Final evaluation of USAID OPG AID/Afr-G-1560

Final special evaluation covers the period 8/79-3/83 and is based on document review, field visits, and interviews with AMREF staff. Overall, the project has been a success. The Kibwezi Rural Health Scheme has made progress in developing a comprehensive, integrated RHS system in the Kibwezi (formerly Makindu) division. Following an initial delay, the Kibwezi Health Center (HC) was built/equipped and has since (2 years) operated at full capacity, handling 40-50 inpatients and 3,000-5,000 outpatients per month and offering weekly maternal/child health, family planning, and mobile outreach clinics. Also, 91 community health workers (CHW"s) were trained and deployed and workshops/seminars were held for HC staff. The learning resources component published and distributed four (of a targeted 12) training manuals for rural health workers, of which three were translated; five more will be completed this year. Two health journals, Defender (for the general public) and AFYA (for rural health workers) were produced and distributed. The RHS and training component improved AMREF"s management, learning, and information systems by providing salaries, overseas training, office equipment and support, and funds for field studies and information dissemination. As a result, AMREF experienced extraordinary growth; it now manages 33 projects and provides outreach services and medical radio communications to remote areas. U.S. training included short-term courses (e.g., for two public health nurses) and M.P.H. degree programs (for two staff). More than 19 documents detailing AMREF services were produced and distributed. Problems have included: attrition of trained CHW"s and a higher population growth than expected (only 25% of the division is receiving RHS); lack of community support for CHW"s; less Ministry of Health project involvement than planned (AMREF will continue as implementors until MOH takeover is complete in 2/86). Recommendations are included.