Midterm evaluation of the primary health care project (Kitui district)

Evaluation covers the period 2/79-7/81 and is based on document review and interviews with CODEL project staff, beneficiaries, community members, and Government of Kenya (GOK) officials during site visits. Strong community support has enabled the project, despite many obstacles, to achieve its goal. Immunization programs and curative and prophylactic care have reduced morbidity rates for diseases such as measles, whooping cough, polio, worms, scabies, and tetanus. Malaria, malnutrition, and diarrhea (the latter due to a lack of potable water) remain major problems, however, and tuberculosis is increasing. By the end of 1980, four mobile teams, attending 66 centers, had provided health care to 19.6% of children under five in Kitui District. From 1978-80, the program covered 29.9% of registered live births, although family planning is severely restricted due to the prevailing Catholic philosophy (which appears inadequate in this male-dominated society). Since 1981, all clinics have provided health education in such areas as basic hygiene, nutrition, malaria, antenatal care, the importance of vaccination, and prevention of diarrhea and worms. Progress has been slow, however, due to the staff"s lack of preparation and high turnover rate and the large number of those seeking health care. Instruction for women"s groups and community leaders has been sporadic and lacks direction. Nonetheless, data collected from 60 women at three clinics showed a reduced incidence of scabies; high rates of pit latrine use (41.7%), daily bathing (75%), composting/burning of garbage (63%), breastfeeding (90%), and home food growing (70%). General knowledge of disease causation and prevention, however, especially regarding the disease potential of water, is rudimentary. Problems include the need for better cooperation between GOK and project mobile clinics and the failure to collect the baseline data needed for final program evaluation due to lack of a formal agreement with the University of Nairobi. The project should be continued (except at static centers such as Kimangao). For USAID/K action decisions consequent upon the other 17 recommendations made, see PD-AAJ-165.