Sexual|Reproductive Health

Delivering High-Quality Family Planning Services in Crisis-Affected Settings I: Program Implementation

In 2012, about 43 million women of reproductive age experienced the effects of conflict. Provision of basic sexual and reproductive health services, including family planning, is a recognized right and need of refugees and internally displaced people, but funding and services for family planning have been inadequate. This article describes lessons learned during the first 2.5 years of implementing the ongoing Supporting Access to Family Planning and Post-Abortion Care in Emergencies (SAFPAC) initiative, led by CARE, which supports government health systems to deliver family planning services in 5 crisis-affected settings (Chad, Democratic Republic of the Congo, Djibouti, Mali, and Pakistan). Read More...

Gender Equity and Women’s Empowerment: The Journey So far; The Experience of the ENSURE Program

The ENSURE Food Security Program is a USAID-funded, five-year intervention designed to profoundly and sustainably impact 215,000 vulnerable and food- insecure Zimbabweans in Manicaland and Masvingo Provinces. The program is a shared commitment by four partners and one service provider—World Vision, CARE, SNV, SAFIRE and ICRISAT—who work together to mainstream gender equity and natural resource management in the three key areas of maternal and child nutrition and health, agricultural production and marketing, and community resilience.

The success of ENSURE can be portrayed through the accounts of thousands of women and men whose lives have been changed through its various programme interventions. Tangible gender transformative changes can be noticed on several dimensions: joint household decision making; reduced violence against women; increased women’s leadership in community leadership; men assisting women with household chores and childcare; women’s ownership of high value productive assets; and increased access and control over income.
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EVALUATION FINALE DU PROJET USAID/NUTRITION – WASH DANS LES REGIONS DE KOULIKORO, SEGOU ET MOPTI

La présente étude vise, en effet, à évaluer l'efficacité de la stratégie nutritionnelle intégrée de l'IRP combinant nutrition, agriculture, eau, assainissement et hygiène (WASH) pour améliorer l'état nutritionnel des femmes enceintes et allaitant et des enfants de moins de 2 ans.

Les principaux indicateurs du projet dans le domaine de la nutrition aussi bien chez les enfants de moins de 2 ans que les femmes en âge de procréer (réduction de la prévalence de l’émaciation, du retard de croissance, de l’émaciation, de l’anémie, amélioration du régime alimentaire minimum acceptable pour les enfants de moins de deux ans et du défit énergétique chronique, de l’anémie et amélioration du régime alimentaire minimum acceptable) ont tous favorablement évolués entre la situation de départ et la situation actuelle. Par contre, aucune valeur de l’indicateur initialement prévu n’a été atteinte par le projet. Il en est de même pour les indicateurs WASH. Cependant, la motivation des bénéficiaires pour soutenir le projet et ses acquis ont été observé. Les bénéficiaires se disent favorables à la poursuivre les activités réalisées après le retrait du projet. Il s’avère nécessaire de poursuivre les activités du projet pour lui permettre d’atteinte des objectifs fixés. Read More...

Evaluation Finale “Dans les Zones de Feed the Future” du Projet USAID/Nutrition et Hygiène/ CARE dans la Région de Mopti – Mali

L’objectif de cette évaluation finale est d’apprécier le niveau d’évolution des indicateurs du Projet entre l’étude de base et étude finale. De façon spécifique il s’agit d'évaluer les niveaux actuels des indicateurs agricultures, les indicateurs Santé/Nutrition/WASH d’une part, et d’autre part, de mesurer l’impact des émissions radiophoniques sur les communautés bénéficiaires.

De façon globale des résultats forts encourageants sont notés, car la plupart des indicateurs ont
connu des améliorations par rapport à leur valeur de base en 2016. La synthèse de ces résultats
est présentée ci-après. Read More...

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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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...

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...

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...

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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