UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
|
| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
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The electronic version of this newsletter is being made available by the
UNFPA Country Support Team for Central and South Asia and the United Nations
Population Information Network (POPIN). For further information, please
contact the UNFPA Country Support Team via email at: CSTNEP@unfpa.mos.com.np
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CASA NEWS & VIEWS
NEWS FROM CENTRAL ASIA
A WARM WELCOME FOR MS. TALAT JAFRI IN CENTRAL ASIA
Ms. Talat Jafri, Deputy to the Director and Chief, South and West
Asia Branch of the Asia & Pacific Division, UNFPA visited- three
countries of Central Asia - Uzbekistan, Kazakstan and Kyrgyzstan from
28 August to 5 September, and received a very warm welcome from the
host governments and UN staff. Her mission began in Tashkent,
Uzbekistan, the most populous country in the region. The government's
commitment to its population programme and its good will towards
UNFPA is striking as she discovered in meetings with high level
officials. She was received at the airport by Dr. Yarkulov, Deputy
Minister of Health, had meetings with Dr. Karimov, Minister of
Health, Mrs. Dilbar Gulyamova, Deputy Prime Minister and Chairwoman
of the Women's Committee of Uzbekistan. Throughout the field trips
in Uzbekistan, the mission was accompanied by Dr. Yarkulov.
In Kazakstan Ms. Jafri met Ms. Madina Djarbouslynova, Head of the
Department of International Organizations and International Economic
Relations of the Ministry of Foreign Affairs and Dr. Nina Kayupova,
Director of the Republican MCH Center and Head of the Council on
Women, Family and Demographic Policy Issues to the President. She
found the government very cooperative in support of UNFPA activities
in the region.
During a very brief visit to Kyrgyzstan, she had a working lunch
with Mr. Ercan Murat, the UNFPA Representative and the Minister of
Health. Later, she also visited a RH clinic in Bishkek.
WORLD POPULATION DAY WIDELY OBSERVED IN INDIA
The State of World Population Report 1996 was released in Delhi,
Bombay, Calcutta and Bangalore simultaneously. The release events
were attended by a large number of national and international press
representatives. The release was extensively covered in the national
press and at the State level by English and vernacular media. The
national television (Door-darshan) and other satellite channels also
gave excellent coverage.
Mr. Wasim Zaman, UNFPA Representative for India and Bhutan, had
a question and answer session with the press immediately following
the release of the report, which was mainly focused on migration and
urbanization and its linkages to health status and poverty. Mr. Zaman
emphasized the importance of the ICPD recommendations to provide
universal access to health and education, especially for girls and
women and high-lighted the reproductive health and family planning
needs. He also emphasized that in countries like India sustainable
development cannot be attained if these needs are not adequately
addressed.
The World Population Day is observed every year on 11 July. This
year's theme was "Community Responsibility: Reproductive Health and
HIV AIDS." On this occasion, the Ministry of Urban Affairs and
Employment, and UNFPA organized a seminar on Population, Health and
Urban Affairs. Mr. Zaman stressed that the time had come for the
private sector to play a major role in protecting social sector
budget along with the public sector and also contribute to and
participate in the population and development programmes.
The Indian Council of Social Marketing (ICSM) in association with
UNFPA, organised a unique campaign on reproductive health and gender
issues through folk media in slums and rehabilitation colonies of
Delhi. Volunteers of the well known street theatre group - "Asmita"
were trained on gender concerns and reproductive health issues for
one day by ICSM experts and UNFPA officials before the commencement
of the actual campaign. Special films produced by the UNFPA India
Office entitled "Violence and crime against women including
reproductive health related violence" and "Zilla Parishad's
involvement in Family Welfare activities of Gadchiroli district of
Maharashtra" were premiered for the media, U.N. agencies and others
as a prelude to the World Population Day.
A UNFPA sponsored "Search Conference" was organized to act as a
catalytic bridge between funding agencies, Government and NGOs. The
18 hours work-shop was carefully designed to discuss, analyze and
discover the status of population and development issues among
national NGOs, local NGOs, FP-RH clients, private sector, community
partners and funding sources etc.
SRI LANKA ADOPTS AN INNOVATIVE APPROACH TO PROJECT FORMULATION
Following the approval of its country programme, the UNFPA
Representative in Sri Lanka, Ms. Suneeta Mukherjee discussed a team
approach with the CST and for the purpose of project formulation
decided to have only four projects to facilitate effective
implementation of a holistic programme approach. The chosen areas
were: reproductive health services, policy and research, advocacy and
increased NGO participation in RH. A joint mission strategy was
adopted so that work on all four projects was undertaken
simultaneously by four different groups. Four teams were constituted
comprising implementors, national consultants and UNFPA/CST advisers.
The task began with the launching of a national workshop (2-4 August)
where inputs from a large number of experts in RH were made.
Representatives of universities and those undertaking research were
also included.
Intensive discussions during the workshop were followed by 10
days of work on project formulation by all missions who sat in the
same compound of the United Nations office in separate rooms and
interacted with each other to coordinate and understand each others'
projects. The completed drafts were exchanged between the teams and
further discussed before they were finalized. Project documents were
then circulated to the Project Appraisal Committee and thereafter,
formally presented to the National Coordinating Council on
Population, where changes were made and after discussion all four
projects were approved.
Though Sri Lanka is poised to reach replacement level fertility
with strong demographic indicators, there are vulnerable groups of
population such as FTZ (Free Trading Zone) workers, estate workers,
migrating women and their families, internally displaced persons,
child prostitutes and adolescents, who require special attention.
There are also underserved geographic areas in the country. Despite
Sri Lanka's positive maternal and child survival indicators, maternal
anaemia is very high (over 60%). Although the contraceptive
prevalence is high (66%), there is also high dependency on
traditional methods (22.4%) with low use of temporary modern methods
(16.5%). There are indications of high levels of abortion (ad hoc
studies estimate 750 per day). The age at marriage is high (females
25.5 years and males 29 years). Unmarried youth are not allowed
access to services in the national family planning programme. Male
participation is low and though there are four national NGOs,
community participation is lacking. Also components of RH such as
Reproductive Tract Infections (including STD/HIV-AIDS) and prevention
and early detection of reproductive tract malignancies have to be
integrated into the programme. The ongoing armed conflict in the
northeast of the country, does not allow the government to invest
more in this area in spite of its strong commitments. Also it has
prevented a census being undertaken in 1991 and a large number of
families (700,000 approx.) have been displaced by the civil strife
affecting mostly the women and children.
