Mid-term review of the Mozambique prosthetics project

The evaluation covers the period 1989-12/92. Considerable progress has been made toward meeting the needs of amputees and some of the other physically disabled in Mozambique. Two very capable NGO's are providing prosthetic and orthotic services: the International Committee of the Red Cross (ICRC) and Handicapped International (HI). Prosthesis production is reasonably on target, the prosthetics repair program seems to be meeting demand, and training objectives are being met for both physical therapists and prosthetists. With the graduation of the prosthetist classes next year, a significant increase in production is expected. The one serious exception to this success is the transit center component -- construction of residence buildings for persons either awaiting or receiving prostheses -- which is well behind schedule, and is becoming a serious constraint. Primary responsibility for the delay lies with Save the Children Federation (SCF), the implementor of this component, though the Mission could have exercised its leverage with SCF and the Government more effectively. The facilities now in use are of very poor quality and demand is growing. New construction is needed now, despite the Mission's understandable reluctance to undertake it. There is also a continuing management problem at the existing centers -- all are badly underfunded by the Government and require outside help from ICRC and HI. There has also been an inordinate delay in estimating the need for project services (although this delay is not threatening implementation of other parts of the project). The field survey is now completed for all but two provinces, but the data remain in raw form. Also, demand may surge when the cessation of hostilities permits the return of some 2-3 million refugees and potentially increases mine injuries as farmers return to abandoned fields. Transport and communication difficulties caused by the war persist, making it impossible to establish an effective prosthetics follow-up program. Both ICRC and HI rely essentially on self-referral; the planned clinical follow-up program is unrealistic, as is the long-term rehabilitation plan called for in the Project Paper. The project's attempt to establish an orthopedic residency program at Maputo Central Hospital never materialized, The new orthopedic plan focuses more on mid-level medical/technical professionals. In addition, recruitment of surgeons with Portuguese language skills for short-term assignments is proving difficult. (Spanish or Italian speakers would be able to work effectively.) Despite considerable efforts to achieve technical sustainability, the project continues to be financially unsustainable without continued donor inputs. With its very limited financial resources and the relatively low priority it accords this activity, the Government is unlikely to allocate sufficient funds to assure sustainability. The project can expect to make only limited progress in increasing the economic self-sufficiency of the handicapped, especially in urban areas, where unemployment is high.