REPORT OF THE BASIC HEALTH SERVICES PROJECT - EVALUATION TEAM - JANUARY 18-FEBRUARY 20, 1981-ISLAMABAD, PAKISTAN

This final evaluation, attached to a PES (PD-AAI-218-A1), covers the period 4/77-2/81 and is based on discussions with project personnel, site visits, and document review. A medical technician training program was developed, and schools were constructed in all provinces. More than 200 persons have completed training. The University of Hawaii provided technical assistance. Production of a set of six training manuals was one of the project"s most notable achievements. Over 400 basic health units and 225 rural health centers were constructed. Six integrated rural health complexes were constructed, but are not operational. Although community health workers were to have been the foundation of the project, only a few have actually been trained. Other shortfalls included the failure to provide management training for project personnel, to prepare field operation manuals, and to institute operational research and communications support programs. Soon after the project began, the Bhutto government was replaced and the project was delayed by the need to orient new officials to the project. Much of the delay could have been circumvented by having given a greater role to provincial officials. Also, the scope of the project was reduced in 1977 when Section 669 of the Foreign Assistance Act was invoked. Project taught the need for overall cooperation and for having modest expectations; modifying basic health services plans to local economic, social, and cultural conditions; and improving communication among provincial health departments. It is recommended that a follow-on project (employing expatriate advisors) be implemented, emphasizing completion of the integrated rural health complexes and deployment of community health workers. Although training female medical technicians would be desirable, this should not be mandatory. Other recommendations include holding workshops for staff members from the various provinces and making available short-term, third-country training for Pakistani project personnel.