Midterm evaluation of technology and resources for child health (REACH II) -- AID project number 936-5982

(JSI), to support USAID's worldwide child survival (CS) program. Interim evaluation covers the first 2.5 years of the 4 year project, which began in 1989. The project overlapped one year with its predecessor, REACH I, which was also implemented by JSI. This circumstance had negative and positive aspects. The overlap created managerial difficulties; for example, the director of REACH II was at times also the Deputy or Acting Director of REACH I. Also, while there are advantages in planning, authorizing, and contracting for follow-ons before the completion of predecessors, in instances such as this -- where the successful bidder on the follow-on also implements the predecessor, and there is substantial funding remaining in the earlier project -- there is a risk that the follow-on may get off to a slow start. On the other hand, one of the project's strengths has been its capacity to draw upon the experience of REACH I and other projects managed by JSI, such as MotherCare and SEATS. Neither the project paper nor the contract specified how the project's impacts on health were to be measured; in fact, the contract calls upon JSI itself to establish progress indicators. The indicators which JSI have identified have usually been qualitative and refer to process and outputs rather than health as such. Due to nature of the project, and the difficulty of describing its results in terms of indicators such as immunization coverage, disease incidence, and morbidity and mortality, such indicators may be appropriate. Given this, REACH II has performed well in the technical areas in which it is involved. The project has many strengths, mostly notably its contributions to management of immunization programs, but also in the area of acute respiratory infection control. JSI has proven itself responsive to unanticipated requests, culturally sensitive, capable of providing high-quality TA and of effectively collaborating with other donors and in-country entities, and able to provide strong management even in the face of political instabilities in host countries (as well as A.I.D.'s own uncertain funding and policy environment). REACH II also provides a leading example of co-funding with other donors in providing TA. In many cases, the project's contribution to, say immunization logistics management or cost analysis, is complementary to existing programs. In contrast to REACH I, the follow-on project has suffered from diminishing Mission buy-ins. The reasons for this range from changes in funding priorities and the buy-in process itself, to factors specific to health and CS interventions (e.g., the large numbers of other donors active in the field). USAID missions in four CS emphasis countries -- Haiti, Kenya, the Philippines, and Yemen -- have used buy-ins to finance a full time presence in their programs; the project has also been active in providing emergency TA to four Central Asian republics of the former Soviet Union, and is beginning new initiatives in Nigeria, Morocco, and Kenya. While the discrete and short-term nature of most activities has limited the project's ability to systematically promote institution building, the project has consistently given attention to sustainability within the context of specific activities, e.g., by promoting routine service delivery systems rather than one-shot immunization campaigns. Some outstanding concerns about the project include the following: (1) self-evaluation requirements have been overshadowed by day-to-day operational demands; (2) the unique capabilities of REACH II subcontractors have been underutilized; (3) the project has been slow to engage the for-profit sector in its programs; (4) attention to IEC has been limited, by direction of USAID; (5) activities proposed for the remainder of the contract may overextend REACH capabilities; and (6) competition with contractors for other, overlapping projects has, on occasion, discouraged collaboration.