Common use of Conclusions and Recommendations Clause in Contracts

Conclusions and Recommendations. Xxxx Xxxx was an exciting, successful project that pioneered innovative approaches to improve child health, particularly SECI and H/PD, and learned a lot about when and how to apply these approaches in rural Bolivia. The project successfully met nearly all of its objectives and surpassed many, as presented in the Results Summary Table. Vaccination coverage increased dramatically, the numbers of acute respiratory infections seen by health services and Promoters increased by 224% from 2001 to 2003, nutritional status improved in the majority of children participating in the H/PD sessions and 54% of children with diarrheal diseases received more liquids, compared with a baseline of 21%. 85% of children received Vitamin A compared with the project objective of 50%10. In 2000, only 13% of children received a checkup at the health center within their first week of life. In 2004, 41% of children received a check up within their first week. Community members, health personnel, SC, and APROSAR attribute these achievements to several factors including: • SECI planning together sessions raised awareness and knowledge about communities’ health problems and status using simple-to-understand tools and processes so that community members, authorities, and health personnel understood the information and could discuss and plan ways to improve health status together. • CB-IMCI increased community access to trained Promoters who helped families learn to identify danger signs and problems during home visits and community meetings and served as an important bridge to the formal health service. In some cases, Promoters provided basic health services (cotrimoxazole for ARI, ORS for diarrhea, paracetamol). • Increased presence of health personnel in communities due to SECI sessions, better coordination with Promoters and communities and, at times, assistance with transport and/or gasoline from Wawa Sana for supervisory and program visits; • The recently introduced universal health insurance (“SUMI”) likely contributed to improved economic access by making health services free to children under five years old and pregnant women. • Program management was notably strengthened since the MTE to focus more on team efforts to coordinate actions, decentralize financial monitoring, monitor progress during monthly (local) and quarterly (all project areas) quality circle meetings. One objective that Wawa Sana did not meet, due to policy and cost structure constraints as previously described, was for 80% of Promoters to have had adequate supplies of ORS. Health personnel, Promoters, community members, and SC and APROSAR staff all strengthened their technical, organizational, and management capacities to identify health problems, set priorities, work together to plan and take action to address these priorities, and monitor their 10 No reliable baseline data existed for comparison.

Conclusions and Recommendations. Xxxx Xxxx was an excitingObjects, successful project that pioneered innovative approaches to improve child health, particularly SECI Outcomes and H/PDSuccess Everyone who participated in this project, and learned all those involved in the final evaluation collectively felt that the project had gotten off to a lot about when slow start. However, a review of the data shows that in spite of the time taken for the project to establish itself, tremendous gains were achieved throughout the life of the project, and while there is still room for continued growth, everyone was surprised at how far they had actually come. Plan managed to apply these approaches meet or exceed nearly every project indicator target by the final evaluation of this project, as demonstrated by a review of the data tables contained in rural Boliviathe body of this report. Plan Cameroon successfully piloted IMCI in one district of Cameroon, leading the effort to introduce IMCI to the country, with the intention by Plan and the MOH (and UNICEF, WHO, HKI, PSI and others) to scale up IMCI throughout the entire country based on the results of this project (as well as the other two pilot districts carried out by UNICEF and WHO). Plan intends to submit another CS proposal, this time under the expanded impact category to scale up IMCI in four provinces in the country as part of a nation-wide scale up campaign being co-funded by several donors. The project successfully met nearly staff witnessed a dramatic shift in the thinking and behavior of mothers /community members and health facility staff as they became more open to participation and learning. This motivated everyone to work even harder to amplify the incredible changes they knew the project was facilitating in an inhospitable environment plagued with poverty and disease, and in the face of tremendous hardship. They stated that the project has been very challenging, but also very rewarding! Achievements, Constraints and Other Factors Plan’s IMCI intervention in this child survival project, which began in 2000, preceded the government roll-out of IMCI in Cameroon by two years. Initially, Plan trained all of its objectives and surpassed many, as presented the 46 health facility staff working in the Results Summary Tablethree project districts using a 6-day IMCI training, which was later to be followed up by the standard 11-day IMCI training recommended by WHO. Vaccination coverage increased dramatically, the numbers of acute respiratory infections seen by health services and Promoters increased by 224% from 2001 to 2003, nutritional status improved in the majority of children participating in the H/PD sessions and 54% of children with diarrheal diseases received more liquids, compared with a baseline of 21%. 