Invermectin delivery program, Suchitepequez Department, Guatemala : mid-term evaluation

The project is being implemented by the International Eye Foundation (IEF). Mid-term evaluation covers the period 10/91-5/93. The project has become a model for the National Plan for the Elimination of Onchocerciasis in Guatemala. Perhaps the project's greatest strength has been the capacity of its numerous players to work cooperatively to achieve project goals. A program for operational research, drug delivery, personnel training, health education/motivation, and monitoring and evaluation has been established within Guatemala's health care structure; these activities will eventually be assumed by the MOH. More specifically, project has: developed a methodology for rapid epidemiological assessment; established a functioning health management information system at project headquarters in the Universidad del Valle and in the MOH; developed a treatment coverage system in endemic areas (30,833 persons, or 84.1% of those eligible have been treated); created a system for the treatment of adverse reactions to ivermectin (2,228 persons were treated during the first distribution round); and developed a monitoring system which, with further refinement, will be capable of tracking key indicators of program performance and financial management. The project has suffered from the following weaknesses. Training materials and the content of training sessions have been inadequate, particularly for MOH health promoters and community-based distributors. Recurrent costs continue to be relatively high. Official counts have placed considerably more residents in the project area than project staff have been able to locate; nearly 56,000 of 91,000 official residents failed to be located in the distribution area. The figure, if accurate, may consist largely of migrants from the highlands who descend for the coffee harvest in the fall. Community-based distributors are only now beginning to function in their communities, although none has yet begun to distribute ivermectin alone; training to ensure sustainability will be a key concern. Overall, health education has been neglected, due to limited funding and time, lack of experience with health education, and lack of communication with personnel from other ivermectin delivery programs, including the IEF Yepocapa project.