Project assistance completion report : health vitalization (VISISA) project no. 519-0291

The project allowed the MOH to maintain its health care capacity during a crucial time, despite declining public sector finances. The MOH was strengthened by the pharmaceuticals, supplies, vehicles, and medical equipment provided by the project, as well as by improvements and additions to the physical infrastructure, including warehouses and workshops for repair and maintenance of vehicles and biomedical equipment. Construction of operating rooms, and purchase of X-ray machines and other equipment enabled hospitals to meet hygienic standards and the country's increased medical needs. Additional project achievements include the following. (1) The project had a major impact on lowering the number of malaria cases in 1986 and 1987. (2) MOH capacity to carry out emergency drug and supply distribution was improved in the aftermath of the 1986 earthquake. (3) Cold chain equipment provided by the project continues to be used to prevent loss of perishable medicines and blood. (4) A vehicle maintenance program was well organized and had considerable success in streamlining and standardizing the fleet, implementing cost controls, and providing preventive maintenance. (5) Teaching modules for trauma care were developed. (6) The computerized management information systems began to operate in 1987, but further training is needed for both users and operators. Lessons learned include the following. (1) Institution building is not accomplished with resource transfer alone, and it takes time. In this case, 5 years was clearly insufficient. (2) Continuity in the provision of TA has positive effects on results and is an important element in institution building. (3) MOH policy decisions are key to making the system effective, and they should not be sacrificed to meet pressures for quick results. (4) Cooperation between management groups is important and must begin early in the project. (5) Hospitals have an advantage over the rest of the system in obtaining resources, and measures must be taken to elevate the priority of lower-level care facilities. (6) Project papers should be written with specificity concerning what will take place and how, but should also be flexible regarding areas that are almost certain to require modification.