85% of children received Vitamin A compared The project then began working with the project objective of 50%10. In 2000, only 13% of children received a checkup health facility staff to support them in fully integrating IMCI into their daily practice at the health center within their first week of lifecenters in all three districts. In 2004Two years later, 41% of children received a check up within their first week. Community membersin 2002 the MOH initiated the pilot IMCI program in Cameroon, health personnelselecting three districts to begin with – Doume District in the East Province with Plan, SCNgaoundere District in the Adamaoua Province with UNICEF, and APROSAR attribute these achievements Eseka District in the Centre Province with UNFPA (who eventually dropped out due to several factors including: • SECI planning together sessions raised awareness and knowledge about communities’ health problems and status using simple-to-understand tools and processes so that community members, authoritiesfunding constraints, and health personnel understood the information and could discuss and plan ways to improve health status together. • CB-IMCI increased community access to trained Promoters who helped families learn to identify danger signs and problems during home visits and community meetings and served as an important bridge to the formal health service. In some cases, Promoters provided basic health services (cotrimoxazole WHO has assumed responsibility for ARI, ORS for diarrhea, paracetamolthis district). • Increased presence Thus, half way into this child survival project, Plan was required to redesign its IMCI intervention and scale it back to only one district (Doume District), which was selected by the MOH to participate in the IMCI pilot program for Cameroon. This situation greatly impacted Plan’s ability to demonstrate substantial success in IMCI implementation in the East Province. However, in spite of health personnel in communities due the situation, Plan did manage to SECI sessions, better coordination with Promoters and communities and, at times, assistance with transport and/or gasoline from Wawa Sana for supervisory and program visits; • The recently introduced universal health insurance (“SUMI”) likely contributed to improved economic access by making health services free to children under five years old and pregnant women. • Program management was notably strengthened since the MTE to focus more on team efforts to coordinate actions, decentralize financial monitoring, monitor progress during monthly (local) and quarterly (all project areas) quality circle meetings. One objective that Wawa Sana did not meet, due to policy and cost structure constraints as previously described, was for 80% of Promoters to have had adequate supplies of ORS. Health personnel, Promoters, community membersdemonstrate significant impact, and SC and APROSAR staff all strengthened their technicalwith a bridge-year ensuing upon the end of this project, organizational, and management capacities they are certain to identify health problems, set priorities, work together to plan and take action to address these priorities, and monitor their 10 No reliable baseline data existed for comparisonachieve additional results which will greatly impact the sustainability of CS project activities.

Conclusions and Recommendations. Xxxx Xxxx was This is a technically-sound, innovative program to address the health needs of an excitingunderserved region of a country, successful project as well as the health needs of an underserved population: newborns. The BCC strategy is in progress and its quality is excellent: print and audio materials have been developed following proper materials development techniques. The laminated picture cards have been praised by all and the main complaint is that pioneered innovative approaches not everyone involved in training others has a full set. The trainings on IMNCI and MAMAN, as well as the educational sessions related to improve child healthIMNCI topics, particularly SECI were well received by all of those who have attended: from health personnel to CHWs to expecting/new mothers. They are described as dynamic, interactive, participatory and H/PDinteresting, both due to the topics covered, and learned a lot about when and how the techniques used (with special mention to apply these approaches in rural Boliviathe role plays). The project successfully met nearly all of its objectives and surpassed many, as presented in Many people have complimented the Results Summary Table. Vaccination coverage increased dramatically, the numbers of acute respiratory infections seen by health services and Promoters increased by 224% from 2001 to 2003, nutritional status improved in the majority of children participating in the H/PD sessions and 54% of children with diarrheal diseases received more liquids, compared with a baseline of 21%. 