Final evaluation for child survival VII project : PDC-0500-A-00-1097-00 -- Indonesia

The project had a positive overall impact. Stated summarily, gains in knowledge and practice of CS indicators were significant in regard to maternal and pediatric immunization, moderate in the area of breastfeeding and weaning practices, and marginal in regard to modern contraceptive usage. Although the utilization of qualified professionals and traditional birth attendants (TBAs) for service delivery showed a uniformly consistent pattern over the course of the project, qualitative assessments revealed significant improvements in the appropriateness and timeliness of referral of high-risk obstetric cases by TBAs; this has been corroborated by Ministry of Health (MOH) data reflecting lowered maternal death rates. This finding may be attributable, in part, to the project's TBA training and refresher programs for at least 74% (800 of 1,085) of all known/registered TBAs within the project field area and for assistance in their regular supervision. Equipped with UNICEF-type delivery kits and weighing scales, these trained TBAs represent a major success for the project. These TBAs were also able to correctly identify 43% of newborns as having low birth weight. The project can be also indirectly credited with the improvements in the quality (accuracy and completeness) and timeliness of health-related reports generated at the district offices of the MOH as a result of efforts to improve the health information management systems. Although the district MOH offices are not fully utilizing the existing resources (computer hardware and software) at present for lack of time and trained personnel, plans are being made to overcome these obstacles. Other project accomplishments include: (1) improvements in safe water supply in 8 of 11 targeted villages; (2) malaria prophylaxis for 300 pregnant women in the highly endemic Tamako area; and (3) some increases in the percentage of mothers possessing antenatal cards. Regular interaction by project staff with other PVOs before and during the project implementation is a positive step in coordinating health and other related activities in a given area. USAID/Indonesia also deserves credit for establishing the 6-monthly PVO workshop, a mechanism that facilitates this networking process. Finally, the close, continuing collaboration and enthusiastic support from the MOH at every level (central, provincial, district, subdistrict, village, and community) is perhaps the single most important factor that has contributed to the project's success and potential for sustainability. By ensuring that project objectives and approaches were congruent with those of the MOH, and by working closely with MOH personnel, the project staff and the implementing PVO have provided an example of an efficient, effective, and sustainable CS program. Among lessons learned are that, to be successful, PVO CS projects must: maintain proactive relations with all stakeholders; develop sustainable, community-based and -supported activities; ensure congruence between project and government objectives; avoid creating a parallel health care delivery system; enable the PVO to function as a change agent; promote interaction between PVOs; and train trainers and provide ongoing refresher education. (Author abstract, modified)