IRAN'S MID-TERM REVIEW CONDUCTED
A very successful MTR of the Iran Country Programme was held
during 8-14 September. The UNFPA Representative, Mr. Shu Yun Xu and
his colleagues in the Country Office played a very active role.
Participants from UNFPA included two members from the Nepal Country
Support Team, Ms. Daphne Rebello and Ms. Jean Robson, and Ms. Talat
Jafri represented UNFPA Headquarters.
General conclusions of the MTR were that the country programme
(CP) was proceeding very well: objectives and activities did not need
major modification. Population growth rate has been reduced from 3.2%
(1986 Census results) to 1.56%. Although other sources indicate that
it is closer to 2%, the decline nevertheless does exceed the goal set
in the current Five Year Plan of 2.3%. The MTR noted the main reasons
for the success of the programme were government commitment, high
degree of political participation, emphasis of the present government
on education and reorientation of FP to address the wider issue of
RH including HIV/AIDS.
PAKISTAN DECENTRALISES IEC TO THE PROVINCES
The participants of the national IEC Strategy Reformulation
Workshop, held from 5-8 August in Islamabad considered the outcome
of recommendations made in the four provincial workshops and
identified policy development, training, advocacy, public relations,
research and evaluation, and coordination, as the key roles of the
Ministry of Population Welfare. The workshop was inaugurated by
Mr. Ijaz Ahmed, Secretary, Ministry of Population Welfare and
addressed by Mr. J. Salik, Minister for Population Welfare, among
others. The inaugural session was also attended by Mr. Geoffrey
Allan, the Australian High Commissioner, Mr. Muzaffar Mahmud Qureshi,
Director NIPS, Provincial Secretaries, various Directors-General,
over 25 participants and guests from donor agencies and NGOs etc.
Mr. Iqbal Qureshi, IEC Project Coordinator, and several resource
persons coordinated the workshops and formulated the main
recommendations. Mr. Javed S. Ahmad from the Kathmandu CST
facilitated the workshop.
The workshop in Islamabad completed the series of five IEC
strategy reformulation workshops funded by the AUSAID and UNFPA. The
recommendations of the workshop were in tune with the Government
policy of decentralization of population welfare programme and
improving provincial capacity to undertake greater responsibility for
IEC activities.
UPDATING KNOWLEDGE OF CST ADVISERS
UNFPA-HQ has been making several efforts to update knowledge
among CST Advisers and make them more effective in their work. As a
part of such efforts, a group of eight CST Advisers (from Addis
Ababa, Amman, Bangkok, Dakar, Kathmandu, Santiago and Suva) and two
TED officers were sponsored to attend a short course on Monitoring
and Evaluating RH Programmes, at the London School of Hygiene and
Tropical Medicine from 22 July-2 August. Mr. G. Giridhar, who
attended the course from the Kathmandu team reports that he found the
course very useful and more importantly the opportunity to meet CST
colleagues from other regions.
The next phase of such updates are the Thematic Workshops to be
organized by the UN Specialized Agencies and The Population Council
in the last quarter of 1996 and the first quarter of 1997.
POPULATION OF BHUTAN WILL DOUBLE IN 23 YEARS
UNFPA's Programme Review and Strategy Development (PRSD) Mission
to Bhutan (16 September-2 October) has informed the government of
Bhutan of the serious implications of rapid growth of population on
Bhutan's prospect of achieving its cherished goal of sustainable
development. This statement was a reinforcement of Bhutan's Royal
Edict of 1995 in which the importance of population planning is
underscored within the context of population and sustainable
development. The mission estimated that the population was growing
at the rate of 3.1 percent per year and at this rate, would double
in about 23 years.
The mission was led by Mr. Rafiqul Huda Chaudhury, Adviser,
Population Policies and Development Strategies; other two members
were Dr. Saramma Mathai, Consultant, Reproductive Health and Mr.
Najib M. Assifi, Adviser, Population Advocacy. Mr. Wasim Zaman, UNFPA
Representative for India and Bhutan and Mr. Jens Peterson, JPO from
UNFPA Delhi office accompanied the Mission to facilitate its tasks
in Bhutan.
The mission's recommendations covered three broad subject areas:
Population and Development Strategies; Reproductive Health,
including Family Planning and Sexual Health; and Population Advocacy
and Information, Education and Communication. In the area of
Population and Development Strategies the mission argued that to meet
shortage of trained manpower, human resource development in the areas
of survey sampling, operations research, data processing and analysis
and population and development should be supported. With regard to
improvement of information data base, the Mission recommended strong
linkages between the Central Statistical Organization and district
level planning offices and improvement of data collection systems
at the district level for decentralized development planning. To
meet gaps in policy research, the PRSD Mission recommended priority
population development research on topics such as: interaction
between population growth, poverty and environment; demographic and
environmental impact of development policies and programmes; and
dynamics of rural-urban migration, etc.
The PRSD Mission also recommended that each sectoral Ministry
should incorporate population concerns into its mainstream development
activities. Under the rubric of Reproductive Health, including Family
Planning and Sexual Health, the Mission recommended that the national
reproductive health strategy takes into consideration all aspects of
essential reproductive health package which includes education and
services for family planning, safe motherhood including care of the
newborn, abortions, infertility, reproductive tract infections/
sexually transmitted diseases and adolescent reproductive health
needs. The Mission also recommended that access and availability of
quality reproductive health services are improved through expansion
of outreach clinic facilities, training of female VHWs and
strengthening of BHUs and district hospitals; increasing availability
of a wider choice of contraceptives and provision of quality health
services through counseling and informed choice.
