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Epidemic Control and Reinforcement of Health Services (ECRHS) Phase 1 Programme in Sierra Leone
This report presents findings from the end phase evaluation of the Epidemic Control and Reinforcement of Health Services (ECRHS) Phase 1 Programme in Sierra Leone, which was implemented from November 2015 to December 2018. The aim of the Programme is to ‘Improve the health status of the population of Sierra Leone’. The Programme was originally designed to provide response to the Ebola outbreak in Sierra Leone, but also considered a longer-term view and worked towards putting in place preparations putting in place preparations for the transition of an extended health system strengthening (HSS) effort.
The overall purpose of the evaluation was ‘to assess result and impact of the above-mentioned Epidemic Control and Reinforcement of Health Services Programme against the Programme goal and outcomes in targeted northern region of Sierra Leone. The evaluation was specifically commissioned to; 1) Assess the Programme result areas in relation to effectiveness, relevance and efficiency of the Programme, 2) assess changes made in general conditions and perspectives, 3) assess need for additional (Programme-) support in future, 4) assess sustainability of achieved results with respective to the DHMTs and Community-based Surveillance (CBS) system, 5) identify the Programme’s key challenges during implementation, and lessons learnt/best practices, and 6)generate concrete recommendations for decision making process regarding health and SRH Programming in the future.
The Evaluation integrated both quantitative and qualitative research methods. 1,608 respondents were randomly selected from across 80 communities for households/individual interviews. This sample included 1,196 female and 412 male respondents. Focus Group Discussions (FGDs) were held with community members in 60 communities and 30 key informant interviews (KIIs) were done with CARE, implementing partners, state actors and chiefdom authorities. Twenty-seven (27) Community Health Workers (CHWs) and 5 Water Management Committee members were also interviewed. Also, facility assessment was conducted for -77 PHUs using the Ministry of Health and Sanitation standard tool and case studies/insight stories were further documented from the field interviews.
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The overall purpose of the evaluation was ‘to assess result and impact of the above-mentioned Epidemic Control and Reinforcement of Health Services Programme against the Programme goal and outcomes in targeted northern region of Sierra Leone. The evaluation was specifically commissioned to; 1) Assess the Programme result areas in relation to effectiveness, relevance and efficiency of the Programme, 2) assess changes made in general conditions and perspectives, 3) assess need for additional (Programme-) support in future, 4) assess sustainability of achieved results with respective to the DHMTs and Community-based Surveillance (CBS) system, 5) identify the Programme’s key challenges during implementation, and lessons learnt/best practices, and 6)generate concrete recommendations for decision making process regarding health and SRH Programming in the future.
The Evaluation integrated both quantitative and qualitative research methods. 1,608 respondents were randomly selected from across 80 communities for households/individual interviews. This sample included 1,196 female and 412 male respondents. Focus Group Discussions (FGDs) were held with community members in 60 communities and 30 key informant interviews (KIIs) were done with CARE, implementing partners, state actors and chiefdom authorities. Twenty-seven (27) Community Health Workers (CHWs) and 5 Water Management Committee members were also interviewed. Also, facility assessment was conducted for -77 PHUs using the Ministry of Health and Sanitation standard tool and case studies/insight stories were further documented from the field interviews.
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Kore Lavi Safety Net Beneficiary Resilience Assessment
As part of its mandate, the Kore Lavi program has developed and established a food voucher-based social safety net model for the poorest households in conjunction with the Haitian Government – through the Ministry of Social Affairs and Labor (MAST). This Resilience Assessment contributes to a stronger understanding of the current food security and resilience situations of the most vulnerable program beneficiaries.
Based upon the data collected, the social safety net members – which is considered as the study sampling universe – are mainly affected by Illness, death and drought, respectively. The experiences shared by the respondents also revealed that they often face several types of shocks and stressors simultaneously.
