Comparative study on management of family planning programmes in selected African countries

EJECAISER.Al13

'i'lb\

AFRICAN POPULATION STUDIES SERIES

NUMBER 15

ECOHOUIC COMMISSION FOR AFRICA

COMPARATIVE STUDY ON MANAGEMENT OF FAMILY PLANNING PROGRAMMES

IN SEL ECTED AFRICA N COUNTRIES

•

ECONOMIC COMMISSION FOR AFRICA

1996

AFRICAN POPULATION STUDIES SERIES

NUMBER 15

COMPARATIVE STUDY ON MANAGEMENT OF FAMILY PLANNING PROGRAMMES

IN SELECTED AFR ICAN COUNTRIES

ECONOMIC COMMISSION FOA AFRICA

ECONOMIC COMMISSION FOR A FRICA

1996

E1ECNSER.AlIJ

AFRICAN POPULATION STUDI ES

_{SERI K~}

:-mm ER 15

Comparative Study on Management of Family Planning Programmes in Selected

African Countries

sco x o xnc COM M ISSION FOR AFRI CA

19%

TABLE OF COSTENTS

EXECUTlVE SUM M ARY . . . .. . . • , •• i · IV I. L""TR ODUcnO:\' , _.• • . • . . . , . . . • . . . . .•• I

II.

ORGANlZAT IOlliAl Al'm ADMC'lolSTRATIVESTIWCTl: RES . . . •

2

Bouwana . . • . . . . , . . . • . . . • , J

Kenya • • • , . • . . . .. . . .• •••••• •••••••• , •• ••• • . . • . •• ,4 Tunisia •. . . • . . . . • . . . • • . . . • . . . ..5

Zimbabwe , , . . . • . , . . . • . ..6 Ill. STRATEG IC PLAJ'I,'NDr'G • • . • • •• • • • • • • • • • • • , •••• • • • ••••• .••1

Mission statement . • .. • , • • • , • ••• • • • • • , • • • • • • • • • • . • • ••• 8 SWOT analysis . . . . .• , .•. •• •••••... , .. .. . .• . . . 8 Establishing goals and

specific objective s or targets , , . .•. , .. , 11

Slralegies for anainingthe goals .. , . . . . • . . . • . .. . . .

1J

AClivities for each objective and work plans . . . • . . . . • . • .. IS A financial plan fe r lhe 5tr.negies adopted •••.•••••• .• , . . . 1:5 IV. IIUM A.!'01 RESO L1tCFS MANAGE.I\IEN T . • . . " . . ,. , 16

Tnininl ..• . . • . . • . . . , ,., , ., . . . .. .• 16 SlIJlICf"isioll .. , , , .. , . , . , , , . , 19

v .

MANAGEM ENT FOR QUALI TY . . , . .. •. . , . " , , 22 VI. MA."oIAGE.l\I EN T lNFOR.'\1An ON SYSTEM (M IS) . , . , . , , 21

VII. LOGISTICS MANAGF~IF}\/T. . , . . , . . , . , . , .. , , 30

vm.

fL"iAf\iCIA L RESO URCIiS MANAGEMENT , , 32

IX. MO:o.iITORI:"' G A:'IoU EVALUATIO :'" . . . • .• ' •. . . • . . .. . J5 X. PROG RAU\I E PERfO RM A NCE A:'Ioll CO:'\o"TRIBun'iG FACTORS .. ,. 31 XI. GE/WRAL LESSO:"'Sl EARNT •. . . .. .. .. .. .• , .• ' . , . . . 39

L....no~ESIA FM nlY PLA~:"'L"'lG

t>ROGRA~L'\IE AS A SUCC ESS STO RY , .. 43

EXECUTIVES~RY

1. Effective management is one of the driving forces to the success of population and family planning programmes whose objectives focus on moderating demographic trends, and improving reproductive health as well as the improvements in general socio-economic conditions of the people. Major regional and international conferences have given due recognition to the importance of management in population and development related programmes. The current comparative study covering Botswana, Kenya, Tunisia and Zimbabwe on management of family planning programmes has addressed the following issues: improving and/or strengthening organizational and administrative structures; use of strategic planning; human resources management; management for quality; management information systems (MIS); logistics management; frnancial resource management; and monitoring and evaluation. An annex on the Indonesia National Family Planning Programme is given at the end of the paper. This Programme is internationally acclaimed as a success story.

2. The study was prepared as part of the 1996/97 approved work programme of the Economic Commission for Africa. It is targeted at policy-makers, programme managers, individual researchers involved in or interested in population, family planning and reproductive health care programmes.

3. On organizational and administrative arrangements, the paper stresses: the need of having structures for delivery of services and coordination among various delivery systems; national programmes to have structures that involve the participation of the private sector and non- governmental organizations as well as the communities in delivery of services; organizational structures to be modified based on changing environmental situations; the importance of decentralization which facilitates planning, decision making and administrative actions to be taken quickly at lower management levels to respond to the needs of the people. However, decentralization calls for increase in the numbers of trained staff to undertake expanded administrative and management responsibilities at lower levels.

4. Kenya has managed, through its organizational structures, to encourage the private sector and NGOs to provide family planning services. In Tunisia, the strategies since 1990 encourage greater involvement of the private sector and NGOs in the provision of family planning services.

In Zimbabwe, there had been less involvement of the private sector and NGOs in provision of family planning services in the past, however, this is being changed sothat the private sector and NGOs became more involved in the delivery of services. In Botswana too, there had been very little involvement of the private sector and NGOs on delivery of family planning services in the past. Until 1988, there had been no private or parastatal national family planning association in Botswana.

5. The study underlines the importance of strategic planning whereby the following elements need to be addressed by managers:

setting a clearly formulated organizational mission statement;

analyzing the organizations, strengths, weaknesses, opportunities and threats (SWOT);

esubllshinl 10111 ~ Ilntegies foe Ilw nmenl of the goals;

seuinl objectlvu as well as activities for eachobjective andwork pbns;

preparinl financial plans for theimplementation of strltel iesadoplt.d;

6. A dearl y wrilten mission statement should luide the operational activiliu to be u.cwkrtaken. GentraJly, mission statements an not presented ~tely in African national family p1annilllJ)fOIr&IIImes. Thex an integrated in llIcofficial national populationpolicies where such policies e.ist Of as part of I Wnily p1anninl policy. Analysis of strengths, weablcsses as well as cpponunities and tIuuU of the ora:anization is one of the ways lIYN.ganenl wouldconlribute10 improve furtheranainmenloforgll1lillitional goals. Not much information isavailableOlI lhis kind of analysis by member SQles for compuison. However, the rtttnt lcncral trend has beento review nationalpopulilion policies IJId progTalR me!in the COIItnt of IheDabt/N,or Dccbntion and tile ICPD Proerammeof Action. Ibscd on such reviews, member States formulite

or

refonnulite policiesandadopt strategia to improve

ue

rnanaa;emenl and implementation of population and family plannina: programmes. All !he "

countries inchldod in the study have u!W:d goals and objectives in ee rontnl of improvina:

reproductive healthandor moderation of delllOgraphic uends Ull'OUJh illCrcuo:d oonIlaccplivc

use.

