use of reference centers to reach primarily urban, middle class women, a group which has taken the lead in adopting long-term contraceptives. The MOPH will also lobby for more public sector budgetary support for FP/MCH.