Rural medical assistance

Joint USAID/M-MOH PES covers the period 8/79-3/82 and is based on interviews with USAID/M, MOH, and contractor personnel and with community health worker (CHW) trainees and their supervisors. Project objectives are being achieved. One CHW has been trained in each of 96 communities and training of CHW supervisors and of education staff is on schedule. However, the current system of training, installing, and supervising CHW"s is too costly, reducing the likelihood of project replication. A.I.D."s elimination of a technical advisory position for health education prevented the development of scientifically sound educational methods and materials and health data collection instruments, demonstrating the adverse consequences of eliminating technical advisory positions in order to increase funding for other budget line items. Other problems have been the failure at the design stage to provide for project logistics (drivers, office personnel) and to specify roles for PCV"s (resulting in discontinuance of PCV assistance to the project). Finally, the contractor"s recommendations were often not acted upon because her MOH counterpart lacked decisionmaking authority. To render widescale replication of the project feasible, it is recommended that costs be reduced by integrating CHW training and supervision within the existing administrative structure of the MOH and that the Ministry more rationally coordinate its functions at the regional level. It is also recommended that the long-term prospects for community support of CHW"s and for community acquisition of needed medical supplies be studied and that the scope of work for the technical assistance contract be expanded to account for administrative duties not foreseen in the design documents.