Milwaukee International Health Training Center

External evaluation covered the period 4/86-1/89. While the project was a learning experience for MIHTC, it progressed modestly and modified or postponed 5 of its 10 goals. MIHTC staff lack primary health care (PHC) experience and have relied strongly on outside institutions and consultants for help in implementing training programs. MIHTC has also not established a specialized Third World-oriented training capacity, as is found in other university public health programs. Moreover, MIHTC is far from reaching a level of financial sustainability, although its knowledge of international funding sources has improved. MIHTC provided labor-intensive, individually tailored training to 21 developing country participants in Milwaukee. The training, mostly practical and clinically based, was low in cost but not particularly cost-efficient. In Africa, MIHTC was able to quickly identify and implement training programs (library management in Zimbabwe, intersectoral planning for PHC in Malawi). However, these opportunities were previously selected as areas of need by the two host governments and UNICEF, though they had not been identified as such by the local Missions. Four lessons were learned. (1) The rate at which institutions develop depends not only upon strong political commitment from its sponsors, but also upon the investment made in the number, experience, and orientation of its professional staff. Since no U.S. organization has received indefinite support from A.I.D. for institutional development, administrative and financial sustainability should become a major objective early on. (3) The use of seasoned and sensitive development professionals with prior PHC experience is critical to the success of international development projects. Experience in U.S. public health programs is helpful in preparing staff for PHC in a developing country setting. (4) Academic institutions which are new to the field of development should be given extra guidance in the use of A.I.D. funds. (5) Institutions receiving A.I.D. grants for the first time should be informed of the roles of Missions and the protocol required in carrying out projects in developing countries.