BACKGROUND AND ANALYSIS OF PROPOSED HEALTH SECTOR ACTIVITY

This report, which includes a bibliography covers the period 1/77-12/79 and is based on onsite visits. Three main issues are addressed in this report -- health planning as a process, uneven project implementation, and limited and shifting resource allocations. Most of the project activities are behind schedule due to delays in identifying a contractor, fielding a technical assistance team, and consummating project negotiations. Only the construction component progressed as expected -- the first phase of construction in Siliana and Sidi Bouzid will be completed by 6/80. Six months following the arrival of the technical assistance team, an amendment should be drafted to take into account the project"s current needs and resources. If time constraints and/or funding deadlines prohibit this option, an amendment should be designed once the technical assistance team has linked up with their Tunisian counterparts. The third best scenario would be to design an amendment, with the help of Tunisian counterparts, after a contractor has been selected. The Ministry of Public Health (MOPH) should actively participate regardless of which option is chosen. The proposed amendment should take one of two courses: (1) On a large scale, the project can be extended to include the five delegations of Kasserine province, with changes made to reflect the extended project area, the conditions in Kasserine, and the Tunisia health outreach program experience. Additional technical assistance and capital inputs would be required. (2) On a smaller scale, the amendment can be limited to specific interventions complementing both project and MOPH goals, such as U.S. participant training in public health management and statistics, providing further technical assistance to the internship program in community medicine, short-term technical assistance in blindness prevention as a part of primary care training, internship programs in rural areas for midwives, and providing funds for MOPH"s National Infant-Maternal Morbidity/Mortality Survey.