Evaluation of the health management improvement project

Special evaluation covers the period 9/81-4/83 and is based on document review, site visits, and interviews with project personnel. Implementation, which has diverged widely from the project's design, has lacked true collaboration among the major parties (the MOH, A.I.D., and the contractor), and has been notably hampered by Government of Jamaica (GOJ) delays in filling key middle management positions (from the Project Implementation Unit to field administration). As a result, progress in the project's various components has been uneven. In construction (despite procedural delays) and especially in nutrition, progress has been fairly good. Management systems, supplies, and health information are doing well in some areas (e.g., development of computerized management information systems), mainly due to the technical work done directly by expatriates, but not in others (e.g., the inability to ensure adequate supplies of drugs and medical equipment at PHC centers). The planning, training, and maintenance components are significantly deficient. Further, no plans yet exist to promote community participation, an integral part of GOJ health policy which has recently been incorporated into the project, or to further the MOH's long-standing policy to decentralize the PHC system; implementation has in fact focused on strengthening central MOH functions to the neglect of field operations, despite the readiness of parish and area staff for more responsibility. TA has generally been of good quality, although behind schedule in manpower development; a major MOH concern is the dependence on expatriate TA even when local expertise is available. Detailed findings on individual components are included in the evaluation. Achievement of the project's purpose in the time remaining is highly unlikely. It is recommended that the MOH and A.I.D. redesign the project in the light of current needs and activities, which in some cases extend beyond PHC, and that the project be extended, probably to a total of at least 6 years. Specifically recommended are to improve coordination by incorporating the MOH's PHC Services Unit and its new Management Services Unit into the project.