Assessment of the training program of the primary health care component of the community-based health and nutrition systems project of Guatemala

Special evaluation covers the period to 8/10/83 and is based on document review, site visits, and interviews with MOH and USAID/G personnel and with trainers and trainees. Although implementation has been delayed (due to political and bureaucratic factors within the MOH and the GOG), a total of 60 (vs. 95 targeted) auxiliary nurses, 48 (vs. 75) rural health technicians, 577 (vs. 1,500) rural health promoters, and 610 (vs. 975) comadrones have been trained. Training is by objectives and task-oriented. Trainers are competent and the training is generally of good quality, although the training of comadrones (by auxiliary nurses) is weak compared to other training areas. Impressive accomplishments have been made in adaptation and revision of training materials, standardized services and training norms, and training guides; all personnel have been trained in the use of these materials. However, due to the fact that a supervision/information system has not yet been implemented, neither the performance of the trained personnel at the community level, nor their impact on service utilization and coverage can be assessed. Training evaluation methodologies are also lacking and the MOH has failed to provide adequate support services such as transportation, per diems, and training materials. Other problems have included insufficient staffing, competing task assignments, and the severely curtailed implementation time frame. Area medical chiefs report an imminent shortage of personnel to train further groups of community-level workers. Problems facing the project as a whole include: poor orientation toward project objectives by area and district physicians, lack of field support for rural health technicians, and the MOH's failure to develop a communication flow among project levels or to decentralize decision authority. Numerous recommendations are made.