Mid Term Evaluation Of The Congregation Based Primary Health Care Program Phase III (2011-2015)

Background:
Congregation Based Primary Health Care Project (CBPHCP) is an initiative of Mohulpahari Christian Hospital (MCH) situated in Dumka district of Jharkhand. 45% people are of Santhal or Paharia tribes and 6% belong to schedule caste groups. CBPHCP are bringing congregations to the center stage in responding to the need of the local community. The project is now in its third phase and though the focus was to improve access to health care, it has also responded to the development needs by organizing women, capacity building, economic activities, improving agriculture and by addressing rights issues.

Purpose/objective:
The purpose of mid-term evaluation of CBPHCP is to assess the progress of the project and analyze reasons for gaps if any and assess long-term sustainability of the project.
• Follow up of the evaluation recommendations from Phase II, 2004-2009.
• Evaluate progress of Phase III at Mohulpahari Christian Hospital in Congregation Based Primary Health Care Program, and in particular assess if the project’s organization, management, operational and administrative procedures are adequate in relation to the 
achievement of the stated project objectives.

Methodology:
Review of documents - The external team members reviewed the following documents. Site visits - The team visited the and interacted with the following groups between 20th and 27th September 2013]
For study of financial system interviews were done with  
• Administrators of MCH] Dr. J. Kisku and P. Soren 
• Administrative staff 
 
• Accountant (currently CBPHCP) 

• Visit to hospital departments and stores

Key findings:
The role of MCH managing board as a separate entity is not clear as many MCH leaders are also directly involved in CBPHCP. Animators work in a group independently of all other activities, directly at the community level. Congregations interact with the project workers but the committee at the congregation level is not actively involved in planning and monitoring of project activities. There is lack of clarity in line of command and control at operational level.
• Project coordinator and staff are limited to managing the project activities. Project coordinator needs to be directly responsible and accountable for all administrative processes, personnel management and project implementation under the overall supervision of the CEO of MCH and within MCH policies.
• For administrative issues the decision making process is centralized at MCH and not at the project level with little participation from other players in the team.
• The understanding of M&E is lacking in the team. There is no one trained in this aspect of project management and training by Rural Development did not play a role in improving it.
• Some SHGs have developed to become truly remarkable examples of empowerment and emancipation. Some women have become PRI leaders and playing decisive role in the local self-government.

Recommendations:
• Develop and maintain administrative and project management systems to support
• CBPHCP at Central coordination level, MCH level and project management level. Specific systems needed are good financial management, clear partner agreement, Monitoring and Evaluation system at project level and defined role of project management committee/ board.
• Build competency of staff and project coordinator for project planning, implementation and management.
• Modify the project proposal to align the inputs planned with outcome and impact, according to the original vision and objectives. Develop appropriate indicators and M&E system for it. 

• Redefine roles of partners to support field project staff and maximizing benefit to the community.
• Project is lacking alignment of overall vision, objectives and activities with specific indicators towards expected outcomes.
• Put in place an external monitoring group (including the funding partner) to follow the progress. 

• Bring the congregations into the center-stage as equal partners involving them at each 
step to identify needs, develop plans, prioritize, develop appropriate strategies for intervention and monitor the project implementation.