Dioro child survival project, phase II : final evaluation report

Thanks to the social mobilization and information, education, and communication (IEC) strategies implemented in Phase II villages, the project was able to accomplish a large majority of its objectives in maternal health and child survival, community participation, and women's health-related empowerment. This accomplishment has led to the acquisition of strong health- related knowledge and skills by village health teams and health committees, as well as by mothers and fathers. The strengthening of the number and the multi-disciplinary nature of the village health teams, supported by the Africare field agents, allowed the routine implementation of all project activities. The IEC strategies were successful because they were based on the results of operational research and on innovative solutions using local traditional resources. Involving men in health activities and involving women in making decisions about their health and that of their children allowed the project to increase and broaden its coverage of maternal health and child survival. Because of the project's enlightened and encouraging leadership, the skills of project staff were strengthened through on-the-job training. The collaboration of the staff with local counterparts allowed the project to implement a multi-sectoral approach. The documentation of project activities permitted them to be shared with all collaborators, NGOs and other donors. The project's sustainability, already well advanced, will be completely assured by its integration into the national health policy plans to which the project will bring its "know-how" in community participation and IEC. Project weaknesses are due to its failure to continue following the specific community participation strategy that was developed in Phase II villages. This specific strategy determines the outcome of the composition and the quality of work of the health committees, the selection of the village health workers and their commitment to preventive health activities, and, finally, the communities' payment of service fees for child birth deliveries. It is recommended that the project be extended at least 2 years. Lessons learned are as follows: (1) The full participation of the community can be attained if the community understands the benefits of what it is being offered and its role as partner and key player, and so long as its own priorities are taken into account and its social structure and customs are respected. (2) Women's participation in decisionmaking is not necessarily perceived as a threat to men's authority if the latter understand their own roles and the role of women in child survival activities. (3) IEC messages must be designed for men as well as for women. Men's roles are extremely important in maternal and child health activities, and men must understand why and how to participate in them. (4) A multi-disciplinary team, carefully chosen, trained, and regularly supervised, can play an extremely important role in preventive health activities at the village level. (5) It is not necessary to be an "expert" to be effective. By encouraging a leadership that knew how to validate, consolidate, and mobilize its talents, the Dioro team, with a moderate level of training, knew how to meet the challenge of community participation, IEC, and supervision. (6) The members of the community are capable of taking care of malnourished children. In this context, the function of role model mothers is especially important. (7) Project results must be disseminated in order to raise interest among beneficiaries, collaborators, and counterparts and mobilize resources. (8) The project's intervention strategies assured the sustainability of all interventions except vaccination and, to some degree, growth promotion.