Primary Health Care Reform Project (USAID)

The Primary Healthcare Reform (PHCR) project, the largest project in the field of Primary Health Care (PHC) in Armenia so far, was a nationwide five-year (2005-2010) program aimed to increase the utilization of sustainable, high-quality primary healthcare services with an ultimate goal of improving health of the population of Armenia.  The project was funded by the United States Agency for International Development (USAID) under a contract awarded to Cardno Emerging Markets USA, Ltd. (Cardno), formerly Emerging Markets Group, Ltd in September 2005.

The AUA Center for Health Services Research and Development (CHSR), a sub-contractor to Cardno, carried the primary responsibility for monitoring and evaluation (M&E) of the PHCR project.  This responsibility was reached through two coordinated approaches: internal monitoring and external evaluation. While internal monitoring was mainly focused on Developing Project’s Performance Management Plan (PMP) indicators and monitoring those through internal data gathering, the external evaluations were built on a set of assessments that measured the project’s influence at its target sites and among its beneficiaries.  The M&E assessments followed the project’s regional scale-up approach that expanded the reforms zonally throughout the country.  The M&E team conducted 18 different assessments including baseline and follow-up surveys in target facilities (facility resource assessments, facility and provider performance assessments) and among target communities (client satisfaction surveys, and health knowledge, attitude, and practice (KAP) surveys) in each zone, and a countrywide Household health survey to measure the project’s overall impact on the perceived health status and health seeking behavior of general population. The external evaluations sought to comprehensively measure the effect of the project through comparisons of baseline and follow-up data specific to project activities and level of intervention, and to contribute to better planning/designing of similar projects in future. In the meantime, the M&E activities provided the project team and its stakeholders timely performance feedback that shaped changes to program activities and contributed to the project’s documented improvements in almost all indicators.

The M&E team’s dynamic, comprehensive, multi-perspective assessment approach matched design and sampling rigor to program goals, objectives, and resources.  This approach resulted in a valid and effective framework for monitoring and evaluating the complex, multi-year PHCR project and documenting its success in meeting its objectives. One of the main lessons learned due to this experience was that robust monitoring and evaluation efforts are integral and crucial to assessing project progress and ensuring that future efforts are more efficient, more effective, and more sustainable.