Maidema Eye Health Centre (Trianing Centre and Eye Clinic) A summative evalutation 1996-2007

Background

The report is the result of an external, summative evaluation of the operations at Maidema Eye Health Centre from 1996 to 2007. This summative evaluation gives a review of Maidema`s performance since its start in 1996

Purpose/objective

The purpose of the evaluation is to assess whether the project has achieved its objectives or not. The evaluation should provide a summary of lessons learned during the 1996-2007 period, how they were solved, and of whether - and to what extent - original goals have been met - or have not been reached.

Methodology

A number of approaches were used. The present report is based on information from meetings held during the field visit and from available report and documents obtained from NABP. The team has also used information from the 2004 evaluation of Maidema. A series of interviews were conducted with the heads of departments and heads of divisions at both the national level (MOH), and the regional (Zoba) level. The team also made a visit to Maidema and met the clinical and administrative leaders there. The evaluation team, however, missed the responses of the clients (beneficiaries) of the project. Documents consisting of policy guidelines, project plans, reports, surveys evaluation and reviews, etc related to the project have been consulted. Partner programme documents were also used as reference for the evaluation.

Key findings

The Eye health and training centre in Maidema has been a success. The number of patients treated at Maidema since 1996 is substantial. In total Maidema has reached its objective to reduce prevalence of blindness from 1 % to the targeted 0,5 %. The overall and general impression of NABP`s 12 years work in Maidema, Eritrea is that everyone involved in the project has a reason to be proud of - and very satisfied - with the results that have been obtained.

Recommendations

It is important to avoid goals that are specific but not verifiable.
The lack of a baseline study makes all later assessments of whether the project has reached its goals fairly illusionary. Baseline studies are costly but informative. We recommend that all projects should conduct a baseline study before start up. Such a study should also make assessments of the critical factors that may affect positively or negatively the project's activities.

NABP must be commended for the way it rebuilt and reequipped Maidema after the war offensives in 1998 and 2000

Alternative places of localising a clinic in
a) an area that already has most of the needed infrastructure, or
b) areas that has the highest prevalence of blindness

should have been thoroughly assessed - also with security and financial costs in mind - before a final decision was taken. A choice between Maidema and Mendefera would today have given a different result than in 1993.

When the decision was made to establish the clinic in Maidema, NABP followed a policy of being as self-sufficient as possible. New technology has only been introduced as and when the organisation in Maidema was ready to use it.

The clinical activities at Maidema have been outstanding both in terms of quantity and quality. NABP must be commended by the way it has brought both funding and professionalism into the Maidema clinic.

Maidema has clearly fulfilled its original goals to contribute to the improvement of human capacity in the filed of Eritrean eye health.

Spreading the knowledge of how to prevent blindness is a core activity in all efforts to reduce prevalence of blindness. Maidema did not put in strong enough efforts to reduce blindness through preventive measures.

NABP and MOH ought to have found a practical solution to where eye-drops should be produced, and who should be in charge of it. As production of eye-drops is a very uncomplicated process, it is unsatisfactory that 12 years after Maidema was established, there is still no production of eye-drops in Eritrea.

Maidema could have been more than an excellent clinic. Far more than 6200 people have been inside Maidema`s walls, and for NABP/Maidema there have been excellent opportunities to lobby (on the grass root level) for rights, social inclusion and participation for the blind.

The evaluation team recommend that liaison offices should mirror more of NABP`s professional approach and activities than what has been the case in Asmara. They suggest that NABP actively use liaison offices (if they still have some) to act as their professional extension office, representing NABP in networks, meetings, and activities that work to the betterment of the livelihood for the blind.

The management committee did not function as expected. NABP should have followed up more frequently in order to ascertain that formal minutes, recommendations and decisions were made by the management committee and implemented by the administration at Maidema.

NABP`s representative in Asmara should have had a stronger hand on the process. Both NABP/Oslo and MOH should have prepared a more detailed checklist for the take-over and followed the process in more detail than what was the case.

It is in general problem for all government entities to compete with salary levels in NGO`s. In order to reduce the consequences of differences in salaries, a handover process must start so early that it is possible to adjust existing salaries or replace the highest paid employees (who will most probably not accept government salary levels) with new personnel.

The way the new agreement has been designed is exemplary. It provides funding for a highly needed ophthalmologist in Mendefera. The agreement is positive also for Maidema as the agreement requires the doctor to continue to spend some time at Maidema.

NABP makes an internal study of how its organisational and individual competence combined can be made available to the national planning and advocacy level for the blind in Eritrea.