World Development Report 1984

services. Program staff recruit potential clients and of family planning services, and medical staff may
offer information on proper use of methods. The give priority to curative rather than preventive
mass media can be used to inform people of the services. Multipurpose workers who are overbenefits
of small families and how to obtain contra- loaded with responsibilities will do none of their
ceptive methods. Instruction on human reproduc- tasks well. If an integrated delivery system
tion, family planning, responsible parenthood, employs single-purpose workers, friction may
and problems of rapid population growth as part arise over differences in training, seniority, salaof
school curricula can inform young people before ries, and promotion. For example, in addition to
they marry; such instruction can also be offered their salaries, family planning workers have somethrough
nonformal education, such as adult liter- times received incentive payments based on the
acy programs. These efforts complement other number of acceptors they recruit, whereas health
economic and social policies, discussed in Chapter workers receive only salaries. In Kenya family
6, to create demand for smaller families. health field educators (with family planning
Because of the need for medical services for pro- responsibilities) were paid more than the enrolled
vision or follow-up of many contraceptive meth- community nurses to whom they were to report.
ods, most family planning programs are linked to These personnel issues can seriously affect worker
the public health system. The nature of these links morale and performance.
varies among countries and has often changed. In Although family planning programs need some
some programs, family planning workers provide link with health systems, family planning services
services through clinics administered by the minis- need not be confined to them. When services are
try of health, but are responsible to some other provided through a maternal and child health probody.
In Pakistan primary responsibility for family gram, important client groups may be overlooked:
planning lies with the Population Welfare Division men, adolescents, unmarried women, and nonof
the Ministry of Planning and Development, pregnant women. Ministries of health may be
using the division's own specialized facilities and poorly equipped to organize social marketing
workers. Elsewhere family planning is directly schemes (for subsidized commercial distribution of
administered by the ministry of health, through a contraceptives, discussed below), to develop mass
special department of family planning (as in media programs, or to coordinate public, private,
Egypt) or as part of preventive or maternal and nongovernmental, and commercial activities.
child health services (as in Botswana, Kenya, and Some of these responsibilities are often delegated,
Malawi). Staff may specialize in family planning for example, to information or education minis-
(that is, as "single-purpose" workers), as in Kenya, tries. Many programs have boards within or out-
Pakistan, and Indonesia; or they may be responsi- side a ministry to coordinate the wide range of
ble for general health or maternal and child health family planning activities. In Mexico the semiservices
in addition to family planning (that is, as autonomous Coordinacion General del Programa
"multipurpose" workers), as in Bangladesh, Bot- Nacional de Planificacion Familiar monitors and
swana, and India. coordinates all family planning activities; it is
There have been obvious advantages in integrat- located within the Ministry of Health but has direct
ing health and family planning in the delivery of access to the president and works closely with the
* services. The health benefits for mothers and chil- National Population Council (CONAPO), a sepadren
of spacing and limiting births clearly establish rate body responsible for population policy. In
family planning as a valuable component of mater- Indonesia the National Family Planning Coordinal
and child health services. For both services the nating Board (BKKBN) is an autonomous body
main target group-married women of childbear- that collects data, produces information and edu-
- ing age-is the same. Joint delivery can reduce unit cation programs, coordinates activities, and has its
costs, and in countries where family planning is own fieldworkers who promote family planning,
controversial, integrated services make the pro- refer clients, and set up community distribution
gram more acceptable. points. In some countries these family planning
But integrated services also present difficulties. boards are also responsible for overall population
Health ministries are often understaffed and policy-a role discussed more fully in Chapter 8.
underfunded; they cannot always mobilize the In conclusion, there is no simple formula for the
political and administrative wherewithal to imple- best organization of family planning programs.
ment an effective family planning program. Heavy Programs that differ widely in structure can be
demands for health care may eclipse the provision equally successful. Workers in India deliver both
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