The food voucher had a very positive impact and helped a lot during each key moment: before the shock or stressor affected the respondent, immediately after, sometime after and now. In the different stories that were shared, a certain number of respondents mentioned that they have no other means to ensure their food security - other than the Kore Lavi food vouchers. With regard to the food vouchers indirect contribution, it is important to highlight that 59% of
respondents used the money they saved to pay school fees and 28% to pay medical fees. 36% save it in their Village Saving and Loans Association (VSLA). Yet, there is also an emerging group that used the money to invest in agricultural endeavors and start-up income generating activities.
When comparing the three main types of assets (personal, social and physical-financial resources), it could be observed that especially vulnerable respondents tended to rely on social resources. Generally, the respondents used more negative coping mechanisms that compromise their food security like eating less or less preferred meals per day (58%), reducing expenditures related to household needs (32%), producing charcoal (33%), reducing agriculture production area (20%) and livestock (19%) or selling assets.
The study identified that 22% of VSLA members followed resilient pathways versus 16% of non VSLA respondents. In almost all the signifier questions, there were found small differences between both groups, but not as much as it was initially expected by the Kore Lavi team. Read More...
Based upon the data collected, the social safety net members – which is considered as the study sampling universe – are mainly affected by Illness, death and drought, respectively. The experiences shared by the respondents also revealed that they often face several types of shocks and stressors simultaneously.
The food voucher had a very positive impact and helped a lot during each key moment: before the shock or stressor affected the respondent, immediately after, sometime after and now. In the different stories that were shared, a certain number of respondents mentioned that they have no other means to ensure their food security - other than the Kore Lavi food vouchers. With regard to the food vouchers indirect contribution, it is important to highlight that 59% of
respondents used the money they saved to pay school fees and 28% to pay medical fees. 36% save it in their Village Saving and Loans Association (VSLA). Yet, there is also an emerging group that used the money to invest in agricultural endeavors and start-up income generating activities.
When comparing the three main types of assets (personal, social and physical-financial resources), it could be observed that especially vulnerable respondents tended to rely on social resources. Generally, the respondents used more negative coping mechanisms that compromise their food security like eating less or less preferred meals per day (58%), reducing expenditures related to household needs (32%), producing charcoal (33%), reducing agriculture production area (20%) and livestock (19%) or selling assets.
The study identified that 22% of VSLA members followed resilient pathways versus 16% of non VSLA respondents. In almost all the signifier questions, there were found small differences between both groups, but not as much as it was initially expected by the Kore Lavi team. Read More...
Kore Lavi Title II Program Haiti – Midterm Evaluation
This reports presents the findings, conclusions and recommendations related to the Kore Lavi mid-term evaluation.
DESCRIPTION OF KORE LAVI. Kore Lavi’s Theory of Change holds that positive and lasting transformation must happen within interrelated domains: (1) where the effective social safety net programming and complementary services reach the most vulnerable populations and protect their access to food while building self-reliance; (2) that achieve breadth and depth in behavior and social change needed to tackle under-nutrition among vulnerable women and children; and (3) that institutionalize accountability, transparency and quality of delivery for mutually reinforcing social protection programs under the leadership of MAST.
EVALUATION METHODOLOGY. The evaluation employed three data collection methodologies: document review, key informant interviews, and focus group discussions.
PRIMARY FINDINGS AND CONCLUSIONS.
At the time of the MTE, Kore Lavi had completed data collection in 16 communes demonstrating the ability to adapt and innovate to address the initial data quality problems that existed at the beginning of the program.
In terms of its implementation on the ground, the food voucher scheme is operating well in identifying voucher recipients and enrolling them in the program, distributing food to beneficiaries via paper or electronic vouchers, recruiting and managing the network of collaborating vendors, enforcing policies governing the scheme and overseeing operations. Food received by beneficiary households from both paper and electronic vouchers is inevitably shared with non-household members, including neighbors and even strangers. The VSLA scheme has effectively provided a mechanism by which large numbers of vulnerable women and men living in program communities can save and access small loans at reasonable interest rates to invest in their businesses or children’s education or for other purposes.
