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Evaluating family planning program effectiveness and efficiency.

This article proposes an integrated in-house evaluation model for family planning programs. The model is designed to meet the need of program management for an operational and internal evaluation system suited to the ongoing character of program activities and focused on the feedback of information for program planning. The ideas presented are applied to the context of the Albany County Family Planning Service, Inc., Wyoming.

Adolescent

Cost-effectiveness evaluation of a home visiting triage program for family planning in Turkey.

Graduate Turkish midwives were trained in triage rules for determining family planning home visit frequency based on risk of couples. In a sample of 542 couples followed for six months, modern contraceptive use increased 22 per cent among high-risk and about 15 per cent among moderate- and low-risk couples. After making assumptions about the fecundity, contraceptive success, and pregnancy complications, the estimated average cost per complication averted was $61 for high-risk, $177 for moderate-risk and $526 for low-risk couples.

Adolescent

Improving management through evaluation: techniques and strategies for family planning programs.

Evaluation aimed at providing managers with the information needed for day-to-day decision making has generally received less emphasis in family planning programs than evaluation of long-term programmatic and demographic achievements. A series of evaluation techniques are reviewed that are applicable to the key management areas of operational target setting, administrative monitoring, measuring interim achievements, and cost concerns. Barriers to such evaluation inherent in the training of and relationship between managers and evaluators are reviewed, and means to ease the barriers are proposed.

Costs and Cost Analysis

Estimate of births averted in the Profamilia program.

Kelly's parity approach is used to estimate the number of live births averted at 6, 12 and 18 months after acceptance by 3,518 acceptors at nine Profamilia clinics in 1969. The calculated rates per thousand acceptors at 6, 12, and 18 months, respectively, are 137, 267, and 363. In order to obtain a general idea of the number of abortions averted by contraceptive use through the Profamilia program, Kelly's formula is also used, with modifications, to estimate the number of fetal losses (stillbirths and spontaneous and induced abortions) averted by the sample of users. It is estimated that 86 fetal losses per thousand acceptors are averted at 18 months postacceptance.

Adolescent

Measuring natural family planning in terms of couple-years of protection.

Couple-years protection is a summary index of contraceptive protection. Couple-years protection allows comparisons of natural family planning with other methods. One couple-year protection for condoms is equal to 1 couple-year protection for pills and 1 couple-year protection for natural family planning. Critical in the calculation of couple-year protection for natural family planning is average duration of use. A working group on natural family planning recommended that 2 years of use be used as average duration until more data are available.

Contraception

The impact of service delivery frequency on family planning program output and efficiency.

Operations research is the study of factors that can be controlled by program administrators. Among such factors is the frequency of performing program activities. The present experiment, conducted in Lima, Peru during 1985-86, tested the impact of holding family planning post sessions once per month, twice per month, and weekly. Frequency was shown to have a major impact on program outputs, costs, and cost-effectiveness. Depending on the indicator, sessions held twice per month produced between 1.5 and 2.1 times the output of those conducted once per month. Weekly sessions produced between 1.3 and 1.6 times the output of those held twice per month. At an output level of nearly 11,200 visits per year, twice-per-month sessions were estimated to be 7-38 percent more cost-effective, depending on the indicator, than once-per-month sessions, and 6-28 percent more cost-effective than weekly sessions.

Community Health Services

Family planning programmes in ten developing countries: cost effectiveness by mode of service delivery.

The cost effectiveness of various modes of family planning service delivery based on the cost per couple-year of protection (CYP) is assessed using 1984 data for 63 projects in ten countries (three each in Africa and Asia, and four in Latin America). More than 4.8 million CYPs were provided through these projects during the year studied. Programmes with the highest volume of services delivered corresponded to lowest average costs: social marketing (2.8 million CYPs) and sterilization projects (960,000 CYPs) cost about $2 per CYP, on average; highest costs were for full service clinics and community-based distribution projects ($13-14 per CYP). Costs of clinics combined with community-based distribution services fell approximately midway between these two extremes.

Africa

Cost-effectiveness analysis of family planning programs in rural Bangladesh: evidence from Matlab.

