Sexual|Reproductive Health

Myanmar Endline Report Gender Equality and Women’s Empowerment Programme II 2016-2019

Project name: Gender Equality and Women’s Empowerment Programme (GEWEP) II
Project period: 2016-2019
Number of people that have been directly reached: 4,429 Female and 2,305 Male
Myanmar endline / baseline report submission: 31st March 2019
Result highlights for GEWEP II in Myanmar
Sex Workers in Myanmar (SWiM) is growing. SWiM advocates for the rights of fellow sex workers by advocating for amendment of the 1949 Suppression of Prostitution Act, a law that punishes and fines prostitution, putting sex workers at increased risk. With the contribution from SWiM and other stakeholders, the Ministry of Social Welfare, Relief and Resettlement has been drafting a new law. The draft law is expected to be submitted to parliament by the end of 2019.
More than a hundred brothels have been lobbied to promote safer work environment for female sex workers using a minimal standard checklist. The minimal standard includes provision of condoms, and hygiene and sanitary materials for both clients and female sex workers. It also needs the brothel owners/managers to allow sex worker to go out for regular medical check-up.
58% of the endline survey respondents are members of one or more self-help groups. Participation in self-help groups develops sense of social inclusion among the sex workers. This is important, as sex workers are greatly discriminated in the general community and often excluded from the social activities in the general community.
During the survey, a subset of men – who were partner of, have work relationship with, or are somehow related to FSWs – showed aggressive attitudes towards their intimate partners. These attitudes may be linked to high incidence of violence against female sex workers. More exploration on this finding and more targeted engaging men activities are suggested for future programs. Read More...

(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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Indashyikirwa programme to reduce intimate partner violence in Rwanda: Report of findings from a cluster randomized control trial

Intimate partner violence (IPV), which includes physical and sexual violence, economic abuse and emotional aggression within intimate relationships, is the most common form of violence against women globally. IPV can lead to a wide range of negative health consequences including depression, anxiety, suicidal ideation, post-traumatic stress disorder, drug and alcohol abuse, serious injuries, and death. The Indashyikirwa programme in Rwanda sought to reduce experience of IPV among women and perpetration of IPV among men, and also to shift beliefs and social norms that sustain IPV in communities and couples. The programme also strove to support equitable, non-violent relationships, and ensure more supportive and empowering responses to survivors of IPV seeking assistance. The impact evaluation of Indashyikirwa assessed whether and how the programme met these objectives and sought to inform the global best practices in IPV prevention by generating evidence through a rigorous community randomized controlled trial (cRCT).

The quantitative impact evaluation of Indashykirwa took the form of a cRCT with randomization at sector level and two separate evaluation components: (1) a cohort of control and intervention couples interviewed at baseline, 12 months, and 24 months, and (2) a pair of cross-sectional community surveys with control and intervention communities implemented at the beginning of the programme and 24 months later. This quantitative impact evaluation was accompanied by in-depth process evaluation and qualitative research with beneficiaries and programme staff. Read More...

Sexual Reproductive and Maternal Health (SRMH) Baseline Assessment Report Primary health care project in Sinjar

CARE is implementing a Sexual, Reproductive and Maternal Health (SRMH) Project in three locations in Ninawa Governorate (Zummar, Sinjar and Rabia), which involves providing a full package of SRMH services through existing hospitals and/or PHCs in close coordination with Ninawa Directorate of Health and in partnership with a local partner, Harikar. 230 Primary Health Care (PHC) facilities have been destroyed across the country and there is a heavy burden on PHCs with consultations increasing eight-fold . The consortium will provide a physiological response to returnees’ needs through the rehabilitation of two accessible PHC centres by CARE to support pregnant and lactating mothers, sexual and reproductive health, management of childhood illnesses and other infections. This will include the training of 40 community health volunteers that will identify and refer cases to the PHCs, including gender-based-violence (GBV) survivors and at-risk children to the closest GBV services and provide essential information at the household level about nutrition, WASH, and disability awareness and referral information. The two PHCs that have been selected in Sinjar are AL Shahada PHC and AL Nasser PHC. Read More...

Sexual Reproductive and Maternal Health (SRMH) Baseline Assessment Report in Anbar Governorate

Although people in governorates impacted directly by recent military operations including Anbar remain the focus of humanitarian assistance for 2019, more detailed data collection and improved analysis shows important geographic variations in terms of needs at district level. The most urgent needs are found in areas where past hostilities have led to destruction of infrastructure, a breakdown of services and erosion of social fabric, or in areas indirectly impacted due to hosting and providing for a sizeable displaced population. Limited livelihood opportunities in these locations including FallujaAnbar are a key compounding factor keeping some of the most vulnerable people dependent on humanitarian assistance.

This baseline report was conducted for the "Support for conflict-affected people by strengthening essential primary health care services and protection from gender-based violence" project and was funded by German Federal Foreign Office (GFFO). Read More...

