Assessment of the rural water borne disease control project in Swaziland

Audit report covers the period 8/79-8/83 and is based on document review, site visits, and interviews with GOS, contractor, and USAID/S officials. Leadership problems in the project"s health education component are threatening achievement of lasting project benefits. The GOS Health Education Unit (HEU) was without leadership and adequate TA until 2/83 when a replacement for the unsatisfactory health educator originally contracted arrived. Moreover, the GOS has still not officially established the replacement health educator as leader of the HEU, thus impairing his effectiveness; posts for other HEU staff, while budgeted, have not been established, either. Development of a national health education plan is behind schedule (as is inservice training of health assistants), and the M.S.-level participant trainee - and future HEU Director - lacked an undergraduate degree and thus will not return before the contracted health educator has departed. More positively, an effective oral rehydration campaign was conducted and mass media support for water and sanitation programs has been produced. The schistosomiasis survey has been conducted as planned and some results already used to establish well-drilling sites, but implementation of other components has deviated from project design. Community sanitation committees were not formed - early attempts were unsuccessful, the targeted number (200) was unrealistic, and other mechanisms for promoting the sanitation program proved effective. Also, the requirement that the U.S. Public Health Engineer and counterpart review all designs for dams, reservoirs, fishponds, water supply and irrigation systems, etc., for their health implications was determined by the Ministry of Health and the Rural Water Supply Board, in consultation with USAID/S, to be impractical. These changes in implementation have not been documented, and their potential impacts need to be assessed. In addition, the contractor has prepared only 1 of 2 planned detailed implementation plans. Finally, USAID/S has not determined whether the GOS is meeting its financial commitments to the project. Five recommendations are made.