m-M PERU FINAL EVALUATION REHABILITATION AND RECONSTRUCTION OF THE HEALTH INFRASTRUCTURE IN SOUTHERN PERU Contact person: ADRA Peru Anthony Stahl. Country Director Mailing address: Av. Angarnos Oeste 770, Miraflores Lima 18 Peru Phone number: (51 1) 121 3-7700 Fax: (51 1) 213-7710 r --:I. A-,.,,=,-A.- -.- -- ADRA - PERO PROJECT: "REHABILITATION AND RECONSTRUCTION OF THE INFRASTRUCTURE OF HEALTH IN THE SOUTHERN PERU ". PROJECT (RRHI) FINAL EVALUATION Consultant: Eng0 Nemesio Canelo Almeida October, 2003 Lima - Pet6 ADRA-Peru RRIS PROJECT Final Evaluation FINAL EVALUATION OF RRIS PROJECT FINAL REPORT CONTENT 1. EXECUTIVE SUMMARY .............. ... .......................................................... 6 2. PURPOSE OF EVALUATION WORK AND REQUIRED INVESTIGATIONS ....... .............................................. 8 3. FINDINGS AND CONCLUSIONS ................................................................ 11 3.1 Repair and Reconstruction Component of the Health Infrastructure .............. ................................................................. I1 3.1 .I Samples and Analysis Record 3.1.2 Main Findings in the Component 1 3.1.3 Conclusions of the Evaluation of Component 1 3.2 Reinforce Component of the Baseorganizations 36 3.2.1 Samples and Analysis Record 3.2.2 Main Findings in the Component 2 3.2.3 Conclusions of the Evaluation of Component 2 4. LEARNED LESSONS 58 5. RECOMENDATIONS 59 6. GLOSSARY ................................................................................................. 60 7. BIBLIOGRAPHY .......................................................................................... 62 ADRA-PerG RRIS PROJECT Final Evaluation ANNEXES Annex 1 Annex 2 Annex 3 Annex 4 Annex 5 Annex 6 Annex 7 Annex 8 Annex 9 Annex 10 : Terms of Reference : Framework of the technical team of evaluation : Used Methodology : Composition of the technical team of evaluation and professional experience : Relation of visited places : Relation of checked documents : Relation of strategic plans of development : Relation of interviewee persons : Photo report : Index cards formats of surveys ADRA-Peru RRIS PROJECT Final Evaluation PRELIMINARY CONSIDERATIONS The Technical Team of Evaluation, constituted by the Master Degree in Regional and Urban Planning, expert in regional development with experience in participating process in prevention and relieve of disasters, Civil Eng. Nemesio Canelo Almeida; the expert Physician in Public Health System, Dr. Victor Manuel Cruz Boullosa; the Econ. Daniel Alberto Benvenutto Mavila, expert in projects of evaluation, and the Civil Eng. Jose Trujillo Cerna, expert in structural evaluation in the prevention and relieve of disasters; under the leadership of the first, assumed on June 05, 2003 the agreement with ADRA-PERU in order to carry out the final evaluation of the RRIS project in the deadline and according to the reference terms arranged and allocated in the proposal of technical services of Consultancy that the team invited by ADRA- PER^^ presented. It is important to remark that the proposal conditions in the work plan of the team of evaluation that was agreed by ADRA-Peru, they could not be satisfied at all, insofar as almost all the personal of this field -work resident engineers and promotion facilitators of the reinforce of the base organizations- that labored in the project and which information of a good level and support in an appropriate call and preliminary coordination with the beneficiaries and authorities in the field was important, when they finished their functions nor work for the project neither lived in the work places and achievement to evaluate; except for the interviews with the Manager of the Project, Eng. Victor Huazman Baldeon, the coordinator of the Reinforce component of the Base Organizations, Lic. Nancy Vega, the coordinator of the Strategic Plans of Development, Eng. Henry Leiva, the Arch. Orfa Beltran and the Eng. Ferrer Canaza Rojas, coordinator of the technical work of project field, who led and came with the team of evaluation in the inspection trip conscientiously, calling and coordinating the interviews and meetings of workshop that were required, which ones was executed without enough advance and there were not a lot of people like they thought, specially of the local authorities, the calling was at the last time without any advance and the complaint and uncomfortable of the locals everyday. As a result of documentation exam by ADRA-PERU available to the team of evaluation, interviews with the responsible employees of the project, visual examination, surveys, field workshops with authorities and beneficiaries of the involved localities, directly executed by the technical team of evaluation in the express trip carried out on June 18 to 25, 2003 about the according sample with ADRA-Peru, arrived to the conclusions that presents this report. The agreed sample covered 10 of the 30 health centers, constitute 33% of the world, statistically important number; and 8 of the 14 health nets intervened for the project; in 10 of 23 districts of 7 of the 11 provinces of the 4 South departments of Peru damaged for the earthquake on June 23,2001 (Ayacucho, Arequipa, Moquegua and Tacna). RRIS PROJECT Final Evaluation This sample, agreed with ADRA-Peru, was chosen to try to inspect representatives localities in different areas that was damaged; in this way, it chose three health centers of rural localities of the southern high mountain range of Ayacucho -*CS Chaviiia, PS Carhuanilla and PS Salla Salla-, one of urban area of the north low mountain range of Arequipa -*CS Caraveli- one of the urban marginal area of the Arequipa city -PS El Porvenir-, one of the rural area of the low mountain range of Moquegua -*PS Yacango-, one of the urban area of Moquegua city -*CS 28 de Julio-, one of the urban area of the north high mountain range of Tacna -*CS Candarave-, one of the rural area of the north low mountain range of Tacna - *PS Curibaya- and one of the urban marginal area of Tacna city -PS Juan Velasco Alvarado-. Furthermore, it was considered in the selection the practical convenience of the route of trip follows in the visual examination. * CS (Health Center) * PS ( Health Post) ADRA-Pert RRIS PR03ECT Final Evaluation 1. EXECUTIVE SUMMARY 1.1 MAIN FINDINGS AND CONCLUSIONS ADRA-Peru executed and the MINSA was in charge to the reception 28 (1) of the 30 health centers programmed in the project. The works delivered appear satisfactorily performed by ADRA-Peru, according to the establish specifications in the project, included plumbing, electrical installation and internal nets of water, drainage and electricity. The direct investment programmed in order to performe the works of the 28 centers was US$ 677,511.89 (1); 65% of US$ 1'048,108 estimated for the infrastructure (2). The amount of the clearance sales to the works is US$ 1'069,522.13, including the contributions of the community, something else of that estimated for this matter. In the localities of the most inspected centers we observed that exists faults in the public supplies of water andlor electricity to these centers, so this affect the correct working. In none of the centers exist hot provision of water, although is not required in the specifications of the MINSA, therefore, has not been responsibility of ADRA-PERU providing it, in the high mountain ranges constitutes a necessary comfort because of climatic conditions In two of the reconstructed centers which ones 10 are inspected, appeared some cracks (slight cracks) (3) that would deserve a greater exam of the performance of the plot. ADRA-Peru have achieved to qualify, in self-construction, to beneficiaries involved of each locality and some of them are applying the knowledges and learned technical. ADRA-Peru have executed satisfactorily the reinforced activities of the base organizations according to the mention plan, so ADRA-Peru made an anticipated investment of US$426,768 (2). It has achieved to constitute andlor stimulate the Local Committees of Health for each health center, committees that would have to assume also the function of development as Local Committees of Health and Development; but the majority have decreased its activity to be removed the support of the project by the period of the works. Even thus, it is noticed that ADRA-PERU achieved significantly to sow "seeds of development attitude ". It has achieved that all the localities count on strategic plans of development assumed by authorities. They were formulated in a participatory way under the conduction of technicians of ADRA-PERU, achieving with it the identification of the community which the same The beneficiaries are satisfied with all the aspects of the execution project and grateful with ADRA-PERU, expecting that the aid go on. In general, ADRA-Peru has executed the project satisfactorily, carrying out the activities and goals of competence and achieving the purposes of the same one. The operating organization of decentralized type and the participatory strategy that applied they have been effective, giving flexibility and capacity of answer to the project management. RRIS PROJECT Final Evaluation 1.2 LEARNED LESSONS Avoid to build in plots that have slope andlor a bad capacity. The capacity restrictions of calling are greater in urban localities and in urban peripheries than in rural areas. The works of repair or reconstruction constitute good elements of motivation for the beneficiaries participation and the strengthening of their base organizations, although are not enough to guarantee their sustainability. The work of support and the training requires of greater time and persistence. 1.3 RECOMENDATIONS Stimulate and support the health centers equipment, beginning for the rehabilitated and reconstructed. Stimulate and support systems of Local Nets of Health and efficient Development and rationalized, as well as the sustainability of the Local Committees of Health, the Local Committees of Development and the permanent updating of the Local Strategic Plans of Development Control the performance of the plot and cracks that appear in the locals of the health centers in order to check any risk before future earthquakes, in view of the fact that these centers should be the last ones to collapse in the disasters. 1.4 COMMENTS For the team of evaluation is interesting, the fact that it will have constructed in some localities of few population and production, although the true is they were very isolated and with lack communication, local of health that have a simple framework around them, appear like out of proportion monuments that technically are not justified neither can maintain those localities by itself. In some cases there were lacked in the part of the competent authorities, a better analysis and rationalization of the health net that should attend them, something that is missed to the responsibility of ADRA-PERU in the project. ADRA-Perti RRIS PROJECT Final Evaluation 2. PURPOSE OF THE EVALUATION WORK AND REQUIRED INVESTIGATIONS In order to evaluate the performance of objectives and goals, the efficiency in the use of the resources, taking effect in the achievement of objectives, the effects and immediate impacts of the project and conditions of sustainability for findings and conclusions can recognize the learned lessons, in order to formulate the recommendations of the case, the team of evaluation developed the activity according to a work plan that included the exam of the available documentation refering to the project, interviews with the authorities and functionaries of the same one, as well as with the authorities and beneficiaries of the inspected localities and the visual examination of field in express trip to raise in a sample, surveys and to develop workshops that allow to obtain the necessary reliable information. To the visual examination and interviews, a sample from the world was selected to evaluate (chartla), with the resulting route of trip and localities to visit (See Map I), and was prepared questionnaires and charts (See appendix 10) which analyze and systematize the answers, in order to get all the findings and conclusions of evaluation required (See chart 1 b). As a result of the observations, interviews and workshops of the inspection trip, the information was obtained and that we show below. Chart la LIST OF HEALTH CENTERS INSPECTED BY NETSS AND SUB NETSS, DISTRICTS AND DEPARTAMENTS OF LOCATION ADRA-Perti RRlS PROJECT Final Evaluation Mrpa 1: uticacion de ettdecinientot de $dud inspeccionados y ~ta de we EVALUACI~N ~NAL -RISS￾RUTA DE VlAJE DE lNSPECCl6N 0 EWefhietoodedldinapecdarados r ~baewkhiatorddprogana~~~ RIB de EdeMertcede %id Udadar pMRp\isrdeaocba RRIS Project Final Evaluation Chart lb FINAL EVALUATION - OPERATING CAPACITY OF INFRASTRUCTURE HEALTH CENTER WORK BEFORE CS CliAVlnA 1 Repair 1 . Damaged by earthquak, P.S. . Building borrowed CARHUANILLA Reconstruction . Damaged by earthquake I SALLA '~econslrucuon Inapproprlale Butldmg SALLA Damagea by eartnqdaue P.S. EL PORVENIR Near Building Reconstruction . own - operating P.S. YACANGO Repair . Unsatisfactory C.S. DE Reconstruction . Operating JULIO C.S. CANDARAVE Repair There not modifications P.S. CURIBAYA Reconstruction . Cracks PS JUAN 1 I . A community borrowed VELASCO Reconstruction . A lot of ALVARADO Useful Pmmpt date life I April I I 2003 02 month! larch I I 2003 03 month! I larch 11 20031 February 19 2003 1 04 month! March 2003 O3 month Marc:$3 aj month! April 04 02 month! Infrastructure FTER Requirements Lack of safety in the external suo~lies . . of water and electricity. . Right - Buildinq - It needs an extension. . Lack of residence and water. Generator. Lack of light. Lack of light. Generator The current is too small Lack of space. Lack of water. More appropriate . More appropriate More appropriate Built. Unoccupied Lack of water and drain More appropnate There are not enviroment and adaptation. RRIS Pmject Final Evaluation 3. FINDINGS AND CONCLUSIONS As a result of: I) the exam of the documentation refers to the project done by ADRA-PERU available to the team of evaluation; 2 ) the interviews that then facilitated with its authorities in the project, its two Coordinators - the component of repair and reconstruction of the infrastructure and the strengthening component-of local organizations, as well as with its coordinator of strategic plans, some of its residents engineers of work and faclititators ;and 3) the visual examination, surveys and workshops of field executed directly by the technical team of evaluation in the express trip carried out on June 18 to25 2003, about the according to sample with ADRA-Peru, covered 10 of the 30 health centers and 8 of the 14 health nets intervened for the project, in 10 of the 23 districts of the 7 which 1 I provinces of the 4 South departments of Pen3 damaged by the earthquake June 23, 2001 (Ayacucho, Arequipa, Moquegua and Tacna) damaged by the earthquake of June 23, 2001. it managed to the following main findings and conclusions 3.1 COMPONENT 1 - REPAIR AND RECONSTRUCTION OF THE HEALTH INFRASTRUCTURE 3.1.1 SAMPLE AND ANALYSIS OF THE RECORD The following charts show the obtained records and its analysis, with findings, conclusions and recommendations for each inspected health center. I) "CHAVINA" Health Center REPAIR - "CHAVINA" HEAL JH CENTER AYACUCHO - Chaviria Micro Net Ayacucho -Micro Red Charin. \ I hRQUITCCTURI I ESTRUCTURAS I RRIS Pmject Final Evaluation FINDINGS: According to the Chart repairs made in Chaviiia CS (Health Center) (reinforcing ceiling and cleaning up of damaged walls) have been made as stipulated in the technical file. We remark that exists finishes having faults, the restrooms have problems of lacking public supplies of water and systems, and restrictions in the electricity, in this case that aspects of repair were not responsibility of ADRA-Peru neither were in the technical file of them; those should be seen by other regular agents to the repair. CONCLUSIONS: ADRA-Peru have executed satisfactorilly with the technical file stipulated. However, the center is not operating due to the faults mentioned in the findings. LEARNED LESSONS: The partial repair of the center have not allowed to stay working correctly. RECOMENDATIONS: To promote the repairs of damaged finishes and deficients installations with an appropriate maintenance, as well as improvement of the regular supplies of public net of water and electricity that allow the full work of the center. 2) 'CARHUANILLA Health Post Chart 3a ACABAWS AKQUITECTONICOS - PUESTO DE S&UD " CARHUANILLA " lndloe I I CUMPLE NORMA BUENO I NO CUMPLE NORMA REGULAR ADRA-Perb RRIS Pmject Final Evaluation Chart 3b ELECTRICAL INSTALLATIONS OF "CARHUANILLAS HEALTH CENTER IUP RRIS Project Final Evaluation Chart 3c HEALTH INSTALLATIONS - CARHUNANILLA HEALTH POST INSTALACIONES SANlTARlAS - P I APARATOS Y ACCEORIOS Indice I 1 CUMPLE NORMA I NO CUMPLE NORMA .CARHUANILLA VARIOS I FINDINGS: According to the charts figure the executed reconstruction in the PS Health Post) Carhuanilla have been made as stipulated in the technical file. We remark that there are not connection of water because the public net of this not reach the health Post and there are restrictions in electricity, aspects that were not responsibility of ADRA-Peru neither were included in the technical file of them because the reconstruction was responsibility to the other regular agents. CONCLUSIONS: ADRA-Peru have executed satisfactorily with the technical file stipulated. However, the center is not operating due to the faults mentioned in the findings. LEARNED LESSONS: The reconstruction of the center without a correct conexion to main services guaranteed have not allowed to stay working correctly. RECOMENDATIONS: Stimulate the early extension and conexion of the public net of drinking water to the health Post and the settle of the faults in the electricity. 