. ., II . ; . ... .. ... -. • II •• &IIe • ••• ,....... ,.' ..... ~.¥."'O."'CIoI" '!IOJIC:T 'APER '· ~ ··"'·ET I ,. 'co< ,. f,. I 1 [ • ." ...... .. '~::..."'"~~ ! " r 1}8~08 J !FR , '- JIl • .. I" ... , '.'.. , .... " ! " ,WO 1 • , 1 ' , " , "",,weill ' . 1 , I - • •L I ,.,T 3.900 l,ObJ 0 .... , 1\ 2~ , . • •• • n •••• c. a"" ......... 111., _11111... ,111" TEC)). :C=' I. 'IT ""~ ... ''''0 n".19. , ~ ~ IJ ......0- •... ·\,j.~SC ~ln"TIO. c . •••• ,. .... ~~ CCl~. l o . .. 0." " ~.""1' t a. ",::I •• "'. .. ".. ,. ... 2,000 '" J"! 53C 533 '" '" 1 ' ... " ~.. f2l ..•• .::; L..:J ~·.II' / I&:.QIII G~Iif'Y'HG """,el el.,,,,,,,,,.Cl ( .-? ;".)~l , T~ANSACTION CODE Add I PIC PROJECT IDENTIFICAT!()rJ DOCUMENT FACESHEET ·:.:r.ange I: OO~UM~I\jT CODe D~I_tl' ~ --~----.----------------~l-------- __________ ____________________________ J COUNTRY t~TITY 14 DUCLiMENT REVISlu~ NliMS:H 1--'1 ~IGER i LlJ 5. PROJECT ·~UMBER 11 aU/HI) , L.2..-!UREA.U'O~FIC-;..;E;..... __i I ;JROJEC7 TITlE Imu""u," 40 ct:.r.crlN"fl 1 A. Sv,.,ccl 1 B Coo. 1 r- -, ~83-O208 ] ! .AFR I ~ 1 := i L - s, PROPOSeD NEXT DIJCL:MENT \10. i:STi'v1A.TED COSTS 2· PRP MM YV ,:SOuO or eOwlvalfnt, 51· 2!.;.5 CFA A. 3 B DATE [JJ J • PP 11111 717t ~.______ F_U_N __ D_IN_G~S_O~U_R_C_E _______ +-I~~~'~~K~~~:_ • AID ApprOPriated I 13,541 9. ESTIMATED FY OF A.UTHORIZATIONI9BLIGATION b .11 I OTHERr~------------------~------­ us 12. c. Host Country a. 1"'4ITIAL Fv IIJ§J C. FINAL ~v ~ o. Othltf Donorl~j II. P~OPCSED 9UDGET AID .4PPROP~IA.TED i'\.JNOS 'SOoo) B PRIMARYI A. A.FPRQ· PRIMARV TF.CH. CODE E. FIRST ;:Y liFE OF PROJECT PURPOSE '[ I I PAIATION I CODE C. Grant 0 Lo." F Grant G Loan I H. Gr~nt I L~n -ll-!--~Pf~:----~~5~3~O--~I------------------~~2,~------------~--------~--------- 1 I 121 I (JI i! E ~---------~--------~----------~----------~~~~----------------~-----------TOTAL 2,000 ., I 12. S~CONDAAY TECHNICAL ,:OOES r",.xlmum WI cod., a~ "If" pOSHlon, ~~f11 533 1J. SPECIAL CONCERNS CODES (murmum six codrt of four ,;Josltlon, tHlCIIJ SECONDARY [" PURPOSE COOE BRnIG 15. PI=lOJECT :::;OAL Im"',(1)lIm :UO ,nlJr..t:r.rrl r- To imprvve at low cost the quality of life al'ld ·... orking capacity of ::-.e L r'..tra.. ;o,ulatic~ (9,000 villages). 3y 19·32, t:, prav:'da 3500 vill~s wi th-.J ______~b~a~s~~~'~c health care services, 16. PROJECT PUR,IOSE (mu'mum 480 c";'nK:~rrl r- To establish ~ viable r~~ health deli7~ry system which demonstra~es ~ thp. va.'.ue of prevention, early diagnosis, tiltely curati.va interventicn a"ld proper refen-al. L ~ 17 PLANNING RESOURCE REC.!JIREMENTS (uaft/funds; D"!sig!'"~ Team- Leader, Public Health Physioian, Publ.!.c Health Nurse, Logistics Manpower Sp. 'cialist, Economist, En~ineer, Sociologist _____---:~,~ 18 ORIGINAT NG OFFICE CLEARANCE 19 Dare Documenr ~f.'Cel_ec In AIDIW. or lor A I DIW Documen t5. D. te of Dlltrll)Uhon Slqnalure 7 A y+t:~~.~"'-~~::.....