Honduras : January - February, 1985; a mid-term impact evaluation of hospital institutions for the PROALMA project, Honduras = El proyecto PROALMA, evaluacion del impacto en hospitals

Special mid-term evaluation covers the period 1982-84 and is based on visits to the 3 project hospitals, interviews with the hospitals" medical, nursing, and Department chiefs, and informal discussions with staff and mothers. Through its education programs, two national conferences, and hospital-level impact, PROALMA (the implementing agency) has made noteworthy strides in raising awareness among health personnel of the importance of breastfeeding; results have become especially apparent in the latter half of 1984. A PROALMA office has been established in each hospital, PROALMA personnel are known and considered dedicated by hospital staff, and these staff strongly support continuation of the project. Counterpart committees have been formed in each hospital, and revised procedures for labor, delivery, newborn nursery, premature nursery, and pediatrics - prepared by the committees and PROALMA staff to promote and support breastfeeding, mother-infant bonding, and rooming-in - have been approved and published. Maternal milk banks with trained personnel and electric milk pumps have been established in the hospitals, and identification cards have been issued to nursing mothers, allowing them to enter the hospital to nurse at any time; as a result, most prematures are receiving mother"s milk and mortality among these infants is decreasing. Also, fewer children have been hospitalized for diarrhea, and all hospitals have realized savings through decreased purchasing of infant formulas. It is recommended that: a 2-year project extension be considered; PROALMA staff be maintained and possibly incorporated as permanent hospital staff; physician education be continued, particularly for obstetricians (the most resistant to change); better Ministry of Health linkages be sought; increasing the number of milk banks and extending PROALMA activities to other regional hospitals be considered; educational services for women (especially prenatal) and support for working mothers be increased; committee motivation be continued; and training be provided for the PROALMA staff in data collection methodology.