Joint assessment of the Helen Keller International matching grant

Assessments were done of: (1) the HKI Headquarters' capacity to manage and support their expanding program portfolio; (2) the field program in integrated eye care/blindness prevention in the Dodoma Region of Tanzania; and (3) the field program in integrated eye care/blindness prevention in the southern provinces of Morocco. The study found substantial evidence that HKI Headquarters in New York City had, during the past 21 months, substantially upgraded its organizational structure, financial accountability, managerial systems and planning strategy. HKI's TA capacity and expertise appears to remain intact and continues to support its role as a leader in the field of blindness prevention, treatment, and rehabilitation. The organization maintains its avowed mission to serve as a catalyst for eye care service development and improvement through the demonstration of appropriate and innovative methods, rather than serving primarily as a deliverer of eye care services. That posture is reflected in its field programs and its extensive involvement in the Vitamin A/nutritional blindness activities. Slippage in HKI's managerial and accountability performance during a period of rapid resource growth in the early to mid- 1980's has been substantially reversed during the past two years. The renewed stability in the organization should allow it to continue its leadership role. The most significant remaining concerns are: (1) the implementation of a standard reporting system to gather consistent, ongoing performance data on HKI's numerous field projects and programs; and (2) the more effective inclusion of a system of incentives and rewards tied directly to the performance in the field programs. The two in-country programs observed by the review team provided an interesting contrast in sociopolitical settings. The review team found HKI's country representatives to be highly effective agents dedicated to improvements in and development of eye care services. In each program, HKI appeared to be demonstrating improvements that are technically appropriate. Tanzania's blindness prevention program has the potential for strong community involvement at the village level and the opportunity to train community level providers who are strongly motivated and caring. It lacks the basic resources for supplies, facilities, and worker salaries which would be necessary to sustain an expanded capacity. Morocco's blindness prevention program is quite adequately housed, staffed, and supplied. While it could effectively utilize more and better equipment, there is a need to change the orientation from curative services provided by highly trained physicians to preventative and curative services provided in rural settings by well-trained nurses. Recommendations have been made that might benefit both programs given their very different sociopolitical environments. (Author abstract)