Mid-term evaluation report of the child survival and mother care project implemented by Project HOPE in Kasungu, Malawi in partnership with Press Agricultural Limited (PAL) and the Ministy of Health and Population

Midterm evaluation covers the period 1998- 10/00. The project focuses on reducing maternal and child mortality and morbidity among 30,000 people living on 34 tobacco and coffee estates and in 22 surrounding villages. There have been several important accomplishments. These include: strong working relationship developed between the partners; increased access to health services; expanded coverage of health services; improved quality of care provided by Ministry of Health (MOH) and PAL health facilities; and capacity strengthened among 537 health care providers and community volunteers. These accomplishments were achieved despite frequent stock-outs and chronic shortages of drugs and vaccines; initial challenges in determining the best way to collaborate with project partners; high turnover in the position of the District Health Officer (DHO); a restructuring within PAL during the first year of the project; inflexible MOH policies; and an unstable tobacco market. The first 2 years of the project have focused on creating and reinforcing the capacity of partners and health caregivers. To this end, the project has trained 15 health surveillance agents, 537 community volunteers, and 2 medical assistants. Two assessments have also been carried out (one to assess PAL's institutional capacity to support and maintain the health delivery system, the other to assess the quality of care among MOH and project health care providers) which will guide capacity-building activities during the second half of the project. The project's prospects for sustainability are unusually high. This is because the partner organization is able to employ and support the key health care providers, the medical assistants, and the health surveillance agents. PAL senior management is also highly motivated to see the health delivery system succeed. Furthermore, the present DHO is also very cooperative and understands the benefits of this project to the District Health Management Team. Includes recommendations. (Author abstract, modified)