USAID/Somalia"s rural health delivery project needed management attention

Audit report covers the period 6/79-9/83 and is based on document review, discussions with project officials, and visits to two health care training centers. Serious problems have hindered project implementation, which is over two years behind schedule. Construction of two health care training centers and housing for technical advisors was completed 5 months late, and the facilities are plagued by leaking roofs, poor ventilation, inadequate water pressure, and other serious problems. A contractor was selected to build 16 primary health care units, but no plans have been made for other targeted facilities - 16 district health centers, 256 health posts, and another 48 primary health care units - all of which were to have been completed by 12/82. Training centers are inadequately stocked with drugs and other supplies and equipment; training materials and audiovisual equipment are also lacking. Numerous problems have delayed the procurement of essential office supplies and spare parts for vehicles, and a variety of other commodities have been lost or damaged. A planned special method of health care delivery for nomads was not developed, but has since been shown to be unnecessary. Problems resulted primarily from USAID/S" poor project management and its failure to assign overall responsibility for implementation to a single individual. Communication among USAID/S, the GSDR, and the technical assistance contractor, MSCI, was poor; USAID/S failed to ensure GSDR compliance with conditions precedent, to require the contractor to submit a detailed implementation plan, or to establish a commodity management system. The GSDR has not provided vehicle maintenance as agreed (due mainly to mechanics" unwillingness to work for the low wages offered by the GSDR); as a result, 10 of 30 vehicles are out of service. In addition, project training facilties and vehicles were not properly identified with the A.I.D. emblem. Finally, USAID/S has still not determined if the GSDR is capable of meeting recurring costs after project completion. Six recommendations are made.