Community health outreach, AOPS I, 0169/3, FY 83-85; extended community health and family planning, AOPS II, 0181/3, FY 84-86; urban health and community development II, CMSCS, 0159, FY 85-89

PES covers the period 3/85-5/86. While the evaluation report discussed at some length the steps taken by the PVO"s to improve health delivery, it also identified various shortcomings. (1) Commitment to oral rehydration therapy (ORT) in Haiti is less than expected due to lingering enthusiasm for intravenous rehydration, mothers" disillusion with oral rehydration solution (ORS) because it does not stop diarrhea, and preference for over-the-counter preparations. Also, some project field workers are evidently not actively promoting ORT. To address this situation, AOPS has organized an ORT conference to remotivate upper-level health personnel, address some of the newer scientific issues, and resolve technical concerns. (2) Breastfeeding promotion in AOPS projects requires more systematic attention. Aside from the use of posters, no real interventions exist; bottle feeding appears to be widespread, even in rural areas. CMSCS has developed a promising breastfeeding campaign which includes pre- and post-tests, but there is still need for more operations research (OR) to pinpoint problem areas, solutions, and alternative promotional methods. (3) Neither CMSCS nor AOPS has fully instituted a self-financing capacity although CMSCS has given this area high priority and is committed to carrying out short-term, targeted OR projects to design and test more cost-effective health care alternatives. AOPS, which is a consortium of health PVO"s, is still working intensively on broadening and consolidating its membership and thus has focused primarily on field level implementation. AOPS does, however, intend to develop an income generation program. (4) Some AOPS subprojects have only perfunctory relationships with public sector health providers. In general, however, there has been quite considerable progress in public-private collaboration and coordination of activities. Recommendations - approved by USAID/H, AOPS, and CMSCS - are presented in the above four areas and also with regard to staffing, monitoring and evaluation, and financial management and planning. USAID/H does take exception with a recommendation regarding the home preparation of ORS and it has decided to implement family planning recommendations within the recently obligated Private Sector Family Planning Project (5210189). The external evaluation generated a wealth of information, but would have been more useful had it been better developed and more clearly structured.