Final evaluation of Project HOPE's biomedical engineering project in Macedonia

The component was implemented by Project HOPE and focused on repairing or replacing key medical equipment in Macedonia's hospitals. The Macedonia component was well designed and relevant to Macedonia's immediate needs. Unfortunately, Project HOPE field staff were forced by circumstances to set up a system and implement the bulk of equipment repair actions by themselves, without significant participation from Macedonian counterparts. Nonetheless, HOPE engineers and technicians restored to service a significant amount of essential medical equipment. In fact, 90% of the highest priority, repairable clinical equipment in the Ministry of Health (MOH) hospitals outside of Skopje, the capital city, was dealt with. Additionally, HOPE was able to establish credibility with local hospital directors, and enlist the support of two of the best who agreed to use their facilities and staff to operate regional service centers (Bitola and Kumanovo). Training objectives went largely unmet, at least in the first year of operations, due to the paucity of technicians and engineers in the target hospitals and the unavailability of counterparts and a partner institution. Also, HOPE staff were otherwise occupied with the actual diagnosis, calibration, and repairs of equipment; the training that did occur was primarily informal and on-the-job. Implementation was impeded by circumstances beyond HOPE's control, including the dropping out of a key potential counterpart and a range of challenges, mainly personnel issues, having to do with HOPE's administration of the project. Although HOPE headquarters' staff took responsible corrective action in all cases, valuable implementation time was lost and program execution suffered from staff discontinuity. Lack of direct access to counterparts meant that HOPE had to rely on the good offices of USAID/Skopje to communicate with Ministry personnel at top levels. This may have been partly the cause of delays in the signing of an agreement between USAID and the MOH for support of the two regional service centers. Anecdotal evidence indicates that the project significantly improved the capacity of hospitals to serve patient needs. Further, the basic building blocks for an institutionally sound and perhaps sustainable effort in the form of two regional service centers is close to being achieved as the first phase of the project closes out; it is important that outside support to the regional service centers continue. It is recommended that USAID extend the project 6 months to allow HOPE to implement the two service centers; diagnose and repair remaining repairable equipment; install spare parts in dismantled equipment; and develop a competency-based training plan for hospital personnel and technicians. Also, in future projects HOPE should screen and orient field personnel more thoroughly and insist upon direct working relationships with key Ministry personnel to the highest level. Several lessons have been learned. (1) Identifying and working with local counterparts is critical to the success and sustainability of any program whose major focus is the transfer of knowledge and technical skills. (2) Training should be implemented in tandem with TA. at the national as well as at the local level with respect to the scope and sequence of project activities should not be underestimated. (4) Establishing clear lines of communication within an organization is critical to understanding work responsibilities. Administrative and logistical issues can best be resolved when the persons most affected are involved in problem-solving. (Author abstract, modified)