Evaluation of AID financed health and family planning projects in Nepal

Special evaluation covers the period 1973-79 and is based on document review, site visits, and interviews with Government of Nepal (GON) health personnel. The ICHS project has progressed slowly. Plans to extend a functioning model of integrated basic health services to 675 new health posts (HP's) fell short - of 533 HP's established in 75 districts, 185 offer traditional curative services, 283 offer FP education and extension as well, and only 65 HP's in 23 districts offer fully integrated FP/health/malaria surveillance services. Integration of services is only token, however, as FP/MCH services function independently of the ICHS program; malaria surveillance will not be fully integrated until 1985. Integration difficulties are due mainly to resistance from other agencies, lack of strong GON direction, the low status of the ICHS project in the Ministry of Health, and insufficient project staff with poor management skills. Nonetheless, a system on which to build is now in place. A total of 1,522 village health workers have been trained and make periodic home visits. Among other HP personnel, 77 assistant nurse midwives, 34 auxiliary health workers, and 61 senior health workers received 3-6 weeks of training in 1978-79. Training was not optimum, however, due to staff limitations and inadequate facilities. The project has also suffered from poor reporting, supervision, and logistics; inadequate and delayed travel reimbursement; and, most seriously, severe shortages of medicines - only a 3-4 month supply is available per year. The FP/MCH project, on the other hand, has already substantially met its objectives. As of 1978, the project supported 492 service sites in 62 districts with 1,748 staff. Since then, 4 regional and 40 district offices, and 232 FP clinics (some in HP's) have been established, and 714 outreach workers have been trained to provide education, referrals, and contraceptives. Vasectomies and laparoscopies are being provided - mostly at mobile facilities - to an increasing number of acceptors each year. FP/MCH sites also provide oral rehydration education and immunizations, and have provided effective FP education. Expansion of the ICHP and FP/MCH projects are planned for 1980-85. Eleven recommendations are made.