Mid-term performance evaluation of USAID/Iraq primary health care project

Primary Health Care Project in Iraq (PHCPI) was launched in March 2011 to assist the Iraqi Ministry of Health (MoH) in achieving its goal of better quality primary health care (PHC) services with a specific focus on supporting the delivery of quality services at the community and facility levels. PHCPI consists of three components, namely: (1) strengthening health management systems; (2) improving the quality of clinical services; and (3) encouraging community involvement to increase the demand for and use of PHC services. The purpose of this mid-term evaluation is to determine whether progress is being made toward achieving the PHCPI's development objective of "Primary Health Care Services Improved" by examining findings from eight targeted questions: (1) to what extent has the project achieved or made progress towards the planned results to improve PHC services in Iraq; (2) how realistic and appropriate is the project intervention logic; (3) to what extent has the project management structure been effective and how has it been affecting the program outcomes to date; (4) to what extent has the project reached out to vulnerable groups including women, persons with disabilities, and the internally displaced persons (IDPs); (5) is the project's approach appropriate to respond to the needs of vulnerable groups, and if not, how can its approach be improved; (6) how is the training provided by the project being used in the clinics; (7) how is project-purchased equipment (if any) being used in the clinics; and (8) how is the GoI cost-share being utilized? The evaluation finds that PHCPI should continue for its full life until March 2015. While there have been some significant gaps in how the project has been implemented, it has nevertheless laid a foundation for what it is intended to achieve and has made progress toward the Development Objective, as well as fulfilling the terms of its contract. The project will need significant reshaping and rethinking; even so, there are a number of objectives that can be achieved during its remaining time. The project must start by clearly defining which technical areas will be supported by PHCPI, even if this does not align with all of the MoH's requests. Starting with a review of the Basic Health Services Package (BHSP) and its principles, the project needs to lay an evidence-based foundation for its strategic decisions and then ground-truth those suppositions to ensure their applicability. PHCPI and relevant stakeholders (primarily the GoI and USAID) must reach a precise agreement on the focus for the final two years that will produce rapid, tangible, measurable, and realistic improvements in the quality of health care services. PCHPI must ensure that all of the project's various activities are interconnected by thoroughly reviewing them within the framework of a greater strategic vision and what is currently possible within Iraq's primary health care system structure. All stakeholders must be willing to dedicate sufficient human resources for the project's implementation and oversight. (Excerpt, modified)