Health systems development

Final PES covers the period 9/80-3/83 and is based on document review and interviews with project personnel. The project (as revised in 1980) has been a success, but the sustainability of its effects is questionable. Following a 7/80 evaluation, the project was changed to concentrate on only one zone, Kongolo, testing various innovations in health care, e.g., emphasis on preventive care, and changes in financing and provider attitudes. Three of the major outputs (revised plan) were achieved: four health professionals are completing U.S. Master"s degrees in health planning and 24 others received short-term training abroad or in-country; a national health plan and a Kongolo Zone health plan were prepared; and a low-cost, replicable health system was established in Kongolo. However, concrete plans to extend the system to other zones have not been completed. (Completion is expected by 1986.) Positive unplanned effects include: increased GOZ willingness to countenance local financing, decentralized decisionmaking, and user fees; and increased awareness of the challenging logistical requirements of implementing projects in remote areas of Zaire. The project provided several lessons applicable elsewhere in Africa as well as in Zaire: (1) a personal service contract negotiated directly by the Mission may be the most cost-effective means of service procurement in projects requiring only a few consultants, and should always be considered first; (2) consultants should be recruited by Missions, not AID/W; (3) project planners should take note of the work demands to be placed on local nationals, and their commitments of time and effort should be assured; and (4) planners should assume worst-case scenarios, particularly for implementation schedules. Action decisions are: make counterpart funds available through 8/83; have the GOZ provide a budget line item for direct support of Kongolo health services; and have local officials, working with the Peace Corps and other organizations, involve communities in health center building and management and implement a fee structure that will make health centers self-financing.