Browse POLICY Project (1995-2006) Materials
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- Adolescent Reproductive Health
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Country and regional assignments reflect those made at the time of production and may not correspond to current USAID designations.
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Since the 1960s, the Ministry of Health (MOH) of Turkey has enjoyed the benefits of external assistance for its family planning (FP) program especially from the U.S. Agency for International Development (USAID). The MOH has since developed an FP program that operates through a widespread network of facilities across the entire country. Today, the MOH dispenses about 70 percent of all intra-uterine devices (IUDs) and about 30 percent of all oral contraceptives (OCs) and condoms in the country. MOH’s FP service provision has traditionally been based on free and universal access. The only exception has been that some of the facilities have in recent years started to collect donations from better-off IUD clients as a result of spontaneous trend. In 1995, the Government of Turkey (GOT) and USAID signed an agreement whereby USAID’s assistance for the FP program would be phased out in five years. This meant that Turkey would have to develop a self-sustaining financing policy to bridge the resource gap created by the departure of USAID’s assistance. The MOH has since been continuing its efforts to develop and implement a new policy. According to the phaseout plan, USAID would donate 20 percentage points less condoms and OCs in each year of the phaseout period. IUD donations, however, would fully continue until the fourth year, when they would be lowered to 50 percent of the forecasted consumption of that year. In 2000, total responsibility would pass onto the GOT. However, there was a diversion from the original phaseout in the implementation stage. Although this has caused confusion, the MOH was quick to respond to the plan by initiating its first-ever contraceptive commodity procurement in 1996.
In 1994, after three decades of donor support to Turkey’s national family program, the U.S. Agency for International Development (USAID) announced its intention to phase out assistance. On the eve of donor phaseout, Turkey’s public sector program was serving nearly 60 percent of the market for modern family planning methods, including many nonpoor clients. During the transition period, the Ministry of Health was challenged not only to obtain new resources to replace donated contraceptive commodities but also to assume new technical responsibilities for the program. The story of how the ministry succeeded is often told in technical terms (e.g., number of procurements, budget trends, pilot project design, etc.). An equally important part of the story is the political and institutional context within which success was achieved. Examining how the MCH-FP Directorate overcame challenges to put in place a sustainable strategy for the public sector family planning program reveals the political dimensions of the process. Using a political economy framework, this paper examines the processes that led to implementation two central components of Turkey’s national self-reliance strategy: obtaining annual budget allocations for contraceptives and targeting free services to the poor. The framework used here to analyze the process of formulating and adopting Turkey’s contraceptive self-reliance strategy has five components: stakeholders’ characteristics, institutional characteristics, contextual conditions, process characteristics, and reform characteristics.
The workshop, Pathways to Contraceptive Security, October 31–November 1, 2002, in Konya, Turkey, was organized by the Ministry of Health General Directorate of Maternal and Child Health and Family Planning (GD MCH/FP) and the POLICY Project. Many organizations and professionals contributed not only to this workshop but also to previous policy analysis and dialogue initiatives that have guided the National Family Planning Program in Turkey to achieve contraceptive self-reliance. The workshop embodied the strategic thinking that drives the National Family Planning Program and reflected the visions of the many policy champions, planners, and service providers who share responsibility for public health in Turkey.
The purpose of this paper is to summarize POLICY’s assistance in Turkey featuring results and lessons learned to date. In addition to this introduction, the paper is organized in three parts representing technical components of POLICY’s work in Turkey: Contraceptive Self-reliance, National Strategies for Women’s Health and Family Planning, and Nongovernmental Organization (NGO) Strengthening and Advocacy. This paper reflects experiences through December 2001 and will be updated at the close of the project in December 2002.