7. Strltqics

tot

allamina:!hep sof family planning programmes~heina: pursued inall the .. eounlrin included in Ihcstudy. Some of thesefocus onIECactivities10 rucb men and women; impn>'linc: qualily of Jel"¥ices: e.pansion of services 10 reach the under~servcd

populalio1U; ll'Q.la in'o'Olvement of !he private sector, the local communities and NGOs in delivery of familypbnninJ wnric:es. DataisbckinS on the e.tenllo whi(:h countries prepare specifiCactivitieslOteadt objectivetoachievespecificobjcctivesltallClS~ onworkplans;and on financial plans in rdalion to the strategies adopIed.

S. On humanresoura: manaaemc:nt, the studynotes thai the penonnel trained 10 manage family planninl programmes are few. This illects ee implementationof proSTalRmeI. II.

therefore, puts emphasis onincre;uing the numberof lrIined personnel and thai eooditionsof sevice of these people should he improvedin order 10 retain !heir servitts. The studyII., observes thatfew""omed occupy rnanagerial-Ievd positionsin family plannina:servkedelivery and reproductive tcalth careprovisiOl'l. srece family plarminl KrvW:es are ~l1y wgelld al women.thestudycalls forthe needto increasenumbers ofwomen inmanagementpositionsand intheactual deliveryof family plannina: services. TheRudyequally m:ognilC3the impof1allCe ofsupervisionas an imponant aspect towards thesuccess of family plannina: and reproductive halth programmes. II Slrnses ltQl supervisors should be adequalely trained in interpersonaJ oonlaCland moLivalion of saff. MutualtJUSI bef~ a wpervi.,... and those beine supervised is an imporWttlSpect inbllman resourcedevelopment COIltributins 10 woces.sful implementation of pl'O£rammes.

9. Manage menl forqualityoffamilyplanningand reprodllttivehealth care is animportant aspect thai ronlribuleS IOWaI'ds the suct'eiS of theprogrammes.. Panicular altentionshould he given to ensure thai :(a) there is a wiOe ranr;e on choice of mdhods; ^(b) clients are eiven

"

adequate infOl'lTQtion on the various mel.\ods; (e) pmviden of methods ~ serviees arc:

technically competent ill deli...ery of services: (d) there should be mechanism 10 CfICOlInge Cllfltinuity in u.sinl mctbods and senrices; (e) lbere islUI lIppropriate consteltalionor se...ica.

Interpl:oonal relltions and oommuaicalioos bet..

een eueeu

^and prmtiders if effectively done encounges wnlinuilY of JUVioa by clients. Cveful rourue!inl impro'iU qualiry

or

^{care and}

enhances infonned choices and increases dients latisfaction. Sali$r~ c1ienq v e the mlHl

effeeti\'epromllW1; offamily planningandreprodllCti\'e he~th care.

10. III Tunisia, tbere has been good qual ity of care of the national family planninl proarammc: ...ith respect 10 choice of methods, teChnical competence of pro...iders, mochanism

to encouTaie continuityof theU~ of the iUD, convenience IUId acceptability of K'....;~s and pnwider client relations. Quality ofcare hasbern lUI inteeralelement of theprogramme since the inccptioa of the proJramnlC andwasenhanced since the mid·1981h. Moreover, qu.a.lityof

care bas been buill into the lraininl of the procra.mme acli vitie s. In Bets...ana, Kenya and

Zim~bwe, the qualityof servkes has wffcrcdfrom limited method mil; shortage <:If ttaiBCd .:aff, IOJistics problems. lackof referralservices, ioadajua:euse ofinterpersonal relations and commultications.

II. Manq:ement information system (MIS) is another ...ital component to the succen in adIievineproarantrne pIs andto the sustainability of programmes and yet,Iti.l notad~uatel y

developed in most countries. MIS should timelyCOIlOCl and analylc data on all aspects of the OIllUlir.atiooal programme planning, rnoeitonng, e-ealuauon, organiz.ati(tl1a1 struct ures and proccu, inputsand outputs, results and impact. Tile datashould be presented to management andodlenconcerned intheprogramme10 guide decision ma.lUnl and10 tal eiT",ropriate action 10 erliure that the programmeachi~ itsobjecti...es.

12.

Locillics

ollU~ in • family planning programmelias. keyrole. Its managemenl .tlouId ClWalllee the lI~lability of the riPI quantities and the rigllt type of oonlnCCpti\'e supplies Oesind by clientsand at the riChl time. A good logistics system shouldensure tIIaI penonnel are adequatdytnined inall aspeets oflogisticsuwugcmentof&.mily pla.nninC and

bow to use MIS to ,uide management decision·making. III addition. there sIlouId be good supervisionon IoJistics management. In theput, ll\O$l Afrian countrieshad ~ied ondonor eountries10 mana~ Jocistics of supplies. In the chanCedenvironmenl ...here donon are not

providiJl& U much assisUllCe. thereisneed for African lXlO.IDtrit'S 10 have their nationalsde\telup

~ties to manaae10Jistiesof suwlies of their programmes. In moa countries ~ are weakneues in manqement of logistics rqardinl forecasting. shippi nC. warehouse stora&e.

transportation andinformation s)'Slems. Inboth Botswana and Kenya,effortsare beingmade 10 imP"O"'" the management of Io(istia of supplies. Tunisia bas le$s serioul problems of

""isties ~ement Uwt the other 3 OOWItrics in this study. Here ;l£ain, I better human rewurcc man.ac:ement

throup

^lr.Iining. lUpefVisionand I goodmanagement information system

ba ...e contnbuled 10 Tunis~·s ~ler tnana(ement of family planning IOSislics.

13. Gl:wunmcnts need to play. more IignirlQl'lt role. unlike in the past, in mobilianl

f'CSPUtees for family planninc and reproducti...e health programmes. They should aho utilize

iii

financial resources mere effcctivcJy. In the pastitere ^{wI '} ,realer reliance on donot SIIppof1 lO

linanCli and manage family plllllninil programmes. Such wppon hils been declinina over !he

years.

For national pro aRmm e3 to be suslilinable , NGO$. the priva te lCCt01' llIId \he QDfJImunities shook! all contribute to financing and implcmentation of pr(l~l1Im mCS, To this tffect, there is a lreIId in mml countries 10 involve the NQOs. the private sectorand the communities10 playagrcatel' rotein financing^family plannin, programmes in most^countries, Someinitiativeson CO$! reco.ef)' forservicesprovidedan:beingintfod~in some countries.

However, uiese should take into account the ability ofIISCXS 10pay for the lC1"tIiea. MIS on financial manqement 5hoIIld beaiven the altention it eeserves,

14. Monitoring and evaluatiQn should be an inLqrol.l part of pnlImnmes and should covet allptoIramll'\Caspect,. Itprovides management with informatio n to tale lXlmlC1lve actiOl1J10 imp rove pl'Olramme imple men tation . In Tunisia, it has been given great importance in 11M:

national family pJannin& programme and it Iw intluellCCd decision making to Improve llIId upand delivery of 'lel'\Iices. In Zimbabwe, monitoring and evaluation tIM alto influenced decision making on thefamily planning prognmme.

I~ . Assessment of the pro&lllIJlmel show$ thai in Hot,wana, Ke nya and Zimbabwe the prolll11mlllCll an: currently I11ted to have a moden:le effon ....hile the effort has been Itronl in Tunilia. Tunim strona national PlUiramrnc effon isII rdlection of the utrnt 10 whid! it Iw seriou.sly taken inlO accounl the various crucial f<lClon thaI affect

"JCOe"

^{Qf PJUllramlllCS U}

dilC'ulSOll in the Illldy. The programme effort in Bolswlllla and Zimbahwc eould have been enhanced if proararrtmel ",en: part of an overall flational populationpolicy. Contraceptive use Iw increased in all the. counlrlc i under itudy. These have contributed 10fertility decline.

