Evaluates two projects, implemented by the Institute of Nutrition for Central America and Panama (INCAP), to reduce infant mortality and undernutrition in Central America: (1) 5960115, under which INCAP provides TA in planning and implementing oral rehydration therapy (ORT), growth monitoring, and nutrition education programs (ORT project); and (2) 5960116, under which INCAP provides TA to food assistance programs (PROPAG project). Interim evaluation, which covers activities up to 5/89, also assesses INCAP”s institutional performance. The ORT project is well advanced; with 19 months to the PACD, 80% of planned activities have been completed. Fifty-four Technologies, Methodologies, and Guidelines (TMG”s) have been developed, 27 of which have been transferred to El Salvador, 24 to Costa Rica, 30 to Honduras, and 37 to Guatemala. INCAP”s contributions — in the areas of planning and strategy development, health information systems and human resource development, health education and communications, information dissemination, and operations research — are almost universally lauded by local counterparts and are apparent throughout public and private maternal/child health activities. INCAP has been very responsive to local and national programs, though sometimes at the expense of program coherence. However, no quantifiable estimate is available on the project”s impacts, due to: (1) the diversity of country programs and the number of interventions; (2) INCAP”s strategy of collaborating with other donors, which obscures its own contributions; and (3) insufficient time in which to evaluate individual, local activities. In the PROPAG project, an effective multidisciplinary team capable of coherently developing TMG”s is in place, both at INCAP headquarters and in the field. However, due to delays in start- up, TMG development and transfer are not as advanced as hoped for. Efforts are most advanced in Costa Rica, followed by Guatemala and El Salvador; Honduras is trailing badly, and will require special emphasis if it is to receive its share of the project”s benefits. (In fact, it is unlikely that efforts in Honduras will be completed by the PACD, and Guatemala and El Salvador are questionable.) Key achievements include: the use of operations research to improve feeding (and shortly health) programs in Costa Rica, an information system in El Salvador covering 90% of the country”s food programs, the overhauling of the logistics of Guatemala”s central food handling agency, and the inclusion of food technology in Guatemala”s school feeding program. Impacts at the local (i.e., feeding center) level were difficult to quantify, even in Costa Rica, due to the lack of established effectiveness measures. There is also need to better integrate the ORT and PROPAG projects, promote community participation, and apply scientific rigor to the service areas of technical cooperation, human resources, information dissemination, and management. INCAP”s institutional capacities, especially its human resources, have grown significantly as a result of the two projects, and its stature has increased both in the eyes of member countries and the wider international community. The potential demand for INCAP”s expertise is such that INCAP could eventually become self-sustaining in certain areas, such as in the food assistance field, where its capacities are unique. INCAP”s organizational structure is well developed and has many strengths, but it also has a number of weaknesses, among which are the dual authority structure for the two projects, and an overly centralized administration. Lastly, the relationships among INCAP, ROCAP, and PAHO, in terms of underlying philosophy and operational methods, need to be reexamined and harmonized if future collaboration is to be productive. INCAP should concentrate on improving the ORT and PROPAG projects, and especially on integrating them so that a positive synergy is achieved.
