Gender Equality
Adolescent Girls’ Education in Somalia (AGES) Endline evaluation
This evaluation of CARE International’s Adolescent Girls Education in Somalia (AGES) programme concludes a four-and-a-half-year effort to track the programme’s impact on various cohorts of girl learners. The evaluation is preceded by three previous evaluations: a baseline (BL) round in late 2019, a Midline 1 (ML1) round in early 2022, and a Midline 2 (ML2) round in early 2023. Three key outcomes for girls are measured through this study: 1) learning outcomes, as measured by numeracy and literacy skills; 2) transitions outcomes, measured by girls’ trajectories since first surveyed, such as whether a girl has progressed in grade levels, or secured gainful employment after their participation in the AGES programme; and 3) sustainable change emerging from shifts in social norms at the community and individual level, as well as strengthened institutional capacities to support inclusive education.
In addition, the programme’s theory of change (ToC) posits that several intermediate outcomes mediate the effect of programme interventions on the primary outcomes. As such, this study also examines progress on several intermediate outcomes: 1) attendance rates, 2) quality of teaching practices, 3) girls’ leadership and life skills, 4) school management and governance, 5) community support for girls’ education, 6) girl’s self-efficacy, 7) strengthened economic circumstances for female youth, and finally, 8) access to social support services.
Importantly, this study comprises evaluations for three separate groups of girls, all recruited into the study at various points in time. The study began with an original baseline cohort of girls participating in the formal education (FE), Alternative Basic Education (ABE), and Non-Formal Education (NFE) programmes. These girls were recruited from schools in the following states, or geographic zone: Banadir, South West State, and Jubaland. The ABE programme focused on accelerated education of basic skills to enable girls to transition into the formal education system, while the NFE programme aimed to equip girls with the skills – both hard and soft – needed to pursue livelihoods, though some NFE girls also transition to the formal education system. These initial groups – whom we collectively refer to as Cohort 1 (C1) or the baseline cohort – were first recruited at BL in 2019, and were funded by the UK’s Girls’ Education Challenge (GEC) fund.
Two further cohorts, funded by USAID, were later introduced. Cohort 4, or C4, NFE girls were introduced into the study at ML1, while Cohort 5, or C5, NFE girls were introduced to the study at ML2. As such, unlike the C1 girls, we take the ML1 and ML2 evaluation rounds as the cohort-specific baselines for C4 and C5 NFE girls, respectively, and compare changes in main and intermediate outcomes from those rounds to EL. The USAID expansion of the NFE programming also meant the C4 and C5 Read More...
In addition, the programme’s theory of change (ToC) posits that several intermediate outcomes mediate the effect of programme interventions on the primary outcomes. As such, this study also examines progress on several intermediate outcomes: 1) attendance rates, 2) quality of teaching practices, 3) girls’ leadership and life skills, 4) school management and governance, 5) community support for girls’ education, 6) girl’s self-efficacy, 7) strengthened economic circumstances for female youth, and finally, 8) access to social support services.
Importantly, this study comprises evaluations for three separate groups of girls, all recruited into the study at various points in time. The study began with an original baseline cohort of girls participating in the formal education (FE), Alternative Basic Education (ABE), and Non-Formal Education (NFE) programmes. These girls were recruited from schools in the following states, or geographic zone: Banadir, South West State, and Jubaland. The ABE programme focused on accelerated education of basic skills to enable girls to transition into the formal education system, while the NFE programme aimed to equip girls with the skills – both hard and soft – needed to pursue livelihoods, though some NFE girls also transition to the formal education system. These initial groups – whom we collectively refer to as Cohort 1 (C1) or the baseline cohort – were first recruited at BL in 2019, and were funded by the UK’s Girls’ Education Challenge (GEC) fund.
Two further cohorts, funded by USAID, were later introduced. Cohort 4, or C4, NFE girls were introduced into the study at ML1, while Cohort 5, or C5, NFE girls were introduced to the study at ML2. As such, unlike the C1 girls, we take the ML1 and ML2 evaluation rounds as the cohort-specific baselines for C4 and C5 NFE girls, respectively, and compare changes in main and intermediate outcomes from those rounds to EL. The USAID expansion of the NFE programming also meant the C4 and C5 Read More...
