Burkina Faso -- family health and health financing project (project number: 686-0275) : mid-term evaluation

The evaluation covers the first two subprojects; the third, which had a late start-up, will be reviewed later. Mid-term evaluation covers the period 1990-11/93. Overall, the project has performed well and met most mid-term objectives despite a complex administrative structure and a high rate of organizational change within the MOH. The Government of Burkina Faso has adopted a multi-pronged approach to family planning (FP) service delivery. Subproject 1, child survival and maternal health, has evidenced complementarity among its component activities (FP, nutrition, diarrheal disease control, and condom social marketing). There has been functional integration at the level of service delivery. Only condom social marketing remains somewhat out of the loop as it is oriented toward the private sector; nevertheless its activities have been coordinated with the MOH. Contraceptives are now offered through the public sector, the private sector, social marketing, and -- on an experimental basis -- community-based delivery. In this manner, the country has rethought its health delivery system, which, traditionally focused on providing medical services rather than on preventive care. National health service delivery norms have incorporated project-generated training materials, curricula, policy and standards, protocols, and IEC materials. The MOH has participated fully in project planning and implementation, and is committed to achieving the project's goals, particularly those for FP and maternal/child health. According to the Demographic and Health Survey (1992-93), the contraceptive prevalence rate among women in union is 7.9% (with 4.2% using modern methods) versus 1% in 1987. Finally, the social marketing program has helped define a product image and market niche for contraceptive products and has resulted in the rapid infusion of condoms into the private sector; however, much still needs to be done to raise awareness of condoms as a protective measure against pregnancy and disease. Subproject 3, strengthening health planning, has provided support to the Directorate for Studies and Planning (DEP) to increase its planning capabilities and its budget from non-USAID sources. DEP is now involved in all planning and evaluation functions of the MOH. However, it needs to improve the quality of its documentation and make better use of the annual donor coordination conference. The following lessons were learned. (1) The MOH's acceptance of project activities as integral to its own goals has ensured common training, service provision, and quality targets throughout the country, notwithstanding variations in donor support. (2) Integration of diverse activities of several subprojects can be a sensible strategy when working with limited human resource capacity and infrastructure constraints, especially when efforts are made to ensure acceptance and adoption project outputs by all participants. (3) The design of a bilateral project as a compilation of activities supported by different contractors and cooperating agencies fostered some trade-offs. While efficiencies were realized at the outset in preparing only single set of A.I.D. project documents and in continuing work begun by centrally funded projects, subsequent demands on USAID and MOH personnel were heavy as they had to prepare separate subcontracts for each activity and work with consultants from different organizations. (4) The presence of local technical counsellors and easy access by regional contractor staff ensured routine monitoring of progress, reducing the need for A.I.D. to directly intervene in project activities.