Family planning program structure and performance in West Africa.
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Author(s): Stewart J, Stecklov G, Adewuyi A
Context: The long-standing debate over the relative merits of vertical and integrated organizational structure for the delivery of family planning services has taken on added significance, particularly in poorer regions such as West Africa, given increasing emphasis on reproductive health services as a whole. Methods: Case studies from Cote d'Ivoire, Nigeria, Benin, Ghana and Guinea, as well as large-scale facility surveys using multiple measures of staff utilization in Cote d'Ivoire and Nigeria, are used to examine the efficiency of different organizational structures for delivering family planning services. Results: Vertical programs operated by nongovernmental organizations provided close to half (44%) of all couple-years of contraceptive protection in Cote d'Ivoire and about one quarter in Benin and Guinea. When social marketing efforts are considered as well, sectors other than governmental, integrated programs were responsible for a majority of the couple-years of protection. Only in Nigeria did integrated programs provide the bulk of couple-years of protection in 1994. Facility surveys conducted in Cote d'Ivoire and Nigeria suggest that vertical family planning service structures have staff capacity utilization rates at or above 100%, and thus appear to use their labor resources more efficiently than do the integrated sites. Staff utilization rates are somewhat higher in the privately operated vertical programs in Cote d'Ivoire than in the government integrated programs; in Nigeria, vertical programs also had somewhat higher staff utilization rates, even within government-operated programs. Conclusions: Where both vertical and integrated programs exist, integrated programs may not necessarily be superior. The relative merits of the two approaches almost surely depend on the socioeconomic and political environments in which they operate; thus, optimal program structures may depend on the local situation.
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