In the area of Advocacy and Information, Education and
Communication, the PRSD Mission recommended that advocacy efforts
should be promoted targeting the policy makers and planners of
sectoral ministries, development committees at district level, the
Monastic Body, the National Women's Association of Bhutan and the
mass media, particularly radio. The mission recommends that broader
issues of population and reproductive health such as adolescents and
reproductive health, gender equity, male participation and other
relevant issues should be interwoven in all IEC messages. In this
respect a special emphasis should be placed on strengthening of
interpersonal communication and counseling on reproductive health
issues through all service providers, especially those working at BHU
and outreach levels.
CASA REGIONAL MEETING OF UNFPA REPRESENTATIVES,
CST AND UNFPA HEADQUARTERS
COUNTRY SUPPORT TEAM APPROACH: A MODEL FOR OTHERS
The CASA Regional Meeting of UNFPA Representatives, CST and UNFPA
Headquarters, was held on 17-19 June 1996, in Kathmandu. Mr. Saad
Raheem Sheikh, Director of the Country Support Team for Central and
South Asia (CASA) opened the meeting by extending a warm welcome to
the UNFPA Representatives, the Regional Technical Adviser, National
Programme Officers and to the Headquarters' representatives,
Mr. Mohamed Nizamuddin, Director, Asia and the Pacific Division,
Mr. Sethuramiah Rao, Director, Technical and Evaluation Division,
Ms. Virginia Ofosu-Amaah, Chief, Gender, Population and Development
Branch, and Mr. Bjorn Andersson, Coordination Officer, Planning and
Coordination Division.
Speaking on the future of CSTs, Mr. Nizamuddin noted that their
role had been recognized in extending technical assistance to
countries and they were here to stay. He said that other UN agencies
have acclaimed effectiveness of the team approach and considered it
as a model for providing technical support at the field level.
Mr. Nizamuddin and Mr. Rao then articulated on what a CST should and
shouldn't do. Participants were informed that the role of CST is
evolving and a topic of every IATF meeting; the revised guidelines
on this subject are contained in the circular from the Deputy
Executive Director (Programme) dated 13 June 1996 which included the
agreement reached at the IATF meeting in Geneva 9-10 May, 1996. Some
of the salient points of these guidelines include:
* based on its experiences CSTs should synthesize the lessons
learned;
* further the multi-disciplinary approach;
* assist in conceptualization and development of regional
programmes; and
* encourage the integration of population components in country
activities of the UN agencies.
The ensuing discussion highlighted the role of CST in capacity
building through activities such as training courses. It was felt
that conducting comprehensive assessment of training needs and of the
facilities for training at the national and regional levels was pre-
requisite for organizing training programmes. CST was told that their
activities should not be mission oriented. Its role should include
synthesizing and analyzing country experiences and providing feedback
to the Headquarters. For this purpose, CST Advisers should at least
spend about half of their time at their base for study, writing,
preparation, training and "attachment" activity. Earlier Mr. Sheikh,
in his opening remarks had requested the UNFPA Representatives to use
the CST Advisers more in planning, team activity, and
interdisciplinary approaches rather than rushing them off on "fire
fighting" missions. There was also a general concern that if the
Advisers spent half of their time on nonmission activities, the
country programme needs may get neglected.
After a lengthy discussion and keeping in mind the primary
objectives of the CST, several suggestions were made: that CST should
work in concert with national institutions and/or national
consultants and in that process provide necessary orientation for
capacity building; CST Advisers should be both pro-active and
reactive in their approach to technical backstopping and that team
approach should not replace missions by individual advisers. Mr. Rao
said that CST's role can be strengthened, not by increasing numbers
but by focussing on national capacity building. He also urged the
Representatives to identify strategic areas where CST support will
be required.
Other topics of discussion included: promoting NGO partnership,
gender issues in management of UNFPA and CST offices, revised
procedures for PRSD, programmes, monitoring and evaluation, resource
allocation, etc. UNFPA Representatives reported on the status of
implementation of the ICPD Programme of Action in their respective
countries. The Regional Technical Adviser and National Project
Officers from the Central Asian countries and Bhutan made brief
statements concerning their respective countries. Several CST
advisers made presentations proposing various initiatives to the
group, involving the CST and field offices.
Orientation on Gender, Population and Development for UNFPA
Representatives and CST Advisers
A two-day training workshop on gender issues was held on 20-21
June, after the regional meeting was over. Ms. Kiran Bhatia and
Dr. Arzu R. Deuba conducted the workshop where the Chief of Gender,
Population and Development Branch, Ms. Virginia Ofosu-Amaah
participated as a resource person. Participants were given
sensitization exercises, reading materials and class work. Several
concepts were discarded, clarified, re-defined and new ones
introduced. Differences between `sex' and `gender' for instance, were
clarified: sex is biological and unchangeable reality while gender
is a dynamic and socially constructed concept. The participants were
given a -gender analysis frameworks to review gender dimensions of
projects. An outside resource person, Mr. Neil Andersson, made a
presentation on "Participatory and Gender Sensitive Data Management".
Several recommendations emerged from the meeting. The final session
was moderated by Mr. Sheikh and addressed by guest speakers,
Mr. E. Pelinck, Director General of ICIMOD and Ms. Carroll Long, UN
Resident Coordinator for Development, Nepal.
On 22 June, an exclusive session was held with the RTA and NPOs
from Central Asia and CST Advisers. In the morning session, each
adviser made a brief presentation to the group about their areas of
work and in the afternoon, a brain-storming session was held in which
issues and concerns in the region before and after the approval of
projects were discussed with Mr. Sheikh and Mr. Nizamuddin.
LOOK FOR CASA NEWS & VIEWS ON GOPHER
CASA News and Views is now available in cyberspace. Find it on
Internet on both POPIN and UNFPA sites. The direct address is:
gopher://gopher.undp.org.70/11/ungophers/popin/unfpa/cst/cstcasa/
newsletter
The newsletter can be accessed at this site also via the POPIN WWW
site.: http://www.undp.org/popin/regional/asiapac/asiajour.htm
http://www.undp.org/popin/regional/asiapac/asiapac.htm
http://www.undp.org/popin/journals.htm
and via the UNFPA gopher and WW site gopher:
gopher://fpa003.unfpa. org in the CST section. WWW site:
http://www.unfpa.org (under CST), courtesy of Ms. Susan
Pasquariella of the UN's Population Information Network. Happy
cruising!
