Data for decision making for the health sector project : a mid-term evaluation

Evaluation covers the period 10/91-8/94. The project has tremendous potential to make an impact in countries where there is interest in, and the climate is conducive to, health sector reform. The sub-projects are on schedule to meet the anticipated level of outputs outlined in the design logical framework. While there is great potential for impact during the life of the project, with definite indications that an impact is already being made (particularly in Bolivia), the current implementation period of less than 3 years does not allow for appropriate measurement of this impact. In fact, the project's time horizon is probably too short and it will take more than the 5-year limit of the Centers for Disease Control and Prevention (CDC) PASA and the Harvard Consortium (HC) Cooperative Agreement to measure impact. A.I.D. needs to be prepared to extend these agreements beyond 9/96, assuming progress is still as positive in 2 years as it is today. While the project does not need to be redesigned, it is worth noting that the design should be reviewed in 2 years when the work in Bolivia, Egypt, and the Philippines can be further assessed. What seems to be of primary importance today is the flexibility of the current project design to respond to specific and timely issues of interest to A.I.D. (e.g., privatization of health care, cost efficiency/effectiveness, child survival, HIV/AIDS). The current scope of activities has fully absorbed the staff of both sub-projects. The HC and CDC have reached the limits of their human resources capacity and will find it difficult to take on additional work under the project. Project implementors should consolidate the work they are doing in their present countries before additional countries are added. If more countries are desired by A.I.D., the following actions will be necessary: (1) Additional funding resources will need to be secured; (2) CDC will need to solve its full-time equivalent (FTE) dilemma; and (3) Harvard will need to hire additional people (and amend the cooperative agreement) or A.I.D. will be required to bring in additional institutions (if assistance can be found for the Cognizant Technical Officer (CTO) to take on the additional management burden, the latter is recommended). The main criticism of the project is the lack of communication between the HC and the CDC. While the original project design envisioned HC and CDC jointly implementing activities in three to five emphasis countries, it quickly became evident that mission interests, needs, and funding did not always allow for both "top down" and "bottom up" approaches being offered by the two implementors. Missions have therefore not looked at the project as a whole, but instead have chosen only those elements (sub-projects) that fit and are responsive to specific problems in a particular country. As of this writing there are joint activities only in Bolivia, with little communication between HC and CDC. Consequently, these institutions, A.I.D., and the countries are not benefiting from the full impact of the combined work. While the Missions cannot be directed to buy into both sub-projects, the implementors must communicate and collaborate with one another regarding the project inputs, outputs, and common goals. The convening of a Technical Advisory Group meeting might present one option for beginning to work toward a long-term solution to this problem. (Author abstract)