Midterm evaluation report of the rural health system project of the Ministry of Health, Guyana

Special evaluation covers the period 1979-4/83 and is based on document review, site visits, and interviews with USAID/G, contractor, and Ministry of Health (MOH) and other Government of Guyana personnel. Despite Guyana's severe economic crisis, substantial project progress has been achieved. Following high-quality, 15-month courses taught by tutor/supervisors (T/S's) at the Medex Training Unit (MTU), 105 medexes (mid-level health workers) have been deployed at rural health centers throughout Guyana. The T/S's, who have received teacher training through a number of short-term in-country and U.S. courses, also supervise graduates and provide continuing education through periodic visits to the centers. A two-way radio communication network - connecting ten health centers and the MTU - has been set up and is functioning well; an additional 23 two-way units are awaiting installation. However, due to radio interference, the system - which is used to transmit administrative, medical, and emergency messages and a weekly teaching conference - is not linked to MOH headquarters; this lack of communication has limited coordination between the project and the MOH. Other project accomplishments include the publishing an MTU newsletter containing administrative and clinical information and self-assessment quizzes for medexes and the establishment of an improved MOH financial management information system for the central and regional levels. Although most of the components of an improved supply system (for drugs, etc.) have been implemented, supply problems continue due primarily to a foreign exchange shortage. Other problems have included: an acute housing shortage for rural medexes (no construction or contracts have been completed); major transportation difficulties due to a severe shortage of vehicles and maintenance personnel; the loss of trained personnel, especially in management, due to migration; and overburdened T/S's resulting in inadequate medex supervision. Recommendations are included.