HEALTHCOM

Evaluation covers the period 8/85-2/89 and is based on visits to Honduras, Indonesia, Nigeria, and the Philippines. While AED has faithfully executed the terms of the contract, the project"s use of a "home strategy" has hindered overall effectiveness. Host country Ministries of Health (MOH"s) have often been overlooked, as the project has focused instead on the principal beneficiaries, mothers. This has resulted in a deferral of most attempts to strengthen national institutions. In addition, highly visible mass media campaigns, which often have only a short-term impact on awareness and behavioral change, are disproportionately used and funded, curtailing efforts to improve face-to-face communication via the MOH infrastructure. A third consequence of this strategy has been an undue emphasis on research and development activities, none of which have focused on operations research. Finally, outside technical experts have not given enough attention to strengthening national research and communication planning capabilities. The use of the home strategy is due in part to the contract requirement to produce changes in practices for a significant portion of the population in a 2-year period. While the time for advisory services has been extended to 3-5 years, the evaluation recommends that the project move into a new phase which would stress simultaneous institutionalization efforts with audience-change activities over a more realistic 15-20 year period. Also recommended is a study of the feasibility of streamlining the project"s communication methodology in the interests of more immediate application. The study should examine the extent to which the time for applying the methodology can be reduced and the participation of host country professionals increased.