Health sector I

Final PES covers the period 10/75-10/81 and is based on a review of previous evaluations and other project documents. Overall, the project has been a success. The SBS system (a copy of the 1980 evaluation of the program is included) has generally achieved its objectives. As of 8/81, 5,400 promoters were working in rural areas under a SESPAS Rural Health Directorate, making basic health services available to some 2.1 million rural inhabitants, an increase over the target of 1.8 million due to increased government assistance. A pilot urban SBS program was found to duplicate existing services and was dropped. An Office of Nutrition Coordination was established (although understaffed and showing little ability to coordinate its activity with other sectors, largely because not instituted at the highest government level), and 20 nutrition recuperation centers, serving malnourished children and their mothers, were opened. Nutrition education via mass media, especially radio, and via the efforts of the health promoters have been the activities most influencing nutritional status. Reforms at the SESPAS included the restructuring of several units and the creation of an Office of Administrative Reform. By contrast, development of a commercially marketable food supplement for young children and pregnant women was dropped due to high costs and lack of government funding. Inadequate funding also prevented research into the causes of malnutrition and the cost-effectiveness of current nutrition programs, and problems (changes in government administration, use of a single contractor) in implementing some recommended reforms of the SESPAS caused A.I.D. funds for those components to be transferred to the SBS component. A persistent problem has been the lack of qualified nutrition personnel. Lessons learned include the need for strong working relationships in carrying out administrative reform.