Evaluation of the Haiti rural health delivery system project (RHS)

Special evaluation covers the period 8/79-2/83 and is based on document review, site visits, and interviews with DSPP, USAID/H, contractor, and other personnel. The project has not yet had a significant impact on Haiti's overall national health status and can not meet the target of supplying health care to 70% of the rural population. Nevertheless, eight rural dispensaries have been built or renovated, with another 43 in progress. Some 550 health agents have been trained or retrained and 350 auxiliary nurses/supervisors have received project workshop training and been posted subsequently to rural areas. Management training seminars have been conducted for district and central-level administrators and bureau chiefs. Health curricula have been designed and ten modules (two of which were pre-tested) developed for health agent training. Yet, development of DSPP's institutional capacities has proceeded slowly and the project has had little impact on the pace of regionalization, even though new West and Transversal regions have been established. A major accomplishment has been the creation of the Community Pharmacy Drug Supply Agency (AGAPCO), which has begun to supply drugs to local pharmacies, but AGAPCO lacks the managerial competency necessary for freestanding operations. Seven computerized management information systems have been or are in the process of being developed by the contractor and DSPP, yet the lack of DSPP involvement in and ownership of these systems has caused problems. An excess of information collected thus far has been undigestible and unusable. Health information systems have been established and health statistics reporting from various regions bolstered. However, problems with the data collected, a lack of supplies, organization, and trained staff, and delays in receiving funds for purchasing forms and equipment have limited its effectiveness. Recommendations are made.