Private sector population project 522-0286, operating program grant : project close-out report

The project made significant progress, contributing to an increase in the contraceptive prevalence rate from 35% in 1984 to 44% in 1989. The number of community-based distribution posts and customers was largely increased and, as the result of social marketing activities, ASHONPLAFA's contraceptives are the best known and most widely used in the country. ASHONPLAFA's IEC department was significantly strengthened, growing from a limited regional activity to a national program promoting all of the organization's services. The department's nationwide campaign made use of television, newspapers, billboards, and pamphlets, while community outreach efforts used megaphones and educational films. The pretesting of audiovisual materials to determine public acceptance was also institutionalized. A training unit was set up to provide coordinated and expanded training to ASHONPLAFA staff and other FP providers. Several problems were experienced in establishing the regional clinics. Due to costly designs, project funds were insufficient to cover all five planned clinics, forcing ASHONPLAFA to construct two with its own funds. Although procedures were developed for decentralizing management and administrative functions to these regional centers, the procedures were not sufficiently implemented. As a result, ASHONPLAFA's internal structure remains rigid -- procedures are cumbersome and too many decisions are made by committee, thus slowing the implementation of important activities. In terms of the number of clinic users, the project experienced a large shortfall, mainly due to an intensive campaign launched in 1988 by the Catholic Church and other groups to eliminate FP services from the country. As the result of propaganda spread by these groups (that IUD's cause cancer), the number of users, which had increased to 18,000 by 1988, dropped to only 10,500 in 1989. However, a communications strategy was developed to combat this propaganda, and the number of active users has been steadily climbing to its former levels. The number of voluntary sterilization procedures was also lower than targeted, but this was largely due to unrealistic expectations in the project paper. Additional problems were faced in attempting to make the social marketing program independent of ASHONPLAFA. Although sales increased, sales personnel were receiving exorbitant commissions (37%) and accusations of fraud, theft, and mismanagement are being investigated by the Regional Inspector General.