End of project evaluation maternal and child health aide training project (621-0121)

Final evaluation, conducted by an outside contractor, covers the period 6/73-3/83 and is based on interviews with project officials and site visits. The project was largely a success. The targeted 18 MCHA training centers (3 of which were recently upgraded to allow higher-level training of MCHA's) were built, and a two-track training program (curricula for which were improved in 1980) was developed - a 9-month course to upgrade village midwives to MCHA status, and an 18-month pre-service MCHA course for women not already midwives. A combined total of 2,509 women were trained and placed in the field, although upgrading of 72 to Grade B nurses will reduce the number available. Several teacher-training courses and UNDP-funded continuing education seminars for MCHA's and their supervisors were held, and a successful participant training program benefited 74. The contractor worked diligently to insure project continuity after its termination. The increase in the number of clinics providing MCH services during the project period was impressive, although family planning - strongly resisted by husbands - continues to be a low priority among service providers and political leaders. Further, the program's effectiveness is threatened by by far-reaching logistic, supply, and supervision problems and by GOT financial difficulties which have placed the full burden for recurrent program costs at lower levels. In the critical area of information management, the excellent low-cost recordkeeping system developed early on has deteriorated since 1980, mainly due to a lessened appreciation of the importance of data management and a lack of resolve to undertake it. An unforeseen problem has been the migration to urban areas of upwardly mobile village women trained under the project. Nonetheless, the project successfully demonstrated that the shift to rural-based, integrated preventive/curative services delivered by specially trained cadres of paramedical workers contributes to equity in health care and is attuned to Tanzania's limited resources and demographic characteristics. A total of 22 recommendations are made.