CHRISTIAN CHILDREN`S FUND ANGOLA Emergency Health and Nutrition Project Bocoio, Angola OFDA Grant Reference Number: DFG-G-00-03-00079-00 Final Evaluation October-November 2004 Donald T. Whitson, MD, MPH Evaluator This report was prepared by: Donald T. Whitson, MD, MPH 70/1 Sukhumvit Soi 20 Madan Mansion, 6B Khlong Toey, Bangkok 10110 Thailand Tel/Fax: 66-2-261-6789 E-mail: [email protected] 2 TABLE OF CONTENTS ACRONYMS AND ABBREVIATIONS........................................................... 5 A. Introduction and summary.......................................................................................... 6 1. Executive Summary................................................................................................ 6 2. Project description................................................................................................... 9 a. Brief history and overview of the project ........................................................... 9 b. Target population................................................................................................ 9 c. Health infrastructure and human resources....................................................... 11 d. Project objectives and scope of the evaluation................................................. 12 B. Results and discussion by objective.......................................................................... 14 1. Access, use and coverage of services increased ................................................... 14 a. Immunization.................................................................................................... 14 i). Results........................................................................................................... 14 ii). Activities ................................................................................................... 16 iii). Lessons learned......................................................................................... 20 iv). Constraints ................................................................................................ 20 v). Conclusions ............................................................................................... 21 vi). Recommendations ..................................................................................... 22 b. Curative care ..................................................................................................... 23 i). Results........................................................................................................... 23 ii). Activities ................................................................................................... 25 iii). Lessons learned......................................................................................... 27 iv). Constraints ................................................................................................ 28 v). Conclusions ............................................................................................... 29 vi). Recommendations ..................................................................................... 30 c. Maternal care..................................................................................................... 30 i). Results........................................................................................................... 30 ii). Activities ................................................................................................... 34 iii). Lessons learned......................................................................................... 36 iv). Constraints ................................................................................................ 36 v). Conclusions ............................................................................................... 37 vi). Recommendations ..................................................................................... 37 2. Nutritional status of children improved ................................................................ 38 a. Results............................................................................................................... 38 i). Nutritional status........................................................................................... 39 ii). Supplemental feeding program................................................................. 41 iii). Therapeutic feeding program.................................................................... 43 b. Lessons learned................................................................................................. 46 c. Constraints ........................................................................................................ 47 d. Conclusions ....................................................................................................... 47 e. Recommendations ............................................................................................. 48 3. Infrastructure improved......................................................................................... 49 a. Results............................................................................................................... 49 b. Constraints ........................................................................................................ 54 c. Lessons learned................................................................................................. 54 d. Conclusions and recommendations................................................................... 54 3 4. Quality of services strengthened........................................................................... 55 a. Results............................................................................................................... 55 i). Training......................................................................................................... 56 ii). Standard case management ....................................................................... 59 iii). Supervision................................................................................................ 61 b. Constraints ........................................................................................................ 63 c. Lessons learned................................................................................................. 64 i). Recommendations ......................................................................................... 64 5. Caretakers’ knowledge of basic child care improved ........................................... 64 a. Objectives and activities ................................................................................... 64 b. Results............................................................................................................... 66 i). Constraints .................................................................................................... 68 c. Lessons learned................................................................................................. 68 d. Recommendations ............................................................................................. 69 Attachment A: Team members and their titles ................................................. 70 Attachment B: Assessment methodology......................................................... 71 Attachment C: LQAS Sample Survey Report .................................................. 72 4 ACRONYMS AND ABBREVIATIONS BP-Amoco British Petroleum-Amoco CCF Christian Children’s Fund Comuna Administrative subdivision of a Municipality. The Municipality of Bocoio has 5 comunas: Bocoio, Monte Belo, Cubal do Lumbo, Passe and Chila CRS Catholic Relief Services CORE US-based USAID-sponsored NGO coordinating body for child health DMS Municipal Delegation (or Delegate) of Health FAS Fundo de Assisstência Social, a semi-governmental entity funding infrastructure projects HIS Health information system IMC International Medical Corps, an NGO IMCI Integrated Management of Childhood Illness LQAS Lot quality assurance sampling, a random sampling method for sample surveys MCH Maternal and child health MOH Ministry of Health NGO Non-governmental organization OCHA Organization for coordinating humanitarian assistance, a UN agency OFDA Office of Foreign Disaster Assistance, USAID ORS Oral rehydration salts ORT Oral rehydration therapy (treatment for diarrhea) PAR Programa de Assistência à Reconstrução, European Funded reconstruction infrastructure project. PIP Plano de Investimento Público, Angolan government reconstruction and infrastructure plan SCM Standard case management (use of standard protocols for diagnosis and treatment) TB Tuberculosis TBA Traditional birth attendant UN United Nations UNICEF United Nations Children’s Fund UNFPA United Nations Family Planning Agency USAID United States Agency for International Development WFP World Food Programme (UN agency) WHO World Health Organization 5 A. Introduction and summary 1. Executive Summary The cessation of hostilities in Angola in early 2002 created both a crisis and an opportunity. Large numbers of people, already in poor health, began returning to their areas of origin where health and other services were largely unavailable. At first, large numbers of people were concentrated in resettlement and demobilization camps in the town of Bocoio and immediately surrounding areas. CCF launched an emergency health and nutrition project with support from WFP and OCHA in mid-2002 with a focus