Community-based health and rural development project, Gaza Province : final evaluation report

The water, education, and agriculture components were evaluated separately in 10/97. The CBHRD health component focused on: (1) training community health workers; (2) rehabilitating and constructing health posts, maternities, and health staff housing; and (3) strengthening linkages between 26 rural communities and the formal health system. Objectives and projected outputs in all three areas were achieved and, in many cases, exceeded. SCF census data show that over 104,000 beneficiaries were served by this project. However, access to new facilities was impeded by lack of qualified staff; also, weaknesses were noted in communications between SCF and Government of Mozambique (GOM) and Ministry of Health (MOH) colleagues. Community perceptions of the impact of the CBHRD project were consistently positive and knowledge levels about beneficial health practices appeared to be high. A rough comparison with non-SCF villages showed knowledge and practices regarding diarrhea management and sexually transmitted disease (STD)/HIV prevention to be of significantly lower quality than in SCF impact areas. Sustainability of CBHRD interventions will rely not only on community motivation levels, but on the re-allocation of GOM contributions to the health sector and a review of MOH training, supervision, and service delivery priorities. Additionally, communities must be held to more rigorous standards of participation for volunteer community health providers and promoters. Key recommendations for future health programming include the following: (1) Encourage the District Health Directorate (DDS) to schedule regular refresher and supplementary training events for community health workers; all training events should include a training of trainers (TOT) component. (2) Document all GOM commitments to provide new or rehabilitated facilities with properly qualified staff. (3) Explore alternative pharmaceutical supply mechanisms. (4) Require target communities to submit plans for participating in development activities as well as for compensating volunteer health promoters and providers. (5) Promote donor dialogue with GOM regarding necessary increases in health spending. (Author abstract, modified)