RURAL HEALTH DELIVERY SYSTEMS : PROJECT EVALUATION SUMMARY

LOAN SUPPORTS IMPROVEMENT AND INSTITUTIONALIZATION OF AN INTEGRATED LOW-COST RURAL PUBLIC HEALTH DELIVERY SYSTEM FOR PANAMANIAN RURAL POOR WITH ADMINISTRATION, TRAINING, NUTRITION, ENVIRONMENTAL HEALTH, AND HEALTH FACILITY CONSTRUCTION COMPONENTS. PES IS BASED ON 9/78 EVALUATION BY US PUBLIC HEALTH SERVICE CONSULTANT. PROJECT HAS PROGRESSED SLOWLY. THE CONSTRUCTION, NUTRITION, AND ADMINISTRATIVE COMPONENTS ARE JUDGED TO BE BEHIND SCHEDULE WITH ENVIRONMENTAL HEALTH AND TRAINING COMPONENTS ALMOST ON SCHEDULE. 125 AQUEDUCTS ARE COMPLETED, ACCEPTED, AND REIMBURSED; 249 WELLS HAVE BEEN REIMBURSED WITH OTHERS COMPLETED AND WAITING USAID INSPECTION; REIMBURSEMENT FOR 3457 COMPLETED LATRINES IS AN ISSUE TO BE EXPLORED IN MISSION-REQUESTED AUDIT. TRAINING COURSES HAVE BEEN HELD AT A NUMBER OF LOCATIONS; PARTICIPANT TRAINING IS UNDERWAY IN US AND COLOMBIA. USAID AND THE MINISTRY OF HEALTH (MOH) ARE CURRENTLY DISCUSSING REIMBURSEMENT PROBLEMS INCURRED IN HEALTH ASSISTANT TRAINING COURSES. CONSTRUCTION OF HEALTH FACILITIES IS UNDERWAY AFTER INITIAL DELAYS DUE TO MOH INFRASTRUCTURAL DEFICIENCIES. NEWLY-DESIGNED MANAGEMENT SYSTEM HAS ACCELERATED CONSTRUCTION. VACANCY IN POSITION OF NUTRITION DEPARTMENT DIRECTOR AND ABSENCE OF IMPLEMENTATION PLAN HAVE IMPEDED DEVELOPMENT OF NUTRITION COMPONENT. MOH EXPECTS TO SUBMIT PLAN FOR PROJECT"S ADMINISTRATIVE COMPONENT. THUS FAR LITTLE HAS BEEN ACHIEVED TOWARD THE INTEGRATION OF MOH HEALTH SYSTEMS WITH SOCIAL SECURITY SYSTEM. MISSION RECOMMENDS THAT THE MOH USE TYPE OF ORGANIZATION AND TECHNICAL ASSISTANCE THAT IS NEEDED TO ACCELERATE PACE OF WORK IN NUTRITION COMPONENT. THE MOH SHOULD ALSO BEGIN IDENTIFYING ADMINISTRATIVE PROBLEMS IN HEALTH SECTOR AND PREPARE AN IMPLEMENTATION PLAN FOR TECHNICAL ASSISTANCE. MISSION STATES THAT REALIZATION OF STILL VALID EOPS CONDITIONS DEPENDS ON ADOPTION OF THESE TWO RECOMMENATIONS.