Training subprojects of the Egypt population/family planning II project

No time frame is noted. The three SPs are addressing, each in its own way, the need for well-qualified FP trainers and service providers. (1) RCT has made remarkable progress, and all the essential components of a training organization are now in place. Along with its affiliated satellite training centers, the RCT has trained some 4,400 FP trainers and service providers; the training is well received and contains a first class contraceptive technology component. It appears that RCT trainees have contributed to the country-wide reduction in the birth rate (from 38 per 1,000 in 1986 to 31 per 1,000 in 1993). However, with the diminishing number of FP trainers needing training, RCT must reconsider its mandate and identify and meet the next generation of FP training needs. The ambitious THO SP has had a difficult first 3 years. Training has been the most successful component; to date, THO has developed an excellent obstetrics/gynecology curriculum and trained 46 ob/gyn specialists in 8 public hospitals, modeling a level of care superior to that offered previously. THO has also, inter alia, developed excellent clinical guidelines for THO service providers, established a professional training center at El-Galaa, and opened 7 new FP clinics. However, service delivery outputs are behind schedule and not likely to be achieved, mainly due to the overly ambitious SP design and an unrealistic implementation plan. To increase clinic utilization, THO will have to openly compete for clients in the urban FP market; otherwise, its services will be in insufficient demand and incapable of becoming self-supporting. THO should also implement the new organizational structure proposed by the THO technical director to resolve conflicts over structure and staffing that hamper goal achievement. (3) The PPFPP has accomplished a great deal in 3 years. It has recruited over 1,300 physicians in a network of private FP service providers and trained over 600 clinic assistants. Its physicians have provided contraceptive services to an estimated 204,000 new FP acceptors and, through acceptance of the IUD, has contributed to over 196,000 couple years of protection. This has been accomplished by expanding the FP practice of ob/gyns and by upgrading the FP skills of general practitioners and pediatricians. PPFPP also supports its physicians with marketing assistance, continuing medical education, and monitoring of the services provided. So great is the demand for its services that PPFPP regional offices report waiting lists of physicians eager to participate. The evaluators also discussed several cross-cutting training issues. These include: delineating and strengthening institutional mandates for training; assessing training needs and developing training plans; selecting trainees; assessing training impact; institutionalizing training system capacities; and strengthening inter-institutional coordination. The following lessons were learned. (1) Assessment of the impact of FP training is impossible without pre-training baseline data. (2) Sustainability must be planned for from project outset, and adequate time and resources must be allocated to this effort. (3) Training institutions must serve the needs of the organizations whose people they are training. (4) Where several training institutions are involved, clear delineation of mandates is necessary to avoid overlap and competition for clients. (5) In training programs, it is sometimes necessary to focus on achieving training outputs at the expense of creating sustainable institutional capacity. USAID/E accepts 11 of the 12 evaluation recommendations, the most critical being continued funding of the RCT and THO subprojects in PFP III with specific modifications and more focused mandates, especially for THO. PPFPP, on the other hand, should seek other sources of support. Further USAID/E support to the private FP sector will be provided via competitively awarded contracts under PFP III.