Concurrent audit of USAID/Madagascar"s performance monitoring of selected health services funded by the Southern Africa floods supplemental appropriation

(JSI) to assist victims of three cyclones in 2000. PSI is meeting the targets of the cooperative agreement as follows: (1) By 2/02, PSI had increased the production of Sur"Eau ("safe water") from 27,000 bottles a month to over 300,000 bottles a month, vs. the 6/02 target of 252,000. (2) As of 9/01, PSI had recruited 8,490 retailers and 472 wholesalers in five provinces, vs. targets of 4,000 new retailers and 155 new wholesalers by 7/02. This represents an increase in geographic coverage from one province in 3/00 to five provinces by 6/02. (3) By the end of 2/02, the number of bottles of Sur"Eau sold was 507,092 or 85% of the 6/02 target of 600,000 bottles. In addition, the cooperative agreement required PSI to establish an emergency stock of Sur"Eau to ensure rapid response to future disasters and/or potential cholera outbreaks throughout the country. As of 12/01, pre-positioned stocks were located in nine locations around the country totaling approximately 152,931 bottles. USAID/Madagascar"s long-term goal is to franchise the production of Sur"Eau to local firms under a continued subsidy provided through PSI with donor funds. Currently, a contract has been provided to a local manufacturer to produce the plastic bottles and the Sur"Eau solution. Targets under the JSI program have been surpassed. As of 12/01, JSI had: (1) conducted 500 health education sessions, vs. a target of 140; (2) trained 1,000 volunteers in preventing and treating diseases, vs. a target of 350; (3) provided 50 health posts, health centers, or regional hospitals with basic medical materials and cholera treatment equipment, vs. a target of 15; and (4) equipped 50 cholera triage centers to manage cholera, vs. a target of 5. As a result of these achievements, communities in the cyclone-affected areas have been helped to recover from the year 2000 cyclones and to develop their abilities to respond to the effects of future cyclones. JSI has also prepared information, education and community (IEC) materials on health topics, including disaster preparedness, diarrhea and cholera prevention and treatment, and other health issues. The IEC materials are given to district and community health workers and to village health extension volunteers who complete the training sessions. As of 9/01, more than 800,000 pieces of IEC material had been distributed to target audiences throughout five districts. One such piece of IEC material is counseling cards, which are pictorials on a variety of health subjects such as diarrhea, cholera, malaria, and acute respiratory infections. These cards are written in Malagasy and depict images of people indigenous to Madagascar. Also, disaster alert systems were developed and implemented in disaster-prone sites to include the installation of radios and cyclone flags to warn communities of approaching cyclones. USAID/Madagascar has adequately monitored the performance of PSI and JSI. Specifically, the Mission has conducted site visits, reviewed performance and financial reports, and held periodic meetings with contractor personnel.