Introduction

Contraceptive Requirements and Logistics Management Needs

Training

Coordination and Collaboration

Monitoring and Evaluation

JOICFP-Executed Projects

Centres of Excellence for South to South Cooperation

Safe Motherhood Projects

HIV/AIDS Prevention Interventions

Implementing the Reproductive Health Approach

UNDAF Assessment

Country studies were conducted to assess the progress that has been made in implementing the ICPD Programme of Action's reproductive health approach. The studies focused on the Fund's transition from a MCH/FP approach to a more comprehensive reproductive health orientation in service delivery. Within this context, six principal areas were examined: the country's policy and legal environment; management of the country programme; access to and quality of services; IEC activities; integration of a gender perspective into all elements of the programme; and the Fund's contribution to implementing the reproductive health approach within the country.

A UNFPA-supported symposium sought to clarify the effects of population growth on the sustainability of natural resources like clean water.

Between October and December, reviews were undertaken of six countries: Burkina Faso, Mexico, Morocco, Nepal, the Philippines and Uganda. Separate review teams were assembled for each country study. Each team consisted of three to four national and international experts in health systems management, public health, health education and communication. The teams reviewed documentation; interviewed Ministry of Health managers and service providers at central and local levels, NGOs, donors, and UNFPA country office staff; and collected data according to guidelines prepared by the UNFPA Office of Oversight and Evaluation. A two-day meeting of the team leaders of the country studies was held to synthesize the issues to be included in a global report, which will be reviewed by the Fund's Policy and Planning Committee in spring 1999. The country-level findings will be summarized in the global report.

Preliminary analysis of the findings of the country studies indicates there are strengths as well as weaknesses in the Fund's efforts to implement the reproductive health approach. The Fund's close ties to governments and its excellent relationship with counterparts within those governments ensures that its inputs are in concordance with national objectives. Its field presence, coupled with its direct involvement with implementing agencies, usually enables the Fund to forge a strong collaborative working relationship with its partners. Moreover, UNFPA is sensitive to local circumstances and open to exploring different modalities for programme implementation and back-stopping.

At the same time, the Fund's country offices are small and generally lacking in technical reproductive health skills. For various reasons, insufficient use has been made of national experts or institutions to provide technical backstopping. Technical support provided by UNFPA Country Support Teams has not always been sufficient, due to the short duration of the advisers' visits and the high demands for the teams' reproductive health expertise.

The trend towards increased decentralization within governments has, the country studies found, posed additional demands on UNFPA with respect to programme development and management. The Fund has had to deal with many more implementing units, which are often geographically scattered and staffed with individuals with limited experience in areas like plan formulation, budgeting and monitoring. At the same time, it was found that coordination was better at the local level than at the central level, both among government units and among donors.

The review indicated that monitoring and evaluation efforts were not always strategically planned. There had been a tendency to employ too many indicators at different levels rather than identifying a set of core indicators. While a number of innovative pilot projects were initiated, these were not always designed to serve operations research purposes, thus limiting learning opportunities.

Sustainability of UNFPA inputs tended not to be given due attention in programme planning, although decentralization had led to more participatory approaches. There was an absence of long-term strategies for phasing out external inputs through planned capacity development, gradual cost recovery and formation of partnerships with the private sector or civil society. The review highlighted the advantages of a systems-management approach to implementing reproductive health programmes.

In light of its comprehensive scope, the review yielded much valuable data. The country studies highlighted many important issues that merit attention in future programming.