_Programs in Sasb-Saharan_ _Fanily_ **_Planming_** _Africa_ _7_ quarter of 1989, and intt.rviews with 227 randomly selected clients were encouraging in that almost 89 percent were continuing after three months and 69 percent after nine months; nevertheless cases are too few to confirm a clear pattern.

# _Factors Contributing_ **_to_** _GR&A Program Success_

The three most important factors fostering the success of the GRMA program are the preexistence of a network of health professionals who are indigenous, self-supporting, and in close contact with the target populatioin, the support of the public sector; and the confluence of substantial financial and technical assistance by five organizations which had long term institutionbuilding objectives.

Thus the program has the advantage of the presence of health professionals widely distributed in rural and urban areas, with their own facilities, and linked to a national organization. As practitioners in the private sector who do not require extensive training, they could be quickly mobilized for service delivery. They are known in their communities, especially by women in childbearing ages, and they are especially well-placed for postpartum counseling.

The idea for the family planning training program originated with a Ministry of Health official and the MOH has supported the activities of the GRMA by contributing educational materials, for example. There is a history of cooperation between the MOH and private sector maternities, especially those where MCH sessions are held. Many of the midwives started their careers in the Ministry and personal and professional ties endure.

Each of the organizations that was funded by A.I.D. to assist the GRMA program made its specific contribution to the development of the organization itself, the training program, procedures for supervision, and maintaining motivation and skills (e.g., continuing education, a periodic newsletter), and staff capability for program monitoring.

ACNM technical assistance in helping to establish a central organization capable of managing the training and support services for the midwives has been of paramount importance. The consultants played active roles in planning the program and its budgets, training the trainers, organizing and conducting the training sessions, and on-going management of tile program.

The Social Marketing Program made possible a centralized system for supplying the midwives at wholesale prices. Enterprise consultants led workshops to teach the midwives financial management. (This aspect of the program was evaluated by a sixth A.I.D.-funded program, the Population Impact Project.) The Population Communication Services' contribution was through materials and technical support for the Ministry of Health and transferred from the Ministry to the GRMA; hence that agency was not directly involved in day-to-day operations.

The GRMA program enjoyed some enha-cement of status in official and academic circles as a Columbia University operations research p..ject. The main contribution of the operations research to program success, however, has been through regular reports on the training and on services delivered; also by establishing within the GRMA the capability to collect and analyze data as a routine administrative task for program evaluation.