Community-based health and nutrition systems

PES covers the period 6/80-8/83 and is based on special evaluations of project components (not attached). Progress has been excruciatingly slow, due to the inability of central MOH staff to plan and manage project activities. The project has been affected by two coups (the first replacing senior MOH staff with inexperienced personnel) and by an austerity program begun in 1982, as well as by personnel shortages and lack of coordination among administrative levels. These problems led to neglect of the project at the policymaking level which in turn produced a sporadic flow of inputs and materials. A major delay resulted from GOG failure to meet conditions precedent for disbursing funds for environmental sanitation (ES) construction. While implementation did not get underway until 1982, ES construction is now accelerating, with 13.3% of planned aqueducts and 53.8% of planned latrines completed; community participation has been excellent. Training activities likewise started slowly and then gained momentum. Nearly 65% of the institutional personnel targeted, 62% of targeted midwives, and somewhat fewer rural health promoters have been trained. A major accomplishment has been the complete reorientation of training methods toward a functional task-oriented focus; trainee satisfaction is high. The Regional Service Center in Totonicapan has been remodeled as planned, but neither housing nor health post construction are underway. Despite its problems, the project"s purpose can be achieved if certain administrative policies are adopted and support systems (especially needed for training) institutionalized. Clearly the need for existing MOH management capabilities was underestimated during the design phase of this needlessly overcomplex project. Key action decisions are to focus all activities on ES, integrating training of rural promoters therein, and to eliminate all housing/health post improvements.