Save the Children, Bolivia field office : child survival 3 -- final evaluation report

The project covered 11,000 Aymara-speaking persons dispersed over 58 communities located in the high plains (3600 to 4000 meters above sea-level) in the Department of LaPaz, Inquisivi Province, areas of Quime, Ichoca, and Luruta/Siguas. Primary health care services as well as other basic services did not exist in the majority of these communities prior to the project. The majority of the project objectives were met despite difficult circumstances. The project was strongest in reaching its Expanded Program of Immunization (EPI) objectives, administering DPT, oral polio, and measles vaccines to 52% of 12-23 month-olds, and administering two tetanus toxoid (TT) doses to 46% of eligible women. Thirty-one percent of mothers used oral rehydration therapy, and over 80% of mothers properly nourished their children during a diarrhea episode. At least 50% of children were involved in a growth monitoring program, 39% of mothers breastfed within the first 8 hours, 43% of children were exclusively breastfed for the first 4-6 months, and 70% of mothers breastfed for two years. The project did not fully meet targets for Vitamin A capsule administration, knowledge of safe birthing practices, or acute respiratory infection management. The project used a two-tiered strategy to achieve sustainability -- strengthening of Ministry of Health (MOH) services and the training of mothers in child protective behaviors. SCF has established a good foundation, especially in EPI, for continuing to coordinate and work with the MOH. The team suggests that SCF use a more systematic planning process with the MOH which would include an action plan consisting of objectives, activities, and indicators to further strengthen this link. SCF trained village health workers (VHWs) to train mothers in protective health behaviors. The selection process to recruit VHWs through the agrarian union meetings favored men. Women were not included sufficiently in the decision making process and support for the primarily male VHWs was found to be low. SCF has begun to address this issue by planning to work more closely with women's groups in the community. A Health Information System was used effectively by SCF to plan and supervise activities. This information needs to be shared with the community so they can analyze their preventive health priorities. It is recommended that SCF establish objectives and indicators around community level sustainability. (Author abstract)