Sida Evaluation 06/55:1 Reaching Poor People with Services in Sexual and Reproductive Health: An Evaluation of the IPPF Volume 2: Country Reports from Bangladesh, Uganda and Ethiopia Kim Forss Marilyn Lauglo Anna Nilsdotter Department for Democracy and Social Development Reaching Poor People with Services in Sexual and Reproductive Health: An Evaluation of the IPPF Volume 2: Country Reports from Bangladesh, Uganda and Ethiopia Kim Forss Marilyn Lauglo Anna Nilsdotter Sida Evaluation 06/55:1 Department for Democracy and Social Development This report is part of Sida Evaluations, a series comprising evaluations of Swedish development assistance. Sida’s other series concerned with evaluations, Sida Studies in Evaluation, concerns methodologically oriented studies commissioned by Sida. Both series are administered by the Department for Evaluation and Internal Audit, an independent department reporting directly to Sida’s Board of Directors. This publication can be downloaded/ordered from: http://www.sida.se/publications Authors: Kim Forss, Marilyn Lauglo, Anna Nilsdotter. The views and interpretations expressed in this report are the authors’ and do not necessarily refl ect those of the Swedish International Development Cooperation Agency, Sida. Sida Evaluation 06/55:1 Commissioned by Sida, Department for Democracy and Social Development Copyright: Sida and the authors Registration No.: 2005-005718 Date of Final Report: November 2006 Printed by Edita Communication AB, 2006 Art. no. Sida32385en ISBN 91-586-8248-1 ISSN 1401— 0402 SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION AGENCY Address: SE-105 25 Stockholm, Sweden. Offi ce: Valhallavägen 199, Stockholm Telephone: +46 (0)8-698 50 00. Telefax: +46 (0)8-20 88 64 E-mail: [email protected]. Homepage: http://www.sida.se Table of content Bangladesh Acknowledgement ..........................................................................................................5 Guide to the Reader .............................................................................................................................6 Executive Summary .............................................................................................................................7 1. Introduction ...................................................................................................................................10 Background to the Evaluation .........................................................................................................10 Purpose and Key Questions .............................................................................................................10 Methods ...........................................................................................................................................11 Limitations .......................................................................................................................................12 A Guide to the Reader .....................................................................................................................13 2. Sexual and Reproductive Health in Bangladesh ..................................................................14 Background .....................................................................................................................................14 Family Planning ...............................................................................................................................14 Maternal Health ..............................................................................................................................16 HIV/AIDS and STIs Issues ...........................................................................................................17 Concluding Remarks .......................................................................................................................18 3. The Family Planning Association of Bangladesh ....................................................................18 Origins and Evolution ......................................................................................................................18 Policies and Strategies ......................................................................................................................20 Governance and the Volunteer Boards ............................................................................................22 Human Resources ............................................................................................................................23 Image and Reputation .....................................................................................................................24 Concluding Remarks .......................................................................................................................24 4. The Advocacy of FPAB ...............................................................................................................25 Introduction .....................................................................................................................................25 Defi ning Advocacy ..........................................................................................................................26 Perception Versus Reality ...............................................................................................................26 Impact at the District/Community Level .......................................................................................27 Impact on the Policy Environment: Creating an Enabling Environment ......................................29 Informing National Policy ...............................................................................................................30 Systems to Monitor and Evaluate Advocacy Initiatives. .................................................................31 Concluding Remarks ......................................................................................................................31 5. Effectiveness and Relevance ....................................................................................................32 Assessing Effectiveness .....................................................................................................................32 Clinical Services ...............................................................................................................................32 Domiciliary Services ........................................................................................................................34 Traditional Birth Attendants’ Training ............................................................................................34 Non-clinical Community Based Activities .......................................................................................35 Vulnerable Groups ...........................................................................................................................35 Assessing Relevance .........................................................................................................................36 Partner to the Government Services ................................................................................................36 The Provision of Primary Health Care ...........................................................................................36 Domiciliary Services ........................................................................................................................37 Working with Vulnerable Groups ....................................................................................................38 Concluding Remarks .......................................................................................................................38 6. Reaching the Poor .......................................................................................................................39 Poverty in Bangladesh ......................................................................................................................39 Are FPAB Services Reaching Poor People? .....................................................................................39 The Branch Clinics ..........................................................................................................................40 Satellite Clinics .................................................................................................................................41 Non-clinical Services ........................................................................................................................41 Does FPAB reach extremely poor people and particularly vulnerable groups ...............................42 Concluding Remarks .......................................................................................................................43 7. Conclusions and Observations .................................................................................................44 References ...........................................................................................................................................48 Appendix 1. List of Persons Met During the Evaluation ............................................................49 Uganda Acknowledgements .............................................................................................................52 List of Acronyms .................................................................................................................................53