TWO HEART WARMING TALES FROM RAJASTHAN
Among the "Area Projects" supported by UNFPA, the Rajasthan
family welfare programme has shown much promise. The supportive IEC
and MIS project's second phase was launched in 1989 and is scheduled
to expire at the end of 1996. UNFPA's Delhi Office constituted an
evaluation team led by the eminent Prof. Sagar Jain, other members
were Prof. Lalit M. Nath, Consultant, and Mr. Javed S. Ahmad, Adviser
on Labour and Population (IEC). They reviewed over 65 documents,
visited six project sites and met over one hundred officials during
their three weeks' mission in Rajasthan. Needless to say, the
findings were a mixed bag of shining accomplishments and missed
opportunities. From the accomplishments, we cite here two instances
where UNFPA inputs are making a difference.
One of the success stories is the excellent collaboration
developed under the Area project with NGOs through the Swasthya Karmi
Scheme to reach the hard-to-reach rural population. The scheme was
launched in February 1995. The standardized approach involved
recruitment of women workers "Karmis" from the villages in the
assigned primary health care block of 25 villages and their training
in recognizing a variety of symptoms and problems in reproductive
health, MCH and STDs. Karmis visit each household in their own
village, provide free contraceptives (condoms and pills) and sell
lowcost essential drugs. For every five workers, one Sehyugi
(supervisor), usually an ANM, is appointed. Each Karmi receives an
honoraria of Rs.400 (equiv. $11.40) per month.
The mission met a Karmi working with "Gharib Nawaz Mahila Avam
Bal-Kalyan Samiti", a small NGO operating out of Ajmer District. The
experience of meeting Manju Lata Yadav, 28, mother of three, with 23
continuing users, was an inspiring one. Manju's own youngest child,
a son, is six years old. She has studied up to six classes and is
able to keep records of her work meticulously. She had samples of
26 IEC materials including a flip chart that she could share with
her clients. She also has Swasthya Karmi training Module which she
refers to when she needs to refresh her memory. Manju's story
reflects what the NGO has done in preparing her for the job through
steady contacts, training sessions and friendly supervision, all
orchestrated by the dynamic and charismatic leadership of the
Organizing Secretary of "Gharib Nawaz", Mrs. Shagufta Khan. It is
not surprising that in a short period of about seven months, 25
Karmis working with "Gharib Nawaz" have collectively recruited 708
clients who use condoms, 574 use pills and have referred 19 women for
sterilization and an additional 19 for IUD insertions. It seems that
"Gharib Nawaz" has set up a model of how to implement the Swasthya
Karmi scheme. "Gharib Nawaz" has just about completed successfully
an ILO project on the prevention of child labour, under which 100
children were selected, given opportunity to acquire literacy,
vocational skills, have recreation and to enroll in formal school
system. "Gharib Nawaz" has also been operating a project, called a
Mini Family Welfare Programme, in the urban slum of Ajmer, by
training and supporting 25 female workers, called "Sahelis" (female
friends), who visit women in their homes to educate them on family
planning and also function as depot holders for contraceptives. Mrs.
Khan says that an evaluation of the project showed that none of the
women recruited by Sahelis, using spacing methods got pregnant during
the three years of the project life.
At least four out of the 13 NGOs working under this programme are
excellent, says Dr. Pareekh, the Deputy Director in-charge of the
programme in the IEC Bureau. And about the same number are marginal
performers. Swasthya Karmis are better trained and better paid
village workers who work where there may be no subcentre nearby, and
thus they fill an unmet need. Dr. Pareekh said that Swasthya Karmi
programme is basically self-directed as each NGO takes full charge.
It needs minimal interference but a lot of monitoring and
facilitating, as occasionally local PHCs may feel losing the grounds
to NGOs and may hold back in sharing stocks of contraceptives,
medicines and IEC materials. Usually these issues are resolved
amicably. The success of the project is also evident from the fact
that beginning April 1996, its funding is provided by the World Bank
project.
A second project, Jan Mangal, concerning village based workers
providing door-to-door information and services in Udaipur and Alwar
districts of Rajasthan is also initiated and managed by the State IEC
Bureau. This project was launched in June 1993 when nearly 3,000,
mostly young, volunteer couples were recruited from villages across
the districts and trained in counselling and spacing methods. They
immediately began to contact eligible couples in their villages and
supplied them condoms and pills at their request. No honoraria
payments are made to the volunteer couples.
The scheme was evaluated in depth by an independent agency in
December 1995 covering a broad range of issues and applied varied
measurement techniques. The report indicated some attrition in the
number of couples as only 2,352 were still working. Two thirds of
the active couples were working for 18 months or longer, while one-
fourth were working for 12-18 months and the remaining 10% were
working for under one year.
It was learnt that on average each volunteer in Udaipur had
recruited 3.26 condom users and 1.49 pill users. In Alwar the
averages were 2.5 and 1.43 respectively. In a meeting with a group
of Jan Mangal couples, the mission learnt that husbands and wives
were not always working together, although some wives do go door-to
door. Only husbands contact other husbands and both men and women
may come to the couple's house to get supplies. They could hand out
IEC materials when they had them. It appeared that there was a wide
variation in performance of couples, which probably varied with their
motivation to perform and supervision. It is noteworthy that only
Rs.40-50 are paid to each volunteer as reimbursement for
transportation to attend periodic meetings (baithaks). Unlike
Swasthya Karmi, Jan Mangal programme relies completely on the
interest, goodwill and cooperation of volunteer couples. Roughly
speaking, between 1992-1995 fiscal years, the average management cost
of the project was estimated to be Rs.1,227 (about $35) per volunteer
over the same period. There is no doubt that the scheme is
successful in taking the services and information to the door steps
of those who need them in remote rural areas at a minimal cost.
