Final evaluation report : community health partnerships (CHAPS) project, Chikwawa District, Malawi

The IEF worked with the MOHP in Chikwawa District in the Lower Shire Valley, where IEF has a history of technical and development assistance. The CHAPS project in Chikwawa District was successful in strengthening the accounting system, fleet management, communications between the district hospital and outlying health centers, and community-level capacity. Major accomplishments in these areas included the following: (1) The accounting system was computerized and is functioning. Posting of accounts were 2 to 3 months behind schedule, but all tasks were done electronically and reports were generated from the system. (2) Budgeting was done on the computer, which facilitated planning when problems occurred such as unannounced cuts in monthly budget allocations from the central office. Now that the manual system has been replaced, it can be expected that the accounting will be done electronically in the future. (3) The fleet management system has been credited with increasing the number of functional vehicles from one to eight. (4) The person initially trained as the fleet manager was still in place and producing daily and monthly usage and maintenance reports. (5) The radio system for communication among the health centers and the district hospital was evident at every health center that the evaluation team visited. It worked and was used extensively. CHAPS contributed to sustaining the child survival project that preceded it. Financial and technical assistance from CHAPS concentrated on capacity building and district- level TA, and provided support for continuing community-level services. This is a model worth emulating. Volunteers who distributed contraceptives were the best trained and most active of all the volunteer groups. It is impressive to note that all of the volunteers were active; they were the most knowledgeable, served multiple villages, and had neat and up-to-date records. It should also be noted that the volunteers were women. Because of IEF's work, Chikwawa District has a large cadre of active and committed community leaders. The major constraints were beyond the control of IEF and the district's health care system. The constant staff rotation made it difficult to have continuity of leadership. In too many instances, IEF had to start over again in building leadership capacity. The concept of a decentralized health care system embodied by the CHAPS projects needs to include the district's participation in areas such as personnel management.