Final report : Morocco phase V family planning and maternal and child health project -- May 1994 - September 2000

on the fifth and final phase (5/94-9/00) of USAID-funded maternal child health family planning (MCH/FP) projects in Morocco. The present project was designed to increase both the utilization and sustainability of MCH/FP services. As to the first, the project contributed substantially through: (1) the pilot implementation of innovations to improve the quality of MCH/FP services, such as emergency obstetric care and the integrated management of childhood illnesses (IMCI); (2) improved accessibility to MCH/FP services, especially in isolated areas, by strengthening mobile teams; (3) increased participation of private medical practitioners in preventive MCH/FP service delivery; and (4) strengthening of management support systems, such as quality assurance, training, contraceptive logistics and the health information. As to the second, the project"s chances of sustainability are strong for the following reasons: (1) Health facilities offer a range of MCH/FP services whose efficiency has been demonstrated by the continued improvement of relevant health indicators. It is hoped that project activities to reinforce emergency obstetric care will also have a long-term impact on maternal mortality, which remains a priority problem. (2) Phase V activities have particularly contributed to the integration of MCH/FP services into the organization of health services. The IMCI approach aims at changing management of childhood illnesses through vertical programs into comprehensive and holistic management of the child. Above all, the decentralized management of MCH/FP services, initiated under the project, perfectly matches government efforts to devolve the planning and management of administrative and social services to the newly created regions. (3) One of the most impressive results of Phase V is that, after the Vaccine Independence Initiative, the Moroccan government took over contraceptive financing, thus resulting in quasi total financial autonomy of the recurrent costs of MCH/FP services. (4) The Phase V project invested considerably in strengthening the individual capacity of human resources in both the public and private health sectors through in-service and pre-service training, particularly the in-service training of physicians, who are often very resistant to any reform effort. (5) Lastly, this project, like the preceding ones, resulted from an entirely consultative and participatory consultation process between the Ministry of Health and USAID, aiming at sustainable mechanisms for quality MCH/FP service delivery. To these characteristics favorable to sustainability should be added the relative economic and institutional stability prevailing in Morocco over the past 20 years. Includes recommendations.