_Regina McNamara_ **_cr a)._** _16_ identifying a team with specific villages, improved communication and community participation.

- The midwives were the outreach workers, visiting households for education, motivation, and supply, with back-up by other team members at the centers. Midwives did not receive stipends, but each village worked out a system for payment for contraceptives with a portion of the fee to go to the midwives. The remainder helped to defray health team expenses. Training was decentralized to the district level and to the community level and all health workers participated. Training was phased and the midwives had a chance to gain experience in house-to-house visiting before introducing family planning.

- Supervision and supply from central headquarters had been perhaps the most difficult problem in the Original area, and it had not been resolved by payment of stipends to supervisors. In the Extension project, stipends were not paid. Instead, natural lateral linkages among staff under the medical assistant were exploited, team meetings were held frequently, supervisors were trained to exercise leadership in a constructive, supportive climate, and the medical assistants' visits to district headquarters for pay and supplies were used for discussions of the work in the field.

- DCM staff limited their participation to technical support for training and research. They trained district health officials to train the medical assistants who in turn trained their team members. Analysis of service statistics and the administration of short, narrowly focused questionnaires for program evaluation were operations research methods taught.

The post-intervention survey in the Extension area was conducted in 1987, three years after a baseline survey and after approximately two years of community education and oral contraceptive supply. The baseline survey had indicated that modern contraceptives were currently used by 6.8 percent of the women interviewed. In the final survey, 19.8 percent reported current use; 92 percent of the users were using oral contraceptives. Table 2 shows the distribution of users of modem contraceptives by age and educational level at the baseline and after the project introduced community-level education and supply.

Close to a quarter of the women interviewed for the post-intervention survey had at some time used a modem method (predominately oral contraceptives) and of these, 59 percent said their first source of information about family planning came from the village health team. Respondents who received information about family planning from the health team were more likely to be users of contraceptives than women informed by other sources. Among the women using oral contraceptives at the time of the survey, 77 percent were supplied by the health team. The evidence indicates that, in spite of political, religious and cultural sensitivities, when information about family planning and the means to practice are made available, rural and semirural Sudanese women respond.

# _Reviaization in the Original Area_

A survey conducted in the Original Area at the samne time as that of the post-intervention survey in the Extension Area indicated parallels in results achieved. The major difference was