Child survival -- Guatemala : final evaluation

Final evaluation covers 8/86 to 7/89. Despite difficult socio-political conditions in the project area, PCI staff were able to achieve completely or move significantly toward achievement of the goals, purposes, and most of the output targets. The project has been successful in establishing a functional network of nearly 100 maternal and child health volunteers (MCHV) in the city of Santiago Atitlan. These MCHV"s perform a variety of outreach activities. Through home visiting and group educational meetings, they promote changes in health behavior, including: (1) utilizing health services; (2) participating in priority health programs, e.g., infant and child immunization; (3) recognizing dehydration due to diarrhea and using oral salts for rehydration; (4) recognizing malnutrition through routine growth monitoring and well child services; and (5) undertaking measures to reduce the risks of pregnancy, delivery, and the postnatal period. The work of the MCHV"s is in support of the Ministry of Health program called "Channeling," which seeks to bring selected health services to each home as well as improve utilization of health facilities. Coverage figures for immunizations of children 0-5 in the project service area are low by national standards but are substantially the same as those obtained throughout the Department of Solola. The project had greater success in reaching pregnant women with a complete series of tetanus toxoid, with coverage rates of almost three times the national figures. The distribution of oral rehydration salts (ORS) packets has increased markedly during the grant period and mothers show high levels of knowledge of how to mix and administer ORS. Registration of children for growth monitoring and other well child services has increased about 25%. Finally, although still a very low prevalence, the use of family planning methods for birth spacing is steadily increasing in the service area. Some of the lessons learned in the project include the following. (1) Introducing change in traditional societies is difficult. (2) Certain child survival programs may be more difficult to introduce than others. (3) It is important to consult the community to validate educational messages and training material. (4) Projects should be coordinated with the host government health authorities. Two key recommendations include: (1) not expanding project operations into new areas until current program activities are fully installed, tested, and operational; and (2) conducting a follow-up survey in 1990 to measure progress of a number of indicators since the 1987 baseline survey. (Author abstract, modified)