Mid-term evaluation of USAID OPG AID/AFR-G-1560

Special evaluation covers the period 7/79-11/81 and is based on document review, site visits, and interviews with AMREF, Ministry of Health (MOH), and community officials. AMREF has dramatically expanded its staff and has increased the number of projects conducted from 11 to 22. The Kibwezi Health Center, although 8 months delayed in construction, now serves some 3,000 outpatients and 40 inpatients per month; 19 (vs. 20 targeted) staff are deployed at the Health Center. The mobile outreach program is operational, covering 6 widely dispersed service points, 80 Community Health Workers have been trained, and 6 one-day seminars were held for health staff. AMREF plans to initiate several new activities in Kibwezi, including programs in nutrition, water and sanitation, and midwife training. With regard to learning resources, only 3 of 8 planned manuals (on epidemiology, therapeutic guidelines, and community health) have been printed and distributed; the rest are expected to be distributed during 1982. AMREF"s health publication, Afya, has increased its circulation by one-third to 6,000 per issue, while its health education magazine, Defender, increased its readership to 9,000. AMREF has conducted a socio-anthropological study of health attitudes and beliefs in the Kibwezi area, focusing on birth attendants, as well as evaluations of its Medical Radio Communications Network and Flying Doctor Services. AMREF"s most serious shortcoming is its failure to systematically collect data on all its activities. As a result, some valuable experiences have not been documented. More analysis of project information and additional data collection are needed, as well as an accounting system more useful in project planning and evaluation. Other recommendations are to: make mid-level staff responsible for day-to-day project implementation and concentrate senior staff efforts on project evaluation, review, and development; increase interdepartmental coordination (especially between AMREF"s Medical Director and its finance department); and strengthen ties with the MOH.