Sexual|Reproductive Health
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...
EVALUATION OF LIFESAVING SHELTER, PROTECTION AND HEALTH SUPPORT FOR SOUTH SUDANESE REFUGEES IN UGANDA Rhino extension – Omugo, Arua District
CARE international in Uganda has been implementing a project on “Lifesaving Shelter, Protection and Health Support for South Sudanese Refugees in Uganda” between July 2017 and March 2018. The grant was awarded by the department of Foreign Affairs, Trade and Development (DFATD), International Humanitarian Assistance Division, through Global Affairs Canada (GAC). The GAC project was implemented in Rhino camp extension, Omugo, with a total project cost of 750,000 Canadian Dollars. The ultimate aim of the intervention was to save lives, reduce suffering, and maintain human dignity of refugees and the host communities in the Rhino settlement expansion site, with focus on the three thematic areas;
1) Increased access to appropriate, safe and dignified emergency temporary shelters for South Sudanese refugees, especially women, children and persons with special needs (PSNs) in Rhino Settlement Expansion Site;
2) Increased protection from GBV and sexual exploitation and abuse for refugees & host communities, particularly women and girls in Rhino Settlement Expansion Site; and
3) Increased access to critical SRMCH services for newly arrived refugee Pregnant and Lactating Women (PLW) to Rhino Settlement Expansion Site.
The project was designed to reach a total of 26,400 beneficiaries, 15,840 (60%) of whom are women and girls. Persons with Special Needs (PSNs) were a core target under this intervention, as well as women and girls, including Pregnant and Lactating Women (PLW). The majority of direct beneficiaries were South Sudanese refugees, with activities such as training and awareness raising also benefiting members of the host population. Read More...
1) Increased access to appropriate, safe and dignified emergency temporary shelters for South Sudanese refugees, especially women, children and persons with special needs (PSNs) in Rhino Settlement Expansion Site;
2) Increased protection from GBV and sexual exploitation and abuse for refugees & host communities, particularly women and girls in Rhino Settlement Expansion Site; and
3) Increased access to critical SRMCH services for newly arrived refugee Pregnant and Lactating Women (PLW) to Rhino Settlement Expansion Site.
The project was designed to reach a total of 26,400 beneficiaries, 15,840 (60%) of whom are women and girls. Persons with Special Needs (PSNs) were a core target under this intervention, as well as women and girls, including Pregnant and Lactating Women (PLW). The majority of direct beneficiaries were South Sudanese refugees, with activities such as training and awareness raising also benefiting members of the host population. Read More...
Improving Effective Coverage of Maternal, New-born and Child Health Interventions for Reducing Preventable Child Deaths in Tangail and Khulna
Bangladesh has achieved success in reducing U5 & maternal mortality in last decade. UNICEF is partnering with GoB to contribute to reduce maternal and newborn deaths. To this end, MoH&FW with partnering with UNICEF and technical support from KOIKA implemented a MNCH project (IECMNCH) in Tangail and Khulna in line with UNICEF’s efforts to pay attention to low performing upazilas and HTR areas, started in 2015. CARE is one of the partners on this project.
designed to address main causes of newborn deaths (birth asphyxia, infection, prematurity)
to increase availability, utilization of quality MNCH-&-Nutrition services by
- increasing, sustaining of effective coverage of selected interventions;
- strengthening health system with increased availability & access to quality MNCH services;
-positive behaviour & social norm change through community participation & ownership for effective demand creation for increased utilization of MNCH services.
A baseline study in 2015 and an endline evaluation study in 2018 were implemented by UNICEF. Here are the endline study findings with corresponding baseline findings where necessary.
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designed to address main causes of newborn deaths (birth asphyxia, infection, prematurity)
to increase availability, utilization of quality MNCH-&-Nutrition services by
- increasing, sustaining of effective coverage of selected interventions;
- strengthening health system with increased availability & access to quality MNCH services;
-positive behaviour & social norm change through community participation & ownership for effective demand creation for increased utilization of MNCH services.
A baseline study in 2015 and an endline evaluation study in 2018 were implemented by UNICEF. Here are the endline study findings with corresponding baseline findings where necessary.
Read More...