Control of diarrheal diseases

PES covers the period 4/82-5/84 and summarizes an attached special joint evaluation (XD-AAQ-996-A) based on document review and site visits. Phase one has been remarkably successful. An organizational structure has been developed at the central and governorate level which coordinates effectively with other programs and agencies. Thousands of medical professionals (including over 500 physicians and 400 nurses) have received training in oral rehydration therapy (ORT), an oral rehydration salts (ORS) production facility has become operational and has produced 2 million large and 6.5 million small ORS packets, and rehydration center supply kits and a marketing plan have been developed. Surveillance and baseline data on diarrhea morbidity and mortality are being compiled in phase-one project areas and action-oriented research is being conducted on diarrhea"s clinical patterns and etiology and the operational and sociocultural aspects of ORT. Most importantly, a successful television campaign has significantly increased public awareness of ORT. Subsequent to the attached evaluation, efforts have been made to improve project staffing, personnel policies, and financial management. Also, a standard ORS formula and distribution packet have been agreed upon by the Ministry of Health and UNICEF, and a production contract to meet projected demand has been signed. The television campaign implemented in 1984 will continue in 1985. Further attention must be paid to disbursement procedures, cost-benefit analysis, and governorate-level coordination and supervision and additional training in ORT clinical management should be provided. The lessons learned are: (1) the project"s semiautonomous nature facilitates implementation and permits recruitment of expertise from a variety of sources; (2) problems of salary scales and incentive payments complicate implementation; and (3) outreach and dissemination programs must be coordinated closely with the provision of supplies and services. (NE Bureau abstract, modified)