Mid-term evaluation of a project to strengthen developing country programs to control vector-borne diseases. Evaluation covers the period 1990-5/92. USAID Missions and Bureaus generally have a positive impression of the project, which they view as a quick and reliable source of TA in the specialized area of vector control. However, the Office of Health (R&D/H) has a broader vision of the project, having focused its design on assessment and control of vector-borne diseases, and requiring that the project possess expertise in a number of aspects not included in its predecessor. The project has been more successful in responding to requests for TA than in initiating innovative approaches to the control of vector-borne diseases. Some success in the latter can be identified in places like Bolivia, where the project has assisted in a successful Chagas” Disease control effort. However, problems have been encountered in recruiting and integrating personnel who can support R&D/H”s broader vision. As a result, the project functions much as its predecessor did, maintaining many of the original staff. The key decisionmakers in MSCI (Medical Services Corporation International, the primary contractor) and the project reinforce the vector control perspective. Those familiar with the project over several years describe the difficulty of reorienting the project towards disease control and related health and community participation issues; for example, the search for the Institution/Human Resource Development (I/HRD) specialist lasted over a year and the position has yet to integrated into the project in any meaningful way. The narrow technical vector-control orientation has been reinforced by recruitment of consultants who are often colleagues of senior project staff. While competent in their areas of expertise, they are typically old school specialists who may be less familiar or comfortable with the broader perspective that is called for in a disease control approach. The lack of a strategic plan for allocating project resources (core funds) is a concern. Resources have been spread too thinly among 27 countries and 9 diseases. Almost half of the field work has been in Latin America, the continent where morbidity and mortality rates are least affected by vector-borne diseases. The project”s success in the region can be attributed to the personal energy and vast network of the project”s deputy director, who is to be commended. However, the lack of any concerted effort in Africa, especially toward malaria, is a concern. Even given the difficulty of programming in Africa, the allocation of project resources might have been different if priorities had been established within a strategic plan. What, for example, was the rationale for spending more core funds on Guinea worm than on malaria in Africa and why was $80,000 in core funds spent on malaria in Swaziland, a small country with little malaria? Moreover, the project has missed a number of opportunities to market broad, innovative activities. As a result, it has generated a relatively limited number of buy-ins, approximately $0.25 worth for every dollar of core funds expended. Project management, especially the lack of participation by project staff in the decisionmaking process, is another issue. Although staff meetings are held on a regular basis, decisions are made by the high-level corporate and project managers with virtually no input from responsible staff members who have expertise and experience to contribute. This has led to a turnover in critical staff, especially those tasked with bringing the broader perspective into the project. They did not feel that their ideas were being taken into consideration in the hierarchical decisionmaking process. (Author abstract, modified)
