Story of CARE"s successful integration of family planning and reproductive health services : a case study

Several factors contributed to PFPE"s success, including early and strong support from the Board and senior staff, an interest from the field in developing FP programs, and the development of solid technical expertise at CARE headquarters to support field initiatives, including establishment of a central Population Unit and appointment of Regional Technical Advisors for Africa and Asia. Also key were the good relationships that CARE forged with the donor, including early and consistent dialogue on key technical and administrative needs. CARE also leveraged more than three times the amount of match funding originally proposed, disbursing over $19 million in matching funds since 1992, vs. a target of only $11.6 million. This supported the expansion of PFPE from 10 FP projects in 10 countries to 46 FP/RH projects in 29 countries. At present, only 8 of these programs are supported by CARE"s follow-on Management of Reproductive Risk (MoRR) project. These integrated programs have had substantial impact on modern contraceptive use. FP/RH programs are also being developed in other sectors at CARE (food assistance/Title II, girl"s education, and agriculture) independent of the CARE-MoRR project. Another CARE strategy was to initially focus on a small number of projects in order to build on and demonstrate early successes in the program. This entailed starting with country offices where there was a clear interest in FP and developing a small but technically sound project portfolio. There was a strong emphasis on learning from the process itself. The headquarters technical team also demonstrated their "added value" by being responsive to field needs, and providing both financial support and a variety of TA to country office projects. CARE"s Population Unit also defined a clear strategy for constituency building within CARE itself, which entailed fostering links with other units in the organization to better support the FP program. CARE USA actively endorsed FP programs within CARE International, and thereby helped CARE to diversify technical and financial support for the program. As the project portfolio grew, headquarters and regional staff evolved to meet field needs and provided diversified technical skills and regional expertise to better serve country office needs. Continued political support from CARE leaders was key in maintaining momentum and interest at an organizational level. This support also encouraged more country offices to adopt new and innovative programming initiatives in RH and to think strategically about these areas when engaging in long-range planning. The evolution in CARE from a FP focus to one that more broadly addresses RH reflects the Population Unit"s efforts to better integrate with country office needs and with the overall context of health programs. Over the years, CARE made technical and administrative adjustments to respond to the internal changes within USAID. One such change has been the creation of the Center for Population, Health and Nutrition (G/PHN Center) in 1994, with its mission of global technical leadership. Another change has been the decentralization of authority and resources to USAID field missions and the establishment of two separate funding sources for USAID-supported initiatives: G/PHN Center core funds and USAID mission field support funding. Another change has been the development of strategic objectives at all levels (Agency, G/PHN Center and USAID missions) and the related requirement that all G/PHN centrally-funded activities be consistent with and support USAID field mission strategies. The strategic planning process has increased accountability for results at all levels. Other adjustments have included expanding the monitoring and evaluation system to capture key RH indicators beyond FP. CARE is also supporting several program innovations, including partnering strategies, peri-urban programs, and operations research with other agencies. Headquarters" flexibility to different organizational levels has been key in this process. Implications of CARE"s experience for other PVOs seeking to build organizational commitment and capacity in FP/RH are detailed in conclusion. (Author abstract, modified)