16. Member Stalesneed 10eontin.ue 10improve theIr fa milyplanningandrepronc uvehealth proanmmes. 1lley Illoul d coeu nce 10 implellleni the recommendations in the DakarfNgor Declal11tion and the PrOJl'lI.mme of ACtionor the International Conference en Population aIWl nevetopment and othe rnelaled rq:ional and.inte rnational coofen:nc:e:s which have underlined the need 10 improve family planning and reprodllCuve hullh care prog ram mes.. S\lCCQSful programmes have a $i ~n ificant impact inimpfO'ii n~ the hea lth of molhen andehildrm, family and modenll:ion of dcmoaraphic trends whichcurrently affect lOCio-econornic development.

..

I. L"O"RODl'C'TIOS

17. Proper llWIa&emenl is one of the crucial faaoB UI the J''ClCnS ofpopulation and family p!anJling pmsnmmet that aimat modcnting demographicIlends, providing qlWity lCtVices10

,.asry unmel family planning needsand 10cnSllre continuation of family pWinin, xrviccs in the oontut or reproductive healthcare. The irnportallCC ofmanagementin familyplanningand

matcmal and childbcallh (FPfMCH)programmeshas been highlightedat a numberof important moc:tinc.. AI the Second African Popularion Conference in Al'\Isha in 19&4, fot uample.

African repramtatives calkd on African OovcmmcnlS10 make l"IlfUuaI'J efron. 10 improve plannin,. fundingand llWla&ement for more dTective impk:mtntltionofMCHt fam ilyplanning P"O&ratnlnQ

IhrvuIh

budget and plan Iinkqe..

balancin&

and CORJOlidatin, existing ICtVicc

~ty, mdlilizingadditionaldornctlicIIld elllemli~,improvin,costeffl:lClivenessand eootdinatifll II\Illpower planning and trainin, SlralC&its for ellistinl xrvices.¹ These management iUIIa were alsolivenpl'Oll\llltflCC at the Inrcrnational Conference on Popub tion in Muiw in 19&4 and at Ike 1994 Inu=ml tional Con fe rence on Popo.llllion and DeveJopment (lCPD). The Colloquiumon theimpactoffamilyplanning programmes in w!).Sahann Africa in 1989 called for cfficicl1lmanagement of family planning programmes in Africa .'

18. Manaj:emcrll has therespon sibiliry of ensurin,lhalaction. are taken 10 aclIieve family pW!ninl OfIanUariona1 goals. Thus amon, thecritical issues thai ihould be addressed in l1WI&iemcntoffamilyplanningand ~rodliCtive health cere should include: lmprovin, and or sttenllllc:nin, OlJanizatiOll&I and Ildministr.lti..e structures includinl priV&IC and oommunity in'<Ol..emenl;\IX orstratqic

pIannir!&:

hull\lll resources management;manqClnC'llt forqlWity;

manqcmcotinfonnatioo .ystem.(MIS); klgtslk:.managCDlCllt; fifW'lCi&l I'CSOUlU manq:emtnl~

and monitmiq and evaluation. Tbc:soe Wuc' are the subject of this eompami..e a100y which exunines bowthe Wues lI1.vc ee are bein, add~ in SOll1C Africa countries, especially in Botswana, Kenya. Tunisia and Zimb;lb~. These countries W~ ~Iected because their pmsrammesare amone those which art doine well in Africa. An anrlex on theexperience of the IndoocsIa Family P1annillg ProgrJommt 11 lnclllded u that proJramlnt Is inlCrnltiunally

acclaimed u a JIl«:tIS stor}'.

19. The uudywaslllldelUkep I tpanof the 1996-1 997approvedPf'OIratnmc or wortortile Economic Commission for Africa . It has relied heavilyon rffiew of available li\.Ctal1l!'eby nrioua orpnlzations andindividual researdlerI. Thedraftof the lludy wasstnl lOall the four countries covered ror commentsand additional information. In addition, visitswere made 10

•

,

Unit e d N"ationll Econoilic COII'.m is s lon tor At r i c a ,

! illman1a[o Progra mme of Act I on tor A[ [ ican population and Sel(=Reli ant Deyel opme n t , 1984

Reqi onol Inst it ute tor Pop Ul at ion St Ud i e s, Uni verBl t y ot Chana, peve lo~meot. in ' a mi ly Pl annI ng Pol i c i e s and

Progr,~es in Atri co Proc e edinq s ot t he Co~loqu lua 00 the I=p act ot Fa~ i ly Planninq Proqra~. . in Sub-S~ho r oo

Atri co: CUrrent I.sues and Pros pect. , Leqon, :9d~.

Botswana and Kenya to collect up to date data. During these e usnons, the fir~1 dra ft was discussed with relevant officials in Botswana and Kenya. A revised dra ft was distributed to participants at the International Seminar on Management of Quality Reproductive Health program mes : After Cairo and 8eyond, convened at ^ECA by the International Council on Management ofPopulation Prog rammes, 2 10 6 December 1996. Participants wen: requested tosubmitcommentsto ECA. Therewere noreaction s received00me revised draft. Thisstudy will be of interest to policy-makers. program mc managers, and individ ual researchers involved inor inte rested in family plan:ling programmes and reproductive1tealth care.

II. ORGANIZATIONAL AND ADMINISTRATIVE STRIX TURU

20. A family planning programme need to have an organlzarional and administrative structures for the delivery of services and 10 ensure coordinati on among various delivery systems. National programmes should have struct ures that involve the partic ipation of tile private sector and non-governmental0'1anhatiOJlS as well as the communities in tiledeliveryof services so asto serve a greater ponion of the population. For each organization, there should be an organizational chan that shows Ihe variousII.IIlts and how the units relate and thecha in of command. Organizational structures should be moJified based on changing cnvironmen tal silUations.

21. Organizationaland administtativc structures for the delivcry of family planning maybe centralized or decentralized. It should be: noted thatthere is noone bt:~, structure. TIletype of activities. coverage and Clistinll environment. and services tobe: provided should influence the type: of organizerional structures. However. the general trend has been to encourage decentralized struct ures which facilitate planni ng. dec ision making and administrativeactions to be taken quick ly at lower managemenrtevets 10 respond to the needs ofthe people . However.

dCCl:ntrillization has jmpl i'~ t ions for gover nments to Increase Ihe number of trained staff to undertake expandedadminutrative and managementof responsibilitiesat the tower levels. The Colloquium on the impact of familyPlan ning Progra mmes in Sub-Saharan Africain 1989. for instance,recommended that(a)manage mentatthecentre should be Strengthened and be fluible

to respond to the needsof the prog ramme especially at thc periphery: (11) management should be:docentntliud "'lUI I strongcentrewith sufficientpowersgiven todecentralized unitsto enable them we decisions of iml!!et.! i.'Itc concer n and ab o 10 respond quick ly 10 local situa tio.u _1 Som e or the C>l;Ming org:miZoltionaJ and adminislI'3!ivc ~1'lX'lure, in ""me of !he AfricaJ1 countries ~ described below:

,

_{Ibid, R..giOllal Ino t it. ule tor}

UnIve rsi t y of Ghana, 1989 2

PopUl a t io n St ud i...s ,

BOTSWANA'

22. In Botswana, tI'le Ministry of Health (MOH) and the Ministry of Local Government, Lands and Hou sing (MLGlH) , have joint responsibility for the healthcare system. The MOil isresponsible for health policy formulation aswellasimplementationofplans, human resou rce development, administration of hospitals and clinics and providing technkal support and direction toall health programmes. The MLGUi implements heal th programmes at the district level. In the Ministry of Health, the Department of Primary Health Care Sel'Viccs has five divisions and a!' AIOStSTD Unit. One of these divisions is the Family Health Division which deals with Maternal and Child Health Care and Family Planning (MCHlFP) in iU MCWFP Unit. The Unit is headed by the MCHIFP manaa:cr. The Unit has sections dealing with adolescent health, MCH,population andfamily planning,community mobilitalion, andrcscarcb and evaluation. The Health P\anning Unit in !he MLGlH is tI'le link with the Ministry of Health .

