Conclusion

female circumcision in new generations by 10 percent by enforcing the law criminalizing the act and activating related ministerial decisions. Although these are important areas of work, their inclusion broadens the scope of EPIP 2015–2020, thus straining its already weak management and coordination and diluting its capacity to deliver results.

At the same time, FP programs suffer from other implementation challenges.

Missed opportunities in integrating FP services. FP activities oscillated between being provided as stand-alone vertical services or being horizontally integrated within the continuum of sexual and reproductive health (SRH) services. vertical FP activities were only partially implemented because of insufficient financial resources. Coverage of FP services in integrated SRH programs was fragmented. There was a missed opportunity to incorporate these services and/or information about FP at critical points of the reproductive cycle, including puberty, premarital counseling, pregnancy, and the postnatal period (Shawky, Rashad, and Khadr 2019). Premarital counseling is not fully implemented, and reproductive health and FP counseling has disappeared from ill-health screenings. Antenatal care focuses only on the medical checkup, with no counseling on FP. Demand for postnatal care is very low, and for those who still access it, the focus is on medical care for the mother and child (MOHP, El-Zanaty and Associates, and ICF International 2015a, 2015b; Rashad, Shawky, and Khadr 2019; Shawky, Rashad, and Khadr 2019).

Inconsistencies in the modes of FP service delivery. The provision of FP services was covered through fixed or static clinics and mobile delivery. because of insufficient funding, mobile clinics were unable to cover all the target areas and populations. Their unreliable schedules, lack of continuity of care, and lack of privacy were cited in anecdotal evidence suggesting that clients did not favor them (Rabie et al. 2013). Women were also reluctant to seek services for fear of being noticed and stigmatized for using FP services.

Shortage of health care professionals in the public sector. This has been a point of concern for FP services, irrespective of mode of delivery. Some of the ways that health care providers seek to overcome the low salaries and poor working conditions in the public sector include raising rates and holding dual jobs, migrating to cities, and moving to the private sector. These patterns have depleted the public health workforce and affected the availability and quality of these services (WHO 2014).

CONCLUSION

ENPS 2015–2030 and EPIP 2015–2020 came as critical responses to the alarming demographic trend in the country. However, their goals, objectives, and axes, though appearing comprehensive, suffer from several pitfalls, including (a) fragmented governance and poor accountability, with wavering political commitment to maintain the Ministry of Population and rapid turnover in the leadership of the NPC; (b) insufficient financial resources, with a funding gap of around 50 percent, and weak financial and budgeting skills, which especially affected axis I, a core part of the strategy and plan; (c) limited reach, with a failure to expand geographic coverage of services due in part to low budget allocation and in part to lower capacity, resulting from a shortage of doctors in health care units and fewer mobile clinic visits than planned; (d) lack of attention to the evidence