Learning From Failure 2019

Driven by a wish to learn more from what goes wrong in our programming, and to examine where changes to the broader organization and system can improve our programming and impact globally, in 2019 CARE undertook its first evaluations-based failure meta-analysis. This analysis draws learning and evidence from 114 evaluations of CARE’s work from 2015-2018 to understand the patterns and trends in what goes wrong. This helps us take a data-driven approach to strategic investments and action plans to live out CARE’s commitment to high program quality and continuous improvement across the board.
The review draws from project specific data, but deliberately anonymizes the data and focuses on overarching trends to remove blame for any specific project team or set of individuals. This exercise is designed to help us learn more about how we can change our processes and patterns of support and engagement around weak areas to improve our work. CARE is using this data to build action plans and next steps to continuously improve our programming.
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Improving Effective Coverage of Maternal, New-born and Child Health Interventions for Reducing Preventable Child Deaths in Tangail and Khulna

Bangladesh has achieved success in reducing U5 & maternal mortality in last decade. UNICEF is partnering with GoB to contribute to reduce maternal and newborn deaths. To this end, MoH&FW with partnering with UNICEF and technical support from KOIKA implemented a MNCH project (IECMNCH) in Tangail and Khulna in line with UNICEF’s efforts to pay attention to low performing upazilas and HTR areas, started in 2015. CARE is one of the partners on this project.
designed to address main causes of newborn deaths (birth asphyxia, infection, prematurity)
to increase availability, utilization of quality MNCH-&-Nutrition services by
- increasing, sustaining of effective coverage of selected interventions;
- strengthening health system with increased availability & access to quality MNCH services;
-positive behaviour & social norm change through community participation & ownership for effective demand creation for increased utilization of MNCH services.

A baseline study in 2015 and an endline evaluation study in 2018 were implemented by UNICEF. Here are the endline study findings with corresponding baseline findings where necessary.
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Improving Sexual, Reproductive Health and Rights Including Maternal and Newborn Health in Bangladesh

UNICEF in collaboration with Bangladesh government launched a project “Improving Sexual, Reproductive Health and Rights including Maternal and Newborn Health in Bangladesh” to improve integrated sexual and reproductive health and rights including maternal, newborn, child and adolescent health in 5 districts. CARE was a key implementing partner in this project.

Before implementation of the project a baseline study in 5 project districts (Patuakhali, Rangamati, Sirajganj, Jamalpur and Moulvibazar) with 4 comparison districts (Barguna, Khagrachhari, Lalmonirhat and Sylhet), implemented by UNICEF and conducted by SURCH between 9th May and 18th August 2018
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Gender Equality and Women’s Empowerment Program Global Results Report

GEWEP II works with poor and vulnerable women and girls in some of the world’s most fragile states: Burundi, DRC, Mali, Myanmar, Niger and Rwanda. By end 2018, the programme has reached more than 1 067 200 women and girls, mainly through Village Savings and Loans Associations (VSLAs). Norad has supported VSLAs since they were first piloted in Niger in 1991.
Since then, Norad has supported over 47 800 groups and more than 1 100 000 women. During GEWEP II, from 2016 through 2018, more than 14 200 new groups were established. This report includes results on both outcome and output level. The table below summarises the results at outcome level, for indicators collected at the population level. Overall, there is a positive change in the perception and attitude to women’s economic, political and social empowerment in the programme intervention zones. On a national level, there has been positive changes in legislation, but implementation is still a challenge. Read More...

Women’s Empowerment Program (WEP) Midterm Report

In 2009, Norad-funded women empowerment programs (WEPs) started implementation in seven countries: Burundi, Mali, Myanmar, Niger, Rwanda, Tanzania, and Uganda. In 2009 and early 2010, an extensive quantitative baseline study was conducted in these countries around a common set of indicators. The present mid-term review (MTR), which was done using qualitative methodology, analysed in depth the process and nature of changes that the programs are contributing towards. In all the program countries, the country WEP team carried out the review internally with the technical assistance of an external consultant and CARE Norway (CN).

With slight variations, the overall objectives of the country WEPs focused on the economic, social, and political empowerment of women. The village savings and loan association (VSLA) methodology was common for all the programs; and these groups create the platform for working on other aspects of the program besides economic empowerment. The initial changes that the programs produce are seen in terms of increased access to savings and loans, employment opportunities, and asset ownership. The ability of the women to earn income, generate their own savings and make financial contributions in the household (HH) has greatly improved their self-esteem, thereby giving them better leverage to involve in and influence HH decision making processes. Men were highly appreciative of the income women were able to bring in to the family as a result of being involved in VSLAs. Through their improved position in the household, women reported being able to negotiate the use of sexual and reproductive health (SRH) services and the abandonment of different harmful practices. Through the use of couples-based approach and engaging men initiatives, HH relationships are beginning to improve; men in these households are reportedly starting to have a more positive attitude towards women’s empowerment and are themselves even taking part in domestic activities in some contexts. The VSLA approach is enabling women to create strong social networks that are becoming an influential force for social change. As a result of increased knowledge on their human rights and increasing leadership skills, women are beginning to understand how they have to position themselves to realize their strategic interests. The VSLA groups and networks also enable women to mobilise support when they are running for elections; this support has increased number of women being elected into different posts. The contribution of women in VSLAs and in community leadership positions is being increasingly recognised and appreciated by local authority figures, which can be seen when they actively seek the advice of women and VSL groups in relation to different community development initiatives.
Through working in partnership with others, the programs are being implemented in a high quality and timely manner. Engagement with strategic partners has occurred effectively in some countries, and been instrumental in enabling the programs to link grassroots evidence to national level advocacy activities which have achieved concrete results. [52 pages] Read More...

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