Midterm evaluation of MotherCare, project 936-5966.01

Midterm evaluation covers the period 5/89-3/92. To date, MotherCare has initiated long-term activities in Bolivia, Guatemala, Indonesia, Nigeria, and Uganda; provided short-term TA to numerous countries; organized and hosted workshops and meetings; and developed assessment tools, policy guidelines, training manuals, and numerous other publications. These efforts have raised awareness of maternal/neonatal health and nutrition problems and filled gaps in the state-of-the-art regarding specific interventions. They are also likely to influence host government policy. Indonesia, for example, has already incorporated MotherCare data into its own definition of "low birth weight". MotherCare works with and adapts itself to the local health delivery system, while introducing a broad range of services for the care of mothers and newborns, with referral of women with complications a key strategy. MotherCare's adaptability has improved service provision and augurs well for project sustainability. It is expected that the impact of project interventions will be well documented by project end. The time and resources allocated to behavioral research and social marketing have varied widely by country. The Tanjungsari project in Indonesia, for example, has lagged in the areas of communication and social marketing, while similar projects in Bolivia are contributing to the state of the art and should be more fully documented. The use of women's groups and organizations is a promising outreach mechanism, but so far has realized its potential only in Bolivia and Bangladesh. Applied research has focused on issues critical to reducing maternal and neonatal mortality in the next decade, such as prevention and treatment of anemia, provision of care during pregnancy and labor, and reduction of perinatal and neonatal mortality. The extent of the research is especially laudable in view of A.I.D.'s procedural requirements for approving funding for subcontracts. Future A.I.D. research should build on the experience and comparative advantage that MotherCare has established, placing highest priority on innovative techniques for providing adequate care during pregnancy and labor. The use of modern techniques to provide training in midwifery and obstetric skills is a key project activity. "Life-Saving Skills Manual for Midwives" is an excellent document that deserves to be broadly promoted and disseminated.