EVALUATION REPORT - OPG-518-022 RURAL COMMUNITY HEALTH PROJECT

This special evaluation, attached to a PES (PD-AAG-332-A1), covers the period 10/79-2/80 and is based on an onsite review. Medical Assistance Programs, Inc. (MAP) and Vozandes Hospital are managing the project, which is operating in four provinces -- Bolivar, Chimborazo, Pastaza, and Morona Santiago. Activities in Loja province were cancelled because of a lack of personnel to train health promoters. The MAP staff participated in health worker training and program design. The Vozandes staff were responsible for training placement, supply, and supervision. The project's focus was altered from providing personal health services to community health education. Several new health committees were formed, and promoter training programs were instituted in all provinces. While statistics do not show a dramatic change, the target communities are better informed and more interested in sanitation and health care for their children. The following recommendations are made: (1) Progress reports should focus on problems, experiences, and system needs and changes. (2) Selection of health workers and the relationship between project personnel and the communities should be studied. (3) Project personnel should try to understand local beliefs and, when beneficial, incorporate them into training. (4) When it became apparent that local promoters needed more training, project personnel adopted more flexible procedures. Because that proved expensive, project personnel should carefully document their experiences. In addition, the assistance of Ecuadorean personnel should be sought. (6) Project personnel should try to determine the amount of time health promoters devote to their various duties--and if that time is adequate. (7) Because transportation is difficult (some communities are accessible only by small plane), different patterns of supervision should be tested. (8) Workshops should be held to bring together provincial and national-level health officials. (9) MOH personnel should observe the project. (10) A.I.D. funding should be continued.