Evaluation report : Catholic Relief Services, Djibouti food and nutrition program

Special evaluation covers the period 7/83-6/84 and is based on document review, surveys of MCH and other medical personnel, site visits, and interviews with staff of CRS, USAID/D, and health and donor organizations. The impact of CRS food distribution through MCH centers has been disappointingly small. Although CRS has spent some 70% of its management time on food delivery, commodity management continues to be unsatisfactory by CRS standards (only about half of the food is accounted for in reports received from the centers). Mother/child attendance at the centers is irregular and drop-out rates are high, reflecting, no doubt, the limited economic value of the small CRS food ration in a country in which food is readily and cheaply available (in the market or through other aid programs). Most important, the Ministry of Health (MOH) clearly opposes the distribution of donor food within the health network. Other factors contributing to the program's lack of success are its lack of clear guidelines, objectives, and protocols and the low skills development of center personnel. On the positive side, CRS has had a unique opportunity to participate in establishing Djibouti's primary health care system by instituting child weighing and growth surveillance at MCH centers, training nurses and other center personnel, and setting up a development fund (using mothers' fees) to help pay staffing costs. However, mother education is, for the most part, sorely missing; often, neither MCH staff nor mothers understand the individual child growth chart, while staff who do understand it do not know how to use it as a teaching tool. Also, the master chart is too complicated to serve as an appropriate data gathering instrument. It is recommended that CRS phase out food distribution in MCH centers, transfer other feeding activities to the World Food Program if the host government so desires, and concentrate on: (1) providing health education and training to support the diarrhea control program now being planned with WHO and UNICEF assistance; and (2) expanding growth monitoring, nutrition education, and related activities.