Final evaluation report of CARE International Indonesia's village primary health CARE II project, 1988-1992

The evaluation covers the period 10/88-9/92. Major findings are as follows. (1) CARE's community management approach was successful in increasing Posyandu attendance and increasing knowledge, attitudes, and practices of mothers and kaders (volunteer health workers) in the project areas. (2) The project goals were accomplished successfully, following recommendations made during the midterm evaluation and following the Detailed Implementation Plan. (3) Village Supervision Teams and Subdistrict Supervision Teams have been functioning well, providing important moral support and rallying broad-based community participation in Posyandu. (4) Health education materials introduced during the project were well appreciated, especially by religious leaders. The materials integrated strong health education messages into religious teachings. Religious leaders became active health educators in the community. (5) Kader Incentive Support Systems using traditional mechanisms were beneficial to kaders. The introduction of medicine posts (Pos Obat Desa) were added incentives for both community and kaders. The following lessons were learned. (1) The notion of peer groups has proven to be an important factor positively affecting group behavior. New expected behaviors are beginning to become norms in the project sites among the groups formed: Village Supervisory Teams, Subdistrict Supervisory Teams, kader groups, and among mothers who attend Posyandu. Peer pressure helps to maintain active participation in health activities. (2) A community management project focus is more sustainable than a direct intervention focus as investments are made in human resource development and community organization. (3) Local community agents other than kaders can make tremendous contributions to primary health care. Religious leaders are powerful health educators, given materials which integrate health messages within religious teachings. (4) Working within the government context has highly increased the chances of regeneration, leading to sustained activities. As a change of personalities within the government can affect the support given to community management structures, it is important to involve the second and third layers within a system to assure the system will continue. (Author Abstract)