Audit report on integrated rural health and population project no. 386-0468

Audit report covers the period 8/80-3/84 and is based on document review, site visits, and interviews with GOI and USAID/I officials. The project is 2 years behind schedule and only 7% of planned disbursements have been made. In the three states visited - Gujarat, Maharashtra, and Himachal Pradesh - training and placement of additional village-level rural health workers has been on target, although 45% too few subcenter-level workers have been trained and the quality/content of training has not been satisfactory. Inservice training has been limited to one 7-day course for female health workers in Gujarat and a management course in Himachal Pradesh for two district and 16 medical officers. Only 13 (of the targeted 43) training facilities have been constructed; they lack adequate training personnel, equipment, curricula materials, and books. Although 500 of 2,339 planned health service facilities have been built, many of these are substandard and construction cost overruns have been 100%. Failure to complete baseline surveys and assessments (for training, management, and communication needs) has hampered overall project planning/implementation. While a training needs assessment has been made, it did not cover all health personnel as required. None of the states has determined drug, contraceptive, and equipment needs; supply shortages have occurred. Also, delays in organizing state project management units, ineffective state governing boards, and a shortage of technical staff have prevented research/evaluation activities. Further, the states have violated grant terms by: failing to display signs publicizing U.S. involvement at project sites; using U.S. funds for non-U.S. costs; and using funds to pay motivation fees for FP. GOI and state progress reporting has been poor; USAID/I has neither monitored nor critically reviewed the reports. While accounting records have been generally satisfactory, $90,047 in ineligible costs were claimed because the states did not follow operational guidelines.