Sierra Leone
Rapid Gender Analysis TO SUPPORT THE GOVERNMENT OF SIERRA LEONE TO STRENGTHEN ITS HEALTH SYSTEM
This Rapid Gender Analysis (RGA) report presents findings from the gender and power analysis carried out in November and December 2023 in Falaba, Kambia, Bonthe, Tonkolili, Kenema, Karene, Kailahun, and Pujehun districts of Sierra Leone. The purpose of the RGA is to understand how gender and social norms, roles, relationships, and dynamics influence health outcomes and health-seeking behavior in Sierra Leone, especially for vulnerable populations. The report will inform the development of CARE’s future health programming and proposed interventions for health funding opportunities.
The document is structured into four primary chapters – Background, Methodology, Findings: Results and Analysis, and Recommendations—each containing sub-chapters. The background section outlines the study’s purpose, objectives, and underlying rationale. The methodology section describes the research design, applied approaches, data collection methods and participant information. The study’s key findings are categorized into distinct thematic areas aligned with CARE's Good Practices Framework for Gender Analysis and includes the following Core Areas of Inquiry:
• Household decision-making, division of labor and control of productive assets
• Control over one’s body
• Access to public spaces and services
• Claiming rights and meaningful participation in public decision-making
The RGA also applies the above domains related to health outcomes, behaviors, and health-seeking behavior, including gender dynamics within the Sierra Leone health system with recognition that unequal gender dynamics gaps impact health care providers and their ability to deliver quality services. Finally, the recommendations section outlines actions or interventions CARE should consider in future programming.
Key Findings:
* Men have more influence over decisions for the household than women—including the seeking of healthcare—and women lack control over key decisions related to sex, marriage, and children, including if and when to use contraception. Women’s mobility is limited by social norms which require male permission for movement.
• Contraceptive use is low. Despite around 70% of people knowing about contraceptives and where to get them, only 50% are currently using them. Many community members believe modern forms of family planning are haram or unhealthy, with anecdotal evidence suggesting there is perception that it promotes extramarital affairs.
• Front Line Health Workers (FLHW) face major barriers to effective service delivery: almost half of FLHWs interviewed are unpaid, effectively operating as volunteers, struggle with difficult living conditions and lack of supplies, and report inequitable treatment between male and female workers.
• There is a lack of evidence-based health information for pregnant women: only 27% of pregnant women in the study reported having received any information related to sexual and reproductive health or associated risks.
• Despite generally positive health-seeking behavior, both women and men are concerned by lack of availability of medicine. Read More...
The document is structured into four primary chapters – Background, Methodology, Findings: Results and Analysis, and Recommendations—each containing sub-chapters. The background section outlines the study’s purpose, objectives, and underlying rationale. The methodology section describes the research design, applied approaches, data collection methods and participant information. The study’s key findings are categorized into distinct thematic areas aligned with CARE's Good Practices Framework for Gender Analysis and includes the following Core Areas of Inquiry:
• Household decision-making, division of labor and control of productive assets
• Control over one’s body
• Access to public spaces and services
• Claiming rights and meaningful participation in public decision-making
The RGA also applies the above domains related to health outcomes, behaviors, and health-seeking behavior, including gender dynamics within the Sierra Leone health system with recognition that unequal gender dynamics gaps impact health care providers and their ability to deliver quality services. Finally, the recommendations section outlines actions or interventions CARE should consider in future programming.
Key Findings:
* Men have more influence over decisions for the household than women—including the seeking of healthcare—and women lack control over key decisions related to sex, marriage, and children, including if and when to use contraception. Women’s mobility is limited by social norms which require male permission for movement.
• Contraceptive use is low. Despite around 70% of people knowing about contraceptives and where to get them, only 50% are currently using them. Many community members believe modern forms of family planning are haram or unhealthy, with anecdotal evidence suggesting there is perception that it promotes extramarital affairs.
• Front Line Health Workers (FLHW) face major barriers to effective service delivery: almost half of FLHWs interviewed are unpaid, effectively operating as volunteers, struggle with difficult living conditions and lack of supplies, and report inequitable treatment between male and female workers.
• There is a lack of evidence-based health information for pregnant women: only 27% of pregnant women in the study reported having received any information related to sexual and reproductive health or associated risks.
• Despite generally positive health-seeking behavior, both women and men are concerned by lack of availability of medicine. Read More...
