Mid-term evaluation of the USAID/DR [Dominican Republic] family planning and health project (517-0259)

Interim evaluation covers the period 6/93-11/97. Although the project's highly optimistic assumptions (e.g., regarding host government cooperation, Dominican economic development, and international funding) have been met only in part, the project has in general accomplished its objectives and reached proposed goals for service delivery, contraceptive distribution, information, education, and communication (IEC) strategy design and respective material development, and the training of participating NGO personnel. The project and USAID/DR have also promoted health policy dialogue by providing training, facilitating and fostering contacts and coordination between NGOs and government institutions, and by promoting the exchange of information among NGOs and between NGOs and the Dominican government regarding both technical and administrative aspects and policy. Project impact on fulfillment of demographic and reproductive health (RH) goals is significant, although quantitative measurement is not possible. Contraceptive use by women in union increased from 56% in 1991 to 64% in 1996, and knowledge among both men and women of the existence of FP methods is now almost universal (99%). During the same period, however, the Total Fertility Rate (TFR) stagnated, decreasing only from 3.3 to 3.2, while the proportion of adolescents aged 15-19 who initiated procreation increased from 18% to 23%. The reduction in TFR occurred in rural zones, where it decreased from 4.4 to 4.0 children, while remaining stable in urban zones at 2.8 children. The mix of FP methods has evolved positively, especially with the increased use of all modern temporary methods. Overall, project activities have had a positive impact on RH, the most outstanding being the development of IEC strategies and materials for the promotion of RH and FP methods and the coordination activities carried out by the Interinstitutional Council and other committees. Other activities that have affected RH are the coordination and funding of the 1996 Demographic and Health Survey and the training in the use of this information. Activities carried out in more densely populated areas and centers (e.g., free zones and marginal neighborhoods in principal cities) and the TA provided are having a positive impact. It is likely that activities with lesser impact have been those implemented in remote, low-density, and low-income areas, although these are clearly the areas most in need. The project, in fact, faces two conflicting policies: coverage of marginal areas vs. self-sufficiency. This dilemma, which raises a problem for the NGOs, must be defined by USAID in a way that promotes both goals. The following lessons have been learned: (1) A very extensive project covering numerous areas and entities over a long period of time is difficult to manage, and requires full periodic revisions for the integration and coordination of its actions. The project being evaluated is of this kind and would have benefitted from a full rather than merely partial revision. (2) Indicators and goals must be attainable and motivational, and should be revised if significant amendments to the project are made, or if project assumptions or country conditions change. Goals and indicators must be attributable to the project. If possible, qualitative aspects should be included. (3) The amount of time and effort spent in learning scientific and democratic processes for the development of IEC materials should be taken into account to make the processes more efficient. (4) TA should be ongoing. New situations and changes require continuous technical support. (5) Once experience is gained and maturity is increased, the agencies and the project should respond to this new stage, thus avoiding stagnation. (6) The project has made interventions in a wide range of populations. The resulting network should be used not only for FP, but also for other activities such as STD/HIV/AIDS prevention, the conducting of censuses, surveys, etc.