MIDTERM EVALUATION OF THE THAILAND RURAL PRIMARY HEALTH CARE EXPANSION PROJECT

Evaluation covers the period 10/1/78-03/21/80 and is based on document review, site visits, and interviews with project officials. RPHC has shown impressive gains reflected in declining population growth, reduced infant and maternal mortality, and increased immunization. Considering the enormity of the effort and the logistical/administrative difficulties involved in training a targeted 94,181 RPHS personnel, the training of 56,410 people in 10 categories is impressive. However, the training of only 321 of 900 nurse practitioners has been a disappointment. Because key management personnel -- provincial chief medical officers and section chiefs -- have received little training and only 120 of a planned 528 managers at all levels have been trained, RPHC management has been impaired. Evaluation and research has been slowed by delays in hiring consultants, the Government of Thailand's (GOT) reluctance to finance research, USAID's decision to deny honoraria to Ministry of Public Health staff; and the GOT/Health Planning Division's (HPD) inability to handle a heavier workload. Of nine planned research studies, only three, relating to RPHC training effectiveness and community health conditions, have been conducted. It is recommended that: (1) USAID coordinate RPHC with community development activities; (2) the project's training methodology be researched; (3) refresher courses in curative care, information/education/communication, community development, and drug use be established; (4) problem-solving sessions be incorporated into management training; (5) data management/information flow receive added emphasis; (6) additional researchers be hired; (7) HPD continue efforts to upgrade and design effective mechanisms for coordinating and using research and evaluation; (8) methods of evaluating the health delivery system be developed; (9) strategies to develop a comprehensive approach to primary health care be explored; and (10) the quality of curative care be more closely monitored.