Community-Based Health Program in Targeted Areas of Development Final Evaluation Report

Background

This is a Community Based Health Program conceptualized and implemented by the Catholic Relief Services - Philippines in 14 hard to reach communities in the areas of Dumaguete, Jaro and Borongan in the Visayas. The Goal was to improve the health conditions of poor families in hard to reach and underserved areas (as defined by local health authorities). The program was based on the following strategies: partnership building, community organising, upgrading of health services, capacity building.

Purpose/objective

1. Determine the changes accruing to the beneficiaries in terms of participation in community health activities, leadership and empowerment, health and nutrition knowledge and practices
2. Determine the effects of the program on the availability, quality and utilization of
health services.
3. Determine the effectiveness of the program strategies in attaining the program
objectives.
4. Determine the capability of the Dioceses and the People's Organizations in sustaining the program beyond 2003.
5. Distill the overarching lessons from the program
6. Come up with recommendations for the sustainability of the CBHP.

Methodology

Two simultaneous evaluations were conducted almost the same months. An external evaluation was conducted that run across all levels of the program, from the targeted areas of development, the communities, to the municipality, district, provincial and national level. The findings from the external evaluations were mainly qualitative, whereas the internal evaluation aimed at measuring the impact against the predefined indicators, and is mainly quantitative. An internal evaluation conducted by trained members of the communities themselves. The report is the consolidation of both evaluations. Having had all stakeholders involved, made the evaluation highly participatory.

Key findings

• Health delivery services improved greatly with the designation and appointment of Rural Health Midwives in the areas; peoples awareness is improved through the efforts of the Community Based Health Volunteers health education activities; the district health system of the Department of Health was revived thanks to the program
• Mobilization for health resulted from the community organizing strategy. This developed into People's Organizations, that also engaged themselves in other areas such as income creation, infrastructure, lack of access to medicines etc.
• The partnership with the Local Government Units, particularly with the Rural Health Units have surged this project forward. Local Government Executives allocated funds to pursue health activities. The program transcended problems of politics in most areas. Partnership and linkages reached beyond municipality level and up to the Provincial and National levels.
• As leaders and health caregivers were trained, confidence was gained as the participants used the new knowledge and skills to improve themselves, but their families, neighbours and communities. The volunteer health workers were found to be highly committed, and are ready to be trained more so that the service can continue and expand.
• Although the program could gain more with 3-4 more years of strategic implementation, the program was found to be sustainable due to the new capacity and confidence of the people who have learned how to help themselves. The Local Government Officials and the Rural Health Units have affirmed their willingness to continue the support through future und allocations. All stakeholders have developed enough trust and respect to continue their partnership without an external facilitator.

Recommendations

• Many suggestions as to how the health services delivered by the health authorities could be improved in these remote areas
• The People's organisations should continue to develop and sell herbal medicines in light of the lack of access to other medicines.
• CRS should undertake strategic planning and training in financial recording and reporting with every single peoples' organisation before phasing out
• In order for the People's organisations to function better, they need to clarify organizational structure, roles and functions, develop their membershipbase, define suitable membership forms and improve internal control systems along operational and financial, policies, recording, reporting, auditing and general supervision.
• Partners to improve horizontal links in terms of linkages reflections, monitoring and evaluation, as well as become more proactive in seeking new funds and new partners.
• Document the experiences and lessons learned as case studies which could be used by local governments, health authorities etc for sharing; for partnership building and policy advocacy. CRS may even document its processes into a manual for use by local governments and NGOs in Health.
• Untimely to phase out at this time. The program could expand its network so that the project costs can be shared by other agencies.

Comments from the organisation

Strategic planning and additional training is undertaken with all people's organisations. A manual on how to set up a similar program was made.