2). Service deli'iery network for family planning as of 1996 consised of:

(a) 2 Referral hospitals with special ized professionals such as medical specialists, nurses, midwives and allied health officers;

(b) 15General District Hospitals manned by medical officers , nurses, midwives and related professionals;

(c) 14 Primary HOlopilalS runbyphysicians, nurses and allied health officers ; (d) 209 clinics of which 76 had maternity wards and I)) did not have matern ity

ward s. The clinics arc run by nurses, midwives and Fa mily Health Educators (fV<o"E);

(c) 315 Health Pu~LS ofwhich24S were manned by nurse s ane FWE while 70 were manned by FWE

(0 687 Mobile Stops manned by health teams, nurses and midwives.

•

Based on the In forma t Ion collect ed durin9 a mi s sion to Bot swana , 21-22 November , 1996.

3

KENYA'

24. Al a t me when Ken ya launched a Nationlll Family Plan nin, Prol~me in 1961, ~

Minisuy of HCilth had the initi;ol n'spooiibility for coordinatin, and implementin, \he proenmme. In 1982, a N~tionaI COIInalon Populat ion and Development [.'lCPD)^wa.Icreate;!

and WlI.I

pvto ee

rcspolIsibility for population policy development and coordination of ' lM:rnmcnlal and POfI-,O\'cmmental aetivilia in.:::ludin, population education, meatCh and training. and C\'aluation of pro,rammcl, In this COIlIe=-t, !he N;jtiOllai Family Planning Pro' l'l rllllle came under the:coordinaTion"ftheNCPD. Bdwem 1982and 1m,IMNePDIwl been &dmini~Ulred under various govemmenTlIlinislria . AIpn:ocnt it is under theOffICe ofme Vi<:e. Presidc:nl and Ministry of Plannin, and National Dc:vc:lopmenl. Currently, me NCPD oomprises.ofa c:bairman, a1eCR:W)' and, I~ members representing ,overnment ministries,non- ,ovemmenlallllplliutionsl1..ellasKIlTlelelading",h,,'= involvedinthe NationalPopuIalion l'1o&r.t.mme. The Council is assisted by four oommll ta'S on; public policy andad~ocacy;

rqlroducti ve health and adol~~~ infof'fliltion,eduution, andoommun;cat;on; and !l'lleaI'Ch development, population iUId environment.and tn.inin, . The sec:rewiatoftheCouncilisheaded by • Oi'(:(;1Of. There ~ flYemllln divisioru in the _ ldarial; f1lWlcc andIodministr.llion; proefllmme coordination; policy dcvelcpmem, infol1lllltion, eduutioo and c:ommUlllcalions ;

resardt ,

eviluationand monitoring . Districtbased offtcers ....ith lIIpportofthe _n:lariat an:

mponsible for impk:ml'nl.llion and ~oordinalion at the (\istriC1 level.

2j. The NCPDhas been faced WIlli ronstdc:rabie burcaucrancpmcedum ,nill ooordinallOn to mpon(\ tothe programmen=ll. This ha1 affected its<;apacily in le~pon(\ing timely to dooy to day operation,. To make il moR:effective, esped al ly inthe ~iew of the Nation al Populalioo

Poli~y forSustainable Dev~1expected tobeIdoplcd'1000 by\hegovernment, aproposal hlIJbeen made to give NCPO a speciil ~I.ltus 10enable it 10be fleXIble 10bellef n:spond tothe needs ofthe policy implementationand ooor(\;natioo .

26. The implementation of the natinnal family planning p,.-ogra mrneand aervice de.livcry is done bytheMinislryofHeal lh through tI1e Division ofh milyHeal th, withoverallprogn.mrne and poIicyooordilUlion ftQlll theNationalCounc il(>tI Populalion andDevelopmeM. The Family Health Diviiion is headed by a Dn'cctor. In 1995, the family planning proeramme was imj.llemen led nlOWy tl1Tou~h 96(i public SCC10T $CfV1CC lleli~ery potnts (SUI'!i) which ....ere complemented by O\'Cf 380 SOPSrun by NGOsand tbc private IlCCtOf. Inaddition, therewere community ba'lCd dutnhuticn delivery service nelWOfIr.dcvc:Jopcd by more than2j governmen t andnoo-govemmcntalOfj!atlizalions. The M,nlUf)'of Healthpublished ill September 199~The National lmplemen lalion Plan (NIP) for the Family Plan ning Proj;ramme for the period 1995· 2000. The gOil1 oftileNlPistoprovilk quallty fa milypianninl services toallKenyans desirinl such services. Ina 51fllteCicappl'OOl~h, thc implclIICTll.ltion plan addmses rep'Oduet.ivc hQ,ltll

,

_{va:l o~8 docu ment . On ~enya pre . ented at .a. in a ra ,}

work ahopa, CQnt ~ra nce& and count~y re port, and 1nto t"llat i o n co lloctad during a 1II1s s10n to Kanya 2'5-2 6

N<>va~ber, 19'U ,

,

issues: exparuioeof services; quality of family planning services; infonnatioll, educationand communication; financing offamily planning services. Specific steps inimplemetllation ofNIP have been peeseeted indetail.

n . The ~mmenlofKenyabas beenand willcootinLIC 10~rage theprivate sectorand NOOs and the community in policy imple~ tation. In

w

^{context of health care services}

provision,60'1' oftheseserviceswereprovidedby the Governmentand40~ by NGO(including religiousgroups) andthe privatesector in 1995. Major reproducti vehealthcue serviceoutlets in Kenya areMCHlF P clinicsinpublic hospitals,bealthcentersand in mostdisptnWies. These provideaboul"'I' ofalltile familyplanningservicesin Kenya. These arecomplemented Il.ith theservicesofthe community-based distribution (e SD) programme. In1990,about35~ of all thewb-I<x:ations (Kenya's smaileSl administntive unit) were served by CBD filmily planning

""""".

28. Witll regard 10the staffstrength of the NCPD, there is need 10tncrease the staff10 enhance itsOTgillliutionscapabilityat the secretariat. The sameistrue withthe staff out posted

10the districts. Most disuicts do nOl yet have NCPD staff based there. Strengthening of the orpnizational and managerial <:apability was noted 10 have increased tapilbility 10 carry OUI

expandedand improvedfamilyplanningactivities of the FamilyPlanning Association of Kenya, theChristianHealth Associationof Kenya and the MaendeleoYa

wara

Wake

(a women's

NOO in Kenya)."

nJNISlA'

29. Tunisia's national family planning programme was formally adopted in 1964. The Government of Tunisia has ComJantly regarded family planningas an integral part of

soco-

economic development. Government population policy lias. throughout, beengeared towards lowering feniJi ty and population gro....th; irnproving family planning and health care. The organizational Uroclure under whichthefamilyplanning programme has been implementedhas evolvedovemrre, including theDirecrorase of Family Planningand Maternal and Child Health in the Ministry of Health in 1969; the Institute for Family Planningand Maternal and Child Healtb in the Ministryof Health in 1971, which waschanged in 1973 to theOfficefor Family Planningand Populatioll(ONFP); Ministry of familyandpromotion for womencreatedin 1983

•

,

~The Family Plan ning ManlJ;q e lllent Training Pro ject External Interim Evaluat i o n ~ , by Reber-t. Wic k h a lll, Barbara Pillsbury and David Logan, De c emb er 1], 1989, Report prepared for the Offi c e

ot

Population, Bureau for Science and Technol ogy , AI D, Wa shingt on D.C.

