Chad child survival project (677-0064) : project completion report

Due to the unexpected closing of the Mission in 1994 and the reduction of the PACD by 2 years, the project was reduced to two components: (1) support for the Moyen Chari Prefecture, which received the majority of project funding; and (2) assistance at the national level. The project partially achieved its goals, although its impact has to be measured more by process indicators than by effects on morbidity and mortality. In the Moyen Chari Prefecture, the project focused on three areas. First, the project aimed to improve service delivery by training public and private health personnel, through the use of pretested modules, which initially included trainer training (and covered district medical chiefs in all six districts), and subsequently health worker training. However, a lack of post-training field supervision prevented the assessment of use of newly learned skills (although health worker motivation has increased), and too many modules were implemented in a short amount of time at the end of the project, partly due to the early closure of the project. Second, in the area of institution building, the project created Moyen Chari's first formal health planning division, and, in Sarh and Moissala, provided computers and computer training (as part of decentralization efforts of the national health information system there) and budget training for senior staff. Third, in Sarh, while awaiting the delayed arrival of project-funded pharmaceuticals (12/94), the project trained a pharmacist in drug pricing and inventory, refurbished the prefecture's drugstore, launched a cost recovery program in two dispensaries using drugs supplied by ITS (unidentified acronym), and established community health associations, although the legal framework providing them with decision making autonomy was lacking. At the national level, the project continued previously initiated support for a long-term family health and population advisor to the MOPH and for contraceptive procurement, but primarily focused on upgrading the health information system (HIS) of the MOPH's Bureau of Statistics, Planning, and Studies (BSPE), which was upgraded to the Division of Health System Information (DSIS) in 8/91). The DSIS published a yearbook summarizing the country's health data by prefecture, implemented the decentralization decree, and trained DSIS staff in the preparation of summaries at the local level. The HIS now houses information on maternal health and family planning, the management and follow-up of hospital patients, and cost recovery. An inventory of human and physical resources in each prefecture was issued. The MOPH is not in a position to support the DSIS (e.g., to maintain the two vehicles needed to train prefectural staff), although UNICEF has agreed to continue the advisor's contract for a year after project closure. Lessons learned are as follows. (1) Given the shifting of senior MOPH personnel, it is advisable to establish an Oversight Committee of senior staff to make policy decisions to assess the impact of existing regulations. (2) Selection and refurbishing of housing should be done by the contractor (who holds the advantage of physical proximity to the project site), not by USAID. (3) In French-speaking Africa, the insistence on drugs of U.S. source/origin may actually be dangerous; poorly trained, semi-literate health workers may have trouble following the English instructions on the use of the drugs. (4) The inclusion of senior MOPH personnel in project activities contributes to project sustainability; the senior host country counterpart holds the connections needed to ensure the adoption of the project by the host country government.