RESUMO
PIP: The process of evaluating maternal-child health services in Tokombere, North Cameroon, is described to illustrate the use of different indicators to evaluate different aspects of a health program. The maternal-child health program in Tokombere calls for children 5 and under and their parents to meet once each month for health education and weighing of children to screen for nutritional problems. Vaccinations are provided elsewhere during regular campaigns. The 1st step in evaluating the program is to determine whether a maternal-child health program actually exists in the village and whether it meets regularly. Attendance at the maternal-child health services can be evaluated by calculating the proportion of children 1-5 years old who attended at least 3 meetings during the year. To ascertain the proportion, attendance can be taken at each meeting, or the proportion can be estimated by checking at a single well-attended meeting to see how many children have attended 2 other meetings in the past year. The total number of children can be estimated through a survey, by asking the village head, or by consulting the census or vital register, if they exist. Indicators of the effectiveness of the maternal-child health program in screening for and treating malnutrition include the proportion of children for whom a growth curve is completed and correctly interpreted, the proportion of children identified as malnourished, and the proportion of children among those identified at the maternal-child health meeting who are followed up until their weight returns to a satisfactory level. The most difficult aspect of the valuation is determining its impact on the health status of children. Often quantitative measures are impossible, and even with qualitative measures it may be impossible to distinguish between the effects of the program and effects of other actions or of general social development. THe infant mortality rate, if available, may be a useful indicator, as may the existence of other development projects prompted by the maternal-child health program. The Tokombere project demonstrates the importance of having a series of indicators to measure different aspects of project functioning. The evaluation should be repeated periodically to assess trends and longterm impact. Each result or trend should be examined and explained in order that program weaknesses can be identified and corrected.^ieng
