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Organization of the Department of Family Planning and Maternal and Child Welfare Central Administration

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Organization of the Department of Family Planning and Maternal and Child Welfare Central Administration RETURN To REPORTS DESK RERet NoE PP-4b WITHIN '.Rpr o P4 ONE WEE]K Public Disclosure Authorized This report was prepared for use within the Bank and its affiliated organizations. They do not accept responsibility for its accuracy or completeness. The report may not be published nor may it be quoted as representing their views. INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT INTERNATIONAL DEVELOPMENT ASSOCIATION Public Disclosure Authorized APPRAISAL OF A POPULATION PROJECT TUNISIA Public Disclosure Authorized March 3, 1971 Public Disclosure Authorized Population Projects Department CURRENCY EQUIVALENTS Dinar 1 = US$ 1.905 US$ 1 * Dinar o.525 MEASURES 1 m 2 . 1.20 sq. yd. or 10.76 sq. ft. 1 Km2 = 0.38 sq. miles 2.47 acres GLOSSARY A. Abbreviations GDP Gross Domestic Product GNP Gross National Product IUD Intrauterine Device KAP Family Planning - Knowledge, Attitude and Practice Study MCH-FP Maternal and Child Health and Family Planning RMC Rural Maternity Center SIDA Swedish International Development Authority USAID United States Agency for International Development WHO World Health Organization B. Definitions Maternity Hospital: Hospital providing obstetric and gynecologic services including maternity beds, prenatal and postnatal care facilities. Rural Maternity Center: Clinic in a rural area to provide beds and a delivery room for uncomplicated cases, and to provide prenatal and postnatal care, child welfare and family planning services. Maternal and Child Health Center: Health Clinic which provides prenatal and postnatal care, child welfare and family planning services. Rural Dispensary: Health center in the rural areas providing basic elementary medical care through nurse-assistants. TUNISIA APPRAISAL OF A POPULATION PROJECT TABLE OF CONTENTS Page No. BASIC DATA SUMMARY AND CONCLUSIONS i-i I. INTRODUCTION ..................................... II. THE POPULATION PROBLEM AND GOVERNMENT POLICY ..... 1 A. The Population Problem ..................... 1 B. Family Planning and Public Policy .......... 2 III. THE FAMILY PLANNING PROGRAM ...................... 3 A. Evaluation and Present Organization ........ 3 B. The Present Program ........................ 5 IV. THE PROJECT ...................................... 7 A. Project Components ......................... 8 B. Cost Estimates ............................. 11 V. IMPLEMENTATION AND DISBURSEMENT .................. 13 VI. SOCIO-ECONOMIC ANALYSIS .......................... 15 VII. RECOMMENDATIONS .................................. 17 This appraisal report is based on the findings of a mission that visited Tunisia from May 19-June 2, 1970. It was headed by Mr. D. Miller and included Mr. N. Faltas, Mr. G. Bury (Consultant), and Dr. R. Castadot (Consultant). Mr. Faltas re-visited Tunisia from July 25-August 7, 1970. A mission, composed of Messrs. R. Springuel, head of mission, S. El Fishawy, S. Julin, and L. Currat visited Tunisia December 2-9, 1970. This report was prepared by Messrs. G. Zaidan, D. Miller, N. Faltas, and L. Currat. Mr. G. Baldwin lent his assistance to the group. -2- ANNEXES 1 - ADMINISTRATION OF PROJECT AND PROGRAM 1-1 Duties and Responsibilities of the Project Administrator 1-2 Duties and Responsibilities of the Project Architect and the Project Accountant 1-3 Family Planning Program - Central Administration 1-4 Family Planning Program - Regional Administration 2 - DEMGRAPHIC DATA 2-1 Population Projection--Four Series (1967-1985) 2-2 Estimate of the Natural Rate of Population Increase for the Intercensal Period (1956-1966) 2-3 Projected Number of Women in the Age Groups 15-49 and 20-44 (1967-1974) 3 - FAMILY PLANNING PROGRAM PERFORMANCE 3-1 Provision of Family Planning Services--Number of Facilities by Province (1969) 3-2 Maternity Facilities by Health Region--Annual Number of Deliveries per Bed and Average Stay (1968) 3-3 Family Planning Consultations in MCH Centers (1969) 3-4 Commercial Sales of Contraceptives (1967-1969) 3-5 Distribution by Sanitary Region of Postpartum Educators, Maternity Beds, and Average Monthly Deliveries (1969) 3-6 Family Planning Acceptances by Method and by Month (1969) 3-7 Postpartum Family Planning Program Coverage, Acceptor Motivation, and Rate of Acceptance by Sanitary Region (1969) 3-8 Maternity Facilities Medical Activity Data (1969) 4 - FAMILY PLANNING BUDGET AND PERSONNEL 4-1 Budgeted Personnel Positions (1970) 4-2 Preliminary Projection of Family Planning Personnel (1970-1974) 4-3 Actual Disbursements for Family Planning Operating Expenditures (1968) 4-4 Actual Disbursements for Family Planning Operating Expenditures (1969) 4-5 Actual and Projected Family Planning Expenditures (1969-1974) 4-6 Family Planning Dinar Budget (1970) 4-7 Estimate of Operating Costs for Project Facilities -3- 5 - PR)JECT PARAMETERS 5-1 Demographic Data on Existing and Proposed MCH Centers 5-2 Number of Medical and Paramedical Positions (1970) 5-3 Projection of Paramedical School