USAID support for family planning & reproductive health programs in Brazil

From 1992 to 2000, the final years of this program and the years covered by this report, USAID concentrated the majority of its activities in the states of Bahia and Ceara, located in the poorer northeastern region of Brazil where indicators showed a lag in women"s and men"s reproductive health status. The final strategy also made clear USAID"s intent to phase out support for FP in Brazil by 2000, when all activities would need to be self- sustaining. Over the years, USAID programs in Brazil helped establish a supportive and energized environment for FP and RH activities. The policy environment clearly improved, which should contribute to a strong, continuing program following USAID"s phase-out. USAID"s assistance in research and data collection has increased the quality and credibility of reproductive health information for policy, planning, and program evaluation. USAID"s support for the introduction of new contraceptive methods has broadened the range of methods available to women, although the use of new methods is still low. The phase-out strategy tapped into the resources and networks of the private, commercial sector, helping expand the range of methods and lower the cost of commodity procurement for the public sector. In addition, by the end of 2000, BEMFAM -- the first FP organization to receive USAID assistance in the 1960s -- had reoriented its program and financial strategies to become nearly self-sufficient. Perhaps one of the most remarkable successes, given its relatively late start in 1996, was PROQUALI, a new, client-focused model of service delivery for the public sector. In the two states where it has been implemented, PROQUALI has dramatically improved the delivery of FP and RH services, and offers significant potential for further expansion. A number of lessons can be drawn from the experiences of the various agencies that USAID supported in Brazil over the years. Many of these lessons relate to the importance of local partners investing their own human and financial resources in program activities. The USAID-supported agencies also emphasized the importance of a clearly defined phase-out strategy with adequate time for implementation. For the immediate future, it will be critical to identify additional opportunities for expanding many of the innovative and successful initiatives started with USAID support. (Author abstract, modified)