Evaluation of the health sector loan program for the Dominican Republic (AID 517-U-028)

PES (lacking a facesheet) covers a period ending 10/77 and is based in part on data from a household survey. Prolonged delays have occurred in implementing nutrition activities and the administrative reform of the Secretariat of Public Health (SESPAS), the latter due in part to delays in contracting for technical assistance. (USAID/DR feels that SESPAS finds the entire concept of reform threatening). Nonetheless an Office of Nutrition Coordination (ONC) has been established and a series of seminars have helped both the public and health workers better understand nutrition problems. SESPAS"s staunch opposition to foreign technical assistance and its costs have delayed the mass media program. More successfully, the planned low-cost health delivery system, Basic Health Services (SBS) delivery system has been established, although the government"s failure to expand, as agreed, its contribution to the project - the key problem impeding project implementation so far - has confined the SBS program to Regions I and IV, part of Region III, and one zone in Santa Domingo. Other problems impeding project implementation include several changes in the ONC Director. Coverage of target groups in the SBS program is still inadequate due, according to USAID/DR, to inadequate logistic support provided for health promoters by auxiliary nurses. Health records kept by village health workers have proven quite unreliable. To estimate actual coverage, a random sample of worker health records was studied and showed good results: 19,800 children under age 5 have received DPT; 16,800 children under 10 have been immunized against measles; and 22,700 and 3,900 women aged 15-49 have, respectively, received two doses of tetanus toxoid and accepted family planning. Unplanned effects include the SBS"s duplication of services provided in Herrera and attrition of urban health promoters. Discontinuation of the urban program may be advisable. Project experience teaches the need in implementing low-cost health delivery systems for full employment of local inhabitants, nutrition surveillance for preschoolers, and an efficient logistics system.