Third annual evaluation of combatting childhood communicable diseases (CCCD) project (698-0421) in Atlanta, GA

Special evaluation covers the period 9/81-3/85 and is based on document review and interviews with Centers for Disease Control (CDC) and field staff. The project approach continues to be sound. Bilateral subprojects (SP"s) are underway in 9 (soon to be 11) countries; most are on schedule, delays, where they exist, being due to procurement problems and sometimes to difficulties in coordinating with A.I.D. regional and Mission personnel. Generally, immunization efforts are furthest along, with diarrhea control progressing somewhat more slowly; malaria control has been concentrated in 2 countries. Fee-for-service financing of oral rehydration therapy and chloroquine treatment has been surprising successful, and good integration has been achieved with national primary health care systems. The most serious problems have been the complexities of dealing with malaria control and of finding a reliable, accurate, and cost-effective means of assessing SP impacts - prototype Mortality and Utilization of Health Services surveys, field-tested in 3 countries, have proven quite expensive. Although overall costs for many SP"s are a little under budget, at least one country is unlikely to be able to assume recurrent cost financing as planned. Regionally, good progress has been made in approving small research grants for Eastern and Southern Africa (although reorientation toward broader studies is advisable), and in health education and promotion (marked improvement since the 10/83 evaluation); the Peace Corps has demonstrated its ability to recruit and train professionals and volunteers in health education work. Mid-level training is almost on schedule, but senior management training is behind; considerable time has gone into helping SP countries develop health information systems. A key recommendation is to extend the SP timeframe from 4 to 5 years. Numerous other recommendations address the above functional areas as well as overall project management and the feasibility of adding new health interventions, e.g., in yaws, child spacing, and acute respiratory infections.