Danfa rural health project evaluation; Ghana

Final evaluation covers the period 1970-79 and is based on document review and interviews with key project personnel. The health center was established. Satellite clinics were set up in three nearby villlages and staffed once a week by health center workers, supplemented by traditional birth attendants (TBA's), village health workers (VHW's) and health education assistants. While priority was given to maternal/child health care and curative services, preventive programs were also implemented. Mass immunization failed to reach the targeted 80% of eligible children but did demonstrate that multiple antigen innoculations are more effective than a single antigen schedule. A malaria chemoprophylaxis program was more successful with schoolchildren than with preschoolers, who had to be brought to the center for medication. In addition, health and nutrition education was provided; food supplements were distributed; and family planning services were extended through training of health workers, resulting in decreased birth and fertility rates. Epidemiological studies were performed; one study led to increased emphasis on polio immunization in the target area and later throughout Ghana. Environmental sanitation was not noticeably improved in the target area. U.S. training in health planning was provided to 19 Ghanians and short-term clinical training was provided to 50 medical students; 90 TBA's, 20 VHW's, and 200 health research assistants were also trained. TBA and VHW training manuals were produced. Linkages among various governmental, research, and training institutions were developed and village development committees, which proved vital to health program acceptance, were promoted. The project's research component was not a success, however. Delays in summative evaluations of such research efforts as village health, family planning, and health practices surveys greatly limited policy formulation, service delivery, and the project's overall credibility. A total of 66 recommendations are made in regard to service delivery, family planning, health education, evaluative research, cost assessment, training, TBA's, VHW's, and interagency linkages.