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As family planning programs expand, the mandate to do more with fewer resources becomes stronger. Family planning managers must strive to improve access and quality without increasing the financial burden on already under-funded programs. Perhaps you are concerned about future sustainability and the withdrawal of subsidies.

Throughout the world, family planning organizations devote a significant portion of their funds and staff time to training, with the expectation of improving the effectiveness and efficiency of their programs. But it is often not clear whether the training has made any difference, or whether specific performance problems can be solved through training.

Managers are increasingly focusing on bringing reproductive health services to hard to reach, underserved populations that are geographically, culturally, and economically isolated. By serving the reproductive health needs of these populations, managers will not only increase the use of family planning but also improve the health of mothers and increase child survival rates.

This issue concludes Volumes I through IV of The Family Planning Manager.

Governments in the developing world pay for between 63 and 75 percent of all family planning costs, international donor agencies pay for between 15 and 20 percent, and the clients themselves pay for between 10 and 17 percent of the costs of services [Lande and Geller 1991].

Increasingly health and family planning programs are decentralizing managerial responsibilities. As a result, managers at the local and district level need to make strategic decisions so that their programs will continue to meet the health needs of the communities they serve.

In recent years, some ministries of health around the world have embarked on a process of decentralization.

How can health programs and organizations achieve results under increasingly complex and changing conditions? How can health managers focus their organizations on tackling complicated problems, such as HIV/AIDS or organizational restructuring?

Governments and donor organizations are eager to support program initiatives that create new family planning services, or expand existing services to reach underserved populations. Funders are interested in a wide variety of new initiatives, such as adolescent services, mobile clinics in rural areas, in-school information, education, and communication (IEC) programs, and many others.

Customer service is a powerful tool that helps managers focus their services on what customers, or clients, want and need.

Partnerships between two or more organizations can be effective vehicles for achieving important public health goals.

Human Resource Development (HRD) is a strategic and comprehensive management area that involves establishing policies, practices, and administrative structures that focus on an organization’s most valuable resource--its people.HRD is a leadership, financial, and management issue. Personnel costs consume 70 to 80% of the budget of most organizations.

Having the right contraceptives on hand to meet the needs of all clients builds confidence in the services, helps ensure that the clients will keep coming back to the clinic, and helps prevent unwanted pregnancies.The contraceptive supply systems used by family planning programs differ from program to program.

Tuberculosis (TB) is a highly contagious disease that people catch after inhaling a very small number of TB germs and becoming infected. One-third of the world’s population is currently infected with the TB bacillus, and five to ten percent of these people will become sick or infectious at some time during their life. Nearly one third of people with HIV are also infected with TB.

Supervision is so important to getting things done that most family planning organizations have developed a formal supervisory structure staffed with "supervisors" to help them ensure that activities are supervised. These "supervisors" work alongside managers who also perform their own supervisory activities on a day-to-day basis.

Community participation has long been recognized as an effective means of helping rural and urban people focus energy and mobilize resources to solve their health, environmental, and economic problems.

In many countries, preventing, detecting, and treating sexually transmitted diseases (STDs) are essential parts of reproductive health services. In light of the pandemic of the human immunodeficiency viruses (HIV) and acquired immunodeficiency disease (AIDS) and the roleof STDs in making men and women more vulnerable to HIV infection, STD services are receiving increased attention.

Strategic thinking is a powerful skill that clinic managers and supervisors can use in creating clinic or program plans designed to meet future goals and effectively use available resources. In the past, formulating strategy has been reserved for senior managers and policy makers of large organizations.

When the demand for services increases or a program expands the range of health and reproductive health services it offers, the staff of a health facility can quickly become overwhelmed.

Family planning managers are frequently being asked to add or integrate family planning services into maternal and child health (MCH), nutrition, women's reproductive health, adult literacy, and other health and development activities. Consequently, managers are asking questions about exactly when, where, and how family planning services can be integrated with these other activities.

Gender is one of the most important factors to consider in designing, managing, and delivering reproductive health services. Yet gender may also be the least understood characteristic in terms of how women’s and men’s health needs differ and how those differences can best be addressed.

Health organizations are increasingly functioning in a marketplace where other health organizations offer similar services to overlapping populations. As a result of such competition for users, more and more organizations are turning to marketing to help them both to identify and better serve their target populations’ needs and to increase and sustain demand for their services.

Local resources can significantly contribute to national governments’ and external donors’ efforts to maintain and extend health programs.

No leader of an organization can last forever, but staff often behave as if their leader were immortal. Understandably, the staff may not want to spotlight the need to plan for a transition if their current leader is effective, or if the leader is ineffective but powerful and well connected.

The ability to assess an organization’s management capabilities is rapidly becoming a critical skill for health and family planning managers. As policy makers, national program planners, and donors take an increasingly critical look at program priorities and the use of available resources, their attention is drawn to how well organizations and programs operate.

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