Interim evaluation of the BASICS project (basic support for institutionalizing child survival), project no. 936-6006 : executive summary

Interim evaluation covers the period 9/93-4/97 against a PACD of 9/98. BASICS is implemented by the Partnership for Child Health Care, a consortium of John Snow, Inc., Management Sciences for Health, and the Academy for Educational Development. The BASICS conceptual framework, "Pathway to Child Survival", is used to identify entry points for improving child health. The contractor has focused on curative and clinic-based services, and, consistent with a major project goal to promote integrated service delivery, has adapted the World Health Organization"s IMCI model as its program centerpiece in several countries. It is suggested that IMCI, which to date has stressed the training of service providers, expand the Pathway framework to incorporate more preventive, community, and household approaches. The range of BASICS interventions in a given country depends upon the priority of child health in the Mission portfolio. The contractor has focused on getting new strategies and programs in place, and many country activities are still in the early stage of implementation, frequently in limited geographical areas or serving relatively small populations. However, the more mature immunization programs in the New Independent States have increased coverage, and cut some costs through improved program management. While some USAID staff felt that BASICS should have had a faster start-up since it built on the efforts of earlier USAID child health projects, others noted that BASICS rapidly responded to Mission needs and also needed time to establish alliances with other Cooperating Agencies and donors (particularly where USAID"s presence was being reduced). Given the large volume of activities in the early or middle stages of implementation, there is concern about the level of results and documentation of experience that will be realized before the contract ends. To maintain momentum, BASICS may have to focus on promising activities and encourage key contract employees not to "jump ship" during the last year. There is also a need to review the actual health outcomes and impacts that can be reasonably expected by the end of the contract and to streamline current approaches to contract administration. USAID should consider developing a new Results Package for BASICS, rather than work from the current 10-year Project Paper. This would allow more time to address the long-term problems of child health. Also, BASICS should target country programs that can achieve national coverage of child health interventions in a reasonable amount of time, continue to balance prevention and treatment, expand from a facility-based strategy to home and community interventions, and increase private sector involvement in child health. It will also be important to harness additional resources available through private sector and community structures, e.g., engaging mothers and other caregivers in the prevention and treatment of child illness, track the cost-effectiveness of all major interventions (since replicability must remain an overriding concern of BASICS), and continue to emphasize serving the most vulnerable subgroups in the child health population. Finally, in its next phase, BASICS may need to shift its focus from child survival and illness to child health, and, in order to maintain a global edge in technical leadership, acquire adequate central support, resources for experimentation, and testing of new service delivery mechanisms. Given USAID"s current delegation of funding authority to the field, this should be kept in mind when planning the follow-on project.