85% of children received Vitamin A compared with way the project objective of 50%10. In 2000, only 13% of children received a checkup at the health center within their first week of life. In 2004, 41% of children received a check up within their first week. Community members, health personnel, SC, and APROSAR attribute these achievements to several factors including: • SECI planning together sessions raised awareness and knowledge about communities’ health problems and status using simple-to-understand tools and processes so that community members, team has interacted with local authorities, and health personnel understood the information and could discuss and plan ways to improve health status together. • CB-IMCI increased community access to trained Promoters who helped families learn to identify danger signs and problems during home visits and community meetings and served as an important bridge to the formal health service. In some cases, Promoters provided basic health services (cotrimoxazole for ARI, ORS for diarrhea, paracetamol). • Increased presence of health personnel in communities due to SECI sessions, better coordination with Promoters and communities and, at times, assistance with transport and/or gasoline from Wawa Sana for supervisory and program visits; • The recently introduced universal health insurance (“SUMI”) likely contributed to improved economic access by making health services free to children under five years old and pregnant women. • Program management was notably strengthened since the MTE to focus more on team efforts to coordinate actions, decentralize financial monitoring, monitor progress during monthly (local) and quarterly (all project areas) quality circle meetings. One objective that Wawa Sana did not meet, due to policy and cost structure constraints as previously described, was for 80% of Promoters to have had adequate supplies of ORS. Health personnel, Promoters, community members, and SC and APROSAR staff all strengthened their technicaleach other. This favorable review has led to a feeling of ownership among those involved/participating, organizationalwhich will be important to tap into as plans to make this project sustainable are developed. At the policy level, the (former) Project Director has been working closely with colleagues, on bringing the topic of IMCI with a neonatal focus to the national health agenda, with success. Newborn health is now a national health priority, and management capacities the Healthy Babies project can be used as a trial of the implementation of the IMNCI in a rainforest site: results from this project will help guide national level strategies with regards to identify health problemsthe IMNCI implementation at a national level. Where the project is lacking has been in its scope of work: due mostly to funding issues, set prioritiesas well as various other contextual factors described in that section in detail, work together to plan the project has only done a small number of the proposed trainings and take action to address these prioritiesonly developed some of the materials. The good news is that the training materials and capacity is in place, and monitor the materials are drafted and validated and ready to be printed, so the project is in a great position to implement its activities fully with the complete budget they received for Year Three. Moreover, policy work has been focused on the national level. The new Project Director will be based 50% of the time in Pucallpa, which will be key in full involvement in the work towards development of regional health policies that focus on maternal and newborn health improvements. In addition, as the project enters its last two years, it will be crucial to start working strongly towards its sustainability. It is clear that this work must be done in collaboration with the local municipalities. So again, the presence of a Project Director part- time in Pucallpa will be key for this collaborative work and the discussions that need to take place. One issue that will need to be considered during final evaluation, though, is whether the project, hampered by funding restraints in the initiation of this project’s activities, will be able to attain a change in indicators associated to behavior change, such as seeking health care, since activities to changes these behaviors are really only going to fully start in the third year of this project, and this may not be sufficient time to observe significant changes. With regards to specific recommendations, these can be summarized as: Material Printing and Distribution: With the full budget for Year Three, there should be no stopping of the printing and distributing of health materials. Each CHW should have a full set of the laminated picture cards for their 10 No reliable baseline data existed educational work. Posters have been validated; now they need to be printed and distributed. Training: The number of sites that have benefitted from the trainings is limited. The syllabi and materials for comparisonthe trainings and educational sessions have been used and are well-liked. These trainings now need to be conducted in all sites, and refresher workshops need to be scheduled regularly, again, in all sites. CHW Census and Work: One key activity that seems to have inspired more community involvement, especially on behalf of the CHWs, was the implementation of a community census done by the CHWs themselves by dividing the community into sectors and assigning a sector to each worker. This activity has been done in some communities, and has been highly appreciated by all stakeholders. It is recommended that a census with CHWs be conducted in the remaining project sites. In addition, CHWs play a key role in the sustainability of this project, as resources that will remain in their community long after the project has ended. It will be key to train all CHWs, and initiate supervision of all CHWs so that they can start their work and obtain feedback on it in the next two years. Policy Issues and Sustainability: Continue the