Close out report -- health sector I, 522-0153 : project close out report

The project had a dramatic impact on national health. During the project period, the infant mortality rate decreased from 117 to 60/1000, while general mortality dropped from 14/1000 to 8/1000. Fertility rates dropped from 7.5 to about 5.6 and the national population growth rate was consequently reduced from 3.5% to under 3%. In terms of specific diseases, the following improvements occurred: the number of malaria cases decreased from more than 50,000 to 23,000; whooping cough dropped from 2,453 cases to 223; measles was reduced from 4,188 to 1,033 cases; and deaths from diarrheal disease dropped by 40%. These improvements are attributed primarily to expanded immunization coverage, improved diarrhea treatment and control, and an increase in contraceptive prevalence. These efforts were supported by numerous technical achievements in the areas of logistics, maintenance and transportation, management and planning, mass media health education, training of health personnel at all levels, and supervision of health delivery. In a few areas, the project failed to accomplish objectives. These included: establishment of a chain of low-cost pharmacies, establishment of community-managed rotating drug funds, continuing education of health personnel, and development of manuals for medical/surgical supplies, hospital equipment, and office supplies. Several lessons were learned. (1) Project effectiveness was aided by a design effort lasting 2 full years and undertaken in collaboration with the Ministry of Health (MOH), as well as by the MOH's policy commitment to primary health care and adequate budget support from the Government of Honduras (GOH). Health sector projects are complex and require significant allocation of personnel resources, as well as continuous and intensive monitoring by both the USAID and the TA team. These requirements are more than compensated for, however, by the flexibility of such projects in tackling problems across a broad front. (3) A.I.D. and GOH procurement procedures make delays in arrival of commodities almost inevitable. (4) Project managers must devote considerable effort to balancing institutional and operational objectives, as well as to coordinating with other donors in order to avoid conflicting and overlapping activities.