Report on the final evaluation of the health improvement for young children project

Final external evaluation covers the period 11/77-6/81 and is based on document review, interviews with A.I.D. and project personnel, and site visits. This project suffered the consequences of shifting Government of Jamaica (GOJ) priorities and economic decline during the 21-month lag between project design and start-up of implementation. Planned efforts in health sector information management and manpower development, basic training, and functional analysis were either not realized or reassigned to other donors. The GOJ expanded the project from a planned pilot area (Cornwall County) to encompass the entire country and failed to allocate P.L. 480 counterpart funds as planned for primary health care (PHC) training and equipment. Given these constraints, inservice training achievements were remarkable. Two training specialists, one assigned on short notice to Kingston, the other highly esteemed trainer to Cornwall County, worked together to develop inservice training for PHC health center workers. They helped plan workshops for 340 midwives, trained 36 trainer coordinators (25 in Cornwall), and developed regional and parish-level training coordinating committees. An estimated 925 PHC workers in Cornwall were trained in service delivery/outreach. Support was provided to 100 University of the West Indies medical students interning at rural PHC clinics. Students also conducted three studies - one, unplanned, on Jamaica's infant mortality rate; the other two identifying health service and training needs in two parishes, the results of which were incorporated into ensuing training. While the studies could not confirm the effect of project activities on infant health or health services, the two students involved later became health officers in Cornwall. Lessons learned: beware of long delays prior to implementation and of relying on P.L. 480 counterpart funds; there is no substitute for good people; inservice training is not a panacea for management problems; changes in basic health indices are poor measures of project outcomes; shifting priorities require a flexible response.