End Phase Evaluation: Epidemic Control and Reinforcement of Health Services (ECRHS) Phase II Project in Sierra Leone
The Epidemic Control and Reinforcement of Health System Services (ECRHS) project is funded under the German Financial Cooperation (BMZ) with Sierra Leone through KfW. Two phases have been successfully completed during the project implementation. The first phase of the project was launched in November 2015 and ended in 2018. The first phase was originally designed to respond to the Ebola outbreak. The second phase of the ECRHS project was considered an extended phase of the ECRHS I; and started in January 2019. Whereas the primary focus of ECRHSI was on public health emergency response, the aim of phase II of ECRHS is the sustainable establishment of an epidemiological control system, whilst also strengthening the performance of the health system with a focus on reproductive health / self-determined family planning. The purpose of this report therefore is to present findings of the final evaluation of the ECRHS II programme evaluation which was carried out with the general objective of ‘assessing the result and impact of the project goal and outcomes in targeted northern region of Sierra Leone’. Read More...
REPORT END PHASE EVALUATION (Epidemic Control and Reinforcement of Health Services (ECRHS) Phase 1 Programme in Sierra Leone) Ebola Emergency Response April
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. Read More...
Solar Harnessed Entrepreneurs (SHE) Baseline Assessment: Promoting Productive Use of Energy (PUE) for Women and Girls in Sierra Leone
This report presents findings from a baseline assessment conducted to provide contextual analysis of the Solar Harnessed Entrepreneurs (SHE) project’s target population, capturing initial data against selected indicators in the project Results Framework. The SHE project aims to provide women groups and individual run enterprises with a package of support, including financing for energy-enabled appliances, training in their use and an enhanced market access and linkages with the aim to leverage the new access to energy for business growth. The ideal setting of the project is to cover over 330 newly enabled businesses by engaging 7,120 women, living in Sierra Leone’s mini-grid locations.
Although quantitative data collection was largely used to get primary information using structured questionnaires for personal interviews, the research team also used qualitative methods through Key Informant Interviews (KIIs), with respondents drawn from the renewable energy sector/mini-grid power stations. The study also used Focus Group Discussion (FGD) guides to interview Project’s target groups and individual women entrepreneurs in the study areas. The coverage of the assessment was to include twenty (20) communities in all seven (7) intervention districts (Bo, Bonthe, Moyamba, Pujehun, Kambia, Koinadugu and Bombali), but based on initial targets for the first phase of implementation, only sixteen (16) communities were reached during the assessment.
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Although quantitative data collection was largely used to get primary information using structured questionnaires for personal interviews, the research team also used qualitative methods through Key Informant Interviews (KIIs), with respondents drawn from the renewable energy sector/mini-grid power stations. The study also used Focus Group Discussion (FGD) guides to interview Project’s target groups and individual women entrepreneurs in the study areas. The coverage of the assessment was to include twenty (20) communities in all seven (7) intervention districts (Bo, Bonthe, Moyamba, Pujehun, Kambia, Koinadugu and Bombali), but based on initial targets for the first phase of implementation, only sixteen (16) communities were reached during the assessment.
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Sierra Leone: Smallholder farmers and the global food crisis
The war between Russia and Ukraine has led to unprecedented price shocks in food, energy, and fertilizer globally due to the centrality of both countries in the functionality of these markets. Like in most countries in the world, Sierra Leone is severely affected by these shocks. Prices of food and non-food commodities have also increased exponentially.
Poor smallholder farmers—who already struggled to produce enough food—are facing severe impacts because they can no longer afford inputs and related services. Food security, especially among the rural population who depend largely on farming as a primary source of livelihood, is therefore of grave concern. Farmers are reporting that they are only planting half the field size, the price of seeds and fertilizer has more than doubled, and "low production levels of food crops is inevitable."
To understand the current impact of the global food crisis on smallholder farmers and their (farmers) resilience in the local context, CARE engaged participants of its Solar Harnessed Entrepreneurs project in two communities in the north of the country. The aim is to obtain first-hand information on affordability of inputs, impact of these shocks especially on women farmers and farmers’ coping mechanisms in the wake of the current global crisis.
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Poor smallholder farmers—who already struggled to produce enough food—are facing severe impacts because they can no longer afford inputs and related services. Food security, especially among the rural population who depend largely on farming as a primary source of livelihood, is therefore of grave concern. Farmers are reporting that they are only planting half the field size, the price of seeds and fertilizer has more than doubled, and "low production levels of food crops is inevitable."
To understand the current impact of the global food crisis on smallholder farmers and their (farmers) resilience in the local context, CARE engaged participants of its Solar Harnessed Entrepreneurs project in two communities in the north of the country. The aim is to obtain first-hand information on affordability of inputs, impact of these shocks especially on women farmers and farmers’ coping mechanisms in the wake of the current global crisis.
Read More...
Learning from Youth in West Africa in COVID-19
In July 2020, volunteers from the West Africa CARE Youth Network decided to learn more about what young women and men are experiencing in COVID-19, and how that should shape CARE’s response and our advocacy interests. This team interviewed 128 young people between the ages of 15 and 35 in 8 countries. 86 of the young people (67%) were young women. Volunteers used Whatsapp messages, phone calls, and recorded interviews to let young people tell their own stories. With a few guiding questions, and using ONA as a platform to structure and analyze the responses, the team has been able to see regional trends and individual stories that must shape humanitarian response to COVID-19 and recovery efforts in way that include young people—especially young women, meet their needs, and value their voices and leadership.
