Second interim evaluation : Niger rural health improvement project (683-0208)

Special joint evaluation covers the period 6/78-7/85 and is based on document review, field visits, and interviews with Ministry of Health (MOH) and other officials, village health workers (VHW"s), and villagers. The project has increased rural coverage to 45% and will achieve or exceed most training outputs - 10,759 VHW"s and traditional birth attendants have been trained (143% of target), 80% of them with project funds, and 17,032 have been retrained, some of them several times (126% of target). Scholarships have been provided to 519 nursing students, 125 sanitation students, and 30 laboratory technicians; 18 national and 37 departmental seminars were held, with over 1,100 attendees; third-country training has been provided to 70 persons, of whom 34 have returned. Although management problems continue to be a major constraint, attention is now being paid to major shortcomings (e.g., in village supervision, community participation, and supply management). Support to immunization services has been minimal, as the MOH has only recently defined an Expanded Program of Immunization. Health facility renovations and sanitation improvements (e.g., latrines, water filters) have not met targets, but 7 dispensaries and a warehouse have been completed as planned and 2 other new facilities await only water and electrical hook-ups. The majority of the MOH garages and vehicles are in good working order; project-provided by the mopeds did not prove suitable in rural areas. TA from Africare and Tulane University has generally been excellent. The project"s overly optimistic design underestimated start-up time and funding delays. Inadequate information flow between USAID/N and the MOH has been a problem, but computerized data bases are being installed in both units. Operations research is only now getting underway. Lessons are to make the GON a full partner in the design process, ensure continuity among short-term consultants, prioritize operations research, increase implementation flexibility, consider coordination with other GON development activities and ensure coordination with other donors, and keep in mind that the dichotomy between rural and urban health care is not absolute.