Project assistance completion report : population and family planning support project phase III (608-0171)

The project met or surpassed its objectives: (1) FP information and services have been established for 80% of the population (vs. a target of 70%); (2) contraceptive prevalence for married women of reproductive age has reached an estimated 41.5% (vs. 35%); and (3) planning and analysis capabilities in the areas of FP, child survival (CS), and population have been established at the Ministry of Public Health (MOPH). On a broader level, project and other donor assistance has helped the Government of Morocco (GOM) improve key FP/MCH indicators: infant mortality has declined from 112 per 1,000 live births in early 1970s to 57 in 1992; child (ages 1-4) mortality declined from 77 to 20 deaths per 1,000 in the same period; vaccination coverage increased from 40-50% in 1985 to at least 72% -- and possibly up to 90% -- in 1991; and total fertility rate declined from 5.8% in 1980 to 4.2% in 1992. The strongest elements of the project included: (1) expansion of the VDMS (household visits) outreach program and the integration of child survival (CS) activities into the program, (2) increased awareness of population concerns among policymakers and the development of mechanisms to gather population data, (3) extensive management and technical training programs for local staff, (4) expansion of clinical services programs for long-term contraception, especially the voluntary surgical contraception programs established at 34 fixed centers nationwide, and (5) commercial sector activities, including social marketing of contraceptives. The project's primary weaknesses included: failure to effectively apply information and recommendations derived from operations research and special studies; lack of focus within the IEC component; and inadequate information for efficient contraceptive logistics management. Although the follow-on project, already underway, calls for a phase-out of assistance to Morocco's population sector by 1996, it is unlikely that the program will be entirely self-sustaining by then. The planned phase-out should be re-examined during the next project management review. A 1991 CS impact evaluation derived the following lessons from Morocco's experience. (1) Integrated services are more effective than separate ones; the highly integrated VDMS outreach program is a good example. (2) Giving priority to FP and immunization is a valid CS strategy. (3) Careful phase-in of activities can lead to a more successful program. The Morocco program has been a series of phases, each with its own characteristics. (4) The Morocco model is replicable, but its success cannot be divorced from the social, economic, and religious context in which it functions. (5) An FP program can be successfully initiated even in the absence of a stated public population policy; program achievements along the way can help build support from policymakers. (6) The private sector needs to be involved as early as possible, as this leads not only to increased FP/MCH information and services, but greater sustainability as well.