Delivery of primary health care services in the rural Philippines : an analytical framework for a comparative analysis of the PANAY and BICOL regional projects

Precepts are outlined for a special study to provide relatively rapid feedback on four primary areas of interest in the two projects: (1) financial viability; (2) institutional viability and effectiveness; (3) effectiveness and sustainability of health workers; and (4) critical factors leading to success or failure. An experienced interdisciplinary team of six persons, familiar with the Philippines, should conduct the study. Rather than attempting a rigorous statistical causal analysis or comparison of the projects, they should use "rapid reconnaissance" techniques - group discussions with project participants, direct observation, and interviews with key informants. A certain amount of financial viability was ensured by provision in the project designs for the local governments to take over gradually the funding of all activities. Reviews should be made of the funding/disbursement process, accounting practices, expenditures, and income expected in those areas having an operating health system. Differences in the administrative structure of the two projects (i.e., reliance on the regional Ministry of Health office by the Bicol project and on the political, local government hierarchy by the Panay project) led to variations in outputs; effectiveness of the approaches should be compared and analyzed. To estimate institutional effectiveness and viability, numerous target indicators should be assessed through project records, site visits, or a formal sample survey if necessary. A two-person team, with access to knowledgeable individuals in the GOP and USAID is best for this investigation. Long-run viability should be assessed with regard to continued funding, stability of staffing, strong community satisfaction, and a number of other indicators not reported on in project documentation. Key indicators of the effectiveness and sustainability of health workers should be addressed by a similar team, supplemented by a Public Health Specialist. A number of differences in the two projects afford opportunity for comparison of factors leading to success or failure. Conclusions of the evaluation team members, while necessarily quite subjective rather than statistically provable, should be helpful in determining future approaches.