Interviewers had a set of questions from CARE’s Rapid Gender Analysis toolkit, where they asked young people about the biggest impact COVID-19 has in their lives, their biggest need right now, how they are responding to COVID-19, and what are their hopes for the future. Listening to their answers, interviewers categorized the responses based on a pre-set list of options also from the RGA toolkit.
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Interviewers had a set of questions from CARE’s Rapid Gender Analysis toolkit, where they asked young people about the biggest impact COVID-19 has in their lives, their biggest need right now, how they are responding to COVID-19, and what are their hopes for the future. Listening to their answers, interviewers categorized the responses based on a pre-set list of options also from the RGA toolkit.
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West Africa COVID-19 RGA May 2020
As of mid-April 2020, the number of confirmed COVID-19 cases in Africa is relatively low. That said, there has only been limited testing in Africa, leading many experts to be concerned that Africa could still experience outbreaks on, or beyond, the scale experienced in other regions. Governments are imposing restrictions on movement to reduce the risk of potential outbreaks, and this is directly impacting the ability of humanitarian actors to provide necessary assistance. At the same time, some governments, notably the governments of Mali and Niger, are also expanding their safety nets to help people respond to COVID-19 and its impacts.
CARE’s Rapid Gender Analysis draws from CARE’s deep experience in the region, and from interviews with 266 people across 12 countries. It points to serious ongoing economic, health, and financial impacts that will be especially severe for women. It also paints a mixed picture of impact on women’s rights. Special concern is paid to encroaching limitations to women’s access to resources, as well as to their representation and participation in formal decision-making; increased incidents of gender-based violence. These worrying
observations are accompanied by hopeful examples of women leading the response to the COVID-19 crisis and finding ways to negotiate equitable relationships with men in their communities, as well as with their husbands/male partners at home. Read More...
CARE’s Rapid Gender Analysis draws from CARE’s deep experience in the region, and from interviews with 266 people across 12 countries. It points to serious ongoing economic, health, and financial impacts that will be especially severe for women. It also paints a mixed picture of impact on women’s rights. Special concern is paid to encroaching limitations to women’s access to resources, as well as to their representation and participation in formal decision-making; increased incidents of gender-based violence. These worrying
observations are accompanied by hopeful examples of women leading the response to the COVID-19 crisis and finding ways to negotiate equitable relationships with men in their communities, as well as with their husbands/male partners at home. 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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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.
Read More...
HIV/AIDS Prevention Programme III (HAPP III) in Sierra Leone
The HIV/AIDS Prevention Program (HAPP) III implemented in Sierra Leone, supports the financing of social marketing activities for condoms and the Impact Mitigation Funds (IMF) aimed at mitigating the social impact of HIV/AIDS. The project focuses on the prevention of GBV including FGC; prevention of HIV/AIDS and unplanned pregnancies as well as the empowerment of girls and women.1 The overall goal of HAPP III is to contribute to improved sexual and reproductive health of Sierra Leone. The programme was implemented from June 2013 to July 2017 and granted a no-cost extension to March 2018. This was to make up for 18 months of programme implementation time lost during the outbreak of the Ebola Viral Disease from the 24th May 2014 through 17th March 2016.
The overall purpose of the HAPP III end phase evaluation is to measure improvements in SRHR outcomes (specifically decrease of risk contact of HIV, increased use of condoms by the 15-24 year old generation, reduced stigmatization against people living with HIV and ratio of mother’s age 25-49 years who do not intend their daughters to be subjected to FGC). [70 pages] Read More...
The overall purpose of the HAPP III end phase evaluation is to measure improvements in SRHR outcomes (specifically decrease of risk contact of HIV, increased use of condoms by the 15-24 year old generation, reduced stigmatization against people living with HIV and ratio of mother’s age 25-49 years who do not intend their daughters to be subjected to FGC). [70 pages] Read More...
‘Epidemic Control and Reinforcement of Health Services (ECRHS) Project in Sierra Leone’ Midterm Report
The Epidemic Control and Reinforcement of Health Services (ECRHS) project is funded by the German Development Cooperation (KfW) as a direct response to the Ebola outbreak, for the period 1 November 2015 to 31 May 2017. ECRHS reaches 400 communities in the four northern districts of Bombali (100), Tonkilili (110), Kambia (90) and Koinadugu (100), where the Ebola outbreak was prominent. ECRHS also reaches 233 Peripheral Health Units (PHU) located in these districts. [46 pages] Read More...