Evaluation : Mozambique prosthetics project

The project has been implemented through subgrants to the International Committee of the Red Cross (ICRC), Health Volunteers Overseas (HVO), Handicap International (HI), and the Mozambican Association of the Disabled (ADEMO). Evaluation covers the period 1992-10/93. The ICRC is now using polypropylene rather than polyester resin technology to construct prosthetic devices. Devices constructed of polypropylene are technically superior; are composed of interchangeable parts which can be replaced anywhere in the country; unlike the resin method, do not use dangerous chemicals that have short shelf lives; and require less fabrication time, allowing the technician more time to fit the patient. With the cease-fire, the demand for prosthetic services is increasing (due to, inter alia, potential patients' greater mobility, and the return of amputees from refugee and rebel areas). This increase in demand is already outstripping the production capacity of the traditional workshops operated by HI, where primary level technicians fabricate prostheses of leather and wood. Construction of transit centers -- hostels for disabled persons waiting to receive prosthetic services -- which had been delayed for several years, now appears to be on track; the Maputo center should be completed in January 1994, and construction of a center in Beira should begin in November 1993. HVO's surgical training program is unfortunately not much further along than it was at the time of the 1992 evaluation. Bureaucratic delays and obstacles from both the Ministry and A.I.D. have so frustrated surgical training that the imminent termination of the HVO grant makes it impossible even to start it. While some useful activities, such as training of nurses and provision of orthopedic surgical kits, have been implemented, the basic purpose of the HVO grant -- the upgrading of orthopedic surgeons -- never took place. ADEMO has made significant progress and now has a membership of more than 6,000 disabled persons. ADEMO has developed written materials on handicap laws, and booklets to assist the disabled in their pursuit of equal rights in employment, education, and training. ADEMO, which has received support from a variety of donors, sees itself as a political, rather than a technical organization, and has proven itself an effective fundraiser. The evaluation team also visited the offices of ADEMIMO, a new NGO for disabled military personnel (from both FRELIMO and RENAMO), which serves 2,000 members -- only 10 of whom, however, are current with their monthly dues because military pensions have not yet been issued, though many of the members have been disabled for 10 years or more. ADEMIMO has received approval from the European Economic Community for its first project and support from HI in the form of an advisor. If ADEMIMO is successful it may become an advocate for a large group of disabled persons, attracting both Mozambican and international resources. It is recommended that all prosthetic devices in Mozambique be standardized on polypropylene technology and manufactured at the ICRC workshop in Maputo, and that HI manage all rehabilitation services and transit centers, training ADEMO and/or other local NGOs to take over. Such a change would capitalize on the great strengths of both ICRC and HI. It is also recommended that the PACD be extended, as the project is not sustainable at this point.