Table 2: Strengths and weaknesses highlighted in the 3 year post-project sustainability assessment Strengths Observed in 2007 Weaknesses Observed in 2007 The municipal system has maintained important activities and The erosion of the majority of health indicators and the dramatic functions while Concern support was reduced drastically. Elected situation in terms of malnutrition of children raises alarms about and spite of the absence of a Medical this complex and multi-sectorial urban health officials “come go,” but—in issue. A “sustainable Officer—MHDs have demonstrated an effective, if imperfect, of its children malnourished! system” cannot leave half capacity to support WHCs and CHVs. Demand for services Redressing the mixed picture presented by the 2007 Sustainability continues to increase and performance is high in Dashboard for both municipalities in terms of continued health institutionalized areas such as EPI. gains and critical services requires a new energy, strengthened Few health indicators have continued to improve but none of those leadership at municipality level, support of and resourcing of the municipal health system (although external resources do not have to initially targeted by the CSP have collapsed. be the driving force.) Re-energizing WHCs after the 2004 interruption only required modest efforts. The number of CHVs and their commitment to the essential services targeted by the municipalities needs to be increased. Although strained, the CHV model is basically in place. The local health planners do not yet fully own the information There are signs of ownership and institutionalization of the model at production tools they need to carry out their work. While municipality, UPFHO, policy-maker levels, as well as NGO service organizational self-assessments have largely been transferred into providers. Linkages—notably through the MESPCC—exist and the hands of MHDs, the production of critical information for provide ground for further strengthening of the model. health management decision (financing of and ability to manage a KPC survey, a CHV or a health facility assessment for example) remains in the hands of Concern. (The Health Management Information System is nascent and unlikely to develop without solid external assistance.) Three critical underlying negative factors were identified: Absence of a Senior Health Officer Insufficient consistency of purpose Insufficient role played by central stakeholders
Table 2: Strengths and weaknesses highlighted in the 3 year post-project sustainability assessment Strengths Observed in 2007 Weaknesses Observed in 2007 The municipal system has maintained important activities and functions while Concern support was reduced drastically. Elected officials “come and go,” but—in spite of the absence of a Medical Officer—MHDs have demonstrated an effective, if imperfect, capacity to support WHCs and CHVs. Demand for services continues to increase and performance is high in areas such as EPI. Few health indicators have continued to improve but none of those initially targeted by the CSP have collapsed. Re-energizing WHCs after the 2004 interruption only required modest efforts. Although strained, the CHV model is basically in place. There are signs of ownership and institutionalization of the model at municipality, UPFHO, policy-maker levels, as well as NGO service providers. Linkages—notably through the MESPCC—exist and provide ground for further strengthening of the model. The erosion of the majority of health indicators and the dramatic situation in terms of malnutrition of children raises alarms about this complex and multi-sectorial issue. A “sustainable urban health system” cannot leave half of its children malnourished! Redressing the mixed picture presented by the 2007 Sustainability Dashboard for both municipalities in terms of continued health gains and critical services requires a new energy, strengthened leadership at municipality level, support of and resourcing of the municipal health system (although external resources do not have to be the driving force.) The number of CHVs and their commitment to the essential services targeted by the municipalities needs to be increased. The local health planners do not yet fully own the information production tools they need to carry out their work. While organizational self-assessments have largely been transferred into the hands of MHDs, the production of critical information for health management decision (financing of and ability to manage a KPC survey, a CHV or a health facility assessment for example) remains in the hands of Concern. (The Health Management Information System is nascent and unlikely to develop without solid external assistance.) Three critical underlying negative factors were identified: Absence of a Senior Health Officer Insufficient consistency of purpose Insufficient role played by central stakeholders institutionalized