Evaluation of health sector support for child survival project (693-0228) : Togo

The evaluation covers the period 9/87-8/89. Although interest in improved CS planning and coordination has increased within both the GOT and the donor community, the project has been blocked from achieving its objectives by several factors. The PCU component has been hindered by unwillingness within the GOT to alter its vertical planning process. The MPHSAWC has proven highly resistant to change at the central level, although at the regional and prefecture levels, integration of CS activities and and personnel has begun to take place. The PCU's weakness stems from several causes: it has no defined position within the MPHSAWC hierarchy; the planned Advisory Board and National Commission for CS have not been established by the MPHSAWC, despite a condition precedent to this effect; only one senior Togolese counterpart is working full-time with the project; its director is overburdened; and its coordinators are devoting more time to operational activities than to planning. Although, the PCU has participated usefully in CS planning and policy seminars, it has been too weak to institutionalize integrated planning and budgeting. The health centers component is lagging because the National Health Education Service has been slow to accept project participation and develop a health education strategy. The community outreach component has a set of tried and tested procedures, good logistic field supervision, and a well-equipped and well-staffed project headquarters, but morale is very low. The director is generally absent and MPHSAWC and Mission staff have been slow to act on project matters. A dispute over USAID/T salary supplements for the Togolese counterparts remains unresolved. Administrative procedures are loose in certain respects, and the USAID/T and GOT local cost budgets are not well coordinated. In sum, the project will not produce results of sustainable, developmental value unless the GOT, in cooperation with USAID/T, makes a determined effort over the next few months to remove the obstacles identified in this evaluation. The major lesson learned is that no project seeking to introduce new institutional patterns can succeed without strong policy support from the host government. Secondly, a project of this nature is difficult to launch if the advisors are not on site to work with their counterparts from the outset. Finally, whenever a project incorporates staff from a prior project, those persons should promptly be inculcated in the new project's objectives. In many people's minds this project is a mere extension of te highly visible former water supply project.