Private sector family planning project no. 521-0189 : second interim evaluation

Evaluation covers the period 8/86-6/93. In general, the project has been a success. As of 1992, there were approximately 175,000 new contraception acceptors (vs. a targeted 200,000), although the retention rate could not be measured. Thirty-three (vs. a target of 35) PVOs are providing FP services; and 31 PVOs (vs. a target of 23) are capable of providing voluntary surgical contraception. Almost 6,000 cycles of low-dose orals are marketed monthly at over 200 commercial sales points. The cost per couple year of protection has decreased, which demonstrates the significant returns to early investment and increased cost-efficiencies over time. In general, the quality of services provided falls within accepted averages, and it is clear that project management is placing a good deal of emphasis on improving the determinants of quality; some of these efforts are new and have not yet borne results. Access to a full range of method choice is limited by lack of training of service providers for the more clinically oriented methods, such as IUDs and Norplant, and also, at some institutions by an insistence on conducting pelvic exams before providing hormonal contraception. Great progress has been made in the area of education and counseling provided by nurses, auxiliaries, and community workers, but doctors are far behind in counseling skills, and client contact, from welcome, to group education, to individual counseling still needs a good deal of attention. The Port-au-Prince Field Office has made progress in the collection and analysis of service statistics. Particularly notable is the Mystery Client activity, which provides useful feedback to participating organizations. Contraceptive management practices (i.e., inventory, supply) have improved markedly, and previous obstacles to developing and using IEC materials have been overcome. Project and PVO management (especially financing management and reporting) have clearly benefited from TA and training, but planning and supervision still need much attention. While the project paper did not include a cost-recovery strategy, some PVOs have initiated cost-recovery pilots, and 3 PVOs are conducting cost-recovery operations research. Although PVOs' interest in incorporating cost into program planning has increased, no PVO at this time has devised a cost recovery strategy that would decrease dependence on the project over time. Quantitative targets for many project objectives have decreased through successive project amendments, due to the instability of Haiti's political and economic environment. That no PVO disappeared, and that almost all PVOs maintained continuity during Haiti's periods of upheaval is impressive and can be attributed to committed staff and capable management. Numerous recommendations are made.