Health systems vitalization

Evaluation covered the period 7/84-6/85 and was based on document review, site visits, and interviews with Mission and government officials. The Mission accepts, and is taking action on, most of the evaluation"s recommendations. Several of the recommendations deal with pharmaceutical supplies; they suggest refining selection criteria, prioritizing pharmaceutical products, automating procurement, and improving supply management - all concerns to which project management is already responding. The recommended elimination of mosquito breeding areas as a way of combatting malaria is also beginning under a separate program with P.L. 480 funds. Recommendations to make primary health care and prevention a major focus and to develop a Rural Health Promoter program are being addressed in a follow-on project (5190308). The recommended development of a trauma management program is outside the scope of the program and is not, in fact, supported by a recent study on this subject. The recommendation regarding the physician education curriculum is also outside the scope of current and planned projects; in the eyes of the Mission, physician education, while important, is peripheral to the key problems impeding both the delivery of primary health care services and improvements in health status. The Mission used the evaluation as a source in developing a project amendment which extends the project by a year (to 12/86) and increases funding for the TA, pharmaceuticals, medical supplies, and equipment needed to achieve the project"s purpose more fully. The follow-on project will provide additional TA and will further strengthen supply management and health statistics systems. While the quality of the individual reports within the attached evaluation are "good to excellent," the Mission feels that the reports underscore the difficulty of assessing project impact on larger goals within the first 2 or 3 years of implementation.