1. business and industrial
2. energy
3. electricity

How to organize a
MCH/FP/RH program
HU XIAOYU
[email protected],
[email protected]
China Center for Reproductive Health
Technical Instruction and Training
International Peace Maternity & Child
Health Hospital, China Welfare Institute
Why need a program / project?
• Facing one or more problems
• Want to make change
Program
Present
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Future
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2
What is program / project?
• Complexes of
- goals, policies, procedures,
rules, task assignment, steps
to be taken, resources to be
employed, and other
elements necessary to carry
out a given course of action,
- ordinarily supported by
budgets.
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3
Analysis of the present status
(needs assessment, SWOT analysis)
• What we did well?
• What are the problems?
• Which one is the most
important or critical problem?
• Any solution?
• What have we done to the
problem?
• What we could improve?
• What are barriers to the
solutions / improvement?
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4
SWOT analysis
• a powerful technique for
understanding your Strengths
and Weaknesses, and for
looking at the Opportunities
and Threats you face
• Strengths and weaknesses
are often internal to your
organization. Opportunities
and threats often relate to
external factors.
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Strengths
• What advantages does your
country or organization have?
• What do you do better than
anyone else?
• What unique or lowest-cost
resources do you have access
to?
• What do people in your
market see as your strengths?
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Weaknesses
• What could you improve?
• What should you avoid?
• What are people in your
market likely to see as
weaknesses?
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Opportunities
• Where are the good
opportunities facing you?
• What are the interesting
trends you are aware of?
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Useful opportunities can come from:
• Changes in technology and markets on
both a broad and narrow scale
• Changes in government policy related to
your field
• Changes in social patterns, population
profiles, lifestyle changes, etc.
• Local Events
A useful approach to looking at
opportunities is to look at your strengths
and ask yourself whether these open up any
opportunities.
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Threats
• What obstacles do you face?
• What is your competition doing?
• Are the required specifications for
your job, products or services
changing?
• Is changing technology
threatening your position?
• Do you have financial problems?
• Could any of your weaknesses
seriously threaten your business?
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How to identify the main problem
• Nature of the problem
• Indication of the extent of the
problem
- quantification of its magnitude
(incidence, prevalence, etc.)
• Significance of the problem
- How severe it is
- The effects in terms of health, costs, and
needs for service
- links with other problems
• Relevant to the focus of the gov’t
or partner organizations
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Analysis of the affecting factors of the
problem
• Use diagram
- Tree diagram
- Oval diagram
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A ‘Problem Tree’
Manifestation
Cause 1
Cause A
Cause X
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Cause 2
Cause B
Cause C
Cause Y
MCH program pln & mgmt
Cause D
Cause Z
13
Ex: Adolescent pregnancy
• Use
• Use
• Use
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as variable
as exogenous variable
as direction of causality
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Causal Relationship
• Core problem
• Direct (immediate) cause
• Indirect (underlying) cause
• Root cause
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Causal analysis: “why?”
Outcomes/Problems
Immediate causes
“Status”
Underlying causes
“Services, Access, Practices”
Basic /structural causes
“Society, Policies, Resources”
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From immediate cause to root cause
1
One problem could have one
or more manifestation of
immediate causes.
1 Each cause maybe has other
underlying causes.
1 Different causes could be
correlated.
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What need if implementing a program?
•
•
•
•
Personnel – Manpower
Funding – Money
Equipment / facility- Material
Supports from GOs or NGOs
• All could be obtained through
grants
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Funding agencies
• WHO
• USAID
• …
• Different funding agencies
have different interests with
different grant requirements
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Request For Proposal (RFP)
• Announcement
• Indicate the interests of the
funding agency
• Deadline of the proposal
submission
• Proposal formats (specific
forms)
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The Letter of Intent to submit a proposal
• Brief, often limited to one
page, or longer, depending
on the purpose
• Indicate:
- Who you are
- What you are going to do
- If you have the space
- How and why you plan to
do it
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1. PLANNING
4.
EVALUATION
Project /
Program
Mgmt
Cycle
2. PROJECT /
PROGRAM
IMPLEMENTATION
3. ADMINISTRATION
OR OPERATION
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PLANNING
• Review possibilities and
identify resources
• Set measurable objectives
and targets
• Develop budget
• Develop a work plan and
administrative chart
• Design an evaluation plan
• Secure approval and funding
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PROJECT / PROGRAM IMPLEMENTAION
• Basically consisting of
initiating action with the
framework of the plan
• Organizing
• Staffing
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ADMINISTRATION OR OPERATION
• The routine phase
• “Doing the job” planned
• Continuously or periodic
monitoring
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EVALUATION
• Measure quantitatively and
qualitatively progress towards
attaining the objectives and
targets set in Step 1. It
answers the questions: “how
well have we done, how can
we improve?”
