Final evaluation of the family planning systems development subproject of the Ministry of Health under the Egypt population/family planning II project

Evaluation covers the period 1987-1993. As the SP entered its second year, approximately 2.9 million couples were practicing family planning (FP), representing a contraceptive prevalence rate (CPR) of 37.6%; by 1992, CPR had risen to 47.1%. Although the MOH was only one contributor to this progress, its successful achievement of SP outputs made it a principal contributor. With USAID's support, the MOH has established FP clinics in 21 governorates; provided contraceptive technology training to 6,000 doctors and 7,000 nurses; developed and implemented FP management systems for planning, monitoring, supervision, management information, and commodities management at the central, governorate, district, and service provider levels; trained MOH staff at each of those levels in those new systems; developed a motivated, skilled cadre of full-time FP service providers; and improved the quality of FP services. Most importantly, it provided FP services to over 500,000 clients each year from 1988-91; in 1992 over 600,000 clients were served. Government leadership, from the President, to the Minister of Health, and to Undersecretaries of Health, has supported the national population effort and FP. Challenges remain, however. Fertility in rural Upper Egypt remains much higher than the national rate, and women there are less likely to have prenatal care or be assisted at delivery by a doctor, trained midwife, or nurse. In 1991, the infant mortality rate in rural Upper Egypt was almost double that of rural Lower Egypt and significantly higher than that in urban Upper Egypt. In addition, the MOH FP program at present is essentially a one method (IUD) program. The number and variety of long-lasting methods should be expanded to include progestin-only contraceptives in their oral, injectable, and implant forms. Also, gender roles in Egypt constrain service delivery in rural areas. First, female physicians are led to seek work in urban areas; and, second, due to cultural norms governing privacy, clients (especially in Upper Egypt) seek female providers and/or refuse FP (particularly IUDs) when provided by a male physician. The following lessons were learned. (1) Although provision of quality FP services requires a great deal of effort, attention, and commitment, it need not be not capital intensive; a clean, one-room clinic equipped with very minimal equipment and staffed with trained and caring professionals who listen to and communicate with their clients, can offer high-quality FP services. (2) Public sector management can learn from the private sector how to stay competitive in the total FP market. In Egypt, the MOH learned from the quality focus of the Clinical Services Improvement SP (also under the Egypt Population/FP II Project) of the Egyptian FP Association, and has steadily upgraded the quality of MOH services even though quality per se has not been a focus of this SP. (3) Service statistics based on couple years of protection measure distribution of contraceptives rather than clients served or reduced fertility. A more precise assessment of contribution to reduced fertility can be achieved with client-based service statistics. (Author abstract)