Evaluation report : prosthetics and orthotics project -- Vietnam Veterans of American Foundation/Cambodia

The evaluation covers the period 9/92/9/95 against a 6/96 PACD. The project contributed to USAID/Cambodia's program strategy of providing responsive and tangible assistance during a period of extreme social and economic crisis. VVAF has had a notable and positive impact on the disabled in Cambodia and is a respected provider of prosthetics/orthotics (P&O) and wheelchair services. Its technical work has been of the highest standard. VVAF anticipates that by 10/96 it will have provided more than 4,000 prostheses, 1,000 orthoses, and 2,000 wheelchairs. In addition, it has established major training programs in the production of the Jaipur foot, physical therapy, orthotics, and wheelchair production; financed one expatriate instructor at the National School for P&O and four Khmer trainees; took the courageous step of changing from Jaipur to polypropylene technology; and initiated improvements in prosthetic foot design. Finally, VVAF constructed a facility at Kien Khleang that will outlive it own presence in Cambodia, and provided services in one of the country's remotest and neediest provinces. On the negative side, VVAF has failed to create an indigenous PVO to take over its work in Cambodia, and its overall management of the grant has been poor, leading to inefficient and ineffective use of USAID resources. It is particularly difficult to understand how, knowing by May 1995 that USAID grant funding would virtually run out by the end of July, no measures were undertaken to conserve funding and plan for project closeout. Despite these problems, VVAF now has a solid core of management and technical personnel in Cambodia and Washington and, with the implementation of the evaluation's recommendations, is capable of managing efficiently and effectively a future USAID grant. The uncomfortable working relationship between USAID and VVAF which peaked in early 1995 appears to be on the mend, due largely to the efforts of VVAF's new program director. A project extension is recommended, if there is a significantly higher degree of USAID oversight and if VVAF: drops certain components (e.g., outreach, rehabilitation, and therapy); refocuses on a set of core activities (=provision of 100 prosthetics and 25 orthotics fittings per month); and makes management changes, particularly the closing of the Phnom Penh office and staff cuts (both expatriate and Cambodian). These will obviously cause severe short-term dislocations, but they should also provide the basis for maintaining VVAF operations at a level that can be sustained over the long-term. If the changes are not made, the project will have to be shut down. The following are lessons learned. (1) It is unrealistic to think that financial sustainability can be achieved by a safety-net service in a post-crisis situation. Since USAID will soon engage in similar activities in Bosnia and Angola, it should realize that sustainability will not be attained in these countries any more than it has been in Cambodia (or previously in Mozambique) unless host governments take over the funding and delivery of prosthetics services and rehabilitation programs in general. In an era of shrinking foreign aid budgets, USAID should be asking whether it wants to become involved in emergency relief and rehabilitation activities such as prosthetics, in which no realistic exit strategy is available. (2) While the New Partnership Initiative (NPI) commits the Agency to expanding the role of PVOs and NGOs in USAID programming, reduced foreign aid budgets, especially for operating expenditures, means increasing PVO/NGO implementation responsibilities in USAID activities. As the case of VVAF indicates, however, bringing in "new blood" to the Agency's programs requires an honest assessment of a PVO's capacity to utilize and manage USAID funding effectively and efficiently. In a number of cases, this will require remedial training and capacity building for the PVO as well as increased oversight responsibilities for concerned Missions.