Africare/Guinea : maternal and child health initiative (MCHI) -- midterm evaluation

Interim evaluation covers the period 10/97-11/99. Capitalizing on its comparative advantage as an NGO, MCHI/Africare has undertaken innovative work with the Hearth model, which addresses malnutrition at the community level. Through use of this method, 117 of the 140 children present at the second post-Hearth weighing had been rehabilitated, and mothers had begun to adopt feeding behaviors that should prevent malnutrition from recurring. Africare's organization of a national seminar on the Hearth model has made many other NGOs and ministries aware of the method, which has quickly become a potential model for malnutrition rehabilitation among other NGOs, including Plan/Guinea, Adventist Development and Relief Agency International (ADRA), and Action against Hunger. More importantly, the Hearth model has the potential to help the Ministry of Health (MOH) reduce malnutrition rates nationally. In the project's fourth year, Africare will work with the Dabola Director of Health (DPS) on adapting the Hearth model to its community-based strategy. The MCHI project has increased access to primary health care (PHC) services by: promoting collaboration between community agents and MOH health workers so that more people take part in community-level health activities conducted by health center staff, such as vaccination days; training 48 community agents in nutrition, malaria control and prevention, diarrheal disease control, reproductive health, and information, education, and communication (IEC) skills; implementing growth monitoring and Hearth activities to identify and rehabilitate malnourished children; constructing and renovating health posts; providing motorcycles to MOH agents; supporting and supervising community agents; developing a referral system; improving the emergency evacuation system from health posts to hospitals through the provision of radios to health posts; and working with the United Nations Children's Fund (UNICEF) to develop a community-level emergency evacuation system. MCHI/Africare has developed an excellent working relationship with the DPS and other organizations operating in the area and effectively coordinates its work with these entities. For example, MCHI is working with: the UNICEF/Maternity without Risk Project to develop an emergency evacuation strategy to complement the project's provision of radios to health centers; Pour Renforcer les Interventions en Sante Reproductive et MST/SIDA (PRISM) and 13 other organizations to standardize and share approaches to IEC in the region: PRISM, the Association Guineenne pour le Bien tre Familial (AGBEF), and the National Malaria Control Program (PNLP) to standardize the training of health agents. MCHI is also providing information to PRISM's community-based strategy coordinator to standardize community-level data gathering and supervision tools, and serves as a resource to other NGOs interested in initiating the Hearth model. Finally, MCHI/Africare has provided training and support to increase the capacity of community agents to provide quality care in support of maternal and child health; has developed instruments to track inputs and outcomes; and is advocating for better support and recognition of community-level health activities. (Author abstract, modified)