Source : Evaluati on ot USAID Famil y Planning Program - Tunilllia Case Study Report No. 15, 199]; UNECA,

·Comparative Study on Family Planning and Birth Spa cing Progra mmes in ECA, me mb er States~ 10 December 199 ]

s

and clli1J1ed with tile responsibility of implementation of the n.atiOllaI population policy and supervision oftheOftitefor Family Planning and Population.

30. The ONF PIII semi aulOOOmousgovernmentagtnCywith ada;entrniJ.ed mganizational structure. ItIw regional centres and mobile unitout teaCh systemusina midwives to deliver family plannina services. Decentralization started in the 1970s and continltCd to tile 1980s.

Dccentrniu.uoo wasseenISaneffectivemeansof providinaservices10thepopulationdispersed in rural areas. It

was

also considered as a way of providing family plannina manqcn with authority and resources to solve operational and technical problems.

31. Initially, _invest~twu madein settinga regionalservice deliveryinfrastructuresystem.

ONFP llIen esrablishc:d I Regional Centre for Education and Family Planning in the Headquarters ofeach of tile 23 govemorates in order to extend family planning nation wide.

11Icse centres provided comprehensive services including sterilization and abortiotl. Each regional centre was headed bya"regional delegate". ONFP gave tile regionai lleadsauthority to manage regional budgets and responsibility to defend and account for tile uscof budi e!lito ONFP at headquarters inTunis. Sucharrangements enabled regional heads to solve problems quicklyand improvetilequality ofservicesthrough more efficient deploymentofboth staffand capital resources. In addition, this arrangementgave regionalbeadsasensc ofowncrsllip ofthe programme.

32. The public sector had been tile major source ofdelivery of family plannini services in the past through: regional centres and family planningcentres; fixed centres; and mobile units of clinics and teams. It provided family planning services to 3/4 of users in 1993. Recent trends,15willbe seen later, arc geared 10involvetileprivate seeroe more in delivery of family planning services.

ZIMBABWE'

33. Soonaner independence in 1980, theZimbabweGovernmentdirected tIlatall MCH/FP unitsandruralhealtbcenters $houldprovide familyplanningservicesasan integralpart ofMCH services. In 1981, tileZimbabwe GoYern ment tookover tile Family Planning Association and namedil the Child Spacing andFamilyPlanning Association (CSFPA). However, in 1984 the name was further changed to the ZimJ);,bwe National Family Planning Council (ZNFPC) and

~me an autonomous body within tile Ministry of Health. The 19 85 Act on tile ZNFPC empowered the Council to coordinate and imple ment family planning activities throughout Zimbabwe. In1984,theGovernment ruling partydirectcG tileZNFPC10mountachild spacing

•

Sourc e: Alex F. z Lnanq a , "Development of the Zimbab'ol e Famil y Planni ng Progu tnll\e" Wor ld Bank po li cy Resear ch Working Pa p ers Ser ieB 1053, Dece mber 1992; UNECA. "

Comp a r a t i v e StUdy on Family Planning and Birth Sp acing Programmes in EeA memb e r St a t e s" 10 Dec e mber 19 9 ] .

,

campaign to ensure a reduction in population growth rate. Since then the Government has supported family planning programmes.

34. Among the mandates of the ZNFPC include: providing technical support and quality control to all public and private family planning services; training of staff involved in providing family planning services; carrying out media campaigns, information, education and communications programmes; youth programmes; logistics for contraceptives; research and evaluation. The organizational structure of ZNFPC consists of an Executive Committee which has representatives from various ministries. The Committee is the policy organ of the Council.

It controls the operations and administrative matters of the Council. The Council has the following units:

(a) the Medical/Clinical Unit which has the responsibility for the delivery of family planning services through 30 static and five mobile clinics (as of 1992);

(b) the Community Based Distribution Unit (CBD) which is the main outreach mechanism for delivery of family planning in rural areas. CBD staff distribute oral contraceptives and condoms; they motivate, educate, initiate and resupply contraceptives to clients. In 1994,800 CBD workers served approximately 29%

of the rural population in the country;

(c) Training Unit which is responsible for formal and in service training for all family planning service providers;

(d) Youth Advisory Services Unit which educates and counsels youth of ages 10-25 years both in and out of school (education sessions are provided at primary and secondary schools);

(e) Information, Education and Communication Unit which provides appropriate family planning information to the public, familyplanning service providers and opinionleaders;

(I) Evaluation and Research Unit - it is responsible for data collection system to monitor and evaluate the Council's programme;

(g) the Management and Administration Unit

ill. STRATEGIC PLANNING

35. Strategic planning is increasingly stressed as an essential ingredient for effective management for population and family planning programmes. Among the various issues tobe addressed by managers in strategic planning should include:

(a) development and or review of the organization's mission statement;

(b) analysis of the organization's strengths, weaknesses, opportunities and threats (SWOT);

(c) establishing goals;

(d) strategies for attaining the goals;

7

(el activities for eacb objectiveand work plam;

(f) financial plans fOf the $trategies .oopted.

36.

n -

iSSllCSaredeall witll in thissection. Furtherdetails could bef(lllnd in the Family Plannln, Manll&Cf'1Hmdbook', The extent 10 wllicbsomeof the countries apply iIOme of the elements ar $lJ,nec ic p1annincis rev_ eli.

(I) Mission SlalftDrnl

37. It iJ C$SeI'ltiai that any Cl]lIliution dealing with Wnily plarmine (naIionaJ., public or private orcanilation) should have a clearly statal and written miWort statement. II. miukln llatemeJll Ihould eivea generalindicationofwhattheorganitation intends Coachieveata Civcn lime period q . S-IO yean or longer. The lobtemenl need to be consistent with the nati(N'lai polidcs as well as thosen:latlll' to familyplanningandrrproductive health care. The ltatement should indicate the services Of products 10 lit delivered It well as !he target popul<llion Co be served. II. clearly written minion statement $hould guide tJHo opentiorla1 activities 10 be undertaken.

38. Gcner«l ly, mission statements are not prl:K:I1ted sepuIltely in Mrican naliona1 family plannina programlTle'S. They are integratedin the offICialnationalpopulation policies.. hen:Sl>Ch policiesUiSl or II part ofil familyplanning policy ifno national populaiiOll policy exists. In Botswana, amission Slatemenl was beingformulated regardinGthenational MeH and planning PfO!n1mme wllicllil being reoriwted into areproductive IlcaIth programme.

