INITIAL EVALUATION OF THE BASIC HEALTH SERVICES PROGRAM, URBAN LOW-COST HEALTH DELIVERY SYSTEM

USBS COMPONENT DESIGNED TO PROVIDE BASIC IMMUNIZATION, CHILD HEALTH, AND FAMILY PLANNING SERVICES TO PILOT URBAN AREAS VIA INDIGENOUS PROMOTERS; USBS SUBSEQUENTLY LIMITED TO HERRERA SECTION OF SANTO DOMINGO WITH A POPULATION OF 56, 964 SERVED BY 117 PROMOTERS. EVALUATORS UTILIZED SURVEY OF CONTACTS OF 12 RANDOMLY-SELECTED PROMOTERS TO ASSESS ACHIEVEMENT OF INTERMEDIATE OBJECTIVES. SAMPLE REVEALED 55.0% OF CHILDREN UNDER 5 IMMUNIZED WITH 2 DOSES DPT(INTERMEDIATE GOAL SET AT 80%);4.2% CHILDREN UNDER 10 IMMUNIZED WITH MEASLES VACCINE(80% GOAL);21.9% OF REPRODUCTIVE AGE WOMEN IMMUNIZED WITH 2 DOSES TETANUS TOXOID(80% GOAL);5.74% OF WOMEN 15-49 ACTIVELY USING CONTRACEPTION(2.5% GOAL). DEGREE OF IMMUNIZATION COVERAGE IS JUDGED POTENTIALLY UNDERSTATED DUE TO INCIDENCE OF PREVIOUS SECRETARIAT OF HEALTH,UNIVERSITIES,AND PRIVATE CATHOLIC IMMUNIZATION CAMPAIGNS IN AREA. EVALUATORS RECOMMEND FUTUREJINCLUSION OF OTHER(OUTSIDE) IMMUNIZATIONS IN HOUSEHOLD RECORDS MAINTAINED BY PROMOTERS. CONTRACEPTIVE ACCEPTORS -- FOR WHICH GOAL WAS SURPASSED -- ARE LIKEWISE BELIEVED TO BE UNDERSTATED. THE GREATER MOBILITY OF THE URBAN TARGET POPULATION AND OF URBAN PROMOTERS(27% LOST TO PROGRAM) IS JUDGED TO HAVE HANDICAPPED USBS COMPONENT. IN COMPARING USBS SAMPLE TO THE REGION IV RURAL SAMPLE(SEE 5170107021702),ALMOST IDENTICAL DPT & TT COVERAGES IN BOTH URBAN & RURAL COMPONENTS WOULD SEEM TO NEGATE THE ASSUMPTION OF GREATER ACCESSIBILITY OF THE URBAN POPULATION TO HEALTH SERVICES. EVALUATORS HYPOTHESIZE THAT URBAN MOBILITY DOES NOT AFFECT USBS PROMOTERS' WORK DESPITE MUCH EVIDENCE TO CONTRARY. RELEVANCY OF RURAL & URBAN DISPARITIES IN MEASLES AND FAMILY PLANNING RESULTS IN JUDGED LESS MEANINGFUL. GREATER EFFECTIVENESS OF ONE PROGRAM AS OPPOSED TO OTHER CANNOT BE UNEQUIVOCALLY DEMONSTRATED ACCORDING TO EVALUATORS. TEAM RECOMMENDS RADIO & POSTER PROMOTION OF TT IMMUNIZATION FOR MOTHERS WHO DO NOT REGARD THEIR OWN IMMUNIZATION AS IMPROTANT AS THAT OF THEIR CHILDREN.