EVALt!ATION REPORT OlJ THE CONTRACEPTIVE PREVALENCE STUDIES PROJECT

A Report Prepared By: AMY ONG TSUI 1?h.D. JAY H. GGASS~~, Ph.D. JOHN A. ROSS, Ph.D.

During The Period: JuLY 19-29, 1983

Supported By The: U. S. AGENCY FOr- IN'rEHNATIOi'U\L DEVELOPHENT (ADSS) AID/DSPE-C-0053

AUTHORIZA':L'ION~ Ltr. AID/DS/POP~ 1/6/84 Assgn. No. 582209 ACKNOWLEDGMENTS

The evaluation team is grateful for the timely assistance and cooperation extended by Westinghouse Health Systems and the Office of Population at AID towards assembling the information needed to complete this evaluation and for the supporting services of the American Public Health Association in coordinating the evaluation.

-i- CONTENTS

Page

ACKNO~'lLEDGMENTS ...... • . . . • . . . . • . . • ...... i

AB B REV I AT ION S...... vii

LISTOFTABLES •.•...... •...•.•..•...•...•..••••.••.•...... • ix

I . SUMMARY ...... • ••••• 90 • D •••• " • • • • • • • • • • • • • • • • • • • • • • • • • • 1

II. EVALUATION METHODOLOGY ...... 7 Composition of Team ...... · ... . . 7 Dates and Places of Evaluation .• . . . • • 0 • • e • ... 7

Materials Evaluated .. • • • • iii • • 8 Basic Questions ...... 0...... • • • • • • • • • • 8

III. EXTERNAL FACTORS. • • • fI · .... 13 country Select ion .. 13 Funding Certainty ...... 13

IV. INPUTS ...... • • ., • 0 • • • • • .... 17 Contractor Inputs. 17 AID Inputs 22

V. OUTPUTS ...... ' ..... 25 Further Development of Survey Documentation .. 25 Selection of Participating Countries. · .. 26 Subcontractor Selection. . . . 27 Field Opera t ions ...... 29 Monitoring Field Operations .... . 29 Data Processing and Analysis. 30

Further Analysi s ...... 0 •• 33

VI. PURPOSE ..•.•••.•••••••••.••• 0 • 0 •••••••••••• 0 ••••• 0 •••••• 35

VII. GOAL OF THE PROJECT ...... 37

VIII. BENEFICIARIES ...... 39 Data Produced and Available for Family Planning Program Management ...... 39 Use of the Survey Results for Family Planning Program Management ...... 41 "Further Analyses", A Potential Source of Useful " Re sui t s ...... 41

IX. LESSONS LEARNED ...... 43 Project Performance and Design. 43 Validity of Assumptions Underlying the Project. 44 Future Assistance and Further Analysis ..... 45 TABLES Previous :1?age

-iii- APPENDICES

A Persons Contacted During Evaluation of CPS II Project (Exclusive of Field Site Visits)

B-1 Report on Field visit to Barbados, August 11-12, 1983 by Amy Ong Tsui

B-2 Report on Field Visit to Egypt, September 2-9, 1983 by Jay H. Glasser

C CPS II Project Organization

D CPS II Status Summary Report

E CPS Publication Status Report F Further Analysis LIST OF ABBREVIATIONS

AID Agency for International Development

CDC Center for Disease Control CPS Contraceptive Prevalence Survey

eTO Cognizant Technical Officer

LDC Less Developed Country

PAHO Pan American Health Organization

POPLAB Laboratories for Population Statistics

RFP Request for Proposals

WFS World Fertility Survey

-vii- LIST OF TABLES

1. Level of Effort and Travel Spent on CPS II by Professional Staff

2. Country Survey Monitors, Country Responsibility, Academic and Language Background, and Year Joined CPS II

3. Measurement of ·CPS II Recruitment Effort by Region

4. List of Trip Reports CPS II

5. Regional CPS II Seminars

6. Comparison of End-of-·Project, Current and Anticipated Final Statuses for CPS II

-ix- SUMMARY

The evaluation team finds that the contractor has, in large measure, acted in good faith and with its best effort to meet the essential requirements of contract number AID/DSPE-C-0052; qualifications to this, together with recommendations for the t.cansition to the "follow-up" project, are provided.

Project Background and Current Situation

The objective of the Contraceptive Prevalence Studies Project II (CPS II) is to carry out repetitive sample surveys of contraceptive use prevalence in 25-30 develcping countries, with active public and/or private sector family planning programs, and to publish the resulting data for use by LDC family planning administrators and by AID. The scope of work requires the contractor, yvestinghouse Health Systems, to provide technical and financial assistance to countries that wish to conduct national or subnational surveys in order to obtain information on current levels of contraceptive use and attitudes toward contraception. The contractor assists participating countries in all technical aspects of designing and implpmenting of CPS and provides financial inputs where required as part of its effort to institutionalize the capability to conduct contraceptive prevalence studies. The contractor also arranges for conferences and workshops at which the methodology and findings of the surveys are presented to interested audiences, including planners, policymakers, and other administrators.

This evaluation was carried out during the fourth year of project operations, between July 19-29, 1983. Following a debriefing by AID, the evaluation team discussed and reviewed the contract outputs and related project materials at the contractor's offices in Columbid, Maryland. Two overseas field visits to Barbados (August 11-12) and Egypt (September 2-9) yielded additional insights into the contractor's performnce in arranging for CPSs in these countries.

CPS II is a five-year, incrementally funded contract whi~n began September 30, 1979, and is scheduled to expire September 29, 1984. The total contract value is $11,499,447 of which $9,700,000 had been obligated at the time of the project evaluation. An ddditional $1,600,000 will be forthcoming from some AID regional bureaus and local missions. At the time of the field evaluation a potential shortfall in funding created some concern for project administration and completion. At report submission (mid-Septc~ber), only about $180,000 of the contract total had not been committed (counting non-Washington contributions).

1 Progress Toward Contract Objectives

The contract envisioned approximately 60 surveys fielded, with 21 being first, 24 second and 14 third round surveys. At th end of the CPS II project, it is likely that 32 surveys in 30 countries will have been completed, of which 24 will be first and six second round. As of June 30, 1983, 14 surveys had been completed and eighteen were ongoing. Eight country reports had been published. The evaluation finds that first-round surveys have received more emphasis than repetitive surveys. Only three countries have carried out both first and second round surveys within this project period, and in all three the sample has been changed. Also, the evaluation team is concerned about the forthcoming backlog of 20-some country reports to be produced in the final year of the project. It may not be possible to complete these without incurring an extension of the contract period.

Although a higher volume of surveys was planned for in the project design, the expectation may not be realistic for a five-year contract. The evaluation team found tha~ the contractor is putting forth its best effort, and an impressiv~ ;ne, in meeting contract requirements and furthering the larger goals of AID's population assistance program. The shortfall in survey numbers can be partially attributed to factors in the project environment over which the co~tractor has little control.

Problems Impacting on Contract Performance

Two problems have impacted on contract performance. One 1S the precedence given to AID programmatic i~terests and political considerations in the selection and recruitment of countries for the survey program. This limits the field of eligible participants and the distribution of available survey capabilities, as in the recent focus on African and Middle Eastern countries. A second problem is uncertainty about the full funding of the contract. A demand for contraceptive prevalence surveys has been generated which cannot be met due to curtailed resources. The funding constraints experienced in the fourth year have necessarily limited the number of new survey starts and have jeopardized the timely completion of the reports from ongoing surveys.

Major Findings and Recommendations

The major findings and recommendations of this evaluation are listed here.

1. Inputs. Contractor inputs (staffing pattern, organizatio~support services and project management) have been ad~quate in meeting the needs of this project, with some improvement possible.

2 Recommendation: Staffing should be at maximum early in the project to avoid delays in start-up. Recommendation: The contractor should maintain frequent and reqular monitoring of its fiscal position relative to contract funding for early anticipation of needed financial inputs.

AID inputs have been substantial and well received by the contractor. However, some local missions have not shown much interest and have not cleared survey projects. In some cases this lack of interest has detracted from the full recruitment process.

2. Outputs. The contractor has relinquished control of the survey instrument, in order to permit evaluation of local service programs. The pressure to design and conduct a survey rapidly, however, has occasionally interfered with an unhurried consideration of what useful data can be collected when a survey opportunity presents itself.

Supplemental questions (modules) have been included on an ad-hoc basis.

Recommendation: The supplemental questions or modules should be assembled in a systematic form for country and external review.

country recruitment has been vigorous with 80 percent of the eligible large LDCs contacted and 68 percent of those interested becoming participants in the survey program. Recommendation: The contractor should receive some protection from shifting political priorities in country selection, to allow participation by a larger number of LDCs and to avoid less pcoductive country choices.

The selection of subcontractors has been optimum. Governmental health, family planning, or statistical agencies have been relied upon to conduct the surveys. The average subcontract value has been hjgher than anticipated although the contractor has exercised sood judgment and fiscal responsibility in a'loiding cost over-runs.

Field operations have generally been well executed with some local problems unavoidable but others requiring close supervision.

R~commendation: The contractor should ensure that high standards in field operations are maintained, particularly with regards to following established sampling procedures and recording household visits.

3 Data processing has been provided by the contractor as needed and in an efficient and competent manner. Indeed one of the stronger points of contract performance is the technical assistance rendered in this regard both in the field and at the home office to visiting researchers. The country reports are high-quality products of collaboration. Country summaries are no longer produced.

Recommendation: Country summaries are valuable as a contract deliverable and should be seriously considered in future survey projects.

A major aIm of CPS is the dissemination of results to decision makers. Regional conferences and country workshops have proven to be an ~ffective means and facilitated the exchange of information and experiences and solicitation of new participants to the program. No other formal means of assessing data utilization exist.

Recommendation: More use should be made of regional conferences and workshops and they should be systematically incorporated in initial plans for future projects.

; Recommendation: An ongoing feedback mechanism to ~ssess the utility and specific applications of survey results for LDC family planning administration should be established.

Mail distribution of project reports and other materials IS timely but should be expanded.

Recommendation: The mailing list for project materials should be expanded to reach a larger segment of the local and international scientific community.

Further analyses have not received their due emphasis largely because of a shift in effort toward greater survey volume nd the administrative burdens accompanying the processing of study proposals.

Recommendation: "Further analysis" project activities specifically targetted to topics of program relevance and to pressing methodological questions should be enhanced and expanded In future survey projects, by instituting a simple funding mechanism within the contract, by increasing the availability and access to those survey data which can be reledsed for external use, and by promoting analyses coupling the survey with other family planning program data.

~rip and progress reports ~ave been submitted to AID generally on time. rEhere were several which were submitted late, such as the June Tunis conference trip report unavailable at the time of evaluation.

4 Future Survey Projects. A follow-on survey project is being planned with AID. The evaluation team offers the following additional comments for planners of this project.

CPS II has furthered AID's goal to collect and analyze family planning data for use by local program administraion and for measurement of program impact. The assumptions behind the project design remain valid and important. AID should continue to provide technical and financial support for such projects because it IS unlikely that countries, in spite of existing technical capabilities, will conduct contraceptive prevalence surveys independently.

The political considerations shaping the country selection for the CPS II project has to some extent resulted in a maldistribution of ~urveys, with quite a few concentrated in small Caribbean island nations. A broader representation of key developing countries in a survey program would be desirable for the follow-on project; and the contractor should be more protected from political considerations In country selection. Future country participation should also be derived heavily from prior participants in either the WFS, CPS or similar program in order to maximize the number of places for which a time-series measure of contraceptive prevalence can be developed.

Future survey programs should either reduce the intended survey numbers or consider a longer contract period or both. The present project calls for about 60 surveys in five years. In our judgment that has been a very ambitious target, particularly under the project conditions that emerged.

Continued efforts should be made to institutionalize the survey-taking capability in LDCs. Significant gains have been made through the various AID-supported programs (WFS, CPS, POPLAB, CDC) and these countries stand to benefit from further technical assistance and guidance.

To assist the follow-on project (Phase III) contractor, several transition procedures can be recommended:

• Oral histories from current project staff should be developed immediately.

• Project operations should be fully documented.

o Survey data should be transfered to institutions interested in cross-national comparisons to enlarge the available expertise on present project datasecs. Such institutions could help in writing some final wrap-up technical reports or more in-depth analyses of CPS II program data.

5 The data should be exploited as much as possible by the Westinghouse staff.

The phase III contractor should be selected in a timely manner to mi~imize lag time between survey programs. The loss of staff resources and capablities by possible applicants in the near term is imminent with the phase-out of CPS II, WFS, and POPLAB programs.

In addition, several factbrs should be considered In designing a follow-on project.

• Serious consideration should be given to a pan21 design that would monitor changes in individual contraception or sample the same areas twice (to reduce varianc~ across surveys). This ca~ be done simultaneously with a design that represents the current population and need not interfere with extension of overall coverage.

Records of sample selection should be preserved, partly to permit (1). It is also important to know the extent and sources of sampling and non-sampling errors.

There should be flexibility on the length of the questionnaire and the sample size. The time and effort spent on these phases of the survey are relatively small compared to that absorbed, for example, in reportwriting.

• Surveys should be geared to the level of family planning program development and data needs. Countries can be stratified by need level and standard questionnaires developed for each stratum.

Consideration should be given to collection of and/or potential linkage to other sources of useful data (contraceptive delivery systems records, retail sales data, community areal records, service statistics, household economic r~cords, etc.)

To the extent that phase III is oriented towards underdeveloped regions like Africa, the questionnaire shoulrl cover supplementary areas such as health status and service utilization. This will provide another direct anrl effective link with policy decisions.

More rigorous analysis of the statistical and survey validity of the CPS data is needed. This is a significant question where repeated surveys will be undertaken to track contraceptIve services and practices. Questions concerning the validity of responses have not been resolved.

As emphasized above, "further analysis" activity should become an important adjunct to any survey collection proqram.

6 EVALUATION METHODOLOGY

The Project Paper called for a formal project evaluation in the fourth year of operation (1983). Accordingly the intensive evaluation was to assess in detail the quantity and quality of project outputs and to include recoffimendations conce~Ding the need for future AID assistance in this area. This evaluation also was to serve as a guide for activities rernai~ing under th~ present CPS II, scheduled to be co~pleted September 29, 1984.

Composition of Team

The evaluation team included three me~bers: Dr. J2y H. Glasser, Associate Professor, Dep~rtment of Giometry and Computer Scie~ces, University of Texas at Houston; Dr. Jc/hn A, Ross, PJ.:"ofJssc:: Sch.ool of Public Eealth, ColulT',bia Unive.:..-sit.y, ':"1'0. St:!ni:)r Evalu:-tion f-\.d.vis.JJ.' of tre i\ssoci6.tior, of TIn.L.lntary E;:~ ::-L izc. ion~ :-:1d Dr:. ,"~m,/ 01.] TS1~i, Rese,~rc..!; f'nsoC":_(.·~00, Carc~i(~a PCpl..1-'lti~)~ ~~ente:', U:·dversi+.y of >i(.rth

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Dates und Pl.:..:es ot Eva] uat.:.on

The evaluatio~ begctn JU':"y 19.,.;it11 a two-·day briefing of the team on the bac}:-g17'JU:'.O .) t Cf ,'~ the P:ID Of f i ce of Pcpulation. The briefing !"ia.s cono.. oy Dr. John E. Lawson, Jr., Project Manager. July 21--2:: a:i.d "':'J1..f :25-2?; the t.eam conducted a site visit at Westinghouse Healt~ Systems in Columbia, Maryland. Dr. Ross continued th~ on-site review of materials from July 27-29. During the site visit in-depth interviews and discussions were held with the key members of the Westinghouse professional staff. Indeed, all relevant and available staff persons were interviewed by one or more qf the team members. Telephone interviews were conducted with those staff persons out in the field at the time of the site visit. U.S.~based professionals and experts in contraceptive studies who were affiliated with the project of knowledgeable about its outputs were also interviewed by telephone.

Field visits were made to Barbados (August 11-12) and to Egypt (September 2-9) to evaluate the contractor's performance in coordinating and executing surveys overseas. Reports on the technical and admi~istrative quality of these efforts are included here as Appendices B-1 and B-2. A list of persons contacted and interviewed, outside the Westinghouse staff, is also included (Appendix A). The evaluation team was shown the Westinghouse office facilities including clerical and computer processing resources.

7 In addition to c0ntacts wi'ell Hest-.inghouse and other experts, the evalurltion team had the be.:lefit. of a one-hour discussion with Dr. Steve Sindin~, D~rectoc of t!12 Office of Papulation, regarding AID's perspectives for the "fOLlcw-on" project, the data collection activity on dernograpllic and contr3ceptive prevalence envisioned to begin in late 19f4. This g~VA th8 evaluation team a clearer sense of the prioricles asstgned to and expectations about the survey ins~rument fc~ a~sessinq fertility and family planning levels.

A t~0~augh review of the documents and materials relevant to the CPS II P-'")j-:Jcl has been made. Thes2 include:

1. Con~ract and Project Paper

C~untry reports (final repo~ts)

J • Co~ntry summaries

/I" . ?C'lSlC documentation (core questionnaire, questionnaire modules, interviewer's manual, supervisor's manual, coding manual, and ana:ysis and tabulation pla~)

5 . Project progress reports

6. Trip reports

7 . Mailing list and protocol for publications distribut.ion

8. Financial data on survey costs and supplemental funding sources

9. Proceedings of regional conferences

10. Further analyses reports

IJ.. Reprint series

12. Sampling strategies for surveys

Basic Questions

The Project M,nager presented the evaluation team with a set of problems and i.ssues to guide its assessment efforts. ThT-ee main areas were to be examined: contract performance, data utilization, and project design. Specific questions within each area are listed below.

8 Contract Performance

1. To what extent have the contract output requirements been accomplished?

2. Are +:he contract outP11tS of reason.::l.bly high quali ty?

3. \Vas the cc~tractor's performance in the field,dequate (e.g., CU,.i>ey design, 'sampling plan, training, monitoring of fielf "~ations, etc.)?

4. The con~. _tor was to develop modules on seveLal topics which could be added to the basic CPS questionnaire upon agreement by the participating country. Are these modules well designed? Have they proven useful?

5. Is the contractor adhering to the implementation plan?

b. To what extent do actual project expenditures differ from projected costs?

7. Is the levei cf output completed by the contractor consistent with the level of funds provided?

1 8. The contract lists a number of reporting requirements such as progress reports, trip reports and financia~ reports. Have these requirements been met?

9. In carrying out survey operations, hRS the contractor adequately documented the procedures and experiences of survey implementation?

10. Has the contractor exercised sound technical, fiscal and management skills in implementing the project?

11. Has the contractor employed innovative approaches to data collection and analysis?

Data Utilization

1. Is the quality of the CPS data satisfactory for program administrative and evaluative purposes?

2. Is the variety of data available from these surveys cdequate for family planning program administrative and evaluative purposes? vvhat areas are inadequate?

3. Are the data/survey findings actually being used for program administrative and evaluative purposes? If not, why not? Are they likely to be used for such purposes in the future?

9 4. Are the reports presenting the data clearly written and well organized?

5. Given funding constraints, are opportunities for "further analysis" being adequately pursued?

6. Are the "further analysis" studies well designed and adequately monitored by the Contractor?

7. Are the "further analysis" reports clearly written and well organized?

8. Are the country reports and "further analysis" reports distributed to appropriate parties?

Project Design

1. Is the project design appropriate for achi~ving the stated objecti ves'?

2. Are the assumptions und~ .ylng the project still valid?

3. Are thE staffing pattern and level of effort adequate to accomplish project objectives? Are the range of skills and amount of field experience appropriate for projects of this type?

4. Is there likely to be a need for future AID assistance of this type? What types of data are likely to be needed?

5. Were the workshops/conferences u~e£ul mechanisms for (a) recruiting new countries to the program and (b) providing a forum for the exchange of information and experiences concerning survey operations and/or contraceptive knowledge, availability and practice?