It is estimated that in three years (1993-1996), Jan Mangal
couples had provided over 50,000 Couple Years of Protection. Jan
Mangal volunteers distribute contraceptives free, and serve as
stockist of pills and condoms in their villages. Most of all, Jan
Mangal couples have succeeded in making spacing methods such as
pills, popular among rural women. The success of the programme is
best reflected from the fact that the scheme is now extended to 11
districts, six of which will be funded under the World Bank project.
A quick analysis of the two cases presented here, leads one to
conclude that when community participation in programme
implementation is ensured, results can be rewarding. Small
investments made in training, supervision, management, and care can
yield big returns. A little flexibility in undertaking innovative
schemes, with due checks and balances, allows government machinery
to work with NGOs productively and, as in these cases, permits
extension of the information and services to hard-to-reach
populations in distant and remote areas.
BENCHMARKING: INNOVATIVE ADAPTATION OF BEST PRACTICES
G. GIRIDHAR, UNFPA CST FOR CASA
ICPD calls for a clear positioning of family planning within the
broader context of reproductive health. Simple population growth
objectives have given place to not-so-simple health status and well-
being objectives. But what is equally significant in the ICPD-POA is
a shift in managerial focus which emphasizes effectiveness and
quality of processes, not just the outcomes. It is this emphasis on
processes that calls for developing national management capacities
and creating opportunities for learning from international best
practices, innovative ideas and effective operating procedures.
Benchmarking best practices is a process of seeking out and
studying the best internal and external practices that produce
superior performance. The truth is that no single organisation can
ever control or dominate all effective operating practices and good
ideas. To be effective, one must look outward as well as inward for
constant improvements and review ideas. Benchmarking is nothing but
the old way of learning by borrowing from the best and adapting
their approaches to fit our needs. By exposing the organisation and
people to new ideas and approaches, significant insights can be
developed. But the process needs to be planned and managed well to
focus attention on learning, adapting and implementing.
Experience indicates that for every example of innovative
adaptation, there are many more examples of organisations and people
who have declined to look outward for solutions. Pragmatic managers,
on the other hand, know that there is no need to reinvent what others
have learned to do better. They believe in imitating creatively,
adapting innovatively, to adopt, adapt and advance. A systematic
search for best practices quickly draws managers outside the confines
of their own culture, habits and practices. This is essential if
organisations and individuals want to accelerate their own rate of
progress.
Benchmarking is a tool for achieving idea enrichment. Each study
tour we organise should be a bench-marking trip, a learning safari
producing valuable new ideas and approaches for doing old tasks.
Successful benchmarkers return to their organisations and become
catalysts for change. The process calls for involving employees in
personal discovery of more effective practices. The AT&T Universal
Card Services observes an operating truth that every benchmarking
manager has observed: "Tell me and I forget; show me and I remember;
involve me and I understand".
Studies of corporate companies indicate application of three
distinct types of benchmarking (a) process benchmarking, (b)
performance benchmarking and(c) strategic benchmarking. Organisations
using process benchmarking believe that if core processes are
improved, performance will also improve. They focus on work processes
and operating systems such as customer feedback processes,
recruitment, strategic planning and problem solving processes.
Performance benchmarking focusses on price, technical quality,
reliability, speed of procurement, data transmission, feedback etc.
Strategic benchmarking tries to identify winning strategies that have
enabled organisations to succeed. This influences longerterm
competitive performance and hence benefits may accrue more slowly
than in the case of process benchmarking.
A text book on benchmarking practices proposes a simple litmus
test to determine if these processes will be useful to a manager.
He/she should ask the following questions:
> can my organisation afford to stop improving ?
> can my organisation afford to stop learning ?
> can my organisation afford to ignore client needs ?
If the answer to any of these questions is Yes, then "put this
book aside" says the text, "it will not benefit you"!
EXAMPLE OF BEST PRACTICES IN THE AREA OF REPRODUCTIVE
HEALTH/FAMILY PLANNING
MATLAB EXPERIMENT IN BANGLADESH
Rafiqul Huda Chaudhury, UNFPA CST for CASA
In the backdrop of unfavourable social, institutional and
economic settings, doubts were often raised as to whether fertility
reduction efforts would have any measurable impact in Bangladesh.
Contrary to all conventional wisdom, the MCH-FP (Maternal Child
Health and Family Planning) demonstration project of the
International Center for Diarrhoeal Disease Research, Bangladesh
(ICDDR,B) in Matlab, a rural area of Bangladesh, showed that an
appropriate system of supply that is adapted to client needs and
consistent with social conditions in rural Bangladesh could lead to
rapid and sustained increase in contraceptive use and subsequent
reduction in fertility even in a socio-economic milieu not conducive
to demographic change.
The Matlab MCH/FP project, designed to be an experiment, was
launched in 1977 by ICDDR,B to test the hypothesis that getting
supplies and messages on health and family planning to eligible women
will lead to greater contraceptive use (Hubert and Khan, 1979). For
this purpose, a control and treatment area were chosen in rural
Matlab, the field research station of the ICDDR,B. No innovative
MCH/FP interventions were introduced in the control or comparison
area except for limited family planning services provided by the
government, while in the treatment area a wide range of community
based FP and MCH services were provided at the doorsteps of the
currently married women through regular home visits, twice in a
month, by a batch of educated and well trained community health
workers, under the close supportive supervision of the project
managers at various levels. The Contraceptive Prevalence Rate (CPR)
continued to rise rapidly in the treatment area within few months of
the introduction of the project activities, and has continued to rise
slowly but steadily in the following years. The evaluation of the
project showed that CPR in the treatment area increased from 19
percent in 1978 to 40 and 63 percent in 1990 and 1993 respectively.
The comparable rates for the country as a whole and for the control
area were 45 and 33 respectively in 1993. This increase in
contraceptive use was accompanied by a decline in fertility. Total
Fertility Rate (TFR) in the treatment area declined from 4.5 in 1985
to 3.6 in 1990. The corresponding figures at national level and
control area were 4.3 and 5.2 respectively in 1990.
