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End Review of FDC's Project to Strengthen the Expanded Programme on Immunization (EPI) in the Zambézia Province, Mozambique

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End Review of FDC's Project to Strengthen the Expanded Programme on Immunization (EPI) in the Zambézia Province, Mozambique R 2014: 3 End review of FDC’s project to strengthen the Expanded Programme on Immunization (EPI) in the Zambézia province, Mozambique Siri Lange, CMI Eugénio Salvador Chimbutane Gaspar Sitefane Chr. Michelsen Institute (CMI) is an independent, non-profit research institution and a major international centre in policy-oriented and applied development research. Focus is on development and human rights issues and on international conditions that affect such issues. The geographical focus is Sub-Saharan Africa, Southern and Central Asia, the Middle East and Latin America. CMI combines applied and theoretical research. CMI research intends to assist policy formulation, improve the basis for decision-making and promote public debate on international development issues. End review of FDC’s project to strengthen the Expanded Programme on Immunization (EPI) in the Zambézia province, Mozambique Siri Lange, CMI Eugénio Salvador Chimbutane Gaspar Sitefane R 2014: 3 February 2014 About the author Siri Lange is an anthropologist with more than 20 years of experience from research and commissioned work in East Africa. Research interests include health, gender, cultural processes and natural resource management - with a special focus on political processes and participation at the local level. Lange has spent all together five years in Tanzania and is fluent in colloquial Swahili. CMI Project number: 13063 Contents 1. Introduction ............................................................................................................................................ 1 2. Project Relevance and human resources .................................................................................................. 3 3. Key activities and results ......................................................................................................................... 6 4. Financial management systems, practices, and risks ............................................................................. 19 5. Exit strategy and sustainability .............................................................................................................. 25 6. Recommendations and lessons learned ................................................................................................. 27 7. References ............................................................................................................................................ 29 8. Appendices ............................................................................................................................................ 30 8.1 In Interview schedules ............................................................................................................................. 30 8.2 Budget Execution 2010-2013 .................................................................................................................. 35 8.3 Budget Execution breakdown ................................................................................................................. 35 8.4 Purchased items ...................................................................................................................................... 37 8.5 Analysis of randomly selected transactions ............................................................................................ 38 8.6 Terms of reference .................................................................................................................................. 43 CMI REPORT END REVIEW OF FDC’S SUPPORT TO EPI IN THE ZAMBÉZIA R 2014: 3 Preface This end review was commissioned by the Royal Norwegian Embassy in Maputo. Siri Lange (team leader) and Gaspar Sitefane (local consultant) were hired and contracted by the Embassy after a tendering process. Eugénio Salvador Chimbutane (local consultant) was hired and contracted by FDC in line with the Terms of Reference for the end review. Chimbutane has had main responsibility for the review of the project’s financial management systems (chapter four and corresponding annexes). Chimbutane did data collection and interviews at the headquarters of Fundação para o Desenvolvimento da Comunidade (FDC) in Maputo in the period 4 – 26 November, and follow-up data collection in January 2014. Lange and Sitefane have had main responsibility for the other sections of the report. The main field work took place in the period 3 - 12 November 2013. In addition to interviews in Maputo, Lange and Sitefane visited the provincial capital of Zambézia, Quelimane, as well as three districts; Mocuba, Nicoadala, and Namacurra. Mocuba was selected because a substantial part of the investment of the project was done in this district; a filling station for gas and a new storage building. It was also planned to be the regional distribution center for vaccines to the districts of the northern part of the province. Nicoadala and Namacurra districts were selected because FDC reports show that some of their activities were conducted in these districts and not in others, as well as on the basis of convenience, since they are both located between Quelimane and Mocuba. We wish thank all our informants for their help and good cooperation during our work with this review. iv CMI REPORT END REVIEW OF FDC’S SUPPORT TO EPI IN THE ZAMBÉZIA R 2014: 3 List of acronyms and abbreviations DDSMAS Direcção Distrital da Saúde, Mulher e Acção Social DPSD Direcção Provincial da Saúde DPSZ Direcção Provincial da Saúde Zambézia DDS Direcção Distritais da Saúde EPI Expanded Programme on Immunization FDC Fundação para o Desenvolvimento da Comunidade FUNAE Fundo de energia GdM Governo de Moçambique IDH Índice de Desenvolvimento Humano INE Instituto Nacional de Estatística Km Quilómetros LPG ou GPL Gás liquefeito do petróleo MISAU Ministério da Saúde OCB Organizações Comunitárias de Base ODM Objectivos de Desenvolvimento do Milénio ONG Organizações Não Governamentais PAV Programa Alargado de Vacinação PFV Postos Fixos de Vacinação SIDA Síndroma de Imunodeficiência adquirida SMI Saúde Materno Infantil TdR Termos de referência US Unidade Sanitária VCR Vaccination Coverage Rates v CMI REPORT END REVIEW OF FDC’S SUPPORT TO EPI IN THE ZAMBÉZIA R 2014: 3 Executive summary Background As part of their efforts to reach the MDGs, the Ministry of Health in Mozambique has introduced the Expanded Programme on Immunization (EPI). This report is an end review of FDC’s three year project to support the implementation of EPI in the Zambézia province. The goal of the project was to improve health and environment of the Project’s target community. The purposes of the project were the following: • to improve the system of distribution and conservation of vaccines in health units • to promote the use of gas as an alternative to kerosene and firewood • to improve access to sources of environmentally friendly energy by communities The main objective of the FDC project – to improve the system of distribution and conservation of vaccines in health Units (US) in the Zambézia province - is highly relevant for improving the general well-being of children and is very well aligned with the government of Mozambique’s health policies, guidelines and plans. The other main objective of the project - to promote the use of gas - is not in line with the Ministry of Health’s policies. The Royal Norwegian Embassy in Maputo (RNE) funded the project, which had total budget of NOK 15.5 million (approximately USD 2.7 million). The project was implemented in the period 2010 to 2013. Overlapping with this project period, other donors are funding the province’s health sector with more than USD 77 million. This parallel funding needs to be taken into consideration when one attempts to assess the results and impact of the Norwegian funded project and how the investments should be safeguarded in the future. It was not possible within the scope of this end review to isolate the effects of the Norwegian funded project. Effectiveness and results to the beneficiaries and targets groups The FDC project has greatly improved the cold chain in the project period and most probably more children and women than before have received vaccinations because vaccination services were introduced to 17 facilities that did not previously offer this service, and because facilities now have regular supply of vaccines by the help of the four project cars that were donated by the project. FDC’s reporting appears to overemphasize the project’s activities and results. For example, we found little evidence of community mobilization, and the claim that there are now “no sterilizers using wood” was found not to be true. Efficiency The team perceives the efficiency of the project to be relatively poor. First, the project had much higher administrative costs than budgeted (161%), and more than twenty percent of the total budget was spent on administration. Second, close to one third of the project budget was spent on infrastructure for the privately owned company VidaGás. Third, while the project originally planned to have four decentralised distribution centres for vaccines and gas, all distribution is now being done from Quelimane. The decision to do so has been made by the Provincial headqaurter. This solution greatly increases the distribution costs in terms of fuel, per diems, and maintenance of the cars. vi CMI REPORT END REVIEW OF FDC’S SUPPORT TO EPI IN THE ZAMBÉZIA R 2014: 3 Sustainability As for sustainability, the energy source that was introduced through the project to secure the cold chain - gas - has
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