Midterm evaluation of the Jordan family health services project (278-0287)

Mid-term evaluation covers the period 8/90-5/96. Despite some delays, the project should achieve its goals, provided recommendations are implemented. The original design was modified for several reasons, including changes in the Government of Jordan's (GOJ's) policies and USAID/J's strategic objectives and the World Bank's interest in restructuring the Jordanian health sector. Currently, the project has two major components. The first (and largest) component, Family Health Services Delivery, includes quality assurance (QA) and family planning (FP) activities and the Family Medicine Specialty training program. The second provides assistance to NGOs, including the National Population Commission (NPC) and the Jordan Association for FP and Protection (JAFPP). The family health services/FP component has some work to do if it is to meet its objectives. The Ministry of Health's (MOH's) Monitoring and Quality Control (MQC) Directorate, which is expected to assume full responsibility for QA once the project ends, needs more TA to improve its capacity and to clarify its role and its relationship to other MOH directorates. In the Balqa Governorate, where the pilot QA model hospital and Maternal Child Health/FP (MCH/FP) Center were started, the QA concept has been embraced with enthusiasm. In fact, the ground is very fertile for QA in all governorates, and there is great potential for improving the quality of care in such an atmosphere. In the last year, the project has begun to expand beyond Balqa to two other governorates. To assist in meeting USAID/J's strategic objective of increasing the practice of modern family planning, this expansion should place primary emphasis on MCH/FP centers and birth spacing and less on hospitals. To ensure that the concept of QA is institutionalized, TA needs to be provided until the end of the project; 5 years of continuous TA may be needed to establish a national program of this size. The Family Medicine Specialty Training Program aims to create a new cadre of certified family medicine practitioners by establishing training programs in the University of Jordan (UOJ) and the Jordan University of Science and Technology (JUST), as well as to strengthen continuing education in this specialty. The program has several potentially serious problems: (1) the curriculum and training program used at UOJ and JUST do not comply with the accreditation standards of the Jordan Medical Council; and (2) the faculty at the two institutions are not adequate. Sponsoring newly graduated doctors for U.S. training in family medicine has failed. Alternatives need to be found immediately. Under the second component, JAFPP activities are on schedule; the five authorized new clinics are open and functioning, other quality of care activities are progressing, and there are no serious problems. The NPC subcomponent is just getting underway. The grant was signed in May 1995, with TA to be provided by the Johns Hopkins University Population Communication Services. The activities will be mainly institution building and the implementation of a mass media campaign complemented by advocacy activities.