Sexual|Reproductive Health
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.
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Kore Lavi Safety Net Beneficiary Resilience Assessment
As part of its mandate, the Kore Lavi program has developed and established a food voucher-based social safety net model for the poorest households in conjunction with the Haitian Government – through the Ministry of Social Affairs and Labor (MAST). This Resilience Assessment contributes to a stronger understanding of the current food security and resilience situations of the most vulnerable program beneficiaries.
Based upon the data collected, the social safety net members – which is considered as the study sampling universe – are mainly affected by Illness, death and drought, respectively. The experiences shared by the respondents also revealed that they often face several types of shocks and stressors simultaneously.
The food voucher had a very positive impact and helped a lot during each key moment: before the shock or stressor affected the respondent, immediately after, sometime after and now. In the different stories that were shared, a certain number of respondents mentioned that they have no other means to ensure their food security - other than the Kore Lavi food vouchers. With regard to the food vouchers indirect contribution, it is important to highlight that 59% of
respondents used the money they saved to pay school fees and 28% to pay medical fees. 36% save it in their Village Saving and Loans Association (VSLA). Yet, there is also an emerging group that used the money to invest in agricultural endeavors and start-up income generating activities.
When comparing the three main types of assets (personal, social and physical-financial resources), it could be observed that especially vulnerable respondents tended to rely on social resources. Generally, the respondents used more negative coping mechanisms that compromise their food security like eating less or less preferred meals per day (58%), reducing expenditures related to household needs (32%), producing charcoal (33%), reducing agriculture production area (20%) and livestock (19%) or selling assets.
The study identified that 22% of VSLA members followed resilient pathways versus 16% of non VSLA respondents. In almost all the signifier questions, there were found small differences between both groups, but not as much as it was initially expected by the Kore Lavi team. Read More...
Based upon the data collected, the social safety net members – which is considered as the study sampling universe – are mainly affected by Illness, death and drought, respectively. The experiences shared by the respondents also revealed that they often face several types of shocks and stressors simultaneously.
The food voucher had a very positive impact and helped a lot during each key moment: before the shock or stressor affected the respondent, immediately after, sometime after and now. In the different stories that were shared, a certain number of respondents mentioned that they have no other means to ensure their food security - other than the Kore Lavi food vouchers. With regard to the food vouchers indirect contribution, it is important to highlight that 59% of
respondents used the money they saved to pay school fees and 28% to pay medical fees. 36% save it in their Village Saving and Loans Association (VSLA). Yet, there is also an emerging group that used the money to invest in agricultural endeavors and start-up income generating activities.
When comparing the three main types of assets (personal, social and physical-financial resources), it could be observed that especially vulnerable respondents tended to rely on social resources. Generally, the respondents used more negative coping mechanisms that compromise their food security like eating less or less preferred meals per day (58%), reducing expenditures related to household needs (32%), producing charcoal (33%), reducing agriculture production area (20%) and livestock (19%) or selling assets.
The study identified that 22% of VSLA members followed resilient pathways versus 16% of non VSLA respondents. In almost all the signifier questions, there were found small differences between both groups, but not as much as it was initially expected by the Kore Lavi team. Read More...
Kore Lavi Title II Program Haiti – Midterm Evaluation
This reports presents the findings, conclusions and recommendations related to the Kore Lavi mid-term evaluation.
DESCRIPTION OF KORE LAVI. Kore Lavi’s Theory of Change holds that positive and lasting transformation must happen within interrelated domains: (1) where the effective social safety net programming and complementary services reach the most vulnerable populations and protect their access to food while building self-reliance; (2) that achieve breadth and depth in behavior and social change needed to tackle under-nutrition among vulnerable women and children; and (3) that institutionalize accountability, transparency and quality of delivery for mutually reinforcing social protection programs under the leadership of MAST.
EVALUATION METHODOLOGY. The evaluation employed three data collection methodologies: document review, key informant interviews, and focus group discussions.
PRIMARY FINDINGS AND CONCLUSIONS.
At the time of the MTE, Kore Lavi had completed data collection in 16 communes demonstrating the ability to adapt and innovate to address the initial data quality problems that existed at the beginning of the program.
In terms of its implementation on the ground, the food voucher scheme is operating well in identifying voucher recipients and enrolling them in the program, distributing food to beneficiaries via paper or electronic vouchers, recruiting and managing the network of collaborating vendors, enforcing policies governing the scheme and overseeing operations. Food received by beneficiary households from both paper and electronic vouchers is inevitably shared with non-household members, including neighbors and even strangers. The VSLA scheme has effectively provided a mechanism by which large numbers of vulnerable women and men living in program communities can save and access small loans at reasonable interest rates to invest in their businesses or children’s education or for other purposes.
