EVALUATION OF A LOAN TO NICARAGUA FOR HEALTH CENTERS AND RURAL MOBILE HEALTH UNITS (AID LOAN 524-L-023)

BASICALLY, AID HAS DONE WHAT IT PROMISED TO DO IN THE LOAN, YET THE LOAN HAS NOT PRODUCED AN EFFICIENT AND EFFECTIVE HEALTH SYSTEM FOR POOR PEOPLE TODAY. THE GOVERNMENT OF NICARAGUA (GON) HAS NOT PROVIDED THE GOOD ADMINISTRATION AND RESOURCES REQUIRED FOR SUCCESS. RESULTS ARE DISAPPOINTING IF THE SERVICES TO BE ANTICIPATED BY NICARAGUANS IN THE FUTURE ARE ESTIMATED BASED ON THE SERVICES ACTUALLY BEING RECEIVED. NEVERTHELESS, THE LOAN HAS HELPED CREATE AN INFRASTRUCTURE FOR HEALTH SERVICES THAT COULD BE MORE FRUITFULLY USED IN THE FUTURE THAN IT IS BEING USED IN THE PRESENT. DESPITE LOW PATIENT LOADS, THERE HAVE BEEN SOME PRACTICAL BENEFITS TO POOR PEOPLE FROM THE LOAN. USAID MANAGEMENT OF THE LOAN HAS BEEN EFFECTIVE WHEN FOCUSED ON THE CONSTRUCTION AND PROCUREMENT ASPECTS OF THE PROJECT BUT INEFFECTIVE IN GETTING THE GON TO PROVIDE MONEY AND MANAGEMENT TALENT SUFFICIENT TO ADMINISTER THE PROJECT SUCCESSFULLY. THE EVALUATORS RECOMMEND PRACTICAL MEASURES TO IMPROVE THE PROJECT, THE EFFICIENCY OF THE SUPPORT SYSTEMS, THE PERFORMANCE OF THE HEALTH CENTERS AND MANAGEMENT IN MSP (19 RECOMMENDATIONS IN ALL).