A Review of the HHS Family Planning Program Mission, Management, and Measurement of Results (2009) / Chapter Skim
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The Title X federal family planning program provides these critical services to those who have the most difficulty obtaining them. Title X is a valuable program that successfully serves its target audience: low-income individuals and adolescents.
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The Title X Family Planning Program is the nation's only federal program devoted exclusively to providing family planning services. Through grants to public and nonprofit private entities, Title X funds support the provision of comprehensive family planning and related health services.
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• oes the overall Title X program meet relevant past, existing, and foresee D able future needs of the targeted population, using accepted medical, family planning, recognized and professional standards and reproductive health practices (based on the existing legislation, regulations, and guidance)
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There is also ample evidence that family planning services are cost-effective (Jaffe and Cutright, 1981; Amaral et al., 2007; Frost et al., 2008)
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. Increased Complexity and Cost of Providing Services In the 38 years since the establishment of Title X, the health care system and overall social environment have changed in ways that have dramatically increased the complexity and cost of providing family planning services to the targeted groups.
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Program Goals Clarity and Consistency of the Goals The stated mission of the Title X program is to provide grants to public or nonprofit private entities "to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of
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. The program was designed to address this challenge by dramatically expanding voluntary family planning services.
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Reduce infertility among women attending Title X Family Planning clinics by identifying chlamydia infections through screening of females ages 15–24; and 3. Reduce invasive cervical cancer among women attending Title X Family Planning by providing Pap tests.
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Title X providers feel pressure to offer more and more comprehensive family planning services and comply with new program priorities without additional resources. This situation creates a tension between providing broad preventive care to fewer clients and targeting more limited services to a greater number.
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HHS, the Office of Population Affairs, and their leadership, as well as Title X grantees, should be clearly dedicated to this mission and the goals of the Title X program, supportive of family planning as a critical public health intervention, committed to evidence-based practice, and knowledgeable about the field of family planning and reproductive health. Recommendation 3-3: Develop and implement a strategic plan.
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. Each region receives a core allocation of regular service funds made by the Central Office, based on a historical formula that measures each region's need according to three data sets -- the Guttmacher Institute's Women in Need of Contraceptive Services and Supplies (Guttmacher Institute, 2008)
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Continuity of products is also compromised by the multiple purchasing sources noted above. Administrative Burden Title X clinics bear a significant burden in budgeting for and managing their multiple sources of funding, a burden exacerbated by the multiple funding cycles for the awarding of grants within the Title X program.
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Transparency and Communication The lack of transparency regarding decisions by the Central Office and Regional Program Coordinators (RPCs) in the awarding of funds to g rantees is a program challenge.
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The committee offers the following recommendations for achieving these improvements: Recommendation 4-1: Increase program funding so that statu tory responsibilities can be met. Title X should receive the funds needed to fulfill its mission of providing family planning services to all who cannot obtain them through other sources and to finance such critical supplemental services as infrastructure, education, outreach, and counseling that many other financing systems do not cover.
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Recommendation 4-3: Improve the ability to purchase drugs and diagnostics at reduced prices by consolidating purchasing sources. OFP should work with the various public and private purchasing sources for drugs and diagnostics for Title X clinics to develop a coordinated or consolidated purchasing program.
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Recommendation 4-9: Assess workforce needs. With the help of an independent group, OFP and other agencies within HHS should conduct an analysis of family planning workforce projections for the United States in general and for the Title X program specifi cally.
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A final data source is the National Survey of Family Growth (supported in part by Title X) , which examines reproductive behaviors, health, and family planning services received.
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Recommendation 5-2: Examine the data elements of the Family Planning Annual Report (FPAR)
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• Conduct research to assess program outcomes. OFP should expand research aimed at evaluating program outcomes, such as the impact of the program on pregnancy planning and inten tion, decreased infertility, outreach to those in need of services, and the prevention of unintended pregnancy.
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The committee salutes their steadfast commitment to the overall goals of family planning in general and to the Title X program in particular. REFERENCES ACS (American Cancer Society)
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2006. Family planning services: An essential component of preconception care.
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