Evaluation of the MCH/FP project in Sur Medio, Peru

Special evaluation covers the period 7/79-3/81 and is based on document review and onsite interviews with health personnel at all levels. With most MCH and FP services being offered through hospitals, the project has had little impact to date, although services are also being delivered at 100 health posts, 45 of which are new and have been equipped. FP is being increasingly accepted, although 80% of acceptors have entered through a hospital. The recent distribution of materials to health posts augurs expansion of the project into rural areas. Opposition of the Church has delayed progress. A series of costly, but well prepared manuals for training promoters will soon be ready for printing; they may be useful as a national model and might be adaptable for use by sanitarians and health promoters (HP). A good deal of training, mainly for professional staff, has been conducted, but a large percentage of trainees have left for better jobs. This includes nine of 12 HP"s trained (of 100 targeted). Further training of HP"s should be delayed until support subsystems are in place. Lack of a clear administrative structure has kept the system, the essentials of which are now in place, from being made fully operational. Efforts are being made to integrate the project with the Primary Care Project to clarify leadership problems and to allay suspicions that the project is solely concerned with FP. With the appointment of a director, delivery of peripheral services should begin shortly. Besides addressing administrative and logistic problems noted above, key among the 53 recommendations made are to: concentrate on pre-natal and post-partum care; train Area 2 HP"s and sanitarians in FP methods and develop strategies to help Area 1 workers overcome resistance to services; extend the food subsidy program to rural areas through mothers" clubs and use the program to identify problems affecting children; simplify HP manuals and use them to teach HP"s how to control intestinal parasites; seek expert help in redesigning the vaccination strategy; create a program to detect cervical and breast cancer in Area 3; and replace stress on staff training with information/education activities.