Abstract
Over a period of 5 years (1995-99), the Urban Initiative of the Family Planning Service Expansion and Technical Support Project (SEATS) helped 10 municipalities in Guinea, Mozambique, Senegal, Zambia, and Zimbabwe implement projects and activities to meet the growing demand for accessible, high- quality family planning (FP) and reproductive health (RH) services. Elements common to these programs included: data- driven planning; coordination of public and private-sector inputs; partnership with municipal officials; intersectoral advocacy to form coalitions to promote RH; and "South-to-South" dissemination. Two models -- the Best Practices and the Quick Study models -- proved to be flexible and effective approaches for improving access, quality, and sustainability. Each model increased support for RH programs by municipal officials, knowledge and use of RH data, and access to quality services. Results of the Urban Initiative included services to more than 81,000 new contraceptive users, 221,104 couple years of protection (CYP), and training for 1,702 service providers. Key lessons learned include the following: (1) Municipal governments can increase the efficiency and effectiveness of FP service delivery programs. (2) Municipal officials can, at least partially, manage the impact of increasing urbanization on access to and quality of RH services, but they cannot do it alone. (3) Key to maximizing access in urban areas are two strategies: (a) identify and mobilize underutilized resources; and (b) be creative in using new, even unconventional, resources. (4) Urban decisionmakers are often unaware of research findings that could be used to improve planning and resource allocation. (5) Urban areas have more untapped resources available to support RH programs than is commonly believed. (6) Women in leadership positions can play a key role in advocacy and in expanding services, especially in cities where RH issues are sensitive. (7) The high diplomatic cost of publicly exposing serious quality of care problems must be weighed against the catalytic potential of this information.