Evaluation report of combatting childhood communicable diseases : Liberia

Mid-term external evaluation covers the period 7/83-4/86 and is based on document review, site visits, and interviews with Ministry of Health and Social Welfare (MHSW), USAID/L, Peace Corps, UNICEF, and WHO staff. Although much momentum has been gained during the last 6 months, the project has encountered several severe problems; implementation has been slow and uneven. Immunization activities - which predate the project and are still, to a degree, independent of it structurally - have shown the best results. More than 300,000 vaccinations were provided during a special campaign week in 1/86. The two other main activities - oral rehydration therapy (ORT) and chloroquine dosing of children and pregnant women - have not yet been formally initiated. The most serious deficiency is the GOL's inability to provide budget support due to a severe economic crisis following political and economic upheavals in 1984-85. The GOL has also failed to implement cost recovery measures required in the project agreement and has found it necessary to institute hiring freezes and staff reductions which have resulted in inadequate numbers of personnel to manage CCCD activities; moreover, salaries are being cut and not paid on time, and the EPI has not been provided with new funds for 1985-86. Other problems have included shortages of vehicles for outreach and supervision; vaccine waste due to inadequate cold chain management and equipment; deficiencies in health education, training, and statistics; and internal inconsistencies, i.e., the field is forging ahead with ORT, malaria, and cost recovery while official guidelines are still being developed by the central bureaucracy. Continued A.I.D. support is, however, recommended for several reasons: (1) MHSW understands the need for, and has prioritized, low-cost preventive health care, supporting CCCD to the best of its limited ability; (2) there is ample other-donor support; and (3) CCCD is developing skills and procedures which are fundamental to Liberia's proposed national primary health care (PHC) program. The most urgent needs are to: revise the project agreement to reflect realities as regards financing and scheduling (including a 1-year extension); provide needed commodities such as refrigerators and 4-wheel drive vehicles; revise and formalize the donor contribution plan; realign available MH&SW staff for better management and supervision; formalize and disseminate a national policy on malaria; and implement registration, service and drug fees for financing of CCCD and PHC activities.