Project assistance completion report : health systems management project (517-0153)

The project purpose of improving SESPAS" management systems was partially achieved. All of the planned outputs of the financial management systems and management information systems components were accomplished. Most of the planned outputs of the human resources management systems component were achieved, although standards for employee evaluation were not developed. Recommendations were made for reforming the purchasing and supply systems, but the reforms were not implemented because of personnel problems. Finally, all of the planned outputs of the supervision/monitoring component were accomplished, including the implementation of guidelines for monitoring SESPAS" new management systems. Disease control programs were successfully established and made operational. All five outputs in the dengue/yellow fever program were accomplished, including the out-of-country training of 10 health personnel and the in-country training of 765 health personnel in dengue surveillance. Goals for schistosomiasis were partially achieved. Seven persons were trained in-country in schistosomiasis control and diagnosis and two were trained out- of-country in schistosomiasis control, but the planned training of 108 doctors was not accomplished. In-country diagnostic capabilities for both dengue and schistosomiasis were strengthened as well. The major lesson learned was that an improvement in SESPAS" management systems did not translate into better primary health care as the project was implemented at a time when government health priorities were focused on curative care. Also, the frequent turnover of key SESPAS personnel negatively affected project accomplishments.