work at the national level, but start working towards developing regional policies for maternal/neonatal health improvements. The regional level work must also contain a strong emphasis on the sustainability of the project. Moreover, municipalities have a health budget, but may not have all the technical expertise with regards to how to prioritize health expenditures, so regional policy development must be linked with close work and collaboration with municipalities. Finally, related to sustainability and scaling up, with the results of this MTE, the project is in a good position to approach private institutions and corporations for donations towards the project and this population. Crucial to achieving sustainability of the project is the level of community involvement that can be managed in the next two years. It is key for the project team to form community committees and hold meetings and orientation sessions with them and with community leaders. These activities are programmed for the next two years. It is recommended that they be fully supported financially to complete these tasks in all of the key municipalities, given that successfully involving the community is key to long-term sustainability. Updated Workplan: There are various proposed activities, specifically the implementation of the HLBSS training, the development of emergency transportation plans, and the construction of a maternity waiting home, that need to be thoroughly reassessed by the project management. Based on a meeting with the project management team to present the results of this MTE, it is clear that all involved are aware of the issues associated with each of these three activities, and there is no clear decision with regards to how to proceed. The team must decide amongst themselves what the best strategies would be, and update the workplan accordingly. Moreover, there are various activities that they have been involved in, such as policy level work at the national level, which is only minimally described, if at all, in the workplan. It would be strategic for the Healthy Babies team to include these other activities which are focused on improving maternal and neonatal health within their workplan and discuss ways to evaluate how effective these activities were in obtaining their goal. Training/Strengthening Opportunities for Grantee and Partner Organizations: If the Project Management team decides to move forward with HLBSS, and this should be decided soon, then both INMED and XXXXXX expressed interest in technical assistance associated with implementing the HLBSS training, which was not attained partly due to the costs of bringing the HLBSS trainers to Peru. However, the teams recognize this may not be the best time to push the Peruvian MOH towards a decision on supporting HLBSS due to the political discussions regarding institutional vs. home births. Moreover, INMED had stated interest in strengthening its monitoring and evaluation skills, and the former Project Director in obtaining more training on child survival. I recommend that all partners discuss how their training interests have evolved, if at all, how to meet these training needs in the next two years, within the scope of the existing two years of funding. Funding: With two years left to go, and much to be accomplished, but a good track record for the initial portion of their work, this project should get full funding to finalize its workplan. Moreover, the project management team must continue to meet annually to discuss how to prioritize expenditures on specific activities to ensure that all partners involved have a clear picture of how the funding for the entire year will flow, and on what particular activities. A large portion of the funding must be allocated to the operationalizing of field activities, such as trainings and policy meetings, which are a lot more expensive than originally expected due to distances, access and expenses associated with these.

Conclusions and Recommendations. The demonstration and evaluation process provided an opportunity to test community specific tools with a range of end users from the memory institution domain and to gain greater insight into both the current and future evolution of the SHAMAN prototypes for preservation, access and re-use. Xxxx Xxxx was et al. (2000) in their user evaluation study of the Alexandria Digital Library which incorporated the evaluation of a Web prototype by earth scientists, information specialists and educators raised four key questions in relation to their findings that SHAMAN may be well advised to consider, they are paraphrased here with our conclusions from the investigations. What have we learned about our target organizations and potential users? ▪ Memory institutions are most definitely not a homogenised group; their needs and requirements differ greatly across the domain. ▪ Representatives of the archives community are agreed on the benefits of SHAMAN‟s authenticity validation function. ▪ The representatives of government information services remained unconvinced as to the need or benefit of grid technologies or distributed ingest while librarians saw the value of grid access as an excitingasset of the framework. What have we learned about the evaluation approach for digital preservation? ▪ Within the limits of the exercise, successful project that pioneered innovative approaches in terms of time-frame and resources, the approach adopted has generated useful information for the further development of demonstrators and for the development of the SHAMAN framework overall. What have