Summary evaluation report : eight PVO projects in health and nutrition

The evaluations were conducted in 1983-84 by external teams in close collaboration with PVO staff members. Despite formidable socioeconomic constraints and the difficulties noted below, all 8 projects have succeeded in providing modern, low-cost health services such as oral rehydration, immunization, and blindness prevention in some of the world's poorest, most neglected, and most remote areas. While the impact of these services on morbidity and mortality is less evident due to insufficient baseline or monitoring data, 2 of the projects have dramatically reduced child malnutrition and at least 4 have shown intermediate indicators of impact on maternal and child health. More generally, PVO's often try new approaches which require an independence and creativity not found in public sector projects, and are able to test and demonstrate imaginative, cost-effective primary health care strategies due to the hard work of their dedicated staff and their ability in some projects to work closely with beneficiaries in small, focused interventions. PVO management needs improvement, however. Plans for the MG's are often vague, drawn up hastily, and lacking in understanding of local conditions and in local input; also, MG's should be more rigorously reviewed by A.I.D. Pressure on PVO's to show early results (with MG's up for renewal every 3 years) leads to an emphasis on immediate improvements in health delivery rather than on the collaborative institutional development which could lead to long-term sustainability and replicability. Improvements in monitoring and information collection/dissemination are also needed. PVO health information systems are usually rudimentary. In addition, most of the projects have been ineffective in documenting and replicating their innovative experiences. Lessons learned at the local level often remain there because PVO's, USAID's, and host country entities are not sharing project information. For its part, A.I.D. needs to: clarify, simplify, and facilitate the responsibilities of AID/W and USAID's in approving, monitoring, and evaluating PVO programs; give PVO's adequate time to plan and to achieve realistic objectives; and in particular, pay attention to specific PVO activities, often neglected, which could improve program institutionalization, sustainability, and replicability. The general recommendation is that PVO's expand their health and nutrition outreach activities and that A.I.D. expand, selectively and with certain conditions, its MG support. (Author abstract, modified)