The Family Planning Health Services Project in Matlab is often seen as more expensive than similar activities carried out by the government of Bangladesh. At the same time, it as been observed that the project is much more effective. The alleged high cost of the project is said to make it difficult to replicate throughout the nation. Previously, the true costs of the project had not been documented. This study systemically examines the cost of the project and assesses its cost-effectiveness. An experimental design framework is used as a basis for understanding the cost-effectiveness of the project, although a sensitivity analysis lends further support to the relative efficiency of the approach undertaken in Matlab. Although in the aggregate, the Matlab Project is more expensive than the government's family planning program, it is also more effective, generating enough output to offset the extra costs of the intensified delivery system.

Bangladesh

Impact of social marketing on contraceptive prevalence and cost in Honduras.

In 1984, the Honduran Family Planning Association launched a contraceptive social marketing program by introducing the oral contraceptive, Perla. This report examines the impact of the program on overall oral contraceptive use, use by particular subgroups, source of supply, and costs. Although use of oral contraceptives increased only slightly over the period 1984-87 (from 12.7 percent to 13.4 percent among women in union aged 15-44), the social marketing program significantly increased its share of the oral contraceptive market (from 7 percent in 1984 to 15 percent in 1987, and from 20 percent to 40 percent of sales at pharmacies). For the Honduran Family Planning Association to have realized cost savings as a result of clients switching from community-based distribution programs and commercial supply sources to contraceptive social marketing programs, the association would have had to reallocate its resources. Instead, the number of distributors in the community-based distribution program increased, while the amount of couple-years of protection from oral contraceptives decreased.

Adolescent

Lessons from the Chinese experience: China's planned birth program and its transferability.

This article describes the most salient developments in the planned birth program of the People's Republic of China during the 1970s and discusses the potential for transfer of some features to other countries. Many Chinese activities are of interest because they are designed for a country with scarce resources for development and a low-income population. Some particular program features worth noting are: the encouragement of local initiative and experimentation: specific methods for the diffusion of innovation; and total integration of the health system with other development-political, administrative, economic, and social-at the grass-roots level.

Birth Rate

Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

Abortion, Legal

The use effectiveness of the Copper T-200 in Matlab, Bangladesh.

Using a unique record keeping system, the use effectiveness of the Copper T-200 is examined in rural Bangladesh. In Matlab the Copper T-200 is a highly effective contraceptive modality. The adopters are typically low to medium parity women under 30 years of age. The most important cause of termination among women in the study was voluntary removal of the device. The complaint most often reported was bleeding followed by pain and weakness. The Matlab experience suggests that sustained motivation and regular resupply are the two key components of this highly successful family planning program.

Adult

Family planning through private practitioners: characteristics of Kenyan contraceptive acceptors.

Kenya has one of the highest population growth rates in the world. Innovative programs are therefore called for to help curb the fast population growth rate. The Kenya Medical Association started a new program of involving private physicians in the active provision of family planning services. A preliminary analysis shows that the program serves generally young, better educated women of low parity. Sixty-one percent of the clients are new acceptors and the oral contraceptive pill the most popular method. The level of education of the clients had marked influence on family size. Age, parity and marital status also influenced the pattern of contraceptive use. These preliminary results are discussed against the background of the 1984 Kenya Contraceptive Prevalence Survey findings and possible areas of improvement suggested.

Adolescent

Improving the quality of service delivery in Nigeria.

This study evaluates the effect of a nurse training program in family planning counseling skills on the quality of service delivery at the clinic level, as well as its impact on client compliance with prearranged appointments. The study used a quasi-experimental design to compare certified nurses who received six weeks of family planning technical training with certified nurses who, in addition to the technical training course, received a three-day course in counseling skills. Data were collected through client exit interviews, expert observation, and inspection of medical record abstracts. Trained nurses performed better than their untrained counterparts in the quality-of-care areas investigated--interpersonal relations, information giving, counseling, and mechanisms for encouraging continuity. The likelihood that clients will attend follow-up visits was also found to improve when they were attended by trained professionals. Short-term counseling training can significantly improve the quality of care provided by family planning workers, as well as client compliance with follow-up appointments.

Adolescent