Measuring family planning program effort at the provincial level: A Vietnam application

International Family Planning Perspectives, Mar 1999 by San, Pham Bich, Ross, John A, Phuong, Nguyen Lan, Vinh, Nguyen Duc

Context: Measures of family planning program effort have been obtained repeatedly in crosscountry comparisons, but never for comparisons within a country. This method may be a valuable tool for tracing subarea program changes over time.

Methods: Family planning program efforts were assessed in 15 Vietnamese provinces that are part of a nationwide population and family health project. Thai Binh, a province with a strong program, was added to the study for comparison purposes. Eight officials in each selected province completed questionnaires from which various items were combined and scored on a scale from zero to four, resulting in 34 indices of program functioning. A single score for each index was calculated, based usually on the mean of the responses in each province.

Results: The mean program effort score across all 15 provinces and all 34 indices was 2.5, compared with a mean of 3.6 in Thai Binh, the comparison province. Standard deviations across the 34 indices ranged from 0. 7 to 1.4 for the study provinces, compared with a standard deviation of only 0.6 for Thai Binh, indicating considerable variation within most of the provincial programs. Policy and administrative functioning was strong across provinces (mean score, 3.3), as were program operations such as information, education and communication activities and task execution (3.5 and 3.4, respectively). Contraceptive availability varied according to method: While the IUD was widely available across provinces (mean score, 3.3), access to methods such as the pill, the condom and male and female sterilization was limited. Private-sector involvement was weak in all provinces. Method choice was considerably broader in the South than in the North, but program effort in general was not strongly related to this division or to the overall level of provincial economic development.

Conclusions: This first within-country application of the program effort indices demonstrates the feasibility of provincial analysis of program effort for identifying program inputs and for comparing degrees of effort. It suggests that in Vietnam the primary determinants of effort strength concern leadership, administration and implementation methods, rather than environmental context. International Family Planning Perspectives, 1999, 25(1):4-9

The nature and strength of Vietnam's family planning program varies from province to province. The program is centrally administered from Hanoi, but there is no regional administrative structure to tailor directives or support their enforcement in the country's 63 provinces. Consequently, a certain amount of autonomy exists in the management and implementation of the national family planning program at the provincial level. It is therefore of interest to assess how the provincial family planning programs differ from each other and what the different patterns may suggest for program improvements.

While the family planning program efforts of some 100 developing countries have been measured and compared over time,l a similar analysis has never been applied within a single country. In 1995, the Institute of Sociology in Hanoi decided to examine the program efforts of 15 Vietnamese provinces selected for a World Bank project to strengthen their family planning and reproductive health programs. These 15 provinces represent nearly one-third of the population of Vietnam. This within-country comparison of provincial family planning program efforts will provide a comprehensive picture of program functioning at the outset of the project. The profile of strengths and weaknesses that emerges from the assessment can guide changes in policies and in program administration. Moreover, repetition of the assessment in a few years can establish time trends useful for the project's overall evaluation. In addition, the methodological experience gained from this study may encourage applications in other countries.

Methods

The sample included 15 provinces identified by the Vietnamese government and the World Bank for the Population and Family Health Project. An additional province, Thai Binh, which is generally acknowledged to have an exceptionally strong family planning program, was added to this investigation to provide a standard for comparison. Data on the family planning program efforts of each province were collected in October and December 1996 from eight governmental officials in each provincial capital.*

A closed-ended questionnaire based upon a strict translation of the instrument used in the international studies2 was employed for the within-country analysis. The original instrument included roughly 120 items. For the provincial study, several irrelevant items were deleted, and the remaining items were converted into 34 indices, covering six program effort areas: policy and administrative support; outreach; private-sector involvement; program operations; evaluation and recordkeeping; and method availability. Measures of method availability included two items for each of six contraceptives: one item measuring the availability of the method through program facilities and one measuring the availability of the method through all sources in the province, including both program and private-sector sources.