{bl SWOT A.nalysis

39. Anal)lis of $lrenglhs, w~ u ....ell as opportuniti~ and thrnts (SWan of the organiUltion is one of the

_ y'

management wouldcootribule to improve further ~tai nmenlof the of,anizalional Coalsandobj«lives _ For

swar

analysis, data shouldbecollcclal from the organilal.ioo iucl f (lbrough interviews, exiltingrecord$on ~=cb sludies. ev.tlUilI;OII ~) as ..eu as rromoutside !he Ofianillllion. Bnin slOrmina exercises ,lIould be part of the

swar

process.

40. The SWOT lIlIIysis. should cover all aspects of the orgaJ1iwion 's aetivilies lOCh as 0llanizational and administrative llTu.clures. planning. millilgemc:Ilt, cooroil1.ltion, mffine.

trainine, suprrvision, ma,rulge menl informalion ,yste:n, logistics management, financing etc.

Some nampte\ or specific 'lUClllon,in analyzir.g the 'ntem oll Sl-Teng thl and wcal<nc:s.:;cs on the

•

tn, r. mi ly Pl anning Man a ge r ' s Handbo0 k l BASic SkIlls ODd Tpol s [or ~OnOglnq f amil y Planning Prog r amm e s, ,di ted by

Jamel A. Wol t f , Linda J . Suttenf ie ld, suaa nna C. BinzeR;

Kumartan Pr . IGl 1991 8

topics mentioned ;Wove are l't'j)T\lduced below from _Famil~ I'lanning _Man~er's Handbook.'0

• Orpnlzatilln. 1Sll'llclure: DOClI the organizauonal structure and culture lend iUdf 10afret flow of information, both fromthebottom levels upandfromthe

lOp down? Dol:s the organiutionll structure hinder or facilitate efficient and client-responsive implementationofIlCtivilics? Do all staff, ind udingvolunkeu, Ilive clearly definedroles?

• Plannl.nJ:Have feasibletong-termandihon-ltTmplansteenINde, involvingall of ceI!alTand thecomrnunuyIe beien cd inltle procc~? Do theseplaNguide the IV(Irkofthe organiution? HloVe the~ led 10 successin ilChieving gw,h?

• Coordination: How well do diffel'ttll dl"panmenlS Of divisions within )'OUr Ofginin.lion cooperate and coordinatewith each othcr'? Are any llOUPS (formal Of infornW) or department$ in a thronic $U1e ofwnflict, andifso, why? How well does ee OlJaniution coordinate with ott\er family planning and he.alth organiu ul.'lls?

• Staffing: Do )'01,1 hire peoplewith the appropnare skilll and attitudes for their JlOlitions? Does each staffperson have ajob description^With acleardelineation of roles and duties? Are there $Uff whosejob descnpnons overlap, ^>0 thai the division of responsibilities is unclear'? Are on-going tnining and on-Ihe-job foai backjX"O\'ided consistently to ensurehighperformance?

• Supr".b wn: Do all su ff ill every level Ilive re:ular per:lOrlal contact Il.'ith a supervisor?Do all iWT (incli,din g the supervisan themselves) view the

~pen-itor 'sroleasoneof,uidance ,a.uista/1(:e,and support?Dosupervisor s hdp Sd perfcnTwlCe objf:t'tives for l1lose they aupervise and check progres~ toward

!hese objectives? Do the supervisors effectively solve perfonnancc problems throughIheir_in~rventions?Doeseachsupervisorhavea supervisoryscheduleand a supervisorysessionplan?

• Trainiu,: In whil areas does each typeof staff need trainin: ? In whararea! is each type well-trained? Will training resolve the problem?Do iOl1IC Ilaff have unused potential or skills thaI could be useful 10 the programme? Do you

regularl~ assess training needs of new

su.ff

and of eli)\inl sWT who have performance problemsor

w oo

^are auu.minc

new

responsibilities?Methetnining loalsand contentcloselylinked10these :weummts?DoH. ee t¥aluation of your trniningexamine trainee: satisfaction, mcnases in bowledle, chan,es in on-the job performance.and the impactof training on servicedehvery? Are allpmvKlers

trained in counselingandcommunication skills?

"

^{Ib id, The Falllily Pla rminq} l'Ia na q e r's Hand bo ok, Ku ma r i an

Pres s 19 91

,

• ManagenH'lll InformalioDSynnn: Do maN,i:cn have IIlX:lln. te infor mation on the PTU&ress made loward !he objectives oftileprocr.unme and on whclhcr or IIOt activitiesarehap pcnillg^ISSt'hcdllled? DoslIpervision reporu provide information on the reuons fo r a lad ofProllrtSS in any liven area~ Intile afUlor finance, Illpplies, an4 planning,domanagers havesufficien tinfo rmalion IIIfOra:asllrcnds and make ded $ions? Does the managelfletll information 'yslcm ajso provide information 00 non-quanlirJable issllC's such as Quality of care and user satisfaction?

• Commodit ll'li Man a!:l'm enl: Are there sloclwuts at any level of tile supply sySlem in any essential commodity? Does the central Wa.rchoulilC oonduet an inventory at astonce a. ycar? Do all warehouses and suppl y depots employ the ' first III elpircJfim out' (FEFO) sy!item? Is foreca.slillg eccurate enollgll III prevent both Slockollu and l/fiWa.&e from elpired eontr.liCeptivcs? Dorondition\

a.tall storagepoints preventdamage10orlou.of$llpplies andeontracq>tivcs?Are there any rontrace ptive methods that wo uld Improve the elienl' s choice but ^ilJ1:

not CUrTelltly offered1 Are clinics or community posts adeq ualtly equipped? If not, list what is missing or in disrepair.

Prugrammlo. Capabilit ies: What is the potential capacity of ItIc prOi n.m mc to provide services, train, and/or educate? Does the current level of clil:ntltrai neeled ucaliooa1 activitiC$

malCh this taIMCity? Is the programme able to expand ~imply by incrClsin. ilS efficiency, .,...jthout _~tllring a s:gnirJCal1t new source: of revenue? If so, how can this expansion be implemented? \VItatis your usessmenl of the qualily ofcare in)"OIlr prolramme? what canbe done to improve it? "''1111 i. the currenl userdiscontinUllion raTe'l What is the level of

ene u

satisfaction? Is the tranlpo rtatioo lhat is availab le adequate for programme needs? If not, dC$Cribe what is needed for wllich t)·PC of pcrwnnel and in which areas.(Transpol1ltion could beinadequate for a certain level of staff, such as community promoters, or fo r a gcographic:aJ rtgion). What are thewuk points in your progl'll.mmcs? WIIat arc the realOlls for these weak points? Whal are the strong points? Whatespemse exilu among your staff ~t gives yo u the ability to run yourprogramnY$? Is thil expe rtise under-utilized? Are cxining staffoverworked and unable to underta ke new activitie~'1 Are tlley under-utilited, witll free time ontheir lwlods?

Are there any activille. that would enhance yourcurrent proerammcbut that you can nor: carry out for lack of human or finVlcial resources?

Financinl Clpabililit>\: What is your

currer a level

of self·finmci na'l What are your cur rent sources of financing? How stable are lhey? Are they likely 10 increase, decrease, orre/llilirlthe same in the near future ? In the distant future? \\!hal would have to chan , e in the external Cllviro nmcnt or with inyour organization in order to secure additional fundingor generate more revenuel'l WIIichof these ell.ang~ arc feasible'l Where can youCUI cons in yoor prog n. mme?

What lcvd of cemmunhy supporteoes llle programme enjoy'l Are tllere com munuy boMds' Co mmunity-tevel fund-raising programmes? Voluntee rs? Donation sof materWs or supplies?

