_Kananga CUnlcal services_ **_and socka_** _marketing_ _31_ holding single-mindedly to its objective (to raise contraceptive prevalence in the city of Kananga) was the Project able to reach it.

# _2. Organizational Autonomy_

The Kananga Project was lodged in the IMCK, a nongovernmental, nonprofit institution which had operated in and around Kananga for 35 years. In this context decisions could be made at the local level (without reference to a higher authority in Kinshasa) on all aspects of project design and implementation.

The Project maintained friendly links with other organizations but did not depend upon them. The staff kept regional health authorities informed of its activities, but acted at the level of local health centers and pharmacies. Furthermore, the Project maintained working relations with groups outside the Ministry of Health, both government agencies (Ministry of Women's Affairs, Institute of Statistics, Teacher Training Institute, the army, and the radio station) and nongovermmental groups (industries, Catholic and Protestant schools and churches). Thus the Project, lodged in a nongovernmental church-related health institution, maintained its independence from any one government agency.

lhis organizational autonomy allowed the Project the flexibility to take on unforeseen tasks when necessary. In the initial stages of the Project, the staff tried to work with the regional family planning committee and health authorities. At one early meeting, the different groups agreed on a basic city-wide plan and divided the tasks: training and public information would be handled by the Project, clinic supervision by district physicians, and contraceptive supplies by the family planning committee. After a few months, however, it became obvious that the other groups had neither the means nor the interest to assure supervision and contraceptive supplies. They were perfectly willing for the Project to do everything; reluctantly the Project accepted responsibility for all four aspects of family planning in Kananga.

This same autonomy allowed the Project to set up a contraceptive procurement system, whereby health centers, pharmacies and retailers could buy contraceptives locally, thus getting around the procurement problems outlined above. A large drug depot, located in Kananga and operated by a Protestant church grcup, made the system possible. The depot staff agreed to receive large shipments of contraceptives from the national suppliers, purchasing them and paying air transport when necessary. The depot resold the contraceptives at cost, plus a small administrative fee, to any health center approved by the Kananga Project supervisors. This depot system assured contraceptive supplies for all 16 Kananga clinics.

# **_3. Smkple_** _IZformation Systems_ **_with_** _Rapid Feedback_

Information from service statistics and field research could be translated immediately into new program emphases. Specific examples include the following.

- Clinic records of new contraceptive acceptors in 1988 were compared with 1987 survey data on the general female population. Women over age 35, women with less than a secondary education, and women who had never used any modem contraceptive were underrepresented among clinic clients. The team discussed and tried ways to appeal to the underserved groups.