Final evaluation of the USAID Guinea health service delivery (HSD) activity : integrated health service delivery in the post-Ebola context

Abstract

This final performance evaluation of the Health Service

Delivery (HSD) Activity reviewed the first 4 years of

implementation to understand project effectiveness

in increasing quality of care, increasing demand for

services and strengthening health systems; to identify

lessons learned and missed opportunities; and to

identify factors affecting post-investment sustainability.

Evaluation questions focused on quality of care,

community-focused interventions, health systems

strengthening, fistula prevention and care, genderbased

violence, and leveraging of USAID and other

development partner activities to advance RMNCH+

results in Guinea. Primary mixed-methods data were

collected from key stakeholders and a subset of health

facilities.

HSD activities contributed to substantial progress in

strengthening the system and actors to provide the

integrated care package through provider training

and supervision, environmental and materials support,

and advocacy efforts. Continuing challenges included

training needs and managerial support, human resource

deployment and retention, lack of essential medicines

and commodities, appropriate space for service

provision, and inadequate equipment maintenance.

Systems strengthening achievements contributed to

increased community member utilization, especially

for ANC, family planning, and child health; however,

important disparities and equity gaps remain. Ministry

of Health (MOH) governance, leadership, and ownership

of quality improvement at the facility level remained

insufficient to sustain HSD-supported improvements.

HSD activities contributed to building fistula surgical

capacity and coverage; however, the investment was

small compared to the need and sustainability remains

a significant concern. Similarly, gender-based violencerelated

health and legal services and prevention

activities were made available in targeted areas,

though greater investment and stronger governance

is needed. While HSD activities built on prior USAID

achievements and concurrent programming, flexibility

in USAID programming, and strong government

leadership and coordination is needed. The Standards-

Based Management and Recognition program was

an important driver of quality improvements in family

planning, emergency obstetric care, and infection

prevention and control, and SBM-R recognition

represented high-quality services to health staff and

communities.

Evaluation recommendations include: target client

engagement throughout the continuum of care and

institutionalize functional referral systems (1.1), augment

support for integrated critical services for vulnerable

populations (1.2); support the Government of Guinea to

implement the Community Health Policy and integrate

community health services (2.1); strengthen community

engagement through supporting the community

action cycle, community groups and health posts

(2.2); strengthen social accountability for removing

financial, gender and cultural barriers for vulnerable

groups through addressing service fees and supporting

community health mutuals (2.3); require accountability,

leadership and ownership from implementing partners

for sustainability through results-based accountability

measures (3.1); align SBM-R with existing governmental

quality improvement measures and advocate for an

institutionalized quality improvement approach (3.2);

continue supporting the DHIS2 health information

system to achieve full implementation to facilitate

evidence-based decision making (3.3); scale up support

for pre-service midwifery and nursing education and

skills labs (3.4); strengthen facility-based equipment,

infrastructure, and supply management (3.5); leverage

USAID health sector investments for improved

collaboration, communication and impact between its

projects/activities and others in the health development

field (4.1); incorporate flexibility in project design, and

adapt implementation and outcome measures to

changing needs (4.2); design projects collaboratively

to increase ownership and devolve responsibility to

government partners (4.3); consider demonstrating the

full effectiveness of investment activities by prioritizing

depth of investment (4.4).

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Metadata

Abstract