US economic aid to the health sector of the Dominican republic

AUDIT INCLUDED TESTS OF MISSION & HOST-COUNTRY REPORTS, FILES, AND ACCOUNTING RECORDS AS WELL AS LIMITED FIELD INSPECTIONS & INTERVIEWS. USAID PROVIDED A $4.8 MIL LOAN (512-U-02) ON 10/01/75,SUPPORTED BY GRANTS FOR PARTICIPANT TRNG & TECH ASSISTANCE IN PUBLIC HEALTH DELIVERY,NUTRITION,AND ADMINISTRATION. THE DOMINICAN GOVT AGREED TO CONTRIBUTE $6,920,000 IN COUNTERPART FUNDS. USAID ALSO PROVIDED A COMPLEMENTARY $8 MIL LOAN ON 11/23/78. THE ORIGINAL DISBURSEMENT DATE WAS EXTENDED TO 10/01/80 DUE TO THE DOMINICAN GOVT"S FAILURE TO PROVIDE COUNTERPART FUNDS. (DR IS NOW MAKING CONTRIBUTIONS.) AS OF 3/31/79,AID DISBURSED $1,982,035 OF LOAN 028 AND $580,000 IN GRANT FUNDS. DR HAS DISBURSED $3,520 IN COUNTERPART FUNDS. NEARLY 3200 OF 4500 PLNND HEALTH PROMOTERS HAVE BEEN TRND AND ARE SERVING THEIR COMMUNITIES. THE HEALTH DELIVERY SYSTEM IS FULLY OPERATIONAL IN THREE OF THE COUNTRY"S FIVE REGIONS. IMPLEMENTATION IS WELL UNDERWAY IN THE REMAINING TWO. A NUTRITION COORDINATION OFFICE WAS ESTABLISHED,AND THUS FAR,HAS CONDUCTED MASS MEDIA PROGS,SEMINARS,AND ESTABLISHED FIVE NUTRITION RECUPERATION CENTERS. RESEARCH EXPENDITURES WERE INSIGNIFICANT BECAUSE OF THE LACK OF COUNTERPART CONTRIBUTIONS. THE FOOD SUPPLEMENT PROG WAS DROPPED. THE ADMIN REFORM COMPONENT PROGRESSED SLOWLY DUE TO ADMINISTRATIVE CHANGES AFTER THE 5/78 PRESIDENTIAL ELECTION & THE USUAL RESISTANCE TO ORGANIZAT"L AND MGMT CHANGES. ON 6/3/77,DR SIGNED A CONTRACT ($1,472,848) WITH ARTHUR YOUNG & CO FOR ACROSS-THE-BOARD SYSTEMS ANALYSIS & DESIGN. THE CONTRACTOR"S FINAL REPORT IS BEING DRAFTED & WILL INCLUDE HEALTH/NUTRITION RECOMMENDATIONS. THE CONTRACTOR ALSO RESPONDED TO SPECIAL REQUESTS FROM THE SECRETARY OF PUBLIC HLTH & SOCIAL ASSISTANCE -- INCLUDING A MGMT & ORGANIZATION REVIEW IN ESTABLISHING A NATL LABORATORY & REORGANIZING A PSYCHIATRIC HOSPITAL. WHILE THE CONTRACTOR HAS BEEN PRODUCTIVE,THE SECRETARIAT HAS BEEN SLOW TO IMPLEMENT RECOMMENDATIONS. UPON RECEIPT OF THE CONTRACTOR"S FINAL REPORT,THE MISSION & DR SHOULD EVALUATE IMPLEMENTATION OF ITS RECOMMENDATIONS.