1984 7 ,887000 January

. .. ..- .. j .-.. .. f 4 ; .gI." • -?O.k1ATION/..MILYPL.NNING SUPPORT PROJECT, PHASE . USAID/MOROCCO 608-0133 -' ___ , The project aims to establish and demonsE-ra-e-w'ithin'_ oth 'e bt i a- . private saccors a capability to plan, implement, and evaluate cost-effective family planning programs. The project contains a variety of subactivities (12 separate activities) designed to promote the use of modern contraceptives among the target popuiation; raise the levels of awareness of population problems and commitment to _.$ugus-23...._ ,887,0001787S 608-84-04 January 17, 1984 7 at-ar (Somc1t/) 3 .1797 ,887,- "i 'ut- . I Ursula Nadolny 1Robert C. Chase i ission Director TrTinal _-gvauation _ _ Officer_ _ _ _ _ ___ ___ I_____ IE+C programs and increased availability of services. The subactivities include education, referral services, informational materials design, training, commodity support, and some data gathering/analysis/dissemination. This was the final evaluation of this project and its 12 inter-related sub-activities, prior to the commencement of "Phase III" activities. The general objectives of the evaluation were to determine the progress of the project and of the 12 component sub activities; review the status of the family planning/health/nutrition services provided; I and suggest future directions for family planning activities and funding within the GOM, and potential spheres of cooperation with other ministries and agencies and with individuals outside the formal public health system. Family planning activities in Morocco have progressed substantially during the past 5 years of project activity. Contraceptive Prevalence (CP) estimates indicate that the nationwide CP has more than dbubled from 12% (1978) to 27% (1983). In the 3 provinces , receiving home distribution of contraceptive methods since 1982, prevalence is irr the range of 41% to 53%. USAID funding and technical support have been pivotal in assisting the MOH in its service expansion. Following initial delays in planning and facility constructiou, most of the 12 subprojects are now firmly under way. Two exceptions are the construction I of Family Planning Referral Centers (only 7 of the 10 planned are completed to date), and the commercial distribution of contraceptives (considered a risky activity, given the strong reservations of the medical establishment about the delivery of FP services by anyone except health professionals). ..ecific remarks on major sub-activities were as follows: 1) VDMS (Household Distribution) - Approximately 40% c-' the Moroccan population will be-covered by early 1984. Early service statistics indicate substantial client acceptance of all available methods. Provincial management, training and supervisory capabilities appear good. 2) National Sraining Center fur Reproductive Health - In operation since 1982. The Center provides ! 30-bed in-patient facility for referred obstetrical and gynecological cases, and pzrovides training for physicians in tubal ligation. 3) IE+C - Materials have been produced , both the MOE and the local IPPF affiliate. Materials include printed matter and radio and television productions. 4) Training - U.S., in-councry, and third country training .as been provided for medical students, physicians, nurses, educators, administrators, and statisticians/demographers. These training efforts have been essential to the * successful implementation of the project. 3) Other - During the project there has been a contraceptive prevalence survey in 3 VDMS provinces and field work for a second national CPS is currently underwair. The final report of che National Fertility Surrey was ,renared n..late 1983. • ' NEAR EAST EVALUATION ABSTRACT CONTiNUATION SHEET Page 2 of 2 Pages Key findings and observations by the evaluation team included support for the planned extension of VDMS and other project activities, but coupled with improved monitoring and evaluation of this activity via streamlined data collection and analysis at the local, provincial and national levels. Physician training in sterilization should be increased, and training of IUD insertion should continue, especially in rural areas and peri-urban slums. There is a need for clearer IE+C objectives, and for pre-testing and evaluacion of IE+C materials being produced. Continued efforts to increase collaboration with other government ministries in the promotion and delivery of family planning should be encouraged. Finally, during the coming project period, thought should be given to mechanisms for increasing the self-financing capabilities of family planning activities in Morocco. In summary the evaluation found the project to be generally successful and a good example of productive cooperation and discussion between the GOM/MOH and USAID. LESSONS LERNED (from evaluation report) 1) The implementation of strong, practical family planning programs need not necessarily be proceeded by promulgation of major population policy statements by the Government of Morocco. In this culture lack of overt discussion should not necessarily be construed as an.indication of lack of interest or concern regarding a given issue. 