Midterm evaluation of the Association for Voluntary Surgical Contraception (AVSC) cooperative agreement

The evaluation covers the period 8/88-11/90. In general, AVSC has executed its complex responsibilities quite satisfactorily. Activities have included projects (146 subagreements in 40 countries and 76 small grants in 24 countries), TA, training courses and workshops, and publications and program materials. Outputs in terms of service expansion, free and informed choice, medical safety, and program improvement have been achieved on time or ahead of schedule. For example, 14 regional training centers have been established and 134 training courses held, versus respective targets of 10 and 80. AVSC has performed with sensitivity and flexibility. Although it has definite preferences for certain methods and approaches, it has expanded its scope beyond interval sterilization to include other surgical methods (e.g., Norplant, postpartum sterilization, and IUD insertion). AVSC has shown leadership in quality assurance and counseling, and provides an international model with its focus on free choice. Additionally, AVSC communications with A.I.D./W and Missions are good, and the Association maintains extensive links with other cooperating agencies and multilateral agencies. AVSC needs to make improvements in several areas. (1) Greater attention could be given to information and education efforts and outreach activities. (2) Lack of systematic follow-up of participants in training courses makes it impossible to assess the true effect of training activities. (3) The management information system provides little of value, and there is little systematic effort to utilize evaluation to improve projects or management. (4) Strategic planning is limited to only a few areas of activity. (5) AVSC supports a disproportionate share of small projects, which are administratively time-consuming. (6) Lack of field experience and hands-on technical expertise in the Program Management Division hampers links between headquarters and the field. In the future, AVSC should devote more attention to the private for-profit sector, focus more on sustainability, and increase managerial efficiency by continuing the present trend toward decentralization. Further, as sterilization moves into the contraceptive mainstream in the 1990's, AVSC will not only have to expand its focus from local projects to national programs, but also relax some of its standards of perfection in non-critical areas. It will also have to replace its current impartiality toward policy issues with a stance of scholarly advocacy of progressive VSC laws and regulations.