Report on the first seven years of USAID/Egypt"s assistance to strengthening rural health delivery

Audit report covers the period 7/30/76-3/31/83 and is based on documentation, interviews with A.I.D. and Egyptian health officials, and site visits. Delays and discontinuity have plagued the project and there is no assurance that objectives can be achieved by the revised 5/1/86 termination date. Due to contract delays, TA personnel did not arrive until 4/78. In addition, the contractor"s implementation plan for the first 18 months, when finally submitted in 7/78, was vague in its targets and changed the project"s purpose from improving MOH management of health service delivery to strengthening the services per se. After a 2/81 A.I.D. special evaluation, a revised implementation plan and an amendment extending the project were developed which changed the project"s purpose and output goals to reflect actual implementation; the amendment remained unsigned, however, until 2/21/83. Further, the amendment"s requirement that project data be collected and analyzed to ensure further project development remains largely unfulfilled. Although provision of a long-term health services researcher was considered essential to project success, following departure of the original researcher in 6/81, the contractor provided a health researcher for only 9 months (6/82-4/83); replacement of the second researcher before the contract terminates on 7/31/83 seems unlikely. The contractor has also failed to: adequately update the implementation plan; conduct all Phase I testing; evaluate the project; develop detailed work plans for Phases II-III; and submit substantive, pertinent progress reports. Reports by short-term consultants have also been inadequate. The 140 project vehicles, many of which have been used inappropriately, appear to have had no impact on health service delivery. Despite recommendations made in the 2/81 evaluation, 118 additional vehicles were procured. It is recommended that - USAID/E"s opinion notwithstanding - all data collected before 5/1/82 be identified and analyzed and a submission date (possibly subsequent to 6/1/83) be established, and that USAID/E explore with the MOH alternate sources for contract TA.