Family Planning Program Structure and Performance in West Africa

Abstract

This study used summaries of case studies and facility surveys to examine the role of vertical and integrated structures and their effectiveness/efficiency in provision of family planning (FP) services in West Africa. Case studies pertain to Cote dIvoire Nigeria Benin Guinea and Ghana. The case studies offer a description of existing FP structures in each country. The analysis of facility-based surveys pertains to Cote dIvoire and Nigeria and detailed data on resource use among providers. The analysis of surveys and case studies focused on vertical and integrated structures as relevant to the implementation of the 1994 Cairo Plan of Action. Vertical programs operated by nongovernmental organizations (NGOs) provided 44% of all couple-years of protection (CYP) in Cote dIvoire and about 25% in Benin and Guinea. In Nigeria only integrated programs had most of the CYP in 1994. Facility surveys indicate that vertical programs have more efficient staff use. In Cote dIvoire private vertical programs had higher utilization rates than government integrated programs. In Nigeria vertical programs in private or public programs had generally higher utilization rates but results were more ambiguous. Local context appears important in determining effectiveness of vertical vs. integrated programs. It is unclear what the role of higher quality services greater organizational dedication or weakness of the government service system are in determining effectiveness. The trend is for vertical NGOs to expand into government facilities and for IPPF affiliates to include non-FP services in their clinics.