Various reasons may be adduced to explain this sharp rise in CPR
in the treatment area, of which particular mention may be made of the
following: (i) door step delivery of family planning and maternal and
child health services by field workers who have sufficient
credibility in the community to convince local women to practice
contraception. This was ensured by recruiting young, married and
educated local village women, with at least eight years of education
and themselves using contraceptives, as field workers. "Critical to
the success of the Matlab experiment is the role of young, married
and educated village women as primary service providers" (Phillips,
1994); (ii) delivery of services by building rapport and
understanding fostered by frequent meetings of the field workers with
their clientele in the privacy of their home; (iii) wider choice of
contraceptives, particularly reversible and injectable
contraceptives, with clinical back up for basic health services; (iv)
close and supportive supervision of field workers and continuous in-
service training; (v) informed planning and supervision based on
simple but well-established management information system; (vi)
integration of family planning with maternal and child health
services and (vii) ability of the field workers to help clients
dissatisfied with one method to choose another method, etc. In time,
the Matlab experience showed that an "appropriate system of supply
with structures and functions that are adapted to client needs and
consistent with village institutions, can affect reproductive
behaviour, even in the absence of social conditions that
independently induce a demographic change" (Phillips, 1994).
To examine the feasibility of implementing Matlab's service
delivery strategy at the national level, ICDDR,B launched, jointly
with the government, MCH-FP Extension Project in 1982. The MCH-FP
Extension Project covers two new sub-districts, outside Matlab, and
the main activities of the project centered around improving
management and increasing the quality of care. In the MCH-FP
Extension Project, the services were provided through the normal
government structures, while the research support, particularly the
design and evaluation of the interventions were provided by ICDDR,B.
The evaluation of the MCH-FP extension project shows higher
contraceptive use and lower fertility in the project areas compared
to the national levels.
The results of these two projects of ICDDR,B, Matlab MCH-FP
Project and MCH-FP Extension Project, have influenced the national
policies and programme management in various ways. Among the major
initiatives undertaken by the government in response to project
findings include: (i) expansion of staff density by recruiting more
field level female workers and (ii) adoption of management
information system developed and field tested by ICDDR,B projects.
Many other innovations, developed and field tested by ICDDR,B
projects, to improve programme effectiveness and quality of care are
now implemented by national programme (Haaga, et.al. 1993).
The results of ICDDR,B projects have not only influenced
population policy and programme in Bangladesh but also affected the
national population policy and programmes in other countries,
particularly Pakistan. Learning from the experiences of Matlab, the
Ministry of Population Welfare in Pakistan launched a village based
family planning worker project in four districts of Punjab, on pilot
basis in 1992. The project also envisages delivery of health,
particularly treatment of minor ailments and family planning services
at the door steps of rural married women through regular visitation
of households by a cadre of locally recruited married female workers,
aged 25-40 years, with at least 10 years of education.
References
1. John G. Haaga, et.al. 1993. The Contribution of ICDDR,B
Research to Family Planning Programmes; International Center for
Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Working Paper
No. 95, Dhaka, 1993.
2. Hubert, DH, and AR Khan, "Contraceptive Distribution in
Bangladesh: The Initial Impact", Studies in Family Planning, 10,
8, 1979.
3. Phillips, James, 1994. Matlab and the Bangladesh Family
Planning and Health Programmes in Matlab: Women, Children and
Health: ICDDR,B, Dhaka, 1994.
STAFF NEWS
CST WELCOMES NEW ADVISER
Ms. Jean Robson joined CST CASA as the Adviser for Training and
Research in Reproductive Health/FP, on 7 August 96.
Ms. Robson joins UNFPA from the Global Programme on AIDS/UNAIDS
at WHO HQ in Geneva, where she was training officer for four years.
Prior to that, Ms. Robson has worked as an adviser in child survival,
rural development, PHC and MCH projects around the world and has
extensive experience in the training of trainers, production of
learning materials and educational evaluation. She is a curriculum
and learning systems specialist with more than twenty years'
experience in the health field in Asia, the Pacific, Africa and the
Middle East, mainly with INGOs, national training institutes,
universities as well as international organisations.
A British national, Ms. Robson is both a health and education
specialist. Originally qualifying as a nurse in the UK, she worked
as a public health nurse/midwife and later graduated from McGill
University in Canada. Her postgraduate studies in education were at
Lancaster, London and through the Open University.
In the field of reproductive health, Ms. Robson has worked as
statistical analyst and designed small studies, participatory
research methods and more recently operations research linked to
improving quality of care and services.
... and bids farewell to ...
Mr.K. S. Seetharam, who after having spent three hectic and
productive years with CST in Kathmandu, returned to his mother ship
in Bangkok- ESCAP, as TSS Specialist in Population and Development.
Mr. Seetharam in his personal note of thanks to colleagues said: þI
enjoyed my assignment with CST, both professionally and personally.
As I will continue to be a part of the TSS system I hope I will have
the opportunity to meet and work with you and other colleagues in the
future. Mr. Seetharam can be reached via e-mail address: seetharam.
unesco@un.org
Mr. Sans S. Hutabarat, left CST upon retirement, in May 1996,
after more than three years of distinguished service with the CST
office as the UNESCO Adviser, Population Education. Mr. Hutabarat has
rejoined the Teacher Training and Educational Sciences Institute,
Bandung his home town, where he was Assistant Professor before
joining UNESCO. At the Institute, Mr. Hutabarat will teach Population
and Family Planning Education. His address: tel: 62-22-210956 postal:
Jalan Setiabudi 223, Bandung 40154, Indonesia.
Best wishes to both of our colleagues.
KATHMANDU COUNTRY SUPPORT TEAM'S ACTIVITIES
AZERBAIJAN
- The Republic of Azerbaijan will conduct a population census in
January 1999, the first since independence and the State Committee
of Statistics has started preparations in advance. Considering the
short time available to conduct this massive exercise, there is
urgent need for technical support and mobilization of resources for
the census. During her mission to the Republic, Ms. Luisa Engracia,
Adviser on Population Statistics provided technical support for
questionnaire preparation and demonstrated the use of computer
software MS PROJECT and its relevance to planning for census
operations.
