systems-level impact

SATH (Self-Applied Technique for Quality Health Tool) Systems Level Impact Evaluation

Poor and marginalized women often encounter obstacles in accessing healthcare information and services in Nepal. In response to this equity gap, CARE Nepal introduced a social mapping tool named Self-Applied Technique for Quality Health (SATH) within Health Mothers’ Groups (HMGs) . The objective of this approach is to enhance women's access to health services and information, empowering them to take informed actions based on their learnings. Since 2008, CARE Nepal has implemented SATH in over 3,100 HMGs across 42 districts out of 77, through various projects. To assess the effectiveness of SATH, evaluation reports, case studies, relevant articles, and policy documents were reviewed and analyzed. It was found that SATH significantly contributes to strengthening the community health system by fostering women's involvement in health matters and operationalizing HMGs. Moreover, the tool aids in generating demand for, and utilization of, healthcare services by empowering women and supporting advocacy efforts.

As a result of these positive outcomes, the Government of Nepal adopted SATH as a successful approach under the Equity, Access, and Utilization Program in 2021. This initiative aims to improve access to, and utilization of, child health and nutrition services among marginalized communities, and it has since been expanded nationwide. This milestone marked a significant achievement in localizing the SATH tool within Nepal's health policy framework. CARE Nepal's rigorous policy advocacy played a pivotal role in this integration, highlighting its commitment to advancing maternal, newborn and child health initiatives. Read More...

Systems-Level Impact through the 2018 U.S. Farm Bill

In a global context of rising numbers of people affected by increasingly frequent and severe food security crises, CARE advocated for essential amendments in the 2018 Farm Bill to strengthen critical international food aid programs. CARE's advocacy for the 2018 Farm Bill was rooted in its focus on gender equality and systems change, which in this case meant advocating for a shift away from monetization in support of CARE’s long-term goals for transforming food aid from a commodity-centric model to one that enhances effectiveness, efficiency, and focus on systems change.

Central to CARE’s asks in the 2018 Farm Bill were efforts to end the mandate of monetization and provide greater certainty in the use of the Community Development Funds. Both of these asks would strengthen Food for Peace, a program authorized in the Farm Bill that provides in-kind food aid directly to communities and supports community self-sufficiency. CARE recognized the 2018 Farm Bill reforms, including ending mandatory monetization and expanding Community Development Funds, could strengthen local food systems, empower farmers, and build community resilience by prioritizing sustainable and effective food aid delivery. Read More...

System Level Impact Evaluation Report on Categorization-based Farmer ID (FID) System in Nepal

This report highlights CARE's transformative initiatives through the Farmer Identity (FID) Card system, which significantly benefitted landless individuals, women, persons with disabilities, Dalits, Janajatis, and other marginalized groups in Nepal. Conducted from May to June 2024, the comprehensive impact evaluation utilized a participatory approach and contribution analysis to assess the impacts of the FID system. Key findings illustrate how the FID Card system has been integrated into local and federal agriculture policies, enhancing access to services for marginalized farmers and empowering communities. The report details the significant changes in agriculture policy, improved accountability, reduced discrimination, and enhanced social norms resulting from the intervention. The evaluation also identifies challenges and sustainability factors, providing actionable recommendations for future advocacy and implementation strategies.

Total Page Count: 67 Read More...

Adolescent Girls’ Education in Somalia (AGES) Post Project Evaluation Summaries

The Adolescent Girls’ Education in Somalia (AGES) project is an ambitious six-year initiative (2018-2024) funded by FCDO and USAID, which sought to enable 83,925 ultra-marginalized girls and female youth living in conflict-affected areas of Somalia to access quality education responsive to their needs. AGES combines the provision of three education modalities with financial literacy, youth savings groups, life skills, mentorship, and girl-led civic action. AGES enrolled a total of 90,698 girls in education, including 21,945 in primary education; 1244 in formal special needs schools; 13,276 in accelerated basic education (ABE); and 54,233 in non-formal education classes (NFE). This series of briefs highlights results on different components of results from the post-project evaluation.
Additionally, The Adolescent Girls’ Education in Somalia (AGES) project worked to improve learning outcomes and positive transitions for 90,698 extremely vulnerable girls and female youth in South Somalia. AGES research showed that vulnerable girls’ limited self-confidence and voice hinders participation in class, with a negative impact on learning, particularly among girls with disabilities and displaced youth. To address this barrier, AGES
formed school-based clubs known as Girls’ Empowerment Forum (GEF). Through the GEF, vulnerable students participate in activities to develop leadership skills with support from mentors and are linked to resource
persons within the community. They are trained to act as peer mentors within their schools and community, reaching out to other girls to provide support, and engaging in joint advocacy and action. GEF participants
work together to develop plans to address issues of their choice through girl-led action. GEF mentors and peer mentors are also trained on psychosocial first aid, providing support to those affected by shocks. In 2020-2024, AGES established 911 Girls’ Empowerment Forums with a total of 9,110 members. The GEFs were connected through 18 district-level networks. Read More...

Systems-Level Change in Niger: Women and Girls Are Better Off Today Than in 1991

Few development programs have a decades-long lifespan and impact. CARE’s Mata Masu Dubara model (MMD) has been rolled out since 1991, championing women's leadership and economic empowerment in Niger. Originally conceived as savings and credit groups, the model has evolved over the years to address women’s groups demands to have better access to public health services, improve nutrition, receive technical training and participate in civic and electoral processes, among others.

