Evaluation of the program for international training in health (INTRAH)

Special evaluation covers the period 9/79-9/82 and is based on document review, interviews with project and A.I.D. personnel, and site visits. Although the project concept is sound, implementation has been weak. Only 1,500 midwives, supervisory, and tutorial personnel have been trained in-country, compared to a targeted 18,500; foreign training has been provided to mid-level staff of some countries. The contractor - the University of North Carolina (UNC) program in International Training in Health (INTRAH) - has not invited as many African institutes and personnel to participate as would seem desirable and, although the training provided has been well-done and well-received, it has emphasized teaching methodology to the neglect of clinical FP/MCH content. Poor trainee screening has resulted in high postproject desertion and INTRAH has not always tailored training to specific country needs. Inadequate INTRAH staff capabilities is the basic cause of these difficulties. The 16 core INTRAH staff, while expert pedagogues, are not experienced in FP/MCH, needs assessment, or evaluation; short- and long-term planning have been weak. Efforts to recruit health training professionals have failed due to uncertain job security and A.I.D. constraints; utilization of UNC health personnel has been minimal. As a result, less than one-third of all trainers have been INTRAH or UNC staff; this has led to subcontracting on an ad hoc basis and a loss of continuity and coherence. On the other hand, the INTRAH educational materials unit, which is of high quality, has prepared two training manuals and plans to analyze specific country needs. Selection of regional training centers for East and West Africa is underway. INTRAH's routine adminstration is quite good, but better communications between units and a team approach are needed. Coordination with A.I.D. is also generally good, although budgeting and personnel problems have slowed implementation. The A.I.D. contract is so loose as to permit INTRAH to fulfill its requirements without really focusing on FP/MCH. Recent developments indicate possibilities for achieving the original target of 18,500 persons trained. Recommendations are made to continue support and strengthen the INTRAH project by addressing the above problems.