we learned about the SHAMAN ISP1 demonstrator? ▪ Respondents to improve child healththe evaluation questionnaires and the focus groups indicate that, particularly SECI overall, the presentation of the demonstrator worked effectively and H/PDthat, in general, participants in the demonstration and learned a lot about when evaluation events were able to understand the intentions of the demonstration and how to apply these approaches the ideas presented to their own context. What have we learned about the applicability of the SHAMAN framework to memory institutions? ▪ Respondents to the questionnaires and participants in rural Boliviathe focus groups readily identified the value of the SHAMAN framework to their own operations. The project successfully met nearly majority had not yet established a long-term digital preservation policy, but recognized the need. Generally, the concepts of distributed ingest and grid operations found favour. ▪ Virtually all of its objectives and surpassed many, as presented practitioners in the Results Summary Tablefocus groups, however, drew attention to need of a lower level demonstration that would be closer to their everyday preservation troubles, especially for digital preservation to be applied to non-textual materials, such as film, photographs and sound archives. Vaccination coverage increased dramaticallyIn addition to the criteria suggested by Xxxx et al., we can add a further project-related question: What have we learned that has implications for the training and dissemination phase of the Project? ▪ It was not part of the remit of the demonstration and evaluation specifically to discover information of relevance to the training and dissemination function. However, a number of factors will affect the efficacy of any training programme in particular. o First, no common understanding of digital preservation can be assumed of the potential target audiences for training. Consequently, it is likely that self-paced learning materials will be most effective in presenting the SHAMAN framework. o Secondly, the numbers aims of acute respiratory infections seen SHAMAN as a project must be conveyed clearly: specifically, that it is a kind of „proof-of-concept‟ project and is not intended to deliver a package of programs capable of being implemented by health services institutions. o Thirdly, it needs to be emphasised that the SHAMAN framework is not limited to text documents; it can be applied to materials of all kinds. However, the demonstrations relate to bodies of material that were actually available for use. o Fourthly, the existing presentation materials are capable of being adapted for use in training activities. o Finally, the target audiences will appreciate the possibility of online access to the demonstrator, which will need to have very great ease of access in order that people with diverse backgrounds are able to use it with equal facility. We believe that, overall, WP14 has met its aims and Promoters increased objectives in this demonstration and evaluation of ISP1. Valuable lessons have been learnt by 224% from 2001 all parties involved, which will be transferred to 2003, nutritional status improved the evaluation of ISP2 in the majority of children participating in the H/PD sessions and 54% of children with diarrheal diseases received more liquids, compared with a baseline of 21%. 85% of children received Vitamin A compared with the project objective of 50%10. In 2000, only 13% of children received a checkup at the health center within their first week of life. In 2004, 41% of children received a check up within their first week. Community members, health personnel, SC, and APROSAR attribute these achievements to several factors including: • SECI planning together sessions raised awareness and knowledge about communities’ health problems and status using simple-to-understand tools and processes so that community members, authorities, and health personnel understood the information and could discuss and plan ways to improve health status together. • CB-IMCI increased community access to trained Promoters who helped families learn to identify danger signs and problems during home visits and community meetings and served as an important bridge to the formal health service. In some cases, Promoters provided basic health services (cotrimoxazole for ARI, ORS for diarrhea, paracetamol). • Increased presence of health personnel in communities due to SECI sessions, better coordination with Promoters and communities and, at times, assistance with transport and/or gasoline from Wawa Sana for supervisory and program visits; • The recently introduced universal health insurance (“SUMI”) likely contributed to improved economic access by making health services free to children under five years old and pregnant women. • Program management was notably strengthened since the MTE to focus more on team efforts to coordinate actions, decentralize financial monitoring, monitor progress during monthly (local) and quarterly (all project areas) quality circle meetings. One objective that Wawa Sana did not meet, due to policy and cost structure constraints as previously described, was for 80% of Promoters to have had adequate supplies of ORS. Health personnel, Promoters, community members, and SC and APROSAR staff all strengthened their technical, organizational, and management capacities to identify health problems, set priorities, work together to plan and take action to address these priorities, and monitor their 10 No reliable baseline data existed for comparisoncoming months.

