Final evaluation of strengthening health delivery systems project (698-0398)

Final, external evaluation primarily covers 1983-86 and is based on site visits and interviews with participating officials and beneficiaries. The project succeeded in its main objective of building a consensus for and increasing competency in PHC in participating countries (PC's). Two signal achievements were (1) the use of the training of trainers (TOT) method and a competency-based experiential learning model to build PC capacities in PHC training and (2) development of a network of African trainer consultants. Some 2,400 persons took part in regional, national, and local TOT programs. Several training institutions were strengthened, especially through faculty development. Strong TOT capacities for PHC were developed at Regional Training Centers (RTC's) in Lagos and Lome, TOT capacities in health management were developed in 4 institutions, and the curricula of Cuttington University College and 2 other institutions were reoriented towards PHC. A continuing education program was initiated at the Western African College of Nursing (WACN), and staff of WACN and of 2 other postbasic nursing schools were trained as consultants on PHC training for nurses. Also, health management training was introduced and pedagogy revised at 7 management training facilities which previously had no health programs. The project also: developed informal networks of epidemiologists and PHC researchers by sponsoring conferences on these topics; provided applied research training and grants; produced several quality training manuals (some are now standard texts); and developed a materials production capacity at the Lome RTC. A Review Committee with representatives from WHO, A.I.D., and all 20 PC's met every 2 years to review broader goals; a smaller Coordinating Committee met annually to review work plans and project reports. Despite a lack of continuity in the representation of some PC's, the committees contributed to intraregional sharing of resources and ideas. PC's benefited to varying extents, depending on the degree to which they chose or were able to participate; participation was influenced by political issues and amount involvement by local WHO and A.I.D. personnel.