Evaluation report : OPG 518-0002, rural community health project, Ecuador

External final evaluation covers the period 10/78-11/82 and is based on document review, site visits, and interviews with project, government, and A.I.D. personnel. The project, which was implemented with help from MAP (Medical Assistance Programs) International, by Vozandes Hospital of Quito (a part of World Radio Missionary Fellowship), demonstrated the feasibility of working with evangelical associations to initiate PHC programs. With the help of over 130 community health workers (all of them, men, however) who were trained during the first 2.5 years and who have received extensive supervision by a superior cadre of health professionals, the project extended PHC services to at least 40,000 people in four provinces (the fifth was dropped due to lack of supervisory staff and initiation of a Ministry of Health (MOH) program in the area). The amount of PHC delivered varied by province, and even in the areas served not all communities appear to have been accessible by car or aircraft. Assessment of actual coverage and impact is difficult due to inadequate data collection, a serious deficiency. Nonetheless, project staff helped to install water pumps and participated in vaccination campaigns; latrines, previously almost nonexistent, are now found in every project area and sanitary practices and the conditions of dwelling units have improved. Services were provided regardless of religious belief, but no effort was made to deal with traditional healers. During its course, the project merged with an MOH program, which it has helped shape, and also markedly increased target populations' awareness of and access to government services, (e.g., help in installing sanitation facilities). Many features of this effort - the design of which, as in similar AID-funded PVO programs, appropriately encouraged flexibility - do not appear to be very costly, but replication would be very expensive. This is especially because of the excessive dependence on expatriate professionals who work in special conditions and who receive considerable social and communications support that would be unavailable to government workers.