SO3 social behavioral change communications interventions are, on the whole, well designed and well implemented. Care Groups, moreover, appear to be an effective methodology for mobilizing women and communicating critical SBCC messages. Community health agents and Lead Mothers play a critical role in SO3 activities. While they are, for the most part, doing a good job and are satisfied with their roles, they also have a number of legitimate concerns related to the lack of monetary compensation and reimbursement for expenses incurred. The program has done a good job identifying and reaching the targeted women and infants.
Kore Lavi has taken a holistic approach to gender integration from design to implementation and has made a conscious and good faith effort to integrate gender considerations in each of the four program SOs.
Kore Lavi has prioritized information management and has demonstrated a clear institutional interest in improving knowledge and learning.
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DESCRIPTION OF KORE LAVI. Kore Lavi’s Theory of Change holds that positive and lasting transformation must happen within interrelated domains: (1) where the effective social safety net programming and complementary services reach the most vulnerable populations and protect their access to food while building self-reliance; (2) that achieve breadth and depth in behavior and social change needed to tackle under-nutrition among vulnerable women and children; and (3) that institutionalize accountability, transparency and quality of delivery for mutually reinforcing social protection programs under the leadership of MAST.
EVALUATION METHODOLOGY. The evaluation employed three data collection methodologies: document review, key informant interviews, and focus group discussions.
PRIMARY FINDINGS AND CONCLUSIONS.
At the time of the MTE, Kore Lavi had completed data collection in 16 communes demonstrating the ability to adapt and innovate to address the initial data quality problems that existed at the beginning of the program.
In terms of its implementation on the ground, the food voucher scheme is operating well in identifying voucher recipients and enrolling them in the program, distributing food to beneficiaries via paper or electronic vouchers, recruiting and managing the network of collaborating vendors, enforcing policies governing the scheme and overseeing operations. Food received by beneficiary households from both paper and electronic vouchers is inevitably shared with non-household members, including neighbors and even strangers. The VSLA scheme has effectively provided a mechanism by which large numbers of vulnerable women and men living in program communities can save and access small loans at reasonable interest rates to invest in their businesses or children’s education or for other purposes.
SO3 social behavioral change communications interventions are, on the whole, well designed and well implemented. Care Groups, moreover, appear to be an effective methodology for mobilizing women and communicating critical SBCC messages. Community health agents and Lead Mothers play a critical role in SO3 activities. While they are, for the most part, doing a good job and are satisfied with their roles, they also have a number of legitimate concerns related to the lack of monetary compensation and reimbursement for expenses incurred. The program has done a good job identifying and reaching the targeted women and infants.
Kore Lavi has taken a holistic approach to gender integration from design to implementation and has made a conscious and good faith effort to integrate gender considerations in each of the four program SOs.
Kore Lavi has prioritized information management and has demonstrated a clear institutional interest in improving knowledge and learning.
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Baseline Study of the Title II Development Food Assistance Program in Haiti
In fiscal year 2013, the U.S. Agency for International Development’s (USAID) Office of Food for Peace (FFP) awarded funding to CARE International and its partners, Action Contre La Faim International (ACF) and the U.N. World Food Programme (WFP), to implement a Title II development food assistance program in Haiti.1 The four-year Kore Lavi Program directly supports the Government of Haiti’s (GOH) social protection efforts. The overall objective of the program is to reduce food insecurity and vulnerability by supporting the GOH in establishing a replicable safety net system and expanding capacities for preventing child undernutrition.
KEY FINDINGS.
The Title II program area residents face challenges in all four pillars of food security: (1) availability of food, (2) access to food, (3) utilization of food and (4) stability.
Survey results indicate that 57.5 percent of households suffer from moderate hunger and 13.5 percent of households suffer from severe hunger.
An HDDS of 6.2 indicates that households in the Kore Lavi Program area typically can access and consume 6 of 12 basic food groups. Qualitative data indicate that food consumption is pragmatic at the household level. Individual families eat what is available, what they can grow or what they can afford to purchase. Despite these challenges, many respondents spoke ardently to beliefs about the cultural significance of certain foods, while also holding strong opinions on imported food in comparison to locally produced food.
The household survey data show that 69 percent of all households have an adequate level of food consumption, 22 percent score at the borderline level, and 9 percent score at the poor level.
Across the Kore Lavi Program area, 43.6 percent of households currently live in extreme poverty (less than the international poverty line of USD$1.25 at 2005 prices), with average daily per capita expenditures of constant USD$ 2.10.
The household survey data show that 40 percent of households use an improved drinking water source and 16 percent of households use a non-shared improved sanitation facility.
As measured by body mass index (BMI), the nutritional status of women 15-49 years of age who are not pregnant or two months post-partum is generally satisfactory despite a lack of dietary diversity.
