Medex primary health care project

Final external evaluation covers the period 1981-6/83 and is based on document review, site visits, and interviews with project staff and LDC health officials. The project has developed a unique and comprehensive three-tiered, competency-based health training system, which focuses on mid-level health workers as the pivotal connection between the upper (health professional) and lower (community health worker) tiers. The training materials, which have been published as the 35-volume MEDEX Primary Health Care Series, were tested in Pakistan, Guyana, and Lesotho and have proven to be suitable for adaptation and replication in widely different settings (although the process of adaptation may be complicated and time-consuming in some settings). Other project outputs include reconnaissance visits, training seminars, workshops, and TA. The competency and expertise which have been developed under this project should be exploited fully and rapidly. There is already significant interest among LDC's in using the MEDEX materials. To ensure full use, the University of Hawaii's Health Manpower Development staff (who developed the materials) should seek marketing expertise and should be responsive to potential users whether they need the complete system or merely specific components. It is recommended that: A.I.D. continue support to this project and encourage other projects to use the MEDEX system; training centers be developed; TA and user networks be provided; and plans be made for assessing the training system's cost-effectiveness. The project demonstrates that systems development is costly and time-consuming with numerous unpredictable variables, however, it can be rewarding if the prototype permits easy adaptation and replication, and it is better than financing pieces of a system individually. Measurement of cost-effectiveness is impractical during the testing stage and should be carried out by an independent team during the operational phase. To be maximally successful, AID/W and the materials developers should achieve better working relationships and every effort should be made to facilitate better communication with Missions.