Report of the child survival X project [Ecuador] : final evaluation

The evaluation is based in part on a 9/97 knowledge, practice, and coverage (KPC) survey. The project's education efforts increased knowledge indicators in the areas of nutritional improvement and growth monitoring, control of diarrheal diseases, and pneumonia control. Feeding practices have improved, with significant progress in early and exclusive breastfeeding over the life of the project. Growth monitoring frequency has more than doubled since the project began, from 21.7% to 52.7% among children O-23 months of age. Use of oral rehydration solution (ORS) packets has increased 30%, and goals were exceeded regarding mothers' knowledge of the danger signs of severe diarrhea. Knowledge levels of the danger signs of pneumonia have also increased significantly among mothers, and 80.8% take their children directly to a health services facility during a suspected pneumonia episode, up from 44.8%. One of the project's most important achievements was the development of a strong and dedicated health team. The recommendations of the midterm evaluation were followed very closely, resulting in the successful expansion of all four project interventions from 20 to 130 communities. The main constraints have been as follows: (1) There has been little progress regarding immunizations: most vaccine levels have remained statistically static, and none of the original implementation objectives has been met. The percentage of mothers immunized with at least two doses of tetanus toxoid vaccine is particularly low, 9.0% vs. a goal of 40%. (2) The project had difficulty tracking and analyzing the results of its interventions. The health information system, while greatly improved, is still not adequately utilized, e.g., in following vaccination trends and in undertaking long-planned, long-needed, and long-postponed anthropometric investigations. (3) Utilization of community health workers (CHWs) for both diarrhea cases (17.1%) and pneumonia control (12.3%) is very low, indicating possible problems with the people in whom a great deal of time and effort has been invested. The project's main constraints stemmed from an overly ambitious project design, which called for the implementation of four CS interventions in 147 dispersed rural communities, and for a new health team with little or no previous experience in managing CS projects. PLAN's association with a number of key counterparts -- the Ministry of Health (MOH), Rural Social Security (RSS), the University of Cuenca (UC), and the communities themselves -- guarantees a good degree of continuity. Project training has enhanced the technical skills and management expertise among all of the players concerned, and sustainability will be strengthened through the transfer of a number of project activities to the MOH and the UC, e.g., CHW supervision and educational message development concerning the key interventions. The main mechanism for cost recovery has been the sale of essential medicines and provision of first aid by the CHWs at the community health post. However, this system could be made to function better as an incentive for the CHWs. One possibility is the RSS's interest in promoting community pharmacies, which would include more training for CHWs and allow them to earn more money. PLAN Austro staff will continue to provide educational and technical services to the MOH and beneficiary communities, and to support the cadre of CHWs. Also, a reproductive health component will be added over the course of the coming year.