Evaluates project to develop a nationally replicable low-cost health service delivery model in three Integrated Rural Development (IRD) areas of Ecuador. Special evaluation covers the period 10/81-3/84 and is based on site visits and personnel interviews. Community participation and delivery of primary health care at the community level – issues which must be maintained as a high priority – have not received sufficient attention so far. This has been due partially to strategic emphasis on high levels of administration and on the formal aspects of regionalization, and partially to external difficulties such as conflicts over the meaning of decentralization at the national and regional levels, the difficulty of formally establishing the Area Chief’s role (due in part to weak contracting arrangement with the Ministry of Health), and problems in retaining leaders who were hired and trained. A permanent director and field director for the Centro de Salud Hospital (CSH) would advance community operations and is critical to the project. The training of health promoters for IRD-Health areas is a primary immediate concern and funds should be reprogrammed for this purpose. To coordinate health research with project capabilities and to avoid conflicting political interests, research priorities should be established by someone other than the National Health Council, e.g., by PRITECH and PRICOR, the A.I.D. contractors who have already assisted the project in this area. Also, the new Area Chiefs – namely, the CHS directors – should be trained in-country by the Center for Multidisciplinary Investigations in Development (CIMDER) and should be given supplementary management training. A quality assurance program is needed for the iodized salt used to control the iodine deficiency problem.
