Adamawa State[, Nigeria] maternal health and child survival project (CSP-III) : final evaluation

Assessment of project accomplishments has suffered from the inadequacy of the survey instrument in generating the necessary data. In terms of survey estimates, the Fufore area consistently recorded lower achievement rates than Guyuk, probably because project activities commenced a year later in Fufore. Achievement in providing water and sanitary facilities was very low, with only 15.2% of deserving villages being provided with water and sanitary facilities. The survey's key CS indicators show that in Guyuk there were considerable increase in prenatal visits (60.3-81.3%), oral rehydration therapy/solution utilization for diarrhea (33.9-57.O%), immunization coverage (14.0-44.9%), and exclusive breastfeeding (86.0-92.2%) than in Fufore, where the corresponding rates were 56.4-59.8%, 39.5- 47.4%, 15.2-32.3%, and 84.1-83.3%. Guyuk, however, recorded poorer performance than Fufore in contraceptive usage, literacy, and management of diarrhea. Generally, the two LGAs showed little or no changes in most indicators between baseline and final evaluation rates. AFRICARE has laid a solid foundation for the delivery of MH/CS services in the context of primary health care in four districts, two each in Guyuk and Fufore, in the form of staff development, community mobilization for support, and the creation of a demand for the services. However, the infrastructure and resources needed to operationalize, sustain, and replicate this effort are yet to be put in place, tried, and developed. Sustainability has suffered from inadequate post- training follow-up. Nonetheless, house numbering and home-based records are already in place in all houses in the project area. A good number of village health workers and traditional birth attendants have been trained, and a new cadre of community birth attendants has been introduced. Village and district development committees have been mobilized to co-manage MH/CS activities. Demand for immunization, prenatal care, and water and sanitation services has increased, though largely as a result of direct project input. Several lessons were learned: (1) The listing and timing of activities in the Detailed Implementation Plan (DIP) should be based on a path analysis that orders the relationship between the grouping, ordering, and sequencing of activities to the achievement of the overall project goal. A path analysis will also determine whether the implementation plan is feasible. (2) A contract spelling out the expected contributions of all collaborating parties at the various stages of implementation should be signed by all the collaborators as part of the planning process. (3) A centralized coordination/steering committee should be institutionalized for projects expected to collaborate with institutional partners. (4) The job descriptions and services of all project staff should be regulated, supervised, and coordinated to ensure high levels of productivity, efficiency, and commitment. (5) Projects should be provided with increased technical support input and oversight, e.g., to prepare an action/work plan after the DIP technical review, assess project progress between evaluations, and, when constraints prove insurmountable, request a redesign of components. (6) Project strategies should be designed not to "help" but to "develop" communities. If the aim is to increase demand for permanent services, the community's capacity for such demand should be the project's first focus. (7) Time should be devoted at the beginning to orient staff and set tone and structure; acquaint staff with organizational policies, project objectives, and job descriptions; and develop staff skills in community-oriented primary care, participatory approaches for community diagnosis and program implementation, team development, project planning, and evaluation. (8) Discouraging incentive allowances for participating in workshop/training to salaried project staff will help screen staff for interest and commitment to service. A sustainability plan is presented in conclusion.