RESUMO
Reports on a project aimed at importing the effectiveness and sustainability of Jamaica's National Family Planning Programme in light of the planned phasedown of international donor support particularly the reduction of USAID-donated contraceptive supplies. A "Mapping Study and Private Physicians Survey" was designed to collect background information on the existing infrastructure of service delivery points (SDPs)and a better undrestanding of physicians' skill and interest levels pertaining to long-term and permanent methods. This information would enable interventions to be designed that would target less-well-served areas offer appropriate incentives for private-practice physicians to become more involved in family planning, and meet specific needs among the private physician community as they try to become more involved. Among the noteworthy findings of this study are, given that a key goal of the project is to increase use of longer-acting methods, these methods are not readily available at affordable prices to rural consumers/patients ie. half the Jamaican population. long-term and permanent methods are concentrated in urban areas and offered primarily by private physicians. Short-term or supply methods were widely available to both urban and rural users and were quite affordable. Another significant finding is that private physicians have an interest in increasing their understanding of and involvement in family planning, widespread interest was expressed in the Private Physicians' Pilot Project. The private sector it was found offers the most SDPs, the widest range of methods and the greatest number of hours of operation, however, it is the public sector that provides the most services ie. about 60 percent of family planning services. These was a tendency for private sector providers to be concentrated in urban areas due to available supporting medical services; a further intra-urban clustering of private sector sites was also found; ther was a tendency among newer doctors to establish practices in urban areas outside of Kingston; a more evenly distributed pattern for public sector SDP was found, along with a clear emphasis on serving rural communities; an expansionary trend in terms of number of SDPs in urban areas is noticeable whereas a slight reduction in overall number of SDPs serving rural areas was noted. The recommendations are, to use the findings from this mapping study to plan future activities; to improve availability on long-term and permanent methods for rural groups; to encourage the private sector to increase its participation in family planning; to engage pharmacies and private physicians in expanded social marketingprogrammes; and that the social marketing programme be encouraged to expand its marketing support to include longer-acting methods.