RSDP (rural service delivery partnership) end of project report : program achievements and lessons learned 1997-2002

RSDP successfully increased both the number of customers served from each of the three service delivery points (static, satellite, and depotholder), and the use of all essential services. The average monthly customer flow at RSDP delivery points has increased by over 631% since 1997. In FY 2002 RSDP served approximately 9 million customers. Average monthly customer flow per upazila increased from 117 to 742 at static clinics (512% increase), from 375 to 1,898 at satellite clinics (406% increase), and since 1997 from 382 to 3,381 (932% increase) for depotholders despite the loss of 33 Bangladesh Rural Advancement Committee (BRAC) sites in 2001. Under RSDP, Pathfinder implemented a highly successful newlywed program promoting smaller families, a delay in first childbirths, adequate birth spacing, and prenatal care. The program functioned by identifying and registering newlywed couples, targeted visiting by depotholders, and holding orientation meetings. Program efforts significantly increased the knowledge and use of contraceptives by both male and female newlyweds, as well as the use of prenatal services. The program also highlighted the role of depotholders as a source of important information for the community. RSDP provided regular training in clinical skills, quality assurance, management and finance, and other topics to NGO staff, clinic managers, and clinic staff. Through the head office and four regional units, RSDP provided regular TA and tracked the progress of clinic sites through monitoring and supervision visits. RSDP, with the assistance of the Quality Improvement Partnership (QIP) and other partners, produced numerous manuals and guidelines on essential services. NGOs were extensively trained in strategic planning and goal setting for annual workplan development, and in the development of renewal proposals. NGOs were also trained to conduct RAPID assessments, allowing for self-assessment of performance. RSDP"s extensive management information systems (MIS) collected valuable information for programmatic decisionmaking and project management. The MIS process itself was valuable as a means to build NGO capacity to track performance and manage local clinics. An extensive MIS system was established, starting at the clinic level, where data were compiled and sent to NGOs and RSDP in order that logistics (contraceptives and medicines), clinic services provided, training status, and personnel could be tracked and problems identified. RSDP cut program operating costs, increased clinic and depotholder revenues and increased their market share of FP and health services, decreased reliance on government-subsidized services, and encouraged NGOs to obtain their own clinic site. RSDP conducted studies that resulted in more efficient use of staff time, resources, and the correction of missed opportunities. As a result of a study on cost of services and willingness to pay, there was an 8% increase in service delivery points without any additional staff. The study found that communities largely accepted fee-based services and an increasing number of customers paid for services. At the end of the program, only 20% of pill customers and 10% of condom customers obtained their supplies free, and only 45 of 139 clinics were housed in NGO-owned buildings and did not pay rent. NGO linkages with the private sector were established; dependency on government sources declined significantly -- 33% of pill and 4% of condom users were supplied with social marketing of contraceptive (SMC) products. The majority of NGO contributions to the revolving drug funds were replaced by SMC-provided money. RSDP built long-term support for the program by strengthening relationships with the community, government, and other partners. RSDP developed a relationship with the government over the years to ensure contraceptive and medicinal supplies are received on a regular basis by the clinics. Lessons learned are detailed concerning: the use of the "essential service package"; knowledge and behavior change; service quality and NGO management; and sustainability. Key remaining challenges are also detailed.