Mid-term evaluation : combatting childhood communicable diseases

Special evaluation covers the period 9/81-6/83 and is based on document review, site visits, and interviews with project, host-country, other-donor, and Mission personnel. The project, soundly conceived and well received by African governments, has the potential to make a major contribution to the reduction of child mortality. Nineteen countries have requested CCCD assessments; 10 have been completed (and projects in these countries already approved or started), 4 are in progress, and 5 at the request stage; assessments have been of high-quality in both content and format. The CCCD projects focus on integrating vaccination, oral rehydration therapy (ORT), and presumptive chloroquine treatment (CT) with primary health care (PHC). CCCD"s bilateral approach has proven sound; generally, A.I.D. (the major donor) has funded mainly technical, planning, and operational support, and other donors equipment, supplies, and training. An improved management information system has been devised and will soon be field-tested. The Zaire project, despite the personnel and financial problems seen in all CCCD projects, is a fine example of integrating CCCD into PHC. About 25% of the population has access to vaccination; ORT and CT will soon be added. Excellent training modules have been developed and zonal medical chiefs (ZMC"s) are being trained to implement CCCD activities. However, lack of senior CCCD staff has left supervision of ZMC"s inadequate. The project needs to redefine its overly ambitious objectives (also typical of CCCD projects) and to develop linkages with research institutions as well as techniques to measure morbidity/mortality rates. Other problems confronting CCCD as a whole are: lack of participation by major African countries (e.g., Nigeria, Sudan, Zimbabwe, Kenya); restrictions on financing CCCD projects in Sahelian countries; and less international coordination and multidonor support than expected (Zaire being a notable exception). Among numerous recommendations made, the most critical are to develop senior African management staff and to resolve the problem of recurrent costs. Detailed suggestions are also made for implementing intercountry activities in concert with WHO/AFRO.