3) "SALLA SALLA" Health Post RRIS Project Final Evaluation Chart 4a ARCHITECTONICAL FINISHES- "SALLA SALLA" HEALTH CENTER RRIS Project Final Evaluation Chart 4b Indice I I CUMPLE NORMA A I NOCUMPLENORMA Enado I Casmtr v fumcnamlenlo B I BUENO R I REGULAR RRIS P~J& Final Evaluation Chart 4c LNSTALACIONES SANlTARlAS - P.S. SALLA SALLA r\ I wA 105 Y ACCESORIOS ",? ,-r ," " ~d 2 %, 5% Y u cz ZT: $2 a￾5 :$ rr : 3 zz :$ E IMloe I I CUMPLE NORMA I NO CUMPLE NORMA FINDINGS: According to the charts figure that the reconstruction executed in the PS (Health Post) Salla Salla has been made as stipulated in the technical file. We remark that it has not regular electricity, replace it with a generator of restrited capacity and an operating high cost. The center was not available to the trip date of inspection, despite being delivered the work on March I I. 2003 (1 ). CONCLUSIONS: ADRA-Peru has executed satisfactorily with the technical file stipulated. However, the center is not operating due to the faults of electrical public supplies, do not have responsibility of ADRA-Peru. LEARNED LESSONS: The reconstruction of the center without a correct regular electrical supply restrict its operating capacity. RECOMENDATIONS: To stimulate and support the early authorization of a regular electrical supply for the center. RRIS Project Final Evaluation 4) "CARAVEL(" Health Center Chart 5 G3LzmMu FINDINGS: According to the chart figures that the repairs executed in the CS (Health Center) Caraveli (repair and strengthening of the structure) have not been made at all as stipulated in the technical file. The resident engineer communicate to the modifications are supported in the respective file of work. An old building was demolished through the project because the earthquake on June 23,2003 left it in a risky conditions, reduced with it the physical area of the center in order to its function and operation, which has caused demand of the personnel of the health center. The center is working, but it has faults in space and water supply; these things are responsability of other agents nor of ADRA-PERU neither the project RRIS. CONCLUSIONS: ADRA-Per~i has repaired satisfactorily the center considered the technical file stipulated; this was modified in some parties by the responsibles of the work, who justified the changes in the respective file. The reduction of physical area caused the destruction that was executed during the implementation , it has restricted the work of possibilities in the health center and faults in the water supply need to be resolved. RRIS Project Final Evalualion LEARNED LESSONS: An exact knowledge of condition is required in the repairs structure in order to avoid modifications in the technical file of execution. The demolition of the old building answered to a technical criteria of security, this fact should be suitable socilaize in order to avoid discomfort and demand of the involved people and the repair project should be justified the neccesity and not the reconstruction. RECOMENDATIONS: Technically it should be evaluated the essential of the replacement of the physical area demolished of the health center and resolve the faults in the water supply. 5) "EL PORVENIR Health Post Chart 6a ARCHITECTONICAL FINISHES - "EL PORVENIR - MIRAFLORES" HEALTH POST DNlWS - PUESTO DE SLILUD " EL WRMNlR - MIWLORES" Idae 1 I CUMPLE NORM I NOCUMRENORM4 Eslajo I Conr~v=#iny ivuammeno B I BUENO R I REGUM M I M4LO RRIS Pmject Final Evaluation Chart 6b lWSTALAClONESP Chart 6c ADRA-Peni RRIS project Final Evaluation FINDINGS: According to the chart figures that the reconstruction executed in the PS (Health Post) El Powenir has been made as stipulated in the technical file. The center is avalaible since April 2003 and this has its old building additionally that was not demolished, near to the new construction. The height of the boundary walls enclose the plot of the center does not offer the enough security to the area where is located. CONCLUSIONS: ADRA-Peru has executed satisfactorily with the technical file stipulated. LEARNED LESSONS: A right working project leads to right results, as well as it is detached of this work. But it should take in consideration the characteristics of the environment in order to expect an approprite security. RECOMENDATIONS: To Give to the center a great security system before robberies and intromisiones strange. Provide hot water to the restrooms 6) "YACANGO Health Post Chart 7a ACABAWS ARQUITECTONICOS - PUESTO DE SALUD " YACANGO " indlae I Estad Ccrservautr luncrmm8ento I CUMPLE NORMA BUENO A I NOCUMPLE NORMA REGULAR RRIS Pmject Final Evaluation Chart 7b Chart 7c INSTALACIONES SANITARIAS - YACANGO APARATOS Y ACCESORIOS VARIOS ?: - 2 < x - Y ? RRIS Project Final Evaluation FINDINGS: According to the chart figures that the reconstruction PS (Health Center) Yacango has been executed at all and the center is available. We remark some slight craks in the walls of the back center, which apparently structure was not implicated. The reconstruction has been made on a plot unresolved. It has not had an enough pressure in the water supply, also is not constant, and this is not responsability of ADRA-Peru. CONCLUSIONS: ADRA-Peru has executed satisfactorily with the technical file stipulated. LEARNED LESSONS: In order to execute a right work, it should have in consideration all the characteristics of the plot, not only its admisible capacity but also its leveling, consider the technical regulations that exist for it. (4). RECOMENDATIONS: It is convenient to carry out a regular control of the crack conditions found in order to discover if these increase in time and check the performance of the retaining wall. 7) "28 DE JULIO" Health Center Chart 8a ARCHITECTONICAL FINISHES - "28 DE JULIO" HEALTH CENTER ADRA-Perti RRIS ~mject Final Evaluation Chart 8b IWdioe I CUMPLE CON EXRGiENTE TECNiCO 0 I 53 A 1 NO BUENO REGUM .a*, n Chart 8c I APARITOS V ACCESOWOS Eslado Comwau6n fumonamiento WENO REGULAR M MALO RRIS Project Final Evaluation FINDINGS: The repair of the 28 de Julio CS (Helath Center) is finished, the building is available and according to the charts figure that have been executed following the stipulated in the technical file. We remark some faults in the sanitary installations, aspects that in this case of repair does not have responsibility of ADRA-Penj neither were included in the technical file of them; those should be seen by other regular agents to the repair. CONCLUSIONS: ADRA-Peru has executed satisfactorily with the technical file stipulated. The faults in the sanitary installations were not a reason of the stipulation. Due to the old building and faults in the pipes might be caused by the damp in some walls. LEARNED LESSONS: In the case of repairs should take in consideration the old building and check the condition of healh installations. RECOMENDATIONS: In the maintenance of the building will be identify the reasons of the damp of walls damaged in order to be repaired. 8) "CANDARAVE" Health Center Chart 9a RRIS Project Final Evaluation FINDINGS: According to the chart figures that the reconstruction executed in the Candarave CS (Health Post) has been made as stipulated in the technical file. This is completely finished, although is not available, because of lacking of drain and water supply. It is located around five hundred meters of distance from the old, survival and operating health center; in advanced place to the construction of a future support hospital of the Candarave net and there are not yet nets of drink water and drain of the localities. The people refer to have the technical file for its extension, but its execution is not finished. CONCLUSIONS: ADRA-Peru has executed satisfactorily with the technical file stipulated. LEARNED LESSONS: A right working project leads to fight results, as well as it is detached of this work, but it should not ignore the conexions requiredto the nets of rnainservices. RECOMENDATIONS: Implement to shorter term the extension of public nets of drain and water required by the center. Without use and any maintenance this building is damaged very fast. 9) "CURIBAYA" Health Post Chart 10 RDI*BILIT*CIOY-giTQ~- Tacm - Yicm Rad C.nd.nve I\ I DRaUITECrURa I lndse . I EPECAEME TECNlCO -mmE A I NO CUMPLE RRIS Project Final Evaluation FINDINGS: The repair of the Curibaya PS (Health Post) is finished and the center is working. According to the charts, figure that the repair executed has been made as stipulated in the technical file; but there are lacking of appropriate and regular water supplies and electricity, do not have responsability of ADRA-Penj. It shows damp and frost in the external surface sand of some walls and there are cracks which apparently structure was not implicated. CONCLUSIONS: ADRA-Peru has executed satisfactorily with the technical file stipulated. LEARNED LESSONS: In the case of repairs should consider the old of the factory and check the right conditions of their installations, specially the sanitary. RECOMENDATIONS: Provide an appropriate and regular water supplies and electricity to this center. It is convenient to watch the evolution of the cracks detected to a possible rectify and check the reason of damp in order to be repaired. 10) "JUAN VELASCO ALVARADO Health Post Chart ila ARCHITECTONICAL FINISHES - "JUAN VELASCO HEALTH CENTER ACABADOS ARQUITECTONICOS - PUESTO DF S&UD "JUAN= lndlce I 0 I CUMPLE NORMA I NO CUMPLE NORMA RRIS Project Final Evaluation Chart Ilb MSIbLh~'2SPeSgg;WAN;WYEUSC0 I I Chart llc INSTALACIONES SANlTARlAS - P.S. JUAN VELASCO ADRA- per^ RRIS Project Final Evaluation FINDINGS: The reconstruction of the Juan Velasco Alvarado PS (Health Post) has been finished and the center looks new and completely finished, it is in intense use. According to the charts figure that the reconstruction executed has been made as stipulated in the technical file. Nevertheless, it has appeared cracks in the work that deserve to be checked. CONCLUSIONS: ADRA-Peru has executed satisfactorily with the technical file stipulated; but it is neccesary check if the cracks remarked are origined by settling that could damage the structure in prediction of earthquake. LEARNED LESSONS: To look for the best plots for the centers, as the health centers just in cases of emergency must be the last in standstill and in the case of lacking options, maximize the cautions about the floor suitability and lay the foundations required. RECOMENDATIONS: Doing an inspection more specified about the cracks remarked in order to stablish their reasons and if they could compromise possibly the structure contidions before future earthquakes. MAIN DISCOVERIES IN THE COMPONENT 1 In general, for the Component 1 we obtained the followinfgs findings: 1. It has repaired and MINSA has received the 15 center stipulated (5 health center and 10 health Posts) and it has reconstructed and MINSA has received, 13 of 15 centers stipulated (2 of 4 health centers and 11 health Posts). The Health Center of Ilabaya, province Jorge Basadre of Tacna has not been reconstructed yet, and it concerns to Health Center of Puquina in the province Gral. Sanchez Cerro de Moquegua, it has not been authorized to the team of evaluation the respective agreement of work reception by MINSA. 2. According to the agreement of work reception, for 28 certers executed and delivered to MINSA, the investment stipulated was US$ 677,511.89, with US$ 199.330,69 being allocated to repairs and US$ 478.181.20 to reconstructions (average of US$ 293.33 per roofed square meter). This amount represents the 65% of the investment US$ 1'048,108 that ADRA-Peru budget for this component. The total amount of the final payment of the work rise to US$ 1'069,522.13, belong 80% to direct costs, 15% to indirects costs and 4% of community contributions. The 77% of this final payment are covered by the reconstruction work, which is registered a direct total cost of US$ 571,452.84, with an average cost of US$ 350.54 per roofed square meter. See Charts 12a, 12b y 12c. ADRA-Peru RRIS Project Final Evaluation 3. There was a sample inspected, the 6 reconstructed look better than the 4 rehabilitated. The reconstructed appear completely news and finished, with appropriate and right finishes (5 are in use and one expect to be inagurated); as long as the rehabilitated appear strengthen in the actual infrastructure, but some faults are showed in the finishes, in the sanitary services and in parts not structural, elements that have not been stipulated to rehabilitate with the project. 4. Two of the centers reconstructed from 10 inspected, there have been appeared some cracks on the walls. Chart 12.a Prices of estimated investment in Repair, Reconstruction and indicators od disposal - cost COSTOS DE INVERSlbN PRESUPUESTADA EN REHABILITAC16N Y RECONSTRUCClbN E INDICADORES DE COSTO-EFECTIVIDAD N. TWO DIFAITAUINW LDC&IDADI EST* rrawea SI rrwp.esa US% se.mnlrm 1.1 $WIT0 lbl I I I Area promedio por establecimiento reconstruida (m2) = 125.40 Area total por 13 estabieeimientas reconstruidas (m2) = 1.63020 US$ i m2 de area techada de establecimiento reconstruido = 283.33 NOTAS: (a) Tipo de obra: rc = reconstruccibn, rh = rehabiltacibn. (b) Tipo de cambio a1 15 de agorto de 2003 = 3,47 Si. i US$ (c) Descontando PS Varadero por falta de datos. (d) Descontando CS Puquina y CS llabaya. FUENTE: Act.% de recepcibn de obrar. Proyecto de Rehabilitacibn y Reconstruccibn 6e lnfraestructura de Salud en la Zana Sur del Per". Programa inicial Estadisticas de poblacibn de DlSAS 2004. MINSA. Oficina de Estadistica e lnformdtica. Normas de construccibn de establecimientas de salud de primer nivel. MINSA. RRIS Project Final Evaluation Chart 1Z.b LIQUIDATIONS VALUE OF REPAIR AND RECONSTRUCTION WORK OF HEALTH CENTERS VALOR DE LIQUIDACIONES DE OBRAS DE REHABlLITAC16N Y RECONSTRUCC16N DE ESTABLEClMiENTOS DE SALUD Tip de camb'o Sl.1$= 3.47 FUENTE: Liquidaciones de obras. Pmyedo RRIS - ADRA-PerO. Odubra, ZW3. RRIS Project Final Evaluation Chart 12.c COSTOS DE LIQUIDACION DE OBRAS EN REHABlLlTACl6N Y RECONSTRUCCION E INDICAWRES DE COSTO-EFECTIVIDAD TIp DsvmT*M ENTO LOCI\UD*DI ZSABLEEIMIZNTODR Llqul*rlnmUSf Dn#nei ~~mlm SUUD Ibi CostoDlrc6toUSI bnfldulol( US(D'r'nU I.) , kOfltlui0 I I I TOT ALES 1 3,111,241.19~ 1.~9,522.13( 2,588,232,861 745,888.431 53,830I 13.86 Area pmedio par establecimiento reconrwuido (m2) = 125.40 Area total par 13 es$bledmientos recmrhuidm(m2)= 1.63020 us$ direcloi m2 de Area techada de estabiedmiento recanshuido = 354.54 NOTAS: (a)Tipodeobra: rc = recmrtruaibn: ri~ = rehabillacibn. (b) Tipo de cambio a131 de dubre de 2003 = 3,47 SI. I US$ (c) So mn~ideran iosdalosdel Uladro 12a en lmcarmde Caavdi. Chavina. Ulivay e ilabaya. FUENTE: NcrmaJ de mnibucti~n de esmbletimientmderalud de primer nivei. MINSA informes de i$uidacibn de obar ADRA-Peru RRIS Project Final Evaluation 5. In 7 of the 0 centers inspected have been remarked that the regular public supplies of water and electricity have not been provided correctly, specially 3 of the South of Ayacucho to not be connected to the respective localities in the transmission lines of the Mantaro system (See Chart I b); all these requeriments do not responsibility of ADRA-Peru, just to the other regular agents in the project 6. In the centers inspected figure that has not exist hot water supply, although it has not been required in the specifications of MlNSA and, so, it has not been the responsibility of ADRA-Pert provided it, in the high mountains constitute a necessary confort to the climatic conditions. 7. In none of the health centers inspected do not exist preventive signs of security areas and evacuation before the risk of earthquake or fire. 8. In order to do the works it had to face up to the risk of proceed in some cases with the plots nor finished neither authorize with the connection to the nets of necessary mainsystems. 9. There was not complaints about the logistical support has been inappropriate and that it has been affected to the project results. 10. According to the references received the PRONIEN of MlNSA has executed its function to authorize the approval of the technical files to the works, as well as the supervision of these and reception, but the delay as in the approval of the technical files as in the appointment of the supervisors, damaged the begining of the works and that has originated delays in the execution. 11. The execution of the works counted on not much participation of the development and health local committees stimulated to the project, as well as the support of the local authorities and the health center motivated to the project. 12. There was not any financial attendance of the development and health local committees and the local authorities, to the works, but they help in some many cases, provide labor not qualified necessary and also offering food to the workers. 13. There was not any reference of difficulties with providing financial and material resources to the works. Las ejecutadas fueron concluidas en 10s plazos previstos como consta en las actas de entrega y recepcion de obras. 14. It has been verified that the components of the project worked with a correct join level, as it shows the narrow contribution of the development and health and the support of the local authorities and the health centers. Just it has been filed an imbalance as to the sub component of self construction, that was initiated late. RRIS Project Final Evaluation 15. According to the PRONIEM certification, all the interviews and researches done by beneficiaries involved in works, the materials and technology used for them as well as the health centers authorities, who received good statements with regard to the currently rules of the hospital architecture. 