Final evaluation of the Ghana family planning and health project (FPHP) (641-0118)

The evaluation covers the period 1990-9/95 against a PACD of 3/96. The program has been successful. It has exceeded its goal by decreasing the total fertility rate from 6.4 in 1988 to 6.1 by 1995, and should, by the PACD, reach its goal of increasing the use of modern contraceptive methods by 15%. In addition, the Ministries of Health (MOH) and of Finance and Economic Planning (MFEP) are increasingly claiming ownership of the MCH/FP program, and to a lesser extent, the HIV/AID program; MOH budgeting and planning skills and confidence have grown stronger; quality assurance has become a concern of service providers and policy makers. Specific achievements include the following. (1) Although delays in the release of nonproject assistance (NPA) funds hindered implementation, all conditions precedent set as terms for tranche releases were met, resulting in a number of policy reforms, including establishment of the National Population Council (NPC), preparation of a comprehensive set of action plans for policy implementation, and reclassification of contraceptive products to be legally offered by a wider array of distributors. (2) The MOH"s Health Education Unit (HEU) coordinated an outstanding public-private sector family planning and HIV/AIDS information campaign, although airing of media messages was thwarted to an extent by a vocal minority who felt the ads might encourage promiscuity -- a problem which might have been avoided if the mass media campaign had been legitimized by the public sector. (3) More than 7,100 private and public sector trainers, communicators, and service providers were trained. (4) The MOH used NPA funds and program-provided contraceptives to substantially increase FP coverage, and to improve supervision, management information, outreach, and service integration. (5) The social marketing component underwent organizational change, the long-term impacts of which are yet uncertain. The dramatic increases in couple years of protection achieved under the project have occurred more in the MOH component than in the social marketing component, where levels have remained relatively constant, probably due to the emphasis on short-term methods. (6) HIV/AIDS activities are being integrated into the MOH"s core programs and there seems to be a significant improvement in specific knowledge about HIV/AIDS and condom use. IEC related to HIV/AIDS prevention has been integrated into MOH programs, the social marketing program, and 18 NGOs. Additionally, the Ministries of Information, Education, Mobilization, and Social welfare, as well as the Ghana Armed Forces, were involved in IEC initiatives. (7) The Accra branch of the Public Health Research Laboratory has been completed, equipped, and staffed. The building and equipping of four other laboratories should be completed by the PACD.