41. "The eaviroamental factors affecting the organization may be positive or negative. Positive facton5hw ldbetakenasopportun ities while negative factors are threats. 'rnese shooid be analysed adeq uately. This COIIld inVQlve new donors to fund prog rammes or don ors withdrawin g their funding ~upport.

42. There is scarlly informatio n ⁰⁰ country national procrammes on SWOT OllIalysis for compan sce. However , ue general lIVld recently hs been to re...iew tile national populMioo policies and progra mmes in the conte, t of the Dab r/Ngor Dc<:lariltion on Population , Fa mily andSuslainable Devtlopmentand UIerecommendation, ofthe: Programme of Action of the 199~

International Conference on Population OllId Developmeru(IeI'D). Based on such reviews, member StateSadopl strategies to improve the management OllId implementa tionof populalion and family planning programmes. Similar reviews asnst member States to formulate or rercrmutare national population policies.

o .

A Programme Review and SUlllegy Devdopmen. wu lXInllucial in Bots....ana in Aus " w Scp!l:mber 1996 focu!ing on: populatioo and devl:lopmetl' URleJy: reproduc.li\'eheallh inch..:!in g family planning and Stlual health; and advocacy . Prior to thll e~ercisc I lituation analysisoflIle Botswana MCH/FPProg ramml:had beenconducted and publisllc:d inJuly 1996.

II made recommendations on various aspects of tile MCH/FP Programme. A National Population !'olicy has beendrafted. and will SOI!ll beapproved. by tile government.

44. In Kenya. post Cairo IeI'D activitles have led 10 lhe l'e\Iiew of !he 198-& Populauon Policy Guidelines in preparation of a draft Nahonal PoptJlation Policy for Slistainable Development. The formulation of the draf: pchcy beneflned from the SlIVIlI: tIls in the implem l:flt.ltion of previous pDp\Ilatlon aIld family plann:nl: procra mme s and has taken into account the concernsof tile Progl'1lmme of Action of W: ICi'D. The: new policywhen adop ted ....iIl ll: uide programmes to be: imptementeJ Uple2010.

Ie) £.o,1abli\hlnlGoab and Spl'(jr~ Objtt1i~esor Tarr:ch

45. Family planninglJld re'J'rodllCti~ health caregooh indicate ingeneral terms the Impact the programme e~pe:cu to baveon Illew gtt populationbytbeend of a given time period inIt\('

pr~ramme planning pmeen . Some example! could incl ude the following: to _iller~ contraceptive use in Older 10 reduce un....anted pregnancy and hence Improve the heaJtIl ofboth

....omen and chIldren through long illlC'rval l ofbin h .pacingor Iimitinl births for those: ",110 do

not want any 1llOl'echild ren; to provide fcnilily management programmes that will respond to the needs of sterile or subfecund COIJples to achieve desrrcd family sile. Goals should be:

reasonable, flO( too amb itious and shouldbe ba~ 011 tile availability of TOOIJrces to be: used in Khieving them. Thorough SWOT analysis Should generate a baSISfor sen ing or modifying progr;a mme goals.

46. In some easel , objectives andLargcu may beu~10 mean the1.ll1Tlttilin,and1lencl!'..~ interc~geably. A programme objective ^Ofq elnpres.ses 5(lfIcirIC reslilu e.:pcelet durinS a , iven time period in theimple:me:nt.ltion of lhie procmnllle. 11lC\JD1C frame: 1I1enenllyofshort modium or lonl: lerm (most frequently il lniy be 5 yan, 5·10 yu rs or longer). These

11

i ic, rneasura ^I appr pri ectivesnargets ud 11

time nd.

th rn

t i ove ambitious in th

rives/targets member

J Y t reductic governm nt family pi norm th 1isconduciv

h i. he

n y

cu L POIJIUla

ian na c ' Hand 00 , Ku

.ly Pl a n n' ng

11

11

12

current contraceptive prevalence from33%to 40%by the year 2000. The goals of theproposed Kenya National Population Policy for SustainableDevelopm ent include: improving the standard of living and quality of lifeof the people; integration of population factors into the development process; improving reproductive health;reducing fertility as well as infant, child and maternal mortality; continuing efforts to motivateand encourage Kenyans to adhereto a small familysize norm. Specific objectives have also been proposed in the draft policy as well as demographic, health and social services targets upto the year 20 10 in orderto guide the implementation of the policy. As in Kenya, the National Family Planning Programme in Tunisia has also consistently have had goals of reducing population growth and increasing the use of family planning since itsinception. For example, the current goal is to increase contraceptive use from 50%in 1988 to 64.2% by the year 2001. The Governm ent of Zimbabwe has, since independence in 1980, given family planning an important consideration in its development planning effort without adopting an over all national population policy. Reduction of population growth and total fertility and increasing contraceptive use have been goals of the Government and the ZNFPC.

The Zimbabwe National country report prepared for the 1994 ICPD indicated that the Government wanted to reduce total fertility from 5.5 to 3 by 1996; increase contraceptive use to 48% by 1996;increase the number of users of long-term and permanent methods to 12% by

1996.

(d) Strategies for Attaining the Goals

49. Strategies spell out thecourse ofactionsin order to achievethe general goals and specific objectives on targets. Several strategies complementing each other may be adopted for given goals. The situation analysis of the organization (analyzing internal and external factors affecting the organization and programme) in combin ation with brain storming should assist in establishing strategies.

50. Depending on the natureof family planningorganization (national, private, NGO), some of the areas ofconcern in developing strategies of programmes may want to address the need to serve the unserved or undeserved population, especially in rural areas on urban areas;

addressing appropri ate IEC programmes to targeted audience ; integra ting FIPwithother socio- economic programmes and activi ties; improving quality of services as well as expanding services; addressing the problem of unwanted pregnanc ies among adolescents; improving the technical skills and capability of those delivering services; increasi ng the number of women in management positionsin family planningprogrammes; improvingco-ordinationamong variou s actors involved in various programmes in family planning and reproductive health ; involving communities in implementation and delivery of services; developing institutional capacity and capability and financial suppo rt to sustain program mes etc.

51. Some of the MCH/FPstrategiesbeing pursued in Botswana focusonadolescents, young mothers, women experiencing their firstpregnancy, high-paritywo men,womenwith poorchild spacing, female-headed households , women with little education, women in remote areas, improving women's opportunities to higher educationand employment,as wellas improvingthe

13

gener.aJ. living conditions and inromcs of ee people. There are strategics to improve ITIIlIaIcmenl and planning, twninc . MIS. IOCistics. community-based w:rvic:es, retear'Ch and evaluationand family planninc lEe IICtivilin.

52.

^TIleKenya Government is currenl1yimplementing^I natiooal familyplannincprocnmmc whose goalis10 provide qualityfamilyplanninc services 10 all Kenyans desirinl Iheminonlcr 10 make significant progreu IOwards mcetinglhe unmelneed in family planninl by !he year 2000. Various stratcgies have been de$iCned covering all aspectI of procrammcs from organiulional and institutional structures and capacity buildinc up 10 PJOIlUlmc implcmentation. The strategieshave beenrefocusedinthedraft NationalPopulationPolicy for SustainablcDevelopmcnl up to 2010soontobe adopted. In thecooteu of reproductive heallh and family planning, strategics address issues of IICceU toall population Jroups - ldoJc_nlS, women, men, safemotherhood; male involvement; STDs and HIV/AIDS; reproductivehealth rights.

