Special Evaluation

Humanitarian Policy and Practice from a Gender Perspective Research Report


Despite important achievements made in Afghanistan in the last 15 years, particularly in relation to gender equality and the rights of women and girls, chronic insecurity and conflict, recurrent natural disasters, large-scale displacement of vulnerable groups and concerns about continuity of funding pose a significant threat to the sustainability and continuity of development and humanitarian programming. Given CARE’s interest in adapting to these programming challenges, CARE Afghanistan commissioned a study on the current humanitarian context in Afghanistan from a gender perspective. The objectives of the study are to identify recommendations on humanitarian policy and practice in Afghanistan from a gender perspective and to identify specific recommendations for CARE on how to improve its gender mainstreaming in humanitarian assistance, emergency response and DRR programming. [52 pages]
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Evaluation of the Team-Based Goals and Performance Based Incentives (TBGI) Intervention in Bihar

The Team-Based Goals and Performance-Based Incentives (TBGI) intervention, which CARE conceptualized, developed, and implemented as part of the Ananya program in Bihar, leverages the power of incentives and lessons from motivational theory on teamwork and goal-setting to help improve maternal and child health. Under the intervention, CARE set targets for the percentage of eligible beneficiaries in a subcenter catchment area who should have adopted each of seven key health behaviors or goals (Box 1). All frontline health workers (FLWs) in a given subcenter, including the accredited social health activists (ASHAs), Anganwadi workers (AWWs), and the subcenters’ auxiliary nurse midwives (ANMs), received nonmonetary incentives (consisting of small household items) if their subcenters met five of seven goals in a given quarter. The intervention explicitly sought to encourage teamwork and cooperation among FLWs by providing these incentives for achievements by the subcenter as a whole rather than by individual FLWs, and by providing FLWs with information on the concept and importance of teamwork. It included additional elements to motivate the FLWs in each subcenter, such as a service pledge they recited together and a certificate of recognition for subcenters that met their targets in all quarters. Overall, the intervention was expected to lead to improvements in the incentivized outcomes and to broader changes in related, but nonincentivized, outcomes through increased FLW motivation and teamwork. [82 pages]
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Integrated Family Health Initiative: Catalysing change for healthy communities

Recent trends in the Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), nutritional status, immunization and family planning, as highlighted in Figure 1, 2, 3 and 4, indicate that there are substantial gaps in achieving related MDG goals 4 and 5.

Despite recent gains and commitments from the Government of Bihar (GoB) and active leadership of key stakeholders to improve health infrastructure and outcomes, deep-rooted problems limit the government’s ability to affect lasting change. Persistent barriers include poor quality and availability of frontline and primary health center level services and staff, limited access to services by neglected and marginalized populations, lack of accurate data, lack of effective program management, weak training systems, absence of supervision in health facilities, poor functional integration of interventions, inadequate public health infrastructures, and an underdeveloped and unregulated private sector.

With support from the Bill and Melinda Gates Foundation, the Integrated Family Health Initiative (IFHI) program seeks to support the GoB to improve family health outcomes statewide as well as build their leadership and ownership towards these services. Ultimately this is to accelerate the progress toward MDG 4 to reduce child mortality and MDG 5 to improve maternal health. [12 pages] Read More...

Evaluation of the Information and Communication Technology (ICT) Continuum of Care Services (CCS) Intervention in Bihar

The Information and Communication Technology (ICT) Continuum of Care Services (CCS) intervention was conceptualized and implemented by CARE as part of the Ananya program in Bihar.1 The intervention involves the provision of ICT-enabled mobile-phone-based tools for frontline workers (FLWs) that aim to increase the coverage and quality of services that FLWs provide, enhance their communication with beneficiaries, and facilitate supervision (Box 1 summarizes the features of the ICT-CCS tool). [123 pages] Read More...

Measurement, Learning, and Evaluation Framework for the Bihar Initiative

The Family Health Initiative in Bihar, India (referred to in this report as the “Bihar Initiative”) is one of the foundation’s flagship programs. It represents a new approach to investing in global health, with the goal of yielding greater impacts on health outcomes and mortality, and accelerating progress toward Millennium Development Goals 4 and 5. In particular, the Bihar Initiative takes an integrated approach to improving reproductive, maternal, neonatal, and child health by leveraging and bundling services and delivery mechanisms from several of the foundation’s Global Health Strategies to improve uptake and coverage across the continuum of family health care. These strategies include Maternal, Neonatal, and Child Health; Family Planning; Nutrition; Vaccine Delivery; Tuberculosis; Enteric and Diarrheal Diseases; Pneumonia; and Neglected and Other Infectious Diseases. [60 pages] Read More...

Measurement, Learning, and Evaluation for the Ananya Program (Family Health Initiative in Bihar)

In 2010, the Bill & Melinda Gates Foundation launched the Family Health Initiative in Bihar, India (now named “Ananya”, a Sanskrit word meaning “unique” or “unlike others”). The goals of the Ananya program (2010–2015) are to reduce maternal, newborn, and child mortality; malnutrition; fertility; and morbidity from infectious diseases by developing and implementing innovative and integrated health solutions that involve both the public and private sectors. More specifically, the program aims to expand the reach, coverage, and quality of (1) essential primary health and nutrition services for infants, children, and women of reproductive age; and (2) diagnostic and disease-control services for infectious diseases, including pneumonia, diarrhea, tuberculosis, and visceral leishmaniasis. [68 pages] Read More...

Using Supply- and Demand-Side Strategies to Improve Maternal and Child Health in Bihar, India

This report focuses on the findings from our process study of two early Ananya grants: (1) the Integrated Family Health Initiative (IFHI), led by CARE; and (2) Shaping Demand and Practices to Improve Family Health in Bihar (SDP), led by BBC Media Action. We focused on these two grants because their activities had begun earlier than other grants and had had time to take root. Next, we offer additional detail on the interventions, describe the data collection for the study, and summarize key findings. [120 pages] Read More...

Food security, nutrition, climate change resilience and gender

This Policy Analysis is part of series of country-specific studies on Food and Nutrition Security (FNS) and Climate Change Resilience (CCR) policies in the Southern African region that CARE International is currently conducting. CARE identifies advocacy as one of the priority approaches to influence broader change and scale up effective
solutions. Multiplying the impact of innovative solutions that bring lasting changes, by documenting and replicating successful experiences, promoting pro-poor approaches and advocating and influencing policies are key aspects of CARE global 2020 Program Strategy. [112 pages] Read More...

Zimbabwe ‘Cash First’ Humanitarian Response 2015–2017 Evaluation report

This report is an independent evaluation of the DFID-funded Zimbabwe Humanitarian Response 2015–2017, produced by Oxford Policy Management (OPM) in association with Humanitarian Outcomes. The evaluation was commissioned by CARE International in Zimbabwe. The evaluation was led by Andrew Kardan and the qualitative data collection was led by Sarah Bailey. An incountry workshop on the findings was conducted by Paul Harvey and Andrew Kardan. The evaluation’s design and research were also supported by Molly Scott, Marta Favara, Chris Hearle and Helen Morris. The qualitative data collection was conducted with support from Jimat Consulting. Finally Sheila Chikulo provided peer review inputs. [107 page] Read More...

Adaptable and effective: Cash in the face of multi-dimensional crisis

A summary of the learnings and recommendations from an internal and external evaluation of the Emergency Cash-First Response to Drought-Affected Communities in the Southern Provinces of Zimbabwe project which was carried out from August 2015 to May 2017. The external evaluation was carried out by Oxford Policy Management and is titled Zimbabwe ‘Cash First’ Humanitarian Response 2015-17. [8 pages]
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