“FORTALECIENDO EL MOVIMIENTO DE TRABAJADORAS REMUNERADAS DEL HOGAR A TRAVÉS DEL APRENDIZAJE Y LA TECNOLOGÍA
Resumen ejecutivo
Descripción general Este documento expone un resumen de los hallazgos de la evaluación externa del proyecto “Fortaleciendo el Movimiento de Trabajadoras del Hogar a través del Aprendizaje y la Tecnología”- MovTRH&Tech, financiado por Cummins e implementado en dos fases entre el 2019 y el 2023 en Colombia, México, Brasil y Perú. Usando los criterios de evaluación que propone la OCDE, el informe presenta una valoración de los alcances estratégicos del proyecto, así como, lecciones aprendidas, buenas prácticas conclusiones y recomendaciones.
Hallazgos La pertinencia del proyecto se destaca desde su diseño, ya que, respondió a las necesidades de los movimientos de TRHs, incluyó acciones diferenciadas por país y empleó un enfoque participativo, adaptándose a contextos específicos. Se alineó con prioridades de instituciones y programas, contribuyendo a los ODS 5 y 8, la implementación del Convenio 189 de la OIT, leyes nacionales en México, Perú, Colombia y Brasil, los objetivos del Programa Regional Igual Valor Iguales Derechos, la visión 2030 de CARE y sus indicadores y la iniciativa Cummins Powers Women, entre otros.
El diseño de las aplicaciones contribuyó a la pertinencia, ya que, fueron diseñadas de manera participativa y diferenciada para cada país llevando a que respondieran a las necesidades propias de cada contexto. Así mismo, las campañas de comunicación y marketing contribuyeron a la pertinencia pues su desarrollo fue centrado en la experiencia y participación de las TRH, lo que constituyó un importante éxito para lograr sensibilización a diferentes públicos y ampliar el alcance esperado en un comienzo.
Strengthening the Domestic Workers Movement Through Learning and Technology (Phase III)
This document presents a summary of the findings of the external evaluation of the project “Strengthening the Domestic Workers Movement through Learning and Technology” - MovTRH&Tech, funded by Cummins and implemented in two phases between 2019 and 2023 in Colombia, Mexico, Brazil and Peru. Using the evaluation criteria proposed by the OECD, the report presents an assessment of the strategic scope of the project, as well as lessons learned, good practices, conclusions and recommendations.
Findings The relevance of the project stands out from its design, since it responded to the needs of the HRT movements, included actions differentiated by country and used a participatory approach, adapting to specific contexts. It was aligned with priorities of institutions and programs, contributing to SDGs 5 and 8, the implementation of ILO Convention 189, national laws in Mexico, Peru, Colombia and Brazil, the objectives of the Equal Value Equal Rights Regional Program, vision 2030 of CARE and its indicators and the Cummins Powers Women initiative, among others.
The design of the applications contributed to relevance, since they were designed in a participatory and differentiated way for each country, ensuring that they responded to the needs of each context. Likewise, the communication and marketing campaigns contributed to relevance since their development was focused on the experience and participation of HRT, which constituted an important success in raising awareness among different audiences and expanding the scope initially expected. Read More...
Descripción general Este documento expone un resumen de los hallazgos de la evaluación externa del proyecto “Fortaleciendo el Movimiento de Trabajadoras del Hogar a través del Aprendizaje y la Tecnología”- MovTRH&Tech, financiado por Cummins e implementado en dos fases entre el 2019 y el 2023 en Colombia, México, Brasil y Perú. Usando los criterios de evaluación que propone la OCDE, el informe presenta una valoración de los alcances estratégicos del proyecto, así como, lecciones aprendidas, buenas prácticas conclusiones y recomendaciones.
