Evaluation report, Save the Children, Bangladesh : health, nutrition and family planning project

Matching Grant. External evaluation covers the period through 1/86 and is based on site visits, including a visit to SCF's U.S. headquarters, and interviews with project personnel. SCF's community-based integrated rural development (CBIRD) approach is well designed, well organized, and apparently effective in promoting the health of women and children. The project provides low-cost, door-to-door primary health care (PHC) and has also improved health by upgrading related economic, social, and environmental conditions through activities in agriculture, income generation, literacy, road building, and fish culture. SCF has made certain that the project encourages participation by all members of the community - including those not usually involved in the decisionmaking process, especially women and poor families. Project management is excellent. Bangladeshi staff are competent and dedicated; SCF has provided strong TA and financial support; and monitoring and evaluation are advanced over many similar PVO programs, functioning not only to record impact but also to inform villagers and leaders. Average infant and child mortality rates, average birth rates, and average population growth rates for the four SCF impact areas are decreasing, and are lower than in Bangladesh overall. Infant and child mortality rates dropped perceptibly (by 25% and 13%, respectively) during the first year, even before SCF had completed health training and staff support in all areas, and despite the lack of government immunization programs in three areas. Such a major change in so short a time must result in part from exogenous factors, however. Moreover, when disaggregated the data show mixed results in differenct impact areas. Despite its successes, the project displays some weaknesses. Data collection and processing need to streamlined. The Dhaka office badly needs an expanded health information system and more staff to analyze and use the large volume of health data being collected by field staff. Also, little progress has been made toward developing self-sustaining, self-financing programs that do not depend on external support. Although this is an SCF goal, there are no schedules or target dates for promoting phase-over to local control. Finally, local cost recovery has not been achieved despite SCF's use of a variety of income generation and local revenue schemes. SCF cannot consider its Bangladesh project fully successful until at least one village can manage self-sustaining PHC and until infant and children mortality can be controlled over several years.