Mid-term evaluation of USAID family planning services project in Bangladesh

Special evaluation covers the period FY 1981-82 and is based on interviews with key officials, document review, and site visits. The project, part of a multidonor effort, is contributing positively to the BDG Population Control and Family Planning (PCFP) program. Although contraceptive use - which may reach 32-33% by 1985, compared to a targeted 30% - has increased, the PCFP has been seriously hampered by inadequate BDG financing (due to adverse economic conditions), too frequent changes in direction (especially regarding integration of FP with health care), numerous personnel changes, and deficiencies in organization, administration, logistics, supply management, training, and supervision. The PCFP has overemphasized sterilization, at the expense of other types of contraception. A.I.D. funding of local costs of the PCFP sterilization program (assumed in Spring 1981) has been temporarily withdrawn due to inadequate BDG efforts to ensure strict voluntarism; implementation of required procedures is improving. The bulk of A.I.D. assistance to the PCFP has consisted of providing contraceptives and other supplies. However, clients have been dissatisfied with AID-provided Noriday, attempts to integrate the PCFP with health care have disrupted supply reporting, and too little attention has been given to increasing BDG self-sufficiency in supply procurement and management. Training of physicians and other health and volunteer personnel has been hampered by lack of funds and qualified trainers, but overseas training has been of value. Progress is being made with regard to PCFP contraceptive use surveys and operations research. The Local Family Planning subproject has good potential for increasing local flexibility. Finally, USAID/B has provided high-quality assistance to NGO's, which have proven valuable sources of innovation and evidently have met their goal of accounting for 10% of contraceptive use. To meet FP goals in Bangladesh, high levels of aid, close collaboration among donors, and increased utilization of NGO's are needed, as well as increased attention to efforts to delay marriage age, and decrease desired family size. Numerous recommendations address specific needs alluded to above.