16. In general, there were statements of the inspected community of health localities that consider the work profits are adjustable to initials prospects and that deserves to feel proud of the successful changes. 17. According to the self-construction subcomponent, the registered statements of the volunteers express satisfaction with the innovative technology they learned and they also feel sorry for the suspension of the project and they still want to be supported. 18. There was an information about training in self-construction, that stated the good use of methodology to the target that has the same necessities and priorities, but it started late as well as the support material ready for the effect 19. The explanation and graphic illustration of why the abutments should be spaced in the structural frame of the columns that state in the manual prepared as a support for the training in self- construction with brick, led them into a technical mistake of wrong spacing. 20. The volunteers express that the measurement of proportions for the construction mixing taught in the training should be also expressed in useful units of measure for them; for example, cans instead of bags or wheelbarrows. 21. In general, there were statements that the committees of self-construction was built, but they do not continue working. 22. In general, there were some statements expressed, that the training volunteers apply the acquired knowledge in the construction of area, in the housing program as the material bank, using the technical construction with brick as a favorite. 3.1.3. CONCLUSIONS OF THE EVALUATION OF COMPONENT 1 1. In general terms, according to the reviewed sample, the infrastructure component has been done satisfactory by ADRA - Peru. The beneficiaries and their representatives think that generated profits by works coincide with their initial expectancies, they feel proud of the acquired changes and show satisfied because of executed works, used materials and technology,claiming to the continue support. Likewise,MINSA is satisfied by the suitable architectonical regulation performanced. RRIS Project Final Evaluation 2. The works were done according to the scheduled technical files, except the work did in Health Center of " Caraveli ", where there were justified changes, assumed by the resident engineer of the work. 3. The cracks on walls of some inspected reconstructed health centers could be caused by the ground behaviour and it will require a major exam in order to determine if it offers a risk. 4. The health centers that were inspected cannot guarantee hygiene, asepsis, air conditioning that require a good working because of the current faults in the mainservices supplies ( water, electricity and the indisposition of hot water, that it is necessary in some geographical areas. 5. The health centers that were inspected do not offer enough security because of the lack of preventive signs of its security and evaluated zones in case of disasters. 6. The work execution suffers a surcharge of non-scheduled labor, so in some cases it has to be replaced the deficiencies or slowness delivery of cleaned up plot. 7. The logistic support was suitable for the activities, that we did, answering with requeriments for the work execution, except in the training for the self building, where the manuals were given late. 8. PRONIEM affords consultancy for the performance of technical files when it is necessary, with the approval of themselves, also with the work supervision, and receipt, however its delay in the approval of files and its delay in the appointment of supervisors, affected the work beginning and delayed its execution. 9. The local committees of health and development establishments stimulated for the project, participated closely in the work execution. The local authorities of the local establishment gave their support regularly. 10. Even though neither local autorities nor local committees of health and development gave financial support to the work execution , the last ones colaborated with non qualified labor and with food supply for workers. 11. The works in general, were finished in certain period and there weren't difficulties in the appropiate provision of human, financial material resources; even though in some cases were delays in the beginning of some works and day pay becauseof reorganization that was the result of delays from PRONIEM in the approval of technical files and tha appointment of supervisors. RRlS Project Final Evaluation 12. We can reasure that the projet achieved its goals satisfactory relative to the cost. In 13 of the 15 built establishments budgeted a total direct investment of US$ 478.181,20 for an average roofted area of 125.4 m2 per establishment with an average investment of US$293.33 m2 per roofied area. In the final payment of works, the total direct cost was US$ 350.54 per roofted m2, so this cost is reazonable considering the construction rules and the dificulty of material transportation. See chart 12a, 12b and 12c. 13.Checking these gauges with respect of the total quantity of benificiaries of reconstruction subcomponent. There is also a suitable result : considering a total of 30.394 beneficiaries. We obtain an average cost per place, that ranges between US$ 6.05 in Porvenir PS (Health Post) (Miraflores. Arequipa) and US$ 86.13 in Santa Rosa PC (Tacna. Tacna). Tthis variability is explained byy the differences of concentration of beneficiary people of each town. ( see chart 12c). 14. The cost of the restoration subcomponent amounts to US$ 174,435.59; there is also suitable gauges of effectivity per beneficiary according to the cost. Whereas for a benefiary population of 23.436 people, the cost per beneficiary is US$ 4.29 in Health Center the 28th july (Moquegua. Moquegua) and US$48.92 in Curibaya PS (Curibaya, Tacna). 15. The project components work with a good grade of incorporation, despite an initial imbalance of activities because of other causes unware of ADRA-Peru, such as the delivery delay of educational material of self-construction and the change of local authorities. 16. . The self-construction component did more or less its goal; it trained the beneficiaries with new technology , that apply the lessons in their locality, but the self-construction committees did not continue working. The support manuals for the training did not arrive on time, so there was not enough time in order to obtain sustainable results. 17. The support manual for the training with brick has a technical mistake in the spacing of gauges for the structural framework of columns that is important to correct. 3.2 COMPONENT 2 -STRENGTHENING OF BASE ORGANIZATIONS 3.2.1 REGISTER OF SAMPLE AND ANALYSIS The following diagrams show the analysis result of 82 surveys, that were inspected in workshops, so there was an opportunity to see that members of Health Local Committees, local authorities, health centers staff and involved beneficiaries answered questionaries, specially for them. (See appendixs 8,9 and 10). ADRA-Peru RRIS Project Final Evaluation The questionaries look for information, that allow to evaluate the achievements by RRIS project in order to reinforce local committees of development CLS, local net of development CLD, local committees of self-construction CAC, local strategic plan PEL and possibly, local programs of housing self-construction PACL, even though those are not specific goals of project; its creation, reinforcement in the training, energy of working and solidness. With master copies for the analysis of survey results we stimated the grade (from 0 -does not exist or null demonstration - to 5 - total consequence or maximum demonstration -) of symptomatic specific aspects; such as : To CLS: 1 If there was before the project and with what solidness and energy 2 If it laid down or revived in the project 3 If the members were elected in assemblys or meetings of involved beneficiaries 4 If there was cooperation and how was the magnitude with the repair and reconstruction of the health center 5 If there was cooperation and in what magnitude with others health programs its ES (Local Center), development and PEL (Local Strategic Plans)of its locality 6 If it still works with regularity and dedication 7 If it coordinates efficiently with the staff and authorities 8 If it participates and cooperates in the working of local nets of health 9 If it receives effective trainning of the project. To RLS: 10 If iit exists 11 If it is well-structured 12 If it works and 13 If the project contributedd to get better. To CLD: 14 If it exists before the project and with what solidness and energy. 15 If it establish or reborn with the project. 16 If it cooperates in the reality studies and contributes to PEL. 17 If it works with regularity and dedication. 18 If it receives effective training of the project. To RLD: 19 If it exists 20 If it is well-structured 21 If it works 22 If it contributes to PEL (Local Strategic Plans) and 23 If the project contributed to establish them or got them better ADRA-Peri RRIS Project Final Evaluation To PEL: 24 If it exists 25 If it is published and delivered 26 If the CLD (Local Committees of Development) participated in the production 27 If it prepared the project with technicians 28 If the project gave effective training to the effect 29 If PEL (Local Strategic Plans) proposed investment projects and 30 Until what level get those projects To GAC: 31 If is was created with the project 32 If it subsists 33 If it works and how good 34 If the project gave effective training and 35 If the knowledge they acquired is applied to their locality To PACL: 36 If it exists from before the project 37 If it exists because of the project 38 If it started to build houses 39 If it still exists constructed houses by them and 40 If it uses local resources. For each one of the above specific aspects and as a result of its examinations, surveys, inquires, workshops and analysis of the survey results, the evaluated staff graded its weight from 0 to 5 using their criterias and prefessional experience in the subject. This qualification was objectified in graphics buffeffly diagram for each one of 10 inspected localities that were the sample and that its reading allows to check the goals of the project in each one of them and stated below. ADRA-P~N RRIS hject Final Evaluation Estimated results in the strengthering of base organizations in different places around the inspected health centers: 1) "Chaviiia" Health Center, district of Sancos , province of Lucana, department of CLS (Local Committees of Health) were already created by RRIS Project in Chaviiia because of the acquired motivation, training and the selection by vote of the assembly. It contributed in the rehabilitation of CS (Health Centers) and in others health and development programs. It survives and works not so good because of the withdrawal of the project; its coordination with the authorities and CS (Health Centers) staff is occasionally. In the place exists health net, but seems neither good structured nor functional. The project has not a particular intervention in this area, that it is exclusive jurisdiction of MINSA. It cannot make the CLD (Local Committees of Development) and RLD (Local Nets of Development) up; in spite of the imparted motivation and training by the project. It was substituted for the CLS (Local Committees of Health) helping in the studies of reality and its contributions to PEL (Local Strategic Plans). The authorities assumed it with an active participation. The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This plan prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. Neither CAC (Local Committees of Self-construction) nor PACL (Local Programs of Houses Self-construction) exists, but with the given training in this area by the project, some involved beneficiaries are applying their knowledge as local constructions or in housing programs such as Materials Bank. XI 2) "Carhuanilla" Health Center, district of Chumpi , province of Parinawchas, department of Ayacucho. CLS (Local Nets of Health) were already created by RRlS Project in Carhuanilla because of the acquired motivation, AORLI-PERU EY~L~ACION RNAL DEL PROC~~~~ .Is training and the selection by vote of the assembly. It contributed a little in the reconstruction of PS (Health Posts) and in others health and development programs. It survives and works not so good because of the withdrawal of the project; its coordination with the authorities and CS (Health Centers) staff is occasionally. In the place exists health net, but seems neither good structured nor functional. It belongs to the existing health net, that seems insufficiently functional. The ~LD project has not a particular intervention in this case COMliE LOCliLDC SAIUD because it is an area of direct REDLOCAL Ot SALUD COMiTt LOCAL DE DLSARROLLO RLDLOCAL Dt DESIRHO! 10 jurisdiction of MINSA. It PLliN FSiRAiLGlCO LOCAL COMITF OE AUTUCONS~RUCC~ON cannot make the CLD (Local PROGHAMA DE AUlOCONSTRUCClON LOCAL DE VlVlENDnS Committees of Development) and RLD (Local Committes of Self-construction) up; in spite .SW il.rhm ~cw~t~~~~~~~~,~ RR CHUMPI WS-at,0 CHUUPI PP.,NC,,, WLINACOCULS of the imparted motivation and training by the project. It was substituted for the CLS (Local Nets of Health) helping in the studies of reality and its contributions to PEL (Local Strategic Plans). The authorities assumed it with an active participation. The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This plan prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. Neither CAC (Local Committees of Self-construction) nor PACL (Local Committees of Houses Self-construction) exists, but with the given training in this area by the project, some involved beneficiaries are applying their knowledge as local constructions or in housing programs such as Materials Bank. RRIS Project Flnal Evaluation 3) "Salla Salla" Health Post, district of Puyusca , province of Parinacochas, department of CLS (Local Committees of Health) were already created by RRIS Project in Salla Salla because of the acquired motivation, training and the selection by vote of the assembly. It contributed closely and actively in the reconstruction of PS Health Post) and in others health and development programs. It survives and works regularly and enthusiastic because of the withdrawal of the project; its coordination with the CS (Health Centers) staff is regular and constant.lt counts on a well-known local team leaders and respected by the community. In the place exists health net, but seems neither good structured nor functional.lt belongs to the existing health net, that seems not at all functional because of restrictions in its communication system. The project has not a particular intervention in this area, that it is exclusive jurisdiction of MINSA.. The CLD (Local Committees of Development) began to structure on the active local comminity organization, that was there for these goals, thanks to the given intervention and training by the project. Its contribution to districtal RLD (Local Nets of Development) setting-up began to shape up and activate at the same time.The CLS (Local Committees of Health) participation and the incipient participation of RLD (Local Nets of Development) colaborated carefully in the reality studies and contributed with PEL (Local Strategic Plans), that was assumed by local authorities with an active participation.The project has been prepared, published and given to the authorities and there was a publishment in process when it was inspected. This work prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. Neither CAC (Local Committees of Self-construction) nor PACL (Local Committees of Houses Self-construction) exist, but with the given training in this area by the project, some involved beneficiaries are applying profitaly their knowledge as local constructions or in housing programs sach as Materials Bank. 41 ADRA-Perti RRIS Pmject flnal Evaluation 4) "Caraveli" Health Center, district of Caraveli , province of Caraveli, department of Arequipa CLS (Local Commitytees of Health) were already created by RRIS Project in Caraveli because of the acquired motivation, training and the selection by vote of the assembly. It contributed in the rehabilitation of CS (Health Centers) and a little in others health and development programs. It survives and works not so good because of the withdrawal of the project; its coordination with the authorities and CS (Health Centers) staff is occasionally. In the place exists health net, but seems neither good structured nor functional. The project has not a particular intervention in this area, that it is exclusive jurisdiction area of MINSA. It cannot make tthe CLD (Local Committees of Development) and RLD (Local Nets of Development) up; in spite of the imparted motivation and trainig by the project. It was substituted for the CLS (Local Committees of Health) helping in the studies of reality and its contributions to PEL (Local Strategic Plans). The authorities assumed them with an active participation. The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This plan prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. Neither CAC (Local Committees of Self-construction) nor PACL (Local Programs of Houses Self-construction) exist, but with the given training in this area by the project 42 5) "El Po~enir" Health Post, district of Miraflores , province of Arequipa, department of Arequipa. CLS (Local Committees of Health) were already created by RRlS Project in Miraflores because of the acquired motivation, trainning and the selection by vote of the assembly. It contributed actively in the reconstruction of PS (Health Post) and in others health and development programs. It survives and works not so good because of the withdrawal of the project; its coordination with the authorities and CS (Health Center) staff is regular and close. It belongs to the existing health net, that seems good structured and functional. It cannot make the CLD (Local Committees of c.5 .. 