April. 1982 Prepared Under Contract No. Afr/Aid
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MAURITANIA RURAL MEDICAL ASSISTANCE PROJECT QUARTERLY REPORT JANUARY - APRIL. 1982 PREPARED UNDER CONTRACT NO. AFR/AID-0202-C-00-1DI4-oo PROJECT NO. 682-0202 OlMPEX ASSOCIATES INC. TABLE OF CONTENTS I.. INTRODUCT ION I I. PROJECT'S BASIC DATA I I I. CURRENT ACTIVITY AND RESULTS ACHIEVED TO DATE IV. PROJECT1S MID-TERM EVALUATION ACTIVITY V. ATTACHMENT "A": ACTI VIT I ES PLANNED FOR SECOND QUARTER OF 1982 ATTACHMENT "B": SUMMARY OF ACT IVIT IES D1MPEX ASSOCIAYES INC. I.INTRODUCTI ON The Rural Medical Assistance project for the Trarza Region, under the overall direction of the Mauritania Ministry of Health, in cooperation, with the USAID Mission Health Special ist, and DIMPEX ASSOCIATES consultant in the capacity of Publ ic Health Adviser, and field operations coordinator, is currently in operation. This quarterly report represents an update of project activities covering the period January 1 through April 30, 1982. I I. PROJECT'S BASIC DATA & OBJECTIVES The project's operational activity started in January 1981, and is scheduled to be completed by December 1983. Funding for this project, however, has been earmarked until March 1984. The goal of the GIRM is to create a community supported health care system to be del ivered by trained community health care workers. At project's completion it is expected that primary health care services and a medical suppl ies dispensary will be available to 192 villages and rural encampments in the Trarza Region. II I. CURRENT ACTIVITY & RESULTS ACHIEVED TO DATE In the month of January 1982 the data collection ~ystem and statistical elaboration system to be used for the project's mid-term evaluation, sched uled for the month of April 1982 have been developed and organized. Activity was also directed toward the organization of the third training session of Village Health Workers, scheduled to take place in March 1982. During this session, thirty-six new CHWs (Community Health Workers) will be trained. This activity included: - Tentative selection of new villages for which community health workers will be trained. - Preparation of the re-training course for the health workers grad uated during the first training session completed in March 1981. - Revision and standardization of tests administered to candidates for the CHW Training courses prior to admission to the courses, and revision of tests required to graduate from the training course. - Development of the checkl ists, forms and questionaires to be used by the nurses supervisors responsible for ihe control and evaluation of the field and performance of the CHWs graduated during the December 1981 training session. DIMPEX ASSOCIATES INC. 2 -A village inhabitants census-taking operation was carried out by the nurses supervisors in the course of their CHWs field performance evaluation activity. In order to save time and contain costs, the nurses supervisory teams also organized Community Health Committees in new villages located in the same geographical areas where the eval uation was taking place. This will el iminate the cost of performing this operation at a different time. - In the course of the period covering February and March 1982, 48 villages were animated, and 36 Community Health Workers were recruited. During the March 1982 training session, 32 CHWs were graduated, and 36 Community Health Committees were formed. Steps were also taken to reinforce the animation process in those villages that did not respond to the first animation operation. TRAINING ACTIVITY A new training center was opened at Keur Macene and the first training pro gram was given in the Wolof language. The results of this center have proven disappointing since only four of an anticipated larger number of Wolof villages were found to exist in real ity, and only 2 villages out of 4 were will ing to participate. The number of community health workers to be trained was increased by 2 Wolof-speaking Maures from the region. After several supervisory visits to this center it was concluded that it was inadvisable from both the technical and financial point of view to oper ate this center, and it was closed during the last week of training. The Community Health Workers from this center were moved to the training site of Rosso. The third training session of Community Health Workers began on the 21st of February 1982. Thirty-two CHWs were graduated during this session. At the close of this session a total of 98 CHWs were trained, out of a total of 192 projected. LOCAL ACCOUNT AND LOCAL PERSONNEL During the month of March the project fired one chauffeur and hired two others. At the same time a bil ingual secretary was engaged. The problem of hiring of local personnel by Dimpex Associates contractors has still not been resolved. The final responsibil ity for the local personnel is still under review both by USAID in Mauritania and AID/Washington. Dimpex Assoc. has submitted a proposition and budget which is currently under review. DIMPEX ASSOCIATES INC. 3 Dur~ng the period January through April 1982 the money spent in the local account totaled U.S. $49.847. The bulk of the money went to the payments of trainee scholarships and "per diems" to the field personnel. as well as vehicle maintenance: Local Vehicle Opp. Date Personnel Support Commodities Support Training Total Jan. 82 213.232 103.359 -0- 243.693 19.200 579.484 Feb. 82 188.361 41 .329 -0- 55.017 66. 