• Could be needs assessment
for plan improvement
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Steps in the planning process (1)
1. Ascertain the organizations’
definition of planning and
expectations for the plan
2. Assess the social,
economical and political
environment of the
organization and of the
external environment with
regard to planning
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Steps in the planning process (2)
3. Obtain planning mandate in
writing
4. Obtain latest copies of
organization statement of
mission, goals, objectives,
most recent activities report
and evaluation reports and
review with pertinent staff
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Steps in the planning process (3)
5. Identify resources available
to help with the planning
process
6. Plan the planning
7. Review and clarify the
problem which is the subject
of the planning exercise,
identify and prioritize needs,
and estimate potential
demand for services
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Steps in the planning process (4)
8. Identify resources potentially
available for proposed new activity
9. Identify program constraints
10. Develop priorities and tentative
objectives
11.Develop and carefully review with
decision makers alternative
potential courses of action
including estimates of outcomes
and costs for each
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Steps in the planning process (5)
12. Formulate working
objectives and targets, obtain
approval by decision makers
and select consumers as
necessary and modify as may
be indicated, summarize
anticipated outcomes
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Steps in the planning process (6)
13. Develop operational plan
including time table, key
milestones, job descriptions,
space, equipment and supply
needs. Specify performance
standards. Obtain letters of
support
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Steps in the planning process (7)
14. Develop a budget and
budget justification
15. Plan the evaluation of the
new program and information
feedback
16. Plan the implementation
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Steps in the planning process (8)
17. Prepare an executive
summary of not more than
three pages, including:
problem statement,
objectives, salient features of
work plan, summary of
anticipated accomplishments
and summary budget. Finalize
the proposal submitting for
review
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Steps in the planning process (9)
18. Obtain formal approval of
the plan
19. Obtain formal allocation of
needed resources and formal
order to implement, then
initiate the implementation
plan forthwith
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WHO grants
•
•
•
•
HRP
Safe motherhood
Adolescent health
Etc.
• More interests in researches
(clinical, epidemiological, or basic
medicine)
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Development of Research
Proposal
---- An example from WHO
guideline
START of a research project
- Reading, observation,
personal communication
• Idea
• Hypothesis
• Proposal
Purpose of writing a proposal
• Funding
• Planning
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General guideline
-- Contents and order
1)
2)
3)
4)
5)
6)
7)
8)
9)
Particulars of the project and investigator(s)
(Form 1)
Project summary (Form 2)
Description of the project (Form 3)
Ethical considerations (Form 4)
Budget (Form 5)
Other support for the proposed research (Form 6)
Other research activities of the principal
investigator(s) and co-investigator(s) (Form 7)
Curricula vitae of the PI(s) and co-investigator(s)
(Form 8)
Requisitions through WHO (Form 2)
-- Check list
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Form 1. Particulars of the project and
investigator(s)
• Attachment of ethical
approval
• Attachment of consent form
(English version)
• PI not sign as administrative
authority
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Form 2. Project summary
•
•
•
•
•
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Justification for the project
Proposed research
New features
Techniques and skills
Problems anticipated
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Form 3. Description of the project
• Rationale and objectives of the
study
• Previous similar studies
• Design and methodology
• Project management
• Links with other projects
• Main problems anticipated
• Expected outcomes of the study
• Reference
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Rationale
• Context of present knowledge
• The activities & objectives of
HRP
• Demographic, social, or
reproductive health impact
• Policy, service, or program
relevance
-- An hypothesis
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Objectives
• Main objectives
• Specific aims
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Previous similar studies
• The most relevant ones
• Published
• To show what are the new
features of your study
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Design and methodology
•
•
•
•
•
•
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RCT
Quasi-RCT
Case-control study
Prospective cohort study
Cross-section survey
Ect.
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General outline
• Nature of the study
• No. & main characteristics of
subjects
• No. & frequency of follow-ups
• Investigation
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Criteria for the selection of
subjects
•
•
•
•
•
Study population
Justify the selection
Where and how to recruit
Inclusion criteria
Exclusion criteria
- sampling, randomizing, matching,
etc
- Permission (for special populations)
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Subject allocation
• If applicable
• Comparison groups
• method of allocation randomization
• When
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Description of the drugs and
devices studied
•
•
•
•
•
If applicable
Name
Chemical composition
Manufacturers
Amount and dosage
• For new drugs, pre-clinical
investigation
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Admission procedure
•
•
•
•
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Timing of allocation
Allocation to study groups
Data to be collected
Ideally, attachment of the
admission form
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Follow-up procedure
•
•
•
•
•
Timing
Frequency
Investigations
Data to be collected
Procedure of tracing the
subjects
• Ideally, attachment of the
form to be used
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Criteria for discontinuation
• The conditions that would
lead to a subject being
discontinued from the study
or to the termination of the
study
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Laboratory and other
investigations
• Methods not previously
published: described in detail
• Otherwise: reference to
appropriate published work
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Data management
•
•
•
•
•
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Data coding
Monitoring
Verification
Computer procedure
Staff training
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Data analysis
• Measures of outcome
(endpoint)
• Comparison between groups
• Statistical methods and
models
• Subgroup analysis
• Missing data
• If complex, dummy table
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Sample size and statistical power
• For each group
• Assumption underlying the estimate
– The difference expected to detect
– Significant level
– Power required to demonstrate such diff.
