Audit of rural health projects in Zaire - projects nos. 660-0086 and 660-0107

Program results audit covers the period 1981-6/87 and is based on site visits, discussions with officials, and review of documents, especially of a 1986 project evaluation (see PD-BBF-376 and XD-BBF-376-A). The projects have strengthened rural health services, exceeding objectives in several areas. Accomplishments included: helping to transform curative dispensaries into full-service health centers; integrating disease prevention and control programs into health center activities; training more than 5,000 physicians, supervisors, nurses, and midwives; and protecting over 1,500 fresh water springs from contamination. The projects have also provided TA, subsidies, and commodities (including laboratory equipment, bicycles, motorcycles, vehicles, and medications) for use in supporting health centers and training village workers. However, the audit disclosed two problems with USAID/Z"s project management. (1) USAID/Z"s system for measuring project results - although it provided useful information - did not assess the financial sustainability of the projects" health care system. Essentially, these assessments were lacking because the projects" design did not require them. (2) USAID/Z failed to document all of its responses to the 12/86 evaluation recommendations. The Mission did document its decisions regarding 29 recommendations in the evaluation, but it did not record its decisions to address at least 50 other recommendations contained in the report. The Mission believe that the added recommendations were offered as suggestions and that many were either not appropriate or significant, or were already being implemented. Some of the 50 recommendations, however, addressed serious problems, which if not corrected, could adversely affect the quality of project health care and financial accountability. USAID/Z has agreed with audit recommendations to correct both of the above deficiences. (Author abstract, modified)