Abstract
Final evaluation of a grant to Health Alliance International (HAI) for a child survival (CS) project comprising maternal health, malaria control and prevention, and STI/HIV/AIDS education and prevention in Manica and Sofala Provinces, Mozambique (1998- 2002). HAI's partner in Mozambique is the Ministry of Health. HAI works directly with the Provincial Health Directorate (DPS) for each province. This partnership represents the essential strength of the HAI program, as the approach builds both ownership and sustainability of activities. The program goal is to bring about sustainable reduction in infant, antenatal, and maternal mortality and morbidity in the two provinces. HAI has achieved remarkable success in reaching the targets set in the Detailed Implementation Plan (DIP) for the CS project. However, there are still severe health problems in the central region to be tackled, further exacerbated by HIV/AIDS epidemic that has changed the epidemiological landscape. One of the principal achievements of the CS grant has been the strengthening of the health structures from provincial to health post levels through the extensive capacity building program in an extremely difficult operating environment. Over the period of the grant, HAI has responded to the rapid changes in the HIV/AIDS field by supporting important provincial initiatives that were in accordance with the overall objectives of the organization, namely in the areas of mother-to-child transmission (MTCT) and voluntary counseling and testing centers (VCT). HAI should continue working through the National Health Services (NHS) and work to the organization's strengths in terms of health worker training, operational research, and innovation in cutting edge areas of policy (MTCT and antiretroviral treatment). All aspects highlighted by HAI for the next phase of the CS grant are considered to be priority areas for intervention by the provincial authorities and are more focused than the previous CS program. HAI needs to consolidate its internal structure in order to clarify roles of personnel and their responsibilities towards partners and donors. The current reporting culture in HAI is not conducive to reflective learning, and new mechanisms need to be devised to encourage organized reflection that can stimulate staff members to develop critical analysis of their programs in a supportive environment. Lessons learned are as follows. (1) HAI will work to its strength as an organization and have a more focused operational approach. HAI should disseminate its operational approach by writing an issue paper highlighting the successes and constraints of working through the local health institutions (2) HAI will avoid moving into areas where it lacks the resources or vocation to adequately address the problems. (3) HAI has learned to embrace new challenges of overwhelming importance and urgency, even those not foreseen at the beginning of an operating period, for example, HIV/AIDS work. (4) HAI needs to consider national-level representation to strengthen its advocacy and operational base. (5) HAI has used a considerable amount of resources on health worker training using an in-service training model. It is time to consider a more innovative approach to the capacity building needs of the NHS.