IN-DEPTH EVALUATION OF THE BASIC HEALTH SERVICES PROJECT

BHSP was designed to provide basic health services (BHS) to 830,000 persons living in 50 minor civil divisions within 4 of Afghanistan's 6 health regions. Project emphasizes basic maternl/child health (MCH) and includes developing elements of 2 or more Alternative Health Delivery Systems (AHDS) that are administratively and financially feasible, effective and replicable. AHDS are intended to provide minimal health services to approximately 3,000 persons without access to a Basic Health Center (BHC). Evaluation methodology focuses on assessing project objectives and establishing a framework for a more in-depth 2nd yr analysis of project by interviewing U.S. project staff and management personnel. Field trips were made to existing BHCs and new construction sites to view Village Health Worker (VHW) programs and a final analysis of each subject area coded on questionnaire (staffing, training, construction progress, a fixed amount reimbursement plan, cost estimate, preventive/curative services, recruitment, data collection & commodity assignment) was done when all data had been collected. First AHDS program models have been well received. Eleven VHWs, including 2 women, were recruited & trained to provide optimum curative & preventive services. Eleven traditional birth attendents were trained to provide pre-natal, delivery & post-natal care to mothers & infants. Thirteen Auxiliary Nurse Midwife (ANW) teachers have returned from U.S. training. Comprehensive manuals for BHC staff have been completed, tested, & disseminated. Five mobile training teams have been established & provided on-the-job mgmt training at 54 BHCs. Afghanistan Min. of Pub. Health (MOPH) & AID have agreed that MOPH will assign necessary construction personnel & design a plan for construction supervision & inspection. USAID will not obligate funds for additional BHCs until warranted by construction performance. Evaluation team concludes that project shows prospects of having favorable impact on Afghanistan BHS delivery system based on 1st years experience.