GOT/USAID evaluation of the Tunisian family planning program

Special evaluation covers the period 1982-6/84 and is based on document review, site visits, and interviews with staff of involved organizations. Since 1981 Tunisia's National Office of Family Planning (ONPFP) has increased the number of FP centers, maternity clinics, and mobile units; strengthened regional technical and administrative capabilities; created a postpartum consultation program to further FP education and motivation; and taken steps to expand private sector involvement. Training and retraining, some overseas, has been provided to physicians, nurses, midwives, pharmacists, and social workers; various new curricula and training instruments have been developed. Extensive information, education, and communication activities (using interpersonal, group, and mass media techniques) have resulted in widespread knowledge of modern FP methods. IUD insertions and tubal ligations provided by the public sector rose 68% and 14%, respectively, between 1979 and 1983. The private sector is now an important source of FP services and supplies for some 25% of users (most in urban areas); private sector provision of orals has more than doubled in recent years and that of condoms risen 40%. Data on contraceptive prevalence have been inconsistent, but ONPFP is making good progress in collecting statistics and has developed a promising computer program to calculate prevalence. Difficulties in rural FP have included inadequate data for monitoring program impact; departure of animatrices after training; a shortage of midwives, who oppose placement in rural areas or mobile units; lack of adequate transport; mobile clinic breakdowns; sociocultural difficulties (e.g., women's reluctance to be examined in the mobile clinics); and intervillage hostilities. Lack of physician participation and of cooperation by social affairs personnel have affected peri-urban FP, though there are important regional variations. To alleviate the shortage of midwives, a new cadre of personnel called obstetrical nurses is being planned. Also, medical schools give little attention to FP. Serious scientific research on population topics is badly needed in Tunisia, but is hampered by severe personnel constraints.