Sexual|Reproductive Health
Mawe Tatu II
Mawe Tatu is a Swahili concept that translates to three pebbles. This name was chosen to illustrate the physics of dropping three pebbles into a pond to represent interventions related to women, men and youth as main components of society. As the pebbles fall, they have the immediate effect of moving the water. Each pebble also creates ripples that propagate and interact with those of other pebbles, in space and time. It is a metaphor that expresses, respectively, the short- and medium-term effects of the project as well as the long-term impact that will result in synergistic effects of Mawe Tatu's interventions. Like Mawe Tatu I, the programme works with women and youth and men to improve the socio-economic status of women and youth and their powers to influence decisions at the household and community levels.
The overall objective of this evaluation is to measure the progress and results of the programme based on the Theory of Change, to draw lessons (lessons learned) for future programmes.
To achieve this, the evaluation team used the mixed methodological approach (quantitative and qualitative) to collect data from programme participants, key informants and Mawe Tatu II programme documentation. A range of techniques were associated with this approach including: the document review to understand the logic of the Programme, focus group discussions with the participants of the Programme in the 8 health zones of the evaluated programme (Rutshuru excluded because of the context of the war between the M23 and the FARDC), a household survey which facilitated reaching several households in 9 health zones as well as 2 health zones and two control health zones. In addition, semi-structured interviews with key informants were conducted enriched by direct observations to identify different attitudes related to the evaluation questions.
Overall, this evaluation indicates that the Mawe Tatu II programme has had significant successes in terms of its 3 trajectories linked to the first Outcome, related to access (and control) to capital, knowledge, skills and entrepreneurial mindset, and the commitment of men, and other successes at the level of its other two trajectories (market access and sexual and reproductive health) as we have also noticed in the database of harvested Outcomes shared with us in the Mawe Tatu II programme documentation at the beginning of this final evaluation.
Programme participants testify that thanks to the training and awareness-raising activities in the VSLAs to which they have joined, they have made savings through which they access capital to launch their small to large businesses. Some women and young members of the few VSLAs have accessed loans in some MFIs although for MFIs and banks in general, the services do not yet offer financial services adapted to women and young entrepreneurs who are members of VSLAs and remain indifferent to cooperate and carry out business with VSLAs because they continue to find them less reliable because they lack collateral to give to taking credit. At the same time, mistrust of formal financial institutions, caused by the failures that entrepreneurs have witnessed in the past, has also created a barrier, which was not fully addressed during the programme, in the effective use of services and products. Read More...
The overall objective of this evaluation is to measure the progress and results of the programme based on the Theory of Change, to draw lessons (lessons learned) for future programmes.
To achieve this, the evaluation team used the mixed methodological approach (quantitative and qualitative) to collect data from programme participants, key informants and Mawe Tatu II programme documentation. A range of techniques were associated with this approach including: the document review to understand the logic of the Programme, focus group discussions with the participants of the Programme in the 8 health zones of the evaluated programme (Rutshuru excluded because of the context of the war between the M23 and the FARDC), a household survey which facilitated reaching several households in 9 health zones as well as 2 health zones and two control health zones. In addition, semi-structured interviews with key informants were conducted enriched by direct observations to identify different attitudes related to the evaluation questions.
Overall, this evaluation indicates that the Mawe Tatu II programme has had significant successes in terms of its 3 trajectories linked to the first Outcome, related to access (and control) to capital, knowledge, skills and entrepreneurial mindset, and the commitment of men, and other successes at the level of its other two trajectories (market access and sexual and reproductive health) as we have also noticed in the database of harvested Outcomes shared with us in the Mawe Tatu II programme documentation at the beginning of this final evaluation.
Programme participants testify that thanks to the training and awareness-raising activities in the VSLAs to which they have joined, they have made savings through which they access capital to launch their small to large businesses. Some women and young members of the few VSLAs have accessed loans in some MFIs although for MFIs and banks in general, the services do not yet offer financial services adapted to women and young entrepreneurs who are members of VSLAs and remain indifferent to cooperate and carry out business with VSLAs because they continue to find them less reliable because they lack collateral to give to taking credit. At the same time, mistrust of formal financial institutions, caused by the failures that entrepreneurs have witnessed in the past, has also created a barrier, which was not fully addressed during the programme, in the effective use of services and products. Read More...