Graduates (1970-1973) 5-4 Paramedical Personnel Needs (1970) 5-5 Need and Utilization of Obstetrical Beds by Province (1969) 5-6 Graduates in Midwifery and Personnel Needs for the Health Ministry and IDA Project (1970-1980) 5-7 Location of Facilities 5-8 Project Capital Cost Estimates 5-9 Contingency Allowance 5-10 Family Planning Project Implementation Schedule 6 - THE DEMOGRAPHIC EFFECT OF THE PROJECT 7 - DESCRIPTION OF PROJECT FACILITIES MAPS 1 Proportional Distribution of Population 2 Maternity and MCH Network 3 MCH Network Utilization TUNISIA BASIC DATA Area 164L,000 km2 Population (1970) 5.2 million Urban Population 2.0 million Annual Rate of Growth (1967-70) 2.8% Crude Birth Rate (per 1000 population) h Crude Death Rate (per 1000 population) 16 Women in Age Group 15-49 1,079,000 General Fertility Rate 212 (number of births per 1000 women aged 15-49) Infant Mortality 110 (number of deaths of infants under 1 year of age per 1000 live births) Gross Domestic Product (1970) uS$1,065 million (at current factor costs) GDP per capita US$ 205 GDP Annual Rate of Growth (1965-70) 3.6% (1966 prices) Industrial Origin of GDP (1966 prices) Agriculture 14.3% Mining, Water and Power 8.5% Manufacturing 15.2% Construction and Public Works 8.8% Transport and Communication 8.6% Services 25.3% Government Wages and Salaries 19.3% External Debt Public Debt outstanding (1969) US$700 million Bank/IDA Position (US$ million) December 31, 1970 Bank loans (net of cancellations) 70.1 Repayments 2.3 Total loans outstanding 67.6 IDA credits (net of cancellations) 40,0 Total Bank/IDA T7.6 TUNISIA APPRAISAL OF A POPULATION PROJECT SUMMARY AND CONCLUSIONS i. In 1964 the Government of Tunisia initiated a limited, experiment- al program of voluntary family planning operated through the Ministry of Health. Two years later the Government expanded the initial experiment into a national program and established within the Ministry a new Directorate to provide education, service, and evaluation in family planning. ii. The project would strengthen the Government's program through a series of measures designed to increase substantially the number of acceptors of family planning and to retain more of them as practitioners for longer pe- riods of time. The Project consists of the following: (a) the construction and equipment of: (1) four new maternity hospitals in Tunis, Sousse, Sfax, and Bizerte, with a total of about 500 beds; (2) two new Rural Maternity Centers with a total of about 25 beds; (3) twenty-nine Maternal and Child Health Centers; and (4) the extension of the Avicenne Paramedical Training School and its Postgraduate Training Section. (b) three technical assistance components: (1) provision of consultants to design and recommend a system which would ensure an optimum use of the re- sources at the disposal of the family planning ser- vices and to help the Government implement the sys- tem; (2) provision of experts to assist in teaching at the Avicenne Paramedical Training School and at its Postgraduate Training Section and provision of fel- lowships for training key paramedical personnel; (3) provision of two external review missions of two to three experts scheduled for the Fall of 1972 and 1974 to assess the progress and efficiency of the national family planning program. - ii - The total cost of the project will be US$7.7 million. iii. The present family planning program, after six years of operation, reaches only about 2.5% of the eligible women in the fertile age group each year. This poor performance is attributable to: (a) inadequate staff time given to family planning work as a result of the present staffing pattern and organization of the health services; (b) overcrowding in the large urban maternity hospitals; and (c) ineffective family planning work in the MCH1 centers because of poor scheduling of family planning services and inadequate functional design of the centers. iv. The project's foreign exchange component is estimated at US$4.8 million which would be met by the IDA credit, except for the part of fellow- ships and technical assistance costs related to training which may be met by other agencies. All local currency costs would be met by the Government, ex- cept for the services of local management consultants. v. As a result of the project, the targets of program achievement by the mid-1970's can be set much higher than recent performance. The number of consultations with potential acceptors is estimated to rise from the recent level of approximately 125,000 p.a. to more than 400,000, and the number of acceptors practicing contraception from just over 21,000 to more than 76,000 p.a. Finally, the number of births averted is estimated to rise from 6,000 p.a. to more than 21,000 p.a. vi. A Project Administrator would be appointed within the Ministry of Health to supervise the project. Contracts for civil works and procurement of materials, furniture, and equipment would conform to the Bank/IDA guide- lines on international competitive bidding. Domestic manufacturers of furniture and equipment would be accorded a preferential margin equal to 15% of the cif costs of competing imports, or the existing rates of import duty, whichever is lower.
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