Target or Target Free?
The 'Target Free Approach'
(TFA)
adopted by the Department of Family Welfare,
Ministry of Health and Family Welfare, since 1996 is
coming under serious review by professionals,
administrators and policy makers. The TFA was
adopted as a natural consequence of the intensive
target-oriented
time-bound family planning
programme implemented in the country since the
very beginning, especially from 1962. In the 'target
era' the family planning targets were essentially
based on the number of sterilisation operations or
sterilisation equivalents of IUD insertions, oral pills
and condoms distributions for achieving a pre-
determined decline in birth rate. As long as there was
a sizeable proportion of eligible couples who had far
exceeded their desired family size in the population,
and who did not want any more children at any cost, it
was not difficult for the programme personnel to
recruit the targeted number of cases of sterilisation
or sterilisation equivalents. In many States, such a
programme exhausted this high fertility pool in
different years.
From 1990, it was becoming increasingly
difficult for the programme personnel to recruit cases
for sterilisation operations. This was particularly true
for the states that had already done well in the family
planning programme, i.e. Goa, Kerala, Maharashtra,
Tamil Nadu, and West Bengal. Protests against
targets were largely received between 1990-93 from
these states, which claimed that their fertility levels
were already low and the imposition of family
planning targets of any kind was unreasonable. They
also appealed to the Centre that allocation of any
financial assistance from the Centre, based on
achievement of accepted targets was illogical and
was not acceptable to them. They said that fertility
goals and not family planning acceptor targets are to
be considered as 'sine qua non' for the success of the
family planning programme.
Government of India adopted the 'target-free
apporach' from 1st April 1996 in all the states. Family
planning was made a part of a more comprehensive
and ambitious Reproductive and child Health
package since October 1997 and TFA was
rechristened as "Community Needs Assessment"
approach. The programme switched over from an
aggressively supply and promotion oriented one to a
meeting-the-demands on a wide array of areas
under RCH including family planning. The switch
over was done without adequate planning,
preparation and putting in place alternate goals for
monitoring and evaluation of programme at the field
level. The number of acceptors for family planning
methods almost collapsed during 1996-97 in those
states where fertility was high but it is ironical that the
number of sterilisations, IUD insertions, and oral pills
and condom use continued to remain at fairly high
levels in those states where fertility was already low
and declined. This suggests that once fertility decline
commences at a rapid pace, and once couples
internalise the small family norm, there is practically
no need to impose any targets.
At present, when Government of India is facing
a dilemma on TFA, it appears prudent not to impose a
common strategy on all the states. The strategy
should best be left to the individual states with the
central government playing an advisory and
supportive role.
KJf~
DR K SRINIVASAN
New PFI Publication to be Ready Soon
A publication, based on 14 case
studies of action research projects
in health and family planning
undertaken by NGOs in ten states and
supported by PFI, is being brought
out. Voluntary Action in Health and
Population: The Dynamics of Social
Transition, edited by Sunil Misra is
expected to be available by the end of
this year.
The Foundation has supported
nearly 320 projects for the cause of
population stabilisation since its
inception in 1970. These include
innovative and research programmes
covering various aspects of' the
population in the form of studies,
action research projects and training
in family planning, maternal and
. child health and related areas. Many
of these were area specific, isolated
activities, important in their limited
o bj ectives, wi tho u t necessarily
falling into an organic integrated
pattern. Despite the sincere efforts
put into these programmes, not
much insight was gained into the
long term sustainability and the
overall impact of the programme as
the Foundation's concern ended
with the payment of final instalment
and the receipt of the final project
report.
It was therefore decided to
undertake qualitative evaluation of
the action research projects which
had been completed during the past
three years (since 1996) or were
nearing completion to assess the
quality of their programme
operation, overall impact, extent of
people's participation and the level of
sustainability after the project
funding was over. It was important
to find out the trends, patterns and
processes of change consequent to
programme interventions.
Fourteen action research
programmes were identified for case
study and qualitative evaluation.
Broadly classified, these related to
focus areas of Infant Mortality and
Fertility; Integrated Health, Family
Planning
and Development;
Reproductive Health and Family
Planning in Urban Slums; Reproductive
Health and Family Planning among
industrial workers; and Family Planning
through Rural Medical Practitioners.
The frame of reference for
evaluating the projects was : (a)
assessment of the overall impact of the
programme in the attitudinal and
normative behaviours ; (b) assessment
of the processes and directions of
change consequent to programme
interventions; (c) assessment of the
extent of people's participation and the
level of sustainability after the
programme was withdrawn from the
area; (d) assessment of the factors
responsible for the success or failure of
the programme, the problem areas, etc;
and (e) assessment of the replication
potential
of the programme
methodology for wider applications.
The evaluation sought to assess the
effectiveness of the NGOs in bringing
about desired changes in individual and
community value systems. The purpose
of the exercise was to understand the
intervention processes, the social and
structural transformation consequent
to programme interventions, how the
NGOs react as catalysts of change and
to derive lessons for future activities.
Prof. Sunil Misra, Joint Director in the
Foundation, edited the fourteen studies
and provided an overview for the
publication.
The major challenge before
development workers is to make the
national or state programmes relevant to
the local context so that the people of the
area for whom the programme is designed
can identify their own needs and
aspirations with the programme
activities. Deep rooted and sustainable
changes have indeed taken place in every
project area where interventions have
been made.
The book would be useful to those
interested in social change especially in
areas of family planning and
reproductive health through non-
governmental efforts.
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