Introduction

Key Research Findings

1. Maintaining current contraceptive prevalence levels will severely strain existing services as urban populations grow. Current capacities will have to be augmented if contraceptive prevalence levels1 are to be maintained or increased.



2. Untapped potential exists for increasing current capacity through the large private sector (including pharmacies) and through community-based distribution, which have not been fully engaged in urban areas.



3. Current urban method mixes, heavy in resupply methods, will increase the future service delivery burden dramatically. New facilities and staff capabilities for providing long-term methods, including Norplantr, will have to be developed if prevalence levels above 40% are to be achieved.



4. The quality of urban family planning services is in some respects acceptable. This is good and came as a welcome surprise. Nevertheless, imminent increases in demand dictate the following recommendations: increased information given to FP clients, increased history-taking and examination of new clients, improved waste disposal facilities, access to laboratories, increased production and use of IEC materials. In addition, provider training and provider supervision need improvement.



5. Women are already paying for family planning services and many of those who are not report that they would be willing to do so if required. This important information should encourage municipalities to consider cost-recovery measures.



6. Attitudes and practices around integrating STD/HIV management with family planning services was examined. The study found in all three cities that most service delivery providers already offer STD services, and most providers favor integration. However, little integration has actually taken place, and there are serious barriers against doing so, mainly a shortage of facilities and equipment, inadequate staff training, and a public stigma against integration.

Major Results

• Using local African resources strengthened the capacity of the local organization to conduct research and was successful because the African researchers understood the structure of the culture and had extensive experience working in the region.



• The urban initiative has stimulated greater South-to-South cooperation between cities and nations. Sharing experiences and expertise within and among countries strengthens institutional capacity and increases the possibilities for further cooperation while reducing the need for outside technical assistance. As donor funding continues to shrink, South-to-South exchanges will become increasingly significant.



• USAID/Zimbabwe allocated $1 million for urban family planning services based on the study findings.



• USAID/Zambia has approved a modified urban assessment which is being conducted in Lusaka with assistance from the Bulawayo municipality that conducted an urban assessment during the study.



• REDSO/ESA, USAID's regional office for East and Southern Africa has endorsed the urban initiative and plans to develop a regional strategy to support and allocate resources for future urban activities in the region.



• USAID's Asia Bureau's new regional activity includes urban programing as an emphasis area.



• The Client Contact Estimator (CCE) is tool that estimates the number of client contacts an urban family planning program will have to support in the future. Designed as a simple computer program, the CCE uses the current contraceptive prevalence rate (CPR) and method mix, and calculates future client loads through both automatic and user-directed projections.