USAID"s population and family planning program : a synthesis of six country case studies

According to the report, FP programs have had a positive impact on fertility, health, and the social sectors in Honduras, Kenya, the Philippines, and Tunisia. In general, they have also become more financially efficient over time, although neither USAID nor the six countries have given sustained attention to this issue. USAID contributions to these successes included the following. (1) In each country, including Pakistan and Ghana, where demand for FP was relatively low, USAID-supported interventions increased the use of contraceptives substantially. (2) USAID was the principal FP donor in each country, contributing 40%-60% of all FP resources over a 20-year period. (3) The most frequently used modern contraceptive methods were those strongly supported by USAID, principally female sterilization, pills, and IUDs, which accounted for 92%-96% of the modern methods used in three of the study countries. (4) The programs in Honduras, Kenya, the Philippines, and Tunisia trained more physicians and health service providers, made modern, effective contraceptives more accessible and available to the majority of the populace, established more delivery channels, and educated more couples than did those in the Philippines and Ghana. They also were more likely to respond to clients" needs by providing contraceptives and services more suited to or demanded by the populace. USAID support made many of these activities possible. While no demographic or health effects could be measured in Pakistan, USAID helped build the institutional capacity that is a precursor to fertility decline. In all six countries, USAID supported the first steps toward making FP programs financially sustainable. Some activities shifted public sector costs to the private sector; others tested various cost-recovery strategies. USAID"s work helped mobilize an international consensus favoring greater reliance on private sector service delivery. While none of the six FP programs is financially self-sufficient, there is evidence of progress toward sustainability in the countries where USAID took serious steps to encourage it. In addition, savings outweighed costs in four countries, by a large margin in the Philippines and Tunisia, to a substantially lesser degree in Kenya and Pakistan. Includes bibliography.