Midterm evaluation of the USAID/El Salvador public service improvement project (project no. 519-0320) : water and sanitation for health program (PROSAGUAS)

Interim evaluation covers the period 1998-7/00. In the three project sites where pre- and post- project data have been collected, the prevalence of diarrhea in children under age 5 has been substantially reduced. From 1998 to 1999, diarrhea prevalence dropped from 33% to 6.2% in La Esperanza (Conchagua) and from 14% ti 4.4% in Moncagua. In Istagua, prevalence decreased from 14% in 1998 to 8.5% in 2000. PROSAGUAS is ahead of schedule in reaching the planned number of beneficiaries (45,000) for both water supply and sanitation. Moreover, at the current rate of progress, the program will have significant savings in both funding and time. PROSAGUAS has reached 45% of its target of training 9,000 households in improved hygiene practices. In general, considerable progress has been made in the overall health component. The health and hygiene interventions are having a positive impact, as evidenced in awareness of health issues, improved hygiene practices, and behavior changes. The program has successfully built on existing organizational structures in the communities, primarily through the community development associations (ADESCOs). Besides selecting members of the various committees, the ADESCOs have collaborated in a variety of ways with the water users' associations (WUAs). For the most part, municipalities have also supported the program by providing land or by otherwise collaborating in establishing the water systems. They have given legal standing to water management boards and audited financial records of the water systems. A consistent and constructive role for municipal authorities in oversight, monitoring, and support for the WUAs and water management boards is important in ensuring the latter's sustainability. The community management structures created are viable and effective, and should be able to ensure sustainable operation of the water supply systems. Substantial progress has been made in increasing the participation of women in organizational and management structures, though generally not in positions with power or decisionmaking authority. PROSAGUAS has created small, not-for-profit water utility companies run by the community, with paid employees and other attributes of a commercial enterprise, at least in the larger water systems. This entrepreneurial character should contribute greatly to the sustainability and possibility for expansion of these systems to serve more people, within the limitations of their respective water sources. The systems created under the current phase of PROSAGUAS have a more business-like orientation than those initiated under Phase I. The newer projects also benefit from greater emphasis on community organization and education. These changes should result in an even higher degree of sustainability than observed in the earlier projects. The health education component in PROSAGUAS project communities, together with provisions for follow-on support, is likely to result in sustained health benefits. Overall, PROSAGUAS has achieved an appropriate balance between meeting physical outputs under the agreement and investing in the qualitative, or "software," aspects of project implementation. While it is premature to draw any firm conclusions with regard to the sustainability of Phase II projects, the likelihood of sustainability is validated to a certain extent by the generally strong performance of Phase I community-managed systems. Areas of concern include: a project selection trend toward urban rather than, as originally envisioned, rural areas; inadequate use of monitoring and evaluation data for program planning and management purposes; inadequate process documentation; inadequacy of community involvement in initial design and construction decisions; a too diffused health and sanitation education program; and limited synergy with other USAID programs and strategic objectives.