Report on the mid-term evaluation of the primary health care financing project (PHCFP)

Mid-term evaluation covers the period 1983-11/85 and is based on document review, interviews with key personnel, and a site visit. Progress has been very slow: only 1 of 8 planned special studies (SS) has been carried out, and only 3 of 21-31 planned financing schemes (FS) have been approved. The delay in completing the SS"s has delayed projected improvements in program design and policy for training PHC volunteers and supervisors and in village drug supply and herbal drug processing technology. Only education activities and commodity procurement have been accomplished under the service delivery component, and these were mostly modifications of previous efforts. The key problems have been structural and systemic in nature, compounded by design flaws. The absence of full-time project and component managers has been especially troublesome. In the case of SS"s, the review process is needlessly long and has failed to ensure the adequacy and appropriateness of outputs. As for FS"s, neither the project plan nor project management provided clear guidelines as to what schemes are desirable and worth supporting. Masked by these delays are potential problems regarding project funding. The funds released to date have been much lower than programmed, and the procedures adopted for the 90-day cash advance/liquidation method are expected to create cash flow problems if project efficiency improves. However, due to the devaluation of the peso, substantial excess peso funds are likely to be available. Key recommendations are to: (1) centralize project management in the Office of the Minister of Health, reinforce it with full-time consultancy support, and upgrade staff support in the Secretariat at the MOH and the Philippine Council for Health R&D; (2) streamline systems and procedures for SS"s and FS"s; (3) review the availability of peso funding, as well as USAID/P and Government of the Philippines (GOP) fund release procedures; and (4) replan activities in order to provide more focused directions and guidelines - especially in regard to FS"s - taking into account the prevailing socioeconomic situation, changing health priorities, and GOP financial constraints. Lessons learned are: (1) well-defined systems and procedures are needed for projects that are, like this one, innovative and pioneering in nature; and (2) spreading responsibility for key activities to committees and ad hoc bodies seems to detract from efficiency.