EVALUATION REPORT - EAST COAST DELIVERY PROJECT (FINAL REPORT OF 3/17-31/80)

This contracted final evaluation, which is attached to a PES Facesheet (PD-AAG-335-B1), covers the period 1976-3/80 and is based on interviews, site visits, and a review of project files. Although two conferences were held on the subject, the planned regional health council was never institutionalized. Nevertheless, 34 villages were loosely integrated into a health system and six of these communities have established health posts. In addition, 191 village health workers (VHW) -- 44 health care leaders, 51 nutritionists, and 96 midwives -- have been trained and receive periodical retraining from the Center for Regional Development (CENDER). The bulk of VHW time is spent on curative medicine. Regarding the project's secondary objectives, the planned regional training center facility was not established, nor were training manuals developed. This has impeded the formal reporting of project-related data to other agencies. Moreover, since the Ministry of Health's logistical system has proven unsatisfactory, the Wisconsin Nicaraguan Partners has been distributing the medications by default. A referral system was established in Zelaya, but it is poorly operated due to inadequate transportation and communication. Also, two clinics have set up radio programs to promote health care, yet due to power interruptions, etc., their impact is limited. Recommendations include the following: While the program should definitely not be expanded, it should receive additional support. VHW training can be improved by formalizing the curriculum and developing a teaching manual for each worker; by emphasizing preventive care, e.g., immunization, and community health education in such areas as sanitary practices; and by inculcating a team approach. Finally, a list of essential drugs and algorithms explaining appropriate dosages should be developed. A price range for each drug should be posted and VHW's encouraged to follow-up on patients to whom the drugs are given.