SO3 social behavioral change communications interventions are, on the whole, well designed and well implemented. Care Groups, moreover, appear to be an effective methodology for mobilizing women and communicating critical SBCC messages. Community health agents and Lead Mothers play a critical role in SO3 activities. While they are, for the most part, doing a good job and are satisfied with their roles, they also have a number of legitimate concerns related to the lack of monetary compensation and reimbursement for expenses incurred. The program has done a good job identifying and reaching the targeted women and infants.
Kore Lavi has taken a holistic approach to gender integration from design to implementation and has made a conscious and good faith effort to integrate gender considerations in each of the four program SOs.
Kore Lavi has prioritized information management and has demonstrated a clear institutional interest in improving knowledge and learning.
Read More...
DESCRIPTION OF KORE LAVI. Kore Lavi’s Theory of Change holds that positive and lasting transformation must happen within interrelated domains: (1) where the effective social safety net programming and complementary services reach the most vulnerable populations and protect their access to food while building self-reliance; (2) that achieve breadth and depth in behavior and social change needed to tackle under-nutrition among vulnerable women and children; and (3) that institutionalize accountability, transparency and quality of delivery for mutually reinforcing social protection programs under the leadership of MAST.
EVALUATION METHODOLOGY. The evaluation employed three data collection methodologies: document review, key informant interviews, and focus group discussions.
PRIMARY FINDINGS AND CONCLUSIONS.
At the time of the MTE, Kore Lavi had completed data collection in 16 communes demonstrating the ability to adapt and innovate to address the initial data quality problems that existed at the beginning of the program.
In terms of its implementation on the ground, the food voucher scheme is operating well in identifying voucher recipients and enrolling them in the program, distributing food to beneficiaries via paper or electronic vouchers, recruiting and managing the network of collaborating vendors, enforcing policies governing the scheme and overseeing operations. Food received by beneficiary households from both paper and electronic vouchers is inevitably shared with non-household members, including neighbors and even strangers. The VSLA scheme has effectively provided a mechanism by which large numbers of vulnerable women and men living in program communities can save and access small loans at reasonable interest rates to invest in their businesses or children’s education or for other purposes.
SO3 social behavioral change communications interventions are, on the whole, well designed and well implemented. Care Groups, moreover, appear to be an effective methodology for mobilizing women and communicating critical SBCC messages. Community health agents and Lead Mothers play a critical role in SO3 activities. While they are, for the most part, doing a good job and are satisfied with their roles, they also have a number of legitimate concerns related to the lack of monetary compensation and reimbursement for expenses incurred. The program has done a good job identifying and reaching the targeted women and infants.
Kore Lavi has taken a holistic approach to gender integration from design to implementation and has made a conscious and good faith effort to integrate gender considerations in each of the four program SOs.
Kore Lavi has prioritized information management and has demonstrated a clear institutional interest in improving knowledge and learning.
Read More...
Baseline Study of the Title II Development Food Assistance Program in Haiti
In fiscal year 2013, the U.S. Agency for International Development’s (USAID) Office of Food for Peace (FFP) awarded funding to CARE International and its partners, Action Contre La Faim International (ACF) and the U.N. World Food Programme (WFP), to implement a Title II development food assistance program in Haiti.1 The four-year Kore Lavi Program directly supports the Government of Haiti’s (GOH) social protection efforts. The overall objective of the program is to reduce food insecurity and vulnerability by supporting the GOH in establishing a replicable safety net system and expanding capacities for preventing child undernutrition.
KEY FINDINGS.
The Title II program area residents face challenges in all four pillars of food security: (1) availability of food, (2) access to food, (3) utilization of food and (4) stability.
Survey results indicate that 57.5 percent of households suffer from moderate hunger and 13.5 percent of households suffer from severe hunger.
An HDDS of 6.2 indicates that households in the Kore Lavi Program area typically can access and consume 6 of 12 basic food groups. Qualitative data indicate that food consumption is pragmatic at the household level. Individual families eat what is available, what they can grow or what they can afford to purchase. Despite these challenges, many respondents spoke ardently to beliefs about the cultural significance of certain foods, while also holding strong opinions on imported food in comparison to locally produced food.
