AID integrated low cost delivery system projects : health, nutrition and family planning,. Volume I : project summaries

Since 1976, A.I.D. has steadily increased funding of its health assistance projects, with emphasis on developing integrated low-cost health delivery systems which combine health, family planning, and nutrition interventions targetted primarily at rural populations. This report, the first of two volumes, summarizes 39 of A.I.D."s integrated health delivery projects, either ongoing or planned for implementation by 1979, in Africa, Asia, Latin America, and the Near East, as described in A.I.D. project papers (PP) or project identification documents (PID"s). Project summaries describe the project purpose, outputs, and inputs; planned health, nutrition, and population components; host country and other donor involvement; financial requirements; and project cost, duration, area of coverage (regional or national), and target population. Also summarized are pertinent issues, as discussed in the PP or PID, such as level of host-country commitment and requirements, personnel selection and training, local community acceptance of a project, and coordination of multidonor efforts so as to avoid duplication. In general, two-thirds of the projects, which in toto encompass a target population of 45 million, are aimed at regional populations. Nutrition components tended to be weaker than other components. For example, provision of iron and vitamin supplements to diets is infrequent; promotion of breastfeeding occurs in only six projects; the content and organization of nutrition education is not clearly defined; and many tasks associated with nutrition components are delegated to the lowest level worker (often village volunteers) with the least education, training, or pay -- implying a low priority to nutrition intervention. The innovative feature of these projects is the use of health auxiliaries who will provide preventive and simple curative health care on a large scale -- an approach previously successful at experimental levels -- although many of the personnel, training, and organizational issues remain to be resolved.