English
Supporting meaningful civic engagement for improved accountability by leveraging digital technologies (Ref: ISAF-II) 2019-2023
This is the end of project Evaluation for CARE’s Implementation of Social Accountability Framework (ISAF) Project. Phase two of the ISAF was implemented in five target provinces (Ratank Kiri, Mondul Kiri, Koh Kong Kratie, and Stung Treng) over 50 months (2019-2024). ISAF II aimed to reduce poverty through democratic, inclusive, and equitable local governance and more accessible and equitable public service delivery. ISAF II worked with local Non-governmental Organisation (LNGOs) that were provided grants through the project and citizens of the five targeted provinces who received improved services (commune, health centres and primary schools).
Objective of the Evaluation
The overall objective of the end of project evaluation is to provide a full assessment of the intended goals and objectives of the action including the treatment of key evaluation questions and using the six Organisation for Economic Co-operation and Development / Development Assistance Committee (OECD DAC) criteria; relevance, coherence, effectiveness, efficiency, impact, and sustainability. The evaluation also aims to capture best practices, challenges, and lessons learned during the project intervention, and provide clear recommendations for CARE, the National Committee for Sub-national Democratic Development (NCDD), European Union (EU), World Bank and other relevant Development Partners and stakeholders for future interventions. The evaluation will measure the impact and progress against the project’s logical framework. The evaluation will assess all three sectors (commune administration, health centres, and school services) in all five selected provinces under CARE’s mandate.
End of project respondents were chosen from key project participants: citizens, youth (aged 15 to 30 years old), local authorities/services providers (commune and district levels, healthcare centres and primary schools) and Community Accountability Facilitators (CAFs). A total of 649 respondents were interviewed for the evaluation. Data collection was conducted with a team of 10 data collectors in December 2023. Read More...
Objective of the Evaluation
The overall objective of the end of project evaluation is to provide a full assessment of the intended goals and objectives of the action including the treatment of key evaluation questions and using the six Organisation for Economic Co-operation and Development / Development Assistance Committee (OECD DAC) criteria; relevance, coherence, effectiveness, efficiency, impact, and sustainability. The evaluation also aims to capture best practices, challenges, and lessons learned during the project intervention, and provide clear recommendations for CARE, the National Committee for Sub-national Democratic Development (NCDD), European Union (EU), World Bank and other relevant Development Partners and stakeholders for future interventions. The evaluation will measure the impact and progress against the project’s logical framework. The evaluation will assess all three sectors (commune administration, health centres, and school services) in all five selected provinces under CARE’s mandate.
End of project respondents were chosen from key project participants: citizens, youth (aged 15 to 30 years old), local authorities/services providers (commune and district levels, healthcare centres and primary schools) and Community Accountability Facilitators (CAFs). A total of 649 respondents were interviewed for the evaluation. Data collection was conducted with a team of 10 data collectors in December 2023. Read More...
Lafiyayyan Yara (Healthy Child) – Reducing Infections Disease Among Children Under Five (RIDCU) Bade LGA, Yobe State
The Lafiyayyan Yara (Healthy Child): Reducing Infectious Disease among Children under Five (RIDCU-5) project was a 27-month private donor funded project implemented from October 2021 through December 2023. The project strengthened health systems in Bade Local Government Area (LGA) of Yobe state by providing required equipment and medication for health facilities, increasing capacity of health personnel to use approved diagnostic methods, and engaging the community to improve uptake of health services.
The primary objective of the evaluation was to assess the project's performance and document its achievements, challenges, and best practices to guide future similar programming; and provide recommendations to CARE Nigeria and its partners to make informed decisions and enhance the effectiveness and efficiency of future initiatives.
Effectiveness
Evidence from the desk review showed that the project made remarkable progress towards reducing mortality in under-5 children through a community-based health systems strengthening approach that ensures that communities receive a core package of services. The major factors that influenced the effectiveness and achievement of the project results were the use of community structures (community health volunteers, model mothers, and community-based surveillance focal points), capacity building, the referral system and the Social Analysis and Action (SAA) approach through community dialogues, supportive supervision, routine monitoring visits and facility health promotion session. The SAA approach also helped to shift practices related to family planning, immunization and poor health seeking behavior, as evidenced from the qualitative findings.
