Project assistance completion report [PACR] : family planning and population development, project no. 664-0331

The project achieved its goal of increasing contraceptive prevalence by 9% and was quite effective in strengthening ONFP"s institutional capacity, particularly in the areas of IEC, CSM, and training. The IEC/CSM program assisted ONFP in analyzing media research data, fine-tuning the computerized management information system for product distribution and billing, developing radio and TV spots, and designing strategies and marketing plans. The media program was initially constrained by fears that conservative groups would react negatively to the family planning messages, the first to be aired on Tunisian TV and radio. As a result, there was less systematic reliance on message testing and media survey findings than planned. However, research results confirmed the positive attitude of the population towards media advertising for family planning. The project provided initial supplies of contraceptives and then assisted ONFP in developing the management capabilities and acquiring the financial resources necessary for sustainability of its CSM program. ONFP is now purchasing contraceptive products with its own funds, and is poised to introduce new product lines and adopt a pricing strategy that gradually decreases subsidies. The project strengthened and decentralized the capacity for family planning training. ONFP personnel were organized into inter-regional teams and assisted in providing in-service, pre- service/academic, and postgraduate training to midwives, physicians, nurses, pharmacists, and social workers. ONFP personnel were also trained to perform needs assessment and evaluation to identify changing needs and measure the impact of training programs. Significant gains have been made in the areas of research and management, although much remains to be done. Eight research activities were conducted: a knowledge, attitudes, and practices survey of medical and paramedical service providers; a national survey on continuation and failure rates of pill and IUD acceptors; integrated family health and family planning in the North and North Western governorates; a pilot project for integrated family planning services in peri-urban areas; a family health operations research project in the maternal/child health centers of Monastir and Sayada; a survey on the determinants of fertility in Tunisia; a survey and cost analysis of family planning service delivery functions in both the public and private sectors; and demographic health surveys. A major lesson is that while the project made remarkable achievements, ONFP is nearly overloaded with responsibilities, especially in the area of research. In addition, ONFP will need targeted TA to ensure the continuation of innovative program elements for which there is little in-country experience.