Population Policy and Program Monitoring and Evaluation

1. Population Policy and Program Monitoring and Evaluation Alejandro N. Herrin May 13, 2003

2. POPCOM and PIDS Project Reports • Herrin, A. N., 2002, “Population Policy in the Philippines, 1969-2002”. • Orbeta, A. C., Jr. et al., 2002, “Review of the Population Program: 1986-2002”. • Racelis, R. H. and A. N. Herrin, 2003, “Philippine Population Management Program (PPMP) Expenditures, 1998 and 2000”. • Herrin, A. N., A. C. Orbeta, Jr., F. del Prado, I. Acejo, and J. Cuenca, 2003, “An Evaluation of the Philippine Population Management Program” (in progress).

3. Outline • Part I: Population policy and program review, with attention to population growth and family planning, 1969-2002 • Part II: Monitoring and evaluating the PPMP: a strategy, some results, and information gaps • Part III: Some conclusions regarding future directions

4. Part I: Population policy and program review, with attention to population growth and family planning, 1969-2002

5. Population Policy and Program, 1969-2002 • Marcos administration (1967-1986) • emphasis on negative consequences of rapid population growth • adopted FP that provided both information and services plus advocacy of a small family size norm • Aquino administration (1986-1992) • emphasis on rights of couples to determine number of children • FP program promoted maternal and child health

6. Population Policy and Program, 1969-2002 • Ramos administration (1992-1998) • recognized role of rapid population growth in constraining socioeconomic progress • adopted FP in the context of reproductive health • Estrada administration (1998-2001) • FP to assist couples achieve desired fertility and promote health • contraceptive mix - scenarios to achieve faster reduction in fertility

7. Population Policy and Program, 1969-2002 • Arroyo administration (2001- ) • FP emphasizes objective of assisting couples to achieve desired fertility and promote health • FP program emphasis on promoting modern Natural Family Planning • Will not fund purchase of contraceptives for distribution to public health facilities in the event bilateral and multilateral donors stop providing supplies.

8. Factors Influencing Population Policy • International commitments e.g., International Conference on Population and Development (ICPD) • Opposition of the Catholic Church hierarchy (especially on the promotion of artificial contraceptives) • Views of the general public (national demographic surveys and opinion polls)? • Views of partner GOs and NGOs?

9. Views of partner GOs and NGOs • Role of population growth in development. (88%) agree that a slower population growth is likely to confer greater net benefits than a faster population growth • Role of government in fertility decision-making. About 42% agreed on the need to provide information and services to couples in order to assist them achieve their fertility goals; another 45% noted that fertility decisions of couples have external effects and that in addition to providing information and services, the government can be justified to advocate a small family size norm.

10. Views of partner GOs and NGOs • Family planning objectives. About 22% of believe that the objective of a FP program should be to help couples achieve their desired family size, while 75% said that in addition to the above goal, the FP program should also strive to reduce national fertility and population growth. • Public sector FP service delivery. 93%, view that the government should promote a wide range of legal and medically safe methods from which couples can choose from to achieve their fertility goals; only 5% said that the government should promote only a preferred method, e.g., natural family planning.

11. Views of partner GOs and NGOs • Financing public sector family planning services. 79% said that the government should charge full cost to those who can afford and subsidize those who cannot; 17% want to subsidize all users. • GO and NGO views. In all of the above areas of policy, government and NGO partner agencies expressed similar views. GOs constituted 74% of the total sample of 271 respondents.

12. Some conclusions from the review • Broaden population concerns but address the issue of rapid population growth and fertility reduction once and for all. • Need for clear and consistent statements of national policy to guide national and LGU programs – need to forge a stable consensus. • In formulating policy, consider also the views of partner GOs and NGOs, and the larger, albeit unorganized and silent constituency – the married couples with unmet needs for contraception.

13. Some conclusions from the review • There are opportunities for working closely with the Catholic Church and other groups in some areas of population policy and family planning.

14. Part II: Monitoring and evaluating the PPMP: a strategy, some results, and information gaps

15. Framework for PPMP Monitoring and Evaluation Outputs (services, capacity- building, advocacy, organizational support) Basic inputs Objective Strategy Utilization (intermediate outcomes Outcomes (achievement of policy objective) Other factors Other factors

16. Monitoring PPMP in terms of outputs, utilization and outcomes Evaluability question/comment: The links between outputs, utilization and outcomes are well known. Hence, what is more important is to establish that the outputs exist in sufficient scale to have measurable impact on utilization and outcomes.

17. PPMP Expenditures by Source, 1998 and 2000 Source: Racelis and Herrin (2003)

18. PPMP Expenditures by Use, 1998 and 2000 Source: Racelis and Herrin (2003)

19. Percent Distribution of Total PPMP Expenditures by Strategy/Activity and by Source of Expenditures, 1998

21. Sources of supply of modern methods

22. Fertility and Contraceptive Prevalence Rate, 1968-2002

23. Percent of Currently Married Women by Method, Poor and Non-Poor, 2000-2002

24. Percentage of currently married women with unmet need for family planning

25. Total and Wanted Fertility Rates, 1993 and 1998

26. Monitoring PPMP in terms of outputs, utilization and outcomes Evaluability question/assessment: Data on of outcomes are hard to come by, and they have many determinants that are difficult to isolate. Data on utilization are more available from surveys (e.g., NDHS and FPS), so that evaluation may focusprimarily on the link between outputs and utilization.

27. Prenatal care, 1999-2002

28. Percent of children 0-59 months by type of delivery attendant Percentage for “Others” not shown.

29. Postnatal care, 1999-2002

30. Infant mortality rate

31. High risk fertility behavior, 1993 and 1998 Risk defined in terms of early (<18) and late (>34) childbearing, short birth intervals (<24 months), and high birth order (>3)

32. Infant, child and maternal mortality, 1970-1995

33. Monitoring PPMP in terms of outputs, utilization and outcomes Evaluability question: Are the outputs clearly identified and are they of such magnitude (i.e., the capacity to cover a large number of the eligible target population) that their utilization by the target population are likely to have measurable impact on the outcomes?

34. Age-specific birth rates (per 1,000 women)

36. Teenagers who are pregnant with first child or have begun childbearing

37. Monitoring PPMP in terms of outputs, utilization and outcomes Evaluability questions: The items in italics are not clear nor are they easily measurable. The link between utilization and outcomes of these italized items appears tenuous.