Evaluation report : increased productivity for better health (project 505-0018)

Mid-term evaluation covers the period 3/85-2/87 and is based on document review, site visits, and interviews with Government of Belize (GOB), USAID/B, and contractor (Pragma) staff. The project's technical approach is sound and both Belizean and Pragma personnel are enthusiastic, but a number of management and logistic problems have impeded project implementation, and trends exist which, if not altered, could compromise the success of the project in the long term. For example, the implementation strategies focus on technical targets to the exclusion of a larger view of the project as a process, one which particularly emphasizes community participation, health education, and local institution strengthening and training. Although all project personnel recognize the importance of community participation, no individual in authority has assumed leadership in this activity. Nor are health education needs being met, and the unit responsible for materials production is both overworked and undersupplied. Specific problems include the following: late submission by the GOB of National Plans of Action; an inadequate inventory and supply system; lack of specific planning and documentation for the GOB's transfer of WS/S responsibilities from the Ministry of Health to the Ministry of Natural Resources; the GOB's failure to construct a vehicle maintenance workshop (a condition precedent); and procurement delays. effective internal monitoring, a stronger data management system, better coordination in the areas of logistics and transport, and an expanded training effort, particularly at the community level. Decentralized decisionmaking at the district level should be explored by the GOB. The various project components have yet to be fully integrated; in fact, poor coordination and communication between components could compromise the achievement of project goals. The Pragma team needs to work more on developing integrated strategies which complement one another and emphasize community involvement in decisionmaking and maintenance. Pragma should also maintain more direct contact with USAID/B. Specific technical recommendations are made the areas of WS/S, water quality sampling, vector control, operations research, and community participation.