Report on the first evaluation of Panay unified servies for health (PUSH) project

Special evaluation covers the period 7/78-6/80 and is based on document review, site visits, and interviews with barangay, municipal, provincial, and regional-level personnel. Results have been mixed. Municipal and provincial-level support for Barangay Health Workers (BHW's) and their operations has been weak and participation by the Ministry of Health (MOH) has not been as strong as envisaged. Coordination of inter-agency activities at the regional, provincial, and municipal levels needs to be strengthened. The degree of participation by barangay residents in implementation has also fallen short. Most emphasis has been placed on implementing the project's environmental sanitation infrastructure (ESI) component, at the expense of its health, nutrition, and family planning components. Proper sanitary practices have been promoted by the BHW's in their respective barangays and wells and toilets constructed, with varying degrees of success. The 6-week training course provided to BHW's has focused inordinately on ESI, giving the BHW's little knowledge or skills in the other three areas. In addition, no retraining has been provided, despite strong demand, and no provincial training centers opened. Nevertheless, the basic training curriculum for BHW's has been successfully completed and has substantially prepared them to carry out their functions. BHW trainers also have received orientation training in curriculum use and in training strategies. BHW accomplishments in conducting family planning and medical care activities have been minimal, although child weighing, communicable disease control, vital statistics, recordkeeping, and community mobilization activities have, for the most part, been successfully carried out. Major recommendations are to: implement a BHW retraining course; work to increase understanding of project concepts and goals by provincial and municipal-level implementers; explore mechanisms to facilitate payment of BHW salaries and delivery of ESI commodities; and take steps to increase participation by barangay residents and MOH personnel in project operations.