Final evaluation of a project (1985-8/96) to support four child survival (CS) programs in Egypt: Expanded Program on Immunization (EPI– expanded in 1991 to include hepatitis B), acute respiratory infections (ARIs), child spacing/maternal child health (CS/MCH), and nutrition (eliminated as a separate component in 1992). The project has been very successful and has contributed to reduced infant, child, and maternal mortality in Egypt. The 1995 Demographic and Health Survey (DHS) showed an average 35% decline in infant mortality and 59% decline in child mortality over a 10-year period, concomitant with several CS successes — increased immunization rates, use of oral rehydration therapy, and appropriate treatment of ARIs. The EPI component has been the most successful. Currently, 79% of health districts are polio-free, and only 71 reported confirmed cases were found in 1995 (down from 550 in 1988). If current strategies, including National Immunization Days and Polio Mop-up campaigns are sustained and a sensitive surveillance system capable of detecting all acute flaccid paralysis cases continues to improve, Egypt should attain its zero confirmed cases of polio objective by 1997. Vaccination coverage has been maintained at more than 80% since 1988; at least 83% of 231 health districts have achieved 80% coverage. The 1995 DHS Survey noted 79% fully immunized coverage (excluding hepatitis B3). In addition, incidence of neonatal tetanus has declined by 89% since 1986; and 76% of districts have reported less than 1 case per 1,000 live births. A highlight is the Government of Egypt s (GOE) assumption of total financial support for EPI (by contrast, in 1992 the GOE had zero funding for the imported EPI vaccines, which were provided mainly by UNICEF). A national ARI detection and treatment program based on standard case management has been established in all 27 governorates — one of the first such programs in the world. The project estimates access to standard case management to be 87%; to achieve this high level, the project skillfully handled all the complexities involved in planning, personnel development, equipment, supply line, information system, research, and information, education, and communication (IEC). The CS/MCH component conducted varied and often innovative activities and programs in association with different Ministry of Health and Population (MOHP) departments, with varying levels of success. These included an important Maternal Mortality Study in 1992, the development of 100 neonatal care centers, daya (traditional birth attendant) training and linkage with MOHP health centers, and upgrading of delivery rooms and laboratories. There was, however, relatively little of the desired collaboration between this component and the USAID-funded MOHP family planning program. The project is ending before the crosscutting programs can show final results. The project has laid the framework for a national decentralized computerized health information system (HIS); supplied hardware, developed software, and provided some training; as yet, however, only a few governorates are using the new system (called DecHIS). A training curriculum has been developed for decentralized health planning and management; 4 of 27 governorates have received such training so far. A clinic improvement program (model clinics) has begun and the service standards developed for these 15 clinics are in use there, but not beyond. Very recently, the mass media program developed a series of 12 TV spots on priority MCH topics that have aired in the last several months. A revision of the curriculum for nurses has been completed, and that for physicians has been delayed by agreement between MOHP and USAID. The Field Epidemiology Training program has begun supplying trained MOHP epidemiologists, conducted numerous studies related to public health problems in Egypt, and made significant progress in the institutionalization of the program. In the final 2 years, efforts focused on two areas in particular need of strengthening: training and mass media/health education. Materials produced in these areas are well done and will be very useful in the years to come. Project efforts to achieve sustainability through decentralization and integration are too recent to show results. Numerous recommendations for the successor Healthy Mother/Healthy Child Project are included. (Author abstract, modified)