The household survey data show that 69 percent of all households have an adequate level of food consumption, 22 percent score at the borderline level, and 9 percent score at the poor level.
Across the Kore Lavi Program area, 43.6 percent of households currently live in extreme poverty (less than the international poverty line of USD$1.25 at 2005 prices), with average daily per capita expenditures of constant USD$ 2.10.
The household survey data show that 40 percent of households use an improved drinking water source and 16 percent of households use a non-shared improved sanitation facility.
As measured by body mass index (BMI), the nutritional status of women 15-49 years of age who are not pregnant or two months post-partum is generally satisfactory despite a lack of dietary diversity.
The survey data reveal that 8 percent of children under five years of age in the Kore Lavi Program area show signs of being moderately or severely underweight, and 19 percent of children under five years of age are stunted.
Across the qualitative data, views about gender equality tended to be polarized, rooted historically and in tradition. Read More...
KEY FINDINGS.
The Title II program area residents face challenges in all four pillars of food security: (1) availability of food, (2) access to food, (3) utilization of food and (4) stability.
Survey results indicate that 57.5 percent of households suffer from moderate hunger and 13.5 percent of households suffer from severe hunger.
An HDDS of 6.2 indicates that households in the Kore Lavi Program area typically can access and consume 6 of 12 basic food groups. Qualitative data indicate that food consumption is pragmatic at the household level. Individual families eat what is available, what they can grow or what they can afford to purchase. Despite these challenges, many respondents spoke ardently to beliefs about the cultural significance of certain foods, while also holding strong opinions on imported food in comparison to locally produced food.
The household survey data show that 69 percent of all households have an adequate level of food consumption, 22 percent score at the borderline level, and 9 percent score at the poor level.
Across the Kore Lavi Program area, 43.6 percent of households currently live in extreme poverty (less than the international poverty line of USD$1.25 at 2005 prices), with average daily per capita expenditures of constant USD$ 2.10.
The household survey data show that 40 percent of households use an improved drinking water source and 16 percent of households use a non-shared improved sanitation facility.
As measured by body mass index (BMI), the nutritional status of women 15-49 years of age who are not pregnant or two months post-partum is generally satisfactory despite a lack of dietary diversity.
The survey data reveal that 8 percent of children under five years of age in the Kore Lavi Program area show signs of being moderately or severely underweight, and 19 percent of children under five years of age are stunted.
Across the qualitative data, views about gender equality tended to be polarized, rooted historically and in tradition. Read More...
Village Savings and Loan Associations as Economic Drivers
Exploring impacts of Village Savings and Loan Association (VSLA) at micro level to understand their potential to contribute to the Tanzanian economy
Savings-led microfinance innovation aims to improve access to financial services in remote areas, especially among women. CARE International has been the leading innovator in the field and has initiated Village Savings and Loan Association (VSLA) programmes across Tanzania. CARE aims to increase members in Tanzania to 8 million by 2025 with the vison to help improve the national economy. CARE thus commissioned SFTZ to carry out a study that investigates the potential of VSLA contributions to local and national economies.
METHODS. The study was implemented in six villages in Mufindi district, Iringa region; four of which were assigned as treatment and two as control. Treatment villages had 9 to 15 NGO-facilitated VSLAs, and control villages had only two comparable VSLAs.
RESULTS. Analysis of the data at the village level did not provide evidence that VSLA initiatives have contributed to large-scale economic growth except for one risk mitigation sub-indicator. A number of issues hindered the village-level comparison: First, microfinance savings groups were also present in control villages. Secondly, the penetration of savings groups within all treatment villages was low (below 30%, except for one village).
However, at the household level, VSLA membership showed significant impacts on a number of micro-level measures of economic growth. VSLA households had higher household savings, drew on VSLA savings to overcome negative impacts of household shocks, attained greater food security and more diverse diets, achieved better agricultural and business outcomes, and enjoyed greater economic status. Although these differences cannot be directly attributed to the VSLA programme without before-and-after comparisons with a meaningful control group, the positive household impacts suggest that a VSLA programme scaled to a high density within each village could have a positive impact
on the local economy. Read More...
