An Evaluation of the Congregational Based Primary Health Care Program (2005-2009) of Mohulpahari Christian Hospital, Jharkhand

Background:
Mohulpahari Christian Hospital (MCH) is one of the oldest hospitals in Southern Santhal
Pargana region providing surgical care and management for complicated medical
diseases. It is the largest hospital of Northern Evangelical Lutheran Church (NELC)
which has not only provided medical care but also developed human resource for the
church and the tribal population through training of health care workers. Normisjon has
partnered with NELC and MCH in supporting health and development initiatives for a
long time. A major institution building process with reorientation of the focus for services
took place through Mohulpahari Christian Hospital Development Project (MCHDP) from
1998 in response to the needs of the community and the hospital. Congregation Based
Primary Health Care Program (CBPHCP) was a response of the hospital to the
community to reach out. The technical partner for both these initiatives was Christian
Medical Association of India (CMAI), based at New Delhi.
MCHDP completed in 2005 while CBPHCP continued from then on building on the
previous community based initiatives in health and development, and it will complete
five years in 2009. A mid-term evaluation in 2002 was done for CBPHCP component.

Purpose/objective:
• to evaluate the objectives, performance and to the extent possible, the intended and unintended impact of the CBPHCP
• to provide an overview of the involvement of MCH and CBPHCP in empowering congregations for transformation of the local communities
• to identify steps to be taken by MCH and its initiatives for the local community, to achieve the planned objectives in the present context
• to assess the extent to which the recommendations of the evaluation of Phase I are implemented

Methodology:
Methodology used included group discussion with staff, interviews with various
members of the staff and administrators, and observation of facilities and processes.

Key findings:
• The organizational structure was strong at the start of the project but has weakened in the recent years due to attrition of key staff.
• Technical expertise for community health program management is not developed adequately at the top hierarchy of the organizational structure leading to inadequate monitoring and supervision.
• Grass root workers are motivated but under utilized.
• There is lack of clarity among all stakeholders about their roles and responsibilities, which has contributed to limited progress in internalization and dissemination of the project concept.
• Project committee within the hospital management board was expected to provide technical guidance. This forum rarely had community health expert attending meetings after 2006.
• The most important achievement of CBPHCP is in the strength of women’s groups started or supported by it.
• Health activities for project communities have developed in the form of mobile clinics and subsidized hospital care for those coming to MCH.
• The project has not developed strong collaboration with existing Government health programs for provision of primary health care.
• Health information system is not in use and has failed to collect data for monitoring change in the health status of the community over the project period.
• The travel from Mohulpahari to all project villages scattered in three Community Development Blocks in Dumka district is very difficult due to poor roads.
• Congregations members are involved more as individuals and there is potential for larger group involvement in all aspects of project planning and implementation.
 
Recommendations:
• There is a gap between what is needed for overall development of the communities and what exists now. There is a need for all players in the field to join hand to make the difference. Therefore, MCH needs to continue the efforts to bridge the gaps.
• There is a need to reorganize the program to focus on the strengths for consolidation, and work on weak areas.
• The strengthening of women’s groups and few men’s groups should be the focus for the project. All groups need training and diversification in their activities to include social activities. They have the potential to be the largest advocacy group in the district if they are empowered with necessary knowledge and skills.
• Networking with other similar groups and NGOs is needed for these groups and issue based collaborations should be explored.
• There is a need for NGO hospitals to support the activities.
• Congregations and Church are integral part of the project and CBPHCP and MCH should work with the NELC leadership to develop a strategy to make this partnership stronger and mutually beneficial.
• Project should utilize the opportunity to build on its strengths and develop and empower community-based organizations.