AID ROLE IN HAITI'S MOTHERCRAFT NETWORK FROM 1976, TOWARD THE FUTURE

Onsite evaluation covers the period 10/1/76-12/31/78 and is based on project documentation. This special evaluation, attached to PES (PD-AAF-559-A1), focuses on the performance of the nutrition rehabilitation and education centers for mothers and children (CERN's) established in the project's first stage. Utilization of the CERN's was far below both the maximum and the expected rates. Only 59 children were nutritionally rehabilitated and 181 children protected via mother education -- less than 60% of the maximum projected totals. The per capita cost of $42.40 was $18.00 higher than projected. Moreover, the most nutritionally vulnerable children are not being treated first, a situation made worse by the inadequacy of existing CERN guidelines, which need immediate revision. Criteria for location, admission/exit standards, age of children, length of stay, and supervision are provided. One of the program's most serious problems is that 74% of the children show second and third degree malnutrition upon leaving the CERN, despite an average stay of 5.4 months. The CERN diet is insufficient to fill a child's total nutritive requirements, yet 30% of mothers give no supplements to their children. Dietary studies of CERN food and of children's consumption should be made and a special formula should be given to seriously malnourished children immediately upon visiting a CERN. The mother education component should receive greater stress and training made more applicable to home conditions. Basic nutrition lessons should be presented early and repeated often. Other suggestions to improve education are more frequent home visits and use of alternative teaching methods. Refresher training for CERN directors and extensionists is needed, as is stricter adherence to the length-of-stay limit (4 months). The CERN system alone is incapable of reaching all 270,000 seriously malnourished children under five. A nutrition education component should be introduced into the overall health delivery system in order to make integrated nutrition services available to all children.