Managing Effectively

Elements of good management also contribute to more contraceptive use. Informal comparisons of national programs easily demonstrate this, but it is difficult to control complicating factors. More precise evidence therefore usually comes from experiments or small studies.

· Training can improve provider performance. This is an article of faith for most programs. Several hundred short-term training courses in family planning and maternal health are conducted each year around the world in more than two dozen different languages. Studies in such countries as Bangladesh, Ecuador, Morocco, and Ghana confirm that trained field-workers and supervisors perform better (Finkle and Ness, 1985; Gallen and Rinehart, 1986, p. 825; Brown et al., 1995), and other studies indicate the need for periodic retraining (Gallen and Rinehart, 1986, p. 826). Training does have to match the specific provider's needs, reflect actual problems and options, emphasize practical skills, and focus on developing competence.

· Good supervision is often cited as a central element in program success, given the many shortcomings of supervisors who must labor under "low salaries, harsh working conditions, and the absence of performance-based rewards" and are distracted by administrative requirements and their own pressing personal affairs (Simmons, 1987, p. 251). Studies in Nigeria, Guatemala, Turkey, and Brazil (Townsend, 1991, p. 55; Foreit and Foreit, 1984) indicate that frequent supervisory visits increase program effectiveness. What supervisory visits cover is critical: Providing training and reinforcement and actually observing worker contacts have much more effect than merely collecting management information.

· Strategic planning, aided by reliable evaluation data and good applied research into program options (usually referred to as "operations research"), contributes to program success. The East Asian experience, in which extensive field experiments and continuing research and evaluation were used to guide program expansion (as well as to generate public support), and the similar experience in Bangladesh suggest the importance of these factors. Reviews of development programs similarly suggest the importance of strategic planning or strategic management (Paul, 1983), which requires sensitivity to the environment a program faces.

Targeting services to those most in need, or collecting some payment from those who can afford it, is a sensible option that can improve financial sustainability. Nominal price increases do not appear to affect contraceptive use substantially, as studies of price elasticities in Jamaica and in several Southeast Asian countries suggest (Lewis, 1996). However, the time and the manner for introducing such changes require careful consideration in each case, especially so they do not affect the poor (Lande and Geller, 1991).