Common use of Contributing Factors for Objectives Not Fully Achieved Clause in Contracts

Contributing Factors for Objectives Not Fully Achieved. The three objectives for the CDD intervention were not met, and though there was progress in knowledge of ORT and administration of more liquids during diarrhea episodes, only 12% of mothers could recognize at least one danger sign of dehydration. The IMCI approach, which emphasizes 16 key family practices, including care-seeking, should be a priority for integrated behavior change strategies at the community level. “Caretakers need to recognize a sick infant or child and need to know when to take the infant or child to a health worker or health facility”.4 A key constraint to the success of all project interventions, including CDD, is the difficulty in developing strong linkages between health facilities and communities. Some limitations include: mistrust of modern medicine, a low priority given to health by community members, a reluctance to pay for health care and to spend time seeking care, and the low value placed on the life of a 4 See “Community IMCI: Reaching Communities for Child Health and Nutrition”, CORE, BASICS, USAID, CSTS, April 2001. child under the age of one year. Time used in care-seeking takes women away from tasks that are viewed as essential for survival (i.e. grazing animals, planting, harvesting, etc.). In addition, most health centers are distant from rural villages and require effort and time to reach. Some MOH health staff, many of who are doing their obligatory rural service, or have been hired as directors of Area Health Centers do not speak the native language and unintentionally “mistreat” patients due to a lack of cultural sensitivity. With the new-shared management model, not all staff is selected by CSRA, and a few of the MOH employees have an ingrained prejudice towards the indigenous people. An additional constraint is a poor understanding of the seriousness of diarrhea, a condition that project area families consider to be “normal” among infants and young children.