Midterm evaluation report : child survival/vitamin A project, World Vision Mauritania, Assaba Region

The project began in 10/89, but was interrupted by the Gulf War for 10 months (12/90-10/91). This midterm evaluation covers the period through 10/91. Most of the project"s objectives -- e.g., vaccinating children, promoting breastfeeding, dispensing Vitamin A -- are well on their way to being achieved. Particularly important has been the progress made in sensitizing the Ministry of Health (MOH), other Ministries, and the population in general in how to improve community well-being. These aspects, along with the creation of community health committees, training of community health workers, and the introduction of cost recovery measures, will not only strengthen the health infrastructure in Mauritania, but will contribute to the sustainability of health care services. At first glance, the 10-month interruption of WVRD activities during the Gulf War might lead one to question the sustainability of the project. Many vaccination services were interrupted, Vitamin A distribution by mobile vaccination teams ceased, and supplies from Nouakchott dwindled. On the other hand, a number of project activities continued to function: health committees were still in place, village health workers still provided some services, gardens were still planted, and mothers knew about proper weaning and continued to give oral rehydration solution to children with diarrhea. Most importantly, however, the knowledge that the project shared with the MOH and the communities was not lost when WVRD was absent. What did cause some activities to halt was lack of vehicles and fuel. Although it is currently impossible for developing countries to fully fund vaccines, vehicles, and fuel, it may be reasonable -- now that regions and departments in Mauritania have a functioning budget and cost recovery for some health services is getting underway -- to expect that some recurrent costs such as drugs and fuel for vehicles and refrigerators can be assumed by them. Finally, the evaluation notes specific areas in which more work is needed: mothers don"t understand what tetanus toxoid vaccine is (some think it"s used to sterilize them); mothers don"t know how to mix sugar/salt solutions; and oral rehydration packets are not always readily available. (Author abstract, modified)