and private-sector reports, and other information. It also conducted a series of interviews with Central Office staff, regional program staff, and Title X grantees and delegates, focusing on the administration and management of the program. This chapter also draws on testimony provided to the committee at its public workshops by current and former grantees, as well as regional program staff, and on information obtained during the committee’s site visits (see Appendix A for a description of the workshops and lists of participants). The first six sections review in turn the roles and relationships of the Central Office, Regional Offices, grantees, and delegates; the application process for grants and contracts; the types and distribution of grantees and delegates; and the services provided by, oversight of, and funding of grantees and delegates (including coordination with other federal sources of funding for family planning services). The chapter then presents the committee’s assessment of the program’s management and administration. The final section offers conclusions and recommendations.

CENTRAL OFFICE, REGIONAL OFFICES, GRANTEES, AND DELEGATES: ROLES AND RELATIONSHIPS

OFP, the Central Office, is responsible for the overall administration of the Title X program. As noted above, it is located in OPA, the primary division of HHS that advises the Secretary and Assistant Secretary for Health on reproductive health. OPA is headed by the Deputy Assistant Secretary for Population Affairs, whose responsibilities include implementation of the Title X program and the Adolescent Family Life and Research program, authorized under Title XX of the Public Health Services Act.

OFP develops national priorities and initiatives, policy, performance measures, budget requests, spending plans, and funding announcements for the program. It also coordinates and collaborates with other agencies within HHS (e.g., the Office of Women’s Health, the Centers for Disease Control and Prevention [CDC], the Office of Minority Health); oversees and monitors grants and contracts that are national or cross-regional in scope (e.g., training grants regarding male family planning and reproductive health with the University of North Carolina, clinical training with the University of Missouri, and the National Training Center with Cicatelli Associates; research1; and the OPA Clearinghouse); responds to requests for

1

Research grants and contracts may be used for research in biomedical, contraceptive development, behavioral, and program implementation fields related to family planning. Research projects involve data analysis and related research and evaluation on issues of interest to the family planning field, as well as research on specific topics related to service delivery improvement. OFP has a standing announcement for service delivery improvement research, which encompasses quality of care, including the effectiveness, efficiency, timeliness, and equity of family planning services; reproductive health care of adolescents; reproductive health care of



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