Conclusions and Recommendations. Xxxx Xxxx The project got off to a late start because Nicaragua was an excitinghit by Hurricane Xxxxx in October of 1998. Project activities did not begin until February 1999 because staff was involved in disaster work (paid by other CARE funds). This has not affected the project’s ability complete all programmed activities, successful according to the DIP, which was written taking the delay into account. The project is on time with implementation according to the Action Plan presented in the DIP, but modifications have been made in terms of introducing innovative approaches. For example the DIP outlined the training of teachers using Child-to-Child techniques, this was modified to training teachers in a much more traditional manner. The work with nutrition center was originally to be done introducing the Hearth Model, it was later found that pioneered innovative approaches to improve child health, particularly SECI and H/PDthis would not reflect the reality of work being done at the center, and learned a lot about when has been dropped, as was explained in the first Annual Report. The Trials of Improved Practices (TIPs) model for motivating behavior change has not yet been introduced as was originally planned. Credit and community pharmacies have not been implemented yet, but will be implemented by the end of the calendar year. One of the greatest areas of frustration for volunteers, and CARE and MINSA staff is the lack of participation of many community members. There are reasons for this lack of interest in health and nutrition and the biggest challenge during the next two years will be to identify what those barriers are and how to apply these approaches reach people in rural Boliviaways which attract them, especially in the urban area. Some of the most outstanding aspects of the project are: • Coordination with MINSA at the local level • Accreditation of health facilities as Baby Friendly Units by UNICEF • Improvement in MINSA coordination with the communities • Use of qualitative and quantitative studies for baseline information and to guide project implementation Some of the areas of weakness which need to be prioritized during the next two years: • Follow-up and supervision of all aspects of the project • Improving integrated Health Visits by the Municipal team • More focus on improved methods for changing behavior, not just giving health “talks” • Information System which should be used at all levels • Further strengthening of IMCI One of the most exciting recommendations to come out of the MTE is the planning for differences in activities based on the annual cycle of seasonal employment and workload of project participants. Planning for the work cycle, especially in the urban area, will greatly enhance effectiveness of the interventions, and take a more realistic view of what activities can be accomplished. The project successfully met nearly all of its objectives is planning to use alternative methodologies during the heavy work months, such as theater groups, puppet show, radio and surpassed manyhome visits. During less demanding months, as presented in the Results Summary Table. Vaccination coverage increased dramatically, the numbers of acute respiratory infections seen by health services training and Promoters increased by 224% from 2001 to 2003, nutritional status improved in the majority of children participating in the H/PD sessions and 54% of children with diarrheal diseases received more liquids, compared with a baseline of 21%. 85% of children received Vitamin A compared with the project objective of 50%10. In 2000, only 13% of children received a checkup at the health center within their first week of life. In 2004, 41% of children received a check up within their first week. Community members, health personnel, SC, and APROSAR attribute these achievements to several factors including: • SECI planning together sessions raised awareness and knowledge about communities’ health problems and status using simple-to-understand tools and processes so that community members, authorities, and health personnel understood the information and could discuss and plan ways to improve health status together. • CB-IMCI increased community access to trained Promoters who helped families learn to identify danger signs and problems during home visits and community meetings and served as an important bridge to the formal health service. In some cases, Promoters provided basic health services (cotrimoxazole for ARI, ORS for diarrhea, paracetamol). • Increased presence of health personnel in communities due to SECI sessions, better coordination with Promoters and communities and, at times, assistance with transport and/or gasoline from Wawa Sana for supervisory and program visits; • The recently introduced universal health insurance (“SUMI”) likely contributed to improved economic access by making health services free to children under five years old and pregnant women. • Program management was notably strengthened since the MTE to focus more on team efforts to coordinate actions, decentralize financial monitoring, monitor progress during monthly (local) and quarterly (all project areas) quality circle meetings. One objective that Wawa Sana did not meet, due to policy and cost structure constraints as previously described, was for 80% of Promoters to have had adequate supplies of ORS. Health personnel, Promoters, community members, and SC and APROSAR staff all strengthened their technical, organizational, and management capacities to identify health problems, set priorities, work together to plan and take action to address these priorities, and monitor their 10 No reliable baseline data existed for comparisongroup activities can be conducted.