'L . ,l,L%. R.5 :2:$>tCS:A. .37 ::.$~r.t, tC.1, m:.:w,kl.:.>, :l~W::,,"r<,.,?, Development) and the local wa a:<. 4,; rrwacg..:, *tl - .%" L.:.r13alCliF:.: ..YC1 setting-up RLD (Local Nets of cx ,07,! r: r'' ,. ,:c>.c<,j,+,,.L,.,<.,: "ACL I V.~::I,...V,~~:~ :..a~~~*<:.rt;~.cc.:~:-.<;~. .8~ ,(r,u!yz,.!, Development) up; in spite of the imparted motivation and training by the project. It was substituted for the CLS (Local ... ria-b. - . .::. UI&~~T,U. ::.L..:.mAF,..u5 ., ... .&#&,,,,A Committees of Health) helping in the studies of reality and its contributions to PEL (Local Strategic Plans). The authorities assumed it with an active participation. The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This plan prevents all1 the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. Neither CAC (Local Committees of Self-construction) nor PACL (Local Programs of Houses Self-construction) exist, but with the given training in this area by the project, some involved beneficiaries are applying their knowledge as local constructions or in housing programs sach as Materials Bank. ADRA-Peni RRIS Pmject Final Evaluation 6) "Yacango" Health Post, district of Torata , province of Mariscal Nieto. department of Moquegua. '<"A IIL'I. C",.il*< c* ,)*A; XL P"PiJIIYI""1, CLS (Local Committees of Health) were already created by RRIS Project in Yacango because of the acquired motivation, training and the selection by vote of the assembly. It contributed in the reconstruction of PS and in others health and development programs. It survives and works regularly because of the withdrawal of the project; its coordination with the . . ,. authorities and CS (Health Center) staff is regular.They count with ,. . , -.,, , .. some well-known and RLD active local leaders. The PS (Health Post) belongs (0,. .,., ,,*,:> , ..: to the health net seems "I, . .. .I I, :.A .... . .. well-structured WLU . . . , T ,. ., :.' ...,., s .., and "8 L >.., .,'.!,,~ .,,, ..., - 1-11: , , , ,. functioonal. It cannot "A. i:.1.1<.1 .,..... ... . ,:. I., make the CLD (Local Committees of Development) and the setting-up RLD (Local PSYACWP ,* . . R.WrnCUI. TWTA NncAL NlItO Nets of Development) up; in spite of the imparted motivation and training by the project. It was substituted for the CLS (Local Committees of Health) helping in the studies of reality and its contributions to PEL Local Strategic Plans). The authorities assumed it with an active participation. The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This plan prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. Neither CAC (Local Nets of Self-construction) nor PACL (Local Programs of Houses Self￾construction) exist, but with the given training in this area by the project, some involved beneficiaries are applying their knowledge using the local resources. ADRA-P~N RRIS Pmjert Final Evaluation 7) "28 de Julio" Health Center,district of Moquegua , province of Mariscal Nieto, department of Moquegua.. CLS (Local Committees of Health) were already created by RRIS Project in Moquegua because of the acquired motivation, trainning and the selection by vote of the assembly. It contributed in the rehabilitation of CS (Health Center) and actively in others heaith and development programs. It survives and works not so good because of the withdrawal of the project; its coordination with the authorities and CS (Health Center) staff is occasionally. It belongs to the existing health net, that well-structured and functional. It cannot make tthe CLD (Local Committees of Development) and RLD (Local Nets of Development) up; in spite of the imparted motivation and training by the project. It was substituted for the CLS Local Committees of Health) helping in the studies of reality and its contributions to PEL (Local Strategic Plans). The authorities assumed it with an active participation. The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This plan prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. Neither CAC (Local Committees of Self-construction) nor PACL (Local Programs of Houses Self-construction) exists, but with the given training in this area by the project, some involved beneficiaries are applying their knowledge as local constructions or in housing programs sach as Materials Bank. 45 ADRA-PetG RRIS project Final Evaluation 8) "Candarave" Health Center, district of Candarave , province of Candarave, department of Tacna. CLS (Local Committees of Development) were already created by RRIS Project in Candarave because of the acquired motivation, training and the selection by vote of the assembly. It contributed actively in the reconstruction of CS (Health Center) and in others health and development programs. It survives and works not so good because of the withdrawal of the project; its coordination with the authorities and CS (Health Center) staff is occasionally. In the place exists health net, but seems more or less structured and partiality functional. The project . . .. . , . . .. . . . . . , . . . . , .~ has any intervention in this area, that it is exclusive jurisdiction of MINSA. It can make tthe e CCDIJLI. r~uu~~*r :mamn cuw CLD (Local Committees of development) and RLD (Local Nets of Development) up, thanks to the imparted motivation, training by the projectand the active participation of local authorities in the trainning of PEL (Local Strategic Plans). The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This work prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project and/or profiles. Neither CAC (Local Committees of Self-construction) nor PACL (Local Programs of Houses Self-construction) exist, but with the given training in this area by the project, some involved beneficiaries are applying their knowledge using more the local resources in the construction of houses. 46 RRIS Project Final Evaluation 9) "Curibaya" Health Post ,district of Curibaya , province Tacna. ,.',L .,,. '.L,,. .:A?-., L.. r r. *.v.r*; of Candarave, department of CLS ( Local Committees of Health) in Curibaya were already created by RRIS Project in Curibaya because of the acquired motivation, training and the selection by vote of the assembly. It contributed actively in the rehabilitation of CS (Health Center) and a little in others health and development programs. It survives and works because of the withdrawal of the project; its coordination with the authorities and CS (Health Center) staff is occasionally and weak. In the place exists health net, but seems well￾structured and partiality functional. The project has any intervention in this area, that it is a responsability of MINSA. It cannot make the CLD (Local Committees of Development) and RLD (Local Nets of Development) up;in spite of the imparted motivation and training by the project. It was substituted a little bit for the CLS (Local Committees of Health) together with the colaboration in the reality studies and its contribution to PEL (Local Strategic Plans), that were assumed by local authorities with an active participation. The project has been prepared, published and given to the authorities and there was a publishment process when it was inspected. This work prevents all the prioritized projects by the population in the participating workshops, with the team contribution of ADRA in order to add technical specifications of the project andlor profiles. It was possible to establish, but it declined and worked weakly, The PACL (Local Programs of Houses Self-construction) do not exist anymore, but with the acquired training in this area, they applied their knowledge in construction in order to build some houses using more the local resources. 47 ADRA-Perti RRIS hoject Flnal Evalualion 10) "Juan Velasco Alvarado",Health Post ,district of alto de la Alianza , province of Tacna, department of Tacna. 11:II. WXII CLS (Local Committees of I .~.tri:n.i stur~ nc mlmrr !~5 Health) were already created by RRIS Project in Alto de la Alianza because of the acquired motivation, training and the selection by vote of the assembly. It contributed actively in the reconstruction of PS and a little in others health and development programs. It survives and works not so good because of the withdrawal of the project; its coordination with the CS staff is occasionally. The PS belongs to the current haelth net, that seems neither well￾structured nor functional. The project has any RLD participation in this area. that it is exclusive jurisdiction of MINSA. It cannot make strongly the CLD (Local Committees of Development) and local RLD (Local Nets of Development) up; in spite of the motivation, training by the projectlt was substitute spVLUL . R TlClU k&K TMH* by CLS. together with contribution in reality studies and the contributions to PEL. We can constitute more or less the CAC (Local Committees of Self-construction) and the PACL ( Local Programs of Houses Self-construction) do not exist anymore. Thanks to the taught training through the project in this area, some involved beneficiaries are applying their knowledge using more the local resources in local constructionsof houses as the Materials Bank. ADRA-Peru RRIS Project Final Evaluation 3.2.2 MAIN FINDINGS IN COMPONENT 2 Considering the restrictions in some areas, it is important to strengthen and create essential base organizations. Taking this point into consideration, the evaluated team caused good impression, because through the workshops and surveys we realized the aims project for the results stated below: a) With respect to the smooth running of the health center: 1. In the sample we realized that with the project t, MlNSA increased in 20% the number of staff welfare in the health centers. (See Chart 13). 2. On the other hand, in the own production we realized an increase of 30% , that confirms more attention, that will constitute an important effect of the project.(See Chart 14). 3. With respect to the nets system of health, with the project the relations between the health centers of differents levels of complexity of attention , did not change. Within the project functions was not consider any activity of health nets. It is recommendable to make suggestions that allow a good operating capacity of local nets of health (See Chart 15). 4. On the contrary, the health centers have been reconstructed and have increased its staff, but they did not have enough minimum equipments that make possible a suitable and efficient work. (See Chart 16) The analysis of comparison list of functional health centers and the chapters of results hold these conclusions; as well as interviews and surveys to the health satff and the community members. ADRA-Peh RRIS Project FIMI Evaluation Chart 13 FINAL EVALUATION - HUMAN RESOURCES STIMAlED BEFORE AFTER HEALTH CENTER guL LKE NUMBER OF POPULATION WCTW NURSES -S THmCUNS WCTMS NURSES OBmTRIM TECmM WCTORS P.S. CARHUANILLA 03 MONTHS 478 1 1 P.S. SALLA SALLA VOT YET IN USA 206 1 1 I C.S. EL PORVENIR 1 02 MONTHS 1 3708 1 I 1 I 1111111 Il21 C.S. YACANCO 02 MONTHS 743 1 2 0.5 ONCEA WEEK 1 P.S. SAN FRANCISCO 06 MONTHS 3357 1 1 1 3 1 2 3 4 1 I P.S. CURIBAYA I 1 204 1 111 111 111 111 P.S. JUAN VELASCO 08 MONTHS ALVARADO 4772 1 1 1 2 1 1 1 3 1 - Dentist Dsntirt TOTAL: 9 11 7 1 20 1 10.5 1 12 1 10 24 l3 101 1 0 NOTE: After all the works are ready, the Ministety of Health will contribute giving mom human resources in sme inspected establishments in order to develop welfare performance, such as El powenir CS (Health Center), Yacango PS (Health Post). San Francisco PS (Health Post) and Juan Velasco Alvarado PS (Health Post). To sum up, the health staff have been increased if the inspaaed establishments. ADRA-Perfi RRIS Project Final Evaluation Chart 14 HEALTH CENTERS CARHUANlLLA H.S. SALLA SALLA H.S. CARAVEU H.C. EL PORVENIR H.C. YACANCO H.C. SAN FRANCISCO H.S. CANDARAVE H.C. CURIBAYA H.S. UAN VELASCO LVARADO H.S. USEFUL LIFE OF 02 MONTHS 1 743 1 4 1 141 I I I I 01 YEAR 02 MONTHS STIMATED OF POPULATION 3907 3708 06 MONTHS 08 MONTHS (a) Bdongs to a reference information of heaith center. It is impossible to compare them because they show different period of times and do not have direct relation with the offered attention. (') There is attention in old health centers. HC = Health Center A = Address NOTE: There is an increase of 30% in the production of heaith centers of sample, that is comfirms he extensive coverage of attention, considering as an important effect of the prqect. 51 BEFORE 40 15 3357 21 50 I ATTENTION /DAY 4772 TOTAL: AFTER SIMIHC IIMIA 8 10 CHlLBlRTHS (a) BEFORE - AFTER DIFFERENCE 20 119 DECEASES (a) DECEASES (a) ATTENTDN ~AY ATTENTDNS /DAY 21 2o02 5 24 CHILDBIRTHS (6) 40 155 CHILDBIRTHS (a) 40 20 8 -1OlA 20 36 DECEASES (a) 32 12 10 (') 14 3 2003 111HC 2iA 5 1 4 RlUS Pmject Final Evaluation Chart IS FINAL EVALUATION -NET SYSTEM Considerando el nivei de complejidad de lo5 establecirnientos de la muesta y su relacion dentm de fa red de salud, apreciamoa we con el pmpm esto no ha varbda sustancialmente. Es impoltante que en futum ~rovectos w considere el accionar de la establecimientos intewenidas cam fmndo Dalte de una red de dud que es muy imwrbnte wratwizar. ADRA-Peni RRXS Project Final Evaluation Chart 16 FINAL EVALUATION - EQUIPMENT [ HEALTH CENTER I SALLA SALU H.S. I CARAVEL1 H.C. 1 EL PORVENIR H.C YACANCO H.C. 28 DE JULIO H.C. 1 CANDARAVE H.C, L CURIBAYA H.S. I JUAN VELASCO ALVARADO H.S. WORK 1 BEFORE REHABILITATION RECONSTRUCTION RECONSTRUCTION REHABlLlTAClON RECONSTRUCTION REHABlL!TATlON RECONSTRUCTION RECONSTRUCTION RECONSTRUCTION - Gyneocoiogical table - Sterilizer EFTER . .. . . . . - Tensemeter REAL NECESSITIES - Equiped wim own sources - Stretcher, local for external application. paediatrician.pantompe. - Furniture (donation) - Pantocope (donation) - Radio (donation) - Tensiometer - Nebulazen I - Not yet in use RRIS Project Final Evaluation b) As far the strengthering of the own base organizations is concerned: I. The project achieved that the Local Committees of Health CLS could establish, get done and continue to work for each inspected health centers, selected by vote of the assembly of the own involved beneficiaries. Some committees work more than others on the health center reconstruction or repair as well as on health campaigns promoted by the own staff and expand their functions with the Local Committees of Health and Development name. There were supported by ADRA - Peru facilitators in order to study the reality and development necessities of their communities; for example, census, surveys, workshops of reality to fill them in details about "Recognizing our Comminity" (5), and the channeling of contributions for strategic plans of local development PLD, that together with their provincial local authorities of districtal participation, the technical staff of ADRA - Peru favored, leaded right now is in process of publishment. 2. In most of the cases, specially in rural areas, a close and constant participation of CLSD (Local Nets of Health and Development) with the authorities of their respective health centre was successful. On the other hand, in some rural and urban cases were not successful because the health centers did not understand the advantage to count on their support, interact with them or by ordinary changes, own situations or lack of time of CLSD (Local Nets of members of Health and Development). 3. While personal care of ADRA-Peru lasted in the area during the repair and reconstruction works, most of the CLS (Local Committees of Health) members declined. 4. There are Strategic Plans of Local Development in 22 health center (2 provincials and 20 locals) (6), one more of the 21 scheduled, all the time assumed and led by local authorities, who were encouraged and given, except for the additional one that it is in the process of publishment. 5. Because of the work experience in the area, there were not Specific Local Committees of Development - CLD. So they extend their functions and assumed them the with Local Committees of Health and Development CLSD. Their participated successful together with those purposes as showing the real situation registered in the "Recognizing Our Community" records, in the contributions to strategic plans with the local authorities and in the offes of development projects, etc. We acquired a good training, through; most of the involved people did not keep in mind, understand and develop Local Nets of Development - RLD. The training was not enough bacause it needs more time in order to aim strongly this goal. In "El Porvenir" CLSD in Arequipa, their well- educated members are preparing replacements and are going to achieve functions with the health committees in order to conzentrate in the devolpment tasks. ADRA-Peru RRIS Project Final Evaluation 6. The self-construction committees neither establish nor work, even though the resident engineers, facilitators and developers were trained with manuals (7 and 8) prepared for the effect by ADRA-Peru, for the same reason of lack of support. Nevertheless, in some health centers, involved people are applying the acquired knowledge as local constructors or housing programs as Material Banks. 7. The strategic plans of local development consign all the prioritized projects in the participating workshops by the pupulation, with an important contribution of ADRA-Peru. 8. According to the results of workshops, surveys and statements, ADRA - Peru worked satisfactorily with the training program anticipated by the project; but were not enough to achive the followed objectives. They require more persistence and training time in the areas in order to achive them. 9. According to the final workshop reports, and information of ADRA - Peru staff, there were training courses-workshops in 21 centers about "Stablish Development Nets", "Design and Participate Formulation of Development Project" (9),"Administrative and Finance Management of Local Nets of Development"(lO), "Patrol System of Community Health" and " Relieve of Disasters", as well as for organization and installation of 30 Local committees of Health (CLS). According to that information, the workshops had the participation of 116 people for "Design and Participate Formulation of Development Project" (32 in Ayacucho, 27 in arequipa, 28 in Moquegua and 29 in Tacna). 