FINAL REPORT MOROCCO PHASE V FAMILY PLANNING AND MATERNAL AND CHILD HEALTH PROJECT USAlD Contract No. 608-C-94-00006 Submitted: June 18, 2001 To the: Ministry of Health and USAID/Morocco Maroc ii FINALREPORT OF THE MOROCCOPHASE V FAMILYPLANNING AND MATERNALAND CHILDHEALTH PROJECT FOREWORDAND ACKNOWLEDGEMENTS This final report, submitted to the Ministry of Health and USAID/Morocco, describes the achievements of and lessons learned from the Family Planning and Maternal Child Health (FP/MCH) Phase V Project in Morocco, implemented between 1994 and 2000 under a bilateral agreemenf befween the Moroccan Ministry of Health and USAID, and with the technical assistance of John Snow, lnc. (JSI) as institutional contractor. For further defails, the reader is referred to other project documents, of which an exhaustive bibliography is provided in Annex 2. The drafting of the final report of the FPIMCH Phase V Project, as well as the project itself, are the result of a team effort. It is in this sense therefore that the use of the word "we" in this report should be understood. First of all, I should like to thank, on behalf of the JSI team, my colleagues of the Ministry of Health (MOH) who gave body and soul to the Prpjed and, especially, Dr. Mostafa Tyane, Director of Population, who was the Project coordinator. I should also like to thank the USAlD team, under the direction of Michele Moloney-Kitts and Susan Wright, who provided technical, administrative and moral support throughout the project. Lastly, neither the implementation of the FPIMCH Phase V Project nor the drafting of this document could have been possible without the commitment and enthusiasm of the JSI team and the sub-contractors, of whom I am only the representative. Annex 4 provides a list of the main collaborators. For the editing and formatting of this document, I wish to thank Taoufik Bakkali, Nawal Birdaha and Boutaina El Omari in Rabat, and Stacey Harrison and Emily Alfeld in Boston. Boston, November 13, 2000 Theo Lippeveld JSI Chief of Party of the FP/MCH phase V Project John Snow, Inc. 3 Contract No. 608-C-00-94-00006 FINAL REPORTOF THE MOROCCOPHASE V FAMILYPLANNING AND MATERNALAND CHILD HEALTHPROJECT Table of Contents ACRONYMS ..............................................................................................................6 INTRODUCTION ........................................................................................................ 8 Indicators of the FPIMCH Phase V Project................................................................................. 9 Institutional Contractors and Cooperating Agencies of the Project .......................................... 10 Structure and Contents of the FPlMCH Phase Project Final Report ..................................... 10 RESULTS OF THE FPIMCH PHASE V PROJECT ................................................. 13 lntermediate Result I: Greater Access to Quality FPIMCH Services Responsive to Client Demand ....................................................................................................................................13 A . Geographical Extension of FPIMCH Services ................................................................ 13 B. Family Planning ..................................................................................................................15 C. Maternal Health.................... .. .........................................................................................26 D. Child Health ....................... ...............................................................................................33 lntermediate Result II: Improved Policy Environment Supporting Expansion of FPIMCH Services ................................................................................................................................... 42 A . Information and Analysis ................................................................................................ 42 B. Contraceptive Financing Phase-Over ............................................................................... 43 C . Advocacy Tools and Interventions.................................................................................... 45 lntermediate Result Ill: Reinforced Capacity to Manage FPIMCH Services with Particular Emphasis on Decentralized Approaches Responsive to Client Demand .........................51 A . Decentralized Management at Regional Level ....................................................................52 B. Information. Education and Communication ......... .. ........................................................57 C. Integrated Quality Management in Morocco ........................................................................62 D. Pre-service Training and In-service Training .......................................................................68 . E. Contraceptive Log~st~cs..................................................................................................... 79 F . Evaluation ...................... ...............................................................................................82 G . Health Information System .................................................................................................. 85 lntermediate Result IV: Increased Diversification of the Resource Base Supporting the Delivery of FPIMCH Services .......................................................................................... 94 A . Private Sector General Practitioners ...................... .... ...........................................94 B. Contraceptive Social Marketing ...........................................................................................99 RESOURCE MANAGEMENT OF THE FPlMCH PHASE V PROJECT................. 111 1. Planning, Follow-up and Evaluation ..................... ........ .........................................111 2 . Human Resource Management .........................................................................................112 . 3 . Coord~nat~onlCollaboration.................... .. .................................................................112 4 . Project Procurement ........................ .............................................................................113 5. Financial Management ......................................................................................................118 6 . Training, Study Trips, Conferences ................................................................................. 119 CONCLUSIONS AND RECOMMENDATIONS ......................................................120 John Snow. Inc. 4 Contract No . 608-C-00-94-00006 FINAL REPORTOF THE MOROCCOPHASE V FAMILYPLANNING AND MATERNALAND CHILD HEALTHPROJECT a. ANNEXES ..............................................................................................................123 Annex 1: Summary of Technical Results ................................................................................125 Annex 2: Bibliography of FPIMCH Phase V Project Documents........................................ 133 Annex 3: Training materials and IEC products of the FPIMCH Phase V Project ................... 144 Annex 4: The FPIMCH Phase V Project Team...................... .. ...........................................149 Annex 5: List of JSIIURCIJHU-CCP Consultants on the FPIMCH Phase V Project ............. 153 Annex 6: Financial Report................................................................................................ 166 Annex 7: Summary of Participant Travel ............................................................................. 168 Annex 8: Summary of Invitational Travel ...............................................................................173 John Snow, Inc. 5 Contract No. 608-C-00-94-00006 b FINALREPORT OF THE MOROCCOPHASE V FAMILYPLANNING AND MATERNALAND CHILDHEALTH PROJECT Acronyms ALCO Alternative Consultants BEOC Basic Emergency Obstetric Care CA Cooperating Agency CDA Community Development Agents CEOC Complete Emergency Obstetric Care CEP Community Evaluation and Planning CFR Case Fatality Rate CHU Centre Hospitalier Universitaire CME Continuing Medical Education CMS Commercial Marketing Strategies CNFRH Centre National de Formation en Reproduction Humaine. National Human Reproduction Training Center CTM Compagnie de Transport Marocain DA Division de I'Approvisionnement DELM Direction de I'Epidemiologie et de la Lutte contre les Maladies DF Division de la Formation DHSA Direction des HBpitaux et des Soins Ambulatoires DlEC Division de I'lnformation, Education et Communication DIM Division de I'lnformatique et des Methodes DMP Direction du Medicament et de la Pharmacie DP Directeur de la Population DPF Division de Planification Familiale DPRF Direction de la Planification et des Ressources Fiancieres DRC Direction de la Reglementation et du Contentieux DRH Direction des Ressources Humaines DSA Division des Soins Ambulatoires DSMl Division de la Sante Maternelle et Infantile ECCD2 Etude sur les Causes et Circonstances des Deces infanto-juveniles ENPS Enquete Nationale de Population et de Sante EOC Emergency Obstetrical Care EPPS Enquete de Panel sur la Population ei la Sante. Survey of the Population and Health Panel FPLM Family Planning Logistics Management FPMD Family Planning Management Development FPRC Family Planning Referral Centers GP General Practitioner HIS Health Information System IEC Information, Education, and Communication IFCS lnstitut de Formation en Carrieres de Sante lMCl