Integrated rural health delivery system Ecuador : final evaluation

External evaluation covers the period 7/87-3/89, when the primary goal was construction of rural water supply and sanitation systems (RWSS's). The project has succeeded in institutionalizing the concept of community ownership and management of RWSS's. The relatively high level of community maintenance of constructed systems (50%-60%) is a good indicator of project success. Also, the project's modular operating approach has been an efficient means of organizing construction, and has demonstrated that a team of one engineer, three promotores, and one administrator can construct six or seven systems a year. However, achievement of construction and promotion goals were hampered by logistical problems and lack of transportation, and construction targets of 18 systems per year for each operational module proved unrealistic. Another problem is that latrines with concrete pour-flush devices are not being used because they are hard to keep clean and aesthetically unappealing. Appropriate technology experiments yielded few results but should be continued with more organization and supervision. Also, water tariffs have been set too low in most communities. Training provided by the Ecuadorean Institute of Sanitary Works (IEOS) to 1,200 project-related personnel was effective in manual skills, but less so in promotional skills and hygiene. User education in sanitation also needs improvement, particularly in latrine promotion, construction, and water usage. Too many communities do not understand the health benefits of latrine use. This is partially a result of the underrepresentation of women as IEOS promoters and on community water boards. Health messages from male promoters are highly unlikely to win the acceptance of women. A planned follow-on project will add elements relating to child survival.