Evaluation report : Salvation Army World Service Office, Pakistan, comprehensive primary health care project

External evaluation covers the period 1982-4/84 and is based on site visits, interviews with project personnel, and document review. The project is an innovative approach to transforming the basic orientation of existing dispensaries and health workers from curative to preventative, and has successfully emphasized the importance of PHC outreach in rural areas. Even so, there are some areas of concern: for example, the project has had trouble recruiting Pakistani managers; none of the top full-time staff and only one of the project's four nurses-in-charge are Pakistani. Another problem has been the considerable commuting expense incurred by village health workers (VHW's), who should live near the villages they serve, but do not. The project is currently making considerable effort to strengthen VHW training and supervision. Two other problems - insufficient cooperation with local Ministry of Health (MOH) officials and inadequate documentation of project results - must be remedied if the project is to be replicated by the MOH. The project should revise its information system from the village level up; further expansion should be deferred unless better results by VHW's are documented. While communication with USAID/P has been adequate, A.I.D.'s monitoring role has been negligible. The project would be strengthened if USAID/P were able to monitor progress in a few key areas (e.g., nationalization of management) and ensure cooperation with other relevant A.I.D. projects. The responsibilities of A.I.D. officers in Washington and Islamabad need to be clarified. It is recommended that A.I.D. continue its matching grant funding to the SAWSO, preferably for 5 years rather than 3, and that the project should be expanded gradually and cautiously (if at all) while the problems identified in this evaluation are being solved. Both SAWSO and A.I.D. should be satisfied that current approaches can achieve project objectives (which have recently been revised) and are low enough in costs to be replicable. (Author abstract, modified)