Congo primary health care

PES covers the period 6/82-8/83 and is based on document review, discussions with health workers and project officials, and site visits. Despite a 6-month delay in recruiting a CARE project advisor (leading to confusion on the part of CARE and the evalaution team as to whether the project is in its 9th or 15th month), significant progress has been made. Activities have focused on laying the groundwork for a PHC system; GOC and health officials have been consulted and village health facilties visited. Some 31 village health committees (VHC"s) have been formed and village health workers selected for training. Completion of the maternal/child health center will be delayed 6 months until 1/84 due to construction delays and the extremely poor condition of the building provided by the GOC, delaying in turn the initiation of a health program for children under 5; targets for the latter program are probably unrealistic. Child immunization has begun, but targets are unreasonably high and should be reduced sharply. Baseline data on the incidence of measles, diarrheal disease, and malaria have been established and a disease surveillance system set up, but it is still too early to measure any reduction; the target of a 50% decrease is unreasonably high. A rural PHC training center was established at Mossendjo and a 6-day training course conducted for 12 health personnel. It was decided to substitute a course on MCH services and a course covering PHC, diarrhea, malaria, and nutrition for five planned mini-courses; health education materials are being prepared. The project"s main problems have been due to faulty design - vaguely stated and unrelated purpose and targets, unrealistic impact targets for a 2-year project, and failure to realize the time needed to lay the groundwork and collect baseline data. (Suggestions for target revision are provided in the report.) CARE"s request for a 6-month project extension should be granted provided that CARE undertakes project redesign efforts and USAID/C approve these changes. Follow-on assistance should be provided to projects which establish the foundation of a PHC system.