A.I.D. EVALUATION SUMMARY: PART I A. REPORTING A.I.D. UNIT: B. WAS EVALUATION SCHEDULED C. EVALJATION CURRENT FY EVALUATION TIMING: PLAN? In terim Final x USAID/EGYPT Yes x Slipped_ Ex Post- Other- ES#: 88- Ad hoc D. ACTIVITY EVALUATED: Suez Canal Area Medical Educatimn and Health Services Development Project (263-0136). E. ACTION DECISIONS APPROVED BY OFFICER COMPLETION DATE THE MISSION DIRECTOR: 1. Extend PACD to January 30, 1990. M. Brown June 1988 C. Manticne J. Sam W. Gelabert. G. CLEARANCE/APPROVAL OF EVALUATION SUMMARY AND ACTION DECISIONS: Technical Directorate Program Development aid Support Directorate C. Mantine, H J. Laudato, PDS/ J. Sam, HRDC/ V. Molldrem, PDS/P W. Gelabert, AD/HRDCVl- J. Pattersmn, AD/PDS Approved: ? tv-. ___/__ Marshall D. Brown, DIR (PPP/P, SUEZEV, 5/25/88) - H. EVALUATION ABSTRACT 1. Background and Purpose: Since 1980, USAID has given $ 15.4 million to the Ministry of Health (MOH) and Suez Canal University (SCU) to establish a new medical university with an innovative curriculum to train doctors in primary health care and a program to integrate medical education and health services. The purpose of this evaluation was to assess the overall progress of the project. 2. Major Findings and Ccnclusimis: The project purpose has been achieved. a. Significant Project Achievements: - A fully functicning 6 year medical school with an excellent, innovative curriculum and trained faculty. - Establishment of essential educational support activities: an excellent central library, mini-libraries, audio-visual/educaticnal media center, computer laboratory, multi-purpose demcnstraticn laboratory, a microbiology and central research laboratory. - Masters in General Practice graduate program. - Research program clearly related to communities' needs. - Revenue generating activities that caitribute significantly to school sustainability such as faculty group practices and faculty housing. - Teaching and service facilities ccnstructed or renovated and equipped. b. Outputs partially achieved. - Faculty of Medicine (FOM). Administrative and program management of FOM/SCU require further strengthening. Postgraduate program needs more faculty in General aid Family practice. Clinical laboratories have not utilized and maintained their equipment or marketed their services effectively. - Health Services. The poor quality of MOH clinic services negatively affects community health and students' clinical training. The low status of primary health care services also discourages students from General Practice and Family medicine practice. 3. Key Rec oue-datians. The team recommends a no-cost two year project extension to : - Assist the MOH in developing model primary care clinics through continuing educatin programs, better administrative systems, and introduction of cost recovery measures. - Develop career structure for General Practice physicians. - Strengthen clinical and basic science faculties and develop scholarly community oriented research capabilities. - Strengthen FOM/SCU management aid financial analysis capacities. I. Evaluation Costs 1. Evaluaticn Team Ccntract # OR Ccntract Cost OR Source of TDY Persn Da-ys TDY Cost (US -) Funds Ernest Petrich, Team Leader 263-0136-C-00- $ 76,000 Project No. David S. Greer 8042-00. LE 25,000 263-0136 Yolande M. Gershman Nancyanne Causino Ibrahim H. Abdel-Rahman Aleya Hussein Ayoub M. Lotfy Dowidar A.I.D. EVALUATION SUMMARY: PART II I. SUMMARY OF EVALUATION FINDINGS, CONCLUSIONS AND RECOMMENDATIONS. BACKGROUND: In 1980, USAID, the Ministry of Health and the Suez Canal University Faculty of Medicine initiated the Suez Canal Area Medical Education and Health Services Development Project. The project purpose was: to establish a program for the integration of medical education and health services in the Suez Canal area, and to educate and train primary care physicians as direct providers and health team managers to work effectively within resource constraints. The founding Deans of the Medical School pioneered radical new concepts in medical education by focusing on community health needs and utilizing a multi-disciplinary, problem solving approach. USAID has provided $ 15.9 million to the Ministry of Health and Suez Canal University. Approximately $460,000 will be unspent at the Project PACD. The total amount of GOE contributions was estimated at over LE 60 million. USAID funding has supported: construction ,ind renovation of teaching and service facilities; purchase of faculty housing; equipment for teaching, research and service facilities; foreign and local long-term and short-term training of faculty and other personnel; and technical assistance. PURPOSE: The purpose of this evaluation was to assess progress in establishing a community oriented medical school that