Mid-term project evaluation report : Caribbean regional population and development project

Special midterm evaluation, focusing on the Windward Islands, covers the period 7/82-9/84 and is based on document review, site visits, and discussions with trainees and with host government, project, and Caribbean Community Secretariat (CARICOM) officials. Despite delays, the project is well underway and in most areas proceeding according to plan. CARICOM has held regional and national Medical Contraceptive Policy (MCP) Seminars as well as a Regional Awareness Conference for political leaders. CARICOM's Regional Population Policy and MCP have been approved at the regional level, but only 2 countries (St. Vincent and Antigua) have developed their own MCP's (it is unlikely the target of 3 national MCP's will be met). Population task forces - established in 7 countries - have suffered from lack of leadership and political will. Family planning (FP) services are now available from governments in all countries but Antigua and Montserrat. Renovation is complete at 7 clinics and underway at 11; equipment has been supplied to about 50 clinics. The International Planned Parenthood Federation's Western Hemisphere Region (IPPF/WHR) has trained nurses and paramedical personnel in 6 countries; sex education training has been provided to 80 teachers by the Caribbean Family Planning Association. WHR seminars for physicians, however, were poorly attended (even when sessions were reduced to one day or less), and training in counseling and supervision has not been provided. Commodity supply and distribution systems have been set up in each country and community-based contraceptive distribution (CBD) has been expanded in Barbados and developed in St. Lucia, Montserrat, and Dominica; attempts to initiate a CBD program in St. Vincent have been plagued by difficulties and the Dominica program faces government opposition. Adolescent clinics and outreach programs have been established or are in early stages in Barbados, St. Lucia, St. Kitts, Dominica, and Antigua. Benchmarks on contraceptive use and population/FP awareness among political leaders were not established as planned. Project shortcomings are due mostly to governmental inefficiency, lack of political commitment, staffing constraints, and overly optimistic targets (given the difficulties involved in implementing FP activities in the Caribbean).