Mid-term evaluation : USAID matching grant to AMREF [African Medical and Research Foundation] -- cooperative agreement no. FAO-0158-A-00-2052-00

Mid-term evaluation covers the period 10/92-11/94. AMREF is on track in terms of meeting grant goals and objectives. The NGO is well-respected in East Africa by government officials who see it as an "African" NGO, rather than northern; it enjoys easy access to high-level health policy levels of the Ugandan and Kenyan governments, who tend to look on AMREF personnel as an extension of their own staff. AMREF's Health Policy and Management Department has provided training, management and planning assistance, and systems development services which are highly regarded by Ministry of Health (MOH) officials and by recipient structures in the health delivery system. AMREF's Distance Education Program, which is providing continuing education for thousands of health workers through self-contained correspondence courses, is also highly regarded. In both cases, host governments and recipient health structures indicate a desire for more assistance from AMREF. The institutional impact of the project is difficult to assess, since AMREF's activities are tied to the complexities of implementing government policy, including decentralization, where it appears that each level within the health delivery system has overestimated the capacity of the next to carry out new responsibilities. Because of the lack of standard measures of effectiveness in these areas, AMREF has tried to define effectiveness as meeting the goals it set out for itself at the beginning of the grant period. But because the situation has changed and certain realities about decentralization have not been realized, not all of these measures are necessarily valid anymore. Current indicators used by AMREF reflect input measurement rather than impact; new indicators are needed. AMREF is behind schedule in obligating funds, partly due to a delay in receiving initial grant funds, lag time in negotiating and planning the Uganda program, and changes in policy and delays in implementing health care user fees in Kenya. In order for AMREF to continue to be effective, it should follow two courses of action: (1) formally acknowledge that circumstances have changed since the beginning of the grant and initiate course corrections, including expanding AMREF's management training; and (2) revise the indicators of success and incorporate them into a new monitoring system.