Family planning service expansion & technical support (SEATS II) project : final report

(JSI), on Phase II (1995-2000) of a project to expand access to and use of family planning (FP) and reproductive health (RH) services in underserved populations worldwide (SEATS project). SEATS II worked in 20 countries, implementing 30 FP and RH subprojects in 11 countries and helping establish "nuts and bolts" programs that ensured that all key service delivery components were in place, were promoted, and were continuously improved. SEATS also successfully met the requirements of the three performance results (PRs) added in a midterm contract amendment: analysis, documentation, and dissemination; PVO integration and capacity building; and leveraging. Activities included country programs and subprojects as well as special initiatives (SIs), such as midwifery association partnerships for sustainability; urban, youth, and women"s literacy initiatives; and integrating FP/RH into NGO/PVO programs. USAID"s re-engineering and emphasis on field-driven, field-funded programs meant that each SEATS subproject and country program was developed from discussions with USAID Missions and local partners. SEATS found that its broad mandate, multidisciplinary capabilities, and wide-ranging skills were essential in responding quickly and comprehensively to local needs. USAID Missions sometimes turned to SEATS for assistance because of its flexibility. SEATS also: (1) assisted in such diverse areas as information, education, and communication (IEC), logistics, clinical training, HIV/AIDS prevention, policy, strategic planning, and institutional capacity building; (2) helped USAID respond rapidly and appropriately to new ideas and challenges raised by the 1994 International Conference on Population and Development (ICPD), with its emphasis on RH needs of people at different life stages; and (3) fostered the development of client-centered services. The SEATS project highlighted the inter-relatedness and compatibility of the three core elements of access, quality, and sustainability. In SEATS" experience, focus on the client is key. This value, commonplace in the development community, was new to many in-country partners, who nevertheless became enthusiastic proponents. Services flourished, and long-term sustainability became a real possibility. There are now proven approaches and the tools required to make profound changes in service delivery systems and providers. Lessons learned are as follows: (1) Access. (a) Access encompasses more than physical availability of services. Important barriers still exist. (b) All basic components of service delivery should be in place to ensure service access and use; some components are so vital that without them, other improvements lose their effectiveness. (2) Quality of care (QOC). (a) Quality must be built in from the beginning. (b) The capacity for continuous quality improvement must also be built in. (c) QOC has three core aspects: improving the capability or "readiness" of facilities to provide quality services, improving provider knowledge and skills, and increasing client satisfaction. (d) QOC needs to be continuously monitored and measured at different levels of the system. (e) Attention to quality results in improvements, empowers clients and providers, and ensures that clients will pay more for quality services. Cross-cutting lessons are as follows: (1) Unmet need is most effectively addressed through simultaneous, synergistic improvements in access, quality, and sustainability. (2) Reinforcing evidence-based programming encourages ownership of problems and solutions and appropriateness of interventions. (3) Future programming, particularly in systems undergoing decentralization, needs to build in a permanent capacity to collect and use data. (4) Integrating FP and other RH services responds better to what clients and countries are demanding. (5) Globally, demand is high for a responsive, broad-based capability that combines proven approaches with new strategies. For other lessons, see PN-ACH-159, -161, and -766.