An evaluation of Profamilia's female sterilization program in Colombia

Abstract

The findings of three surveys and three studies used by Profamilia to evaluate and improve their voluntary female sterilization program are presented. The surveys measured sociodemographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost-effectiveness analysis. Results of the projects were used by Profamilia management to identify areas of program strengths and weaknesses and to implement operational changes.

PIP: Profamilia is a nonprofit, private family planning organization based in Bogota, Colombia. To improve program performance, the findings of 3 surveys and 3 studies were used by Profamilia to evaluate and improve their female sterilization (FS) program. The surveys measured socio- demographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost- effectiveness analysis. Results of the projects were used by the Profamilia movement to identify areas of program strengths and weaknesses and to implement operational changes. In 1970, Profamilia offered vasectomy; FS was offered in 1972. The vasectomy program was ineffective; however, FS was very successful. Approximately 72% of all procedures performed in Colombia are done by Profamilia. In 1972, 2 Colombian gynecologists, (1 from Colombia) were trained in Colombia to do FSs by doctors from Johns Hopkins Hospital. At present, Profamilia uses about 40 doctors directly, and contracts with others. Program evaluation is done by using cost-effectiveness evaluation to measure financial efficiency, survey analysis to measure general program efficiency and client satisfaction, and collection of service statistics to measure program output. The 1st survey was done in 1976 and 1977 to learn about user characteristics. The 2nd project was a 2-phase (retrospective-prospective) survey carried out in 1978-83. In 1985, Profamilia decided to do a follow-up survey in conjunction with Association for Voluntary Surgical Conception (AVSC). It emphasized factors influencing the decision to be sterilized. Sterilization acceptors were interviewed in 8 clinics in a nonrandom sample. 3 cost- effectiveness studies have been done on Profamilia's FS program. A departmental study determined the cost per couple year of protection offered by the 5 service departments of Profamilia; an accounting study determined the full unit cost per sterilization; and an organization-wide cost study determined how to assign indirect and shared costs of support divisions to service departments like sterilization.