100 people for "Patrol System of Community Health" ( 32 people in Ayacucho, 24 in Arequipa, 19 in Moquegua and 25 in Tacna ). On the other hand, ADRA-Peru staff reported that in workshops of" Patrol System of Community Healthmy "Relieve of Disasters" in each one of them participated 110 people (45 in Ayacucho, 15 in Arequipa, 22 in Tacna and 28 in Moquegua). 3.2.3 CONCLUSIONS OF THE EVALUATION OF COMPONENT 2 1. The programed goals were achieved on time in the plan implementation plan, showing efficiently in the execution , even though it experimented imbalance respect to the initial purposes. This happened because it was a problem to begin it during the process of local vote, out of ADRA - Peru willpower. 2. The generated beneficy satisfies the initial expectancies of the community, that thanks to ADRA -Peru for the support. 3. At the end its contribution was effective and satisfactory by competitive action of health area; even though there in no evidence of contribution for local development, that effects are early to wait. ADRA-Peru RRIS Project Final Evaluation 4. The project makes to achieve all the goals and we consider that the way of management was not good enough for achieving the goals, because of the flexivity that all the work team offers in order to do the tasks. 5. The community sensibilization had a strong effect for the subcomponent development Community Participation , that based on the strengthening for the health organization. 6. The strengthening organization in health was effective and had an important contribution for the project objectives; even though the development aspects and the establishment of development nets are not yet strongly consolidated and constituded a great potenciality that has to be taken advantage reasonable. 7. In most of the cases, the comminity participation in health centers is satisfactory; in view of the reached organization.With it there were promoted a lot of preventive promotional program attention of health together with the community participation. 8. The attention coverage witth a risk focus raised with the project; as well as welfare attention bacause the inspected staff health centers increased almost 20%. 9. The project impact is prematute to identify if the conditions of level life of beneficiary community got better by the project action; even though as an inmediately impact we can realized that a motivation and security atmosphere in the management of ideas and local development goals. 10. We can notice that the project through ADRA - Peru facilitators. It sowed "seeds of development attitude" in these communities, that success will depend on guidance in the use of technical instruments of developed planning and others that will require in time. 11. The development and strategic plans represent good instruments of moves for the local development, as the participate community "made them ownVand involved its interests ; nevertheless we will require other complementary instruments for the project realizations and considered activities. 12. The "base lines" were established for the respective establishments, expressed in "Recognizung Our Community"records, that they have to be compared through suitable instruments with results we see for the future. 13. The project results of health centers and community organization for health support were satisfactory; being priority the community participation. We consider that the project had lots of activities and suitable development that it is showed in the complementary results. RRIS Project Final Evaluation 14. In the strengthening of base organizations with budget of US$ 426.768 and part of US$ 184.665 was destinated to workshop development of " Design and Participate Formulation of Development Projects" and "Administrative and Finance Management of Locall nets of Developmemt", participaited 116 people in the first one and 100 people in second one, as a total of 216 people-workshop. Moreover, there were performed "Patrol System of Community Health" and "Disasters Relieve" workshops with 110 participants in each one, as a total result of 220 people-workshop. Considering that workshops were performed in 15 days ( 5 of projects, 5 of management, 3 of vigilance and 2 of disasters), there was a US$ 28.24 cost per day￾workshop- participant. 15. The project execution was affected by the local authorities elections, the delay of reception of educational material for self-construction and the inadequate and late of ground cleaning-up by MINSA., considering the first aspect in the complementary strategic.This forced to change dates of trainning components for the strenghtening of local organizations, self-construction and the beginning of some works that affected the resuts in the self-construction. 16.The operative support was suitable for the performance of execution activities and implementation project, bringing the appropiate and efficient resources availavility. The operative organization kind of decentralizied and participative strategic were effective, given flexibility and answer availability of a project management. 17.To guarantee the support of project interventions, the communities did not participate in the identification and design of program activities but they participied in the impletation with final results that deeply satified the expectancies. 18. The participants expressed that the different activities favored them a lot in different ways and are interested in negociating the projectsin their development plans. 19. The beneficiaries are well-organized with the Local Committees of Health and Development and they are able to support and argue the project effect in long-term, that it is a solid base in order to maintain the project, this is a necessary but insufficient term. It is necessary to maintain a permanent support and orientation labor for the design and application of management instruments of local development. 20. During the implementation, the project was linked with MINSA to support the substructure and health component, working with local goverments in order to maintain project goals for the future. ADRA-Peru RRIS Project Final Evaluation 4. LEARNED LESSONS According to the substructure, in the case of Juan Velasco Alvarado in Tacna, shows that even though we did the studies of specialized grounds and followed the recomendations for the work execution, the field shows sign of setting-up. The difficulties with mass media and the different economical activities of involved people, limit the audience of notifications done without previous time. It happened to announced the community participation in advance and stated different strategic of attraction in order to the setters go and stay in the events. The limit capacity are major in urban areas than in rural, so that deserves a different treatment. In urban areas people do not count with the same flexibility of time use, sense of integration and cooperation. In the community the work requires suitable motivation and incentives to their expectancies. In all the cases, the works of repair and reconstruction contituted motivation elements to the beneficiaries participation during the performance.At the end, the community participation began to weak, so the work does not guarantee the support of community participation for the local development. The works could worsen and to prevent these in necessary to maintain the orrganization strongly. Even though, there was sowed "seeds of development attitude", there is a weakness when we apply the knowledge and instruments of local development management and the ability to manage them. The beneficiaries of the project count with instruments, such as current development plans and project records, but they do not have specific tools to allow working these plans very good. The project objective performed by ADRA-Peru never arise to that level, it only limits to find and prioritizes problems and necessities of health and others features that contribute to the communal development that all the social characters, local authorities would have an important and complementary role that gives a great number of tools in order to do the plans. The acquired community organization by RRIS project was a great contribution to be close of the population in health centers through CLSD ((Local Committees of Health and Development) and for the solutions of problems during the communal operative plans, decreased a deep division between the community and health centers. In those problems that projects have in the procedures and coordinations by the participation of different features in the process of execution, the function decentralization, dynamic and flexivility processes of Logistic and Accounting of ADRA - Peru was very effective for the good work and implementation of the project. RRIS Project Final Evaluation 5. RECOMENDATIONS To bring the files, data and project information up date in order to control and evaluate efficiently. To promote and contribute the MlNSA in the project creation in order to implement and maintain efficient and rationalized a system of Local Nets of Health, considering quantity and composition population, place, access and distance between health centers, considering also the geographical and social atmosphere where the health centers are. To stimulate and contribute the suitable health centers, beginning with the repaired and contructed ones. For the infrastructured componenet, it is important that the repair counts with efficient public service of water and electricity, that in most of the cases the repair and reconstruction had not provided. To promote and support efficient and rationalized Local Nets of Health and Development, the support of Local Committees of Health and the current up date of Local Strategic Plans of Development that allow to execute, evaluate and bring the strategic plans up date; specially in the net components: transport road, road link,water supply, electricity supply, drainage system and disponibility of solid waste. To motivate the staff in the differents health centers in order to keep the same close intensity to the involved population, achieved in the acquired methodology for the project. To motivate the specific instruments making of local development management and the use as strategic to reinforce the organization and actions of Local Committees of Development. To control the ground behaviour and cracks, that appear in the buildings of the health centers in order to check any risk before future earthquakes, as those centers should be last ones to collapse in the disasters. To promote and support the improvement and the adaptation of hospitable architectural regulations up date, according to new tendencies of health attendants of people per ethereal group and per processes. To instutionalize procedures and proceedings, fast, flexible and decentralized in the Logistic and Accounting of ADRA-Peru for those kind of projects. RRIS Project Final Evaluation 6. GLOSSARY OF TERMS 1. PLOT SETTLING: Behaivour grounds that gives into building weight superficial charge of buildings. 2. CARRIED CAPACITY OF GROUND: The grounds feature related to the capacity of support the superficial charges of building weight. 3. COST-EFFECTIVITY: Indicator related to total cost of a kind of specific participation with goals and results that expected to achieve with that intervention. 4. FILE WORK: File that every day registered in detail the given experiences. 5. BUTTERFLY DIAGRAM: Graphic concentric and radial representation of many variables; the center generally shows low level and concentric circles and the high level according to the distance of the center. 6. FROSTING: The decay outcropof concret mixing to damp and salinity action 7. TECHNICAL FILE: Group of specific documents and studies before the work performance. 8. CRACK: Longitudinal hole in walls and/or smaller structural elements to 02 mm. of wide (page 145, F-3AL1 "Reduction of Disastes", Author Julio Kuroiwa ). 9. CREVICE: Longitudinal hole in walls andlor bigger structural elements 02 mm. Of wide(page 145, F-3AL1 "Reduction de Disasters", Author Julio Kuroiwa). 10. IMPACT: Change that generates a specific social situation by an indirect action of an interventionor group of actions. 11. BASE LINE: Related to an initial situation of a group of people andlor conditions before to execute an invest project, expressed in indicators values designed and it it compared to the results that generate with the project execution. 12. WORK LIQUIDATION: Organized record of costs and expenses that generated the construction and preparing of the building or part of it. 13. HEALTH PREVENTION: Related to actions that give health services in order to prevent deterioration risks of health people. 14. HEALTH ADVERTISEMENT: Related to actions that promote practices and attitudes of people in order to keep a good people health. 15. PURPOSE: Specific objective that achieves a process or activities. 16. WORK RECEPTION: Act by which the person or proprietary institution of the work gives conformity to the conclusion of the same one and the "receives" for its use. This it is registered in a "file of work reception". ADRA-Peru RRIS Project Final Evaluation 17. REINFIRCEMENT: Any operation that increases the structural behaviour of an element structure according to the original behaviour. 18. FIXING: Any operation in order to re-stablish the structured behaviour of an element/structure with a damage in the original behaviour. 19. RESTORATION: To achieve that the construction is useful and has to use same material or compatibles with the buildings. 20. RESULT: Changes that generate as direct effects of one or more actions. 21. SUPPORT: Project quality in that post-investment stage or the enough condition for its operation . ADRA-Peru RRIS Project Final Evaluation Minute of work reception I Minute of deliver and work reception. MINSAIADRA￾OFASA PERUIPRONAME. 2002-2003 Agreement. "Repair and Reconstruction of Health lnfrastructure in the South Zone of Peru" Formulation Proiect: Department of Ayacucho. Areauipa. Moaueaua y Tacna. ADRA￾Peru, Lima National Requlation of Constructions . Peruvian Chamber of Construction (Camara Peruana de la Construccion ) - CAPECO. Lima - Peru, 1997. Technical Reaulations to Elaborate Architectonical Projects: Health Centers. Health Department.Genera1 of Health to People.Executive Address of Technical Regulations to lnfrastructure in Health. Lima-Peru. November, 1994. Technical Reaulations for the Conceptualization of Arauitectonic and Constructive Proiect of First Level of Attention: Health Centers. Health Department. General Adress of Health of People. Executive Direction of Technical Regulations to lnfrastructure of Health. Lima-Peru. April, 1994. ADRA OFASA OF PER^^. RRIS Project Lima 2002. Localities: San Francisco and Yacango (Mcal. Nieto, Moquegua), Chaviiia (Lucanas, Ayacucho), Carhuanilla and Salla Salla (Parinacochas, Ayacucho), Caraveli (Arequipa), Curibaya (Candarave, Tacna). Strateuic Plans 2003-2013 of Districts. ADRA-PERU, 2002. Strategic Plans of Local. Development of Achoma (Caylloma, Arequipa). Manual of Traininq in the Self-construction of Houses: Brick. Repair and Reconstruction Project of Health lnfrastructure - RRIS. USAID-ADRA PERU-CISMID. Lima - Peru, 2003. Manual of Traininq in the Self-construction of Houses: Adobe. Repair and Reconstruction Project of Health lnfrastructure - RRIS. USAID-ADRA PERU-CISMID. Lima - Peru. 2003. Program workshop of Training in " Design and Participate Formulation of Development Projects" . Final Report. CONTINUE TRAlNNlNG S.A.. Lima, May 2003. "Administrative and Finance Management of Local Nets of Development" workshop. Final report. PACT PERU. Lima, May 2003. Repair and Reconstruction of the Health lnfrastructure in Southern Peru Project (RRHI). Interim Project Report 527-A-00-02-00012. ADRA Peru, Sep. 2002. Annex 1 Terms of Reference (Spanish version) Final Evaluation: Rehabilitation and Reconstruction of the Health Infrastructure in Southern Peru Lima, Peru Abril 2003 Términos de Referencia Para la Evaluación Final del Proyecto de ADRA OFASA, Rehabilitación y Reconstrucción de Infraestructura de Salud en el Sur del País l. ANTECEDENTES El 23 de Junio del 2001 a las 3:33 p.m, un terremoto, que alcanzó una magnitud de 6.9 en la escala de Richter, azotó el Sur del Perú, y se sintió hasta Arica. Chile, La Paz, Bolivia. El epicentro del terremoto fue 82 km al noroeste de Ocoña en el departamento de Arequipa. Inmediatamente después del terremoto, un tsunami azotó las costas de Arequipa penetrando hasta media milla y destruyó la comunidad de Camaná. Los departamentos más afectados por este desastre fueron Arequipa, Moquegua, Tacna y Ayacucho. Según las estadísticas del momento, los daños que sufrió la infraestructura básica de salud fue: 30% en Arequipa, 84% in Moquegua, 49% en Tacna, y 10% in Ayacucho. El 29 de Agosto del 2001 el MlNSA informó a la USAlD que la magnitud de los daños causados por el terremoto a la infraestructura básica de salud y de saneamiento en la región era de 230 establecimientos de salud dañados y 58 estaban totalmente destruidos, incluyendo: 2 hospitales, 10 centros de salud y 46 postas de salud. El siguiente cuadro muestra el daño a la infraestructura causado a los establecimientos de salud en los departamentos del sur del Perú: Arequipa 1 4 I 39 I 48 1 91 1 DEPARTAMENTOS Moquegua 1 1 I 29 I 29 l 59 1 Tacna I 1 I 8 I 31 l 40 l Ayacucho l 2 I 1 l 28 1 31 1 HOSPITALES CENTROS DE SALUD POSTAS DE SALUD Como respuesta a este desastre ADRA Perú con financiamiento de la USAlD implementó el Proyecto de Rehabilitación y Reconstrucción de Infraestructura de Salud en el Sur del País durante el periodo de Noviembre 2001 al 15 de Mayo del 2003. El objetivo principal del TOTAL TOTAL proyecto es "Ayudar a la población del Perú que fueron afectados por el terremoto del 23 de Junio del 2001. Este proyecto comprende dos objetivos estratégicos que han sido implementados por sus dos componentes complementarios: El componente de infraestructura y el componente de fortalecimiento de las organizaciones de base. El primer objetivo estratégico es rehabilitar y reconstruir los establecimientos de salud en el Sur del Perú (Tacna, Moquegua, Arequipa y Ayacucho) que fueron afectados pro el terremoto tsunami. Bajo este objetivo se han desarrollado actividades de (1) reconstrucción y rehabilitación de aproximadamente 10 establecimientos de salud y un aproximado de 20 postas; (2) la creación y capacitación de aproximadamente de 30 comités de construcción. UENTE: Diredón Regional de Salud en Arequipa. Moquegua. Tacna y Aycucho (17 de Julio. 