BANGLADESH
- From 1992-93, UNFPA has assisted the Department of Family
Planning to develop their decentralized data processing capability
by providing computers at district level and supporting necessary
training activities. This facility provides easy access to
programmatic information and should improve use of MIS data in
conjunction with related information on logistics, personnel,
finance, facility status, quality of care etc. Attention will now
have to shift towards developing a process of using information for
management purposes, particularly at the district level and below.
Mr. G. Giridhar, Adviser, Management of Population Programmes was on
a mission to Dhaka from 2-11 July to assist the MIS Unit of
Department of Family Planning in reviewing performance indicators and
developing a process of using MIS information for managerial decision
making.
- Ms. Vineeta Rai, Adviser on Gender, Population and Development
was on a brief mission to Bangladesh from 7-12 July to prepare a
working paper for a workshop on "Gender Issues in Reproductive
Health", planned in August 1996. A number of available documents were
used to prepare this paper, covering strengths and weaknesses of
FP/MCH programme in Bangladesh with special reference to gender
issues and current thinking on how to redress the situation. She has
also recommended priorities for the future in order to implement a
gender-sensitive RH programme.
INDIA
- The Programme Review and Strategy Development mission to India,
has recommended to UNFPA that consideration be given to the
establishment of the IEC Bureaus in the priority States using the
Rajasthan IEC Bureau as a model. However, the mission laid down a few
conditions to be met prior to the establishment of such Bureaus.
These include: conducting feasibility studies, provisions for giving
autonomy to the Bureaus and commitment to multi-sectoral approach in
planning and implementing IEC activities. Mr. Najib M. Assifi
participated in the exercise as the IEC and advocacy specialist.
The overall strategy proposed as part of the advocacy and IEC
programme comprised: (a) population advocacy through national
institutions, and (b) advocacy and IEC at the district/state level.
For conducting advocacy activities, the mission recommended advocacy
at the policy level through media and formal and non-formal education
establishments, and for women's empowerment. At the district/state
level, it was recommended that IEC be integrated into the
reproductive health programme. The main feature of this approach was
preparation of advocacy and IEC plans at the district level with full
participation of community members, service providers and district
authorities. Provision of support in training, production of
materials, mass media campaigns etc. establishment of IEC Bureaus is
also proposed.
UNFPA has also supported the establishment of an IEC Bureau in
the State of Maharashtra, with technical assistance from CST.
- Mr P. M. Jesse Brandt, Adviser, RH/FP Logistics and MIS
assisted UNFPA in preparing and conducting a one-day meeting of
relevant government officials to discuss current status of logistics
systems and operations. A manual on project formulation for
logistics operations that he had prepared earlier was also discussed
at this meeting. During this mission from 26-30 May, Mr. Brandt also
worked on revisions in the 1995 report on Contraceptive Requirements
and Logistics Management Needs.
ISLAMIC REPUBLIC OF IRAN
- Mr. Rafiqul Huda Chaudhury after having reviewed two UNFPA
funded projects, during his visit to Iran from 12-20 May, recommended
that the Population and Manpower Planning Bureau (PMPB) of the Plan
and Budget Organization takes immediate steps to constitute a
drafting committee on population policy, consisting of academics,
experts, policy planners, administrators, representatives of NGOs and
women's groups. He also recommended that a Master's level degree
course in Population and Development be introduced at a renowned
Iranian university or institute to meet the shortage of trained
manpower in this field. Some of the salient recommendations made by
Mr. Chaudhury are that PMPB should take necessary measures to
consolidate coordination of population activities in the country as
well as research; under the projects in the policy sector the role
and status of Iranian women should be adequately highlighted.
- During the same period, Ms. Luisa Engracia, Adviser in
Population Statistics, reviewed the project in the improvement of
vital statistics. She noted that despite the efforts of the project
director, the implementation of the project was behind schedule. The
mission recommended that more detailed vital statistics should be
generated and revised forms for the registration of vital events be
scrutinized and introduced. Also that the project should initiate
an IEC campaign on the importance of civil registration.
- In a subsequent visit, from 22-26 September, Ms. Engracia
assisted the Statistical Center of Iran and others in reviewing the
exercise for training of the staff to be engaged in the forthcoming
decennial national population census (beginning October 22) and in
designing the data processing tools after the census data starts
coming in.
- Ms. Jean Robson, Adviser, RH/FP Training & Research has
recommended urgent technical support for improving monitoring and
evaluation component of the project in Community- based RH/FP, in
preparation for the forthcoming programme cycle. Ms. Robson, who was
participating in the Mid-term Review of five UNFPA supported
projects, made several recommendations for CST's assistance to
consolidate current gains rather than for expansion. For the project
on FP Service and Training Centers, she recommended that
recanalization efforts should not be treated as a priority until
further research has been done into local determinants of
post sterilization regret. Ms. Robson supported audience research for
the FP/IEC Center.
- Mr. G. Giridhar, Adviser in the Management of Population
Programmes, assisted the Ministry of Health and Medical Education to
conduct a workshop on RH/FP management from 18-21 May at the Uroomieh
Medical University in Azarbaijan province. The workshop was attended
by over 40 participants (about half of them women), including
national and provincial level managers and public health faculty from
selected universities. The provincial managers will develop a Plan
of Action for training district and lower level staff in programme
management. Mr. Giridhar prepared detailed notes on management for
this workshop and also conducted several sessions. Mr. Shu Yun Xu,
UNFPA Representative addressed the participants during the inaugural
session and expressed his support to the Ministry in their efforts
in management development.
KYRGYZSTAN
- Using the slogan "Let's Keep Bishkek Healthy", and a newly
designed logo, fourteen educators designed several folders, flyers
and posters aimed at the high risk groups, like drug addicts,
alcoholics, sex workers, prisoners and homosexuals, as well as
youths, women aged 15-45, immigrants, shop tourists, truck drivers,
soldiers, workers in the entertainment and restaurant/bars business.
The seven-days' workshop was inaugurated by Madam Raykhan
Abdraimova, the Adviser and Deputy Mayor of the City of Bishkek on
19 September at the National Library in Bishkek. Mr. Javed S. Ahmad
and Ms. Indira Moldogazieva of UNFPA facilitated the workshop and Ms.