• Basic information from pilot study
• Method of computation
• Adequate allowance for drop-out
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Duration of project
• Pretest or pilot study
• Questionnaire development
• Staff training
• Recruiting
• Collecting samples
• Follow-up
• Lab work
• Data management
• Data analysis
• Report writing
• ……
- A time table is recommended
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Project management
For collaborative study
• Overall responsibility for the
project
• Involved and respective
responsibilities
• Coordinated and monitored
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Links with other projects
Other projects:
• In progress
• the relevant HRP components
• Other HRP components
• Non-HRP or non-WHO
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Main problems anticipated
• Main obstacles and difficulties
• Discussing the potential
solutions
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Expected outcomes
• Contribution to advancement
of knowledge
• Utilization of the results
• Dissemination of the results
• Impact on health care policies
and practices
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References
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Form 4. Ethical considerations
• Informed consent and
confidentiality
• Risk-benefit assessment
• Additional ethical concerns
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USAID proposal format
I.
(1)
Executive summary (<3 pp.)
A. Problem
B. Goal(s) and objectives
C. Plan of Action summary
D. Anticipated outcome with few
lines relevant experience of
organization and/or key
personnel
E. Summary budget
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USAID proposal format
(2)
II. Statement of problem in detail
III. Background
A. Social, cultural, economic and
political
B. Community health diagnosis
C. Existing health services
D. Other resources
E. Constraints
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USAID proposal format
(3)
IV. Detailed needs assessment
and estimated demand for
services
V. Priorities and alternatives
VI. Goal(s), Objectives and
targets
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USAID proposal format
(4)
VII. Project plan / strategy
A. Phases
B. Timetable – GANT chart, PERT
chart
C. Personnel needs and duties
D. Space and equipment needs
E. Supplies needed
F. Project/program organization
chart
G. Quality of care standards
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BAR CHART
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USAID proposal format
(5)
VIII. Budget and justification
A. Complete budget
B. Justification
C. Management of budget, control
procedures, banking and audit
IX. Information systems
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USAID proposal format
(6)
X. Evaluation
A. Internal – including routine
supervision (monitoring)
B. External
XI. Information dissemination
measures
XII. Implementation plan and
replication
XIII. Institutionalization /
sustainability
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USAID proposal format
(7)
XIV. Appendix
A. Letter of support
B. Job description
C. CVs of proposed staff
D. Outline of training program
E. Legal factors
F. Maps and charts
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Result - based Management
and
Logical Framework Matrix
Result-Based Management
Monitoring &
Evaluation
Expected
results
Implementation
Actual
results
Feedback &
adjustment
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LogFrame Matrix:
used in program planning,
assessment, monitoring and evaluation
LEVEL OF
RESULTS
Objective
Verifiable
Indicator
Means
Of
Verification
Risks and
assumptions
Goal
Objective
Output
Activity
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V.D.1
77
How to assess risks and assumptions
Planning
downwards
Goal
Assumptions
Objectives
Assumptions
Outputs
Assumptions
Activities
Preconditions
Thinking upwards
Inputs
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V.D.26
78
Vertical Logic
Goal
Objectives
Outputs
Activities
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V.D.2
79
Horizonal Logic
Identified goal,
objectives, outputs
and activities
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Are
Determined
By
OVIs
MCH program pln & mgmt
Measured
MOVs
thru
V.D.3
80
Chain of Results or aims
• Goal- Greater Why
Rationale and higher results of program implementation
• Objective –Why
Expected results through program implementation.–
Actual outcomes of the program, also the impacts of program
(social, economic, ets.)
• Output –What
Specific results of the program – important indicators of
program implementation, which serve for higher level
• Activity – How
All activities conducted during program implementation,
including all resources inputs (eg. Personnel, material,
money) leading to the outputs.
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Goal
• Ultimate results. In terms of
a country program, it is the
program contribution, and
realized through efforts of all
participants and partners.
