Family planning services

PES covers the period 3/77-8/79 and is based on document review. Despite a decline in the Jamaican economy and in GOJ commitment to the FP program, and a loss of momentum since the 1974 integration of the National Family Planning Board (NFPB) into the Ministry of Health and Environmental Control (MHEC), the project has achieved some success. At least 204 MHEC clinics are delivering FP services to 95,000 users, and, with 25,000 new clients now being served annually, the project goal of 100,000 users should be met or surpassed. The birth rate has declined some, but the goal of 25 births per 1000 is not likely to be met during the life of the project. Training has been provided to 20 GOJ health staff in overseas programs and to 1,200 in 40 in-country courses. The newly-created Center for Research and Training in Fertility Management at the University of the West Indies (UWI) (only partially project-funded) has trained physicians in FP and conducted research on neo-sampoon vaginal tablets (for possible commercial distribution), on clinic drop-out rates, and on contraceptive knowledge, attitudes, and practice. Although sterilization has been limited by low male interest and a shortage of physicians (due to emigration) and equipment, a program has been initiated to: train physicians in laparoscopic sterilization; renovate clinics; provide equipment; and establish a repair/maintenance center. However, only 1,100 of a planned 2,000 community health workers have been deployed and, due to inadequte training, they have not distributed contraceptives to households. USAID/J and NFPB have terminated funding for the family life/sex education component due to curriculum development problems and a shift in focus from sex education. Commercial contraceptive distribution, initially sucessful, has suffered a lack of new outlets and advertising problems. Most seriously, lack of an overarching GOJ FP policymaking body (since MHEC/NFPB integration) has resulted in inefficient FP program administration and implementation, poor coordination and mobilization of non-MHEC FP activities (as other agencies are not represented), and low MHEC/NFPB staff morale. Seven action decisions are given.