Tunisia family planning services : mid-term evaluation, phase one

Midterm evaluation covers the period 1978-9/79 and is based on interviews with staff of the Ministry of Public Health (MOPH), the GOT implementing agency -- the National Family Planning and Population Office (ONPFP), other GOT ministries and agencies, and medical faculties. The ONPFP has made major advances toward realizing project objectives. Achievements include: (1) strengthened educational and administrative structures in all 18 provinces; (2) rural pilot projects testing innovative FP service delivery tactics; (3) a national training center, operational since 3/79; (4) expanded research and evaluation activities; (5) an expanded clinical program including voluntary sterilization; (6) maintenance of performance levels during a period of program expansion and penetration into less easily served rural areas; and (7) demonstration of the value of female FP rural outreach workers. The most successful activities have been the rural pilot projects and research and evaluation activities, both of which have generated a tremendous amount of valuable data. On the other hand, information, education, and communication activities have shown little penetration into rural areas; technical assistance appears to have been underutilized; and training targets have not been met. Recommendations for consolidating recent achievements and improving rural FP service delivery are: (1) review plans for project amendment no.2 to ensure that it reflects current status and needs in all assistance areas; (2) discuss with ONPFP plans for community-based distribution programs in Kairouan, Medenine, and Gabes and consider immediate implementation; (3) plan and implement a pilot information, education, and communication project in one province in 1980; (4) have key MOPH, ONPFP, and USAID/T staff make field studies of successful Asian FP programs; (5) appoint a full-time ONPFP coordinator for the Family Planning International Assistance subproject to expand FP/Maternal Child Health services in four provinces; and (6) provide a special budget to improve participant training. Issues facing the GOT"s FP program in the 1980"s are addressed in a companion report (PD-AAJ-052).