Rural health support project

PES covers the period 9/80-1/85 and is based on a mid-term special evaluation (PD-BAW-097). Targets have not been achieved in training programs, regional capacity for health planning, MCH/FP, or health support for nomads. Delays - especially contracting delays of 20 months in the South and 28 in the North - have hampered the project since authorization. The original design was inadequate in its lack of a strategy linking the project"s diverse activities, insufficient emphasis on health service delivery, and neglect of the many environmental constraints to implementation, especially those regarding transport costs and availability. A modified design developed in 1983 reduced the project"s recurrent cost liability, but encompassed more than 100 activities which were not prioritized, sequenced, or made to complement each other through development guidelines and strategies. External constraints have included serious economic and budgetary crises; "brain drain" reducing the ranks of trained health workers; security problems in the South (forcing cessation of operations in the Upper Nile and Bahr El Ghazal areas); confusing regionalization and decentralization policies, affecting personnel resources in the South and creating unclear lines of authority and jumbled administrative procedures; and a severe drought, displacing many villages and weakening health status. Lessons learned include the need for: (1) in design - sufficient field work to ensure realistic intervention strategies, adequate attention to potential constraints on implementation, and an overall development strategy linking planned activities; and (2) inclusion of a Mission staffer on evaluation teams to help ensure that recommendations are implementable and that findings are incorporated into project and sectoral activities. Despite its problems with recurrent costs, Sudan wishes to maintain health as a national priority. Recommendations and action decisions are, inter alia, to place more stress on counterparts" roles and skills transfer, limit activities in the South to Equatoria region, and procure additional inputs, especially TA.