successfully integrates undergraduate medical education with MOH services, to determine impact of USAID assistance, to identify critical inputs and lessons learned, and to examine the feasibility of replicating this approach at other medical schools. FINDINGS AND CONCLUSIONS: 1. Project Outputs. The major USAID funded outputs are: - A fully functioning 6 year medical school. In 1987, the first class of 44 students graduated. Undergraduates now total 390. - A new medical curriculum. The school has pioneered curriculum reform worldwide and in Egypt. - A comprehensive faculty. Though junior, it is among the best in the world in problem based medical education. - Postgraduate teaching and Research. The school has the only Masters degree in General Practice in Egypt. Small reseaich grants have hastened faculty development and a community oriented research program. - Educational Support Services. These include a well maintained and stocked medical library, an extensively used computer laboratory, and a clinical skills laboratory. An audio-visual, educational media center produces learning materials developed by the faculty. A microbiology laboratory is well equipped to serve community health needs, but underutilized. - Revenue Generating Activities. Group practices and housing provide additional support for faculty and supplement the GOE operating budget. - Renovation/construction and equipment for 24 primary health care clinics in three governorates. -7• Within the Faculty of Medicine, several outputs were not fully achieved: strengthening management, development of faculty to support the Masters in General Practice program, and clinical laboratory services (See Section 2). Major outputs to upgrade primary health care clinics have not been achieved (See Section 3). The real long-term output of. USAID project investment will be future graduates. The majority (80%) are likely to live and work in the Suez Canal and Sinai area. They eventually will outnumber traditionally trained physicians and could have a major influence on health care in the area. 2. Medical Education. The most outstanding school achievement is development of an excellent quality undergraduate curriculum. The problem based curriculum is almost entirely derived from community needs, which are assessed through field projects, student electives, faculty theses, and general assessments. This approach has radically altered learning and teaching. Postgraduate students are working in almost all traditional specialities at both the Masters and Doctoral level, but the Masters of Science in General Practice has attracted a decreasing number of students. General Practice is undervalued both by the profession and patients who prefer specialists. The faculty is not large enough to provide adequate clinical supervision or create a curriculum comparable to the undergraduate course in imagination and relevance. Research at the university has focused on local and regional issues. Research should be expanded to include scholarly topics of interest to the broader professional community in order to bring recognition and promotion of faculty and prestige to the university. Replication of the FOM/SCU Curriculum. The school has stimulated the medical community to consider revision of the Egyptian medical curriculum at other schools. The Ministry of Education has sponsored several conferences focusing on community-oriented, problem-based medical education. Minoufia University is already utilizing portions of the FOM/SCU curriculum and approach. 3. Health Services and Clinical Teaching. 24 MOH clinics and hospitals were chosen for medical students to work with MOH clinic personnel in actual provision of patient care. Service facilities were renovated and are staffed and equipped. During the past seven years, FOM/SCU has worked hard to educate MOH personnel about the goals and objectives of the school. A recent survey identified the following problems: - Physicians are not trained as student trainers. - Technical performance of MOH physicians and health team is low. - Attendance by MOH staff is irregular. - Clinic operating hours are short. - There are too few patiE' ts for a meaningful training experience. I~f The failure of the MOH to develop even model primary health care units has meant that FOM/SCU graduates have no opportunities to provide the type of health care for which they have been educated; however, the Evaluation Team believes that the substantial FOM/SCU - MOH relationships provide a foundation for future service improvements. 4. Management Development. Much of the success of FOM/SCU can be attributed to the participative management style. The broad involvement of faculty and students in planning, monitoring, and evaluating programs was a radical departure from