Improving mother and child health in the Huallaga Valley of Peru : child survival (CS) XII -- 1996-2000 : cooperative agreement no. FAO-0500-A-00-6056-00 -- final evaluation report

The project included four intervention areas -- nutrition and micronutrients, breastfeeding, control of diarrheal disease, and family planning -- and focused on community organization, training and supervision of community health volunteers (CHVs), training and motivation of Ministry of Health (MINSA) field staff, and community education. It is difficult to appreciate the impact of the project, partly because the indicators do not reflect what the project has accomplished in the last 4 years. Only three of the 13 objectives were actually met during the period, due in part to an overly ambitious proposal and the failure to consider factors outside the scope of the project. The project has shown positive impact in two important areas: women who exclusively breastfeed until 6 months and stunting in children. Other improvements include frequency of growth monitoring, initiation of breastfeeding, and use of family planning methods. Major achievements include: development of a very effective educational methodology; encouragement of the value of local foods -- not donated or processed foods; improved quality of nutritional surveillance; development of formula for fortified foods; studies that have allowed focused messages, better understanding of complex disease states, and improved information for use by MINSA officials; and development of leadership skills and greater solidarity in women. Several major problems still need to be addressed: the information system is not fully functioning; supervision and monitoring is weak at all levels; and collaboration and communication with MINSA needs to be further improved. It is also necessary to define the needs for capacity building and institutional strengthening and to further strengthen community structures. Key lessons learned were as follows: (1) Activities that respect and value the local culture have the greatest impact. (2) For adequate implementation, the project should involve all partners (MINSA, HOPE, communities) from the beginning. (3) Continuous follow-up and support are needed to develop new abilities. (4) The greatest impact in changing practices comes with clear, simple messages, based on previous study. (5) Take advantage of the felt need of women to meet in their own group, according to their own vision. (6) To decrease the prevalence of diarrheal disease, it is necessary to improve sanitation conditions through coordination with other organizations. (7) A project cannot advance without the support of local authorities. (8) The use of checklists clarifies expectations and defines what elements are essential. (9) Other members of the community need to be trained to create an environment of change. The original 4-year project has been awarded a 3- year extension to continue working in the same 162 communities. Major changes will be to combat malaria and respiratory infections and improve collaboration with MINSA via transfer of responsibilities, training and supervision, and institutional strengthening. (Author abstract, modified)