Evaluation of the jumla health project

Ex post impact evaluation is based mainly on questionnaire surveys of villagers and village health workers and interviews with government and other agency personnel. The project suffered from early administrative problems (e.g., delays in recruiting project staff), but most of all from the lack of a clear implementation plan and of long-term planning. Three years were spent in community dialogues and in collecting baseline data and no real action was taken until the extension year (9/82-8/83). Nonetheless, the project has had a visible impact on the area and is widely praised by villagers. Although community health committees were never active due to a lack of follow-up to their training, the training of community health leaders (CHL's), the project's main change agents, was soundly conceived and effective, in large measure thanks to trainers from local institutions such as Jumla Hospital and Karnali Technical School. Interest in CHL training was widespread, and practitioners knowledgeable and highly respected by villagers; traditional birth attendants (Sudenis) who were trained as CHL's have proven particularly effective. By 8/83, 452 CHL's (over 100% of target) and 47 Sudenis (no target) will have been trained; only 146 of the CHL's were women, however, and not 216 as planned, and a large number of women never completed their training, for reasons that are not wholly clear. CHL demonstration projects (e.g., latrine construction, for which, however, most did not receive the pay promised them) were very effective in promoting changes in the villages and in promoting the idea that preventative health measures were possible and necessary. Of the construction projects, the government guest house in Jumla is complete. The 5 village water systems, the Bazar drainage system, the health post at Depalgaun, and community and school latrine programs are in varying stages of progress. The question of long-term maintenance for any project has yet to be addressed. Extension of the project, which is just beginning to make its true presence felt, is strongly urged. Specific recommendations are included.