Mauritania rural health services : project evaluation

Interim evaluation covers the period 1987-4/89. Progress toward project objectives has been satisfactory considering the scarcity of economic and human resources, the difficult geography, and the management problems encountered. The PHC approach has been demonstrated to be both feasible and technically acceptable to the Ministry of Health and Social Affairs at all levels and popular with both the people and government officials. Specific findings are as follows. (1) PHC services, which are delivered by community health worker (CHW) teams furnished with medical kits replenished through funds raised by village health committees or the sale of medicines, have been significantly expanded in Trarza and Guidimaka and will be operating in Assaba before the project's end, by which time more than 200 villages in the three regions will have PHC services. (2) Supervision, though well planned, lacks complete execution due to failure of transport. As the Bamako Initiative is adopted, a simpler and less expensive scheme of supervision may be developed. (3) A uniform national PHC curriculum has been developed and published in individual manuals for training CHW's, traditional birth attendants, village health committees, supervisors, and trainers. Retraining programs have been developed for lower level health staff. Training is generally going as planned, but there is a continuing need for more training, retraining, and external training. (4) The data base and information system remains incomplete, and collection of demographic and epidemiological baseline data has been only superficial. The Health Information System is still too incomplete to provide reliable overall data. The EPI information system is much more developed and should provide more reliable data. (5) The PHC program has been hampered by inadequate TA, in particular by the hiatus which occurred when the Chief of Party was permitted to assume the role of counselor to the Minister of Health. (6) Cost recovery is essential to the PHC program, which in its present form is not sustainable without continued donor support. Although some studies of pharmaceutical marketing have been conducted, more intensive research is needed to test recommendations made in this regard by the evaluation team.