Efficiency
In both the design and implementation of the project activities, CARE International RIDCU5 team ensured that the project was efficient. The project design allowed the RIDCU5 project to train and work with community members as volunteers and adequately build their capacity and work collaboratively with local partners and relevant stakeholders. The use of community structures and local partners made the project implementation cost effective and created the opportunity for sustainability.
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The project’s design engaged community volunteers1 to serve as model mothers, community-based surveillance focal points, feedback and accountability volunteers, and community health volunteers, has enabled the project to increase community mobilization through a cost-effective approach. Through the community referral system, and health promotion sessions, many women were reached through the activities of the community volunteers.
Impact
Findings showed that the objectives and activities of the CARE RIDCU5 project were relevant in addressing the humanitarian needs of Bade Local Government communities. The weekly dialogue session with model mothers helped to address social norms and practices that negatively impact maternal and child health and the strengthened detection and referral of infectious disease (acute respiratory illness, malaria, diarrhea, and measles) through community-based surveillance (CBS) that included door-to-door visits and referrals for care. Also, health promotion sessions and supportive supervision in the 22 health facilities of the implementation contributed to quality of services. The project was able to respond largely to the needs of the target groups, including Community Health Workers (licensed and volunteers); children under five and their caregivers; pregnant and postpartum women and adolescent girls through support to strengthen referral systems, community engagement approaches to improve health behaviors and accountability of the health system as well as capacity building and provision of supplies and equipment to improve health service delivery.
Sustainability
The involvement of community volunteers assisted in the community ownership of the project. At present, community volunteers and community leaders, who benefited from the training conducted by CARE International, are engaged in community mobilization and awareness creation among community members on various aspects of the project. Respondents reported that that through the knowledge gained from CARE international, they were able to strengthen their cooperation among each other. The project has also built the capacity of the local partners and community members in a sustainable way through supportive supervision and training for health care workers and volunteers to improve and enhance their capacity to diagnose and detect infectious diseases. Read More...
The primary objective of the evaluation was to assess the project's performance and document its achievements, challenges, and best practices to guide future similar programming; and provide recommendations to CARE Nigeria and its partners to make informed decisions and enhance the effectiveness and efficiency of future initiatives.
Effectiveness
Evidence from the desk review showed that the project made remarkable progress towards reducing mortality in under-5 children through a community-based health systems strengthening approach that ensures that communities receive a core package of services. The major factors that influenced the effectiveness and achievement of the project results were the use of community structures (community health volunteers, model mothers, and community-based surveillance focal points), capacity building, the referral system and the Social Analysis and Action (SAA) approach through community dialogues, supportive supervision, routine monitoring visits and facility health promotion session. The SAA approach also helped to shift practices related to family planning, immunization and poor health seeking behavior, as evidenced from the qualitative findings.
Efficiency
In both the design and implementation of the project activities, CARE International RIDCU5 team ensured that the project was efficient. The project design allowed the RIDCU5 project to train and work with community members as volunteers and adequately build their capacity and work collaboratively with local partners and relevant stakeholders. The use of community structures and local partners made the project implementation cost effective and created the opportunity for sustainability.
7
The project’s design engaged community volunteers1 to serve as model mothers, community-based surveillance focal points, feedback and accountability volunteers, and community health volunteers, has enabled the project to increase community mobilization through a cost-effective approach. Through the community referral system, and health promotion sessions, many women were reached through the activities of the community volunteers.
Impact
Findings showed that the objectives and activities of the CARE RIDCU5 project were relevant in addressing the humanitarian needs of Bade Local Government communities. The weekly dialogue session with model mothers helped to address social norms and practices that negatively impact maternal and child health and the strengthened detection and referral of infectious disease (acute respiratory illness, malaria, diarrhea, and measles) through community-based surveillance (CBS) that included door-to-door visits and referrals for care. Also, health promotion sessions and supportive supervision in the 22 health facilities of the implementation contributed to quality of services. The project was able to respond largely to the needs of the target groups, including Community Health Workers (licensed and volunteers); children under five and their caregivers; pregnant and postpartum women and adolescent girls through support to strengthen referral systems, community engagement approaches to improve health behaviors and accountability of the health system as well as capacity building and provision of supplies and equipment to improve health service delivery.