Gender-sensitive WASH, Health/SRHR, and Nutrition support to vulnerable communities in East Darfur and South Darfur Project
This baseline study is carried out for the project "The Gender-sensitive WASH, Health/SRHR, and Nutrition support to vulnerable communities in East Darfur and South Darfur Project." The project builds on CARE learning over many years in the region, responds to the global overviews and the donor GAC interest in saving the lives of conflict affected communities, by providing urgent humanitarian assistance to 144,173 persons including females, males, girls and boys, from the host, IDPs and refugees’ communities, located in 7 localities in ED and 2 localities in SD. The key live saving activities delivery is designed with a gender sensitive perspective focusing on the health and nutrition needs of pregnant and lactating women and girls of reproductive age and children under 5. The project activities include; WASH, Health and nutrition interventions. Read More...
Impact Evaluation of the Integrated Humanitarian Assistance Project that aiming to Reduce the Secondary Impacts of COVID-19 on the Most Vulnerable Populations in South and East Darfur
The evaluation intended to assess integrated WASH, health, nutrition, and multipurpose cash assistance (MPCA) programs. The evaluation conducted to answer questions related to quality and relevance of the project design, its activities and objectives in addressing the priority issues. This is in addition to assessment of project efficiency and to what extent the project resources have been used economically and in a timely manner. Moreover, the evaluation assessed the effectiveness and major achievements of the project to date. The evaluation also assessed the project impact and to what extent the project contributed to provision of sustainable, adequate, and lifesaving WASH, Health and Nutrition services to the targeted communities. This beside Identification of which positive outcomes that likely to continue after the project ends in addition to assessment of bottlenecks, opportunities and lessons learned to inform future planning.
Based on the desk review of available data, the evaluation was deploying different approaches to ensure rich data and triangulation of findings. These approaches were combining qualitative and quantitative methods to maximize validity and reliability. The main methods of data collection used were interviews with the primary stakeholders, observation, asking questions, review of documents and transect walking at sites. Different tools for data collections were used as well that included focus group discussions with different target groups, and observation check list, Key Informant Interview, questionnaire, asking open and closed questions with beneficiaries at water points and at health and nutrition centers.
The project is in line with national and State WASH plans. It was also found that, the project followed and complied with SMoH specifications and guidelines. The comprehensive community consultation indicated that all project activities, technology adopted, and outputs are quite relevant to the target communities and their actual needs and also appropriate for the selected areas. Generally, the evaluation team concluded that, the planned activities were completed with same allocated initial budget. Despite difficulties and challenges in the SLA areas and at sites located in territories between the government and SLA areas the evaluation team believes that, the project is efficient in terms of implementation of the planned activities and management of resources. Read More...
Based on the desk review of available data, the evaluation was deploying different approaches to ensure rich data and triangulation of findings. These approaches were combining qualitative and quantitative methods to maximize validity and reliability. The main methods of data collection used were interviews with the primary stakeholders, observation, asking questions, review of documents and transect walking at sites. Different tools for data collections were used as well that included focus group discussions with different target groups, and observation check list, Key Informant Interview, questionnaire, asking open and closed questions with beneficiaries at water points and at health and nutrition centers.
The project is in line with national and State WASH plans. It was also found that, the project followed and complied with SMoH specifications and guidelines. The comprehensive community consultation indicated that all project activities, technology adopted, and outputs are quite relevant to the target communities and their actual needs and also appropriate for the selected areas. Generally, the evaluation team concluded that, the planned activities were completed with same allocated initial budget. Despite difficulties and challenges in the SLA areas and at sites located in territories between the government and SLA areas the evaluation team believes that, the project is efficient in terms of implementation of the planned activities and management of resources. Read More...
Learning From Failure 2022
In 2019 and 2020, CARE published Learning from Failures reports to better understand common problems that projects faced during implementation. Deliberately looking for themes in failure has helped CARE as an organization and provides insight on what is improving and what still needs troubleshooting. This report builds on the previous work to show what we most need to address in our programming now.
As always, it is important to note that while each evaluation in this analysis cited specific failures and areas for improvement in the project it reviewed, that does not mean that the projects themselves were failures. Of the 72 evaluations in this analysis, only 2 showed projects that failed to deliver on more than 15% of the project goals. The rest were able to succeed for at least 85% of their commitments. Rather, failures are issues that are within CARE’s control to improve that will improve impact for the people we serve.
To fully improve impact, we must continue to include failures in the conversation. We face a complex future full of barriers and uncertainties. Allowing an open space to discuss challenges or issues across the organization strengthens CARE’s efforts to fight for change. Qualitative analysis provides critical insights that quantitative data does not provide insight into the stories behind these challenges to better understand how we can develop solutions.
CARE reviewed a total of 72 evaluations from 65 projects, with 44 final reports published between February 2020 and September 2021 and 28 midterm reports published between March 2018 and October 2020. Seven projects had both midterm and final evaluations at the time of this analysis. For ease of analysis, as in previous years, failures were grouped into 11 categories (see Annex A, the Failures Codebook for details).
