Health systems development

Evaluation covers the period 8/78-7/80 and is based on site visits, document review, and interviews with project personnel. The project purpose and major outputs were not achieved. A health planning and administration team was established but did not complete planned graduate training; instead, team members participated in a 3-week U.S. study tour. GOZ health agency officials have failed to prepare national health plans as specified, and to establish a replicable, integrated health delivery system. Nonetheless, some health planning/management improvements were introduced. More importantly, the project initiated some highly successful preventive health activities in Kongolo zone, using Peace Corps Volunteers (PCV"s) as rural outreach workers. Unfortunately, the GOZ has no plans to replicate these activities Poor project design, insufficient funding and time, incorrect contracting procedures, and inappropriately skilled technicians contributed to the project"s failure. The project paper called for 41 person-months of technical assistance (TA), the project contract reduced this to 24, and ultimately only 10 were provided. Further problems included a nearly 3-year delay in project initiation, the diminution of health as a GOZ priority, GOZ and USAID/Z personnel turnover, and the delay or non-arrival of critical commodities, vehicles and medical supplies in particular. The project taught the need to: make host country officials responsible for project design; carefully consider host country management capability; clearly define project activities; provide sufficient resources and time; carefully coordinate PCV activities; make demonstration projects, like the one in Kongolo, accessible; and fund fewer but larger projects to maximize use of A.I.D. backstopping staff. Recommendations are: terminate project contracts as scheduled; provide short-term TA to the GOZ as needed and extend the project until 8/30/82, using remaining funds to support PCV activities in Kongolo (including training of animateurs), assist the GOZ to prepare health plans, and provide graduate training for four participants.