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Objectives (Outcomes)
• Expected and reasonable
results, which indicate change
within short time
• Including changes in different
aspects: group behavior
(condom use), attitude (male
involvement), commitment
(matching funds from local
gov’t), social / cultural values,
legislation, rules and habits,
social norms, etc.
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Outputs
• Changes which are timebounded, measurable and
descriptive, are the
responsibilities of program
implementing agencies
• Specific results serving for
objectives
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SMART criteria for objectives & targets
•
•
•
•
•
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Specific
Measurable
Attainable, achievable
Realistic, relevant
Time-bounded
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Objective Verifiable Indicators
(OVIs)
• Used to measure the change
happened in the program
using quantitative and
qualitative measurement.
• Describe the extent of the
program achievement in
different levels, but refer to
the baseline data and
objectives of the program.
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Elements of OVIs: QQTP
(combining quantity & quality)
1. Indicator:
% of delivery
2. Add QUANTITY:
from 60% to 90%
Feasibility
practicablity
% of delivery increased
3. Add QUALITY:
% of delivery increased from
60% to 90% by professional medical workers
4. Add TIME:
% of delivery increased from 60%
to 90% by professional medical workers by
2000
5. Add PLACE:
In X county, % of delivery
increased from 60% to 90% by professional
medical workers by 2000
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OVIs should be:
• Directive: close and direct
relationship with the results to be
measure.
• Objective: with clear definition and
explanation of how to collect relative
data
• Practical: in money, frequency and
time
• Adequate: Not too complicated, but
adequate to ensure the program
achieve the expected results.
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Means of Verification (MOV)
• Used to measure
the states of different
OVIs
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How to obtain related information / how
to measure the states of the indicators
•
•
•
•
•
•
•
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Whether the specific information is obtainable?
Able to get the information from existing data?
Need to collect specific data?
Necessary?
How much data collected is appropriate?
Who pay the expense for data collection?
Who collect data?
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LogFrame Matrix:
used in program planning,
assessment, monitoring and evaluation
LEVEL OF
RESULTS
Objective
Verifiable
Indicator
Means
Of
Verification
Risks and
assumptions
Goal
Objective
Output
Activity
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V.D.1
91
CP5-GOAL
• To assist the Government of
China in implementing the
ICPD Programme of Action in
the areas of reproductive
health, gender equality and
ageing.
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the Outcomes of the Programme
To have contributed to:
• increased utilization of quality, integrated,
client-centered reproductive health/family
planning services by women, men and
adolescents in accordance with the
principles of the ICPD;
• promotion of gender equality in access to
resources (information, education and
social support) and reproductive
health/family planning services; and
• increased political support at national and
local levels for policies and programmes
dealing with population ageing.
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Among the six Outputs, Output 1 is:
• Increased availability to
women, men and adolescents
of quality, integrated, and
client-centred reproductive
health/family planning
information and services
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• Activity 1: Conduct advocacy to
sensitize central and local level
authorities on reproductive health
• Activity 2: Define services to be
provided at different types of
service delivery points
• Activity 3: Moving from CP4 to
CP5
• Activity 4: Conduct Baseline and
End-of-programme Survey and
Situation Analysis
• … (Total 15 activities)
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CP6-UNFPA/CHINA
• Under the UNDAF outcome
“Social and economic policies are
developed and improved to be
more scientifically-based, equitable,
human-centered and sustainable”
• UNFPA Outcome 1: Increased
utilization of high-quality, clientcentered, gender-sensitive
reproductive health and family
planning services in line with the
ICPD and the CEDAW.
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CP6-Outcome indicators
• Contraception prevalence rate for
modern methods sustained about
85%
• The rate of antenatal care for 5
times increased by 50%
• Percentage of youth who need
contraceptive would receive
related services from 10% to 40%
• National and sub-national laws and
policies in place to ensure clientcentred reproductive health
services
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CP6-UNFPA Output 1
• Increased availability of highquality, integrated, clientcentered, gender-sensitive
reproductive health and
family planning information
and services, including those
focusing on HIV/AIDS and
client rights, for women, men,
young people and migrants in
project areas.
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CP6- Output indicators
• More than 80% of service delivery points offering target
groups integrated reproductive health and family planning
services by 2010
• 90% of clients aware of reproductive rights prescribed by
law by 2010
• Systemic maternal health care management rates increased
to 85% by 2010
• Quality-of-care monitoring and evaluation system in place
by 2010
• 80% of project counties’ policy taking into consideration
recommendations by youth group by 2010.
• At least 80% of services delivery points using Standard
Service Delivery Protocols by 2010.
• Gender guidelines for service providers developed and used
by 80% of SDPs
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QUESTIONS
AND
COMMENTS?
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