Evaluation of combatting childhood communicable diseases project in the Peoples Republic of the Congo

External evaluation covers the period 5/84-4/86 and is based on document review, meetings with key personnel, and site visits. Project achievements include: (1) the availability of ORT and vaccinations in almost all of the fixed maternal/child health centers in Brazzaville, Pointe-Noire, and Loubomo; (2) an increase in the percentage of children under 1 receiving all vaccinations and a subsequent reduction in the number of pertussis and polio cases; and (3) collection of baseline data for use in project development. Project personnel are competent and enthusiastic. On the negative side are the slow start of the malaria control program (which will probably prove the project"s most recalcitrant aspect) and of health education efforts; the sometime inadequacy of vaccination techniques (using the same needle for many children); the need to improve quality control in procuring and distributing medical supplies; and a serious delay in implementing in-country training due to the unavailability of short-term TA, financial restrictions, and the lack of a training coordinator. Major problems are two. The first, severely threatening project sustainability, is the economic crisis which makes it doubtful that Government of the Congo (GOC) will be able to make any 1986 contribution to the project, much less assume full fiscal responsibility by 5/88. From the start, GOC contributions have been lower than called for, and in response both FAC and A.I.D. have reduced their funding. A.I.D., in fact, has frozen its funds as of 1/86. A project extension and self-financing through user fees are key recommendations. In any event, project achievements to date warrant continued support from the Ministry of Health and Social Welfare (MHSA), despite the drastic GOC cutbacks in its operating budget. The second major problem is the lack of a coordinated management structure. For example, MHSA"s National Primary Health Care Program, created in 1985, has operated in separation from the Direction of Preventive Medicine, the MHSA office overseeing the project. Greater central-level supervision of regional and district personnel is also needed. These problems (magnified by the lack of national EPI, ORT, and malaria policies) are exemplified in less than successful attempts to vaccinate children in Pointe Noire and Loumobo against measles. For USAID/Kinshasa"s response to evaluation recommendations, see abstract of PD-AAU-030.