The survey data reveal that 8 percent of children under five years of age in the Kore Lavi Program area show signs of being moderately or severely underweight, and 19 percent of children under five years of age are stunted.
Across the qualitative data, views about gender equality tended to be polarized, rooted historically and in tradition. Read More...
KEY FINDINGS.
The Title II program area residents face challenges in all four pillars of food security: (1) availability of food, (2) access to food, (3) utilization of food and (4) stability.
Survey results indicate that 57.5 percent of households suffer from moderate hunger and 13.5 percent of households suffer from severe hunger.
An HDDS of 6.2 indicates that households in the Kore Lavi Program area typically can access and consume 6 of 12 basic food groups. Qualitative data indicate that food consumption is pragmatic at the household level. Individual families eat what is available, what they can grow or what they can afford to purchase. Despite these challenges, many respondents spoke ardently to beliefs about the cultural significance of certain foods, while also holding strong opinions on imported food in comparison to locally produced food.
The household survey data show that 69 percent of all households have an adequate level of food consumption, 22 percent score at the borderline level, and 9 percent score at the poor level.
Across the Kore Lavi Program area, 43.6 percent of households currently live in extreme poverty (less than the international poverty line of USD$1.25 at 2005 prices), with average daily per capita expenditures of constant USD$ 2.10.
The household survey data show that 40 percent of households use an improved drinking water source and 16 percent of households use a non-shared improved sanitation facility.
As measured by body mass index (BMI), the nutritional status of women 15-49 years of age who are not pregnant or two months post-partum is generally satisfactory despite a lack of dietary diversity.
The survey data reveal that 8 percent of children under five years of age in the Kore Lavi Program area show signs of being moderately or severely underweight, and 19 percent of children under five years of age are stunted.
Across the qualitative data, views about gender equality tended to be polarized, rooted historically and in tradition. Read More...
Emergency Water, Sanitation, Hygiene and Nutrition for Crisis Affected Communities in East Darfur and South Darfur, Sudan, 2017-2019
The project under evaluation was a two-year project implemented in one locality in South Darfur and three localities in East Darfur during the years 2017 and 2019. The Project was implemented by CIS in partnership with two local organizations and in cooperation with the State institutions.
The intervention activities are tailored to address urgent lifesaving needs of the vulnerable communities through improving communities’ access to WASH facilities and nutrition services. Where, the two components are expected to complement each other and the resultant outcomes are expected to reflect on the improvement of maternal and child health in particular.
The ccomparison of the actual implementation with the planned showed that the types of the activities implemented conform to the planned and that planned outputs are almost completed in accordance with the plan in quantitative and qualitative terms. while the number of beneficiaries reached exceeded the target by about 30%.
As immediate outcomes, IDPs and refugees’ camps expressed improvement in their access to safe drinking water, where 98.6% indicated obtaining water from protected sources. They also revealed satisfaction with availability of water by 65% of the HHs and the water distance has been cut to about 320 m in SD and to 106 m in ED, with an average water distance of 213 meter.
Evident progress has been made along communities’ access to and use of latrines, including women, where, 89.3% and 86.1% of target community members indicated their access to and regular use of latrines. The created hygiene awareness has induced the required positive changes in hygiene and sanitation attitude and practices among communities.
In overall, the treatment of malnutrition reached 80% of the cases and for both girls and boys the cure rate is 75% also for both sexes and the Number of MAM cases treated ranges between 10 to 15 daily, while number of PLW treated ranged between 4 to 7 women daily.
Ultimately, The WASH and nutrition interventions the project delivered so far have addressed emergency humanitarian needs of the IDPs and host communities, without which their lives would have been at great risk. The inadequate unsafe water sources are now more accessible, clean and healthy. The personal hygiene and environment has much improved due to increased awareness and positive change in attitude and practices. VSLAs have added a new livelihood means for women and their families by starting to save and becoming economically active and contributing to households’ budget.
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The intervention activities are tailored to address urgent lifesaving needs of the vulnerable communities through improving communities’ access to WASH facilities and nutrition services. Where, the two components are expected to complement each other and the resultant outcomes are expected to reflect on the improvement of maternal and child health in particular.
The ccomparison of the actual implementation with the planned showed that the types of the activities implemented conform to the planned and that planned outputs are almost completed in accordance with the plan in quantitative and qualitative terms. while the number of beneficiaries reached exceeded the target by about 30%.
As immediate outcomes, IDPs and refugees’ camps expressed improvement in their access to safe drinking water, where 98.6% indicated obtaining water from protected sources. They also revealed satisfaction with availability of water by 65% of the HHs and the water distance has been cut to about 320 m in SD and to 106 m in ED, with an average water distance of 213 meter.
