RURAL HEALTH SERVICES II

This terminal evaluation covers the period 12/1/78 to 3/31/80. No methodology is specified. Over 50% of the Huehuetenango rural hospital renovation has been completed and the remaining work will be financed by the GOG. Also, construction of the Jutiapa Nursing School is almost finished, and phase III of the renovation and expansion of the Quiriqua Training School has been completed. The open contract procurement for equipping hospitals, health posts, and training schools was finalized and 50% of the bid equipment has been procured. The GOG has also assumed financial responsibilities for funding eight advisors who will work in the health planning unit in the CNPE. The installation designs for four boilers were finished and the GOG has budgeted funding for their installation. The Nutrition Institute for Central America and Panama study on nutritional status of the rural population was completed. Project beneficiaries are the low-income families who will use the eight regional hospitals renovated under this project and those who will have access to the regional health practioners (TSR) and health post network. The escalation of operating costs at the Quirigua Training Center required an increase in GOG counterpart funding. Also, cost overruns in construction have required additional GOG funding. During this project, several key Guatemalan administrative personnel were transferred to other posts and this delayed project activities and required more monitoring and assistance from Mission personnel. Finally, TSR"s and the construction and equipping of rural hospitals were not integrated with related activities in Guatemala which would have maximized their impact. Four lessons emerged from this project: equipment purchases should include installation costs; a separate implementation entity for the project is less effective; policy changes rather than the "bricks and mortar" approach have greater impact on improving rural health systems; and coordination with other donors is essential.