Project activity completion report (PACR) : ORT, growth, monitoring and education (596-0115)

The project was implemented by the Nutrition Institute for Central America and Panama (INCAP). The project was a success and contributed greatly to improved MCH in the region. Specifically, INCAP: (1) facilitated, in collaboration with WHO/PAHO and UNICEF, national agencies, and the private sector, the development of effective national MCH programs, and supported diagnostic studies and applied research; (2) strengthened MCH delivery systems by promoting use of WHO/PAHO's methodology for system evaluation, conducting research on specific child survival subjects, and helping to establish sentinel surveillance systems and MCH management information systems; (3) improved MCH skills by participating in educational and networking activities of the UNICEF-WHO/PAHO-supported Regional Training Project for MCH personnel, helping to establish educational reference centers in key training hospitals and to establish regional education units and special health and nutrition units, collaborating with Ministries of Health in developing child survival training modules, and producing educational materials for community members and volunteer health personnel; (4) increased the dissemination of scientific and technical MCH information by publishing the bimonthly bulletin Progress in Child Survival (ASI), developing three distance learning programs for MCH providers, distributing packets of MCH technical materials on a quarterly basis as well as packets of reference materials for 80 national and regional seminars, and responding to hundreds of individual and institutional requests through its information clearinghouse; (5) provided quality control services for oral rehydration salts to all member countries; (6) supported basic research on risks of perinatal, neonatal, and maternal mortality in Guatemala, applied research on dietary management of diarrhea and the causes of persistent diarrhea, and operations research on diarrhea, growth monitoring, and appropriate feeding practices; and (7) helped El Salvador to control Vitamin A deficiency by fortifying sugar with Retinol Palmitate. The project strengthened INCAP's technical cooperation capacity in MCH in the region, and in 1991 an INCAP professional responsible for such cooperation was assigned to each participating country. In addition, the decentralized process of TA delivery supported by the project has continued at the country level through formation of technical groups that support local health systems. This development is particularly noticeable in Guatemala, El Salvador, and Honduras. The following lessons were learned. (1) While interinstitutional coordination between donors and implementing agencies at regional and national levels slows project implementation and is time-consuming and expensive, it conserves resources over the long term. (2) INCAP's effectiveness is contingent on the willingness of beneficiaries to adopt technologies as they are introduced; at times, the project's effectiveness was limited by host countries' lack of follow-through, limited resources, and high turnover of top-level officials. These realities must be taken into account if INCAP is to provide effective TA. (3) INCAP staff and their counterparts are limited more by management deficiencies than by technical deficiencies. Training in both areas is necessary. (4) A country- or even locality-based approach to problemsolving is required to complement regional programs. The latter are useful when there are gains due to economies of scale (e.g., in certain kinds of training, equipment-intensive analyses, and basic research). However, country or local action is needed to effectively respond to variations in conditions, capabilities, interests, etc. (5) Multicenter studies can be effective means by which to transfer technology while checking applicability under different conditions. However, multicenter studies require close supervision and frequent follow-up, which are more time-consuming and expensive than isolated studies.