Rural health delivery project

PES covers the period 6/79-4/83 and is based on a special evaluation (PD-AAN-024). Project targets are generally being met. PHC training is underway in two of the four project regions (and in nonproject regions as well) and 198 PHC workers (including 13 tutors, 81 trainers, 18 community health workers, and 30 traditional birth attendants) have been trained. However, curricula developed by the contractor are technically unsound, being more of a topical outline, and the contractor was unaware of curricula developed by the MOH for each cadre to be trained and did not conduct the planned needs assessment. Although various training manuals have been developed, they require further detail and adaptation to in-country conditions. In addition, training has taken place in temporary facilities and most trainees have not been suitably placed; reasons have included delays caused by USAID/S and the MOH in building training facilities and PHC units and a lack of commodities (such as pharmaceuticals) due to lack of a USAID/S commodity procurement plan, one aspect of USAID/S mismanagement of the project. Other major problems have been the contractor"s failure to field a team from the project"s inception; the underqualification of many of those fielded; and lack of communication among USAID/S, the contractor, and the MOH. Nonetheless, the future looks brighter: two training centers are now almost completed; construction of PHC Units is imminent; responsibility for procurement has been transferred to the contractor; progress in long-term, U.S. academic training is excellent; and with the MOH"s incorporation of PHC as a major part of future planning and use of the project by other donors as a model, replication is occurring more quickly. Project experience shows that for a project requiring application of methods and techniques to several distinct programs, a detailed implementation plan should be developed before any deployment of resources. For a summary of recommendations, see the abstract of PD-AAM-024.