Epidemiological surveillance and training, 538-0027 : project assistance completion report

Project outputs - to establish a training unit and data processing center at CAREC, provide training courses to 19 CAREC member countries, procure laboratory equipment, and produce educational materials - have mostly been met. By 2/85 training had been provided to over 3,400 course participants; CAREC"s ability to produce appropriate training materials had increased; member countries had experienced a significant increase in both surveillance and laboratory capabilities; and some CAREC expatriate staff had been replaced with qualified West Indies staff. After 1985, three activities were funded: noscomial infection control, traffic epidemiology, and occupational safety and health. The noscomial infection program trained "infection control nurses" in hospitals in 10 countries and implemented programs to improve hand washing facilities, containment and transport of soiled linen, use of hospital equipment and supplies, floor cleaning practices, and isolation of infectious patients. The program (which included special training in AIDS control, production of a manual, and an improved regional reporting system) has proven that low-cost interventions can have significant health impacts. The traffic epidemiology program was less successful; surveys of frequency, severity, and causes of traffic injuries and fatalities were performed and recommendations made for each country, but in only two cases did this information make its way to the Cabinet for consideration. The lesson here is that programs that require multisectoral cooperation should only be attempted where there is broad-based political will and a responsible coordinating agency. The occupational safety program, which was provided only start-up assistance by the project, conducted risk assessments of occupational hazards in five countries, and held a 2-week training program for 19 environmental health officers. The project teaches the following lessons: (1) the period of time required for CAREC to grow into a confident regional institution suggests that organizational development takes time; (2) new organizations should be allowed to gain skills (and take responsibility for exercising each new skill) one at a time; (3) CAREC"s growth and expansion over the last 18 years highlights the importance of providing timely, relevant service to constituents to earn their respect and support; and (4) CAREC"s organizational and management structure may be useful models for regional cooperation in other development areas.