Results
The most common failures in this year’s report are:
• Understanding context—both in the design phase of a project and refining the understanding of context and changing circumstances throughout the whole life of a project, rather than a concentrated analysis phase that is separate from project implementation. For example, an agriculture project that built it’s activities assuming that all farmers would have regular internet access, only to find that fewer than 10% of project participants had smartphones and that the network in the area is unreliable, has to significantly redesign both activities and budgets.
• Sustainability—projects often faced challenges with sustainability, particularly in planning exit strategies. Importantly, one of the core issues with sustainability is involving the right partners at the right time. 47% of projects that struggled with sustainability also had failures in partnership. For example, a project that assumed governments would take over training for project participants once the project closed, but that failed to include handover activities with the government at the local level, found that activities and impacts are not set up to be sustainable.
• Partnerships—strengthening partnerships at all levels, from government stakeholders to community members and building appropriate feedback and consultation mechanisms, is the third most common weakness across projects. For example, a project that did not include local private sector actors in its gender equality trainings and assumes that the private sector would automatically serve women farmers, found that women were not getting services or impact at the right level.
Another core finding is that failures at the design phase can be very hard to correct. While projects improve significantly between midterm and endline, this is not always possible. There are particular kinds of failure that are difficult to overcome over time. Major budget shortfalls, a MEAL plan that does not provide quality baseline data, and insufficient investments in understanding context over the entire life of a project are less likely to improve over time than partnerships and overall MEAL processes.
Some areas also showed marked improvements after significant investments. Monitoring, Evaluation, Accountability, and Learning (MEAL), Gender, Human Resources, and Budget Management are all categories that show improvements over the three rounds of learning from failures analysis. This reflects CARE’s core investments in those areas over the last 4 years, partly based on the findings and recommendations from previous Learning From Failure reports. Specifically, this round of data demonstrates that the organization is addressing gender-related issues. Not only are there fewer failures related to gender overall, the difference between midterm and final evaluations in gender displays how effective these methods are in decreasing the incidence of “failures” related to engaging women and girls and looking at structural factors that limit participation in activities.
Another key finding from this year’s analysis is that projects are improving over time. For the first time, this analysis reviewed mid-term reports in an effort to understand failures early enough in the process to adjust projects. Projects report much higher rates of failure at midterm than they do at final evaluation. In the projects where we compared midline to endline results within the same project, a significant number of failures that appeared in the mid-term evaluation were resolved by the end of the project. On average, mid-term evaluations reflect failures in 50% of possible categories, and final evaluations show failures in 38% of possible options. Partnerships (especially around engaging communities themselves), key inputs, scale planning and MEAL are all areas that show marked improvement over the life of the project.
Read More...
As always, it is important to note that while each evaluation in this analysis cited specific failures and areas for improvement in the project it reviewed, that does not mean that the projects themselves were failures. Of the 72 evaluations in this analysis, only 2 showed projects that failed to deliver on more than 15% of the project goals. The rest were able to succeed for at least 85% of their commitments. Rather, failures are issues that are within CARE’s control to improve that will improve impact for the people we serve.
To fully improve impact, we must continue to include failures in the conversation. We face a complex future full of barriers and uncertainties. Allowing an open space to discuss challenges or issues across the organization strengthens CARE’s efforts to fight for change. Qualitative analysis provides critical insights that quantitative data does not provide insight into the stories behind these challenges to better understand how we can develop solutions.
CARE reviewed a total of 72 evaluations from 65 projects, with 44 final reports published between February 2020 and September 2021 and 28 midterm reports published between March 2018 and October 2020. Seven projects had both midterm and final evaluations at the time of this analysis. For ease of analysis, as in previous years, failures were grouped into 11 categories (see Annex A, the Failures Codebook for details).
Results
The most common failures in this year’s report are:
• Understanding context—both in the design phase of a project and refining the understanding of context and changing circumstances throughout the whole life of a project, rather than a concentrated analysis phase that is separate from project implementation. For example, an agriculture project that built it’s activities assuming that all farmers would have regular internet access, only to find that fewer than 10% of project participants had smartphones and that the network in the area is unreliable, has to significantly redesign both activities and budgets.
• Sustainability—projects often faced challenges with sustainability, particularly in planning exit strategies. Importantly, one of the core issues with sustainability is involving the right partners at the right time. 47% of projects that struggled with sustainability also had failures in partnership. For example, a project that assumed governments would take over training for project participants once the project closed, but that failed to include handover activities with the government at the local level, found that activities and impacts are not set up to be sustainable.