53. As for Tunisia, the organ izational and programme stratcgy of thc family plannilll prognmmc for the 1990sand bcyolld focus on ttle fo1lowillg aspects.^II

theONFP10concerllrate on co-cremation andas a facilitatorof familyplvln ing motillltion and service deliveryactivitiesin the fee-for sr:rvict' private ICJCtor as well as in thepublicsector.

fOC1l1 on the undcnclV'od populaliorl (young married couples, peri-urban, rural couples)

COIl!iIlUed improvcmellt in the educatlonand SWIlS of women

self·reliance on contraceptive procuremenland 100ilties managCmenl improved management and cost effCCliveness

Coli recovery andselfsu§lainabilily

improvedquality of services through technicalskills transfer10 the private sector and the Minisuy of Public Health

Gready C1~ the: number of service poinll, usinCthe private sector and the Minisuy ofPublic Health

"

^{"Tunisia: Pop Ul a t i o}n Strate9Y tor the 199 05" by Barbano

Ph l 1 l s bur y et. 11. 27 July 199 0, pre p~red tor the Of tice of Popu l at ion Bureau for Sc ience and Techno l oqy, AID Wa sh inqto n D.C.

14

' 4. In Zilllbabvoe. amoaa the stnllqics of the Zf'o'FPC include in~slfyinl lEe effor'1.l ...heRby the Illvlli-lII«Ii. il uleeSfocusineon malesand youlhswithfamilyplannini informa tion;

mclOIlnJin, \lieof Ionl term and IXrmanenl methods of fVllilyp1an nin,; broadeninl Il'ldhod rna of

eontnct'pti_:

^{increHing filWltiai} sustainability through the sale ofCOfItraeeptives and dIM.in. for lU. iceI \While elIltirin, ^IICII;:CSJ to 10\0' income croups; increasin, privalc sector ddivery of fvroily plannin, xrviocs. A SectoraJ Review Miwoo on p;lpuLation and family pbrulin,lnZinm.b\O'ein1994 identifiedlackof . coorditlated_~tiOnaIimplementationOfaction p1ul 1O direct fuUlyplanninJ !ief'lil:e.^1O

5'. Pmgnmme lTWIa1er1 should detcnnine activities to be performed in order to .chieve ach specifIC objective or l.ar&et. In addition, programme managers must also detetmine who will UTI'}' OUI

uese

acth ities md when. As an example, if ae objectiveis 10 employ

.so

^IUifl

10produce and diuem inalC lEe materials on family pLa.1ning, one activity would be to m;ruil the SO peopIc:; anotIler activity ...auld be 10 train the SO reauited lUff in production and disscminatioo oflEe:naJer'.als. Thereis not mIlChinformati on on theellent10 which countries prepare specific acti....

rues

^{10achieve the specific} objecti veslwgets. In Bouwana, )'Qrly work plans arc: pttpaIed IOwa-'l b acnievemenu of' yearloais. Ifl Kenya the NCPD don prepare annual work plans.

(0 F1~ndal Plan for 1M Slnllt ~ iei Adopt~

56. BaKdon goals, 5U'a.:q:ics,objectivt$lWJels andactivlhes. PfOlf&fllnlt managers Ihoold then prepare the financial plan which estimates reven ueand espenses fortheprogram me, This may be on a year by year basis for • number of yean for ue programme. In the process of preparingJ. fi~ plan, program me managen do the fol:low,nl; lJ.

analyse current and potentw.sources of revenue;

make I conseruliveestiJnlllCofthe ~1Jt to be rC'ttlveddunng the period for which the plan is being made;

arW)'X _~l andpoltrItW elpensel for tne strattgies etosen; male I ceaservauve esumateofthe espeases WI...ill be ineur.'ed; cacutne to Sff ....hether theatlllCIpated revenues wmcover lllee_penlot~

..

"

zltlb a b W! PORIll A..t..1.2-n S@ctp n l As se s so:t.M. by So l l i e Cu l.q

Hu ber et al ., Popul.t ion TeChni cal "•• b e .nee Proj .et, Re po r t pre par ed t or US"lO, Bu reau for Global Proqraras,

ott

^{le e of PopUla tion , Dec ember 1994}

op.cl t. The t."llllly Plann inq Ma na ier ' . Handbook, Kuaor ior, Pr•• • 19U

\,

revUe stntqies ~ activitiesas noctMaty to ensure thefinancial helJth of the

procramme;

prepare detailedyear-by-ycar estimatesof revCtlues and expenses.

:57.

o.ta

is lacki"110 compare thepractice ofpreparin&financialplantinthe national family plannin&procramrnesin African countries. III Bouwana, the &ovemment providel 1 &realef suppon 10 MCHIFPand ~prodllCtivehelJtll iWOJrammein Ihe ooonlry. MMly oraanilationl havebeen provid ing assiSlanCC: 10these Procrammes. UNFPAIwbeen 1 majordonot IUpp;nt

thepast 10 yean.. OthmareU5AID,UNICEF, WHO etc. Bud&mareprepared in the llSUalIy

piCffiIDClIl format for allocation of funds to family plannin& proarammes. In Kenya. the

Minisuyof Healthhasprepareda NationaIl mplemenlationPlan(or me Kenya FamilyPlannin&

Pro&rammeCOV1:ring

1m

^{to-2(X)). Itcontains}

^a

^IeCtion

^on

^lmplementalionstepI tobe followed for improvinafinancial

mources

fOf family plannini .

IV. HUMAN IU'SOURCES MANAGEMENT

Sit African countriesfK:c problemsor tnincd manpower 10effoctiYdy manageand deliver familyplanning and lq'I'Oductive bealthsavien. The numben of trained penonncI

an:

(cw. In many cues, well tnincd pm Olinei in national family plannin&prtIll1lmmes move 10 the privales«1OI"~conditionsoflCI"\'iceare belief. II is essentialthai anincrc:aJed number of penonnd should betrained Iemanaac family plJMiniand .epiOdilClivebeallbprDiramrnes and I/'Iallheir condition. ofIef\Iioe .oould 1110beimproved inClfdcr 10 retain their scrvica. b is equallyimpoltanl W Ithere .oould be increased numbeR of womezI in rnanagemellt positions andinmeactual delivery of familyplanning andn::productive healthservicessince these services are mostly

qeted

It

women.

Curnntly few ^WQII'IeIl occupy rnanqetiaI·1cvd positions In

family plannina Xl"Yicc delivery and reproductive health care proviiMln. Thul pvticu1ar emphasis has 10be given10 inaeasina the number of &iris and

women

in meedllCllion Iystem 10eventually enable them 10 participlle in man. aerialposition. in the reproductive healthcare and family pb.nnin& pt'OCl1Immes. Anothef impol1anll5pectofhuman rnouree ~ement is provision of ldcqua1e friendly supen;sion .ua111eYtis of prDiTtinme ~ and xniu deliveryin the field. This5ClClion reviewl trainin, and supervisionaspectsinthecountrinunder study.

j9. Starremployedto workfor l familyplann ingprog~m me need 10be trained on ac:nc:ral family planoin, activities and on specific activities they are expected 10pcrfotm. l1lesepeopIc shouldbe properlyorientedtotheir;wignmenls. There shouldbe institutionalarrangements for uainin, III variouslevell. Prog~m me ~e...need 10determine whaltrainingand when saff members need10 be tnr.ined and to provide thaI training. New staff members II«ICI lm ning in basic u well as specific skills for their jobs. Change in assi,nments and c.panded responsibilities for Maffwill all require retrainingfor staff. Refresher training is an importalll

"