SUR MEDIO MATERNAL CHILD HEALTH AND POPULATION

Evaluation covers the period 7/79-3/81 and is based in part on site visits. The project is only partially successful and has had little effect on speeding the shift from a hospital- to a health center-based delivery system. Project implementation has been delayed mainly because of a lack of global planning and subprogram integration and inadequate administrative structure at the national, regional, and area levels. Supervision of health centers by hospital staff is too infrequent, no integrated supply system backs the community workers, and lack of transportation is a major problem. Training efforts have been frustrated by the absence of adequate support systems -- training has been largely restricted to professional persons, with only 12 of the planned 100 health promoters trained. An information/data collection system has been established, but the data are unreliable. The authors make recommendations to improve each of these management-related areas. Recommendations to improve MCH/FP delivery include: (1) increasing the emphasis on regular prenatal checkups and providing at least one post-partum visit to each mother; (2) providing on-the-job FP training to sanitarians and health promotors and developing strategies to increase the number of FP acceptors; (3) integrating child care with the maternal health and supplementary feeding programs; and (4) increasing the nutritional impact of the feeding programs by organizing recipients into Mothers Clubs (MC"s) and restricting expansion until MC"s have been formed at all existing distribution points. Future distribution points should be located directly in needy rural areas, rather than linked to nearby urban centers. Now that a national plan of primary health care (NPHC) has been developed, the project should be redesigned and its scope reduced in accordance with NPHC objectives. MOH responsibility for the project will increase and a management consultant will be provided to design and implement an effective management system.