End of project evaluation : primary health care I, (482-0002), AID/Burma

Final evaluation covers the period 1980-1/85 and is based on document review, discussions with GOB and USAID/B officials, and field visits to rural health centers (RHC's) involving interviews with village volunteer health workers and beneficiaries. Overall, the project was effective and most targets were achieved, although delays in all categories have required a 2-year extension to complete project expansion. The project trained three categories of volunteer health workers: 9,418 community health workers (CHW's), 1,787 auxiliary midwives, and 4,000 traditional midwives. The performance of the volunteers was impressive, especially since they were volunteers and labored with limited resources (still, project inputs of medical kits, though delayed, were essential); the performance of both classes of midwives was particularly impressive, reflecting the high quality of their training. Although the absence of reliable data makes it impossible to measure health impact, coverage has clearly increased, and indicators point to a positive impact on health, particularly in the area of maternal and infant mortality and morbidity. However, several problems remain. CHW performance was less effective than that of other volunteers and may be declining over time; their services remain more curative than preventive, and some of them are providing services for which they were not trained (although their training has been lengthened, 4 weeks is still insufficient). Supervision is the project's weakest element and needs strengthening. Finally, monitoring and evaluation are not functioning as expected; the information system is cumbersome and ineffective and evaluation, while well designed, is not comprehensive. A follow-on project is recommended. This project should: (1) provide medical kits at the start of training, increase medicine supplies to last 1 year, and help volunteers find ways to resupply kits; (2) upgrade the training and supervision systems; (3) develop an information system from the bottom up to exploit good RHC data; and (4) establish evaluation priorities. Recommendations for USAID/B beyond the follow-on project are included.