Tiwanacu health project (PVO)

PES covers the period 5/83-5/85 and summarizes an attached special mid-term evaluation (XD-AAS-579-A). The project"s limited promotion/preventive activities and the low utilization of its medical services (1-2 visits per health post, per day) suggest that it has not had a significant health impact. This failure is ascribed to: (1) competition from about 10 other health projects in the area offering free goods and services as opposed to the project"s modest charges; (2) difficulties in transforming the project from a curative to a preventive medical orientation, partly due to the reluctance of auxiliary nurses to do promotional and preventive work in the communities; (3) too little coordination between RSG"s broadcasting/health promotion activities and the health work being performed at the project sites; and (4) design failures - goals which were ill-defined and not clearly related to prevalent health problems, and lack of an overall project strategy. The planned self-financing drug fund and self-financing social security system will not be achieved, largely due to the people"s preference for other health services which are either free or cost less; neither objective was realistic. RSG"s project management appears to be improving, especially with regard to recent changes in reporting and in coordinating with other health projects. USAID/B, for its part, should have been more demanding, before project approval, concerning objectives, evaluation methods, and action plans, and should have ensured that the mid-term evaluation was conducted on time. Confusion and delays were caused by the requirement to purchase U.S. drugs, though this problem may not have been within the control of USAID/B. It is recommended that RSG make substantial improvements in the above problem areas before being considered for additional funding beyond project end in 5/86. Although the Ministry of Health is to assume the salary cost of auxiliaries at that date, continued external financing will be needed to cover other costs. Specific recommendations are included.