Senegal : the Sine Saloum rural health care project

This evaluation of the Sine Saloum Rural Health Care Project to establish a network of village health huts to deliver basic health services provides a partial answer to this question. Despite difficulties from the start, several important achievements were realized. With the help of villagers, health huts were constructed and equipped in 200 target communities. Training materials and a records system were developed and a village health staff was trained in their use. Three conditions must be met, however, if the project is to succeed: the huts must earn enough to cover operating costs; government supervision and support must improve; and the medicine resupply system must function. Other problems areas include a high turnover of hut health workers; the close proximity of the huts to each other which forces some to close; and the high salaries paid to village health workers which drain the system's capital. Finally, the project's scale is too large and project management unsatisfactory. Although the huts have not operated long enough to make the project's impact clear, records show that visits to village health huts are often for the same treatment already obtained at larger, more distant health centers. However, the continuous closing of health huts because of poor project management may well negatively affect villagers' attitudes toward primary health care. Recommendations include: altering the health hut financial system to avoid collapse; closing health huts which overlap services; halting construction of additional health huts until the existing huts are improved; including a family planning component; obtaining firm assurances of budgetary support from the government; and strengthening A.I.D.'s project management team. Since this evaluation, several corrective measures have been made such as delaying project expansion; recruiting an experienced project manager; studying similar, more successful projects; and redesigning the project. A 24-item French and English bibliography (1968-80) and technical appendices are attached.