STRENGTHENING HEALTH SERVICES II

THIS PES SUMMARIZES THE FINDINGS AND RECOMMENDATIONS OF TWO PREVIOUS EVALUATIONS. IT WAS ANTICIPATED THAT THE DSPP (MINISTRY OF PUBLIC HEALTH AND POPULATION) WOULD DEVELOP AN EFFECTIVE HEALTH PLANNING UNIT AND INTRODUCE ADMINISTRATIVE REFORMS DURING THIS PROJECT PERIOD. HOWEVER, THESE WERE UNREALISTIC TARGETS GIVEN THE TWO-YEAR IMPLEMENTATION TIME FRAME. FURTHERMORE, THE LONG-TERM PROJECT ADVISOR LACKED EXPERIENCE IN INTERNATIONAL HEALTH PLANNING AND MANAGEMENT, AND FAILED TO DEVELOP SUFFICIENT RAPPORT WITH DSPP OFFICIALS. THE BHP/E (BUREAU OF HEALTH PLANNING AND EVALUATION) CONTINUES TO BE VERY WEAK IN THE AREAS OF DATA COLLECTION, MANAGEMENT, AND ECONOMIC ANALYSIS. THE WHS (WESTINGHOUSE HEALTH SYSTEMS) TECHNICAL ASSISTANCE EFFORT DUPLICATED, IN LARGE PART, ASSISTANCE PROVIDED BY PAHO. THE WHS TEAM SPENT A MAJOR PORTION OF THEIR TIME PRODUCING MANUALS AND REPORTS -- WHICH HAD LITTLE IMPACT DUE TO POOR COMMUNICATION WITH THE DSPP COUNTERPARTS. TWELVE RECOMMENDATIONS FOR A FOLLOW-ON PROJECT (091) ARE LISTED IN THIS SECTION OF THE EVALUATION. THE SNEM (ANTI-MALARIA COMPONENT OF THE PROJECT) HAS NOT REDUCED THE INCIDENCE OF MALARIA. THIS FAILURE IS ATTRIBUTABLE TO INSUFFICIENT ASSESSMENT AND ANALYSIS OF EPIDEMIOLOGICAL DATA AND THE IMPACT OF VARIOUS INTERVENTIONS. IN ADDITION, THE PROGRAM GOAL WAS NEVER CLEARLY DEFINED. ALTHOUGH THE GOAL WAS INITIALLY IDENTIFIED AS A LONG-RANGE CONTROL EFFORT (REDUCING THE MALARIA INCIDENCE BELOW 500 CASES PER MILLION), THE PROPOSED 1979 PLAN OF ACTION STATES THAT THE GOAL IS SHORT-TERM ERADICATION. SNEM HAS SPENT OR OBLIGATED OVER $522,000 FOR 145 TONS OF FENITROTHION--AN EXPENSIVE, HIGHLY TOXIC INSECTICIDE OF UNPROVED EFFECTIVENESS. DUE TO THE LACK OF RELIABLE INFORMATION ON THIS AND OTHER INSECTICIDES, NO DECISION CAN BE MADE AT THIS TIME ON THE TECHNICAL FEASIBILITY OF AN ERADICATION PROGRAM.