100 350.807 Mar. 82 371. 520 61 .541 -0- 54.582 I 71 .00I 658.644 Apr. 82 283.639 58.686 -0- 147.145 164.691 654.161 1.056.752 264.915 -0- 500.437 420.992 2.243.096 45 UM = $1.00 U.S. MEDICAL/PHARMACEUTICAL SUPPLIES PROCUREMENT AND DISTRIBUTION The community health workers have begun buying medical suppl ies at the wholesale bulk rate. as well as obtain a special 10% discount requested for them by the Director of Health. This reduces substantially the costs of medical suppl ies for the villagers and should serve as an incentive towards continued buying. Approximately 80% of the project villages seem to have re-stocked the supply originally furnished them by the project. Some ~f the suppl ies were fur nished as a gift by the governor or by wealthy relatives 1iving outside the vi Ilage. The minority of the suppl ies were purchased at Pharmarin. the wholesale dis tributor. at Rosso or Nouakchott. IV. PROJECT'S MID-TERM EVALUATION ACTIVITY The project's mid-term evaluation was originally scheduled to coincide with the last week of the training programs in March 1982. The evaluation started the first week of April 1982. The evaluation teams consisted of the following members: - TEAM LEADER: Dr. Ramiro Delgado, Professor of Publ ic Health at the Touro Research Dept. and Dimpex Associates Consultant. DIMPEX ASSOCIATES INC. 4 - TEAM MEMBERS: GIRM Ministry of Publ ic Health: - Dr. Mohamed Mahmoud Ould Hacen, Director of the Ministry of Health, and Director of the Rural Medical Assistance Project of Trarza. - Dr. Moskar, Chief of Medicine of The Trarza Regional department. - Mr. Diouf Ibrahima, Nurse Supervisor and the Trarza health pro administrator. - Mr. Moctor Ould Memah, Nurse Supervisor and Education Adviser for the Trarza health project. - Ms. Mamadou Sy, Nurse Supervisor of The Traditional Midwife department of the Ministry of Health. - DIMPEX ASSOCIATES, INC. - Ms. Mona Grieser, U.S. Publ ic Health Adviser, and Trarza Health Project Chief of Party. - U.S. PEACE CORP VOLUNTEERS - Ms. Rebecca Brooks, Director. - U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT {USAID) - Linda Neuhauser, USAID Health Officer and Manager of the Trarza Hea Ith Project. - George Jones, USAID Health Regional Officer, Abidjan, Ivory Coast. - Alan Reed, USAID Program Director. - David Carr, USAID Economist. - GIRM MINISTRY OF RURAL DEVELOPMENT - Diall0 Amadou Yero, Administrative Dept. Supervisor. - GIRM MINISTRY OF ECONOMIC AFFAIRS - Ba Cumar Pusala, Economist. DIMPEX ASSOOATES INC. 5 - WORLD HEALTH ORGANIZATION (WHO) - Andre Kitoko, Sanitation Engineer. Dr. Ramiro Delgado arrived at post March 29 and Dr. George Jones the fol low ing day. The program of the evaluation was such that the evaluators spent the first few days planning the evaluation, preparing the tools and famil iarizing themselves with the project. Three field teams were organized each visiting three villages in the departments of Mederdra/R'kiz, Boutil imit and Rosso, after which a general assembly of the evaluators drew their conclusions for the final draft. Some recommendations made by the evaluators are already being put into action (revision of forms; standardizat·ion of procedures, amendents to the medical kits, etc...). Others await government discussion and approval of particular importance has been the problem of integrating the project in such a manner as to ensure continuation of project activities by the government. The GIRM (represented by Dr. Hacen, project director as well as Director of Health for Mauritania has categorically stated that it will be impossible for the govern ment to finance any future activities of this project. It simply does not have the means. This depressing but real istic summation of the situation forced the project's principals to look for alternative solutions. To examine this problem more data is needed than can be generated through the project itself and it was decided to request additional funds through PRICOR. These additional funds will be used to examine the condition of the villages, their socio-economic situation to determine whether or not their structure can support the financing necessary to maintain proje~t activities. A detailed proposal has been sent to PRICORlWashington outl ining a program of research. That would provide community financial data. At the moment of writing no word has been heard from Washington as to whether or not this project has been accepted.