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Assessment of family planning service delivery in Egypt.

The Arab Republic of Egypt has used family planning service delivery as the main vehicle for implementing its national family planning policy since 1965. This paper reports results of a study undertaken during 1975-77 using a systematic sample of 100 health units offering family planning services in two governorates of Egypt. The findings suggest that there is considerable potential for improving the service delivery system through better management. Broadening the choice of technology offered, increasing the quantity and quality of outreach and communication activities for new and continuing contraceptors, and improving staff availability could lead to improvements in national program participation and continuation.

Contraceptive Agents↗

Management of community distribution programs in Bangladesh.

In Bangladesh, five high- and five low-performing nongovernmental organization-supported community distribution projects were studied to determine which management, supervisory, and field activities differed between the better and poorer performers. A total of 37 variables were studied, and differences between the higher- and lower-performing projects were noted for nearly all of the variables. In general, project effectiveness was associated with higher service quality, more proactive field supervision, and greater organizational clarity. No project performed all of the 37 activities well. No one or two variables predicted project success, and none of them was found to be a necessary condition for project success. Higher performance was associated with doing well on many of these variables.

Adult↗

The strategic approach to contraceptive introduction.

The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.

Africa↗

A cost-benefit analysis of the Mexican Social Security Administration's family planning program.

A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSS's family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The cost data are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexico's 32 states. Based on the average cost per case, the analysis disclosed that for every peso (constant 1983 currency) that IMSS spent on family planning services to its urban population during 1972-1984 inclusive, the agency saved nine pesos. The article concludes by raising the speculative question as to the proportion of the births averted by the IMSS family planning program that would have been averted in the absence of IMSS's family planning services.

Child Health Services↗

Sterilization and the birth rate.

Sterilization remains irreversible for all practical purposes, but as its procedures become more feasible in developing countries, the question of its potential contribution to fertility decline vis-à-vis other contraceptive methods has increasing significance for family planning program administrators. This question is examined by means of a model that calculates births averted in defined time durations from the acceptance of various contraceptive methods by women of different ages. The findings suggest that without ready access of the population to reversible contraceptive methods that are attractive to birth spacers and tentative birth terminators, the rate of fertility decline is not likely to be satisfactory regardless of the availability, promotion, or popularity of sterilization.

Adolescent↗