Hallazgos La pertinencia del proyecto se destaca desde su diseño, ya que, respondió a las necesidades de los movimientos de TRHs, incluyó acciones diferenciadas por país y empleó un enfoque participativo, adaptándose a contextos específicos. Se alineó con prioridades de instituciones y programas, contribuyendo a los ODS 5 y 8, la implementación del Convenio 189 de la OIT, leyes nacionales en México, Perú, Colombia y Brasil, los objetivos del Programa Regional Igual Valor Iguales Derechos, la visión 2030 de CARE y sus indicadores y la iniciativa Cummins Powers Women, entre otros.
El diseño de las aplicaciones contribuyó a la pertinencia, ya que, fueron diseñadas de manera participativa y diferenciada para cada país llevando a que respondieran a las necesidades propias de cada contexto. Así mismo, las campañas de comunicación y marketing contribuyeron a la pertinencia pues su desarrollo fue centrado en la experiencia y participación de las TRH, lo que constituyó un importante éxito para lograr sensibilización a diferentes públicos y ampliar el alcance esperado en un comienzo.
Strengthening the Domestic Workers Movement Through Learning and Technology (Phase III)
This document presents a summary of the findings of the external evaluation of the project “Strengthening the Domestic Workers Movement through Learning and Technology” - MovTRH&Tech, funded by Cummins and implemented in two phases between 2019 and 2023 in Colombia, Mexico, Brazil and Peru. Using the evaluation criteria proposed by the OECD, the report presents an assessment of the strategic scope of the project, as well as lessons learned, good practices, conclusions and recommendations.
Findings The relevance of the project stands out from its design, since it responded to the needs of the HRT movements, included actions differentiated by country and used a participatory approach, adapting to specific contexts. It was aligned with priorities of institutions and programs, contributing to SDGs 5 and 8, the implementation of ILO Convention 189, national laws in Mexico, Peru, Colombia and Brazil, the objectives of the Equal Value Equal Rights Regional Program, vision 2030 of CARE and its indicators and the Cummins Powers Women initiative, among others.
The design of the applications contributed to relevance, since they were designed in a participatory and differentiated way for each country, ensuring that they responded to the needs of each context. Likewise, the communication and marketing campaigns contributed to relevance since their development was focused on the experience and participation of HRT, which constituted an important success in raising awareness among different audiences and expanding the scope initially expected. Read More...
Evaluation intermédiaire du projet « Féministes en Action » 2021-2023
Description of the document:
L’évaluation intermédiaire du projet « Féministes en Action » intervient près de trois ans après le début du projet et deux après le démarrage effectif des financements aux organisations féministes. Couvrant la période 2021-2023, elle poursuit plusieurs objectifs :
∇ Un objectif d’apprentissage et de capitalisation, alors que Féministes en Action est le premier consortium financé au titre du FSOF, l’un de ceux cherchant à atteindre directement les OSC féministes les plus fragiles et celui ayant le périmètre thématique le plus large (les autres sont construits en général autour d’une thématique d’intervention). Le consortium constitué, avec la présence d’ONG internationales et de fonds des « Suds » est lui aussi inédit.
∇ Un objectif stratégique et prospectif, avec une réflexion portant à la fois sur les changements visés et l’architecture globale du projet alors que le projet devrait disposer de nouveaux fonds à mettre en oeuvre après 2023. L’évaluation doit notamment permettre d’accompagner une réflexion sur les objectifs du cadre logique du Projet dans l’optique d’une redéfinition afin d’assurer la cohérence avec les objectifs réellement visés par le Projet et les indicateurs prévus difficilement renseignables.
∇ Un objectif de redevabilité, tourné avant tout vers les sociétés civiles féministes que Féministes en Action cherche à renforcer. Il s’agit de s’assurer que l’action menée apporte une valeur ajoutée (« do not harm ») et que les conditions de mise en oeuvre sont cohérentes avec les valeurs féministes promues tout en tenant compte des exigences d’un bailleur de fonds publics.