-../ _~_ T,tle Regional Development Officer AID 1J30-2 (J-761 IMPROVING ffiJRAL nEAT rT'1f{ ( 68 3· 02 c8 ) T~b~e of Conten~2 Part I. Summary an:: ?ecommer:s.ati.GI1s 1 A. Fa.ce Sheet 1 B. Recommendations 1 C. Project Descri~t:on 1 D . ~ \.U!lIIl.a.ry F i:1di.ng .:; 1 E. Project I.5sues 3 F. 611 (a) Determination ; Part II. Project BackgTour.d and Detailed Descriktion 4 A. The Historical Basis of the GON Rural Health Strategy 4 B. Detailed :ie;;l:riyi.il.:IJ. 5 Part III. 11 A. Tec.hnir.:al Analysis ( 11 B. Financial Analysis and Plan 22 C. Soc.ie.l Analys is 47 D. Economic Analysis 61 r..r- ." r_ l '( ! Itt 4 : ~A Part rv. 67 A. Adlll..:L."J.~.strati ve AlTange:m.ents 67 B. Im1?l=mentation ?lan 72 C. IrJ.plementation Scnedule 74 D. :r.:valuation Al":-angements 77 Anne:ces A. Main Causes of DeRth 85 B. Major Diseases Trea.ted try Ar!'ondissement 86 C. Health Care by Circumscri?t1on - 1976 88 D. Hauth i.f.anpower Availaoili ty 90 E. Niger Health Personnel and Board 91 F. Eealth Personnel Needed in Oreer to Fulfill Objectives of Tr..ree Year Plan 92 G. Personnel in Trair~ng Outside of Niger 93 H. Af!'icare and its Relationsh!p to the Imrr~~g R~~ Health Project 94 I. Breakdown of Urba.'1 P.:::'ll th Budge-::' 95 ;. Con'tl~ct1on Costs 96 K. Recurrent Costs Proj~ct~~ns to GON 97 L. DispensaI1P E.:a.uipment List 99 M. Drug Li.:;t 10C N. Ya.ccine List lOl O. Cold Chain Equipment 102 P. Eq'\lipruent Lists for Ga.rages and Me-:ical Equipment Workshop 108 Q.. Educa.tional a.r.d Audio-Visual Materia.J.s 111 R. logica.l.-:;Yar::e'N"ork .Yf.a-:r:.x lJ2 S. Other:Jc _.:lr A.ss:'stan:e 119 T. Check.L.s-::f St atu"tory Cri :,eria 132 G. Iaitial ~lvirorxe~tal ~xam:'natiGn 143 v. r;raft Gra:-_t A6reer::ee}t 150 W. The F9JIl:'.ly :iea.l.th Car,=, Report; Ru.ral :1ealth :?oJ.i.cy 158 and Vi.:J.~e Hea.l~h 3er"!:.ces in ~r:"ger: 'I'ech."l:!.~al Analyses md Prcgra..'Cl Recot:l.'":".enda"t~cn.s for an AID Project Paper, Volu.me II: A;:pencices, November 14, 1977: 1. Niger Hei~th Sector Assessment 2. ~-i1_!rlstry of :IeaJ.th, Summa.ry of Three- Year Plan II PeI-sp!ct1ves, " 4. Village :-:eal:':h Teams SecOUI:'st~ JOD I..escription, Trai.ning Schedule and Conte:..ts O:,~ ET..a.rr:..acy K:!. t • Matrone J-Jb Descripti::m, TrllI'.i.ng Schedu.l~ and contents of Pha.rmacy Kit Curricula. of Health Tra:'!Jing Institutions: • ENICAS E:!lSP • ESSM (Summa.r'J, Years 1, 2 and 3) 6. other D::nor ~ogr3.mS ie} the Healt"j Sector in Niger 7. Village Health Tea.m.s: :Documents Helating to Supervision and the Rol; of the Certi.fied I1urse 8. Ministry of Health Items ,]oUI'nees d I Etudes de 113. Sante, Tahoua, July 1976 (Second National Level Health Conterence) 10. Job Descriptions f'Jr Long-Term Techn:cal Assistance Personnel ll. Tables • Village Health Teams, August 1977 Hea.lth Facilities in Niger, AUgJ~t 191i Glossa.ry TABLES 'table 1 Niger: Central Gove~ent Revenues & Expenditures, 1971-1977 Ta.ble 2 Niser: PeI'centage Share 'bf National Budget ?ece.i ved by Selected M1n:'stries or Services, 1977 Table 