Evaluation report : Project Concern International, The Gambia, primary health care project

External evaluation covers period 1979-85 and is based on document review, site visits, and interviews with project personnel and beneficiaries. The project has made major contributions to improving basic health services throughout The Gambia. PCI's approach to the development of a PHC system has proven appropriate to the Gambian political and economic environment and is apparently adaptable to other African countries. Although PCI's direct involvement in the GOTG bureacracy may delay some achievements, it maximizes the possibility that the PHC system will be replicable and sustainable. The system which PCI has helped to create relies on volunteer village health workers (VHW's) who are chosen by their village, feel a sense of duty towards it, and are proud of their status; although many complain of the lack of village support and want to be paid, very few drop out. PCI's strategy of focusing on training has been sound. The VHW's trained under the project are not only increasing the availability of health services in rural areas but, it is likely, will also be effective in improving overall health standards. Further, the GOTG has accepted full responsibility for the training system established under the project, and is committed to strengthening and sustaining it. A GOTG counterpart, trained under the project, has taken over administration of the training program. PCI field staff, backed up by a well-organized support system at their U.S. headquarters, appear to have been competent and effective. Unfortunately, the project demonstrates what appears to be a common problem in PVO-sponsored PHC programs: insufficient time and insufficient funding to ensure (1) that the PHC system is fully developed, with strong community participation and full community financing; and (2) that its effectiveness and impact have been measured and documented. In this case USAID/G terminated the PCI project early as part of a phase-out of all health sector assistance. The Gambian PHC system is one of Africa's best models (particularly in the support, supervision, and financing of health workers), but it needs, and merits, much fine tuning. USAID/G support should have been continued.