Conclusions and Recommendations. The demonstration and evaluation process provided an opportunity to test community specific tools with a range of end users from the memory institution domain and to gain greater insight into both the current and future evolution of the SHAMAN prototypes for preservation, access and re-use. Xxxx Xxxx was et al. (2000) in their user evaluation study of the Alexandria Digital Library which incorporated the evaluation of a Web prototype by earth scientists, information specialists and educators raised four key questions in relation to their findings that SHAMAN may be well advised to consider, they are paraphrased here with our conclusions from the investigations. What have we learned about our target organizations and potential users?  Memory institutions are most definitely not a homogenised group; their needs and requirements differ greatly across the domain.  Representatives of the archives community are agreed on the benefits of SHAMAN‟s authenticity validation function.  The representatives of government information services remained unconvinced as to the need or benefit of grid technologies or distributed ingest while librarians saw the value of grid access as an excitingasset of the framework. What have we learned about the evaluation approach for digital preservation?  Within the limits of the exercise, successful project that pioneered innovative approaches in terms of time-frame and resources, the approach adopted has generated useful information for the further development of demonstrators and for the development of the SHAMAN framework overall. What have we learned about the SHAMAN ISP1 demonstrator?  Respondents to improve child healththe evaluation questionnaires and the focus groups indicate that, particularly SECI overall, the presentation of the demonstrator worked effectively and H/PDthat, in general, participants in the demonstration and learned a lot about when evaluation events were able to understand the intentions of the demonstration and how to apply these approaches the ideas presented to their own context. What have we learned about the applicability of the SHAMAN framework to memory institutions?  Respondents to the questionnaires and participants in rural Boliviathe focus groups readily identified the value of the SHAMAN framework to their own operations. The project successfully met nearly majority had not yet established a long-term digital preservation policy, but recognized the need. Generally, the concepts of distributed ingest and grid operations found favour.  Virtually all of its objectives and surpassed many, as presented practitioners in the Results Summary Tablefocus groups, however, drew attention to need of a lower level demonstration that would be closer to their everyday preservation troubles, especially for digital preservation to be applied to non-textual materials, such as film, photographs and sound archives. Vaccination coverage increased dramaticallyIn addition to the criteria suggested by Xxxx et al., we can add a further project-related question: What have we learned that has implications for the training and dissemination phase of the Project?  It was not part of the remit of the demonstration and evaluation specifically to discover information of relevance to the training and dissemination function. However, a number of factors will affect the efficacy of any training programme in particular. o First, no common understanding of digital preservation can be assumed of the potential target audiences for training. Consequently, it is likely that self-paced learning materials will be most effective in presenting the SHAMAN framework. o Secondly, the numbers aims of acute respiratory infections seen SHAMAN as a project must be conveyed clearly: specifically, that it is a kind of „proof-of-concept‟ project and is not intended to deliver a package of programs capable of being implemented by health services institutions. o Thirdly, it needs to be emphasised that the SHAMAN framework is not limited to text documents; it can be applied to materials of all kinds. However, the demonstrations relate to bodies of material that were actually available for use. o Fourthly, the existing presentation materials are capable of being adapted for use in training activities. o Finally, the target audiences will appreciate the possibility of online access to the demonstrator, which will need to have very great ease of access in order that people with diverse backgrounds are able to use it with equal facility. We believe that, overall, WP14 has met its aims and Promoters increased objectives in this demonstration and evaluation of ISP1. Valuable lessons have been learnt by 224% from 2001 all parties involved, which will be transferred to 2003, nutritional status improved the evaluation of ISP2 in the majority of children participating in the H/PD sessions and 54% of children with diarrheal diseases received more liquids, compared with a baseline of 21%. 85% of children received Vitamin A compared with the project objective of 50%10. In 2000, only 13% of children received a checkup at the health center within their first week of life. In 2004, 41% of children received a check up within their first week. Community members, health personnel, SC, and APROSAR attribute these achievements to several factors including: • SECI planning together sessions raised awareness and knowledge about communities’ health problems and status using simple-to-understand tools and processes so that community members, authorities, and health personnel understood the information and could discuss and plan ways to improve health status together. • CB-IMCI increased community access to trained Promoters who helped families learn to identify danger signs and problems during home visits and community meetings and served as an important bridge to the formal health service. In some cases, Promoters provided basic health services (cotrimoxazole for ARI, ORS for diarrhea, paracetamol). • Increased presence of health personnel in communities due to SECI sessions, better coordination with Promoters and communities and, at times, assistance with transport and/or gasoline from Wawa Sana for supervisory and program visits; • The recently introduced universal health insurance (“SUMI”) likely contributed to improved economic access by making health services free to children under five years old and pregnant women. • Program management was notably strengthened since the MTE to focus more on team efforts to coordinate actions, decentralize financial monitoring, monitor progress during monthly (local) and quarterly (all project areas) quality circle meetings. One objective that Wawa Sana did not meet, due to policy and cost structure constraints as previously described, was for 80% of Promoters to have had adequate supplies of ORS. Health personnel, Promoters, community members, and SC and APROSAR staff all strengthened their technical, organizational, and management capacities to identify health problems, set priorities, work together to plan and take action to address these priorities, and monitor their 10 No reliable baseline data existed for comparisoncoming months.