Anyura Sagenbaeva was the resource person. The IEC materials
development workshop's programme included handson experience in
qualitative research, pretesting and development of proto-type
materials. The participants appreciated and fully utilized the
services of two graphic artists and the desk-top publishing
facilities made available by UNFPA and the organizers. At the end of
the workshop all the participants were awarded certificates.
NEPAL
- During 9-16 June, Mr. R. H. Chaudhury, Adviser on Population
Policy and Development Strategy, assisted the Ministry of Population
and Environment in conducting a workshop on Population and
Development and integrating population variables in development
planning. He was actively involved in this workshop as a resource
person as well as a lecturer. He recommends that such workshops in
future should also include practical hands-on computer training and
forecasting demand for education, food, health, housing, labour force
etc.
- In recent years all demographic and health indicators in Nepal
have begun to show a favourable trend and this needs to be sustained
and strengthened further. UNFPA has provided technical and financial
support to HMG on three major thrust areas: improving service
delivery in rural areas; developing an effective training system and
implementing HMIS to improve programme management. UNFPA is also
playing a key role in coordinating donor assistance to HMG in the
family planning sector.
- Ms Vineeta Rai, Adviser on Gender, Population and Development
and Mr. G. Giridhar, participated in the PRSD mission of Nepal from
21 April, 10 May. The mission greatly benefitted from
specially prepared documentation and presentations made by the UNFPA
Field Office and HMG officials on various aspects of the reproductive
health and family planning programme in Nepal.
- Mr. P.M. Jesse Brandt participated in a World Bank mission in
Nepal from 24 June -2 July to assess the progress made in the IDA
financed Population and Family Health Project. Mr. Brandt's role in
the mission was to review progress made in the logistics management
and supplies component of the project. Among other things, he
recommended more effective supervision and monitoring of logistics
activities and transportation of supplies. In this connection, HMG
is likely to make district health offices more accountable for
movement of commodities and utilization of funds provided under the
project for this purpose.
SRI LANKA
- Ms. Luisa Engracia was on a mission to Sri Lanka from 22-26
July to conduct the end-of-project evaluation of UNFPA's assistance
to strengthen the Statistical Unit of the Registrar General's Office.
The project was meant to upgrade data processing capacity and improve
the quality of collection, compilation and analysis of vital
statistics. The mission concludes that the project objectives were
reasonably achieved, even though the project duration had to be
repeatedly extended due to delayed implementation. A detailed
evaluation report was prepared by Ms. Engracia, in conjunction with
a national consultant from the University of Colombo.
- Ms. Daphne M. de Rebello, Adviser on Population Education in
the Formal Sector was on a mission to Sri Lanka from 27 June - 5 July
to conduct final evaluation of the UNFPA assisted project on
Population and Family Life Education (PFLE) in schools. She
emphasized the need for institutionalizing PFLE in the school
curriculum and teacher training programmes. At present PFLE is
included in social studies, science and health education, but even
here a more balanced perspective on gender was recommended.
- Under the new country programme cycle, reproductive health (RH)
and advocacy issues are being given priority treatment in Sri Lanka.
Ms. Vineeta Rai, Adviser on Gender, Population and Development and
Mr. Najib Assifi, Adviser in Population Advocacy, participated in a
two-day workshop with representatives of the government, NGOs and
experts, and developed three projects. Ms. Rai prepared a project
with several NGOs and community based organizations that will provide
funds to integrate RH as a complementary incremental activity into
their on-going programmes. Gender training and promotion of male
participation will be undertaken as the key areas of concern. In
addition, NGOs' network will be strengthened under the project. The
other two projects were developed by Mr. Assifi: a sub-project on IEC
in support of the RH including population education through schools
and a second project on advocacy in support of reproductive health.
While the IEC project is built upon activities initiated in the
previous cycle, the advocacy project will support a large number of
institutions as potential advocates of RH issues.
OUTSIDE THE REGION - PRSD Mission to Mongolia
- CST for CASA often provides technical support to countries in
other regions, upon specific request. Mr. K. S. Seetharam, Adviser
on Monitoring of Population Policies and Programmes led a 3-member
PRSD mission to Mongolia from 9-31 May. He was also responsible for
the Population and Development area. Recommendations contained in the
PRSD report will be the basis for UNFPA's next country programme in
Mongolia.
FIRST CASE OF AIDS REPORTED
Both Kazakstan and Kyrgyzstan have recognized their first case
of AIDS each. In Kyrgyzstan, the identified case is of a national,
married woman doctor of 35, who under-takes foreign trips to procure
consumer goods to sell back home (such people are commonly referred
to as "shop tourists").
Each month hundreds of shop tourists, mostly women, travel to
neighbouring countries of Asia and bring back sacks full of
clothing, shoes and other items in demand back home.
AZERBAIJAN APPLAUDS UNFPA'S ASSISTANCE
The Azerbaijan Minister of Health, Mr. Ali Insanov has
congratulated UNFPA for supporting his country's reproductive health
and family planning programmes. He was speaking at a press conference
recently which was called on the occasion of the approval of two
projects, in reproductive health and family planning and IEC and
advocacy activities of the Government and NGOs.
Speaking on the occasion, Mr. Ali Insanov presented the current
situation in the field of mother and child health and what UNFPA's
assistance would support. Mr. Paolo Lembo, the UNFPA Representative
in Azerbaijan stressed the importance of population programmes in the
light of ICPD Programme of Action and UNFPA support to the related
activities. After the press conference, participants were invited to
the opening of a children's painting exhibition as part of UNFPA's
international poster contest on the subject of "Where we live now".
More than 600 children had participated in the contest.
Editorial Board
Mr. Javed S. Ahmad - Chairperson
Mr. Garimella Giridhar - Member
Ms. Malicca Ratne Castelli - Member
"The views expressed are those of the author(s) and the editors, and
do not necessarily reflect those of the United Nations."
CASA NEWS & VIEWS
UNFPA CST for CASA
P.O. Box 5940, Kathmandu
Ka-105 Bakhundole Heights
Lalitpur-3, Kathmandu, Nepal
Tel: (977-1) 523880
Fax: (977-1) 527257
E-mail: cstnep@unfpa.mos.com.np