2001) 7 80 150 230 El objetivo estratégico 2. implementado por el segundo componente del proyecto, tiene por finalidad fortalecer a las organizaciones de base para gerenciar los temas de desarrollo y prevención de desastres. Las actividades que se desarrollaron bajo este objetivo fue el establecimiento de aproximadamente 21 redes locales de desarrollo en operación y 30 comités locales de salud en operación. La meta primaria del componente de fortalecimiento es fortalecer la organización de los servicios de salud de los centros de salud tanto reconstruidos como rehabilitados. El objetivo especifico mensurable del componente de fortalecimiento es: ... Para lograr el impacto deseado, el proyecto a través de su componente fortalecimiento, realiza la capacitación con el personal del MINSA, miembros de organizaciones de base y autoridades locales en elaboración de planes participativos de desarrollo y planes estratégicos a nivel distrital en las localidades donde se está implementando el proyecto. Los resultados del componente de infraestructura son definidos como sigue: 1) Rehabilitación y reconstrucción de 10 establecimientos y 2) reconstrucción y rehabilitación de 20 postas y 3) capacitación en autoconstrucción de viviendas utilizando ladrillo y adobe. II. PROPOSITOS DE LA EVALUACION La evaluación cubrirá todo el periodo de implementación del proyecto, Noviembre del 2001 hasta la fecha. La evaluación del programa RISS de ADRA P~N es requerida tanto porADRA Perú como la USAIDIPerú para que la administración del proyecto pueda evaluar el logro de los objetivos establecidos, a la vez que la eficiencia con la que la agencia implementó el proyecto y entender los efectos e impactos a largo plazo del proyecto. Asi mismo, la evaluación debe identificar las lecciones aprendidas durante el período de implementación del proyecto que permitan a ADRA mejorar el diseño de proyectos futuros similares. Otra dinámica clave que la evaluación debe analizar es el grado de sostenibilidad que se ha logrando con el proyecto, ej. , si los impactos positivos en los que respecta a organización comunal y mejora en la prestación de los servicios de salud en los centros construidos tienen posibilidad de ser mantenidos más allá de la duración del proyecto. Se debe analizar las estrategias de sostenibilidad, y se deben incluir dentro del informe de evaluación algunas recomendaciones para cambios o adiciones a aquellas estrategias, ADRA Perú intenta no sólo utilizar la evaluación tanto como un medio para verificar si las metas y objetivos originales planteados en el proyecto han sido o no logrados, sino busca también utilizarla como una herramienta de planificación que permita a ADRA Perú, mejorar el diseño de proyectos futuros similares y así ampliar el impacto de sus intervenciones de salud y mitigación desastres, incorporando en estos las actividades y estrategias más exitosas del proyecto RISS. La evaluación, por lo tanto. debe analizar adicionalmente las estrategias del proyecto comparándolas con las prioridades de desarrollo de la USAlD Perú y los objetivos, y las estrategias de desarrollo del Gobierno del Perú. Los objetivos de evaluación que deben ser abordados en la evaluación incluyen los siguientes: $ Efectos e Impactos delproyecto: Identificar las determinantes claves del impacto del proyecto o la falta de este. $ Efectividad del proyecto: Identificar en que medida el proyecto ha producido los productos esperados y si estos han permitido lograr los objetivos estratégicos y objetivo final del proyecto. $ Eficíencía del Proyecto: En que medida el proyecto suministró y gerenció los insumos necesarios para la implementación de las actividades del proyecto y si las actividades de implementación fueron organizadas en la forma más apropiada. Finalmente, si todo lo anterior se ejecutó al menor costo para producirlos productos esperados. $ Sostenibilidad: Identificar los determinantes importantes de la sostenibilidad del impacto de la presente intervención y hacer las recomendaciones para ser incluidas en el diseño de futuras intervenciones similares de ADRA para incrementar el grado de sostenibilidad del impacto a través de los cambios que se puedan hacer en la composición del proyecto, al igual que en los aspectos técnicos y administrativos del mismo. $ Costo Efectividad: Compare y haga contraste de los méritos relativos a las diferentes actividades realizadas por el proyecto de acuerdo a su costo efectividad. Esto debe incluir el costo por centro de salud rehabilitado o reconstruido. Las preguntas ilustrativas que cubren cada uno de estos objetivos están adjuntas como un apéndice a este documento. III. NIVEL DE ESFUERZO DEL EQUIPO DE EVALUACION (NDE) Y COMPOSlClON El equipo de evaluación estará constituido por tres personas que estarán contratadas por ADRA por el espacio de 30 días, de los cuales no menos de 15 días se pasarán en las áreas de los proyectos. Los miembros del equipo serán como sigue: un experto en mitigación de desastres con experiencia (con experiencia comprobada en evaluación de estructural y de vulnerabilidad de establecimientos de salud de primer nivel) y en evaluación participativa como líder del equipo, un especialista en salud pública o áreas afines con experiencia en organización administrativa es servicios de salud, post desastre y evaluación de procesos participativos comunales. Especialista en planificación de desarrollo regional con experiencia en procesos participativos de desarrollo post desastre. Además del equipo contratado, el Coordinador de la Unidad de Monitoreo y Evaluación de ADRA Perú formará parte del equipo de evaluación como supervisor de la misma. El papel que desempeñarán y las habilidades específicaslexperiencia de cada miembro del equipo evaluador deben ser como se describe a continuación. El líder del equipo planificará y supervisará el trabajo de campo, proporcionará guía técnica, hará el borrador del informe final, y proporcionará el control de calidad general. Ellella debe ser un profesional ejecutivo con amplia experiencia en desarrollo, debe tener experiencia en programas de mitigación de desastres (de preferencia programas en América Latina), debe tener excelente de redacción en castellano y tener experiencia de trabajo previo en proyectos similares. Ellella también debe ser un especialista en monitoreo y evaluación de impacto con amplia experiencia en evaluación estructural de centros de salud de primer nivel y sistemas de vigilancia y mitigación de desastres. Experiencia en diseñar y operar sistemas de M&E, preferentemente en proyectos de mitigación de desastres en establecimientos de primer nivel(puestos y centros de salud). Además, la persona que sirva como líder del equipo debe tener experiencia en facilitar evaluaciones participativas, incluyendo el desarrollo de los planes de acción del proyecto en respuesta al informe final de evaluación. El especialista en salud pública tendrá como primera responsabilidad la evaluación del componente de fortalecimiento del proyecto. Ellella debe tener amplia experiencia en ámbitos rurales y urbano marginales, de preferencia en Perú, y debe tener un amplio conocimiento de la provisión de servicios de salud en el ámbito comunal, disetio, monitoreo y evaluación de proyectos de salud, incluyendo experiencia en métodos de evaluación rápida. Esta persona debe tener excelente redacción en castellano y trabajará en coordinación del líder del equipo. El equipo de evaluación contratado trabajará en coordinación con el coordinadorde la Unidad de M&E de ADRA quien estará a cargo de la supervisión de la evaluación. IV. PRODUCTOS DE LA EVALUACIÓN El equipo evaluador contratado deberá producir los siguientes productos durante el proceso de evaluación: Un plan de trabajo de todo el proceso de evaluación. Un informe preliminar Un taller participativo sobre el contenido de la evaluación Un informe final. V. METODOLOGIA DE LA EVALUACION Se arreglarán juntamente con los miembros del equipo las entrevistas, citas y viajes de campo para facilitar el recojo de la información. Se proporcionará toda la ayuda necesaria para hacer que ellos cumplan con los requisitos preparación de informe. Esto incluirá proporcionar al equipo de evaluación el documento de la propuesta original, informes de resultados, perfiles de proyectos, Liquidaciones de obra, y cualquier otra documentación del proyecto pertinente a la evaluación. Estos serán proporcionados al momento de seleccionar al equipo evaluador para permitir que los miembros del equipo se familiaricen con el proyecto. La evaluación será de carácter participativo, involucrando a los principales agentes que participaron del proyecto eje. El personal de ADRA Perú, la USAIDIPerÚ, y los beneficiarios del proyecto. La participación de los agentes involucrados será organizada de acuerdo a dos grupos: 1) el personal de ADRA y representante(s) de la USAlD y 2) miembros de la población beneficiaria. USAlD también participará en la revisión del equipo de evaluación de los principales aspectos del proyecto y sus problemas. El equipo contratado hará saber sus inquietudes a estos agentes involucrados y buscará retro alimentación de ellos antes de preparar su informe. Al segundo grupo de agentes involucrados. beneficiarios (incluye representantes de organizaciones de base, personal del MlNSA y autoridades locales) se les consultará separadamente y su retro alimentación se hará saber al personal del proyecto, permitiendo a ADRA Perú analizar y responder a las inquietudes de la comunidad. Esta retro alimentación se buscará a través de las entrevistas que se haga en las diferentes áreas de intervención donde se realice el trabajo de campo. Esta retroalimentación será incluida en el borrador del informe final, el cual será presentado tres días después del taller a ADRA Perú y la USAIDIPerú. VI. CRONOGRAMA DE LAS ACTIVIDADES DE LA EVALUACION Firma de contrato con el equipo evaluador ..................................................... Abril 29, 2003 Equipo de evaluación prepara borrador plan de trabajo ............................ Abril 22-25, 2003 Metodología presentada para aprobación .......................... .... ................... Abril 28, 2003 Trabajo de campo ....................................................................................... Mayo 5-16. 2003 Preparación del informe preliminar ......................................................... Mayo 17-23, 2003 Taller con personal de ADRA ........................................ 26, 2003 Respuesta de ADRA Perú al taller ....................................................... Mayo,27-30, 2003 Borrador del informe final ........................ ........... .............................................. Junio 6 ,2003 Entrega del lnforme Final Junio 10, 2003 VII. REQUERIMIENTOS DEL INFORME Aparte de los informes orales semanales al supervisor de la Evaluación del Proyecto, el contratado enviará lo siguiente: Plan de trabajo: El equipo contratado preparará un plan de trabajo detallado el cual incluirá la metodología que se va a utilizar, herramientas para recojo y análisis de datos y la enviará a ADRA Perú para su aprobación el tercer día de la evaluación. Taller: El equipo de evaluación presentará un resumen oral de sus recomendaciones en un taller donde estarán incluidos representantes de ADRA Perú (personal de administrativo y de campo del proyecto), y la USAID. La discusión que siga a esta presentación será considerada en los informes preliminares y finales. lnforme Preliminar: El equipo de evaluación enviará a ADRA Perú diez copias del informe preliminar. el cual incluirá los hallazgos y recomendaciones claves y la retroalimentación del taller, y los presentará en una sesión de resumen a ADRA Perú y la USAlD tres días después del taller. ADRA Perú enviará sus comentarios al equipo de evaluación y se hará el cierre de las acciones al siguiente día. El equipo evaluador abordará los comentarios en el borrador del informe final. Borrador de lnforme Final: El equipo evaluador enviará diez copias del informe, el cual incluirá los comentarios y observaciones del informe preliminar. Se harán reuniones con la USAID y ADRA para discutir el informe del borrador final. lnforme Final: El equipo evaluador contratado enviará 15 copias del informe final de evaluación y su versión en diskette (mínimo Word 98) a ADRA Perú, de acuerdo al cronograma establecido anteriormente en estos términos de referencia, después de haberse entregado los comentarios al borrador del informe final. El informe final incluirá las modificaciones y justificaciones para las variaciones del diseiio original, metas, actividades y estructura del presupuesto recomendada por el equipo y acordada con la USAIDIPerú y ADRA Perú. El informe final no debe ser más de 50 páginas, incluyendo las siguientes secciones: Resumen Ejecutivo Cuadro de Contenidos Cuerpo del informe. el cual incluirá: $ El propósito y las preguntas hechas para la evaluación $ Hallazgos y conclusiones $ Lecciones Aprendidas $ Recomendaciones Los datos de apoyo se deben incluir en los apéndices. Los apéndices deben incluir, entre otra documentación pertinente técnica o de apoyo: $ El marco de trabajo del equipo de evaluación $ La metodologia empleada $ La composición del equipo de evaluación y su experiencia profesional $ Una lista de los lugares visitados $ Una lista de documentos revisados $ Una lista de las personas entrevistadas Además el informe deberá cumplir con las siguientes normas de lenguaje y presentación y técnicas. a. Normas de lenguaje y presentación - Carátula indicando el nombre del proyecto, autor y fecha. Estar escrito de manera clara, suscinta y de buen estilo y toda la información debe estar completa y exacta sobre toda referencia efectuada. b. Normas Técnicas Describe el propósito de la evaluación y anexa los términos de referencia Contesta las preguntas planteadas en los términos de referencia. Describe la metodologia empleada para recopilar y analizar los datos. Indica las limitaciones de la evaluación o su metodologia. Indica la confiabilidad y validez de los datos utilizados. Describe cualquier muestra tomada por el método de muestreo, número de elementos seleccionados y disponibles. Incluye los datos principales. debidamente analizados, en que se basan sus conclusiones. VIII. METODO DE PAGO Ya que la evaluación incluirá viajes al interior del pais, recomendamos que los miembros del equipo de evaluación entreguen una propuesta a todo costo incluyendo los gastos por transporte a los lugares a evaluar, tasas de aeropuerto, hospedaje, comida y honorarios profesionales. El monto total del contrato será pagado de la siguiente manera: . 30% al momento de la aceptación por escrito de parte de ADRA Perú del plan de trabajo. . 30% a la presentación del informe final. . 40% a la aceptación del informe final por parte de ADRA Perú y la USAID /Perú. Lista de Preguntas de Evaluación COMPONENTE DE REHABlLlTAClON Y RECONSTRUCCION DE INFRAESTRUCTURA DE SALUD REHABlLlTAClON Y RECONSTRUCCION EFICIENCIA ¿Qué tipo de amenazas ha encontrado el proyecto durante su implementación que afectó los resultados finales? ¿En que medida el apoyo logistico ha sido apropiado para las actividades de implementación del programa? ¿Cómo ha contribuido en los resultados obtenidos? ¿En que medida apoyó el PRONEIM en el asesoramiento y la aprobación de expedientes técnicos? ¿Cómo ha contribuido en el cumplimiento de metas? ¿En que medida apoyó el MlNSA en las entregas de terreno debidamente saneadas? ¿Cómo ha contribuido en el cumplimiento de metas? ¿En que medida apoyó la Supervisión por parte del PRONEIM en la ejecución de obras? ¿Cómo ha contribuido en el cumplimiento de metas? ¿Durante la implementación, en que medida el programa se ha vinculado con los gobiernos locales, comité locales de salud y desarrollo (CLSD), para implantar las diferentes actividades del proyecto? ¿En que medida apoyaron con sus recursos financieros? ¿Los recursos financieros y materiales requeridos por los residentes de obra en el campo se proporcionaron a tiempo? Si es NO 'Cuáles fueron las principales dificultades? ¿Cuál fue el grado de integración de las componentes del proyecto? ¿En que medida las DIRESAS de las áreas de intervención cumplieron con la entrega de los terrenos saneados? EFECTIVIDAD 1. ¿Los beneficiarios están satisfechos con la tecnologia utilizada en la rehabilitación y reconstrucción de la infraestructura de salud? 2. ¿Las infraestructuras de salud cumple con las normas vigentes de arquitectura hospitalaria? 3. ¿Los beneficiarios están satisfechos con los materiales usados en las construcciones de las obras? IMPACTO 1. ¿Los beneficiarios están satisfechos con la tecnologia utilizada en la rehabilitación y reconstrucción de la infraestructura de salud? 