It is difficult to assess the success of health projects funded by international aids or loans on the basis of outcome indicators (i.e., mortality, disability, morbidity and high risk rates) because the project evaluation designs are not valid. This is a consequence of not involving the project evaluator at the project design stage. However, judging from the sustainability of the interventions being tested it can be safely said that most of the projects are unsuccessful. After the conclusion of the projects, and project funds have dried up, the innovative initiatives stop and health workers return to their former ways of doing things.
The purpose of borrowing or accepting foreign funds is to improve the public health status through means of disease control interventions that are more effective, efficient and efficacious. National and international consultants are invited by international banks (e.g., ADB, WB), with technical assistance grants, to design projects. Or foreign sponsors (e.g., WHO, AusAID, IDRC) have their own consultants to design the projects. These consultants are expected to propose interventions that address the root cause of problems in disease control. Project failure usually starts at this stage because the consultants fail to recognize the core of the problems or, if they find the root cause, fall short of using the right concept to fix it. Generally, they propose popular interventions that are being used in other places that do not necessarily have a progressive theoretical and empirical footing.
Another cause of project malfunction is the mental attitude of bureaucrats at the central level. There are those who hold that loan/aid funds are in lieu of routine operational funds (not for pilot testing of innovative interventions). Sometimes one encounters attitudes of arrogance that blocks the acceptance of new ideas or of authoritarianism that arbitrarily change project interventions. At project sites one frequently comes across mind sets of unwillingness to participate in projects that are managed by other departments or of reluctance to deviate from customary practices. Pilot tested interventions are discontinued when there are no more honorariums for project related meetings, committees and activities. Projects that require community support (i.e., ”community empowerment” projects) are often fruitless because actual problems or traditions are not understood.
To avoid the above mentioned problems it is better if the Provincial Health Offices (which main task is to provide technical guidance) design projects that enhance the capability of the Municipal/District Health Offices (and their Technical Operational Units) in controlling priority diseases. The “substance-oriented” Functional Group (which consists of experts in fields related to Personal Health Care) ought to collaborate with the “process-oriented” Structural Staff (which consists of experts in fields related to Public Health Care, including MonEv experts) in formulating project proposals. The initiative to conduct a project should originate from the Provincial Health Office based on needs of the District/Municipal Health Offices in their respective jurisdictions. Through this arrangement the innovative projects become means to provide technical guidance.