Assessment of USAID Reproductive Health and Family Planning Activities in the Eastern European and Eurasian Region with Special

This 110-page evaluation shares the results of an assessment that examined the extent to which the US Agency for International Development (USAID)'s reproductive health (RH) and family planning (FP) programming/assistance over the past decade in the Eastern European and Eurasian (E&E) region has been effective in addressing the major RH/FP needs of women and men. These key needs are related to high levels of unintended pregnancy, heavy reliance on abortion, and high maternal morbidity and mortality (compared to Western Europe and North America).

In brief, the evaluating agency - The Population Technical Assistance (POPTECH) Project - found that, although "the importance of RH/FP for maternal and child health has not been sufficiently promoted in the E&E region", USAID's assistance has on the whole been successful in encouraging use of modern contraception, training health care professionals, establishing contraceptive logistics management systems, providing information and education, and conducting mass media campaigns. They note that "the E&E countries that have been most successful in providing quality RH/FP care have also had rapidly growing economies, higher levels of government commitment to RH/FP programming, greater USAID Mission support for RH/FP activities, more involvement of the commercial and nongovernmental organization (NGO) sectors, and a greater willingness to integrate RH/FP care into primary and family-centered maternity care."

Some of the strategies USAID has used to achieve this progress are described in detail here; communication approaches figure prominently:

1. Data collection, analysis, and dissemination - official health statistics tend to be inaccurate in E&E countries, with underreporting prevalent. USAID has supported population-based RH/FP surveys in 12 countries since 1993 that provide baseline measure for USAID's programmes and supply information on which to base monitoring activities over time.
2. Policy dialogue and advocacy - the authors stress that USAID's policy-related activities seem to be most effective when closely coordinated with health sector reforms.
3. NGO development and support - for example, USAID has funded the POLICY Project to build NGO networks in Russia and the Ukraine to better promote RH/FP care and to advocate for health sector policy reforms. In many countries in the E&E region, however, the NGO sector remains weak.
4. Training and quality improvement - clinical and counselling training has been the cornerstone of the majority of the training efforts, conducted mostly through JHPIEGO, the PRIME II Project, and John Snow International (JSI). For example, the Red Apple social marketing project has trained over 100 trainers, 1,000 physicians, and 1,000 pharmacists in the Central Asian Republics region. Further, updated training tools for RH/FP have been designed and distributed in many E&E countries (though their effectiveness has not been extensively evaluated, particularly with regard to their incorporation into formal medical school curricula).
5. Management assistance and institutional development - by identifying the capabilities and resources of local organisations, USAID-funded projects have "sought to encourage and develop sustainable institutions that can support RH/FP and lead to a greater sense of involvement and ownership within participating communities...[which] have produced promising results in terms of increasing the use of human and material resources."
6. Behaviour change communication (BCC) activities - various mass media campaigns, typically accompanied by promotional activities built around slogans, logos, and informational materials, have been undertaken with collaboration from the Population Communication Services programme of Johns Hopkins University (JHU/PCS). Project-specific results are cited here to indicate success in motivating couples to use FP services. However, some of these campaigns have "studiously avoided the issue of abortion".
7. Contraceptive security initiatives - "currently, USAID-funded projects provide very little contraceptive support....However, for the majority of countries in the region, government programs cannot purchase and deliver enough contraceptives to meet demand..."
8. RH/FP care expansion
   
   • integration of RH/FP care into primary health care
   • creation of model service sites
   • social marketing of contraceptives
   • establishment of services specifically designed for youth
   • postabortion FP

An excerpt from the evaluation follows:


Recommendations:


Continue Long-Term Assistance for RH/FP Programs in the E&E Region

It is essential that funding for RH/FP programs continue at a substantial level in the E&E region. Countries with the highest abortion and maternal mortality rates and the lowest levels of modern contraceptive use should receive greater priority in future USAID allocations...

Expand Successful Pilot Interventions

Much USAID support for RH/FP programs in the E&E region has been in the form of demonstration (pilot) projects. Several program models implemented by USAID have been successful in improving RH/FP care accessibility and quality....While these activities have often produced impressive results, national-level impacts will be limited if successful pilot programs cannot be replicated and expanded.

Promote Greater Contraceptive Security in the E&E Region

Without a reliable supply of modern contraceptives, it will not be possible to make significant progress in providing RH/FP care. USAID should assist governments in improving their contraceptive management capacity and plans for ensuring sustainable and self-reliant procurement operations...

Expand Social Marketing Efforts Combining Behavioral Change and Targeted Commodity Distribution Approaches

USAID should assist governments in the E&E region to strengthen contraceptive social marketing programs to better serve high-risk (vulnerable) groups. In countries with small potential commercial markets (e.g., nations in the Caucasus), regional approaches in which similar product lines are introduced in several countries should be considered.

Promote Preservice Training and Curriculum Reforms in Supporting the Strengthening of Family Doctor and Family Group Practice Service Delivery

....The introduction of new RH/FP training curricula in medical schools responsible for graduating new family practitioners is an important priority in many settings. Such initiatives will help ensure that health sector reforms introduced in many E&E countries will become permanent features of the region's newly restructured health delivery systems.