Project assistance completion report : family planning assistance project no. 492-0396

As a result of the passage in 10/91 of the Devolution Act, or Local Government Code (LGC), responsibility for the NPP was transferred from the Department of Health (DOH) to more than 3,000 Local Government Units (LGUs), none of which had any previous experience with health and FP programs and many of which did not view FP as a priority. This unexpected turn of events caused numerous uncertainties and delays, but also provided a challenge which the project met by helping 30 carefully selected LGUs to design and implement a pilot decentralized, performance-based FP delivery program. The lessons learned from this experience were used to develop the follow-on Integrated FP/Maternal Health Program for implementation in the remaining LGUs. Funding for this implementation shift and for substantially increased training (particularly training in injectable contraception) became available after the Global Bureau's Office of Population provided $11.786 million worth of contraceptives to the project free of charge. In the end, the project met all its major targets. It: (1) expanded the number of government/NGO clinics offering FP services to 3,297, vs. 3,000 targeted; (2) made voluntary surgical contraception available at 29 district hospitals (vs. 25); (3) provided clinical training to almost 61,000 public and private health professionals (vs. a target of only 20,000-25,000) although the training was not competency-based, a problem the DOH has agreed to correct in the follow-on program; (4) established a logistics system providing contraceptive supplies at 2,640 outlets (vs. 3,000 targeted); (5) produced 13 general and method-specific FP brochures (no target) as well as the three targeted media campaigns; (6) helped the Philippine NGO Council award 13 subgrants (vs. 10); (7) made FP information and services available in 61 workplace sites (vs. 98); and (8) established the planned contraceptive social marketing program. At the goal level, the contraceptive prevalence rate rose from 36.2% in 1988 to 50.8% in 1995, although most of the increase between 1993 and 1995 was in the natural FP methods sanctioned by the Catholic Church, whose strong opposition virtually halted the NPP during the last 2 years of the Aquino administration (1990-91). Current estimates for total fertility rate (TFR) are unavailable; the most recent estimates show a TFR of 4.09 in 1991, well below the target of 4.21. The project taught numerous lessons, some (but not all) of which were used in designing the follow-on. (1) Sufficient attention was not paid in the design to the sustainability of several key activities (logistics management, IEC, training), and as a result at PACD, none of these had full-time staff. (2) Assignment of counterparts to TA personnel should have been a condition precedent. The Project Management Unit established at the DOH is staffed almost entirely by contract personnel. (3) Given the uncertainties about USAID and other donors, it is important to press the DOH to increase budgetary resources for the NPP, which up to now has been almost entirely donor-funded. (4) Although the LGC is almost 5 years old, the roles and responsibilities of the DOH and its Regional Health Offices remain undefined. Several management information systems are operational at the DOH, virtually all of them developed prior to passage of the LGC, and none of which are relevant or useful. (5) Clear guidance from the national level on service delivery polices and standards is essential for effective program implementation at the LGU level. (6) Despite the project's best efforts, participation of the private and NGO sectors continues to be minimal. Market segmentation is key to energizing these sectors. (7) The case management approach used in the 30 LGUs should be reviewed to determine if it is the most cost-effective and efficient way to implement a performance-based FP and maternal/child health program.