2. ¿Cómo se comparan los beneficios del programa con las expectativas originales de la comunidad? 3. ¿Cómo se siente la comunidad acerca de estos cambios? 4. ¿En que medida motivó a los beneficiarios en los aportes comunales por la infraestructura propuesta por el proyecto? AUTOCONSTRUCION EFICIENCIA 1. ¿Los voluntarios están satisfechos con la innovación de tecnologia que han aprendido? 2. ¿Los recursos financieros y materiales requeridos por los capacitadotes en el campo se proporcionaron a tiempo? Si es NO ¿Cuáles fueron las principales dificultades? EFECTIVIDAD 1. ¿El proyecto formó los comités de Autoconstrucción? Sí es así, 'estos siguen funcionando? 2. ¿Los voluntarios capacitados están aplicando las técnicas aprendidas en sus actividades de construcción de viviendas? 3. ¿La metodología de capacitación empleada fue apropiada para el grupo objetivo? 4. ¿Los temas de capacitación que se realizaron coincidió con las necesidades sentidas y prioridades de las comunidades participantes? IMPACTO1 EFECTIVIDAD 1. ¿Los beneficiarios manifiestan que le es útil para sus necesidades, el programa de capacitación desarrollado? 2. ¿Qué técnicas están aplicando con mayor énfasis en sus actividades? 5. ¿Los voluntarios están satisfechos con la innovación de tecnologia que han aprendido? 6. ¿Los participantes han aprendido las técnicas desarrolladas? COMPONENTE DE FORTALECIMIENTO DE ORGANIZACIONES LOCALES EFICIENCIA 1. ¿En que medida las metas del proyecto se han ejecutado en el tiempo programado de acuerdo al plan de implementación aprobado? EFECTIVIDAD 1. En que medida el beneficio causado del proyecto ha satisfecho las expectativas originales de la comunidad? 2. En que grado se está contribuyendo al logro del objetivo General 2. En que medida el proyecto ha logrado las metas trazadas 3. En qué medida el estilo de manejo gerencia1 ha sido efectivo para el logro de las metas. EFECTO DEL PROYECTO 1. 'Qué actividades desarrolladas por el programa contribuyeron al impacto planificado en Participación Comunitaria y cuales fueron las limitantes para alcanzar el impacto deseado? 2. ¿Qué contribución tuvo el componente de fortalecimiento de las organizaciones locales en sus dos fases, tanto en Fortalecimiento de Organizaciones Locales y Conformación de las redes locales de Desarrollo? 3. ¿En qué grado se está dando actualmente la participación comunitaria con los establecimientos de salud para contribuir en la solución de los problemas de salud de las zonas de intervención? 4. ¿En qué grado se ha promocionado los diferentes programas de atención preventivo-promocional a la población beneficiaria? 5. ¿En qué grado se han elevado las coberturas de atención gracias a la atención con enfoque de riesgo? IMPACTO DE TODO EL PROYECTO ¿Se pueden identificar diferencias entre las condiciones previas y actuales de los participantes del programa? ¿Cómo ha cambiado el estándar de vida de los beneficiarios? 1. ¿En que medida se ha incrementado el valor bruto de las ventas de los agricultores? 2. 'Cuán efectivos son los planes de desarrollo elaborados por las comunidades participantes? Los proyectos son identificados en los planes que se están desarrollando? Qué nivel de pertenencia de la comunidad se desarrolla a través de la facilitación de la formulación de los planes de desarrollo? 3. Los resultados logrados entre las comunidades son los que el programa esperaba? De acuerdo a las prioridades, cual de los resultados son mas relevantes al diseño original del programa? ¿Cómo se refleja esto en términos de costo 1 efectividad? ¿El programa ha tenido un número apropiado de actividades? Si no es así, que actividades se podrían cambiar o eliminar en futuras intervenciones? 4. ¿Que tipo de amenazas ha encontrado el programa durante su implementación que afectó los resultados finales? 'Estos problemas fueron considerados en la estrategia de implementación? En que grado estos han afectado los resultados obtenidos? 5. ¿En que medida el apoyo operativo ha sido apropiado para las actividades de implementación del programa? ¿Cómo ha contribuido en los resultados obtenidos? SOSTENIBILIDAD DE LAS INTERVENCIONES DEL PROYECTO 1. En que medida las comunidades han participado en identificar, diseñare implementar las actividades del programa? ¿Los resultados finales respondieron a sus expectativas? 2. Los participantes del programa sienten que las diferentes actividades del programa los han beneficiado? ¿Ellos desean continuar gestionando los proyectos que resultaron de los planes de desarrollo elaborados con ayuda del proyecto? 3. ¿Cómo se han organizado los participantes para mantener los impactos del programa en el largo plazo? ¿Las diferentes organizaciones creadas por el programa proporcionan apoyo para la Sostenibilidad del impacto del programa? 4. Durante la implementación, en que medida el programa se ha vinculado con otras organizaciones gubernamentales y privadas para implementar las diferentes actividades para ampliar la Sostenibilidad y proporcionar el soporte necesario para los beneficiarios una vez que el proyecto RlSS haya terminado? Annex 2 FRAMEWORK OF THE TECHNICAL TEAM OF ASSESSMENT The Technical team of assessment is made for this purpose according to USAlD Requirements and Terms of Consultancy Reference, in this aspect on the execution and results of the Project of Rehabilitation and Reconstruction of the Health Infrastructure -- RRlS in charge of ADRA-PERU. The work is organized on the basis of a plan and work program with enough local logistical support that would allow to call and to meet in appropriate way the main agents that take place in the development of the project in order to participate in the advance workshops. For this, the work began with the training in charge of the evaluation team plan and the program of work in order to be referred to Coordinators of the Area and field Auxiliary Technicians, that parallel there would be to appoint with exact instruction of functions, days of the work, places and dates of the contributed workshops and dates of trips and that in general lines, would consist in the preparation of assessment questionnaires, guides in order to be filled, quality control and handbooks and chronograms of work. All the activities have been realized in narrow coordination with ADRA-PERU employees. thus proceeded to select a sample to evaluate 10 rehabilitated or reconstructed health's establishments and 7 networks or local sub networks of development. The elaboration of reports counted on the active contribution of personnel of ADRA PERU, that contribute in the check of the documents, in emit its 0bse~ati0nS and comments and to reach the appropriate additional reports. Annex 3 METHODOLOGY USED TO EVALUATION The Methodology applied to execute the respective evaluations enclosed: - Application to ADRA PERU and reception of all the documentation according to development of the project and results in the components that make it up: .:. Com~onent No 1 Rehabilitation and Reconstruction of the Infrastructure of Health. .:. Component No 2 Strengthening of locals organizations. - Checking the received documentation, contrasting with it required by the RRlS and the regulations for the case (flats, technical files, reception of works, etc.) - Preparation of the instruments to apply in the field of work, to evaluate (surveys, masters of evaluation, comparison lists). - Selection of a sample of 10 establishments of health rehabilitated or reconstructed, its respective local committees of health and self construction committees; and 7 networks or sub networks and its respective local committees of development. - This selection is elaborated having in count the available time for the evaluation, the accessibility to the localities, the volume of the benefited population and its location in a network or sub network, being the interest of the evaluation to act inside of all the Health Institutions that belong at the influence's area of a same network or sub network. - In the work's field the evaluation of the networks and its respective local committees of development was given calling to all the agents linked of all the health establishments articulated to each one of them in a workshop that was realized in the health's main center of the network or sub network; and the evaluation of rehabilitation and reconstruction of the health establishments carried out visiting each one of them and calling to workshops to the respective committees of health. The opportunity was considered to evaluate with the facilitating and resident engineers the committees of self construction, which was not possible because they was not in field when the project finished. Preparation and Programs of the trip with that the team of evaluation realized the work of field, setting with precision the route to follow and itinerary to fulfill, of such form that the arrival of each locality they have already called all the agents of the locality that participated in the development of the project in their two components (rehabilitation of infrastructure and institutional strengthening). It was expected that this action will carry out by the resident engineers, developers and facilitating, but they were not found for it; so it was assumed by the component's coordinator of rehabilitation and reconstruction of the health infrastructure. By the universe wide of the sample to evaluate and the short available time for the evaluation, it agreed in preliminary meetings with the Supervisor of the Team of Evaluation, The Coordinator of Evaluation Unit and Monitoring of ADRA-PERU, that all the team of evaluation travel together, in a good vehicle done by ADRA PERU, traveling through the route and the indicated itinerary. - Record of the information answers got in workshops or meetings in each locality visited by the team of evaluation. - Interviews to local authorities, DlSA employees, of health establishments and representatives of base organizations, Health's Local Committees, of self construction and of other local institutions linked to the project. To the return to Lima, analysis of the information obtained in the work of field and preparation of a rough draft with the main conclusions and recommendations of the evaluation that served of reference to the workshop with representatives of ADRA￾PERU and USAID. Presentation of an oral summary of its discoveries and recommendations to the workshop with representatives of ADRA-PERU and USAID. Preparation of the preliminary report, including the discoveries and key recommendations of the supply network of the workshop, in order to present it in a summary session to ADRA PERU and USAlD (Cabinet Work). Preparation of the rough draft of the final report, including the comments and observations of ADRA PERU and USAlD to the preliminary report and its diffusion in meetings with USAlD and ADRA PERU. Preparation of the final report, including the modifications, justifications and recommendations obtained in the discussions. Annex 4 COMPOSITION OF THE TECHNICAL TEAM OF EVALUATION AND PROFESSIONAL EXPERIENCE A. TECHNICAL TEAM OF EVALUATION NAME 3g. Nemesio Canelo Umeida X. Victor Manuel Cruz 3oullosa ing. Jose Trujillc :erna 30. Daniel Albertc 3envenuto Mavila CHARGE Leader of the team Specialist in planning of regional development. Specialist in Public Health Specialist in structural evaluation and vulnerability of establishments on firs1 level health. Expert in evaluation, systematization and documentation. SPECIALITY :ivil Eng. flaster Degree iv Zegional and Urban 'lanning 'hysician ;ynecology Ibstetrician. Aaster Degree ir jocial Management hector of 'lanning :ivil Eng. jpecialist in revention and elieve of lisasters :ormulation anc !valuation of ?vestment projects. FUNCTIONS Development of work plans. Data gathering instruments design. Indicators' Design Analysis and evaluation o contributed processes ir prevention and relieve o disasters. Data aatherina - - instruments design. Indicators' Design. Analysis and evaluation of organization and contributed processes of health services. Data gathering instruments design. Indicators' Design. Analysis and evaluation of contributed processes of construction. Data aatherinn instruments design. Indicators' Design . Analysis and evaluation of results, effects and impact. Analysis and evaluation of institutional development on the basis of contributed processes. Systematization and documentation of data. ADRA-Peru RRIS Project Final Evaluation Annex 5 Relation of visited places Depaement.. . .. . . Net. ..-' . . . . ... . . .. . . .. . . . .. . . . . . . .. . . .% %.?. I Micro Net Chumpi Ayacucho I 1. Micro Net lncuyo 1. Micro Net Caraveli Arequipa Micro Net Pacificadore5 Moquegua I Micro Net Candarave Tacna I Net Tacna Health PostlHealth Center HP Carhuanilla HP Salla Salla HC Caraveli HP El Porvenir HC 28 de Julio HPYacango HC Candarave HP Curibava HP Juan Velasco Alvarado ADRA-Perú RRIS Projed Final Evaluation Annex 6 Reviewed docurnent relation Acta de recepción de la obra 1 Acta de entreaa y recepción de obra. Localidades. Convenio MINSAIADRA-OFASA PERUIPRONAME. 2002-2003. Acta de Constitución del Comité Local de Salud y Desarrollo. P.J. El Porvenir, distrito de Miraflores, Arequipa Formulación del Proyecto "Rehabilitación v Reconstrucción de Infraestructura de Salud en la Zona Sur del Peru: Departamentos de Avacucho. Areauipa, Moaueaua y Tacna. ADRA-Perú, Lima. Realamento Nacional de Construcciones. Cámara Peruana de la Construcción - CAPECO. Lima - Perú, 1997. Normas Técnicas para la Elaboración de Provectos Arquitectónicos: Centros de Salud. Ministerio de Salud. Dirección General de Salud de las Personas. Dirección Ejecutiva de Normas Técnicas para Infraestructura en Salud. Lima-Perú. Noviembre, 1994. Normas Técnicas Dara la Conce~tualización de Provectos Arquitectónicos y Constructivos del Primer Nivel de Atención: Centros de Salud. Ministerio de Salud. Dirección General de Salud de las Personas. Dirección Ejecutiva de Normas Técnicas para Infraestructura en Salud. Lima-Perú. Abril, 1994. Reconociendo Nuestra Comunidad. ADRA OFASA DEL PERÚ. Proyecto RRIS, Lima 2002. Localidades: San Francisco y Yacango (Mcal. Nieto, Moquegua), Chaviña (Lucanas, Ayacucho), Carhuanilla y Salla Salla (Parinacochas, Ayacucho), Caraveli (Arequipa), Curibaya (Candarave, Tacna). Planes Estratéqicos 2003-2013 de Distritos. ADRA-PERÚ, 2002. Planes Estratégicos de Desarrollo Local. Manual de Capacitación en la Autoconstrución de Viviendas: Ladrillo. Proyecto de Rehabilitación y Reconstrucción de la Infraestructura de Salud - RRIS. USAID-ADRA PERÚ-CISMID. Lima - Perú, 2003. Manual de Capacitación en la Autoconstrución de Viviendas: Adobe. Proyecto de Rehabilitación y Reconstrucción de la Infraestructura de Salud - RRIS. USAID-ADRA PERÚ-CISMID. Lima - Perú, 2003 Taller Programa de Capacitación en "Diseño y Formulación Participativa de Proyectos de Desarrollo". lnforme Final. FORMACIÓN CONTINUA S.A. Lima, Mayo 2003. Taller "Gestión Administrativa y Financiera de las Redes Locales de Desarrollo". lnforme Final. PACT PERU. Lima, Mayo 2003. Rehabilitation and Reconstruction of Health Infraestructura in Southern Peru Proiect (RRHI). lnterim Project Report 527-A-00-02-00012. ADRA PERU. Sep. 2002. ADRA-Perú RRIS Project Final Evaluation Annex 7 Relation of Strategic Plans of Development - RRIS Project Lic. Noerní Roque AYACUCHO Parinacochas Ing. David Diaz AREQUIPA MOQUEGUA Caraveli Arequipa Cayllorna TACNA Sánchez Cerro Ilo Mcal. Nieto Tacna Curibaya 1 Lic. Patncia Suárez Chaviíia Caravelí Miraflores Achoma Chivay Candarave Eco. Max Arroyo Lic. José Altarnirano Ing. Armando Villa Ornate Puquina El Algarroba1 Torata Moquegua Alto de la Alianza Jorge Basadre Eco. Max Arroyo Ing. Narciso Pino Lic. Patricia Suárez Arq. José Nina Lic. Ange~a Sandoval Patricia Suárez Candarave Quillahuani Cairani Huanuara Locurnba Lic. Ange~a Sandova1 Lic. Rosario Maqueri RRIS Project Final Evaluation Annex 8 Relation of people intewiewed A YACUCHO LOCALIDAD 1 . . ESTABLECIMIENTO R~A DE S$kU.D CS Chaviíia Autoridades Teniente Alcalde Mariano F. Mocheco Ocahuay Miembros del Vocal del CLS. Mariano F. Mocheco Comité Local de Ocahuay Salud Secretario del ~ ~~ Comité. ~ ~ Wilfredo Falcón .... ... . . , .. , . ..... ..... ... ... . ... .... .... Profesor de CE ......... Palacios . . - .- .:.--_=-=.F::?i :: :: PS ~a&uanilla Miembros del vicepresidente del ~abriei Orosco Comité Local de Comité Local de Salud Villegas Salud ........ ......... .:-z.z. ...... ........... Autoridades ~iniente ~obernad;~ Antonio Baldeón Olivo ... ..... lnvolucrados en el Peón Alberto Montes R. Proyecto Docente Lucio Oreste Baldeón López Miembros del Vocal de CLSD Jaime Arenas Benites Comité Local de Salud Autoridades Dirigentes Presidente de CLSD y Santiago Hilarión Agente Municipal Murga Vocal. Agente Oreste L. Mitma comunitario de Salud Huarcaya - Tesorero de CLSD Humberto Hilarton ..... Taboada Técnica ~nfeheria Nancy ~lorec~uadros Presidente C.C. Salla Angel Taboada Prado Salla Agente Municipal Y Santiago Hilarion Presidente del CLSD Murga. Segundo Teniente Feliz Huarcaya Mitma Gobernador Teniente Gobernador Basilio Mitma Huarcaya Presidenta de Club de Esidora Hilarión Madres Murga Director Club Deportivo Edwin lnca P. ~nvolucrados en el Proyecto comunidad césar Canales Espinoza Norma Bernaola comunidad Carbajal Lino Baez Mitma comunidad ~ugusto Hilarion comunidad Murga Félix Bonifacio Baez comunidad Mitma comunidad Humberto Prado Tesorero de la Agencia ~dalberto Ramos Catano Rosalino Orlando comunero Hilarion Hilarión Comunero Cirilo Mitma QuisPe Rub& Wiiiiam Hilarión ("tegrante del Pueblo Hila@ . -.-a~~~;: 3.gg~s?y-" .:=yz: : .>% . .-z=*.~?eazz-~-~~ :.+.* =+<.:: =.=--. - -. .=,. .. .. . - .. .. ... . ADRA- Perú RRiS project Final Evaluaüon AREQUlPA LOG%AB&D 1 EST@&MIENTO .