Sustainability
The involvement of community volunteers assisted in the community ownership of the project. At present, community volunteers and community leaders, who benefited from the training conducted by CARE International, are engaged in community mobilization and awareness creation among community members on various aspects of the project. Respondents reported that that through the knowledge gained from CARE international, they were able to strengthen their cooperation among each other. The project has also built the capacity of the local partners and community members in a sustainable way through supportive supervision and training for health care workers and volunteers to improve and enhance their capacity to diagnose and detect infectious diseases. Read More...
Impact Case Study and Documentation of the Tea, Herbs and Spices Farmer’s Situation and Experiences in the Phase I of Her Money, Her Life Project Implementation
CARE International's two-year Her Money, Her Life (HMHL) project (2021-2023), funded by Bloomberg Philanthropies, aims to empower and economically uplift women farmers in Tanzania's tea sub-sector. In collaboration with Kazi Yetu Limited and key industry partners, the project targets 150,000 individuals, including 30,000 tea smallholder farmers (80% women). HMHL project builds on CARE's Agri Fund model with aim of investing in women to increase independence and economic opportunities to boost quality, quantity and diversification in Tanzania’s tea sub-sector. The impact study, conducted by Solveris Consulting Limited in November 2023, assesses the project's outcomes across seven districts in four regions, offering valuable insights into its effectiveness.
carried out by Kazi Yetu, funded by the project's grant. This ROI is expected to be more than doubled (188%) in 2025. The partnership between Kazi Yetu and stakeholders
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significantly impacts the specialty tea sector, showcasing rapid grant recovery/factory’s investment rate of return within 2.5 years. The project fosters economic viability and tangible benefits for farmers, contributing to positive transformation in livelihoods. Kazi Yetu's project interventions, highlighted by the SSTC demonstration factory, bring substantial and lasting benefits to farmers. Premium prices for green leaf tea sales, employment opportunities, and transformative training initiatives have significantly increased income for women tea farmers. The project's emphasis on value addition, including a solar dryer in Bumbuli, enhances product quality and market opportunities. Diversification into tea, herbs and spices production and commissions from bulk orthodox tea sales further contribute to income streams. The project's impact extends nationally, shaping the tea strategy and promoting specialty tea. The success of SSTC has catalysed national interest, leading to scaling efforts and increased global recognition for Tanzanian tea, enhancing market opportunities. Effectiveness of Village Savings and Loan Associations (VSLAs) on Collective Investment: VSLAs demonstrate a significant 30% increase in women's involvement from 46% during baseline to 60% now, indicating successful interventions that contribute to economic resilience and social cohesion. Regional variations underscore localized impacts. Additionally, the study reveals that the majority of respondents (87%) comprising 89% females and 84% males reported their VSLAs engaging in collective investments using mobilised savings. This level of collective engagement in collective investments through VSLAs is approximately double the baseline figure (47%). The investments take various forms, including small businesses, transportation equipment, and livestock husbandry. Further evidence suggests that collective investments have enhanced VSLAs' capital, improved members' access to loans, and overall increased income through dividends from collective investments. Read More...
carried out by Kazi Yetu, funded by the project's grant. This ROI is expected to be more than doubled (188%) in 2025. The partnership between Kazi Yetu and stakeholders
ix
significantly impacts the specialty tea sector, showcasing rapid grant recovery/factory’s investment rate of return within 2.5 years. The project fosters economic viability and tangible benefits for farmers, contributing to positive transformation in livelihoods. Kazi Yetu's project interventions, highlighted by the SSTC demonstration factory, bring substantial and lasting benefits to farmers. Premium prices for green leaf tea sales, employment opportunities, and transformative training initiatives have significantly increased income for women tea farmers. The project's emphasis on value addition, including a solar dryer in Bumbuli, enhances product quality and market opportunities. Diversification into tea, herbs and spices production and commissions from bulk orthodox tea sales further contribute to income streams. The project's impact extends nationally, shaping the tea strategy and promoting specialty tea. The success of SSTC has catalysed national interest, leading to scaling efforts and increased global recognition for Tanzanian tea, enhancing market opportunities. Effectiveness of Village Savings and Loan Associations (VSLAs) on Collective Investment: VSLAs demonstrate a significant 30% increase in women's involvement from 46% during baseline to 60% now, indicating successful interventions that contribute to economic resilience and social cohesion. Regional variations underscore localized impacts. Additionally, the study reveals that the majority of respondents (87%) comprising 89% females and 84% males reported their VSLAs engaging in collective investments using mobilised savings. This level of collective engagement in collective investments through VSLAs is approximately double the baseline figure (47%). The investments take various forms, including small businesses, transportation equipment, and livestock husbandry. Further evidence suggests that collective investments have enhanced VSLAs' capital, improved members' access to loans, and overall increased income through dividends from collective investments. Read More...
