Midterm evaluation of family planning self-reliance projects, Costa Rica

The evaluation covered the period through 6/91. Although the public sector FP program is still marked by numerous weaknesses, some progress has been made. The project has contributed to the establishment of a Reproductive Health (SR) unit in the Preventive Medicine Department of the Costa Rican Institute for Social Security (CCSS), and FP services are available in virtually all CCSS and Ministry of Health service facilities. Contraceptive supplies are generally adequate, FP informational materials have been distributed to all facilities, and supervision is good. CCSS and the MOH recognize FP as an essential service, and CCSS will assume full financial responsibility for FP when USAID/CR support is terminated. Principal weaknesses of the public sector program include: (1) serious delays in reforming medical and nursing school curricula to incorporate FP as a subject and in providing FP in-service training; (2) failure to integrate the SR unit into the CCSS; (3) lack of technical or administrative authority of SR unit supervisors, resulting in deviations from guidelines for contraceptive supply; (4) poor research skills and management information systems; (5) lack of SR unit skills in program planning and management; (6) lack of progress in sex education for the in-school population; and (7) lack of organized postpartum FP counseling. The contraceptive social marketing program has been implemented by PROFAMILIA, a for-profit subsidiary of the Costa Rican Demographic Association, using condoms provided free by USAID. PROFAMILIA's condom sales have increased from 500,000 to 2.6 million, or 30% of the market. The firm has not been successful in offering oral contraceptives, due to product registration requirements and lack of interest among suppliers. However, PROFAMILIA has made remarkable progress toward financial self-sufficiency. Net assets of $1 million and 100% self-sufficiency are expected by the end of 1995. The project has made little progress in expanding the alternatives for FP service delivery. CCSS does give financial support to several doctors' cooperatives in urban areas. Clients receive care free of charge, but in effect, if employed, are paying through their social security taxes.