Savings-led microfinance innovation aims to improve access to financial services in remote areas, especially among women. CARE International has been the leading innovator in the field and has initiated Village Savings and Loan Association (VSLA) programmes across Tanzania. CARE aims to increase members in Tanzania to 8 million by 2025 with the vison to help improve the national economy. CARE thus commissioned SFTZ to carry out a study that investigates the potential of VSLA contributions to local and national economies.
METHODS. The study was implemented in six villages in Mufindi district, Iringa region; four of which were assigned as treatment and two as control. Treatment villages had 9 to 15 NGO-facilitated VSLAs, and control villages had only two comparable VSLAs.
RESULTS. Analysis of the data at the village level did not provide evidence that VSLA initiatives have contributed to large-scale economic growth except for one risk mitigation sub-indicator. A number of issues hindered the village-level comparison: First, microfinance savings groups were also present in control villages. Secondly, the penetration of savings groups within all treatment villages was low (below 30%, except for one village).
However, at the household level, VSLA membership showed significant impacts on a number of micro-level measures of economic growth. VSLA households had higher household savings, drew on VSLA savings to overcome negative impacts of household shocks, attained greater food security and more diverse diets, achieved better agricultural and business outcomes, and enjoyed greater economic status. Although these differences cannot be directly attributed to the VSLA programme without before-and-after comparisons with a meaningful control group, the positive household impacts suggest that a VSLA programme scaled to a high density within each village could have a positive impact
on the local economy. Read More...
Emergency Water, Sanitation, Hygiene and Nutrition for Crisis Affected Communities in East Darfur and South Darfur, Sudan, 2017-2019
The project under evaluation was a two-year project implemented in one locality in South Darfur and three localities in East Darfur during the years 2017 and 2019. The Project was implemented by CIS in partnership with two local organizations and in cooperation with the State institutions.
The intervention activities are tailored to address urgent lifesaving needs of the vulnerable communities through improving communities’ access to WASH facilities and nutrition services. Where, the two components are expected to complement each other and the resultant outcomes are expected to reflect on the improvement of maternal and child health in particular.
The ccomparison of the actual implementation with the planned showed that the types of the activities implemented conform to the planned and that planned outputs are almost completed in accordance with the plan in quantitative and qualitative terms. while the number of beneficiaries reached exceeded the target by about 30%.
As immediate outcomes, IDPs and refugees’ camps expressed improvement in their access to safe drinking water, where 98.6% indicated obtaining water from protected sources. They also revealed satisfaction with availability of water by 65% of the HHs and the water distance has been cut to about 320 m in SD and to 106 m in ED, with an average water distance of 213 meter.
Evident progress has been made along communities’ access to and use of latrines, including women, where, 89.3% and 86.1% of target community members indicated their access to and regular use of latrines. The created hygiene awareness has induced the required positive changes in hygiene and sanitation attitude and practices among communities.
In overall, the treatment of malnutrition reached 80% of the cases and for both girls and boys the cure rate is 75% also for both sexes and the Number of MAM cases treated ranges between 10 to 15 daily, while number of PLW treated ranged between 4 to 7 women daily.
Ultimately, The WASH and nutrition interventions the project delivered so far have addressed emergency humanitarian needs of the IDPs and host communities, without which their lives would have been at great risk. The inadequate unsafe water sources are now more accessible, clean and healthy. The personal hygiene and environment has much improved due to increased awareness and positive change in attitude and practices. VSLAs have added a new livelihood means for women and their families by starting to save and becoming economically active and contributing to households’ budget.
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The intervention activities are tailored to address urgent lifesaving needs of the vulnerable communities through improving communities’ access to WASH facilities and nutrition services. Where, the two components are expected to complement each other and the resultant outcomes are expected to reflect on the improvement of maternal and child health in particular.
The ccomparison of the actual implementation with the planned showed that the types of the activities implemented conform to the planned and that planned outputs are almost completed in accordance with the plan in quantitative and qualitative terms. while the number of beneficiaries reached exceeded the target by about 30%.