Evident progress has been made along communities’ access to and use of latrines, including women, where, 89.3% and 86.1% of target community members indicated their access to and regular use of latrines. The created hygiene awareness has induced the required positive changes in hygiene and sanitation attitude and practices among communities.
In overall, the treatment of malnutrition reached 80% of the cases and for both girls and boys the cure rate is 75% also for both sexes and the Number of MAM cases treated ranges between 10 to 15 daily, while number of PLW treated ranged between 4 to 7 women daily.
Ultimately, The WASH and nutrition interventions the project delivered so far have addressed emergency humanitarian needs of the IDPs and host communities, without which their lives would have been at great risk. The inadequate unsafe water sources are now more accessible, clean and healthy. The personal hygiene and environment has much improved due to increased awareness and positive change in attitude and practices. VSLAs have added a new livelihood means for women and their families by starting to save and becoming economically active and contributing to households’ budget.
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Indashyikirwa programme to reduce intimate partner violence in Rwanda: Report of findings from a cluster randomized control trial
Intimate partner violence (IPV), which includes physical and sexual violence, economic abuse and emotional aggression within intimate relationships, is the most common form of violence against women globally. IPV can lead to a wide range of negative health consequences including depression, anxiety, suicidal ideation, post-traumatic stress disorder, drug and alcohol abuse, serious injuries, and death. The Indashyikirwa programme in Rwanda sought to reduce experience of IPV among women and perpetration of IPV among men, and also to shift beliefs and social norms that sustain IPV in communities and couples. The programme also strove to support equitable, non-violent relationships, and ensure more supportive and empowering responses to survivors of IPV seeking assistance. The impact evaluation of Indashyikirwa assessed whether and how the programme met these objectives and sought to inform the global best practices in IPV prevention by generating evidence through a rigorous community randomized controlled trial (cRCT).
The quantitative impact evaluation of Indashykirwa took the form of a cRCT with randomization at sector level and two separate evaluation components: (1) a cohort of control and intervention couples interviewed at baseline, 12 months, and 24 months, and (2) a pair of cross-sectional community surveys with control and intervention communities implemented at the beginning of the programme and 24 months later. This quantitative impact evaluation was accompanied by in-depth process evaluation and qualitative research with beneficiaries and programme staff. Read More...
The quantitative impact evaluation of Indashykirwa took the form of a cRCT with randomization at sector level and two separate evaluation components: (1) a cohort of control and intervention couples interviewed at baseline, 12 months, and 24 months, and (2) a pair of cross-sectional community surveys with control and intervention communities implemented at the beginning of the programme and 24 months later. This quantitative impact evaluation was accompanied by in-depth process evaluation and qualitative research with beneficiaries and programme staff. Read More...
Sexual Reproductive and Maternal Health (SRMH) Baseline Assessment Report Primary health care project in Sinjar
CARE is implementing a Sexual, Reproductive and Maternal Health (SRMH) Project in three locations in Ninawa Governorate (Zummar, Sinjar and Rabia), which involves providing a full package of SRMH services through existing hospitals and/or PHCs in close coordination with Ninawa Directorate of Health and in partnership with a local partner, Harikar. 230 Primary Health Care (PHC) facilities have been destroyed across the country and there is a heavy burden on PHCs with consultations increasing eight-fold . The consortium will provide a physiological response to returnees’ needs through the rehabilitation of two accessible PHC centres by CARE to support pregnant and lactating mothers, sexual and reproductive health, management of childhood illnesses and other infections. This will include the training of 40 community health volunteers that will identify and refer cases to the PHCs, including gender-based-violence (GBV) survivors and at-risk children to the closest GBV services and provide essential information at the household level about nutrition, WASH, and disability awareness and referral information. The two PHCs that have been selected in Sinjar are AL Shahada PHC and AL Nasser PHC. Read More...
Sexual Reproductive and Maternal Health (SRMH) Baseline Assessment Report in Anbar Governorate
Although people in governorates impacted directly by recent military operations including Anbar remain the focus of humanitarian assistance for 2019, more detailed data collection and improved analysis shows important geographic variations in terms of needs at district level. The most urgent needs are found in areas where past hostilities have led to destruction of infrastructure, a breakdown of services and erosion of social fabric, or in areas indirectly impacted due to hosting and providing for a sizeable displaced population. Limited livelihood opportunities in these locations including FallujaAnbar are a key compounding factor keeping some of the most vulnerable people dependent on humanitarian assistance.
This baseline report was conducted for the "Support for conflict-affected people by strengthening essential primary health care services and protection from gender-based violence" project and was funded by German Federal Foreign Office (GFFO). Read More...
This baseline report was conducted for the "Support for conflict-affected people by strengthening essential primary health care services and protection from gender-based violence" project and was funded by German Federal Foreign Office (GFFO). Read More...