Somalia : rural health service delivery project

Special evaluation covers the period 6/79-4/83 and is based on document review, interviews, and site visits. Progress has been seriously hampered by the underqualification of many of the contract staff, including the Chief of Party (COP); lack of communications facilities and of regular communication among the Ministry of Health (MOH), USAID/S, and the contractor; and weak USAID/S management, especially its failure to prepare a commodity procurement plan. Responsibility for the latter was transferred in 11/82 from USAID/S to the contractor and orders have now been placed, although no extraordinary steps have been taken to remedy this long-standing situation. The recent establishment of technical review and project coordinating groups with the MOH may be a first step towards resolving communications problems. Although 199 PHC trainers and workers have been trained, PHC curricula developed by the contract team have not been standardized and often consist of a topical outline; the team did not conduct the planned needs assessment and was unaware of an MOH document outlining curricula and job descriptions for various classes of health workers. Four training manuals have been developed, but need to be edited and adapted to Somali conditions. In the construction component managed by USAID/S, work has not yet begun on the 64 targeted PHC Units (although all should be completed by the end of the project), but is proceeding at the national PHC training centers at Baidoa and Burao. The MOH's renovation of 16 district health centers is still being discussed. In other areas, the contractor has prepared two papers to help the MOH conceptualize the PHC system, but has not yet discussed with the MOH the important task of delivering health services to nomads and has been ineffective in helping the MOH develop management support systems. Also lacking are adequate field supervision and follow-up of trainees. Despite these problems, the foundation of a PHC system has been laid and a 2-year project extension, focusing on development of the two national training centers, hiring of a new COP, and revising training curricula, is recommended.