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
· 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
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,