The Methodist Rural Public Health Programme Evaluation January 2006

Background

The Methodist Public Health Centre was started in1962. The work in Mursan started some years earlier when a team from CFC Hospital Vrindaban visited Mursan once a week. The project received the first support from NORAD already in 1978 and from 1986 NORAD has been among the main donors through the United Methodist Church in Norway. The work has gradually increased from a mobile clinic into a mayor public health work supported by three small clinics of which the centre being the clinic at Mursan with a total of nine beds.

MRPHP has been evaluated several times, the last was in 2002. Since then the work has been shifted to include one new component of different activities related to prevention of the spread of HIV/AIDS. The present evaluation has looked into both the previous health work in this report called "general health work" and the new HIV/AIDS work.

Purpose/objective

To assess the achievements of the project compared to the objectives stated in the project plan.

Methodology

The evaluation has been carried out as a transparent participative evaluation. The project staff and management have been invited to participate in the discussions of the evaluation team and this has permitted direct feedback on different questions from the evaluation team. The evaluation has been qualitative, and the main evaluation instruments that have been applied are:
• Desk studies of project plans, annual plans, activity reports, annual reports and financial reports.
• Observations of clinic activities as well as outreach.
• Interviews and dialogue with staff management and employees.
• Interviews with cooperating partners.
• Conversations with clients and target group.

Two minor workshops were conducted with the project staff as part of the evaluation. The first workshop was held as plenary session. The second started with separate groups for men and women and a plenary session at the end. The staff gave valuable contribution to the evaluation during the sessions.

Key findings

The work of MRPHP is in many ways impressive. The project is located in a small village Mursan in the district of Hathras in Uttar Pradesh. Uttar Pradesh is one of the most impoverished states in India and a classic example of how the rural part of the country is lagging far behind the rapid growth of the urban parts mostly in the south or the India. The general socio development indicators of Uttar Pradesh are similar to what one can find in Africa south of Sahara and far from comparable figures from the "modern urban India".

In this very difficult context MRPHP has managed to establish efficient and effective general health services prioritising services to women and children. The project has managed to establish good relations to the communities surrounding the centres as well as to public authorities and to other NGOs. An indication of the first is the high number of patients seeking the services provided by MRPHP, an indicator of the second e.g. the approval of MRPHP as a diagnostic centre in the DOT programme, the joint eye and sterilisation camps and thirdly one should notice the ability of the organisation to network effectively with other NGOs.

The organisation has shown ability to change and to adapt to new challenges. One indicator of this is the quick and well implementation of the new HIV/AIDS work and e.g. the very fast response in finding an alternative solution when the organisation had to leave the Methodist Hospital in Mathura and find an alternative location for the new counselling office and delivery services along national highway number 2.

The quality of the services of the organisation and the competence of the staff is considered to be good. It is also important to point out how quickly the staff was able to absorb new knowledge related to the new epidemic of HIV/AIDS and to efficiently and effectively implement the new HIV/AIDS project.

Based on the sustainability model applied by the office of Norwegian Missions in Development, one can conclude that the work is well in balance with the context (the needs of the population of the region), and the activity profile (the services provided by the organisations). The weaknesses of the organisation are related to the organisational capacity. The evaluation team has not detected weaknesses in the operational daily activities but related to overall project management and finance.

The present plans are based on a funding agreement with the main donor in Norway covering the period from 2003 to 2007. The activities are based on two different plans, one for the general health work and one covering the new HIV/AIDS work. There are deficiencies in relation to both these documents regarding how the projects were to be monitored regarding the achievements of the objectives. All activities are well supervised and monitored, but the higher level of monitoring of objectives is almost not existing and not as described in the project plans. This weakness has also been pointed out in previous evaluation reports e.g. in 2002.

The second weakness is the high level of dependency upon foreign donors. The general health work is financial self sustainable for 46% of the project cost while the new HIV/AIDS work only covers 1% of the project budget from local income.

Recommendations

Based on the above considerations the evaluation team does not find it necessary to recommend major changes in the operational activities. Any programme will be in the need of constant improvement, but the staff of MRPHP should be well prepared to do that. However, the organisation should strengthen the project management function. This could e.g. be done as a combination of stronger staff involvement and specific input from outside experts as e.g. temporary advisors with experience in field service management when needed. It will be particularly important that the organisation takes time to prepare a well structured plan for the next funding period starting in 2008 and make sure that the proposed activities, monitoring and supervision is in accordance with the organisation's competence and capacity. Based on the previous experience the evaluation team wants to point out the necessity of good monitoring mechanisms not only about daily activities, but also on vital statistics monitoring project objectives.

MRPHP should also seriously look into the possibilities of increased financial sustainability. This is particularly important concerning the general health work as there are clear indications from the main donor that one cannot expect additional funding after 2007. The HIV/AIDS work is presently almost totally dependent on foreign funding. Although there is a reasonable change to obtain funding for a new period starting in 2008 onwards, the organisation should seriously consider both how the activities can become more self-sustainable and consider other sources of funding.