Uganda prosthetics project evaluation

Evaluation covers the period 1989-2/92. Each component is moving at a different pace. Orthopedic surgery -- implemented by Health Volunteers Overseas (HVO) -- has progressed the furthest and has the fewest problems; this element is almost ready for transition to local operation. The prosthetic/orthotic component -- implemented by the British Red Cross (BRC) -- is struggling in some areas, but has increased production of artificial feet and knees from 6 to 20 per month, although the target of 100 is not possible. The A.I.D.-financed revolving fund has allowed access to prostheses to those previously unable to afford them. BRC also produces and fits orthotic braces, orthopedic shoes, crutches, and a much sought after three-wheel wheelchair of local design and materials. It also operates a patient hostel outside Kampala. The third component, comprising physical therapy and up-country prosthetic workshops -- implemented by the International Service Volunteer Association (AVSI) -- has not really gotten off the ground yet due to lack of trained staff. Unfortunately, staff training is also behind schedule, and AVSI, for reasons that are not clear, has been reluctant to use physical therapy volunteers who have been offered through HVO. The relative success of the orthopedic surgery component appears related to two factors: a dedicated, energetic leader, and the fact that it is newly designed and has a new implementor, whereas the other components are an attempt to change service-provider, emergency-mentality organizations into institution building trainers, a role they have accepted slowly and with difficulty. The Ugandan government is pleased with the program and wishes it to continue, with expanded external support. USAID/U is also pleased: the project has been highly visible and photogenic (visited by Senators Leahy and Mikulski and U.S. Health and Human services Secretary Sullivan). Moreover, it is a popular activity in the health sector, where the Mission has larger investments in the more controversial areas of family planning and AIDS, and the management burden is slight. Although physically close, the three components do not intertwine, despite the efforts of a Committee chaired by the HVO director. USAID/U has taken a relaxed position in regard to management, and views the HVO director as de facto project manager (a view in which the director, justifiably, does not concur). A similar project in Mozambique, though generally progressing faster than this one, has similar problems with lack of Mission involvement.