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L’évaluation intermédiaire du projet « Féministes en Action » intervient près de trois ans après le début du projet et deux après le démarrage effectif des financements aux organisations féministes. Couvrant la période 2021-2023, elle poursuit plusieurs objectifs :
∇ Un objectif d’apprentissage et de capitalisation, alors que Féministes en Action est le premier consortium financé au titre du FSOF, l’un de ceux cherchant à atteindre directement les OSC féministes les plus fragiles et celui ayant le périmètre thématique le plus large (les autres sont construits en général autour d’une thématique d’intervention). Le consortium constitué, avec la présence d’ONG internationales et de fonds des « Suds » est lui aussi inédit.
∇ Un objectif stratégique et prospectif, avec une réflexion portant à la fois sur les changements visés et l’architecture globale du projet alors que le projet devrait disposer de nouveaux fonds à mettre en oeuvre après 2023. L’évaluation doit notamment permettre d’accompagner une réflexion sur les objectifs du cadre logique du Projet dans l’optique d’une redéfinition afin d’assurer la cohérence avec les objectifs réellement visés par le Projet et les indicateurs prévus difficilement renseignables.
∇ Un objectif de redevabilité, tourné avant tout vers les sociétés civiles féministes que Féministes en Action cherche à renforcer. Il s’agit de s’assurer que l’action menée apporte une valeur ajoutée (« do not harm ») et que les conditions de mise en oeuvre sont cohérentes avec les valeurs féministes promues tout en tenant compte des exigences d’un bailleur de fonds publics.
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Línea de Base: Proyecto “Higiene, Agua y Saneamiento en La Habana y Pinar del Rio”(Spanish)
This Baseline Report provides an overview of the "Hygiene, Water, and Sanitation in Havana and Pinar del Rio" project, implemented by CARE Cuba in collaboration with local partners. The project focuses on improving access to safe water for two isolated rural communities (El Vallecito and Valle San Juan) that rely on contaminated local wells and inadequate water storage systems. It addresses water-related health risks and promotes menstrual health by introducing menstrual cups to women and menstruating individuals. The baseline data will serve as a reference for measuring project outcomes aimed at reaching 256 people and 250 women.
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EJERCICIO DE REVISIÓN DESPUES DE LA ACCIÓN
The evaluation report outlines the efforts of the Climate Change and Resilience Program, which focuses on enhancing the capacities of vulnerable populations to manage extreme climate events and other natural disasters. One significant project aims to conserve and restore forest landscapes in the municipalities of La Reforma, El Quetzal, and Colomba Costa Cuca. This initiative seeks to build on previous conservation efforts by strengthening local governance through the establishment of Environmental Management Units. Key activities include the formulation of municipal environmental policies and the reactivation of stakeholder dialogue to ensure community participation. Additionally, the project supports community-level training for volunteer promoters and the implementation of biocultural productive projects that diversify agroforestry systems. Running from December 1, 2022, to May 31, 2024, the project covers 33 communities and is funded by the Tropical Forest Conservation Fund (FCA).
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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...
USAID’s CNHA Health Facility Readiness and Functionality Assessment, 2024
The Community Nutrition and Health Activity (CNHA), funded by the United States Agency for International Development (USAID), is dedicated to enhancing the nutritional status of women and children within vulnerable 1000-day households in Bangladesh—those with pregnant and lactating women and/or children under two years. This assessment, conducted between March and June 2024, evaluated the readiness and functionality of 1,336 community clinics (CCs) and 354 Union Health and Family Welfare Centers (UH&FWCs) across 14 districts. It aimed to identify strengths and weaknesses in key operational areas, including governance and management, health workforce presence, service delivery, logistics, and information systems. The findings revealed a significant presence of community groups in CCs but highlighted operational gaps in regular meetings and management practices. While the availability of maternal and child health services was generally high, discrepancies existed in the provision of family planning methods and comprehensive nutritional services. The assessment serves as a foundational tool for CNHA to target interventions, enhance health systems, and improve overall community health outcomes by integrating these findings into local government improvement plans.
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