Evaluation report : strengthening health delivery systems

Evaluation covers the period 1981-4/82 and is based on document review, visits to 11 countries, and interviews with donor, host government, project, and health service personnel, and with village health committees. Most goals of the project's four components were met. Regional and national capacities for public health planning/management were bolstered by 21 well-received workshops or short-term courses (of which the project initiated 6 and assisted 15) given to 87 top and mid-level officials and supervisors at centers in Senegal, Nigeria, and Togo. WHO/AFRO also began a plan for a regional network of 11 national institutions which could further the work of the project; the group's secretariat will need much support to make this plan a reality. To strengthen national and regional capacities to train health workers, the project funded: 2 years of graduate work for 9 nurses in America; 3 nursing workshops in English for 42 participants and focusing on primary health care (PHC); and long- and short-term training at regional training centers in Senegal, Cameroon, and Liberia and at WHO centers in Nigeria and Togo, where efforts proved particularly beneficial. To strengthen communicable disease control (CDC), demonstration and training areas (DTA's) were set up in Cameroon, Ivory Coast, and Gambia and three full-time epidemiologists were stationed in regional organizations. Geographic coverage in the DTA's has been achieved and immunization of target-age children against major diseases to a great extent accomplished, while efforts are being made to improve the program to immunize pregnant women against tetanus. All three countries also began moving towards national expanded programs of immunization (EPI). This component also conducted 9 workshops for 202 participants on EPI management. Negatively, the goal of training 6 CDC advisors was only partially met; efforts in disease surveillance and demographic data collection were limited; and little was done to establish national health planning information systems. Finally, the project assisted 3 workshops on PHC applied research and 2 on practical PHC organization for a total of 55 participants; it also funded a study of immunization in the Ivory Coast. In-country follow-up in the above areas is recommended.