Evaluation of ACSI-CCCD project, Republic of Guinea, May 14-June 4, 1987

External evaluation covers the period 6/85-6/87 and is based on site visits and interviews with involved personnel and other donors. Impressive progress has been made despite major and unusual constraints. The project has been instrumental in assisting the Government of Guinea (GOG) to plan and operationalize programs in immunization, diarrheal disease control (DDC), and malaria control. There are many indications that the project, if extended, can achieve most of its objectives. These indications include: (1) the GOG"s major fiscal commitment to the health sector (albeit reduced in the last several years); (2) sustantial other-donor commitments in complementary areas, offsetting GOG budget reductions; (3) the availability of a substantial number of highly trained health personnel (although the need for further training and skill upgrading remains great); (4) the GOG"s strong commitment to project goals; (5) the assignment of a full-time national project coordinator; (6) the existence of national programs, directors, and plans for immunization and malaria control (though not for DDC); (7) a demonstrated capability to undertake major vaccination campigns, both in Conakry and in the interior; and (8) the establishment of demonstration centers for oral rehydration therapy at the central and prefectoral level. Some of the constraints which have delayed the project are: the national economic crisis and changes in the manner of handling of counterpart funds, which has hindered the availability of local currency; major limitations in transportation, communications, and energy infrastructure; a serious lack of management training at all levels of the health system and of technical training in immunization, DDC, and malaria control; inadequate support in the areas of epidemiology, data processing and analysis, health and management information systems, microcomputer applications, and applied research; and a limited health education/communications capacity (although significant media help was mobilized for Conakry vaccination days). In view of the GOG"s commitment to child survival activities and to overcoming project constraints, it is recommended that the project, which is due to end in 12/87, be extended for 5 years. Other recommendations are, inter alia, to: focus on DDC and malaria control; disburse no U.S. funds until the GOG has assigned a national coordinator for DDC and has advanced at least 50% of its annual local currency contribution; enhance activities in project areas so that these can become demonstration sites; and conduct applied research in technical and socioeconomic areas. (Author abstract, modified)