Swaziland primary health care project : a mid-term evaluation

External mid-term evaluation covers 4/86-9/88. The project's design was broad, leading to a diffuse workload which is still being revised. There is some uncertainty about the project's major objectives and its priorities at the regional and central level, and there are unmet expectations for support and commodities in several areas outside of the MCH/FP target population. Contractor performance by Management Sciences for Health has been satisfactory, given start-up delays and a shortage of Ministry of Health (MOH) counterparts. Recent visits by a Senior Technical Officer have helped prioritize activities and delineate advisor roles. The project should collaborate with the MOH to identify areas where decreased support is appropriate. The project, in collaboration with the MOH and other donors, has developed effective methods to screen high-risk infants and mothers, implemented a clinic health information system, improved supply management for drugs and contraceptives, and increased supervisory competence. Several workplans (maternal health, immunization, diarrheal diseases, acute respiratory infection, and malaria) have been developed. Areas for attention now include strengthening of the referral system and evaluation of training and training materials. Clinic management is helping to strengthen the clinic linkage to regional planners by generating data and monitoring supply needs. An orientation manual has helped staff nurses make the transition from hospital to rural clinic, and a clinic reference manual is widely used. The MOH is decentralizing administrative and some planning and resource allocation functions to the four Regional Health Management Teams (RHMT's). The project has produced guidelines for personnel management, financial management, and drug inventory control, and helped two of the four regions prepare annual budget requests. Establishment of a management information system for RHMT's is a high priority. Training has been conducted at all levels. Workshops have been used widely and successfully and have raised nursing morale and confidence, but little evaluation of post-training change has been done, a priority for the next year. The evaluation recommends clinic-based learning with planning and training by regional public health nurses and supervisors. Also, health education has received insufficient attention at the clinic or community level. In conclusion, the project is progressing in its Phase 1 MCH/FP services and clinic management components. Encouraging developments have taken place at the regional and central levels. If further institutionalization is achieved, the project will make an important contribution in enabling Swaziland to reach its health goals. (Author abstract, modified)