As immediate outcomes, IDPs and refugees’ camps expressed improvement in their access to safe drinking water, where 98.6% indicated obtaining water from protected sources. They also revealed satisfaction with availability of water by 65% of the HHs and the water distance has been cut to about 320 m in SD and to 106 m in ED, with an average water distance of 213 meter.
Evident progress has been made along communities’ access to and use of latrines, including women, where, 89.3% and 86.1% of target community members indicated their access to and regular use of latrines. The created hygiene awareness has induced the required positive changes in hygiene and sanitation attitude and practices among communities.
In overall, the treatment of malnutrition reached 80% of the cases and for both girls and boys the cure rate is 75% also for both sexes and the Number of MAM cases treated ranges between 10 to 15 daily, while number of PLW treated ranged between 4 to 7 women daily.
Ultimately, The WASH and nutrition interventions the project delivered so far have addressed emergency humanitarian needs of the IDPs and host communities, without which their lives would have been at great risk. The inadequate unsafe water sources are now more accessible, clean and healthy. The personal hygiene and environment has much improved due to increased awareness and positive change in attitude and practices. VSLAs have added a new livelihood means for women and their families by starting to save and becoming economically active and contributing to households’ budget.
Read More...
SUAAHARA II GOOD NUTRITION PROGRAM ANNUAL SURVEY YEAR TWO (2018)
SII aims to reduce the prevalence of stunting, wasting and underweight among children under five years of age and to reduce the prevalence of anemia among WRA and children 6-59 months of age. SII works across thematic areas including nutrition, health and family planning (FP), water, sanitation and hygiene (WASH), agriculture/homestead food
production (HFP), and governance, using a gender equality and social inclusion (GESI) approach for all interventions. CARE is a sub-grantee to Helen Keller International.
Annual surveys are a key component of SII’s monitoring system. The primary purpose is to monitor progress over time related to key SII inputs, outputs, outcomes and impacts in intervention areas. The first SII annual monitoring survey was conducted between June to September 2017. Similar to the first annual survey, data collection for the second SII annual survey was conducted between July to September 2018, again, among a representative sample of households with a child
under five years. Read More...
production (HFP), and governance, using a gender equality and social inclusion (GESI) approach for all interventions. CARE is a sub-grantee to Helen Keller International.
Annual surveys are a key component of SII’s monitoring system. The primary purpose is to monitor progress over time related to key SII inputs, outputs, outcomes and impacts in intervention areas. The first SII annual monitoring survey was conducted between June to September 2017. Similar to the first annual survey, data collection for the second SII annual survey was conducted between July to September 2018, again, among a representative sample of households with a child
under five years. Read More...
SUAAHARA II GOOD NUTRITION PROGRAM ANNUAL SURVEY YEAR ONE (2017)
The Government of Nepal (GoN) is currently rolling out the second phase of a national Multi-Sectoral Nutrition Program (MSNP), with the support of external development partners. Suaahara II is a USAID-funded multisectoral nutrition program, aligned with Nepal’s MSNP, being implemented in 42 of Nepal’s 77 districts from 2016 to 2021. Suaahara II aims to reduce the prevalence of stunting, wasting and underweight among children under 5 years of age and to reduce the prevalence of anemia among WRA and children 6-59 months of age. CARE is sub-grantee to Helen Keller International on this project.
Annual surveys are a key component of Suaahara II’s monitoring system. The primary purpose is to monitor progress over time related to key Suaahara II inputs, outputs, outcomes and impacts in intervention areas. The first SII annual monitoring survey was conducted between June to September 2017 among a representative sample of households with a child under five years, by New Era, a local survey firm. Read More...
Annual surveys are a key component of Suaahara II’s monitoring system. The primary purpose is to monitor progress over time related to key Suaahara II inputs, outputs, outcomes and impacts in intervention areas. The first SII annual monitoring survey was conducted between June to September 2017 among a representative sample of households with a child under five years, by New Era, a local survey firm. Read More...