Save the Children/Cameroon : child survival 9 -- final evaluation

The project focused on using training to build local capacity to promote access and use of services for four CS interventions: immunization, diarrhea disease control, nutrition, and vitamin A. Using training curricula and materials developed in collaboration with Ministry of Health (MOH), the project trained health workers from the Ministries of Agriculture/Community Development (MoAg/DC) and Social and Family Affairs (MINESCOF) and from Community Health Committees (COSA), who then conducted awareness raising activities among mothers and women of child bearing age. In addition, the project provided health centers with scales, cold boxes, vaccination/growth cards, information, education, and communications (IEC) materials, nutrition demonstration equipment and, unexpectedly, vaccines. The project also repaired some health center refrigerators. Despite being delayed 9 months, due to an overlap with a complementary Mission-funded operational program grant, the project achieved many of its objectives. Of note is the vaccination coverage among children 0-11 months, which increased from 21.6% to 60%, and the increase from 18.8% to 53% of women of child bearing age receiving tetanus toxoid immunizations. While progress was made toward the other objectives, full attainment was hampered by many factors, including personnel overload, poor management during most of the first 2 years, and a lack of expected inputs. A significant and noteworthy achievement was the project's ability to work collaboratively not only with the MOH but also with the MoAg/DC and the MINESCOF, both of which have mother and child health mandates. The project not only worked effectively with these three ministries, but also promoted collaboration between them to the point where a Department-level Coordinating Committee (CC) was established to coordinate and oversee their joint child survival activities. Interviews with committee members revealed a commitment to continue the work of the CC even after donor funding ends. Pursuant to this, provincial government officials have committed funds, materials, and human resources to maintain the achievements of the project. The following lessons were learned. (1) A child survival project is much more likely to be sustainable if, as in this project, it focuses on strengthening existing delivery systems rather than on creating parallel systems. (2) A structure for coordinating partner's efforts and resources is needed to ensure effective implementation. (3) Collaboration enables each partner to take advantage of the strengths of the other, but also exposes it to the other's weaknesses. In this case, the MOH depended on UNICEF for vaccines for the project. When the supply was interrupted, this project objective was put in jeopardy, from which, fortunately, it was bailed out by SC using private funds. (4) Training is very effective in promoting sustainability, especially training mothers and trainers of mothers in ways to change their child care behaviors. Nonetheless, changing feeding practices, especially within traditional ethnic groups, poses a formidable and time-consuming challenge. (5) A CS project should address the health problems in the area in which it is working. USAID should control more stringently for this in reviewing proposals. In the present case, there seems to have been no need for a Vitamin A intervention. (6) Personnel and financial management skills are just as important in a project manager as technical knowledge about CS issues. (7) Knowledge, Practice, and Coverage (KPC) survey results should be used not only for monitoring and evaluation purposes, but also to confirm or amend project objectives and indicators. (8) A policy that promotes the achievement of one CS intervention may work against the achievement of another that is equally as important; in this project, USAID's policy to use disposable needles to prevent the spread of AIDS worked against the project's vaccination efforts as the need to purchase syringes and needles drove the cost of being fully vaccinated beyond the means of most Cameroonians.