Population programs intermediaries : IPAVS, JHPIFGO, IFRP, Westinghouse, Population Council and INTRAH

PES covers the period 10/81-10/84 and is based on document review, site visits, and interviews with USAID/T, National Office of Population and Family Planning (ONPFP), and other personnel. Overall, FP service delivery, supervision, training, and follow-up have been good, as has the performance of project intermediaries; significant progress has been made. From 1980-83 the crude birth rate dropped from 35% to about 31% and the natural growth rate from 2.7% to between 2.3 and 2.4%, while contraceptive use increased from 28% to 35%. Between 1979-1983 the number of new acceptors for all methods (except pills) increased - 14% for tubal ligations, 68% for IUD"s, and 6% for secondary methods. Increased private sector distribution of oral contraceptives has largely compensated for a 34% drop in public sector distribution. Rural FP delivery (through 6 mobile clinics, 2 teams, and 40 animatrices) has made good progress, despite personnel turnover, inadequate transport for animatrices, and some hesitancy among the populace to use mobile services; new management tools have been developed to identify target populations, reinforce information delivery, and improve follow-up. ONPFP"s continuing education unit has developed training curricula emphasizing problemsolving and conducted management workshops for ONPFP staff. A 10-day optional FP course is being incorporated into medical school curricula to supplement the existing 5-hour course. Also, FP program management/evaluation have been improved with the development of new statistical data collection and processing techniques (e.g., use of surveys, microcomputers, etc.), but more research on population-development interactions is needed to strengthen FP planning. However, peri-urban delivery, which depends on support from other Tunisian agencies, has been uneven and private sector service provision, while greatly increased, needs further expansion. Finally, although FP promotion efforts have been positive (in 1983 90% of Tunisian women were aware of modern contraceptive methods), more audiovisual aids, including television, are needed for group education. (Near East Bureau Abstract, modified)