~%E~ALuD CS Caraveli PS El Porvenir Autoridades Miembros del Comité Local de Salud Autoridades Miembros del Comitb Local de Salud Jefatura del cs Caraveli Presidente del CLSD Ángel Anibal Montoya Negrillo .., Médico Jefe del PS E¡' Pedro Zevallos Porvenir Carazas .... Presidenta del C¡SD Lic. Modesta ~edina Gonzáles Secretaria de Actas del Hugo Condori CLS Chamblla Vocal Representante de Apolinario L. Quispe Municipio Apaza Enfermera del PS El Ruth Roman Delgado ..- .. .. -=. . , . . . .- -z::- ... " ,. ., ...... .... RUS Project Final Evaluation MOQUEGUA LOCALIDAD 1 ESTABLECIMIENTO CATEGOR~A DE SALUD PS Yacango Autoridades Miembros del Comité Local de Salud C.S. 28 de Julio Dirigentes Involucrados en el Proyecto .. . - . -. , Capacitados en Autoconstrucción Autoridades Miembro del Comité Local de Salud. Enfermera del PS Rosario Luz Gonco Yacango Pino Médico SERUMS Érika Yessenia Carcia equivalente Pérez Teniente Gobernador del Manuel Toala Centro Poblado Menor Espinoza de Yacango Presidenta del CLSD Vicentina Arocutipa Arcos Secretaria del CLSD Edina Susana López Jorge Promotora de Salud Silveria R. De Valdez F~scal del Comité Manuel Toala Espinoza Comité Silveria R. De Valdez Promotora de Salud Fidelina Martina Cuayla Diaz Directivo de Frente de Henry Valonia Defensa Romero Presidenta de la Vicentina Arocutipa Organización Social de Arcos ase "Dos de Julio" Tesorero del AA.HH Rildo Valdez Ramos Cerro Baúl. Agente Municipal del Eloy Quispe Ramos. ~Rexo de le gama. Secretaria CLSD. Edina Susana López -.. :.:-. -. . Jorge. .- ,--. William Felix ~aldez Ramos. Tesorero del AA.HH Rildo Valdez Ramos Cerro Baúl. Agente Municipal del Eloy Quispe Ramos. Anexo de Alegama. Secretaria CLSD. Edina Susana López Jorge. .... - . . Jefe de Establecimiento Victor Jorge Loaiza Vela Medico Gerardo Calderón . . .. Escobedo. .. - .. Presidenta María vasquez de Tesorera Delgado. Lucia Lupaca Flores. Vocal Leoncio Olvianina Primer Vocal Arnbrosio Pari Pari. Técnico de Enfermería Ysabel Nina Tintaya. ADRA-Perú RRIS Projed Final Evaluation TA CNA LOCALIDAD 1 ESTABLECIMIENTO DE SALUD C.S. Candarave. .......... . ......... - -. .- - . - . ...... P.S. Curibaya P.S. Juan Velasco A. Autoridades Medico Gerente Miguel Angel Del Carpio Torres. .... Dirigentes secretario del CLAS ~re~orio Justo Aduvire. Presidente Clas - Salomón Laqui Gndarave. ..-z: Mamani. ....... ..:.. ... .:.S- -- -. ., Miembro del Comité Presidente del Comité Salomón Laqui Local de Salud de Salud ............. - .... ... .... Mamani. .... lnvolucrados en el ~nferhya Jefe. Vicky Cerna Araos. Proyecto. Enfermera Carlisa Gilma Coaquira Carpio. Obstetriz Asistencial. Dilcia Manzano G. .. -.- . -. ...... .a . - -. . .i;i"i'.%." -=.a.-3-. < -a>". -=.--..-.. . - . . -.-- . .- .--- ..z+z:. .......= ............ Autoridades Enfermera del Puesto de Paula Hideki Salud de Curibaya. Huacanmamani. Ex Teniente Alcalde. Fredy Mamani Rejas. . , ..-. %" .--: ". -.-. .. -p. Miembro del Comité Secretario del Comité Daniel Gutierrez Local de Salud. . . . Local de Salud ..... .... ==.. .:. ..... :, .. Maldonado .-.: Ca~acitados en Maestro de Obra. Isidoro Aguilar ~u~oconstrucción. ... . . . . .. Mamani. .....&. ...... . .. .. :-: __i Autoridades Gerente del CLAS P.S. Hugo Ballón Moscoso. Juan Velasco A. Enfermera Juana Adrianzén Villalobos Jefe de la Oficina de Lic. José Luis Administración Carhuamaca Paria. Tributaria. .. . . . "- -. .----xzm= . -. .. ... ..--. -- . -- -. . . Miembro del Comité presidente xzino Alave Ticona. Local de Salud. Tesorera Adela Maauera lnoenieros "- - Residentes. Dirioentes . .... .... .- Caiis.. ........... Facilitadora ADRA-Perú. Anaela Sandoval LIGO~. ....... ..... .. .:.. .- - -. -- - Presidente de J.V. Gabino ~lave%cona - INTIORKO Tesorera. Adela Maquera .... ... Calisaya. ..... . . ..... .... . . . . .... .......... ... - ... ... ....... ....... : : ADRA-Perú RRIS Project Final Evaluation Annex 9 Photo Report ADRA-Perú RRIS Project Final Evaluation Annex 9 Photo Report RRls Pmject Final Evaluation HP Salla Salla - Ayacucho RRIS Project Final Evaluation HP El Powenir- Arequipa HP Yacango Moquegua ADRA-Perú RRIS ~ruject Final Evaluation HP Juan Velasco Alvarado- Tacna RRIS Project Final Evaluation Anexo 10 INDEX CARD FORMAT OF SURVEYS (spanish version) ADRA - PERU Final Evaluation FECHA: 1 1 A PREGUNTAS PARA LOS DIRIGENTES* DE LA LOCALIDAD LOCALIDAD: RED 1 MlCRO RED: ESTABLECIMIENTO DE SALUD: Marque con una equis (X) la respuesta que corresponde y escriba en los espacios en blanco. 'SABE LO QUE ES UNA RED LOCAL DE DESARROLLO?^^^) (NO) 'PARA QUE SIRVE? ¿LE PARECE UTIL Y CONVENIENTE? (SI) (No) ¿POR QUE? 'EXISTE EN SU LOCALIDAD? (SI) (NO) ¿QUIÉN LA ORGANIZO? 'ESTA USTED INCORPORADO A LA RED DE SU LOCALIDAD? (SI) (NO) 'COMO SE INCORPORO? LALGUIEN LE EXPLICO LA LABOR DE LA RED7 (SI) (No) &QUIEN7 'SABE USTED LO QUE ES UN COMITÉ LOCAL DE DESARROLLO? (SI) (No) ¿PARA QUÉ SIRVE? ¿ALGUIEN LE EXPLICO SOBRE EL PARTICULAR? (SI) (NO) ¿QUIEN? ¿LE PARECE UTIL Y CONVENIENTE UN COMITÉ LOCAL DE DESARROLLO? {SI) (No) 'POR QUÉ? ¿EXISTE EN SU LOCALIDAD? (SI) (NO) LCUANDO SE FORMO? LQUIÉN COORDINA? ¿SE COMUNICAN CON FRECUENCIA? (SIMNO) 'SOLO CON EL COORDINADOR? (SI)(NO) ¿ENTRE TODOS? (SIMNO) 'CON QUE FRECUENCIA SE REUNE EL COMITE? <,HA DESARROLLADO ALGUNA CAMPAÑA ESPECIAL" (SI) (No) ,,CUAL O CIJALES? .- - . ADRA - PERU Final Evaluation 'TIENEN UN PLAN ESTRATEGICO O DE DESARROLLO PARA SU LOCALIDAD? (SI) (NO) ¿EN SU FORMULACION PARTICIPO LA COMUNIDAD? {SI) (NO) ALE PARECE QUE ES BUENO? (SI) (NO) 'PROPONE PROYECTOS IMPORTANTES PARA EL DESARROLLO DE LA LOCALIDAD?(SI) (No) LCUALES? 'APROVECHAN LOS RECURSOS LOCALES DISPONIBLES? {SI) (NO) 'ALGLJNAS DE LAS ACCIONES O PROYECTOS PROPUESTOS EN EL PLAN ESTRATEGICO O DE DESARROLLO SE HAN REALIZADO O SE ESTAN REALIZANDO? (SI) (NO) 'CUALES? 'HAY RESULTAWS?(SI) (NO) 'CUALES? AQUÉ PROPUESTAS DE ACCIONES O PROYECTOS DE SU PLAN ESTRATEGICO O PLAN DE DESARROLLO SE ENCUENTRAN A NIVEL DE IDEA? DE PERFIL? DE PRE-FACTIBILIDAD? DE FACTIBILIDAD? ¿QUÉ PROYECTOS SE ENCUENTRAN EN FESTIÓN PARA SU FINANCIAMIENTO Y EJECUCIÓN? 'CUALES YA CUENTAN CON FINANCIAMIENTO Y ESTAN PENDIENTES DE EJECUCIÓN? 'CUALES YA ESTAN EN EJECUC~ON? ¿ESTOS PROYECTOS SON IMPORTANTES PARA EL DESARROLLO DE LA LOCALIDAD Y SE AJUSTAN A LA REALIDAD? (SIIO ¿TIENE ALGON COMENTARIO O SUGERENCIA QUE HACER? Nombre: Cargo: * Directivos de las oreanizariones de base de la mci~dad civil aue han inrmwnido o son h~neficiarios del Prnvecto ADRA - PERU Final Evaluation FECHA: 1 1 B LOCALIDAD: RED 1 MlCRO RED: ESTABLECIMIENTO DE SALUD: PREGUNTAS PARA LOS MIEMBROS DEL COMITÉ LOCAL DE SALUD Marque con una equis (X) la respuesta que corresponde y escriba en los espacios en blanco. LQUIÉN LE EXPLICÓ DE QUÉ SE TRATA? ¿EN UNA SOLA OCASIÓN O EN VARIAS? (SI) (NO) LCÓMO SE INCORPORÓ AL COMITÉ? ¿LE PARECE ÚTIL Y CONVENIENTE O ES PÉRDIDA DE TIEMPO? LQUIÉNES MÁS LO INTEGRAN? ¿QUIÉN LO COORDINA? ¿CÓMO FUE NOMINADO? ¿CUÁNDO SE FORMÓ EL COMITI? LOCAL DE SALUD AL QUE PERTENECE? ¿SE COMUNICAN CON FRECUENCIA? m $ÓLO CON EL COORDINADOR? (SI)(NO) ¿ENTRE TODOS? (SI)(NO) ¿SE REUNEN CON FRECUENCIA? (SI)(NO) LCUÁNTAS REUNIONES HAN TENIDO HASTA LA FECHA? ¿QUÉ HA HECHO HASTA AHORA EL COMITÉ LOCAL DE SALUD EN SU LOCALIDAD? ¿PARTICIPÓ O COLABORÓ USTED EN LA REHABILITACIÓN O RECONSTRUCCIÓN DE SU ESTABLECIMIENTO DE SALUD? (SI) (NO) ¿EN QUÉ FORMA? ADRA - PERU Final Evaluation ¿EL COMITÉ APOYA LA EJECUCI~N DE LOS PROGRAMAS DE SALUD PREVENTIVOS PROMOCIONALES? (SI) (NO) LCUÁL O CUÁLES? ¿EXISTE COORDINACI~N ENTRE EL COMITÉ LOCAL DE SALUD Y EL ESTABLECIMIENTO DE SALUD DE SU JURISDICCIÓN? (SI) (NO) ¿EN QUÉ FORMA COORDINAN? ¿SE COORDINAN FRECUENTEMENTE? (SI) (No) ¿HAY DIFICULTADES PARA COORDINAR CON EL ESTABLECIMIENTO DE SALUD? (SI) (NO) LCUÁLES SON LOS PRINCIPALES INCONVENENTES? ¿SABE EL COMITÉ LOCAL DE SALUD LO QUE ES UNA RED LOCAL DE DESARROLLO? (SI) (NO) ¿SE INTERESA EN FORMAR PARTE DE ELLA? (SI) (NO) ¿EN PROMOVERLA SI NO EXISTE AÚN? (SI) (NO) Nombre: Cargo: ADRA - PERU Final Evaluation FECHA: 1 1 C PREGUNTAS PARA LAS AUTORIDADES* DE LA LOCALIDAD LOCALIDAD: RED 1 MlCRO RED: ESTABLECIMIENTO DE SALUD: Marque con una equis (X) la respuesta que corresponde y escriba en los espacios en blanco. ¿EN LA REHABILITACIONIRECONSTRUCCION DEL ESTABLECIMIENTO DE SALUD HA PARTICIPADO m COMITÉ LOCAL DE SALUD? (SI) (NO) 'HACIENDO QUÉ? ¿FUE UTIL?(SI) (NO) ¿EN QUE? ¿YA EXISTJA O SE CONSTITUYO DEBIDO AL PROYECTO RRIS? ¿suBsIsTE?{SI~(NO) ¿CON VITALIDAD?{SI)(NO) ¿SE REUNE PERIODICAMENTE U OCASIONALMENTE? ¿CADA QUÉ TIEMPO? ¿QUIENES LO INTEGRAN? ¿RECIBIERON ALGUNA CAPACITACI~N? (SI) (NO) 'DE QUIEN? 'CON QUE RESULTADOS? 'QUIÉN COORDINA AL COMITÉ LOCAL DE SALUD? LCÓMO FUE NOMINADO EL COORDINADOR? ADEMÁS DE PARTICIPAR EL COMITÉ EN LA REALIZACI~N DE LA OBRA, ‘SE INTERESA EN EL MANTENIMIENTO DE LA MISMA? (SI) (No) ¿COMO? ¿Y EN SU FUNCIONAMIENTO Y EL SERVICIO DE SALUD QUE EL ESTABLECIMIENTO DEBE PRESTAR? (SI) (NO) ¿COMO? 'Y EN GENERAL, EN EL DESARROLLO DE SU LOCALIDAD? {SI) (NO) ¿COMO? 'SE HA CONSTITUIDO UN COMITE LOCAL DE DESARROLLO PARA SU LOCALIDAD? (SI) (NO) 'YA EX~ST~A O SE CONSTITUYÓ CON OCASIÓN DEL PROYECTO RRIS? 'FUNCIONA? (SI) (No) 'QUE HACE? ¿SE HA LOGRADO ESTABLECER UNA RED LOCAL DE DESARROLLO?(SI) (No) 'YA EXISTIA O SE CONSTITUYO DEBIDO AL PROYECTO? ¿QUIEN LA IMPULSA Y ARTICULA? 'QUIENES LA INTEGRAN? 'FUNCIONA? (SI) (NO) ¿BIEN? (SI) (NO) 'REGULAR? (SI) (NO) ¿MAL? (SI) (NO) 'POR QUÉ? ¿QUE SERIA RECOMENDABLE? .TIENEN UN PLAN ESTRATÉGICO O DE DESARROLLO PARA SU LOCALIDAD? (SI) (No) &EN SU FORMULACION PARTICIPO LA COMUNIDAD? {SI) (NO) ¿LE PARECE QUE ES BUENO? (SI) (NO) 'PROPONE ACCIONES O PROYECTOS IMPORT9NTES PARA EL DESARROLLO DE 1.A LOCALIDAD? (SI) (NO) ¿CUALES? LESI~AN A NIVEL DE IDEA O ESTAN IIESARROLLADOS PARA FINANCIARSE Y EiECUTARSt' __ ADRA - PERU Final Evaluation 'APROVECHAN LOS RECURSOS LOCALES DISPONIBLES? (SI) (No) ¿ALGUNAS DE LAS ACCIONES O PROYECTOS PROPUESTOS EN EL PLAN ESTRATÉGICO O DE DESARROLLO SE HAN REALIZADO O SE ESTÁN REALIZANDO? 'CUALES? ¿HAY RESULTADOS?(SI) (NO) ¿CUALES? 'QUE PROPUESTAS DE ACCIONES O PROYECTOS DE SU PLAN ESTRATEGICO O PLAN DE DESARROLLO SE ENCUENTRAN A NNEL DE IDEA? DE PRE-FACTJBILIDAD? DE FACTIBILIDAD? 'QUE PROYECTOS SE ENCUENTRAN EN GESTION PARA SU FINANCIAMIENTO Y EJECUCION? ¿ESTOS PROYECTOS SON IMPORTANTES PARA EL DESARROLLO DE LA LOCALIDAD Y SE AJUSTA A LA REALIDAD? (SI) (No) ¿SE NCIÓ ALGlh PROGRAMA DE AUTOCONSTRUCCIÓN DE VIVIENDAS ANT~S~M~CAS EN LA LOCALIDAD? (SI) (NO) ‘YA EXISTIA O SE CONSTITUYO DEBIDO AL PROYECTO? ¿YA CONCLUYÓ?(SI) (NO) ¿CON QUÉ LOGROS? ¿SUBSISTE? lS1) (NO) 'CONTARON CON ALGÚN APOYO? (SI) (NO) ¿DE QUÉ CLASE? ¿FALLO EL PROGRAMA EN ALGO O SE AFRONTARON OBSTÁCULOS? ¿EN QUE? ¿CONTARON CON UN COMITÉ DE AUTOCONSTRUCCIÓN DE VIVIENDAS? (SI) (NO) iHAClENW QUE? 'YA EX~ST~A O SE CONST~TUYO DEBIDO AL PROYECTO? ¿FUE ÚTIL? (SI) (No) ;EN QUE? ¿RECIBIERON LOS AUTOCONSTRUCTORES ALGUNA CAPACITACION? (SI) (NO) 'DE QUIENES? ¿CONTARON CON ALGÚN APOYO? (SI) (NO) ¿CUALES? ¿QUE RECOMENDAR~A PARA UN MEJOR LOGRO DE AUTOCONSTRUCC~ÓN DE VIVIENDAS ANT~SISM~CAS EN LA LOCALIDAD? ¿COMENTARIOS O SUGERENCIAS? ADRA - PERU Final Evaluation FECHA: 1 1 D LOCALIDAD: RED 1 MlCRO RED: ESTABLECIMIENTO DE SALUD: PREGUNTAS PARA LOS INGENIEROS RESIDENTES* DE LA LOCALIDAD Marque con una equis (X) la respuesta que corresponde y escriba en los espacios en blanco. PREGUNTAS PARA LOS DE APOYO ¿EN LA REHABILITACI~NIRECONSTRUCCI~N DEL ESTABLECIMIENTO DE SALUD HA PARTICIPADO UN COMITÉ LOCAL DE SALUD? (SI) (No) ¿HACIENDO QUÉ? ¿FUE ÚTIL? (SI) (NO) ¿EN QUÉ? ¿YA EXIST~A O SE CONSTITUY~ DEBIDO AL PROYECTO? ¿SUBSISTE? (SI) (NO) ¿CON VITALIDAD? (SI) (NO) ¿SE REUNE PERIODICAMENTE U OCASIONALMENTE? ¿CADA QUÉ TIEMPO? LQUIÉNES LO INTEGRAN? ¿RECIBIERON ALGUNA CAPACITACIÓN? (SI) (NO) ¿DE QUIÉN? ¿CON QUÉ RESULTADOS? LQUIÉN COORDINA AL COMITÉ? ~CÓMO FUE NOMINADO EL COORDINADOR? ¿SE INTERESA EL COMITÉ LOCAL DE SALUD EN EL MANTENIMIENTO DE LA OBRA? (SI) m LCÓMO? ¿Y EN SU FUNCIONAMIENTO Y EL SERVICIO DE SALUD QUE EL ESTABLECIMIENTO DEBE PRESTAR? (SI) (NO) LCÓMO? ¿Y EN GENERAL, EN EL DESARROLLO DE SU LOCALIDAD? (SI) (NO) LCÓMO? ¿SABE EL COMITÉ LOCAL DE SALUD LO QUE ES UN COMITÉ LOCAL DE DESARROLLO Y LO QUE ES UNA RED LOCAL DE DESARROLLO? (SI) (NO) ¿SE INTERESA EN FORMAR PARTE DE ÉSTA? (SI) (NO) ¿EN PROMOVERLA SI NO EXISTE AÚN? (SI) (NO) ¿SE WICIÓ ALGÚN PROGRAMA DE AUTOCONSTRUCCION DE VIVIENDAS ANTIS~SMICAS EN LA LOCALIDAD? (SI) (NO) ¿YA EXISTIA O SE CONSTITUY~ DEBIDO AL PROYECTO? ¿YA CONCLUYÓ? (SI) (NO) ADRA - PERU Final Evaluation ¿CON QUÉ LOGROS? ¿SUBSISTE? (SI) (No) ¿CONTARON CON ALGÚN APOYO? (SIm ¿DE QUÉ CLASE? LFALLÓ EL PROGRAMA EN ALGO O SE AFRONTARON OBSTÁCULOS? (SI) (NO) ¿EN QUÉ? ¿CONTARON CON ALGÚN COMITÉ DE AUTOCONSTRUCCION DE VIVIENDAS? (SI~O~ ¿YA EXIST~ O SE CONSTITUYÓ DEBIDO AL PROYECTO? FUE ÚTIL? (SI) (NO) ¿EN QUÉ? 10. ¿RECIBIERON LOS AUTOCONSTRUCTORES ALGUNA CAPACITACI~N? (SI) (NO) ¿DE QUIÉNES? ¿CON QUÉ RESULTADOS? i 1. LQUÉ RECOMENDAR~A PARA UN MEJOR LOGRO DE AUTOCONSTRUCCI~N DE VIVIENDAS ANTIS~SMICAS EN LA LOCALIDAD? 12. ¿SE HA LOGRADO ESTABLECER UN COMITÉ LOCAL DE DESARROLLO? (SI) (NO) ¿YA EXISTÍA O SE CONSTITUY~ DEBIDO AL PROYECTO? ¿QUIÉN LA IMPULSA Y ARTICULA? LQUIÉNES LA INTEGRAN? ¿QUÉ SER~A RECOMENDABLE? ¿SE HA LOGRADO ESTABLECER UNA RED LOCAL DE DESARROLLO? (SI) (No) ¿YA EXIST~A O SE CONSTITUYO DEBIDO AL PROYECTO? LQUIÉN LA IMPULSA Y ARTICULA? ¿QUIÉNES LA INTEGRAN? Nombre: Cargo: ADRA - PERU Final Evaluation FECHA: 1 1 E LOCALIDAD: RED 1 MICRO RED: ESTABLECIMIENTO DE SALUD: PREGUNTAS PARA LOS INVOLUCRADOS EN EL PROYECTO Marque con una equis (X) la respuesta que corresponde y escriba en los espacios en blanco. 1. ¿QUÉ TIPO DE AMENAZA HA ENCONTRADO EN EL PROYECTO DURANTE SU IMPLEMENTACIÓN EN LA REHABILITACIÓN O RECONSTRUCCI~N DE SU PUESTO O CENTRO DE SALUD (CLIMA, SUELO, UBICACIÓN, NIVELES DE IDENTIFICACIÓN, OTROS)? -- ~EN QUÉ MEDIDA EL APOYO LOGfSTICO HA SIDO APROPIADO PARA LAS ACTIVIDADES DE IMPLEMENTACIÓN? &ÓMO HA CONTRIBUIDO EN LOS RESULTADOS OBTENIDOS? DEL PERSONAL ESPECIALISTAS MAQUINARIA Y EQUIPO 'HUBO APOYO APROPIADO? APOYO FINANCIERO @MO CONTRIBW~ A LOS RESULTADOS OBTENIDOS? '~6~0 CONTRIBW~ A LOS RESULTADOS OBTENIDOS? MAQUINARIA INSUMOS Y MATERIALES A TIEMPO OTROS.. ................ ¿HUBO APOYO APROPIADO? (SI) (No) 61) (No) 61) Wo) 'C6MO CONTRIBWÓ A LOS RESULTADOS OBTENIDOS? PARTIDAS A TIEMPO JORNALES PAGADOS A TIEMPO DE LA COMUNIDAD 2. ¿EN QUÉ MEDIDA HUBO APOYO DE DIVERSAS INSTITUCIONES? APOYO DEL PRONAME OTROS ......................... ¿HUBO APOYO APROPIADO? (Sr) (No) (SI) (No) (SI) (No) ¿HUBO APOYO APROPIADO? &ÓMO CONTRIBWÓ A LOS RESULTADOS OBTENIDOS? ADRA - PERU Final Evaluation APROB. DE EXP. TÉC. A TIEMPO (SI) (No) RECEPCIÓN DE OBRA A TIEMPO SUPERVISI~N DE OBRA A TIEMPO (SI) (NO) OTROS ................................ (SI) (NO) APOYO DEL MINSA INSCRIPCI~N DE LA PROPIEDAD OTROS APOYOS .......................... 4. ¿SE ENCUENTRA SATISFECHO CON LA TECNOLOG~A UTILIZADA EN LA REHABILITACIÓN Y10 RECONSTRUCCIÓN DE LA INFRAESTRUCTURA DE SALUD? (SI) ¿CONOCE USTED LAS NORMAS VIGENTES DE ARQUITECTURA HOSPITALARIA? [sn m ¿SABE USTED SI LA INFRAESTRUCTURA DE SALUD CUMPLE CON DICHAS NORMAS? m 5. ¿SE ENCUENTRA SATISFECHO CON LOS MATERIALES USADOS EN LA CONSTRUCCIÓN DE LA OBRA? ¿CON LA MANERA DE COMO SE CONSTRUYÓ? (SI) ¿CON LOS CAMBIOS HECHOS? (SI) 6. ¿LOS BENEFICIOS ALCANZADOS CUBREN SUS EXPECTATNAS ORIGINALES? m 7. ¿ESTA SATISFECHO CON LA EJECUCIÓN DEL PROYECTO? (SI) ¿POR QUk? ~CÓMO CONTRIBW~ A LOS RESULTADOS OBTENIDOS? TERRENOS SANEADOS A TIEMPO ASESORIA TÉCNICA APROB. DE EXP. TÉC. A TIEMPO RECEPCIÓN DE OBRA A TIEMPO .... (SI) (NO) (SI) (NO) 3. $UÁL FUE EL GRADO DE PARTICIPACIÓN DE INVOLUCRADOS EN EL PROYECTO? ¿ALGUNA SUGERENCIA O COMENTARIO? ¿HUBO APOYO APROPIADO? (SI) (No) (SI) (No) (SI) (No) 61) (No) Nombre: $6~0 CONTRIBW~ A LOS RESULTADOS OBTENIDOS? COMITÉ LOCAL DE DESARROLLO COMITÉ LOCAL DE SALUD GOBIERNOS LOCALES DIRECCIONES REGIONALES DE SALUD OTRAS INSTITUCIONES ....... 'HUBO GRAN PARTICIPACION, (SI) (No) (SI) (No) (SI) (No) (SI) (No) FECHA: 1 1 F LOCALIDAD: RED 1 MlCRO RED: ESTABLECIMIENTO DE SALUD: PREGUNTAS PARA LOS CAPACITADOS EN AUTOCONSTRUCCION Marque con una equis (X) la respuesta que corresponde y escriba en los espacios en blanco ¿ESTA SATISFECHO CON LA INNOVACIÓN TECNOLÓGICA QUE HA APRENDIDO EN LA CAPACITACION EN AUT~CONSTRUCCI~N DE VMENDAS? (SI) (NO) ¿SABE SI SE LLEGÓ A FORMAR LOS COMIT'ÉS DE AUTOCONSTRUCCIÓN? (SI) (NO) ¿ÉSTOS SE ENCUENTRAN FUNCIONANDO? (SI) íNO) ¿ESTÁ APLICANDO LAS TÉCNICAS APRENDIDAS EN ACTIVIDADES DE CONSTRUCCIÓN DE VIVIENDAS? (SI) (NO), ¿DE QUÉ FORMA LO ESTÁ APLICANDO? ¿SABE SI OTROS CAPACITADOS LO ESTÁN APLICANDO? [SI) (NO), ¿EN QUÉ OBRAS? ¿EL MODO DE DAR LA CAPACITACI~N LE PARECE QUE FUE CLARA Y APROPIADA? (SI) (NO). ¿USTED CREE QUE LOS TEMAS DE CAPACITACI~N QUE REALIZARON COINCIDIERON CON LAS NECESIDADES SENTIDAS DE SU COMUNIDAD? (SI) (NO) LQ~É SISTEMA DE CONSTRUCCIÓN UTILIZARfA PARA CONSTRUIR SU VIVIENDA? m ADOBE (SI) (NO) = LADRILLO (SI) (NO) ¿LOS MANUALES QUE LE ENTREGARON SON ENTENDIBLES? (SI) (NO) ,SE SIENTE CAPACITADO PARA PODER ENSENAR LA AUTOCONSTRUCCI~N A OTRAS PERSONAS DE SU COMUNIDAD? (SI) (NO). ¿SABE CÓMO SE UBICA EL TERRENO PARA QUE NO SEA AFECTADO POR ALGÚN FEN~MENO NATURAL? PI) (NO), ADRA - PERU Final Evaluation ¿DONDE NO SE DEBE CONSTRUIR? EN ZONAS PRÓXIMAS A LOS PANTANOS (SI) (NO) EN TERRENOS CON MUCHA PENDIENTE (SI) (NO) CERCA A QUE A LAS MARGENES DEL RÍO (SI) (NO) CERCA A QUEBRADAS SECAS (SI) (NO) LA PROPORCIÓN DE MEZCLA PARA CIMIENTO ES: UNA BOLSA DE CEMENTO + DIEZ BOLSAS DE HORMIGON + 30% DE PIEDRA DE 8" (SI) UNA BOLSA DE CEMENTO + CiNCO BOLSAS DE HORMIGON + 30% DE PIEDRA DE 8" (SI) UNA BOLSA DE CEMENTO + OCHO BOLSAS DE HORMIGON + 30% DE PIEDRA DE 8" (SI) EL FIERRO PARA LAS COLUMNAS ES DE: 518 m %" m 318" (SI) %" (SIJ EL FIERRO PARA LOS ESTRIBOS ES DE: 518" (SI) %"(SI) 318" (SIJ %" (SI) LOS ESTRIBOS SE DEBEN COLOCAR CADA: 20cm. (SI) 25 cm.m 30 cm.m ¿TIENE ALGUNA SUGERENCIA O COMENTARIO? Nombre: Cargo: