Medex approach : an evaluation of the work of the health manpower development staff of the University of Hawaii

Special evaluation covers the period 7/78-2/81 and is based on document review, interviews with project and LDC personnel, and visits to three countries. HMDS's approach to designing PHC management and training systems is logical, sensible, and understandable, and is in fact the most complete and systematic prototypical approach known. The approach is not perfect, however. Potential problem areas include the relationship of mid-level health workers (MLHW's) to physicians, community health workers (CHW's), and other paramedical personnel; the quality of MLHW preventive care; and a lack of adequate data to assess cost-effectiveness. HMDS has developed high-quality prototype competency-based modules for training and continuing education of CHW's and MLHW's. Prototype management materials are still in preliminary draft form, but are well regarded by LDC health officials. Materials for doctors who will direct the PHC programs and supervise MLHW's have not yet been developed. HMDS has performed less well in planning and executing field systems. HMDS is now implementing PHC projects in three LDC's (Guyana, Lesotho, Pakistan), but these are still in early stages - MLHW's have been or are being trained in all three, but are deployed only in Guyana. The MLHW training modules were successfully adapted to these countries through seminars and workshops. HMDS has been criticized by A.I.D. and LDC personnel for its reluctance to circulate its materials while still incomplete, out of concern that other institutions might adapt them for commercial use. A more open and flexible approach is recommended. There is also a feeling, particularly at some Missions, that HMDS is inflexible in adapting materials to local needs, but this is not the case in the above-mentioned countries. A.I.D. should increase understanding among Bureau and Mission staff of the MEDEX project. While HMDS has formed a network with two other U.S. universities to increase its response capability in developing PHC systems, thus far the costs of the network have probably outweighed its benefits.