The First 1000 Days, Phase III in Sekong and Phongsaly Provinces
The First 1000 Days Project Phase III focuses on improving maternal and child mortality, improving health outcomes for women, adolescents, and children in the first 1,000 days of the life of children in Sekong and Phongsaly Provinces as well as to support poor and vulnerable households in remote, rural areas to facilitate access to and improve the quality of nutrition-related health services for mothers and children and improve food and nutrition security for community members. The project also integrates adolescent sexual reproductive health, women’s economic empowerment, responses to gender based violence, and stakeholder engagement in health.
This report examines the health, nutrition, and economic empowerment of women, adolescents, and children in Phongsaly and Sekong provinces of Laos. The baseline assessment aimed to understand the current situation and identify areas where interventions could have the greatest impact. Data was collected through a combination of surveys, focus group discussions, key informant interview with key stakeholders and interviews with mother of CU5, adolescent (age 15-19), men, healthcare providers, and community leaders.
The results showed that despite high antenatal care (ANC) utilization rates in both Phongsaly and Sekong, there remains room for improvement in overall healthcare delivery, particularly around childbirth. Home births remain common, highlighting the need for increased access to skilled birth attendants at health facilities and mobile outreach services. Sekong lags behind Phongsaly in skilled birth attendance rates.
Another area requiring attention is postnatal care. While attendance is satisfactory, there's potential to improve these services. Additionally, a concerning practice of some women lying over fire after childbirth needs to be addressed due to potential health risks.
Regarding family planning, awareness and usage vary significantly between the two provinces, with Phongsaly showing higher rates. Sekong especially needs increased access to family planning services, while both provinces could benefit from addressing confidentiality concerns surrounding these services, particularly in Phongsaly.
Food and nutrition security presents a significant challenge, as nutrition indicators showed poor nutritional status of children. Stunting rates among children under five are high, particularly in Sekong. Both provinces struggle with low dietary diversity, lacking adequate consumption of fruits, vegetables, legumes, and animal source proteins. While breastfeeding practices show positive trends in early initiation and colostrum feeding, there remains poor long-term rates of exclusive breastfeed. Sekong has lower rates of early initiation and exclusive breastfeeding duration compared to Phongsaly, and even in Phongsaly, many mothers wean before the recommended 6 months. Read More...
This report examines the health, nutrition, and economic empowerment of women, adolescents, and children in Phongsaly and Sekong provinces of Laos. The baseline assessment aimed to understand the current situation and identify areas where interventions could have the greatest impact. Data was collected through a combination of surveys, focus group discussions, key informant interview with key stakeholders and interviews with mother of CU5, adolescent (age 15-19), men, healthcare providers, and community leaders.
The results showed that despite high antenatal care (ANC) utilization rates in both Phongsaly and Sekong, there remains room for improvement in overall healthcare delivery, particularly around childbirth. Home births remain common, highlighting the need for increased access to skilled birth attendants at health facilities and mobile outreach services. Sekong lags behind Phongsaly in skilled birth attendance rates.
Another area requiring attention is postnatal care. While attendance is satisfactory, there's potential to improve these services. Additionally, a concerning practice of some women lying over fire after childbirth needs to be addressed due to potential health risks.
Regarding family planning, awareness and usage vary significantly between the two provinces, with Phongsaly showing higher rates. Sekong especially needs increased access to family planning services, while both provinces could benefit from addressing confidentiality concerns surrounding these services, particularly in Phongsaly.
Food and nutrition security presents a significant challenge, as nutrition indicators showed poor nutritional status of children. Stunting rates among children under five are high, particularly in Sekong. Both provinces struggle with low dietary diversity, lacking adequate consumption of fruits, vegetables, legumes, and animal source proteins. While breastfeeding practices show positive trends in early initiation and colostrum feeding, there remains poor long-term rates of exclusive breastfeed. Sekong has lower rates of early initiation and exclusive breastfeeding duration compared to Phongsaly, and even in Phongsaly, many mothers wean before the recommended 6 months. Read More...
Women, Youth and Resilience Project Final Evaluation Outcome Harvesting: Understanding Changes in livelihoods, Gender Based Violence (GBV) and Government Accountability for Gender Equality.
The project was implemented by CARE International in Austria, Care International in Uganda, and two local partners, the Community Empowerment for Rural Development (CEFORD) and THRIVEGulu between 2021 and 2024 and is being followed up by a similar five-year project called the Gender Equality and Resilience Project (GEAR) to be implemented in Uganda and Rwanda. This is important to note as the findings from this final evaluation have implications for the programming of GEAR.
The main objective of this final evaluation is to assess effectiveness, impact and sustainability of the WAYREP project. It offers an understanding of the extent to which WAYREP achieved its stated objectives and it answers the five evaluation questions set out in the Evaluation Matrix (see Annex 2). The evaluation results will inform the programming of GEAR, WAYREP’s follow on program in Uganda and Rwanda.
The project successfully met its planned objectives, expected results, and indicators, demonstrated through the results below.
1.1: Enhanced Sustainable and Dignified Livelihood for Women and Youth
Over the five years, WAYREP significantly increased the average weekly income (49.6%) and by the end of the project, income gains surpassed the national average (Finding A). The increase in income was closely tied to an increase in confidence and self-reliance. While various groups of beneficiaries (e.g., refugees, youth, older beneficiaries, GBV survivors) experienced increases in their confidence, it was young women who experienced more significant gains in their self-confidence. These wins stemmed from their membership to savings groups and their newfound ability to earn an income (Finding H).
Although income gains were seen across beneficiary groups, gender and youth disparities were observed; men reported higher average earnings across Income Generating Activities (IGAs) compared to women
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(Finding C) and younger beneficiaries in the 15-19 age group reported heightened engagement in income generation activities, compared to beneficiaries in the 20-30 age bracket (Finding B). While young people appear to have experienced more significant wins in participation, their average weekly income was lower than older beneficiaries (Finding D). Younger adults (20-30) were also less likely to develop business plans compared to older participants (31-45) (Finding E).
Specific differences were observed in Omugo Settlement in terms of income earning opportunities. Overall, in Omugo Settlement beneficiaries participated less in savings groups (Finding F) and were able to save less money compared to their peers in Arua City, Gulu City and Omugo Sub County. This is important, as the lower savings values have the risk of limiting refugees' ability to access capital to grow their businesses (Finding I). That said, South Sudanese refugees in Omugo settlement experienced unique wins from their increased economic status and improved their relationships with the host community. This is significant as it highlights the project's positive impact on social cohesion, particularly in locations where relationships between the refugee and host community relationships were strained (Finding F).
The final evaluation found that financial management practices and savings habits improved across all four locations. While most savings groups still preferred traditional savings systems that included a locked box kept in a member’s house, in Gulu and Arua City savers were experimenting with mobile savings that offered increased security, flexibility and accountability (Finding G). This points to the potential for greater exploration of mobile savings systems in GEAR, WAYREP’s follow on program, especially in locations which have already started to adopt this practice.
1.2: Evidence of WAYREP Achieving Reduced Acceptance for Gender Based Violence in Communities
The final evaluation found a decrease in experience of GBV from 28% at baseline (2021) to 20.7% at endline (2024) and a similar rejection of intimate partner violence (IPV), from 71.6% at baseline, to 77.1% at endline (Finding J). The project's strong focus on economic empowerment (Section 1.1 above) had a positive effect on the confidence and self-resilience of women and young (Finding H) which intern contributed to a positive shift in social norms and facilitated a reduction in the acceptability of violence (Finding K).
1.3: Evidence of WAYREP Providing Enhanced Support to GBV Survivors
The increase in GBV reporting (Finding L) suggests that survivors felt more comfortable coming forward, due to the project's efforts to raise awareness and improve survivors access to support. Beneficiaries reported there was now more support available for survivors of violence (Finding L) and improved access to mechanisms for expressing dissatisfaction with inappropriate treatment by local authorities or service providers (Finding M). The findings suggest that the project empowered survivors to seek help and enabled them to hold service providers to account (Finding L, M).
1.4: Evidence of WAYREP Achieving Increased Accountability by the Government of Uganda to Implement Relevant Frameworks for Women and Girls’ Protection and Rights
Women and girls across all four locations reported increased capacity to advocate for their rights (Finding N). The project had a strong contribution to this result and motivated and supported the Government of Ugandan (GoU) and key religious and cultural leaders to implement or strengthen frameworks to protect women's and girls' rights (Finding O). These changes intern created a more enabling environment for women and girls in Uganda and provided a supportive legal framework for them to advocate for their rights Read More...
The main objective of this final evaluation is to assess effectiveness, impact and sustainability of the WAYREP project. It offers an understanding of the extent to which WAYREP achieved its stated objectives and it answers the five evaluation questions set out in the Evaluation Matrix (see Annex 2). The evaluation results will inform the programming of GEAR, WAYREP’s follow on program in Uganda and Rwanda.
The project successfully met its planned objectives, expected results, and indicators, demonstrated through the results below.
1.1: Enhanced Sustainable and Dignified Livelihood for Women and Youth
Over the five years, WAYREP significantly increased the average weekly income (49.6%) and by the end of the project, income gains surpassed the national average (Finding A). The increase in income was closely tied to an increase in confidence and self-reliance. While various groups of beneficiaries (e.g., refugees, youth, older beneficiaries, GBV survivors) experienced increases in their confidence, it was young women who experienced more significant gains in their self-confidence. These wins stemmed from their membership to savings groups and their newfound ability to earn an income (Finding H).
Although income gains were seen across beneficiary groups, gender and youth disparities were observed; men reported higher average earnings across Income Generating Activities (IGAs) compared to women
11
(Finding C) and younger beneficiaries in the 15-19 age group reported heightened engagement in income generation activities, compared to beneficiaries in the 20-30 age bracket (Finding B). While young people appear to have experienced more significant wins in participation, their average weekly income was lower than older beneficiaries (Finding D). Younger adults (20-30) were also less likely to develop business plans compared to older participants (31-45) (Finding E).
Specific differences were observed in Omugo Settlement in terms of income earning opportunities. Overall, in Omugo Settlement beneficiaries participated less in savings groups (Finding F) and were able to save less money compared to their peers in Arua City, Gulu City and Omugo Sub County. This is important, as the lower savings values have the risk of limiting refugees' ability to access capital to grow their businesses (Finding I). That said, South Sudanese refugees in Omugo settlement experienced unique wins from their increased economic status and improved their relationships with the host community. This is significant as it highlights the project's positive impact on social cohesion, particularly in locations where relationships between the refugee and host community relationships were strained (Finding F).
The final evaluation found that financial management practices and savings habits improved across all four locations. While most savings groups still preferred traditional savings systems that included a locked box kept in a member’s house, in Gulu and Arua City savers were experimenting with mobile savings that offered increased security, flexibility and accountability (Finding G). This points to the potential for greater exploration of mobile savings systems in GEAR, WAYREP’s follow on program, especially in locations which have already started to adopt this practice.
1.2: Evidence of WAYREP Achieving Reduced Acceptance for Gender Based Violence in Communities
The final evaluation found a decrease in experience of GBV from 28% at baseline (2021) to 20.7% at endline (2024) and a similar rejection of intimate partner violence (IPV), from 71.6% at baseline, to 77.1% at endline (Finding J). The project's strong focus on economic empowerment (Section 1.1 above) had a positive effect on the confidence and self-resilience of women and young (Finding H) which intern contributed to a positive shift in social norms and facilitated a reduction in the acceptability of violence (Finding K).
1.3: Evidence of WAYREP Providing Enhanced Support to GBV Survivors
The increase in GBV reporting (Finding L) suggests that survivors felt more comfortable coming forward, due to the project's efforts to raise awareness and improve survivors access to support. Beneficiaries reported there was now more support available for survivors of violence (Finding L) and improved access to mechanisms for expressing dissatisfaction with inappropriate treatment by local authorities or service providers (Finding M). The findings suggest that the project empowered survivors to seek help and enabled them to hold service providers to account (Finding L, M).
1.4: Evidence of WAYREP Achieving Increased Accountability by the Government of Uganda to Implement Relevant Frameworks for Women and Girls’ Protection and Rights
Women and girls across all four locations reported increased capacity to advocate for their rights (Finding N). The project had a strong contribution to this result and motivated and supported the Government of Ugandan (GoU) and key religious and cultural leaders to implement or strengthen frameworks to protect women's and girls' rights (Finding O). These changes intern created a more enabling environment for women and girls in Uganda and provided a supportive legal framework for them to advocate for their rights Read More...
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...