3 29 Table 4 S1.m'tIlarj Cost f.s:im.ate WI::' Financial Plan 42 Table 5 CostL'1g of OutputS/Input3 43 Table 6 Budget-Ir:rproy';-!:.g Rurs.l Health 44 Ta.ble 7 Nursi.r.g ?r-ogr3lIl Summary • 62 I. Project Sc:!Ilar"l and ?ecomme:ldations A. Facesheet (Attached) B. Recamrler:dat;ions This Project ?aper recommends that: AID as.ist the Goverr~ent of Niger (GON) in the strengthenL~ and irr~roving its rural health delivery system with grant :funds in the amount of $13,541,000 for the life of the projec"t. Assis~ance De ad~lis"tered over a five-year period of time (FY 78-IT 82), :::~ocusir.g on t'1l0 essential areas of health programming: 1. Human Resources Development 2. Institu"tional Support AID approve the 'Ilaivers and conditions in the Implementation Section. T..rhicn are cons idered essen"tial to successful projec~ i=plem~~tation. ~. Project Descript;ior. In order "'co meet the 'Ja3ic he:lJ.th needs of a growing rural population, a,t a reasor-able cost to the GaN, this project has oeen design,,:d to ass::'st the >1ir.is"tI"'J or' Health to ievelop its village health ~ program (v':1'"T). ~ conc.::rt "..,ri th c:he (JON the proj ect, over fi.ve years, "rill 2cr.centra-ce on tr:e ":rainir:g of "r..ey vO::!..'.zlteer villa.ge health workers alld :pro'liiing them "..rj::h physical and. personnel in:=astr'.1ct"..U'e .. The activ~ties of the project will be carried out by ~he ~~OH Nith constan t ~\Upport and :r.oni toring by the Mis sion :hrough i t.s ,raj ect ID.S.Ilager and se:"ected technical personnel. The specific inputs enumerated in the project paper ha.ve been selected on the basis of their rele~'ince, uti.lity~ and. replicability in the ongoi~g development processes of the rural tealth pr8gr3.E. It is projected that the investment in manpower developnent, a major item in the project, will result in a more expansive health cov2rage and thus curtail the need and usage of cos"tly secondaI-:,' and tertiary health modalities. The ultimate goal of the project is the prevention of disease and the promotion of health with tne eventual outcome - a higher quality of li~. -2- 1. S~=c1fic Project Activities a. _Human Resource Develonment-6___ __ 1. third-countl"'J training - theory and technology ot rural health delivel"'J systems ~ ~or ministeri~ level personnel, medical instructors, and health log1~tics/rna~~tenan~e prafes~ionals. 2. i..'1-country tr6.ining for pro£pective village health workers as WIll as advanced train,tng for bona ~ members of the ~n.llage hea.l.th team. 3. in-countl"'J continuing education grograms for health personnel at r..a-cional and depar..;mental levels. 4. tra.i.n.ing of certified and Sl:ate m:• ..rses ·,.,rhe -,lill be responsible for the treatment, ~raining, and supervision of v~ag~ health workers. 5. field training experience in rural J:l'2d.icine for medical student.s so as to givt:! them the necessa.1"'J skills for health intervention in a non-urba.'1 envirOIJ!l1.ent ~ 6.