BASIC HEALTH SERVICES PROJECT

Evaluation, attached to a final report (PD-AAI-218-C1), covers the period 4/77-2/81 and is based on discussions with project personnel, site visits, and document review. The groundwork has been laid for rural basic health services in Pakistan. An external factor impacting on the project was the 1977 coup which resulted in the replacement of ministers and secretaries at both the federal and provincial levels. Once acquainted with the project, the new leaders became staunch supporters. The University of Hawaii (UOH) provided four long-term advisors. The World Health Organization was supposed to provide a management advisor and a public health officer, but the advisors were so late in arriving that a fifth UOH advisor was recruited to fill the void. Outputs included six medical technician training manuals, a training manual for community health workers, a prototype management manual, 20 medical technician training schools (a minimum of 6 was planned), 200 trained medical technicians (80 were planned), construction of over 400 basic health units (compared to the planned 329), and 225 rural health centers (36 were planned). Shortfalls included community health workers (none compared to the minimum of 48 called for), integrated rural health complexes (6 were planned, a few are nearly operational), a baseline health survey to be completed 18 months into the project (a limited survey of six villages was eventually carried out), support workers (none have been trained), field operations manuals (none), operational research and development (no research documents have been prepared), and communications support, i.e., posters, pamphlets, and radio broadcasts (none in evidence). This project is a successful departure from Pakistan"s traditional emphasis on developing medical colleges and large, urban hospital complexes. Also, the project demonstrated the importance of cooperation, patience, and administrative know-how. The evaluation team concludes that a follow-on project should receive substantial financial support from A.I.D. as soon as possible.