In 2023, CARE initiated a ground-breaking systems evaluation of MMD groups in Niger to explore the actual influence the groups have on women’s and girl’s voice, leadership, economic autonomy and climate justice, published in a May 2023 report. A complementary mixed-methods evaluation conducted from July to December 2023 explores the influence of MMD on women and girls’ maternal health, early and forced marriage, education and nutrition, in partnership with the Government of Niger.

Using CARE’s pathways of systems-level change, combined with qualitative and quantitative data, the study explored four dimensions of change for each one of the topics mentioned above: 1. Advocacy to influence policies and programs; 2. Changes in social norms; 3. Supporting social movements; 4. Strengthening systems and social responsibility. Today, CARE Niger serves 33,795 groups with 865,000 women and girl members. In Maradi, Zinder, Dosso and Tahoua 1,378 women and men answered a survey; 314 women and men participated in focus group discussions and individual interviews.

Are women and girls of Niger better off in 2023 than they were in 1991? Yes. While the review noted progress made towards more gender equity for girls’ education, access and use of sexual and reproductive health services and more attention paid to the welfare of pregnant and breastfeeding women, early and forced marriage still persists. Leveraging the power of MMD groups and other trusted community leaders (teachers, principals, MMD female leaders, religious leaders) to design interventions to curb early marriage would yield tremendous benefits. Indeed, early marriage robs girls of 9% of their future income.

Through MMD, women of Niger have found their voice, been elected to parliament in record numbers (over 30% in 2021), and participate in local decision making processes as town councilors and local representatives. Acting both at the program, local level and the national, influencing one, CARE, its partners and networks of MMD groups will continue to create a better, safer, more prosperous environment for Nigerien girls. (86 pages) Read More...

CARE’s Fast and Fair COVID-19 campaign: Comprehensive local-to-global impact

Report available in English, French and Spanish

In November 2020, CARE launched the Fast and Fair campaign to push for fairness and efficiency in the global COVID-19 vaccination effort. We skillfully leveraged our global reach and influence to build and maintain support for more comprehensive funding for vaccine delivery while working hand-in-hand with national and local governments in 34 countries to get the vaccines into the arms of those most in need. Our advocacy and influencing of US and global policy, along with our deep engagement in communities and years of programming investments drove systems-level change that contributed to 21.2 million people getting fully vaccinated in 29 countries. To determine the comprehensive impact of the Fast and Fair campaign, we utilized country case studies, internal program data, and an external evaluation. These sources all affirmed CARE's advocacy and influencing contributions to the global vaccination effort, resulting in millions of vaccinations at the last mile. Read More...

Fast and Fair Country Case Studies: Mini Advocacy and Influencing Impact Reporting (AIIR) Tool Analysis

Fast and Fair Country Case Studies: Mini Advocacy and Influencing Impact Reporting (AIIR) Tool Analysis Read More...

Global Covid-19 Supplemental Campaign: A case study to assess the efficacy of CARE and the coalition’s advocacy strategies

Between December 2021 and late March 2022, CARE and five close allies led an ad hoc coalition advocating for US government approval of $17B in supplemental funding for global COVID-19 relief, specifically for resources to support vaccine delivery and front-line health workers. The purpose of this case study is to assess the effectiveness of the advocacy strategies employed by CARE and allies and draw out lessons to (1) inform future campaigning and (2) better integrate this type of assessment in CARE’s MEL activities. Read More...

Evaluating systems-level change and impact in CARE’s programming in Ecuador, Ethiopia, Nepal and Uganda: A global report

This report provides a detailed analysis and review of the evaluations of four CARE systems-level change projects - from Ecuador, Ethiopia, Nepal and Uganda exploring the extent to which their actions influenced systems change and led to impacts in people’s lives. It represents what is understood as the first time CARE has undertaken a deep dive evaluation into its systems-level approaches. The report begins with an overview of these projects and the Outcome Harvest evaluation methodology used across these countries to measure systems change, including the adaptations made to apply Outcome Harvesting to a systems-level project rather than standard CARE programming. Read More...

Evaluating Systems-level change and impact Findings from the evaluation of the Humanitarian Assistance Program (PAH) in Ecuador

CARE’s ten-year strategy, Vision 2030, seeks to deepen the organizational focus on systems-level change and impact, recognizing that this is essential to expanding CARE’s reach and fulfilling our mission to save lives, defeat poverty and achieve social justice. To support this, CARE launched a systems-level impact initiative to measure the effect of our programs that have influenced or changed systems, and the impact of this systems-change on people’s lives. The initiative also increased capacity across the CARE confederation to design, finance and implement high-quality systems change programs, and to strengthen the focus on systems-level change within our Country Office organizational frameworks and strategies. Four CARE Country Offices were selected to evaluate a project or program, and to synthesize the results for national and global learning. Read More...

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Keywords

Adolescents Agriculture AIDS Basic and Girls' Education Cash Vouchers Child Health Child Nutrition Civil Society and Governance Climate Change Conflict Mitigation COVID 19 COVID 19 RGA Disaster Risk Reduction Economic Development Education Emergency and Humanitarian Aid Entrepreneurship Environment FFBS Food Security Gender Gender Based Violence Gender Equality Health Livelihoods Maternal Migrants and Refugees Natural Resources Nexus Nutrition Resilience RGA Sexual Sexual and Reproductive Health Shelter Social Norms Usaid Vaccination Value Chain VSLA WASH Water Women's Economic Empowerment Women's Empowerment Youth