CASE STUDY by zy636H


									                                         CASE STUDY

                            MANICA DISTRICT, MOZAMBIQUE

You are responsible for a PHC development project in the District of Manica in central
Mozambique. You have $500,000 available for the next four years to be used to improve health
status and primary health care serives (including water and sanitation, if you wish). Your
funding agency and the Ministry of Health request that you formulate an itemized budget in 60
days. The funding agency also requires a mid-term and final evaluation of project impact.

Manica District has a population of approximately 120,000 in an area appoximately 80 x
150km. There are 4 health centers (small hospitals with 10-40 beds each) in the population
centers of Vila Manica, the district capital, Machipanda, the railway terminal, Messica, the
lumber mill, and in Vanduzi, a large farm. There are apparently physicians in Vanduzi and
Messica working with foreign organizations; the other health centers are genearlly staffed by
nurses and other mid-level personnel, although there is also 1 physician working in Vila
Manica. Vila Manica is also one of the sites where HIV treatment (including antiretroviral
treatment) is offered. Of the 19 health posts in the district, 12-15 are supposedly functioning.
There is one vehicle (Toyota Landcruiser) belonging to the health services; some motorcycles
are apparently available.

The district health director, a nurse, tells you that the major health problems of the district are
diarrhea, malaria, HIV, and tuberculosis. You had been told previously that the transmission of
malaria is actually less intense in Manica most other districts in Mozambique. You know from
UNICEF reports that the estimated IMR in Mozambique is around 200/1000 live births and the
cumulative under 5 mortality is nearly 300/1000. The HIV seroprevalence rate for Manica
Province, in which Manica District sits, was 19.7% based on the 2004 HIV sentinel surveillance
project. One of the sentinel sites for this study was the antenatal care clinic in Vila Manica,
where the HIV pevalence was 15.7%.

Food production in the district was poor last year, although the current rains seem plentiful.
Water and sanitation is inadequate in rural areas.




Other questions:
How will you obtain the data?
Where will it come from?
How reliable will it be?
What are the costs of the data?
Epi/Health Services 539
Winter 2001

Assignment # 1

Please list the information you would like to know to develop and evaluate the Manica District
primary health care project

Information (Indicator)      Data Source   Quality   Problems and concerns?    Time       Cost
                                           4-good                              required

A few assumptions re: Cost

Trained Mozambican interviewers: $100 per month
       (nurse level)                 $10 per day
Outside consultant (MPH level-knows Epi-Info): $3000/mo plus housing, transport
Per diem       $20/day overnight; $5/day full day surveying

Vehicles: Rental:     $50/day (sedan car without fuel)
                      $75/day (10-seater without fuel)

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