6. Are the "further analysis" studies a useful approach for encouraging/facilitating greater utilization of the contraceptive prevalence data? Should more emphasis be placed on "further analysis" studies?

7. \-vhat changes should be made for any "follol.-l-On" project? How could the project design be modified to increase the efficiency and effectiveness of the project?

8. vfuat is the best strategy for accomplishing the transition to the "follow-on" project?

10 The team and Project Manager recognized some overlap in the questions. A protocol was established to ensure sufficient attention to the three gener.al areas and questions. Each team member assumed primary responsibility for one a~ea, but questions requiring collective judgment were handled accordingly. An additional division of labor, but one not strictly observed, was to adopt regional areas of responsibility (Asia, Near East and Africa, and Latin America and the Caribbean). This followed ttle regional linei of coordination at Westinghouse and enabled a concentration of effort in examining trip reports, country reports, and the like.

11 III. EXTERNAL FACTORS EXTERNAL FACTORS

No project of this scope can expect smooth and unhampered implementation over five years, particularly when national statistics froM developing countries are the intended products. Surprisingly little disorientation has occurred, which compliments the Contractor on applying a successful strategy of single-mindedness to conducting the survey work. Two externalities, however, are in need of mention as they impinge on contract performance: country selection and funding certainty.

Country Selection

Country recruitment is the outcome of several processes--Office of Population cables sent to AID missions familiarizing them with CPS II and available technical assistance and support; AID regional bureaus seeking an upgrading of information on family planning behaviors in certain countries; local AID mission ~nterests; and national willingness to participate in CPS II. It does not appear to be the case that all developing countries are eligible to participate (e.g., Argentina or Uruguay) or that extant local interests are uniformly and successfully translated into an opera t. i ve subcontract (e. g., Turkey). 'rhe Contractor has been very responsive to and accommodating of political currents in AID that have directed some countries' recruitment (e.g., Lebanon, Nicaragua, EI Salvador) even though the validity and reliability of the data may be diluted by abnormal fieldwork conditions and future political developments.

These processes shaping country selection are discussed more specifically in Section IV. It is only noted here that the ability of a contractor to accomplish high quality survey-taking in 25-30 countries is not independent of external interests on the part of participant countries and AID. Neither is it independent of local capabilities to conduct large-scale sample surveys. Their motivation nntwithstanding, a number of countries, such as Guyana, Uganda, and Chad, may not have the skill resources to participate productively in the CPS II program. Additionally in some, the concurrent implementation of a WFS or a survey conducted under the auspices of the CDC, which also collect contraceptive use information, absorbed what limited technical capabilities were available. In these cases enlisting government participation in another such survey would at least involve a waiting period of one or two years between surveys, particularly if modern contraceptive practice was a relatively dormant behavior.

The drive to conduct a large number of surveys to provide family planning statistics to local programs and governments as well as to inform the U.S. population assistance effort is not supported by all countries. Also, not all countries have inherent capabilities for such work.

13 Funding Certainty *** Note (added September IS, 1983) *** This section describes the funding uncertainties that prevailed at the time of the evaluation in Washington. Since then, an additional $1.45 million has been obligated, about $990,COO from the Office of Population's FY 83 b~dget and $347,000 from the AID regional bureaus. Also, it was decided to conduct a contraceptive prevalence study in Zimbabwe rather than Nigeria. The disruption of funding has led to staff cutbacks at Westinghouse earlier than anticipated and distractions in project administration as well. The 50 percent reduction of professional staffing will likely slow down the completion of country surveys and format of reporting.

***

The full contract value of C'S II is about $11.5 million, of which $8.8 million has been obligated to date. An additional $1.1 million has been contributed by the regional bureaus for surveys in Egypt, Pakistan, Botswana, and Nigeria. CPS II operates with a cost plus fixed fee (as versus fixed price) contract,;which has been incrementally funded with following sequence of obligations from five fiscal year budgets of the Research Division of the Office of Population.

(in thousands)

FY 79 $1,900 FY 80 1,400 FY 81 1,800 FY 82 1,900 FY 83 1,800 Tctal $8,800

The shortfall in funding has created financial problems for the ~Jestinghouse CPS Project. At the time of the evaluation, discussions were taking place between the contract officers of AID and Hestinghouse to clarify the funding expectations and modify the contract deliverables. Full funding of a contract is not a guaranteed outcome in the federal procurement process, a condition not recognized or previously experienced by Westinghouse Health Systems. In Westinghouse's view the anditiona1 regional funds of $1.1 mIllion should not be considered part of the total $11.5 million in estimating the shortfall, since th2 monies directed toward specific countries were not divertab1e to other countries. However, AID's position was that the contract could not exceed its

14 original negotiated value; thus any additional funding should count towards the full amount. Thus, depending on the institutional perspective, the shortfall in contract funding ranges from $1.6 to $2.7 million. Indeed 'ivestinghouse initially viewed C11e regional funding as supplementing the $11.5 million total.

Th2 funding disparity and its consequences are complicated by the conflicting needs and desires of the contractor to wind down project activities und complete outstanding survey obligations and country reports as well as to capitalize on a present and growing interest in about 10 to 15 countries to participate in CPS II.

On July 20, 1983, Westinghouse's financial office informed AID that the contract activities could not be completed without full funding. Even with the existing monies an immediate curtailment of survey activities was necessary; furthermore, staffing would be reduced by 50 percent. Since then, discussions have been ongoing, through the time of this report writing, which suggest that the project will be funded at near contrct value counting the regiondl contribution and additional funds committed from FY 84. AID approval has been given to Westinghouse to complete all current surveys and to proceed with the four surveys having regional bureau funding. It is likely that three additional surveys will be approved: El Salvador, with Economic Support Fu~ds (ESF), Thailand (technical assistance provided only; AID mission to fund survey costs), and Morocco (survey costs to be provided by CPS II). Approximately $1.0 million from FY 84 funds may be committed to the ongoing operation of CPS II.

~he annual obligations from fiscal budgets to a project is generally not a problem. In the CPS II it became so not only for the reasons mentioned above but also because AID's FY 83 budget was fully committed and no additional funds were available. AID did not anticipate having to use FY 84 funds for CPS II in calendar year 1984 because it had committed funds from five fiscal year budgets already for a five-year program.

The financial crisis surfaced during the evaluation and unfortunately made it difficult to tell how many surveys would be completed prior to project expiration. The evaluation tedm sympathized with the frustration of the Corporation in confronting this reality and felt that AID had not formally apprised the Contractor tnat limits in funding were likely. There were, infact, internal misconceptions about the funding within AID. However, the team also felt that Westinghouse had not maintained close monitoring of its expenditures against the upcoming completion date. Hestinghouse's form of periodic accounting for CPS II also did not enable it to anticipate that its pace of outlays was rapidly approaching the maximum inputs it would receive from AID.

15 The evaluation took place in .th~ midst of financial deliberations that will affect the final volume of contract deliverables, the utility of this eValuation's recommendations for remaining work in CPS II, and tre resources immediately available for the follow-on project.

16 INPUTS

Contractor_Inputs

Staffing. The project is directed by Dr. Lawrence Smith, Jr., a sociologist, who also managed CPS I and who has extensive experience in health systems work both nationally and overseas. He is fluent in many languages, of which Portuguese, Spanish, and French have been immediately beneficial for CPS II work in Latin America and Africa. Dr. Smith also directs the unit (Applied Research and Evaluation) within Westinghouse Health Systems that is responsible for the USAID-funded Contraceptive Retail Sales program and the Demographic Data for Development project. Sixty percent of Dr. Smith's effort is charged to the CPS II project; 10 to 15 percent of that time is spent traveling overseas. Dr. Smith has been actively involved in Latin American surveys and the regional conferences.

Three regional coordinators oversee the country recruitment, contract negotiation, and survey implementation activities. Sushil Kumar, M.A., M.S., who was Project Director in CPS I, is a statistician and social psychologist with extensive experience in survey research and project evaluation. Prior to joining Westinghouse, Mr. Kumar worked with IPPP/New Yor~. He is fluent in Spanish and therefore responsible for CPS surveys in Latin America and the Caribbean.

Gary Lewis, M.A. (Demography), is a present Director of Technical Operations. He is also responsible for regional coordination of surveys in Asia. Mr. LeYJis was formerly at the International Statistical Programs Center in the U.S. Bureau of the Census. Like Mr. Kumar and Dr. Smith, Mr. Lewis was on the original staff of CPS I. Mr. Lewis is one of the more active analysts on the staff, having written and published several articles on the contraceptIve prevalellce surveys and the use of their data. Mr. Lewis is not fluent in any foreign language. Dr Ann Way, the third regional coordinator, is responsible for Africa and the Near East. Dr. Way is a sociologist who has worked in research and evaluation programs in Indonesia and in Chicago. She joined CPS II at its inception in 1979. Like Mr. Lewis, Dr. Way has also been active in research with CPS data, writing and pUblishing on contraceptive services in Egypt and Tunisia. Dr. ~lay speaks French.

All three regional coordinators devote 100 percent of their effort to this project. Table 1 gives the level of effort for each professional staff person in CPS II as well as an estimate of the percentage of time spent in travel.

17 Dr. Alfredo Aliaga is the sampling specialist, trained in Biostatistics at the University of Michigan in Ann Arbor. He also serves as a country survey monitor as needed. Prior to joining CPS II in 1980, Dr. Aliaga worked at universities in the Dominican Republic, Chile and Peru; he speaks Spanish, French, and Portuguese. Dr. Aliaga is responsible for the sampling design in CPS surveys. He provides technical assistance in establishing sampling frames, outlines the procedures for drawing the sample, and estimates sampling errors.

There are at present seven country survey monitors. Gver the contract period four others have left the project. TablE~ 2 lists the academic background, country responsibility, language capabilities, and year of recruitment for the current monitors.

Most country monitors have had previous experience with internutional survey research. Dr. Lioy has had extensive experience with public program research and administration in the Canadian government. Dr. Ayad was the survey director for the Tunisian National Fertility Survey in the WFS program. Ms. Cross worked for five years with POPLAB at the University of North Carolina at Chapel Hill. Dr. Nair worked on African migration at the Horld Bank and on fertility research at Georgetown University and Johns Hopkins University. Dr. Novak directecl survey work in the Dominican Republic.

Dr. William Duncan, who also serves as a Senior Technical Advisor, joined CPS II in 1983. Dr. Duncan's background includes being a survey statistician at ISPC and working with the U.N. Refugee Commission. The evaluation team was told that Dr. Duncan's involvement in CPS II would probably be brief. He will ?ery likely be shifted to another funding base to assist in develop ng other projects.

For computer programming support, there are two professional-l0vel person: Jeanne Cushing, B.A., B.S., Chief Programmer, and Joseph Regan, B.A., Programming Assistant. Ms. Cushing is responsible for all the statisti~~J and financial programmirlg in Hestinghouse's Public Applied Systems and travels extensively for CPS II Lo assist in and upgrade survey data­ processing work. She has installed CONCOR and CONCENTS software packages in a nunber of overseas locations and is experienced in the use of SAS and SPSS software as well as in the programming languages of PASCAL and COBOL.

l1r. Regan is an M.A. candidate in medical sociology at the University of Maryland, Baltimore County. He assists in the data processing needs for CPS II and also manages the mailing distribution of CPS publications.

18 The C?S staff is comprised of technically competent and experienced professionals. Many of them have foreign language facility and travel experience. The staff members are largely young and enthusiastic about their work. The staff's background in survey work prior to joining CPS II and its ac~umulated experience since have made it possible for CPS II to implement LDC survey work efficiently.

Financial and administrative matters have been handled by Mary Ann Abeyta-Behnke since September 1982 under the direction of Dr. Smith. Prior to that time M. Lioy, J. Hayes, T. Whittier and K. Evans managed these affairs.

There are fifteen professional positions currently filled in CPS II including one half-time research assistant and one half-time financial administrator. (Se~ Appendix C for Staff organization chart). At the start of the contract Smith, Kumar, Lewis, and Way were added (all shifting f~om CPS I to CPS II). By September 1980, twelve months after the contract start-date, seven additional professionals were engaged including the sampling specialist.

Two other professional staff persons have been employed over the course of the contra~t and served as country monitors. In addition administration has been handled by one full-time~and two half-time Westinghouse core staff persons.

Westinghouse has made a good-faith effort to staff the project suitably. There was some slack in the initial 15 months of the project, and, as a result, only six surveys were begun during FY 80. However, 14 persons were to have been working on the project by the end. In addition the loss of three full-time professionls over the term of the contract was covered with the employment of two full-time persons (one as recenlty as January 1983), and two half-time staff. It is possible that workload volume peaked at the time of these personnel changes, creating some slack in an otherwise ,strong pace of survey implementation. It also appears that staff transferred from CPS I to CPS II may have been encumbered ~vith w~nd-up duties from Phase I, such as report writing.

Given the facts that the contract has nearly run out and that there is a moratorium on survey startups after September 1983, the evaluation team does not find any reason to recommend changes in staffing. Certa~nly staff changes are imminent with the phase-out of CPS II. Looking toward the follow-on activity, the team recommends intense recruitment in the early months of the new project. The momentum for steady progress in the project depends greatly upon the availability of qualified personnel. The team has fou~d the existing quality of professional skills available to CPS II to be very adequate.

19 Organizational Support Services. The evaluation team did not devote a significant share of its time to reviewing the support services, i.e., clerical, administrative, financial, and dat~ p~ocessing. The Applied Research and Evaluation (ARE) Ulit is a very small component in the overall Westinghouse corporate structure. Word-processing, high-volume duplication l.nd financial records-keeping services were very much available and were charged to CPS II as overhead.

System Six, ~vestinghouse word-processing facility, handles the editing and preparation of country reports and other project documents that are issued in Columbia. The quality of this direct offset type-copy is very high.

The team spent time reviewing the data-processing capabilities with the computer programming staff. A terminal cluster within the ARE Unit houses the following hardware: six terminals (4 Televideo 920C, 1 ADM 31, I Hewlett Packard 2645A) plus the modems and four printers (1 Printronix Model P300, 1 Prism Model 132, 1 DEC printer III, 1 DEC printe~ 300 baud). In addition a terminal and modem is in tl1e office of both the chief and assistant programmers. CPS processing is usually done on the IBM 433l-Group 2 computer at American University. This installation has 6 tape drives, 6 - 3330 disk spindles and 10 - 3350 disks.

~ The CPS staff has run the WFS Clusters prog~am and the CONCOR software at American University. Given sufficient disk storage, they hope to install CONCOR on the AID computer to increase their use of that facility.

In the past some expertmentation was done \iith different computer systems before settling with American University (AU). The AU cost is reasonable; CPS people can access it 24 hours a day; and turnaround is fast. Jobs submitted on-site are usually printed there too although the main printer is set up to transmit at only a 1200 baud rate. l

On the whole the evaluation team found both the word- and data­ processir.g resources available to CPS of very high quality and were impressed particularly by the c~ r ability of the chief programmer in managing the office needs as well as the overseas training in computer applications.

IVarious reasons including the telephone company's switching and call routing patterns and the needs of the Westinghouse Demographic Data for Development Project hove k~pt the printing at the 1200 baud, rate.

20 Project Management. The organiz&tion of the project's staff (see Appen~ix C) reveals a good degree of coordination of survey activity across the developing regions. Furthermore, while there are seven country monitors, three regional coordinators and one project director, all eleven are frequently in the field working on all aspects of survey and project implementation. Multi-country travel schedules are cost efficient and make it possible for more than one CPS staff member to supervise survey work when needed. Thus if Dr. Way's travel to Zaire leaves a matter undecided, Dr. Ayad's following trip can include a Zaire stop to resolve it.

Dr. Smith has been personally involved in only the Brazil and Jamaica state surveys. This has allowed him more time for central office &dministration and coordination. However, he is implicitly involved in each survey's implementation--the selection of subcontractors and approv~l of their costs and the regional seminars. By continuing to be involved in the field, Dr. Smith has kept staff integration and problem-solving at an optimal level. Internal project management is very high in quality.

Financial administration and monitoring could have benefited from closer and more rigorous supervision. In particular subcontract obligations should be treated as expended funds so that the financial reporting to AID does not portray ~he contract as underexpended. \fhen viewed against the contract value, incurred costs to date (July 31, 1983) totalled $7,796,000, but committed costs (subcontract obligations) totalled $1,055,000, for a total contract expenditure of $8,851,000. Based on incurred expenditures only, the basis by which costs are reimbursed to the contractor, the project is significantly underexpended against the contract total of $11,499,447. The financial reports submitted to AID have, until recently, not shown these committed costs as funds which should be encumbered.

Perhaps due to a long history of federal contracLing, there has been a minimum of concern at Westinghouse over cost reimbursement and contract funding until recent developments. The expectation of full funding plus regional and mission supplement may have created a sense of plenty in the central offices. The initial termination of funding caught the CPS II administration short in terms of distributing the available funds across ongoing surveys and against the the total funds received from AID ($8.8 million). In essence, the project was over expended by $51,000, although the supplemental $1.18 million had been received for specific country surveys. If those supplemental monies could not be used to defer partially some forthcoming costs, the CPS II project would have had no funds available to complete analyses and reports for ongoing surveys.

The near-full funding of the contract eventually resolved several problems. However, questions pertaining to why AID decided

21 not to fund at full value and why the contractor was not formally apprised cf the possibil~ty earlier remain. The evaluation h~s not been able to obtain a satisfactory answer.

AID Inputs

There have been three contract monitors assigned t~ this project since September 29, 1979~ Mr. Richard Cornelius (who also served as the monitor during Phase 1), Dr. Alvin Onaka, and Dr. Jack Lawson, Jr. (since early 1981). A critical element jn establishing the initial momentum for country recruitment is the timely issuance of cables and memoranda by AID/Washington to AID missions familiarizing them with the new project. This was done early in CPS II. Depending on the volume of response, the contractor inputs are scheduled accordingly. In CPS I there was a positive responsei in CPS II the response was moderate. Follow-up discussions also take place witl~ AID regional bureaus. The Latin America Bureau has been a particularly strong supporter of CPS II. The regional bureaus suggested and targetted countries that might participate in CPS II.

AID missions also provide inputs. They might solicit a Westinghouse visit or contribute mission funds in support of survey costs (such as Pakistan, Thailand, and Egypt). Mission approval for travel to the country (as well as by the CTO) is necessary, and, if approval is withheld the initial recruitment process can be limited. In most cases the Westinghouse staff have found the mission officers very helpful. In the case of the Barbados cluster of surveys (across St. Kitts-Nevis, St. Lucia, St. Vincents, Dominica, and Antigua) the AID population officer played an instrumental role in facilitating the implementation of male surveys on contraception. In other instances, such as for sub-Saharan African missions, there is no population officer and the interest 1n a contraceptive prevalence study is mild. Thus the chance of forging a survey agreement are almost nil.

On the whole Westinghouse has indicated that it enjoys good relations and support from all offices of AID. Close consultation is maintained between the project director and contract monitcr on all aspects of CPS work. In its present financial negotiations, resources are being pooled from various levels (the Office of Population, regional bureaus, and local missions) to meet CPS Needs.

The CPS II project has followed the country leads provided by AID very closely. This willingness to be guided by AID probably explains why CPS cond~cted family planning surveys in Lebanon, Nicaragua, and El Salvador in spite of present political conditions and gave less priority to conducting another round of prevalence surveys in Thailand or Sri Lanka. Less input by AID is needed for the technical operations (such as core document preparation or . survey procedures). AID missions, however, have helped identify potential subcontractors.

22 'I'he A.ID CTO has discouraged "further analys is", ac ti v i ties to accommodate a demand (gen~rally internal to AID) for more surveys. (This is discussed in more detail later in this report.) Some CPS staff were dissatisfied with AID for discouraging further analysis activities and secondary analysis of CPS data in general.

In general, the evaluation found AID/Washington inputs to its missions to be timely and supportive. It is possible local AID missions in Africa and very underde' .. eloped countries in Asia and Latin America could be better informed about the value of the CPS program. ::Iowever, the lack of local survey capabilities or interest in population may explain the indifferences in those regions.

23 v. OUTPUTS OUTPUTS

Further Development of Survey DocumentatIon" .

The contract called for a thorough review of the existing core documents (developed largely under Phase I) for refining their content and format. First, six optional questionnaire modules were to be developed. possible topics were age at first marriage, attitudes toward family planning, impact of lEe programs, community availability of contraception, reasons for non-use of contraception, and prevalence of breastfeeding. Second, alternative questionnaire items were to be suggested to "further the basic objectives of the project. II Third, the basic documentation required from the Contractor for CPS II was to include the following:

(a) Questionnaire (g) Sample plan (b) Questionnaire modules (h) Pre-test plan ( c ) Interviewer's manual ( i ) Analysis plan (d) Supervisor's manual ( j ) Tabulation plan (e) Coding manual (k) Report format ( f ) Ec:i ting manual ( 1 ) Publication/presentation plans

The questionnaire modules were generally developed on an ad-hoc basis. Modules were not usually developed as a stand-alone component to be incorpor.ated selectively into surveys as the modules of the V'vor ld Fert iIi ty Surveys are, for example. Those CPS modules available for review had usually been included in one or two survey applications, depending on the local interests for evaluating particular health or family planning delivery strategies. Four modules were reviewed: household amenities, impact of lEe programs, prevalence of breastfeeding, and maternal/child health. The development of a male questionnaire on contraceptive prevalence and the abortion module used in the Nicaragua survey are examples of supplemental modules. In most cases, the modules are a collection of five or so questions cOllcentrating on a particular topic. Brevity was a key feature on the CPS Program and full-blown questionnaire modules were not actively pursued except when the data collection effort was directed at evaluating an existing program area. Questions on age at marriage, attitudes toward family planning, community availability of contraception, and reasons for non-use of contraception were incorporated into the core questionnaire.

In many cases the Contractor and Subcontractor worked collectively to incorporate additional questions of immediate relevance to the country program. Fuller detail on these instances can be found in the last column of the Status Summary Report, Appendix D. This flexibility in accommodating local evaluation interests is to be commended. The male prevalence survey in the Caribbean is an example of an innovative survey measurement to derive unique information on family planning decision-making.

25 Four core documents have been widely distributed and are available in Spanish and sometimes French. These are the core questionnaire, the interviewer's manual, the suppervisor's manual, the coding/editing manual, and an analysis manual. All are of high quality and readily adaptable to local survey conditions. Plans for sampling and pre-testing were not written up as core documents. There also appeared to be no standard report format or formal plan for publication/presentation.

The further development of survey documentation appears to have materialized somewhat erratically. The questionnaire modules and supplemental questions and sampling strategies should be assembled and documented in a systematic fashion for the benefit of the follow-on project. Because much customizing of report writing was done, there is less standardization than might be expected.

Selection of Participating Countries

Early identification of potential country participants is and has been essential to the successful implementation of CPS II. The Contractor has made a good faith effort to solicit participation from all eligible and interested countries. Criteria in the contract specify that the country should be of 1.igh programmatic priority and should have an active public or private family planning program. Table 3 shows the level of CPS II recruitment effort by region. Of 110 developing countries with a population of at least a half a million, only about four-fifths were eligible to participate in the program. Of those eligible a majority expressed interest (50 countries). nlirty-four of the 50 that expressed interest will have conduted prevalence surveys by the expiration of the contract. l At least one-half of these are interested in conducting another round of surveys, however, the prospect for a second round depends on future technical and financial assistance. Thus, by one measure .. CPS II has generated 68 percent participatj.on among the 50 countries which were interested and eligible. That level is higher in the Latin American, Caribbean, and Asian regions and lower for the Near East and Africa.

The contract also listed 39 key potential participating countries, 2 of which are not at present eligible for u.s. assistance. Of these 37, 2 were surveyed under Phase I but not re-surveyed in Phase II in order to devote more resources to first-round surveys in other countries. Of the 35 remaining, 20 (or 57 percent) were then covered in Phase II. (The remaining 10 of the

IThis includes the Caribbean/Barbados group which reviewed technical assistance from ~vestinghouse but are not counted toward total surveys performed under this contract.

26 30 countries participating include a number of Caribbean island nations and other large LDCs such as Nicaragua, Somalia, and Bolivia) .

The evaluation team found that Westinghouse worked closely with AID in pursuing the possible participation of eligible countries. As mentioned in Section IV, in some cases Westinghouse forged and implemented a survey agreement under politically turbulent circumstances because of AID's programmatic interests.

The number of visits per country contacted in CPS II can also be considered an informative indicator of the Contractor's effort to guarantee the quantity and quality of outputs. Table 4 shows the number of trip reports per country. They range as high as 13 visits for Egypt and Honduras. The average number of visits made in the countries on which there is a published survey report is 8.9 each. This is about three more than originally anticipated (see subsection, Monitoring Field Operations). These visits do not always involve separate trips originating from Columbia or for only one project person. For one region the regionel coordinator routes his trip across several countries and then doubles back to monitor progress since the first visit. This is an effective and economical means to encourage action.

In general, country selection has proceeded in a systematic fashion with the Contractor making a good faith effort to enlist the participation of interested countries ~nd countries where AID has programmatic interests.

Subcontractor Selection

Much of the potential and actual utility and products of a survey are fixed at the time it is negotiated. In planning the follow-on project, the lessons learned from negotiations should be analyzed. Several country sites, including the two visited, have expressed frustration in getting coverage of analyses appropriate to their own perceived programmatic data needs.

As the Westinghouse staff pointed out, budget and technical considerations (sampl~ size, field work time, and site survey capabilities) place general and specific constraints on the negotiation range. The negotiation process should also produce an orderly plan for further analysis, dissemination, seminars on CPS Program use, and feedback. If appropriately structured and adequately encumbered in a budget, the integrated program can be carried out without a lot of contractor monitoring.

With the exception of one survey area, subcontractors have been either government agencies or family planning associations. The one

27 exception is the Cdribbean group of Barbados, Antigua, St. Kitts­ Nevis, Dominica, St. Lucia, and St. Vincent where a private market research firm had to be used. In all cases subcontractors were agencies with an immediate interest in the prevalence data.

The evaluation team could not review the credentials of the subcontracting agencies. Certainly there is a range from highly experienced countries like Costa Rica and Colombia to the very novice ones like Somalia and Botswana. We can only assume that the agencies were well screened and assessed. The fact that surveys have been or are being carried out is evidence that the agencies are capable. In Barbados (see Appendix B-1), the market research firm, SYSTEMS, Inc., was the only eligible institution, because the only other candidate, the Barbados statistical Service of the Ministry of Finance and Planning, was disallowed from contracting with private organizations. Subcontractor selection was done with the cognizance of the local AID office; therefore, it is unlikely that any gross misjudgment has taken place in any survey.

The prime contract originally envisioned that the cost for implementing the surveys locally would range between $50,000 to $100,000. Counting only the U.S. contribution, i.e., the fun~s provided through CPS II, and not the local in-kind contributions, costs of the 32 surveys to be conducted are as f011ows:

Under $50,000 3 $50,000-$74,999 3 $75,000-$99,999 7 $100,000-$124,999 6 Over $125,000 7

Total 26

The remaining 6 surveys are Antigua, Dominica, St. Lucia, and St. Vincent, for which Westinghouse provided only technical assistance, Dominica, and St. Kitts-Nevis, which were included in the Barbados 2 subcontract. r~us 13 surveys have exceeded $100,000 in subcontract value. The average amount across 25 survey subcontracts (excluding the first four Caribbean nations listed above and Barbados 2) is $101,084, which is near the upper limit of the projected costs.

The Contractor appears to have been fiscally responsible in negotiating these subcontracts, even though average costs have been higher than expected. It is worth noting that these estimates do not include local contributions, which in some cases have been substantial (Nicaragua $126,094, Ecuador $96,167, and Kenya $211,239). The total costs per survey and per responden~ would be much greater with these inputs considereu.

28 Subcontracts were processed in a timely manner, and Westinghouse has monitored each very conscientiously as survey work cannot begin until approval has taken place. In addition, westinghouse has monitored the subcontractors' performance closely through a series of field trips made and exercised control through in~remental subcontract funding. The evaluators found that Westinghouse made a responsible attempt to avoid cost over-runs when negotiating subcontracts.

Field Operations

All field operations procedures (subcontract approval and survey document finalization, pretesting and interviewer and supervisor training, fiel~ interviewing, spot checking, editing, call-backs, and editing, cleaning and coding) have all been implemented in the CPS II surveys. The Contractor has made good effort to ensure high quality operations. Obviously field problems will and do occur; isolated sample areas in Nepal for instance tax the ability and motivation of field personnel to reach targetted respondents. Likewise, as the field report on Barbados notes (Appendix B-1), systematic adherence to a call-back routine may be lacking, resulting in an unusually high non--response rate. CPS II country coordinators have initiated field operations per$onally. The trip reports indicate that their usual tasks are to monitor the pre-testing and launch the actual fieldwork. At that time quality checks are taken to verify and review completed questionnaires. In Barbados, when a high non-response rate was reported, a trouble­ shooting visit was made. Sampled enumeration districts were re-visited and households contracted to determine the accuracy of the initial refusals.

The evaluation team noticed that call-back records were not consistently maintained in Egypt and Barbados. This may be true to other surveys. It is difficult to tell since information on response rates is not uniformly presented in the country reports (e.g., Nepal and Thailand), and original questionnaires are not available for review. The evaluation team strongly ~ecommends that all field recording in future surveys be carefully monitored and maintained to enable later evaluation of quality. This is not a major issue but is important.

t10nitoring Field Operations

A review of the survey records, which detail the dates and purposes of each field visit made by CPS II staff, indicates that the survey process was systematically monitored at key points. As mentioned earlier, a commendable amount of travel has taken place, and the average number of visits to countries now having completed the survey process is higher than originally projected. The length

29 of these visits tends to be between one to t~JO weeks, usually about ten days. In some of the more recent surveys, the visits have lasted almost one month. Shorter visits are found in the Latin American surveys. In most surveys, one visit will be made by the sampling statistician to plan the design. On the whole, field operations have been monitored closely and at timely intervals, even though at times visits are relatively short. The sampling statistician's visit ensures that the sample is scientifically drawn.

Data Processing and Analysis

Data coding and cleaning follow the completion of fieldwork. The intention of CPS II has beeu to sU~.)p'urt in-COllntry processsing (and analysis) to strengthen in~titutiDnal capabilities. In all surveys a cleaned and edited raw Jata tape has been transmitted to westinghouse.

Most tabulations have been done in-country. However, there are excepticns. Some countries lacked good software packages, and others, especially Zaire, faced high charges for comput~r time. Moreover, access to local computers has been very restrict8d. Analysts from Egypt, Morocco, Nepal, and Thailand have come to Hestinghouse headquarters to run tabulations here. In fact, all tabulations were done at \lestinghouse for Egypt, Morocco, Honduras, Nepal, and Bangladesh. The Honduras and Nepal tabulations were sent there to be written up. For Bangladesh, Egypt, and Morocco much of the writing was done in Columbia. Otherwise most tabulations and report writing were done in-country.

Neither Westinghouse nor the individual countries produce a fixed set of tabulations following the preparation of a clean tape. The exact tabulations included in the analyses vary depending upon preferences of the country monitor and of the analysts in each country. There has of course been a large overlap across the countries since they all used a similar questionnaire that implied a similar final report. However, there has not been a blind set of standard tabulations to execute, which would have facilit~ted country comparisons.

The computer programmer has devoted an important share of her time to technical assistance overseas. This was not much needed at the very beginning becallse the active countries were technically stronger. Later, however, the countries needed much more technical assistance. The programmer travelled to Zaire, Haiti, and the Dominican Republic to get the CONCOR program operative and to train staff for its use. Her travel provides assistance on programming, tabulation, and editing, in addition to the training dnd the installation of software mentioned above.

30 Not surprisingly, the Contractor is somewhat concerned about the quality of the data. Sampling errors have been measured to some extent: however, the Westinghouse sampling staff has not had adequate time to prepare sampling error calculations as a matter of routine. Westinghouse does have a computerized variance estimation routine which has been used when sampling variances are calculated for presentation. There has been little consideration of non-sampling error contributions to CPs. (Some studies have been proposed but not carried out under the "further analysis" c.::ttegory). The issues of survey error and time series analysis (with more repeat surveys) will eventually become more significant. As countries consider various program alternatives, the CPS must maintain high quality standards and provide precise estimates.

In the judgment of "the team, Westinghouse has followed a reasonable course regarding pUblication of the final reports. (Appendix E gives the publication status report). Basically, each report covers the full variety of sUb-topics contained in the questionnaire, giving relevant text and tables separately under each heading. (Some reports have included selected results from previous surveys to show time trends). These reports serves as a reference document for readers across a spectrum of needs and interests.

The report format is much superior to other possible alternatives: a large set of tables with a slender initial text, which would present undigested material unlikely to be used, or a series of technical journal articles, which would be difficult for local personnel and would leave much of the general material unreported. The final report requires much labor by both the country personnel and by Westinghouse, but it develops local talent; and this helps compensate for the variation in report quality. The final reports have been promptly produced, within given limits, but they could benefit from wider distribution.

Originally country summaries, usually a twenty-page review of the major survey findings, were produced. Tnese were discontinued in part because they were not a contract deliverable. The evaluation team feels that country summaries, if presented in standardized format, are helpful and should be reviewed for their in-country utility in future projects.

Westinghouse has been an able and ready source of technical assistance for data processing and analysis. To maintain standards of quality in the final country reports, it has actually assigned staff to report writing, which absorbs time from other activicies. However, because there is no fixed tabulation plan, this has also delayed the analysis process. The evaluation team recommends that a fixed set of tabulations be established and prepared for each survey, regardless of whether or not they are completely incorporated in the final report. Because of the dual purposes of

31 this contract--servicing

In addition to analysis and reporting, the Contractor was to present the findings orally to the local AID mission personnel and host-country government officials; disseminate the final country report to AID/Washington and throughout the international scientific community, using a detailed stratified mailing list; and arrange for regional conferences for participating countries to further disseminate findings.

In at least six of the ten countries completed (Peru, Honduras, Thailand, Egypt, Barbados, and Nepal) findings were presented locally. Traveling seminars were brought to districts of Thailand. Dissemination ir Peru was accompanied by much media pUblicity. Country findings have been disseminated broadly through regional seminars. Although Westinghouse does not have a formal presentation plan, it has attempted to have the findings presented locally in all countries to apprise family planning administrators of key results.

Copies of the published country reports are distributed to AID/Washington in the Office of Population and the regional bureaus. At the time of the evaluation, a two-hour presentation of findings was made in the Office of Population to interested AID Officials and tIle evaluation team. The distribution is prompt and complete within AID.

For the international scientific community, the distribution follows a maximum mailing list of about 500 institutions and persons. However, the mailings are stratified by geographic region, and many pUblications are sc~t to a much shorter list. The team recommends a much wider dissemination, particularly given the modest marginal cost of larger print runs and the free postage available to Lhe project. All publications are free to recipients. Specifically, the distribution procedures are as follows:

1. There is region-specific distribution, i.e., AID missions and other organizations in a region receive the reports on countries in that region.

2. A request form for further publications is included.

3. The Library of Congress, Population Index and POPINFORM automatically receive copies. A number of institutional libraries, both overseas ana domestic, are on the mailing list.

32 Hestinghouse Corporation provides the postage for this distribution at no separate charge to the prqject. This is a significant contribution, since often a report is printed in the United States and bulk copies must be sent back to the country. The number of reports printed varies. Some reports, e.g., Bangladesh, Colombia, Egypt, and Barbados, have been microfiched because of dwindling supply. The mailing list is maintained and upda~ed through System Six, Westinghouse's word-processing facility.

The mailing list could be expanded by extracting institutional list~~gs from standard bibliographic sources, like the Population Index or directories of professional population associatio~ There is an existing demand for these publications. Additionally, a depository system whereby key centers are enlisted to maintain CPS documents, as they do for WFS publications, could be he~pful. Requests and updatings are handled in a timely manner, although towards the phase-out of the contract with the rapid appearance of more reports there will be added pressure to disseminate quickly.

Regional seminars were a small item in the contract. However they have evolved into an effective forum to disseminate findings and to enlist future participants in the cps Program. Four seminars have been held, with the proceedings of two already publish9d. These are detailed in terms of their locations, dates, and size in Table 5.

At the seminars, each participant country presents selected findings from its survey. These presentations are followed by group discussions in which survey experiences are discussed and compared and future approaches and improvements are considered. Non-CPS countries in the region are also invited, and th~ response has been fai~. The seminars provide the opportunity to solicit their participation, many have shown interest. l Recent funding constraints and the contracts forthcoming expiration have nullified the possibility of capitalizing on this interest. However, it can be followed up in the next project.

The evaluation team found this means of creating awareness about the CPS us~ful and effective and recommends that future survey programs incorporate and expand the role of these seminars.

Further An~lysis

It was anticipated in the prime contract that approximately 75 "further analyses" subcontracts would be completed during the life or the project, each not to exceed $10,000 in value. Experience with the "further analysis" studies has not been encouraging; and

lVerbal interest must then be followed by an official invitation to visit and discuss the possibility of holding a CPS and by approval from AID/Washington and the local AID mission.

33 the activity has been considerably de-emphasized in an informal agreement between Hestingnouse and the AID/CTO. Thus only seven further analyses have been subcontracted by Westinghouse. Two have been publish8d; three are under revision: and another two to be completed. Two others were submitted for approval but later withdrawn because of administrative delay in the review process. These are listed in Appendix F which also details additional studies done on CPS data for journal publication and meeting presentations either directly or indirectly involving CPS staff.

Part of the difficulty in fully pursuing further analyses studies has been the technical review procedure at AID. Also separate small grants were too much of an administrative load to deal with. If further analyses had been provided for as an additional line item in the prime contract, with perhaps a simple sign-off required from Westinghouse, then some good studies might well have been accomplished. l As is discussed more fully in Section X, the assumptions behind the purpose of further analyses remain valid and the advant&3eS are there to be had. The present disadvantages in administrating this project activity have all but emasculated this effort.

The agreement to reduce effort in this area has its own disadvantages. Given the professional investment on the part of host-country researchers to design, execute, and complete the survey, it seems reasonable to extend some support for later exploitation of the data beyond the first report. The further analysis mechanism was designed to meet this demand. In many countries interesting nd programmatically relevant patterns of contraceptive us~, e.g., high levels of traditional use in Peru and Sri Lanka or discontinuation of family planning in Egypt, call for such investigations. However, this interest was not translated into research support. As a result, for a program as large as CPS II, there is a disproportionate level of effort focused on survey implementation rather than on analysis, interpretation, and dissemination of its findings.

lThe three countries "further analyses" topics were or are being incorporated into the final report (Costa Rica, Peru, and Ecuador).

34 PURPOSE

Tne purpose of tnis project is to carry out repetitive sample surveys of contraceptive use prevalence in 25-30 developing countries with active public and/or private sector family planning programs, and to publish the resulting data for use by LDC family planning administrators and by AID.

Tne contract is beginning its fifth and final year of operation. As of June 30, 1983, fourteen surveys had been completed and ei~nteen were ongoing. In July 1983 four more were likely (E~ypt, Morocco, Botswana, and Nigeria) with anotner two under negotiation (Thailand and El Salvador). Table 6 compares tne current and final anticipated status against tIle end of project status.

Trle project paper called for an unspecified number of multi­ round sample surveys in 25-,30 key developin~ countries. The prime contract, nowever, specified tnat aDout 60 surveys would be taken with 21 being first-, 24 second-, and 14 third-round surveys. In actuality at the end of tne project the contractor ~ill nave completed with certainty 32 surveys in 30 countries of whiCh 24 will De first-round and 6 second-round. If tne additional six under current negotiation are implemented, then 38 survejs in 32 LDCs will be completed (29 first-, 8 second-, and 1 tnird-round surveys). Of tne 30-32 LDCs, 6 are small Caribbean islands (Barbados, Antigua, Dominica, St. Kitts, St. Lucia. and St. Vincent). How "key" tnese are as LDCs in need of prevalence estimates is questionable. However due to an active AID mission and a larger ~olitical interest in CARICOM, the group has participated in the CPS ?rogram.

One-fourth of the surveys involve subnational samples (Tunisia, Egypt, Brazil (2), Indonesia, Lebanon, Somalia, Morocco, and laire). Tnis reduces cross-national comparability and the utility of tne prevalence estimates for AID purposes. On the other hand, in some cases tne suonational 3cileme is directed at tne evaluation of pre-existing service strategies, e.g., Indonesia and Morocco, whiCh ennance tne utility of the survey data; and in others the survey may represent the only data source of its kind, e.g., Somalia, Lebanon, add Zaire.

Only 10 country reports have been finished in tIle four years (8 have Deen published), and 22 remain to be issued in tne next 12 montns, a fairly unlikely prospect. A no-cost extension of time for the project seems imminent. The slower output of reporting illay be due to an unanticipated need for greater involvement by CPS staff in producillg reports. The origindl intention was to coordinate and supervise, but not write, tIle reports. Also tne local survey directors nave had problems locating sufficient time and comput~r

35 resources to devote to report analysis and writing. The CPS staff have remedied t,lis by cringing many to the Columbia offices to concentrate on finalizing tne draft tilere. This gives the dirGctors immedi~te access to computer processing and tecr.nical and clerical support and removes tnem from daily office distractions.

In sum, tile end of project status conditions (see Table 6) are reasonabl~ given tne purpose of this project. It is likely that the contractor will nave yathered sur.vey data in 30 LDC~ but complete pUblication of the results is unlikely by September 29, 1984. In mo~t c0uIltries survey data will be utilized by planners, but there is no systematic manner by which this can be assured nor is it a contractual oUligation of Westinghouse tc yuar.antee their utilization. Tnus far Westinghouse has presented completed survey' results to the go?ernments and family planning programmers, and perhaps to the press in each participating country. This is the extent of its effort. Whether or not executing agencies have Decome technically capable of conducting second round surveys (another condition expected at the end of tne project) can at present be verified in only six countries wnere second-round surveys have been or are being taken. Since the evaluation team visited only two countries, it is difficult to evaluate in any technical w~y how much institution Duilding ha~ occurred. At least 30 countries have had the experience of doing tne survey once. However,~ the team feels it is necessary that AID continue to provide technical and financial support for these surveys as it is unlikely tnat even countries with existing capabilities will conduct them without external assistance.

36 GOAL OF PROJECT

Tllis project is directed toward the goal of collecting analyzing family planning data to assist family planning administrators in program design and implementation and to provide evidence to LDC planners and to AID on the impact of family planning in developing countries.

To date the CPS II project has progressed reasonably well toward the achievement of this goal by collecting data on contraceptive ~revalence in 14 countries and is in the process of completing tlle collection in another 18. These data have been or will be systematically analyzed and reported and then formally presented to relevant government ministries and officials. In-depth analysis, going beyond rudimentary patterns and their differentials in contraceptive use, have not been done largely because of a mutual decision betweell AID and the contractor to maximize the number of surveys undertaken through this project. In conjunction with prevalence estimates available from tre WFS and CDC survey programs and other national family planning surveys fielded, the results of CPS II have significantly enhanced tne overall capability of documenting the extent of and rise ln modern contraceptive use.

Tnere has been progress in making available t"h'e information needed by family planning administrators to design and evaluate service strategies. In at least seven countries this is a primary goal of the survey design. On tne other hand, this project has not been oriented towards analyses to sUbstantiate the impact of contraceptive use on LDC fertility. The eventual disseminatiJn of all survey results, when they are correlated with current fertility information, mdY provide some indication of the impact of family planning. However, sucn a full and scientific analysis would necessarily be the responsibility of another project.

To tne extent that research into the determinar.ts of fertility regulation shares equal parity with data collection in tl1e realm of AID's interests, this proJect has been diverted from contributing more extensively toward analyzing the interpreting trle significance of the survey results. However, this is inherently a Scylla dnd Charyodis dilemma. It is difficult for a contractor to meet the ooligation of collecting numerous surveys, reporting on tnese in a succinct and non-technical faShion for policy makers, and also pursuing demanding technical studies to evaluate the role of family planning. The Contractor has given its best effort toward furtne.cing ble larger goals and i1as done so wi th dedication and enthusiasm.

37 VIII. BENEFICIARIES BENEFICIARIES

Tale project paper (pp.16-17) identifies the LDC family planning proyrams as direct beneficiaries of the CPS II project. The indirect beneficiaries are the programs' clients.

One of the goals of this project is to produce succinct data analyses, written for non-technical LDC family planning administrators, which will sUffi!L1arize data findings and discuss their significance. To the extent that these analyses impact upon sound program manage­ ment, tnis project could have a significant effect on tne future success of family planning programs, and hence on the health and well-being of the families to whom these services are available.

Another indirect beneficiary is AID for whom contraceptive prevalence data systematically collected are necessary for the planning of its population assistance program.

A balance must continually be struck in designing and implementing a project to meet tne local needs for family planning data as well as the larger donor needs. The contractor must fit this set of needs' into a structured survey program, bounded by limits of time, staffing, changes in operating environment, fiscal resources, anu other inputs and obligations. Uniform success in fulfilling data needs is not to be expected.

In CPS II the empnasis has been on using a standard format to assemble a body of prevalence data through rapid survey collection, with some accommodation of local program needs. The question of data utilization and quality of data has several distinct ramifications for specific country programs and AID-supported inItiatives. The question of quality of the survey data is complex, but it is at tne hea=t of the issue of the CPS utility. Tnis section of tne evaluation summarizes tne nature of the project's iJenefits and comments on the use of the results in LDC family planning program administration. (Note that this discussion will at times overlap witH tnat cf Section V).

Data Produced and Available for Family Planning Program Management

~he CPS program has proivided an appropriate variety of data, DotIl of baseline and additional coverage data, whicn identify areas of additional program relevance. The content is flexiole--an important feature--but, at tne same time, there is standardization across surveys. (The modules have nad uneyual development, largely

39 because they are tne primary vehicle oy which a variety of "customized" data can be provided on a survey-ny-survey basis. There is general agreement that more work is required to develop the full utility of tne modules, add new areas, and, in general, support a greater variety of data.)

The quality of CPS data in providing baseline information on specific countries is both appropriate and adequate for an initial suyvey. This is particularly true where a point estimate or descriptive-level is appropriate. By implication, there is concern over the quality of data Where repeated surveys are being or have been undertaken. More attention needs to be paid to factors of statistical validity and survey reliability. As additional cycles accrue within a country or setting, time-series analysis will become important and essential for evaluating trends and progress in con~raceptive servicing.

Westinghouse, consistent with the aims of the contract, has emphasized the timeliness of reports within tile constraints of a host's perceived methodology capabilities and overall budget. vvestinghouse has generally provided timely data once a specific CPS contract has been negotiated. Dissemination of the results has consisted mainly of ~ailing out publications and, on a limited, ad hOC oasis, conducting conferences on specific coun~ry surveys and more formal region~l conferences on CPS. .

Efforts are being made to expand the mailings. Tne local conferences have, as one would nope, increase the utility of the s~rveys by providing guidance in how administrators can employ SUCIl results in prograril applications. The reg-ional conferences are d device tnat nas been useful for recruiting furtner CPS candidates.

Westinghouse could expand its dissemination activities. In particular more follow-up is required to determine the actual utility of CPS data within a country or survey setting. There have Deen no established or formal feedback mechanisms. SUCh follow-up evaluations would immeasurably aid all aspects (country-specific and AID-wide) of tne CPS program.

The ini~ial and summary reports available fcr local use are well organized. Basic tables, text, and graphs are clear. Generally the entire repJrt or at least a summary is presented in the local language.

As noted previously, availability of data for planners and administrators is closely tied to tile analyses performed. The "further analyses" envisioned in the RFP would considerably aid tne production of more detailed reports. For a variety of reasons this program has never been realized and nas been a major drawDack to mining the extant data base.

40 Use of the Survey Results for Family Planning Program Management

There is little systematic evaluation of tne findings and actual use of survey data and products. Ho~vever, CPS use can be evaluated by looking at evidence provided by country requests for furtner follow-up surveys, regional conferences, AID population officers, Westinghouse contacts, other related programs, and AID/Washington and mission offices. According to these sources CPS results are used, and if successive s~rveys are undertaken they will also be used. Specific evidences are primarily anecdotal. In Thailand a series of regional conferences increased the effectiveness of a Thai CPS survey. In addition, Egypt (the Population and Family Planning Board in conjunction with the Institute of Statistical Research) held a seminar based on CPS and CPS-related data use. From time to time, countries or population officers have requested additional copies of project publications. Still, systematic follow-up of CPS use IS needed should extend beyond a snort-term assessment following report presentation.

Several points regarding data utilization nave been raised by external and internal parties to the project--how ace program decisions affected by available CPS data, wnat happens WIlen CPS results do not 'appear favorable to a family planning goal/component, and should CPS results be used to justify a famil~ planning program in general (versus an in-depth evaluation of its activities)? In summary I tile central question of whet.her CPS has an ='-,npact on decisions is not systematically addressed within tne project. Indeed it is not perceived as a contractual obligation that SUCll an ongoing feedback mechanism be established.

"Further Analyses", A Potential Source of Useful Results

As an embryonic program, the "further analysis" activities became an aside to the larger CPS country survey program. There really is no fair test of "furtl1er analysis" activities. TIle handful of studies show little coherence. As described earlier, the process to contcact for d specific study was perceived as cumbersome and time-consuming, and initial enthusiasm for this component faded. rrilere are some excep-cions that can illustrate the potential of the embryonic program. Contracts were let to the Population Reference Bureau (in progress) to produce a fact book and wall cnart using the Egyptian CPS and related data. This is a useful dissemination activity. A proposal from Egypt to do a response reliability analys~s (based on data collected on reinterviews) costing $4,000 was not funded. Tilis represents a potentially important and practical statistical validity study. A more precise and "furtner analysis" subcomponent could be a fundamet:.ta] asset to the CPS program. The flexibility of the "furtner analysis" format is useful in adapting to specific country opportunities and needs,

41 while supporting the general dissemination dnd methodological development of the CPS program. "Further analyses" can be a.n important adjunct to institutional building activities.

In sum, within the given CPS program structure, fitting local data needs to contracted objectives of producing baseline prevalence estimates quickly has not been e3sily accomplished. However, the Westinghouse staff is sensitive to them and the evaluation finds tnat greater sensitivity should become part of the project design for any follow-on survey activity. In particular, re-activation and reinstatement of tne "furtner analysis" component will significantly increase the utility of the data for local purposes and the effectiveness and worthiness of AlDis investment in such projects.

'1

42 LESSONS LEAfu~ED

Project Performance and Design

The project design t1as been generally appropriate to achieve stated aims. The evaluation team recommends no changes in the essential intent of the project, nor in tne overall nature of the questionnaire. It has served to produ~e information on prevalence; it has been practical; and it has been adapted for particular uses in various individual countries.

Ttle team does recommend greater exploitation of the data gathered. Clearly, the successful creation of so many surveys has required a single-minded focus upon the data collection function. Ten million dollars has been invested. \fuile difficulties will always attend new surveys, the data in hand should not be neglected. This is not intended as an argument for "academic analyses;" indeed, if anything it is intended as an argument for closer attention to the primary intent of the project, which is program guidance. More can be done by way of analyzing survey results in conjunction witn ~lternative data sources, including service statistics, for intelligent program planning. In addition, valuable perspectives for the donor communjty arld for those who wish to understand developing country experience can corne from comparative analyses--again not merely of this set of surveys but in conjunction with related sources of information.

There is the question of where work of this type can best be done. Tne Westinghouse stress upon institutionalizing in-country capacity is commendable and should contine to De first priority. Tile team recommends that more money and staff time should be allocated to developing in-country capacity. Similarly the team has been favorably impressed by favorable reports about seminars and about the value of having LDC analysts coming to Hestinghouse headyuarters with rougn drafts and clean data tapes, for limited intensive periods, to complete "report writing. Report preparation is tne most difficult part of the entire survey sequence, and one where interaction with more experienced analysts can be particularly valuable. Moreover, ready access to computer processing enables more rapid turnaround on more or less standard tabulations.

Cross-country analysis is rarely of interest within a single developing country. It generally rests with international organizations, universities, AID itself, and institutions like the Population Council, the Rockefeller Foundation, and others. Some sensitivities attend this, and Westinghouse has been commendably conservative in protecting the countries' proprietary rights to the data. As final reports appear, and as the surveys age, tne sensitivity usually recedes. The team recommends that institutions toat can do responsible cross-country analysis be positively encouraged to do so, with due attention to country participation.

43 This is primarily a matter of arranging access to data and providing from Westin~house neadquarters copies of tapes and documentation, as the institutions wishing to conduct such analyses generally have tlleir own funding and staff capacity. The Westinghouse staff itself should continue to do some cross-national comparisons.

The Westinghouse operation should receive greater protection from political considerations in the choice of co~ntries. Agreement should be reached on the criteria by which countries are chosen. Giving excessive weight to political factors has wasted managerial and staff resources, as the choice of countries and other survey plans have suddenly shifted.

In the future fewer tiny countries, or countries with inactive programs or low contraceptive prevalence that shows little sign of changing snould be chosen.

Validity of Assumptions Underlying the Project

The assumptions underlying the design are listed below:

1. Developing countries have an interest in and a need for timely and accurate family planning data ~or program mana0ement.

2. Existing projects for collecting family planning data are incapable of accurately assessing prevalence in the private and commerical sectors.

3. Repetitive contraceptive prevalence surveys, if properly designed and carried out, can provide accurate family planning data for program management.

4. Government or private research organizations/personnel are available in nost countries and possess the necessary skills to undertake a project of this nature with proper assistance.

5. At the conclusion of this project, participating countries will be willing and able to assume tecnnical and financial responsibility for continuation of repetitive prevalence surveys.

6. AID program managers need reliable, current, and continuous family planning data for program management a~d evaluation purposes.

In general tllese assumptions continue to be valid, with two reservations:

1. Assumpt~0n 3: Linkage needs greater attention, and the surveys will be more substantively useful if they are used in conjunction with other data sources.

44 2. Assumption 5: On the financial end, this assumption does not hold if it means that the countries will use their own resources to do repeat surveys. If it means that tne countries will continue to do surveys using ~vhatever resources that they can obtain, including other donor assistance, tnen the assumption nolds. Without donor assistance, few countries will conduct similar surveys, at least not at the frequent intervals needed.

Technical capacity has indeed grown to a gratifying extent in some places, but these are a minority. Even in Thailand, the Philippines, and other advanced places, good survey work depends appreciably upon advisory help, particularly at the stages of analysis and report preparation.

Future Assistance and Further Analysis

There is likely to be a need for future AID assistance in conducting this type of survey. Tne types of data needed are generally the same as in CPS II, with greater use of health-related modules in African studies. Very close attention should be paid to contraceptive supply in the public and private sec~ors to cldrify wnetIler prevalence and fertility change is related to program or non-program sources. (Identifying the brand names of pills used will hel.p assess contraceptive retail sales projects also). Also the most prominent method that has emerged for assessing program effect, i.e., tne proximate determinants framework, relies directly upon survey estimates of prevalence.

One of the assumptions we feel is not valid is that countries will do repeat surveys without any outside monetary or technical dssistance. Other donors are not positioned so well as Westinghouse has been to give a good mix of financial and technical assistance. Taken aloGe, either type of help can be relatively unproductive. It is unfortunately true that very few developjng countries, no matter now advanced, are able to go beyond mere data collection. In a majority of countries careful interpretation of what tile data mean for program guidance depends upon some assistance from expatriate scientists.

Tne CPS oody of data calls out for more extensive analysis, as noted earlier in Section V, and the "further analysis" mechanism deserves a furtner trial. The costs of funding and managerial time that have attended the previous efforts have been due partly to the AID technical clearance process. If this is foregone in the future,

45 toe gain in studies done would probably more tnan offset any diminution in quality. He sugg':st the inclusion of a line in some subcontract budgets for one or two studies, at approximately $5,000- $10,000 each, to be done at the initiative of the country. At most, a simple sign-off by Westinghouse personnel mignt be attached. This would permit easy starts on such studies and all topics of local interest. Should this experiment prove satisfactory, it could be expanded, and greater success might be achieved toward the original intent that a substantial number of small, flexible analyses be done beyond the requirements of the basic report.

'J

46 TABLE 1

LEVEL OF EFFORT AND TRAVEL SPENT ON CPS II BY PROFESSIONAL STAFF

a Percent Effort Percent of Time Staff Person on CPS II in Travel

Director (Smith) 60 10-15 Regional Coordinators Latin America/Caribbean (Kumar) 100 50 Asia (Lewis) 100 50 Africa/Near East (Way) 100 50

Sampling Specialist " (Aliaga) 100 50 Country Coordinators b Novak 100 40-45 Nair 100 40-45 Lioy 100 40-45 Ayad 100 40-45 Evans 100 40-45 Cross 100 40-45 Duncan 100 a

Computer. Fr.ogranuner:9 ·,r Cushing 100 40 C Regan '.' 50 0 Financial Administrator (Abeyta-Behnke) 50 a

aEstimated average. bForrner staff members include J. Ka~ush, T. Wardlaw, J. Hayes, K. Evans (50%), T. Whittier (50%). c rn past year. TABLE ·2

COUNTRY SURVEY MONITORS, * COUNTRY RESPONSIBILITY, ACADEMIC AND LANGUA9E BACKGROUND,AND YEAR JOINED CPS II

Year Joined Monitor Country Re$poQsibility Highest Degree/Field Language(s) CPS II

Mohamed AYAD Morocco, T~nis.ia,Zaire, Ph.D./Demography French, Arabic 9/81 Francophone Africa Anne CROSS Somalia, l\enya M.A./Demography Spanish 1/82

Ann EVANS Nepal, Sri,Lanka, D.Sci./Demography Spanish, French 10/80 Indonesia .

William DUNCAN E1 Salvado~,Nepal Ph.D./Sociology Spanish, French, 1/83 ( ana 1 y sis).· Portuguese

_1- _1_ Michele LIOY " " Haiti Ph.D./Sociology French, Spanish, 2/80 Italian Neal K. NAIR Barbados, Caribbean D. SCi./Demography Spanish 11/79 group, Bangla~esh

John NOVAK Bo~ivia, Dominican Ph. D. /Ge·bgraphy 11/79 Republic, Honduras, Spanish Colombia

-k Former monitors have been G. Karush and T. Wardlaw.

_1- _1_ ~, .1\ Pl-ior to survey work, M. ~ioy, J. Hayes, T. Whittier, and K. Evans assisted in CPS II aumini.str.3tion. TABLE 3

Mt:ASUREMENTOF CPS II RECkUITMt:NT EFFORT BY REGION

Total Eligible Interest Participation Total Eligible Countries Among b Among c Countries ·a Countries Contacted Contacted Interested Africa Number 45 41 28 17 B Percent 100 91 68 61 47 Near East Number 10 , 5 4 3 1 Percent 100 50 80 75 33 Latin America Number 19 16 15 13 9 Percent 100 84 94 87 69

vrav-i 1.l.. hbeanL..J II d Number 12 10 10 10 9 Percent 100 83 100 100 90 Asia and Oceania Number 24 14 12 7 5 Percent 100 58 86 58 71 TOTAL Number 110 86 69 50 34 Percent 100 78 80 72 68 dCountries with population 500,000 persons or more. b . . . h 1 en countries "'ere recent partl~lpants in ot er survey programs. c ,· At least seventeen countries desire a sllrvey (or another round) if funding is available. dlncludes six small i.slands L!f 6arbados, St. Kitts, Antigua, St. Lucia, Dominica and St. Vincent:s with populations less than 500,000. r -::s::' TABLE 4 LIST OF TRIP REPORTS CPS II

Argentina 1 ~lalays ia 1

Barbados Male Survey 7 Mexico 1

Barbados,St. Kitts­ 7 Morocco 8 Nevis, Dominica Bolivia 4 Nepal 11

Botswana 1 Nicaragua 10

Brazil 4 Nigeria 1

Francophone Regional 1 Panama 1 Conference Anglophone Regional 2 Pakistan 4 Conference Costa Rica 9 Peru 12

Colombia 4 Latin American Workshop 3

Dominican Republic 5 Asia Workshop 1

Ecuador 11 Somalia :l

E1 Salvador 1 Sri Lanka 7 .' -

Egypt' 13 Tanzania 3

Haiti 11 Thailand :l

Honduras 13 Togo 1

Indonesia 3 Tunis 9

Jamaica :l Turkey 2

Jordan 2 Venezuela. 1

Kenya :l Zaire 9

Lebanon 3 Zimbabwe 2 TABLE 5

REGIONAL CPS II SEMINARS

Region Dates Location Participant Size

As i a February 16-20, Pattaya, IS from 7 countries 19S1 Th a iland 3 AID represen ta t i ves 4 observers/ consultants Latin November S-13, Lima, 50 from 17 countries America and 1981 Peru 10 AID representatives Caribbean 3 observers/consultants Anglophone March 20-24, Harare, 25 from 14 countries Africa and 1983 Zimbabwe 3 AID representatives Middle East 6 observers/ cor.sultants

Francophone June 12-1S, Tunis, 19 from 9 countries Africa and 19S3 Tunisia 1 AID re'presen ta ti ve Middl~ East 3 observers/consultants

/ ,. I I;; \ .' TABLE 6

COMPARISON OF END-OF-PROJECT, CURRENT AND

ANTICIPATED fINAL STATUSES FOR CPS II

End of Project Status CUtTent Status Anticipated Final Statu::; a. M u 1t i-I' 0 II n d sam pIe s u t'V e y . d. There have been 14 surveys a. 35 surveys in 32 LDCs, of on con t l'acept i ve pl'eva lence com'pleted in 14 LDCs of which 29 are first round, gathel'ed and published for' which 11 are first l'ound, 6 second round, and 25-30 key develop ing courl~ 3 second round, and none 1 th ird round. tries third t'ound. . b. All remaining 28 final (Cont ract calis fOt' d bOll t h. There are 18 surveys on­ reports will ha ve to be 60 surveys of which 21 an:! going in 17 countt'ies of completed. * fi rst round, 24 second which 15 dl'e first and l'ollnJ, and 14 thh'd rOL:ndJ 3 second round.

\=. Six othet' LDC ~urveysare likely to be cl")mpleted by contI'act expil.-ation; of these 3 will be fiL'st round, 2 second round, and 1 th it-d round. d. There al'e 10 final repo['ts completed.

b . Ddt a pub li s h (~d a s a l' e s III t The ['e:;;uits of each sUl'vey There will be continued util­ of tht~sesurveys are util­ ha ve been pl'esen ted i n-coun tt-y ity of these sUl'vey results in ized by LDC planllers fot' to FP progcaffi dnd govel'nment all participating countries. i)perati,-)n and evaluation of . officials. In a number of in­ L.lmily planning pl'Ogt'drllS. stances the da ta ha ve been used f,-)l' IH'ograIH pldnning and management. End of ProJect Sta t U~ CUlTent Sta tu~ Anticipated Final Statu~ c. Executing agencie~in pac­ Participation in CPS pl-ogram In several cases capability ticipating Lountde~, ·stt-engthens existing ~urvey existed priol- to participation. th n)ugh [-epet it i on of ~u[-­ capabilities. CPS ha~ tl-ans- In most cases, particularly vey operation~over the poned various questionnaire for Africa and Near Ea~t,the cou t-~eof the Pl-O Jecl, are :modules, introduced 5ul.-vey participation will Significantly technically capable of con"':' innovations, and upgl-aded improve local su[-vey opera­ duct i ng future n.)und~of com puter.- softwa l-e fot- i £1- tions. Repetitive experience prevalence burvey~. countr.-y data pl-ocessing. available to 9 LDCs.

,', Four Ca ri bbean island su [-v~ysVfere prov ided with techn ica lass btance on ly and no fina 1 report b being issued through theCPS,:pl-O)ect. APPENDIX A

PERSONS CONTACTED DURING EVALUATION OF CPS II PROJECT

(EXCLUSIVE OF FIELD SITE VISITS)

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT/OFFICE OF POPULATION

Richard Cornelius John E. Lawson, Jr. (Project Manager) Elizabeth Maguire Steve Sinding (Director, Office of Population) Joseph Speidel

WESTINGHOUSE HEALTH SYSTEMS

Mary Ann Abeyta-Behnke Alfredo Aliaga Mohamed Ayad Anne Cross Jean Cushing William Duncan Sushil Kumar Gary Lewis N. K. Nair Joe Regan Larry Smith (Director, CPS 11 ProJect) Richard Sturgis tDirectot",· :DDD· ~ro]ectJ . Jerry Su lli v an . A'nn' Way . .,.

OTHER

Jane T. Bertrand, Tulane University and consul[ant to CPS 11 Richa.rd Bils borrow, Un i vers it y of North Carolina and POP LA B A?PENDIX B-1

REPORT ON FIELD VISIT TO BARBADOS, AUGUST 11-12, 1983 BY AMY ONG TSU I

Purpose: To evaluate the field performance of West­

inghouse I s Contraceptive Preva lence Surveys (Female and Male Samples)

Persons Contacted: • Mr. Charles Alleyne, Executi ve Director, Barbados Family P lann ing Associa tion (BFPA) • Mrs. Angela Cropper! Project Manager, International Planned Parenthood Federa- tion/Western Hemisphere Region (I PP F /WHR) • Mr. Joe Da vis, Research Coordina tor, SYSTEMS, Inc. • Mr. Pierre Gueng ant, University of the French West Indies • Dr. Tirbani Jagdeo, Caribbean Family Plan­ ning Association (CFPA) • Mr. Mark Laskin, Regional Public Health Advisor, USA ID • Mr. Neville Selman, Caribbean Community Secretariat (CAR ICOM) • Mr. Eric Straughan, Barbados Department of Statistical Services (BDSS) • Ms. Gail Washchuck, Contraceptive Social

.. J Mar:ket.ing Pro·Ject

Summary Findings: 1. Westinghouse has made a gooe-fa ith effort, as required by contract, to conduct a contraceptive prevalence survey and a male dttitude survey in Barbados, one based on a sample of 1463 women and another on 1300 men.

2. There is a difference in the interests of the implementing and sponsoring institutions for the two prevalence surveys resulting in

a) data late in being reported and dissem­ inated and b) data of marginal value to a program addressed to refining service delivery as opposed to increasing acceptor volume. (( j 2

3. There have been seLious fieldwork problems for various reasons which have compromised the quality and utility of the data.

Background to the SurveY2:

Westinghouse Health Systems (WHS) has assisted in the conduct of two contraceptive prevalence surveys involving Barbados and other nearby Caribbean island naLLons. One in Barbados was based on a sample of 1,463 women 15 to 49 years of age living in?rivate households and fielded between November 1980 and March 1981. The sample design was established by WHS using census and other statis­ tical data from the BDSS. The 8 FPA was subcontracted for the survey, and in tUrn subcontracted with SYSTEMS, a local market research corporation for the fieldwork, data processing and ana lysis 0 The first survey (BCPS) also was simultaneously conducted in Antigua, Domin.ica, St. Kitts-Nevis and St. Lucia; however, WHS in vol vement in these areas was limited to technical assistance. The final country report for BCP~, was published in February 1983 and a brief presen­ tation made to the Ministry of Health in April 1983. The reports for the remaining blands have been written by the executive director of the B FP A and are being printed now.

The second survey was based on a. sample of 1,300 males aged 15 to 49 years living in private households, and was simultaneously conduc.ted in Barbados, Dominica and St. Kitts-Nevis. The sample design, using the same household appr.oach as in the BCPS. was drawn up by the WHS and implemented under a direct subcontract with SYSTEMS. Fieldwork ran from September to November 1982 and then again from February to April 1983. WHS is in the process of finishing the analysis and reporting for this three-island group. Since the survey interviewed males, there is great interest in seeing the results from the -. q uestion-s concerning" .. , their '" .-role - . in family' p lann ing decision-making...... ! .... '. ,

The Findings of the Field Visit:

Th\2re has been uneven progress in the implementation of both BCPS and the male surveys. Three problems affect the overall utility of these collected data:

1, Inability to achieve sample size objectives resulting in 36 percent nonresponse in the BCPS and like1.y the same if not higher in the male attitude survey (~IAS)

t 2. A delay in reporting and systematic dissemination of the survey results

3. Marginal val ue of the in forma tion collected in the Be? Sand pOSSibly the MAS J[: ( ~ f-' 3

These are discussed more fully beJ.ow.

At the outset it is necessary to be mindful that Barbados itself enJoys an advantaged position among the group of countries labelled as less developed or developing. Its 1980 per capita gross domestic pr-oduct was almost US $3000 and its total fertility rate in the same year was estimated at 2.4. The annual population gr-0wth rate is about 0<8 percent. The island is 20 miles long and 14 miles wide and supports 250,000 inhabitants. Thus it does not share the same urgency in its population control efforts as Nigeria, for instance. Nonetheless, the B FP A has become- more active over the past four years expanding its clinical and nonclinical distribution of contraception and improving servIcIng. The same can be said in general of population activity in the region, as large projects have been recently initiated with IPP F /WHR, CAR rCOM, and other international and private agencies.

The BFPA is semi-governmental in that about three-fifths of its budget is government-supported. Otherwise it is an independent affiliate of IPPF/WHR while the smaller islands are represented by the CFP A affiliate. The B FP A is currently targetting spec ia l popu La t ions, such as adolescents and males. USA 10 I s population and health program beg an on ly five years ago in 1978 and is largely directed a t is lands outside of Barbados, which mor-e classically fit the LOC de!;,criptive. In fact, the BCPS was one of the first pL"oJects of the new population progr-am. Recognizing that Bar-bados I cwn family planning needs are somewhat more mature than a newly oriented program I s is important toward understanding the contribution of the contraceptive prevalence surveys in the region.

Sampling Problems

SYSTEMS, Inc. is a well organized market research firm based in Barbados and is the only such business of its kind. The contractor (W'HS) was.·· unable to·· find ·com.par.a.ble s.ut:vey-~aking capability that would have been available to undertake the wor-k. Consequently SYSTEMS has.' ~een. involved i:;:'l both· s.urveys and may be involved in. future rounds.

In the BCPS the first effor-t over- 31 of 50 enumer-ation distncts (EDs) netted only 625 interviews out of a targetted 2000. A sample design adjustment was necessary and another 838 intervlews wer-e comp leted in the rema in ing 19 EDs. Sample we ig h t ing bring 5 the n um­ ber of cases for analysis up to 2023.

In the male CPS the target of 1500 rren also entailed :'110 field efforts, after the first resulted in on ly 601 respondents. The second

1 As a future a lterna ti ve I a b ila tera 1 ag reemen t between lJSA I D a nd the BDSS or ~!in is tr-y of Finance and P lann ing (in which the BDSS is 1oc ate d ) mig h t be con sid ere d to use the ire xis tin g sur v eye a pal; it it Y . 4 effor:t, again after sampling procedures were ad] usted, obta ined 695 interviews. The interviewing on the other islands apparently suffe!:ed less nonresponse.

SYSTEMS fields an omnibus survey quartedy on 1000 households and experiences almost comp lete cooperation. The r:estnction of these field response problerr!s to Barbados is also puzzling.

Various persons contacted gave various reasons. Laskin and Selman noted that the Barbados male population was extremely mobile and rarely at home. Alleyne attributed field problems in BCPS to the fie Idwork timing (Christmas season and on the eve of a gener:al election). Davis felt that many potential respondents were not only uninterested in the survey topic but also deliberately avoided being intervie ..ved. WHS has indicated in its trip repor-ts that tighter' field work was needed. Straughan mentioned that sampling procedures could ha ve been loosely followed. In addition, original estimates for nonresponse built into the sample design proved to be too con­ servative. The combination of all these factors may well explain the shortfalls in sampling.

Sur-veys in family planning may indeed encounter: some sensitiv-­ ity among respondents due to religious and social mores. The BCPS was the second of its kind; a KAP study was done in 1971. However. the use of a market research group with little pr:ofess1:onal interest in the area could also dilute the motivation to achieve sample o:)]ectives. The sociological patterns of conjugal residence may have played a small role. Efforts to build in-house research and sur.vey capabilities are called for. As capable as SYSTEMS may be, it is not a population/development enterprise and not a r:eady client for insti­ tution building. The ability to collect and use contraceptive preva­ lence data for pr:ogrammatic purposes is an impol"tant goal and one which AID can assist directly in improving.

, ,Several improvements,,' to, ,the 'existing' sample, d.es.ign can be considered for future survey work. One is to conduct a listing of households,' in "the sampled EDs' pri.or to household' selection. This as sures fu II and re 1ia b le informa t ion and ena b les p rese lee t ion ra ther than selection of households at the time of field interviewing. 0Jext. the allowance for higher non-response, by including more EDs and sma ller sam p 1ing fractions, as we 11 as purs u lng fie Id work more v igor­ ously at offtimes would probably have helped achieve the randorr: self-weighted sample. The possibility of mixing sampli:1g strategies. particularly to reach elusive subpopulations .. should also be enter­ tained.

Delay in Reporting and Dissemination ot Results

The first serious discussion of holding a CPS in Barbados WelS in April 1980. A subcontract 'NelS signed in September. The report 'Nas not completed until February 1983. although the fieldwork 'Nas com p leted in ylarch 1981. 5

The male attitude survey is now being analyzed. With funding constra ints at the central WHS offices, the pace of comp let ion is Jeopardized a,nd will undoubtedly delay the appearance of the final report.

The delay in BCPS reporting was due to a needed reVISIon of SYSTEMS' submitted versi.on and undertaken by N. K. Nair of WHS. The final report was then appreciatively recei"ved by Dr. Alleyne in April 1983. A four-page newsprint flysheet summarizing the survey was then prepared by WHS and BFPA to accompany the latter's FAMILY newsletter, issued in June 1983. Thus the dissemination began only two months prior to this field visit. There has been little oppo::-tunity for a percolation of the cesu Its.

No furthec analysis of the survey data has taken place, largely due to little local interest, availability of those capable, and cestricted access to the tape until the final report was issued. Also there are limited computer resources.

While there appeared to be no systematic procedure for distrib­ uting the BCP S report, it seemed that all re levan t persons had re­ ceived a copy. Even Dr. Alleyne mentioned that the BFPA could not afford to distribute them w:dely. The flysheet however has enabled greater dissemination, as 5000 copies of FAMILY are freely distri.b­ uted.

To what extent the specifk findings in the BCPS will see pro­ grar.1ma tic a pp lica tion is unc lear. Although information on cont racep­ tive secvicing by BFPA is included, it is my impression that the BFPA sees the survey as a general statement on prevalence and the ocganization's role is to service about 20 percent of those needs. The survey may then have only a general, rather than specific practical utility. However, the report itself will. likely become an important refer.ence document for the newer family planning activities being . imp l~mented; . Most persons" :interviewed.·· aCknowLedged' that the report, while good to have, does not answer the key questions of "why" certain contra:cepti ve' patterns emer;ge·...

The male attitude survey results are nl.)w beir:g awaited wi.th anticipation to yield a broader picture of sex differ.ences in contra­ ceptive adoption. A regional semiq.ar to create greater awareness -In the part of policymakers of the contraceptive patterns is planned for January 1984. The data from both sucveys will receive '.vider dissemination then.

There is a minimum of intet"est in taking the BCPS data and su b Ject ing them to 5 pec ia 1ized aL a lyses for program purposes. Iii i. th the fut ure efforts on the part of the I P P F /WHR p rOJ ect to improve serv ice delivery in the Caribbean, perhaps. this capability can be developed. It is however encouraging that the BCPS and male surveys in Barbados a nd other Ca rib bean coun tries '.viil serve as a base 1ine for measuring the impact of future family planni:"!g activity. A second round of CPS that is regionwlde is planned for in t,.vo years' time.

I \ ',- ) \ ,.~/ \ 6

I t is important that A ID/W and WestingilOuse endeavor to ensure the comp let ion of the ana lys is and reporting of the male attitude surveys. The present funding crisis for the CP S I I project Jeopardizes the timely and eventual delive!:"y of these results.

Marginal Value of the Surve¥2

Criticism came from some quarters on the inherent value of the survey data in part because, of the need to follow the standard prevalence questionnaire. With respect to the BCPS it was stated that as KAP information went, the level of knowledge (Barbados adults are almost :lniversally aware of some for:n of contraception) ",,'as known prier to the survey. No in-depth examination of attitudes towards fam dy planning was made, and the prevalence estimate of 36 per-:ent amcng all women 15 to 49 and 47 percent among those in union was suspect because of an inconsistency with the low crude biLth rate of 10.

The AID regional officer has been particularly interested in investigating potential social psychological barriers to family plan­ ning adoption, especially among men. Thus the male attitude survey, which is a measurement innovation in and of itself in prevalence studies, was developed. However, Westinghouse I s view was more toward rna le prevalence and hea vi.ly wedded to a repeat a pp l ica tion of its core questionnaire rather than to accommodating substantial modifica tions. Given the na t ure of the prime con tract, WHS I pOSt t ion can be supported. The question of utility however is not resolved as the essential issue is "data for whom?". If the data are designed for maxim urn prog ram utility then local needs should transcend externa 1 interests. If the central, Washington-based needs for comparable prevalence data are paramount, then this should be clear at the outset of colla bora ti ve negot ia tions.

Hence~,. in' the case· of. Barba·dos where the local· program is in an ad v anced stage of attracti.ng adopters of family p lann ing and dea ling with a wen-educated popuLation ,the· . standard KAP reporting is of limited direct va.lue. The repot~t too was viewed as "academic" and there are plans to digest it even further for the policymaking audiences.

Another issue arose in inter.preting the low prevalence level Ul the light of low fertility. Other proximate determinants were con­ sidered--induced abortion, late marriage and .postpartum infecundity. The measurement of abortion is difficult; at the time of the survey a bart ion was and, for all in ten ts and purposes, rema ins illeg a l In Ba rbados. . y!a rriage is La te, a ve rag ing 25 yea rs for women and 30 year s for men. Howeve r, con Jug a l. patterns a re loose in the younger ages and sex ual act i v it y commences early. Th us de La yed marr-i.age or uni.on may be a major factor expl.aining the Low fertility but not the low level of contracepti'/e use. Breastr"eedin,g has apparently declined lea ving women exposed to risk of pregnancy earlier.

.1 I.- \1-; '"l li 7

It is highly likely that underreporting of current contraceptive use has occurred in part because family p lann ing is vi.ewed as a pri.vate affair and in part because field interviewers may not have been personally sui ta b le for this sub Ject. (~[any of the fema le in ter­ viewers are younger than 25 years and could have encountered res is­ tance among older women 40 years and up in dtscussing contracep­ tion.) The tables support this conjecture as the level of current use drops from 65 percent among 35 to 39 year old women to 34 percent among those 40 to 44 years. It is 38 percent for women 45 to [.9 years. Thus, the question of what the true measure of contraceptive prevalence is in Barbados will remain and will unfortunately confound comparisons and interpretations made with future estimates. Appendix B-2

REPORT ON THE FI ELD TRI p' TO EGYPT I

SEPTEMBER 2-9 I 1983

Prepared by

Jay H. Glasser, Ph.D.

Pu rpose: to eval uate the performance and use of the Vlesti ng hou se Egy ptian

Contraceptive Prevalence Survey of 1980-81 (ECPS 1) and implications for the cu rren t 1983 -84 ( EC PS 2) Westi ng hou se Egyptian Contracepti ve Preva lence

Survey. Principal Persons and Staff Contacted

Dr. i\\. Samaa Deputy Director Population and Fami 1)/ Plan­ ning Board

Dr. Nabi I el- Khorazati Consul tant Population and Fami Iy Plan­ ning Board

Dr. Hussein Aziz Sayed Consultant Popu lation ar,d Fami Iy Plan­ ning Board

Dr. Makmoud Farag Expert, Social Ministry of Social Planning A ffa i rs (and Popu lation Family Planning Board)

Rapid staff (t'-,12rmine National Family Planning Saad Gouda, Hassan Zaky, and Ola Hassan Faymy)

Dr. Saad Zaghloue Undersecretary, Population Center, CAPly\AS /-\min (ai'ld staff) Chief of Resea rch and Studies

Eng. Abdelhamid Director, Technical CAPtvlAS Shalaby Affairs

Dr. Helmy el Bermawy, Director General fvli n i stry of Heal th

Dr. ,'vlosh i ra el-Sha ffi Deputy Ministry of Health

Dr. Abdel Monem Director General Ministry of Health Foud (and staff)

Hamed Fahmy UN FPA Deputy Rep re­ sentative

Dr. Mahmoud Khalil Scientific Expert W.F.S. (London) posted at NPFP Board

Dr . .'/I, Nizamuddin United Nations Chief Technical Advisor/ Demographer

Dr. Tom Vreba!ovich Scientific Attache U.S. Embassy, ':airo

Dr. William Oldham Health Health ana Population, US-l'\ID

John Pau I James Population Health and Population, US-AID

Tir.l Seims Population Health and Populatioll, US-AID Egypt has made large investments in fami Iy planning and population developments p rog rams. International donor agencies and, in particular, the

United States through A 10 have supported a variety of economic and fami Iy planning activities.

These efforts have leaned heavi lyon surveys: since 1979, four popu!a-

:ion based surveys emphasizing contraceptive prevalence survey data have been undertaken and one is currently underway. Two of these surveys, one completed and one underway, are joint undertakings of Westinghouse and the

Population and ramily Planning Board of Egypt.

Technical assistailce in survey design and conduct in Egypt is a continu- ing need. Westi rig hou se has success fu II y su ppl ied th i 5 su pport In EC PS-i , and is actively engaged in the current ECPS-2. The particular data needs, intensity of family planning programs and the solid technical base for surveys in Egypt provide unique lessons for the future of CPS programs. These issues are emphasized in this report.

The site visit and the information gathered was facilitated by the cooper-

ation, candor and commitment of the Egyptian professionals I either working in

ECPS or commenting in the capacity of users of ECPS data. Westinghouse staff helped in the arrangement for the site visit.

ECPS-l 1980-1981

Our i n g 1 9 8 0 f the fir s t E gyp teo n t r ace p t i ve Pre val en c e sur v e y '. '/ () S initiated. The sClr:Jp!e size was slightly in excess of 5,000 ever married women drClwri from the rural population of ECJYPt. The survey '/:as the third fertility survey carried out ir. this last decade. The ECPS-1 was successful in all the major areas of the survey aims I both in terms of the general aim of the CPS contract and the particular design and execution from the Egyptian perspective.

The Egyptian team I under the leadership of an experienced team I

pianned and conducted the training I field operations, and provided an edited clean tape for analysis. In concert with Westinghouse, the ECPS staff has carried out the analysis and issued timely reports. Sl;bsequently, two dis­ semination workshops employed ECPS 1 data and were highly successful (but

!'lot exclusively devoted to ECPS). Additionally, a contract with the Popula­ tion R.eference Bureau is active to produce an attractive !lfact-book!l forr.lat summary of ECPS 1.

Westinghouse provided appropriate backup at all stages of the negotia­ tion, survey design, field work, analysis, and follow-up.

The AID mission provided a positive climate for ECPS 1, including facili·­ tating the survey and providing additional funds.

There Ivere several problems in negotiating the original ECPS 1 and funds transfer delays in the in itial stages.

The negotiation problems revolved around the sample size and the rela­ tion to the ability of ECPS 1 to support evaluation of the Population Develop­ ment' Program (PDP), a significant rural social and family planning program.

ECPS-2 1983-1984

ECPS-2, the second Egyptian Prevalence Survey, is now in the pre-field development stage. The sample size projected is in excess of 10 , 000 ever married women drawn fror.l both ur[:m and rural populations of Egypt. This survey is the sixth fertility survey carried out in this last decade. A similar climate exists fur the current ECPS 2. The collegial atmosphere of the Egyptian and Westinghouse relationship has strengthened and the A I D Egyptian Mission is providing a large measu re of funds to sup­ port the survey.

Significant questions and lessons for the current ECPS 2 have been rai sed. These concerns arise out of th ree developments:

1 . the range of population and fami Iy planning activities in Egypt,

2. intervening fami Iy planning and CPS-I ike surveys providing additional

data; and

3. the essential basic fixed structure of the CDS survey form and uniform

constraints on methods.

These concerns Clre a function of the unique setting of the Egyptian family planning and health development programs': users are looking for more' detai led data, yet sti /I ~eq ui re sign i ficant su pport in ana Iysi s, di ssemi nation, and appl ication of data to management, and planning decisions.

The criticism and concerns arise out of the positive developments of family planning data and increasing critical recognition for additional data in

Egypt and concomitant needs f6r prog ram evaluation.

Despite the anomalous situation in Egypt, there are general lessons for the future direction of the CPS program:

- How much flexibility is desirable for CPS in individual survey settings?

- underscores the continuing need for assistance, particularly in slipport

of analysis, institution building and dissemination

points to the need to evaluate the impact c:md utility of CPS products in

speci fic survey settings. This report emphasizes the experience of ECPS 1 in the context of both the CPS Westinghouse contract and the current setting for the second

Egyptian Contraceptive Prevalence Survey.

There was general agreement on problems and opportunities facing contraceptive prevalence study needs in Egypt. The views summarized in this report recognize that the larger structural requisites and aims of the

CPS Westinghouse contract are sometimes at variance with the particular perceived needs for fami Iy planning in Egypt.

There was also general agreement on the competence and skill of both the Egyptian survey staff and th contribution of the Westinghouse staff.

The frequency and extent of fami Iy planning oriented surveys within the last decade provide a graphic summary of survey activity.

Table 1 National Fertility Surveys in Egypt, 1974-1983

Approximate Date Year Name Field Work Commenced

National Fertility Suniey 1974 Not Available

Rural Fertility Survey 1 (RFS 1) 1979 ~/\ay 1979

Egyptian Fertility Survey (World 1979-1980 Late 1979 Ferti Iity Su rvey in Egypt) Contraceptive Prevalence 1980 October 1980 Survey 1 (ECPS 1) Rural Fertility Survey 2 (RFS 2) 1982 April 1982

Contraceptive Prevalence 1983-1984 Spring 1984 Survey 2 (ECPS 2) The following section on speci fic findings emphasizes the experience and constructive suggestions for CPS in the current context of the considerable investment in and expectations for family planning program in Egypt.

( 1 \0

7 Specific Findings

ECPS and its related lineage of companior survevs have provided valuable data on the general population attributes of K-A-P levels for far.1ily planning in Egypt. The difficulty lies in penetrating beyond the gross descriptive leve Is of ferti I ity determi nants.

The efhrt and relative maturity of population programs in Egypt re- quires a r.10vement beyond the current ECPS overview level of the survey content. The CPS survey of 1980 was, at the time of the survey and initial report, highly credible. When viewed from the perspective of 1983, it is dated--a testimony to both maturity of experience and level of collateral popu lation based research.

By all accounts, the questions of today concern the programatic aspects

0; .population service delivery and the dynamics of risk-specific husband-wife fami Iv fo rmation behavior.

The additional data needs are two fold:

- the second layer of va riab les: dynamics and determinants of

fertility - where and when does program interaction impact on fertility

change?

- the val idity and rei iabi Ii ty of the cu rrent cumu lative stock of da ta: the

consistency of trends across sur\:,ey and the inconsistencies that seer.1 to

exist ar.1ong fertility survey, programatic, and demographic data sources.

As one commentator noted, the last national family planning survey in

Egypt, only one year ago (Rural Fertility Survey 2), raised a "whole plate-fuli" of questions relating to communication among husbands and wives and contraceptive decision making. Another interviewer cOI,mented on "vari- ety of d i fficu I ties" of eva I uating the Popu la tion Developmen t Project (now covering 70% of the Egyptian rural population, and having fami Iy planning as one of its major activities), and a thi rd person identified : .ldepth knowledge of distribution and availability of family planning pills and ~ondoms as a first priority.

ECPS was concerned with such questions, but it is purposefully not designed to examine these questions in detail. The range of · activities of family planning and the perceived management and evaluation needs have 90n~ beyond what a general descriptive data oriented survey can provide.

A significant challenge faces ECPS 2: most informants say that another baseline survey, while having some utility, is not what they .feel is needed.

What do they want, and what can ECPS reasonably provide? These questions and responses are summarized below.

Content

,"lore special ization of questionna i re content: translated into the pa rlance of CPS, more emphasis on modules--but the particular emphasis dependent on the person I ~ own pa rticu la r interest. Severa I examples of areas often empha­ sized include I E&C, MCH, and Health Status and Health Services related uti I ization data.

Several persons cited review of content as a need into itsel f, suggesting convenir.g a wider range of family planning personnel to fix on the content priorities.

Prog ram Evaluation and Population Dynamics of Fami Iy Plann i ng

A major concern _was . expressed over the applicabiiity of the content of the survey as it related to specific government programs, such as P. D. P., contraceptive distribution, and private sector role. The general comments would tend to emphasize the need for more of the marke( type survey data

for contraceptive use and the relation to prog rams of del ivery.

ECPS 1 did contain questions that provided generalized evaluation dtaa

for PDP. Analysis of ECPS 1 was stratified on the basis of PDP and non-PDP

villages, and hence specifically addressed this issue. When asked "was this

not responsive to the needs of PO P eva Iuation? ," the answer was yes, but

depth was lacking. It was possible to detect some differences between PDP

and non- PO P vi lIages but it was not poss ib Ie to eval uate reasons for such

differences.

Simi larly, comments were made on tl-,e lack of data on determinants of

popu lation dynamics. For example, interviewing women on Iy was held tc be a

severe I imitation on under~tdnding fami Iy planni ng acceptance. I n this con­

text RFS 2 was cited as the proper direction to take.

Geographic Political Coverage and Detail

The plans to do urban and rural populations in ECPS 2 were considered

a necessity. Although agreeing that the emphasis on rural population was

appropriate. the growing urban areas are in the need of surveying.

The need to provide local estimates, particularly on a governorate level,

was also er.lphasized. This would help assure J larger ir.lpact and use of the

results. [~Jote: the sample anticipated for ECPS 2 will produce statistically

acceptable estimates for the larger governorates, but not the smallest.)

SUI~vey Design

>"- ---\ \ A va riety of techn ica I comments were made on the des ign of EC PS. The comments that follow are closely related to questions on content and coverage that were raised in the previous sections.

Sample Size - Questionnai re Length

Questions were raised concerning the cap. of sample size and questionnai re length. Citing Egyptian capability in field operations and ability to code and edit, observers felt that there would only be a marginal cost in increasing the sample size or questionnaire length. The expedience of the survey would not be sacrificed and much more practical and precise information would be gathered.

Sample size and length of the questionnaire limitations on content and coverage were said to be dictated largely by the sample size limits generally imposed on CPS surv~ys: a maximum of (approximately) 5000 and on length of interview time (15-20 minutes).

In particular, the struggl~ over the degree that the PDP rural programs could be or should be evaluated by ECPS 1 hinged on the sample size.

Initially, a sample size of 10,000 was requested, but Westinghouse felt 5,000 was the maximum, given the limitations and aims of the general CPS program.

Respondents - More emphasis was suggested on male or couples surveys: this would help understand lithe true" dynamics of family planning accept2nce.

Validity studies - response bias has not been examined sufficiently. Esti-

I :ates are held to be suspect in measures of acceptors. Surve~1 experts have pointed out their own desire to undertake such studies. [See later recom- mendations under "further analyses. II J

./ /\\..1 ,,+' • Anal,>,:sis of the Current Stock of CPS and CPS-Related Survey Data for Time

Trends

The considerable accretion of data over the last several years from multiple surveys have led to both questions about survey direction and op­ portunities to examine the total picture of fami Iy planning that is er:lerging.

Time series analysis, and an orderly review of survey results have been strongly suggested. Further surveys, ECPS 2 in particular, must be sensi- tive to such needs.

Professional Staffing

The professional staff assembled to carry out the ECPS Surveys are highly competent. Both discipline knowledge of survey techniques and in experience is admirable.

The problem in Egypt is that there are but a few demographers and survey researchers available. In addition, employment opportunity in Gulf countries and other sites adds to the relative scarcity or depth in these. disciplines. All sources agreed that there is literally only.a "handfull" cf well-trained demographic-survey leadership working in the population-fami Iy planning field.

Three conclusions are warranted:

1. The availability of professional consultJtion and suorort of CPS is

necessary to compl~ment existing t21ent to effectively c;Jrry out CPS

and CPS-like surveys. 2. The support also helps to provide incentives to the professionals

within Egypt through direct stimulation of survey work, strength-

ening programs and professional positions, and provides opportuni-

ties for professionals to oxchange experience and gain recognition

internationally.

3. Training programs collaterally deserve support to increase the pool

of professional at various levels. Demographic methods and infor-

mation and survey work in particular will continue to be a corner-

stone from fami Iy planning prog rams.

While employment opportunities abroad will compete for any newly trained or increased manpower needs, this on Iy underscores the need to strengthen training programs. A regional (;'vliddle-East) view would also argue for in- creased training support.

I nstitution-Bui Iding

Institution building and trained professionals are closely intertwined.

There arE"' several institutional bases that are tapped for help of considered as potentia! sources in CPS surveys. These include (but are not confined to):

-. CAPMAS - The Central Statistical Agency

- Cairo University Demographic Center and the Institute of Statistics

- American University

[!'Jote: Senior persons working on surveys typically hold university posts. J

Processing and analysis of survey data is a further aspect that requires review. One of the main areas of weakness that Westinghouse bClckstoflped is carryins out the analysis phase for the data in Egypt. As is common world-wide, there is a genuine shortage of prograr.lmers. The use of avai lable "user-friendlyll software such as SPSS, SAS, or any number of

derivative processi ng packages can off-set such shortages. However I there

are only a few sites and limited access currently to such canned I standard- i zed packages.

Three conclusions are warranted:

1. Strengthening institutional bases will further complement the pro-

cess of building a cadre of family planning oriented demographic

and survey professionals.

2. Support to increase the availability of analysis - applications pro-

gram software will enhance the ability of Egypt to provide more

direct in-country work on survey results I focused in-depth re-

ports, and dissemination of results.

3. Institution bui Iding would remove one of the chief areas of survey

weakness I while at the same time strengthening the traditional

Middle-East reg iona I role in train ing that Egyptian institutes of hig h

learning have filled.

Further Analysis

w • <

The evaluation team for this current CPS contract have seen an increased need to streng then the II fu rth~r ana Iysi s II acti v ities. However, in doing so the evaluators redefined further analysis to be a focused progr2r.l component which would be targeted toward family program priorities, informa- tion needs, or specific technical issues dealing with accuracy and precision of the CPS survey.

One II fu rther a na I ysi Sll - eon tract wi::h the Popu I ation Re fe renee 8 u r2au is extant to produce an attractive IIfact-book" summary of ECt-=>S 1. Egyptian experience supports the need for sLlch focused further analys- es. The evidence comes from several persectives:

- The 1980 ECPS 1 produced several problems that the investigators felt

they would have liked to pursue and carry out further analyses 0/'1. For

example I they wished to examine re-interview data avai lable to examine

reliability ,of information.

There is some confusion as to what the series of data now available from

ECPS and othe.r related surveys does or does not say about the course

of fami Iy planning in Egypt. This is a source of contention and

concern.

There is a felt need to have in-depth-program related analyses carrying

0U~ the reports one step further I or to examine a specific progran issue

in more detail. It was felt that reports and products of further analysis

would be both timely and practical.

Two conclusions are warranted:

1. Further analysis of ECPS results can focus on practical or technical

questions on data reliability and on in-depth programmatic aspects

related to fami Iy plalming. Investigators fel t di scou raged from

doi ng th i 3, al though speci fic proposa Is were pu t forwa rd. T he data

they feel are under-analyzed. To do so req:Jir!3s nore pre-planning

and arrangements to carry out these analyses.

2. CPS results require further examination and analysis with respect

to the multiple series of other far.1ily planninSJ related surveys

avai labie. Lessons or inferences abcJlJt family planning 0Y'iul'ics in

Eg ypt shou Id be syr. thesi zed. The upcomi ng EC PS 2 ,;vi /I fu rther

.. /.\\ \p focus attention on the need for time-series anulysis and interpreta-

tion of trends in the findings.

o i ssemi nation

The issue of dissemination is of paramount concern, not only as a central aim of the CPS contract, but also as a perceived need by the Egyptian counterparts.

Information dissemination is problematic and consists not only of the dissemination of timely reports but also the understanding and use of data by fami Iy planning administrators and pol icy-makers.

Both are issues that have concerned the "producers" and "users" of

ECPS 1. Both users and producers have emphasized the need to get reports out. ECPS 1 was successful in that effort. A second printing of lhe final report has been requested (Annex contains a copy of the basic mailing list). The problem is not so much in finding the "audience" for such data, but how to get the maximum use out of it. The producers of the data define two stages for dissemination activities:

the preparation of further in-depth reports (discussed in further analy-

sis); and

- post-survey disserllination efforts of publ ished data.

The latter activity has seen the use of ECPS data as part of seminar offerings. These semi na rs were more of the na tu re of afte r thoug h ts u si ng funds remaining in the ECPS 1 budget but proved to be highly successful.

Currently, a IIfurther analysis" contract to produce a summary fa(~t book presentation for ECPS 1 is activ~ (with the Poplllat;cn ReFerence Bureau). Ir, ac .ummaries in Arabic are routinely distributed. Arabic summaries have :1anced the use of EC PS data.

Two conclusions are justified:

1. Workshops and seminars are effective "'lnd well received, and it is

the consensus that preplanning and budgeting for such conferences

and dissemination activities will further enhance the use of CPS

data.

2. There is no systematic evaluation of how data are used beyon:-' the

dissemination or after the dissemination effort. Iv1any persons

pointed out that they felt that data are often more ornamentation

unless its use is reinforced at all levels of family planning delivery

systeM.

Overall Survey Strategy

The premise adopted in this report is that survey data will continue to be an important source of data for Fgypt to monitor and evaluate population change and far:1ily planning.

The report also stressed the relative volume and frequ.ent fami Iy "plan­ ning surveys undertaken in Egypt - albeit with each having appropriately different emphasis, but having a common content core.

iv\any person s contacted ccmmen ted on the desi ra b iii ty of a mast8 r" su rvey plan. Given the size and investment of AID-sponsored prograrr.s, such .3 plan

(at le2st for AID programs) that draws upon CPS data would be effective and rational.

Six recommendations are justified: 1. A master plan covering, say, a 3-5 year period is practical. The

Population and Fami Iy Planning Board (PFPB) in concert with other key

survey / fami Iy planning authorities cou Id eas·t!y devi se and admin i ster

such a plan.

2. Built around a C0re, appropriate questions or indepth topics could be

systematical I,! factored into surveys in a cycle of survey rounds.

3. Such a plan is ·justified on the basis of the current volume of surveys,

and additional cost savings can be realized in analysis, staff, and output

capabilities.

4. More latitude in survey design, sample size, and subsample re-survey

and prospective studies could be planned, fiE~ld tested and carried out.

In depth data on continuity and other critical areas of far.lily planning

impact could be systematically mr:nitored.

5. The master plan can emphasize institutional bui Idin9 and hopefully ame-

liorate current CPS deficits while still preserving and enhancing the

advantages of timely data collection and dissemination of the current

CPS.

6. Any future CPS contract shouid recognize that Egypt is a special situa-

tion, with mission concur;ence. The ECPS program could easi Iy accom-

modate and in fact benefit from the increased informational needs of

family plLlnning in Egypt. MINEX 1: LIST OF D!~'!'~IBT!T!ON OF THE REPOnTS OF TP.'F CO~lTP..ACl:.PT.IVF. ~:.\"ALE!·TCE ~VEY In RUP.AL EG~ 1980 TO TEE CONCERnED AU'THORITIES

1. Dr. Ah,~ed Hassan El rla.... aziny Dean, Sta.tistical Studies & Researches, Cairo University 50, Sarvat Street, Dokki

2. Dr. A~~ed Seif El Na.sr Statistical Studies ~ Researches Institute 5 Sarvat street, Dokki

3. Librar.r of the Statistical Studies ~ Researches Institute El Massaha Street, Dokki

4. Dr. Saad El Shayal Head of Applied Statistics, Statistical Studies & Researches Institute

5. Dr. Ali El Salmy Faculty of Commerce, Cairo Uni' lersi ty

6. Library of Cairo University Cairo UniVE!rsity, Giza 7. Library of F!!culty of Economy & Political Sciences Cairo University, Giza

8. Dr. Nadia Makary Faculty of Economy ~ Political Sciences, Cairo University

9. Dr. Mohamed Abdel Ka.d.er Hate.rn Office of the General Supervisor on S'pec1.alized National Councils Ettehad E:shteraki B1dp;., Cornish El Nil, Cairo

.10. Dr.• Aziza Hu.ssein " Head of Family ·Pl6.nnt'n~ 'Association ,50E.1 GOumhourieh. Street, . Gairo ll. Librar'/ of Social Resenrch Centre at the AmE!rican Un! verst ty 113 Kasr El Ain! Street, Cairo

12. Library of Scientific Research Academy Kasr El Aini Street, Cairo

13. Dr. Tarek Amira Faculty of Economy ~ Political Sciences

14. Dr. Ahr:!.ed Mohamed Ornar Faculty of Economy & Political Sciences

15. Dr. Adel Ezz Head of El Sadat A.cademy for ~~8.n8.p'ement Sciences 16. Library of the ~inistry of Hi~her Education Ministry of Higher Education, Cairo

17. Dr. ?..falek EI Nornross 4 Ahmed Abdel Sala.rn Zaki Street, EI Nouzha, Cairo lS. Dr. ~;ahed Saleh National Centre for Social & Cri~inolo~ical Research Midan Ebn Khaldoun, Embabeh

19 .Dr. Mahmoud Aboul ~rasr Faculty of Commerce, Ain Shams University

20. Dr. Fathy Mohamed Aly Dean Faculty of Commerce, Ain Shams University

21. Library of Economy, Politics, Statistics & Le~islation Association 6 Ramses Street, Cairo

22. Library of the Central Agency for Public ~obilizati.:m & Statistics

23. Library of AI-Ahram El Galaa Street, Cairo

24. Library of the Middle East Nevs Agency EI Sherifein Street, Cairo

25. Arab Deoographers Association 9 Bis Khaled Ibn El Walid Metal Ville, Tunis Republic

26. Library of Geographic Section Fac~'ty of Arts, Cairo University, Giza

27. Library of the British COUI1Cil British Council, El Al101.l~a, Gtza. , .,;" .". . .":. 28. Dr. Saad E1 Din Ibrahim Professor··dt'" Sdciety Science'at 'the American University

29. Dr. Salah Galal Al Ahram Newspaper, EI Galaa Street, Cairo

30 ~ Dr. ~tohamed Abdel Rahman El Badry Director of Demo~raphic Centre, Cairo 2 Lebanon Street, EI Mohandessin, Dokki, Giza

31. Bahira Houkhtar Al Ahram newspaper, EI Ga.laa Street, Cairo ·l 32. Dr. V.a~~oud Abdel Kader National Centre for Social &: Criminological Research ~~dan Ibn Khaldoun, ~babeh, Cairo 33. Library or the American University l American University

34. Li~rary of the Demographic Center at Northern Africa Lebanon Street, Giza

35. Population Studies Centre Central Agency for ~blic ~~obilization &: Statistics

36. Public Association for Family Planning ' Talaat Harb Street, Cairo

37. Training &: Statistical Researches Arab Io.st! tute

38. Library of the National Planning Institute Madinat Nasr, Cairo

39. Dr. Ahmed Ismail Faculty of Arts, Cairo University

40. Library of the Higher Institute for Public Health Gamal Abdel Nasser Nev Avenue, In front of the Faculty of F.n~ineeri~, Alexandria

41. Dr. Abdel Moneim Shavky Head of Social Studies Section Faculty of Arts, Menia University

42. Dr. Mohamed H'.'ssein Dean Higher Institute or Public Health Alexandria University 43. World Health Organizction P.O. Box 517 - Slut an ~bdel Aziz St.~ E1 R~~ Station,Alexandria

, . 44:; . Tanta University· Library .. '... ~ . E1 Gharbia Gover.norate ~ ' . ,,;,. ,

45. ~ i ociety Section Library Faculty of Al~S, Cairo University, Giza

46. American University Research Centre American University

47. Mr. Ismail/;!> Raafat First Undersecretary, Central Ap.,ency ~or Public ~~obilization &: Statistics

48 • Library of the Na.tional Pla..'1ninp: Institute 49. Dr. Farag Sedky Head of' the tlational Centre for Computer for the Public ~obilization ~ Statistics

50. Hr. Zaki Azmy Faculty of Economy & Political Sciences

Mohamed Said General Secretary for Radio & T.V. Union

52. Ms. Nadi.a Halim Head of' the Population Section National Centre for Social & Criminolo~ical Research

53. ~..r. Saad Zaghloul Directc? Centre of Population studies & Researches Central. A(Z,ency for Public Hobilization & Statistics

54. Dr. Nazek Nosseir Social Research Centre American University

55. Dr. Zeinab Soliman Faculty of Economy & Political Sciences

56. Dr. Ibrahim El Essawy Consultant, National Planning Institute

57. Dr. Rakia Solima."1 Faculty fof Economy & Political Sciences

58. Dr. Riad Tabbarah

59. Dr. Mahmoud Khairat Professor, Faculty of Science Ain Shams University 60. ' Mr'. R:i'faa.t Nasr' Abd'el 'Ghani Manpower Ministry .' . . . . ' . , Dr. Na,guib Gheita r~anpover Ministry

Mr. Es~~t Abou El Ela . ,AI-Azhar University

Mr. ?ouc!1cii ~ '~~hr.1oud Hassan "- Institute of Statistical studies & Researches

Dr. ?·1okhless Abdel Ghany Population & Family Planning Board

~~S. Seham Sayed Mahmoud Population ~ Family Planning Board

Mrs. Kavsar E1 Hosseiny Population & Family Planning Board

Mr. Abdel Salam Ahmed Hassan Research National Centre

Mrs. M~~ Mostafa Institute of Statistical Studies & Resear~~es

Dr. Saral... Loza

Mr. Osama Mohye El Dine Population & Family Planning Board

Mr. Nabil Abdel Fattah Population & Family Planning Board

Miss Nahed Mohamed Saadoun Population & Family Planning Board

Dr. Salah Ibra.h~ , . , , ' ", ' Population &: ' P"e..nrllY 'PI'aIming Board

,Dr. Salah Namek

FamilY Plann:L'ng Officesin the Governora.tes

Offices &: Adr.linistration of' the Population & FamilY Pla.nning Eoard (Internal distribution)

'\ \ f' .... 'i I ~'\ l \ \ I " LIST OF DrSTRIRTT'T'ION OF THE REPORTS OF THE CONTRACEPI'IVE PREVAr , E!~CE SU?VEY nr RURAL EGYPr 1980 TO '!'HF. GOVFR~TORS

1. Port-Sa.id El Sayed Sarhan 2. Istr.ai1ia Aqdel Moneim Emara 3. Suez Bekir Mohamed Bekir 4. Red Sea Ali Mohamed Osman 5. Dakahlia M. Tevfik Karara. 6. Sharkia Mohamed Amin Hitnis

7. Gharbia Fikri Abde1 Hamid ~ohamed 8. Menoufia Dr. Hamdy Eakim

9. Kafr E1 Sheikh ~~. Nabil Halawa 10 ... Beheira Labib Mohmmed Zamzsm ll. Damietta M, Esam Radi Abde.1 Hamid Radi

12. Alexandria Leva Falo1zi ~oaz

13. Matrouh ~~ohamed Yousri E:l Shatd 14. Cairo Dr. Youssef Sabri Abou Taleb 15. Giza Dr. Abde1 Hamid Hassan 16. Fay-oum Leva Sarvat AtalLah

17. ' N ,;.~w Valley- Dr. Farouk El Tehvy

18. Beni Suef' Dr. Mahmoud Kame~ E1 Raiss

19. El Menia Salah E1 Din Moh~ed Ibrahim ,, - "' 20~ Assiut· ,', LeVa. 'zliid. Badr" ", "

,·21. Sohag : .' 0. "Ali ,Ibrahim " Ali', ' 22. Kena Abdel Hakim E1 Seidi 23. ASlo1an Lewa 3halo1ki El Me:tiny 24. Kaliubia Omar Abdel Akhar 25. Northern Sinai Mow:dr Chas s

26. Southern Sinai Le~~ Magdi AhmeQ Soliman LIST OF' DISTRIBUTION OF THE REPORT~ OF ·1'HF. CO?TTRACEPTIVE PRF.VAL~TCF. SUP.VFY Dr' RtfPAL EGYP!' 1980 TO THE ME.mERS OF THE CABTITET

1. Foua.d r~ohye El Dine/Prime ~ifinister

2. Kamal Hassan Ali/ Deputy Prime Minister ~ Minister of Forei~ Affairs

3. Mostafa Ka.m9.l Helmy/" " If &: State r~inister for Education {, Educational Research

4. Houchir Mohamed Abdel Ha.lim Abou Gha.zala. / Deputy PriI!le ~Uni ster & ~ini ster ~f De~ence & Military Productio~ 5. Ahmed Ezz El Dine Hela1/ Deputy Prime Minister for Produc.tion & Minister 0:­ Petroleum 6. M:...... Albert Barsoum Salama./ State r-!inister fer l:Jni€Q:'ation & 'E~tians Abroad Affairs

7. Mahmoud Salah El Dine Harned/ Minister of Finance 8 Eng. Hassaballa Mohamed El Kafra6ui/ Minister of Reconstruction & State Ministe: for Eo usinp: & Land Re(:lamation

9. Boutros Boutros Ghali/ State M~nister for Foreign Affairs

. 10. Saad ~~ohemed Ahmed/ Sta.te ~.finister for Labor Force & Traininp: 11. Dr. Amal Abdel Rahim Osman/ Minister of Social Insurances & State Minister for Social Affairs 12. Ahmed Memdouh Attia/Hini3t,er of Justice

13. Soliman Metvalli Soliman/Minister of Transport & Communications ~ Naval Transport 14. Mohamed Abdel Hadi S~aha/ ~inister of Irrigation 15 ' ~M ~. Mohained· .Maher . Aba:za./Minister: 'o'f -Electricity . &: Energy 16. Moha.med..1Ta~ . 9:hat1a I. Ministry of. Supplies & L"lternal Trade . ." .. ~ ...... ' . . " . . .. '. . . . 17. GE!-Dlal E1 Sayed Ibrahim/ 3te.te )~inister ~or 9Iil:'t2.r~~ 'Productior.. 1P • ·'E'.:-.n:ouc1. ?~.shvan '''a..".Moud/ State Minister ~or People Assembly '( Advisory A:'fai::- 19. Moukhtar Hany/ State ~Unister for the " It " 20. Mohamed Abdel Hamid Radwan/State Minister fo~ Culture

21. Dr. r-'!oh8.I:!.ed S~bri Zald/State Minister for .F.ea.lth 22 Adel Mahmoud Abdel Baki/ Minister for , Cabinet Affairs · & State ~in~ster ror Administration Development 23. Moh~edSa~at El Sherif/State Minister ~or ~ess Communication 24. Dr. Kmnal Mohamed E1 Ganzoury/~'inister of I'!.a.nnin~ 25 ~ 'l\fohamed El Ghoroury/ H~. nister of Industry ~ Mineral Resources 26. Hassan SoliMan .A.bou Basha/ Minister of Interio=" 27. Dr. Youssef Amin Wuy/ State ~Jinister for AP-Ticul ture 'c ~Tutri tional Security' 28. Ibra..'1i:m El !)essouki/State ~.,.finister for Awka!'

29. Saad \/aar.oun/ '~inister of Local Ad.--ninist·;-aticn

30. Dr. ~·!e.gih 'Johamed Sha.ndy/~inister for Investnent '= International Cooneratior: Affairs

31. Dr. ~.rostafa Kamel El Sa id/~·finister of FconoMY ~ Fxternal COI!'.merce 32. Tewfik Abdou Ismail/Minister for TouriSM & Civil Aviation LIST OF DISTRIEtJ"":'IO!r OF THE REPOR'!'S OF THE CO~CEPTTVE ~EV ALE'rCE SURVEY I~T RURAL EG~ 1980 TO THE ~.fE'·mERS OF THE SUPRBAE COm'iC IL P'OR FArUL Y PLftJT!UNG

1. Dr. r..fohamed Sa.bri Zaki / State Minister for Eee,l th ?r. Chai~an of the Supreme Council. for ?opulation & Family Planning

2. Dr. Hostafa Kamal Hel..~y / Deputy Prime rKinister &: M:inister of Education &: Scientific Research 3. Saad Moha.I'!1ed Ahmed / State Hinister for Labor Fc!'ce &. TraininEZ' 4. Dr. Kamal Ahmed El Ganzoury / Minister of Pl~lnin~ 5. E1 Sheikh Ibrahim E1 Dessouki Marei / State Ministe? for Awkaf 6. Dr. Youssef' Amin Waly / State Hinister for Agri.cul ture & Nutritional Security 7. Dr. Arnal Abdel Rehim Osman / Minister for Insurances & Social Affairs 8. Mohamed Safvat E1 Sherif / State ~~illister for Mass Communication 9. Saad Maamoun I ~inister for Local Administration

10. Adel ~ahmoud Abdel Baki / State Ministe~ for Cabinet & Adw~nistration Develo~rnent Affairs 11. Dr. Avad Mo~~htar Halluda I Head o~ the Central A~ency for Public Mobilization " Statistics 12. Abdel Ahad Gamal E1 Dine / Head of the Supreme Council for Youth & Sports

13. Dr. Mamdouh El Belta~i / Head of the Public Information Organazltion 14. Dr. Ahmed El Benhaoui / Dean of Ain Shams Faculty of ~edicine 15. Dr. Maher !·fahran / Head of Gynecology & Obstetrics Section , Faculty of ~.fedicine, Ain Shams Un! vers! ty ,16. Mr. 'Aziz Hussein )Hea.d of. F~ly Planning" Association

17 0 • Dr •. Farkhanda.. F...a.ssan I H~mber: " , ~eople.' ,s, Assembly LrS'T OF PARTICIPA!~S TO ALFXA~m~IA S~' ~INAR "Er';YPr POPULA'!'IOr,r - FACTS/POLICI~S"

Thrahi1:l ~~ohamed Youssef E1 Far Director. Economic Research Administration, ~fi'nistry of Economy & Fxternal COT!'lnerce

Ahmed Ibrahim Abdel Hamid General 1·tana,g'er of Plannin~, Minis'cryofof APTiculture

Ahmed Labib Abou El Seoud Undersecretar.r Ministry of Awka~

Dr. El Mootaz Billah Osman First lli~dersecretary Mobara.k Min:tstry of Health

Dr. Helene Kelly Expert

Dr., George Broadford Sims Expert

Dr. James Christopher Expert

Hamed ~ohamed Soliman General ~1anager o'f Plannins:z: & Follow-Up, Ministry of Education

Hosam El Dine Hassan General Hanap:er ot' General Ins'Pection & E1 Badry Supervisor of Plannin~, Awkaf ~1inistry

Hosny Mohrumed El Hatiby Undersecretary 1,unistry of Local. Administration

Dr. Helmy Mahmoud El­ General Mana~er o~ Planning BaramaWy' , .. ' M1n1stry- "o'f Health'

Undersecretary &" Head Po'pulation Studies ,~ Researches Centre, CAP!..fAS

Soliman Khaled Soliman Member of Technit:al Office for the Minister of Social Affairs

Samiha Hamdy Undersecretary &5ead o~ Pecruit Section at the·S~prerne Council f~r Youth & Sports

Dr. Samir Mohamed Farid Expert at the International Institute for Statistics~ London

Abdel Raouf ?.fohamed Agouz General ~9.na~er o-r Planninp: at 1tfanpo...,er !;fi:li st~:r

Abdel Raouf ~ohamed Farag First undersecretary Ministry of ?lann!n~ ------~~~~------=--~ Dr. Abdel ~fef.Uid ~1ostafa Far!'e.p: Vice Dean , Faculty of CCT!ur.erce p, Po1i tical Sciences at Cairo University

Abdel r-foneim Abdel Me~id Sabet Director of Plannin~ at Radio & T.V. Union

Attiat ~ohamed Abdallah Director o"!: Society & Labor Care & ~es'Ponsible ~or Population ?, Family Planning at ~Ii!'listry of ~' fe.npc ·"' · & Traininp: Ali ~~oha.med Ali Yehia General Manager of Plannin~, Ministry of Local. Admi r.:. istration

M. Magued Mostafa El ~haabiny General rAanager of' Planning, Construct::i.OIl ?e DE:'velopment of ?ural EPo'Y'!'t Or~ani za· tion r.foh8liled Ahmed Hashem Attia Assistant General Secretary of the Ca~inet

Mohamed El Sayed ?·1ohamed Gammal I_rector, Population Education Administration, Ministry of Educ~tion and Occupational Training

Mohamed Amin Ali Ismail Director of Planning & Follow-Up, Center of' I.E.C.~ General Organization for Information Mohamed Adel Abdel Azim Director of Plannin~, Ministry of Transportation

Hoha.med Abdel Moneim Masrour First undersecretary, Ministry of Econ~J

Mohamed Mohar.'led Khalil E1 Nemr First undersecretary, Ministry of Emi~tion Affairs

Dr. Mohamed ?1ezam El Dine Expert, Central A~ency for Public Mobilization & Statistics

Mar~oud Salah El Dine .El Director uf Researches, Daa'.rashy General Or~anization for Construction Flannin~, Ministry of Reconstruction . Dr .Yehfa. Abdel' Me(nlia . . tJridersecretary ' -ro~ '!:co'nornical' Affairs, Mohye ElDine . . ~n~.stry of Arn-i,eulture " . . -. ' - ' .. .: ;. " Dr. j·:ohamed Nab!l Ezzat Faculty of Economy and Political Sciences, El Khorazaty Cairo University

Dr. Aziz El B1ndarl Chairman , Population & ~amily Plannin~ Board

Ahmed El Ayyatt Director of Stat~stics, PFPB

Ahmed Mohamed Hacdy General ~~ana~er., Financial ~ Administrative Affairs, PFPB Dr. Hussein Abdel Aziz Helmy Super/isor of Pl~~nin~, Faculty of Econor.y, Cairo University Dr. Abdel Gha.:'lY ~-iohBJr.ed Director of Planning, PFPB

Moursi Hussein ?~oursi Director of' Chainr.an Office, PFPB

~-1ostafa Mohruned ~~ohe..med El Sayeci Director of Researches, PFPB

Sa'ori Saad Saad Director, Alexandria Office of Population & Family Plannin~ I L. Smith Jr. Ph.D. I [ Project Direc~ W. Duncan Ph.D. M.A. Abeyta-Behnke, M.Ph. Senior Technical Adv. Project Advisor and Finance/Subco~tracts Country Honitor J. Regan M.A. Gary Lewis M.A. Research Assistant Director Technical Publications Operations

J., Cushing B. S ~ Programmer Kumar,M.A., M.S. Ann Way Ph.D. A. Aliaga Ph.D. Sampling s. Senior Technical Advisor C,)Qrdinator for Asia M. Weymouth Res, Asst. I.frica and Neareast Data Processing Coordinator for Latin America and Caribbean

Anne Cross M.A. J, Novak Ph.D. Counlf'! !Ionitor Country Monitor Ann Evans Sc.D. M. Lioy Ph.D. Country Honi tor Country Monitor H. Ayad Ph.D. N.K. Nair Sc.D. Country Bonitor Country Moni tOi-

CPS I I PIWJ ECT OI<.CANJ ZATI ON CONTRACEPTIVEPREVALENCE STUDIES 11 PROJECT As.",

~TATUSSUMMARY REPORT

<,COUNTRY IMPLEMENTING SAMPLE SAMPLE FIELDWORK STATUSAS OF EXPECTED AODITIOHI.l , ' ORGANlZATI ON SIZE 'POPULATION DATES COHPlETlOI QUESTIONS/REH~KS 5/31/83 "DATE

ASIA

Indonesia Faculty of Public Hea1tl~ Cur~ently 10;000* married 6/83 to Prestest completed. 6/30/84 Five separate urban ' surveys t o be University of Indonesia and' women, l'i-49 years 1/83 used aa an evaluaUontoal fo r" new ' INSEARCfI of .age urban delivery scheme. Nepal Family Planning/Maternal .. Ever married wo~en 2/81 to ~inalreport com- Survey done in tllree major la Q- 5,410 ~ompleted & Child Health Project 15~49year~ of age 4/81 pleted guage groups. A separate four , ' district: survey has also been , carried out.

Pakistan Population Devel _\'lment E,,~ t:'ri~.i 5.000* women 3/83 to Pre_ aUns in 9/30/84*1 National oample to oeDlodif1e d Center 15-t;:J yean of age 4/83 progress to allow evaluation of World Bank and UNFPA Project areas. "

Sri Lanka Ministry of Plan Implemen- Eve~married women 1/82 to Report subDiitted te 10/31/82 Survey done in two languages: tation of the D~mocratic 5.881 15-49 years Qt age 2/82 printer Sinhalese ~ndT8Dlil. Socialist Rept;blic of Sri Lanka (Dept. of Census and Statistica) . :

Thailand National Institu t e of " Ever Dwrried women 7.018 3/81 to troject completed Completed Community Characteristica 50d ule Devel0pulent Administration 15-49 years age ,', of 6/81 .. .

..:

'il Expected number of woulen who will ~~ interviewed iI* End of Westinghouse invo vement , WESTINGHOUSEHEALTHSYSTEMS

CO~TRAtEPTlVEPREVALENCESTUDIES II PROJECT

',,: MIDDLE EAST AND SUBSAHARAN AFRICA STATUSSUMMARY REPORT

COUNTRY IMPLEMENTING SAMPLE SAMPLE FIELDWORK STATUSAS OF EXPECTED ADDITIONAL ORGANEZATION SIZE POPULATION DATES COHPLETIOI QUESTIONS/REMARK$ S/ll/83 DATE -. I '/ fUddle East

Egypt ropulation & Fa~ily 5,lll Ever married women 10/SO to Final Report com- 9/30/82 Rural 8ufVey only Planning Board .5-49 years of age 12/80 pleted

, " Lebanon Lebanon Family Planning 3.000* Ever married women 3/83 to Field work in prog- 10/31/83 Regional survey -to ~e conduct ed A88ociation ~5-49years of age 4/83 re~8Jr. the Nortb in areas ",here LFPA is tmpl~- !; menUns a household dbtdbut ion program

Morocco Ministry of Public Health 3,062 Ever, ~rried women 11/81 to Final report com- Regional survey providing bas Completed e- 15-4~years of 8ge 1/82 pie ted line data for thr~epr.ovlnces where Ministry of Public Heal th . hall KeH Integrated lOervtc8S

Tunisia Office National du Planning 3.000* Evei'~arrtedwo~en 5/83 to neld ~or~in 12/31/83 National lev~lsurvey iQcludi ng Familia! et de Ie 15-109 'years of age 8/83 progress spec!.al aeries of que5tfon~0 D Population utilization of private 8ector sources for contraceptive 6er vices aha ran Africa ,-', Questionnaire trans- 9/lG/~4 Kenya Central Bureau of 6,400 All ~omen15-49 H/83 to lated. Work temporarl] NationaJ level survey to prov ide Statistics IY , yean of age 2/84 halted due to contracl regional prevalence estimates froblemso Somalia Ministry of Health 4,250* Ever' married women 6/83 to 'leld \lork in 6/30/84 Regional survey provldigg pr~va- 15-49 years of age 8/83 ptoareS8 lence for t~veurban areas

Zaire Institut National de la 5,000* , All women 13-49 9/82 to 12/31/83 Regional survey conducted tn Stat~st1que yealCB of age 2/83 progress , four urban centers and a:vo ru ral areas. Include questiopson abortion and frequency of tIl ness.

* Expected number of women ho \,Iill be interviewed. Wt~11NtiliUlT.:>t < nuu: III ~T.l,,·a:ro-

tw.·. .··.· ·.,.·· CONTRACEPTIVEPREVALENCE STUDIES II PROJECT\!::!Y . CARIBBEANICENTRAL AND SOUTH AMERICA STATUS SUMMARYREPORT PAGE1 Of 2 .. COUNTRY IMPLEMENTING SAMPLE SAMPLE fiELDWORK STATUSAS Of EXPECTED ADDITIONAL ORGANIZATION SIZE POPULATION DATES 5/31/83 COHPlETlOI QUESTlONS/RotARKS DATE

CARIB8EAN

Barbados 1 Barbados Family flanning 1,463 All women lS~49years 10/80 to 11nd report co,.pleted Completed Questions on exposure tofam! ] AS50ciation ot age 2/81 planning infortQatton (Iladio/Tl

Barbadod 2 H&MS Consultants 1.500~ All men 15-49 yearq 9/82 to Data processing tn Some attitude qu~ations (Systems Inc.) of age 2/8] progress 3/11/84

H&HS Dominica Consultants 1.000~. All men 15-49 years 9/82 to Data processing in 12/31/81 Conducted in conjuQcUon with (Systems. Inc •• Barbados) ,'. ~f age 1/83 progress Barbados 2 .

Dominican Rep. Consejo Nacional de 4.800*. All. woolen 15-49 years ]/8] to Field wcrk in 2/29/84 Bresatteedlng module y Poblacion Pamilia ~f age 5/8] progress CONAPO~AProgr~m Vsriables Teenage Attitu4es Hodule lIat t1 Division d'ilygiene 4.50"~ ~11women 15-49 years 4/83 to Field work in 1/31/84 Questions on breastf~ad.ng; FamUiale 9f age 1/83 progress modules on maternal ~ealth. abortion and child health Jamaica National Family Planning Women 15-49 years of 7/8] to Questionnaire desig n in progress 1/84 Additional questions to be 80ard age 9/83 decided

M&HS St. Kitts-Nevis Consultants All Olen 15-49 years 9/82 to Data proceq~tn8in 6/30/84 Conducted in conjunction with (Systems Inc., Barbados) of age' 1/8] progress Barbados 2

CENTIlAl. AMERICA

Costa Rica 2 Asoclacl;n Demogr:fica 4.580 Women 15-49 years of 1/80 to Final report completed Completed Wo~n never pregnant were not COdtarricense age ]/81 asked all questionsi Co~unit "odule I

Uonduras Hlnlsterio de Salud Publica· 3.594 All women ~.· -49 years 4/81 to Final report being 8reas t feeding Dlodule i IEIloC 6/15/8] y Astst~nctaSocial. Asoci- of age 6/81 published modale; Vacctnatlor. History acton lIondurena de Plantft- Module cacion de FamUia. Dln~c- clOIl de Estadlatica y CentiO::;

I , Nicaragua A::iOclac1on Demografica All wonten 15-49 years 7/81 to nata processing in 12/31/8] Abortion Ulodule Nlearaglicn~e of ag~ 9/81 progress t!ethod fa:llUl·~ and ~tdeeffe1

*ExpcClcd number of fndtvJd. als who wi ) be in t erviewed. WESTINGHOUSEUEAlTIlSYSTEMS

CON1RACEPTIVEPREVALENCE STUDIES II PROJECT CAlli BBEAN, CENTRAL AND SOUHI AMERI CA STATUSSUMMARY REPORT PAr.F 'J. 01= ? COUNTRY IMPLEMENTING SAMPLE SAMPLE fIELDWORK ORGANIZATION STATUSAS Of EXPECTED ADDITIONAL SIZE POPULATION OATES 5/31/63 COHPlEHOI QUESTIONS/REHARKS DATE iOUTII AMERICA

loliva Sociedad Boliviana de 4,500* ~vermarried women 4/83 Field wor"- in progresB 12/ll/81 ChUd Health Module RcproducciO'n Ilumana tged 15-4~years of -. j.tge lrazll Piau! State Soc1edad Civil Bem-Estar 4,620* .': ~11women 15-44 year~7/82 to Data processing unde r- FaIR!l iar no Brasil (BEHFAM) 1/ll/83 Breastfeeding module, CBD pf sge 9/82 way module, pt"egnancy hlatory Amazonas State Sociedad Civil Bem-Estar 3.000* __ ~U women 15-44 yeus 8/82 to Data processblg unde r- 5/10/83 Breastfeedlng module, CBD Familiar no Brasil (BEHFAM) pl age 10/82 wa"j -- - module, pregnancy history l:olombla 2 ._ Corporac1o'n Centro Regional 3,462 ­ ~1lwomen 15-49 years 10/80 to Final report complet ed Completed HCH Module; 1I0usehoid Survey; de Poblac1~n p( age , 12/80 Country report 1n English only Ecuador -. iHillisterio de Salud Publica 4 SOO:!: jill women 15-49 yens 9/82 to Data processing in Patterns of lac~atipn ti, age 12/31/83 3/83 1n progress Level of use of Hell services Pen~ InsUtoto Nadonal de Esta-I.:." .. 1\11 women 15-49 years 8/81 to Final report !completed Hedical attention before & for ~'stica;Hinisterio de Salud pf age 12/81 pregnancy termlnat'oQ.Hortalft) questions; published report wi} be available in mid-February.

* Expec t ed nUDlher of indiv1 uals wtlO 101 11 be interviewed.

I~ I - -r")'

L_ ____.______""""1WPENIJIX i~ PUBUCATIOOSTATUS REPORT 1

• lPllATE CmRENllY PUBlISHIOO ~!SJED CYATlIC , ~1flI HAILE DATE PUBlI CAl ION IIYIIU 1r:Jt "Xi'ILI( nltr'i hAlF

611/8) tlonduus Final Report Country/Hovlik Novak flnsl Edit & Ty~ln8 Novak July 198) Westinghouse

-, Hovak First draft written Novsk AUlust 1981 Westinghouse 6/H81 lIondurllll Su_ary Report Novak "

6/1/81 Egypt SUlIIIII4ry Way , Ws)' "dUen, ready for Hor.an June 1981 Westinghouse type-sell:

, ,

Westinghouse 6/1/81 Bangladesh Summary Hemry ft.~yira 11h'lsi lI"~wiHe ii~nry June 1981

6/1/83 COlta ldcs Su~ary KUIlllSlIr/Wardllaw IXUl'lIellI" IUnal lI"eW1rHe l!loaenbelI"g June US] WeeUnghouse stege

, '

6/1/81 Colombia Summary . HenD'"),' Hovsl!!. ~eedy for type-set Eiolilenbell'! June 1983 Well'tlnghouee

6/1/8) l4Q!pal Summary lienry/rI.vana Evana !FirSIt drah re- Syetem-6 Juny 1981 Westllnghouae wlrAitlten

6/1/81 Nepal 4-Diaulct Reports Henry Evans Morndng on HnllIl !lenry .Bune 1981 Weet£nghouee ,- rewrrhe

( .....,......

-.....~ . ...--:... ---~~

Ueetlnghouse 6/I/B) Nepal Hila I Hl!l,ort (:lIlDncr;y/'i.v;JIlIJ [vans 6'IIM hUu~d - Hay 18, 19S1 CPS 2 PUBlICJ\TlOO STATUSREPORT

; ~ lJPn\TE ClIlRENTlY Plft..ISlm pt_I!~Ustfll nt\TE PUBLICA1100 WlITER mNl1m ctmOO SlAWS I-DlDltii hUE BY f'l'11Ei

6/1/8] Peru tinal Report (Spanlah) Country [(uDlar Printing Prln!te<. Hov. 1982 Country

. 6/1/8] Morocco final Report (French) Country!AYfllcll Ayacll PlI'!ntAng Printer June 198] Country

~

: Peru SUlIDary Kl.lllilar o ·

I:.

Thailand Suanary l!.G:wfie

'. 6/1/8] Sri Lanks r 1n=ft Report Countrry !Evans Countll'!! lrevAcew Country August A981 Westlngbouse . . of Unal duU .' . .. 6/./8] Sri tanka SUmlIIsrry IEvaDe

:

6/1/81 Aides Cc:.ference We8ltiri~houaeWay !FAnsi "dUng anell Roeenbelr$ June 19iB Westinghouse I'!'oceed!nge eclh • ..

6/I/B) Barbados final Report Nla ir Nah fubD laDled - Apdl 19B} Westinghouse X

6/1/81 Egypt Final Report Country/Way Way pub l nsheJ - ApI'! ~ 1983 Westinghouse )<

('~

.-~,....;~ _ _ _ J ...._- ,.---..._ ------_ ... PVDlICATlOO STAlUS RErooT - - - , UPDATE CUlRENTLY PUBLISM'i PUBlJSIED DATE PUBUCATIOO WlITER I-lJNnm ctIlRENT STArus lVlDING DATE BY MAIlED : 6/1/B3 NicarBsua final Report Country Kumar Drafted but no final Country Country or reviewed version

, .

..'

6/1/83 Horocco SUlIIIIIsry Ay,uB Westinghouse

...... ' 6/1/83 Barbad08 Summary Nah Ftnt draft written aOlsenbel'B June 1961 Westinghouse

6/1/83 i'Elper "Indirect iEstilllSitOI!' of Duration of Post~artu.

Anlello!!'Irhes" J. Knodel ~ewhi F~naa~ed~ftl!'e t draft Q.ewl1s Lewhl ,

6/1/83 "The CPSI Content snd Statue" Lewh n.ewfis Submitted £nd acc~pted Pop. index July !91B Pop. Index

,APLIC 6/1/83 "The CPS Project" . l.ewRe 'tJ.ewh ~ol!'kAn8on final drs f t ArLIC 198J n'roceecUns

6/1/83 Comparison of wrs & CPS J.CleUsnd Lew AIII FArret cIIuh bellnR put Cl eland wrs ( uIIUt l ed) J.Ant.ielreo together I.e",ae

6/1/83 "Recent Research on the AvaUa- R. CtlJrue- Novak Submlt. te d f or revaew St udiAea hn Studies in •••

bHhy o~ F.P. Meth ods in n tus 6. ~·am4ay PR8~- Develop8ng Countriea" Novak n l ng

, ...~

:'~ !""-l"-., ,.,-,..-<,,- ,.,.~ FURTHER ANALYSIS

COHPLETEDSUllCONTHACTS

Author(s) Title Comments

Luis Rosero Bixby Perspective Study of the Women Interviewed in Funded by Westinghouse; both Cont~aceptivePrevalence Surveys in published Costa Rica

Jose Gar~iaNunez & Estim~~ionof Subnational Contraceptive Prevalence Funded by Westinghouse. Felipe Garcia Espania Rates; An Application of Synthetic Estimation to published the Mexican Contraceptive Prevalence Survey 1919 (in Spanish)

Mary M. Kent The Ef·fects of Contraceptive Method Mix on Funded by Westinghouse; Fertility ' Under revision , .

Emily Moore Summary of Analytical Findings - Contraceptive Funded ~y Westinghouse; Knowledge~Availability and Use i n Latin America Under revision

..'

Chai Bin Park» nee Soon Factor~A~fecting 'ContraceptiveUse among High Funded by Westinghouse; Hahm Lee and Nam Risk Women in Korea Under r~vision Hoon Cho

Joseph Potter An F.vctluation of the Fertility Data Collected! in Funded! by Westinghouse; the Me.~icanContraceptive P:'evalence Survey D 1979 To be c~mplE:ted

Luis Rosero Bixby Availq~ilityof Services and Use of Contraceptives Funded by Westinghouse; in Rural Costa Rica To be completed

INCOMPLETESUBCONTRACTS

Luis H. Ochoa Sociodemographic Determinants of Contraceptive Use Withdrawn

Peerasit Karnnuansilpa. The Influence of Contraceptive Availability and Withdrawn Apichart Chamrathri­ Community Level Development on Contraceptive Preva­ thirong, John Knodel lence .~ndFertility

OTIIER ANALYSES

A. Way, M. Ayad, and Experiments in the Delivery of Family Planning Reprint Series E. Maguire Servicestn Rural Tunisia: A Case Study 1981

L _ __ .______.._ .____ .. _,_,_ ___ _ ..___ __ . __ ___ ..___ ,__ .. ...__ .,... .." .""".___ .., _ ..__ "... . _. ______...... , _... _,.______._._ .._._ . _ _.. " .____ .___ _ .._ _ __ .__ ._ ...._ .._ __ Author(s) Title Conunents

T. 'Wardlaw» A. Way and Comparison of Results of Contraceptive Prevalence Reprint Series L. Smith SurveXl? in' Six Countires with Particular Emphasis on Kno~1edge,Use and Availability 1981 .. .. C. Lewis and J. Novak An Approach to the Measurement of Availability of Family Planning Services 1981

.. II A. Khalifa & A. Way Evaluation of the Impact of the Population Develop­

ment Pr'ogr~mBased on Data from the 1980 Contra­ ceptiv~Pf~valence Survey 1981

II N. K. Nair, L. Smith F~ctor~As~ociatedwith Contraceptive Use in and C. Lewis Costa Rica' 1982 .. A. Way and T. Wardlaw Compar2tiv~Data from Contrace~tivePrevalence " Surveys: Knowledge p Use. and Availability of Family Planning in Eight Countires, 1982 .. R. Cornelius and John Recent , Research on the Availability of Family .. Novak Planniqg Methorls in Developing Countries

INDErENDENT STUDIES

Aeturo G. Garcia Castro Some Non-S~mplingErrors in Hexican Contraceptive and Jose Garcia Nunez Prevalence' Survey 1979 (in Spanish)

Aurora Rabago and Continued ~se of Contraceptive in Mexico during Ricardo Aparcid 1974-79

Juan Felipe Garcia Some Effects of Development on the Child Mortality Espania and Octavio in Hexico (in Spanish) Hajarro Davilla

Dorothy L. Nortman Measuring the Unmet Need for Contraception to Space Westinghouse collaborated and Limit Births in the study

PAPERS UNDER PREPARATION

J. Knodel and G. Lewis. Indirect Estimation of the Duration of Postpartum Amenorrhea Sushil Kumar and Gary Lewis, Unmet Need for Spacing in Latin America Sushil Kumat. Desired and Undesired Fertility in Peru Gary Lewis and Alfredo Aliaga~Synthetic Estimation of the District-Level Contraceptive Prevalence Rates in Sri tanka