INITIAL EVALUATION OF THE BASIC HEALTH SERVICES PROGRAM (LOW-COST HEALTH DELIVERY SYSTEM), REGION IV, DOMINICAN REPUBLIC (MARCH 77) & EVALUATION OF THE HEALTH SECTOR LOAN PROGRAM : AMENDMENT NO. 1 (12/14/77)

SBS program designed to provide basic immunization, child health, and family planning services to rural communities via indigenous promoters. Specially-commissioned evaluation utilizes random sample survey of 20 rural communities in pilot region of 4 southwest provinces to measure degree of progress in achievement of intermediate objectives. Promoter monthly reports deemed unreliable due to over-reporting. Survey conducted by 10 health professionals who examined household records in sample communities. Sample revealed 50.5% of children under 5 immunized with 2 doses DPT (intermediate goal set at 75%); 14.7% of children under 10 immunized with measles vaccine (75% goal); 21.4% of women of reproductive age immunized with 2 doses tetanus toxoid (80% goal); 8.2% of women 15-49 actively using contraception (4.8% goal). USAID judges sample findings likely underestimated with respect to measles immunization (most children contacted disease during previous epidemic); tetanus toxoid immunization (2nd dose often administered following delivery in hospital); and contraceptive users (overlooks incidence of sterilization). Sample results are termed disappointing, but USAID is pleased with Dominican participation in the evaluation process. USAID and GODR are currently mounting health education campaign in pilot area, emphasizing DPT, tetanus toxoid. Villages identified below goals are being blanketed with posters & radio spots and then offered immunization. Follow-up evaluation is planned. Infant dehydration & breast feeding components are not widely enough implemented to permit evaluation. Amendment #1 provides comparative data based on census of 3 pilot region communities prior to SBS program inclusion. Results (5.5% DPT; 2.9% tetanus toxoid immunization; 4.6% contraceptive usage; no measles vaccination) confirm low estimates of immunization coverage and contraceptive prevalence in rural Dominican Republic.