Audit report, USAID/Laos : maternal and child health, project no., 439-11-570-081

The maternal/child health (MCH) program is designed to improve MCH health care and to provide a distribution system for birth control information and contraceptives. The audit included a review of pertinent records and discussions with officials of USAID/Laos, the Royal Lao Government (RLG), the Lao Family Welfare Association (LFWA), and the World Health Organization (WHO). After initial delays, the first 226-bed MCH center in the Mahosot Hospital, Vientiane, was completed in 9/73. A second MCH center in Pakse is nearing completion. Some progress has been made in the family planning program; however, data is either nonexistent or too insignificant to measure progress toward project goal. Project planning did not adequately consider the capability of the RLG to provide the financial and manpower resources required by the project. Although the RLG has agreed to provide the financial resources to operate, staff, and maintain the facilities constructed under the project, realistic estimates of financial requirements have not been made for inclusion in Project Agreements. The RLG submitted a staffing pattern for the Mahosot MCH Center 1 month before the scheduled opening - it provided for only 27% of the required number of nurses, 32% of the needed housekeeping staff, and no maintenance personnel. To correct staffing deficiencies at Mahosot, 70 nurses will be transferred from Luang Prabang and Pakse and 2 USAID maintenance employees will be assigned to the Center. The RLG has been unable to contract a local maintenance firm due to lack of funds. The project has placed a burden on the RLG"s already strained public health budget and continued operation of the project will require substantial USAID assistance for an indefinite period. The lack of basic planning documents has prevented meaningful project evaluation. USAID/Laos should develop more specific project targets and evaluate the project annually prior to budget review.