PRITECH assessment of the CRS/Tunisia PN/LAD program

The evaluation covers the period 6/86-11/88. Despite financial uncertainties, weak MOH leadership, and the lack of a long-term strategy, the program has made remarkable progress, largely due to excellent technical and management support from Catholic Relief Services (CRS). Studies indicate that mortality due to diarrheal diseases has markedly decreased, from about half of infant deaths in 1980 to 5%-25% today. Unfortunately, however, further progress is doubtful, since the MOH lacks sufficient personnel for assuming program leadership after the closing of the CRS office (planned for 6/89). Materials developed for training health professionals appear excellent, but while some 30% of public sector physicians have received refresher training, these activities have not reached private sector physicians, who play a large role in Tunisian health care. Moreover, diarrheal disease control education in schools of medicine and public health has been uneven. Materials for training mothers are flexible and well adapted to Tunisian realities, but they had a very limited application. Laudable efforts have been made in mass media communication, but the content of radio and television spots has not always been clear and complete. For example, the promotion of five different home solutions is potentially confusing. A very solid evaluation program has been carried out to monitor and revise the program approach. The MOH information system, on the other hand, should be simplified and better supervised, with increased emphasis on feedback and application to program operations. While ORT appears to be widely practiced in public health facilities, the use of inappropriate and dangerous antidiarrheals remains extensive. It is recommended that the MOH ban the importation, local production, and sale of these products, while supporting the production of oral rehydration salts by the Pharmacie Centrale de la Tunisie.