The family planning program effort index: 1999 cycle

Context: Indices of effort by large-scale family planning programs have bee n measured periodically since 1972. These scores are intended to capture pr ogram effort or strength, independent of outputs such as contraceptive use or fertility change. Methods: Questionnaires were sent to expert observers who provided judgment s on the details of program effort for 89 developing countries. The respons es for each country were converted to scores for 30 program features, which were then grouped into four components of program effort. An overall progr am effort index was calculated as the sum of all 30 feature scores. Results: The average program effort index was higher in 1999 (54% of the ma ximum possible score) than in 1994 (48% of maximum). Countries with low sco res in 1972 improved considerably more than those with initially high score s; by 1999, the gap between these two groups was small. On average, strong and weak programs differed sharply in their score profiles; strong countrie s outscored weak ones in every feature category. All countries, regardless of their average score, were selective in the program features they emphasi zed, but weak programs were more erratic in their selectivity. The stronges t programs have stabilized at about 80% of the maximum score. Prevalence of contraceptive use continued to be highest for countries possessing both fa vorable social settings and strong programs. Conclusions: Many developing countries have expanded their reproductive hea lth programs in accordance with recommendations issued by the 1994 Internat ional Conference on Population and Development. The improved program effort index and scores for 1999 suggest that countries have been able to do so w ithout seriously weakening their family planning efforts.