TECHNICAL HEALTH INSTITUTE

Evaluation covers the period 10/79-10/80 and is based on a document review. The project"s problems began at the design stage. Due to the newness of U.S.-Syrian relations and USAID/S inexperience, the project paper was apparently prepared in AID/W without discussing with MOH the need for educational and administrative reforms at THI and the project"s overall goal of improving services to the rural poor -- and also without heeding warnings made in the American University of Lebanon (AUB) feasibility study. These warnings concerned the unpreparedness of anesthesia trainees and the doubtful competence of potential U.S. trainees. Both questions remain; MOH did not accept a USAID strategy for anesthesia training, and the competence of the 18 current trainees (of 26 targeted) remains undetermined. A major problem has been the difficulty of the U.S. contractor, Medical Service Consultants (MSC), in fielding an Arabic-speaking team (MOH animosity towards AUB due to the feasibility study ruled out the use of AUB). Advisors in science, environmental health, and physiotherapy are still lacking. Moreover, while MOH has accepted some of MSC"s revisions, including a new core curriculum, it has rejected proposals for administrative changes, especially regarding THI"s need for a full-time faculty and a semi-autonomous role within MOH. Other problems have included continuing changes in THI"s directorship and the failure to complete renovation of the laboratories. MOH lacks public health programs, and even an understanding of the people"s health needs, as well as quality personnel to develop such programs. Unless MOH"s view of health care changes (which is not likely to happen soon), project staff can only seek to achieve the maximum possible under reduced goals, with continual monitoring of the problem areas noted above. The project should be re-evaluated before summer, 1981. The Government of Yemen and A.I.D. will decide during the next year whether to extend the advisory team"s services.