Bangladesh : mid-term evaluation -- Dhaka urban integrated child survival project (DUICSP)

Evaluation covers the period 10/94-8/96. The project is being implemented by World Vision/Bangladesh. DUICSP is one of the more, if not the most, successful of urban health projects in Bangladesh. Its value extends far beyond its direct health effects to its success in empowerment at the community level and its framework as a viable strategic option for urban health. The project has achieved a remarkable partnership with the community (e.g., neighborhood health committees, focus mothers, traditional birth attendants, and community volunteers), project staff, the Dhaka City Corporation, and the Government of Bangladesh (GOB). Health delivery is decentralized to the cluster (i.e., 400 family) level. Certain services, such as semi-annual distribution of Vitamin A, registration, and health promotion, are delivered door-to-door; other services (polio National Immunization Days and measles tetanus campaigns to immunize defaulters) are delivered at collecting points; while still others (immunization, and maternal care and treatment of minor illness) are provided at the four project health facilities. The community has assumed a remarkable degree of ownership of the project, making significant inputs in cost recovery and volunteer labor. Quality of preventive and treatment services has been excellent, and good progress has been made toward project objectives, with the observed rates of night blindness and reported cases of disease preventable by immunization falling. However, the project needs to be strengthened in a number of areas, including the addition of family planning services, the integration of service delivery, and the rationalization of a burdensome information system to ensure the availability and use of data at the local level. Moreover, considering the high percentage of urban poor within the catchment area, it is unreasonable to expect that the project can be financially self-sustaining. However, two major urban health projects are expected to begin in the next 24 months: an African Development Bank loan for urban health and an USAID urban health service project. In the meantime, it is strongly recommended that a search be made for bridge funding to ensure momentum pending these new funds.