2) The provision of family planning via the existing health structure is more likely to ensure the long term availability and coverage of such services. 3) Home visits for family planning setrice delivery, by male and female health workers, are acceptable in Moroccan society. .; f-.OC.CTL VAL.UA.-ION . ,A %Y (FES) - PART I .,;.-.i Sym l-. ! 608-0153' USAID/MOROCCO SUPPORT, Ii A-ZVY LUAT .1 Ue.'ZA (E f.- --. ,ma,-,in:'.; r Ponn|kriovi.POPLATION/F.AILY im: PLA NING sT-L".aozr-IN-un., s.., Cauntry or AI=Af - ,.oe, F.I Yr,.SilJ No. .NzI,,,nl1 "' FY) 84-04 LI, REGULAR EVALUATION C3 SPECIAL EVALUATION -. Y ?FOJC.T IMLEMS.T.TION MATES r.- ESTIMATED PROJECT I 7. PERIOD COVERED- BY EVAtUATION A*,. -- I' M- C. oralaFlnai P.., FUND ING Fra (,.,,. ,) October, 1978 35 P;;o. or Cbicin Input A. 'ra-i s ,00 .000 T~i(ord. December, 1983 EuL4f axI~___ 0118 12000,000. T1 (o~yJDcme,18 F_ ,y __ aS.U $1,00S iow Iir:Iofn January, 1984 . ACTION DECISIONS APRCVED BY MISSION OR AIO/W OFFICE DIRECTOR A. L h elilaImanfd/or unresolved tIavs; cite hua kam deing fur"rmray. 3NE 5Or DATE ACTION (NOTE: Mlmon ,islJims which a tki;wt AIO/W or rwgion-a ol,,Iea b-tlon should S RESPONSIaLOFFICER E C OMPLETEDLTEBe @aP=y ?VP 01 du:.-..n1, 9.6.. alrram, SPAR, PIO wh:c will prrm deta.led queer.) FOR ACTION 1. The proJect has been successful and should be MOH.AMPF/ continued 'and expanded.. USAID New Project 2. Information which documents public acceptability of 'and demand f6r (ontraceptive services should be made available on a regular basis to senior Govern mental leaders to encourage political and material .support for population and F.P. programs. MOH/AMPF Ongoing 3. Encourage use of up-dated RAPID presentation to senior GOM officials. MOH/USAID 06/84 4. Encourage AMLPF and MOH to develop compatible methods of collecting F.P. statistics; Determine TA require ments for data collection and management for both C ATF and MOH. USAID/AMPF/MOH 06-84 5. Establish system to determine acceptability and/or effectiveness of health interventions included in the VDMS package. USAID/MOH .06-85 6. In order to attempt to meet the demand, training of physicians in sterilization techniques should focus on HDs who do not have extensive administrative O i duties. MOH Ongoing 7. Standard criteria for the provision of tubal ligations should be dewveloped and uniformily used throughout the country. I (Continued) S S. INVENlTORY OF DOCUMENTS TO SE REVISED PR AaOVE DECISIONS 10. AL.T ERNATIVE DECISIONS ON FUTUR IOF PRO0JECT PmIlct Paper lImplarrnton PlnOther (Specify) A. E C~antinue Proje=WItmou. aangs 4~., CI Network 1" E] 2napneWa Plan PI017 -_______8 Chwa Projoc: u. r~o Li ga. mF~ra P10/C Other (Spi ly I Ch.angs Implarnti.natinPlan Prepare new Lr "Okcainu ProjecT PojA,.nn ,P"Project Paper ii. PROJ5T OFFICER AND HOST C:UNTRY OR OTHER RANKING PARTICIPANTS 12. M;on/AO,/W Offca 0lt:' .r A mr-o's- AS APPROPRIATE (?Jan- and Ties) Gerard R. Bowers, Population Officer B. Eilene Oldwine, Assistant Population Officer Tye "s ,Ursla Nadolny, Evaluation Officer Ty Nm,, . Robert C. Chase Onto JA N 2 4"D~~", .1015(1-3 PROJECT EVALUATION SU5ARY (PES) Continuation Sheet page 2 8. Establish a system for periodic review and revision of training anuals and provincial level supervisory responsibilities. MOH 06/84 9. Provide TA to the MOH to assist in IE+C materials development. USAID/MOH 08/84 10. Encourage the improvement of F.P. services provided by the private sector through the development of promotional training and information materials for pharmacies and their staffs. MOH/USAID On-going 11. Continue to develop the linkages between the HOH and other GOM ministries and private organizations to promote F.P. activities. USAID/MOH On-going ACKNOWLEDGEMEN TS The evaluation team would like to express its appreciation for the administrative and logistic support provided by the MIOH and the staff of USAID/Rabat, and the openess and candor with which the family planning project vas discussed vith the team. The evaluation .as further assisted by the extensive efforts of the MOH, APPF, and USAID to provide all relevant project documentation. We would also like to acknowledge the generous hospitality of the provincial medical -staff in Casablanca, Kenitra, Beni Mellal, and Marrakech. TABLE OF CONTENTS TEAM COMPOSITION---------------------------------- 3 I. SUMMARY ----------------------------------------- 4 II. RECOMMENDATIONS --------------------------

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