• Partnerships—strengthening partnerships at all levels, from government stakeholders to community members and building appropriate feedback and consultation mechanisms, is the third most common weakness across projects. For example, a project that did not include local private sector actors in its gender equality trainings and assumes that the private sector would automatically serve women farmers, found that women were not getting services or impact at the right level.
Another core finding is that failures at the design phase can be very hard to correct. While projects improve significantly between midterm and endline, this is not always possible. There are particular kinds of failure that are difficult to overcome over time. Major budget shortfalls, a MEAL plan that does not provide quality baseline data, and insufficient investments in understanding context over the entire life of a project are less likely to improve over time than partnerships and overall MEAL processes.
Some areas also showed marked improvements after significant investments. Monitoring, Evaluation, Accountability, and Learning (MEAL), Gender, Human Resources, and Budget Management are all categories that show improvements over the three rounds of learning from failures analysis. This reflects CARE’s core investments in those areas over the last 4 years, partly based on the findings and recommendations from previous Learning From Failure reports. Specifically, this round of data demonstrates that the organization is addressing gender-related issues. Not only are there fewer failures related to gender overall, the difference between midterm and final evaluations in gender displays how effective these methods are in decreasing the incidence of “failures” related to engaging women and girls and looking at structural factors that limit participation in activities.
Another key finding from this year’s analysis is that projects are improving over time. For the first time, this analysis reviewed mid-term reports in an effort to understand failures early enough in the process to adjust projects. Projects report much higher rates of failure at midterm than they do at final evaluation. In the projects where we compared midline to endline results within the same project, a significant number of failures that appeared in the mid-term evaluation were resolved by the end of the project. On average, mid-term evaluations reflect failures in 50% of possible categories, and final evaluations show failures in 38% of possible options. Partnerships (especially around engaging communities themselves), key inputs, scale planning and MEAL are all areas that show marked improvement over the life of the project.
Read More...
Urban Community Health Workers in Afghanistan
Building strong relationships and trust between community health workers and the communities they serve prior to public health emergencies can help ensure continuity of health seeking behaviors during times of crisis. When health services dropped during COVID-19 lockdowns, women community health workers increased services 25%.
Health-seeking significantly decreased during COVID-19 lockdown due to fear of contracting the virus, and
many of the health posts in CHWs homes were shut down at this time. In contrast, CARE-supported urban CHWs,
particularly in Kabul and Balkh, were able to continue service provision in their homes due to the strong trust
they had built with the communities they served and their recognized leadership among community members
and as part of the health system. The relationship between CHWs and local communities was complemented by
CARE’s efforts to quickly provide CHWs with personal protective equipment and build capacity on WHO
protocols for COVID-19 screening, detection, and referral of cases as well as risk communication and
community engagement. During COVID-19 lockdown, the CHWs also continued provision of SRH, GBV services,
and referrals to midwives at community-based health centers run by CARE. In addition to maintaining service
delivery, the CHWs also began offering counseling and support to local women using mobile phones. Read More...
Health-seeking significantly decreased during COVID-19 lockdown due to fear of contracting the virus, and
many of the health posts in CHWs homes were shut down at this time. In contrast, CARE-supported urban CHWs,
particularly in Kabul and Balkh, were able to continue service provision in their homes due to the strong trust
they had built with the communities they served and their recognized leadership among community members
and as part of the health system. The relationship between CHWs and local communities was complemented by
CARE’s efforts to quickly provide CHWs with personal protective equipment and build capacity on WHO
protocols for COVID-19 screening, detection, and referral of cases as well as risk communication and
community engagement. During COVID-19 lockdown, the CHWs also continued provision of SRH, GBV services,
and referrals to midwives at community-based health centers run by CARE. In addition to maintaining service
delivery, the CHWs also began offering counseling and support to local women using mobile phones. Read More...
Building sustainable and scalable peer-based programming: promising approaches from TESFA in Ethiopia
This research was written by Pari Chowdhary, Feven Tassaw Mekuria, Dagmawit Tewahido, Hanna Gulema, Ryan Derni, and Jefrey Edmeades.
In Ethiopia's Amara region, girls encounter child marriage at a high rate. They are also less able to negotiate sex or use family planning. With the purpose of improving their lives, CARE's TESFA program delivered reproductive health and financial savings curriculum to married girls through peer-based solidarity groups to 5,000 adolescent girls. This was divided into 3 interventions: sexual and reproductive health, economic empowerment, and a combination of both. Participants reported improvement in both areas. Four years after TESFA, 88% of groups communicated meeting without continued CARE's assistance, and some of the girl participants created new groups following the TESFA model. Also, some girls that did not participate in TESFA, replicated the model to create their own groups. Despite this, there is still in question who contributed to this sustainment and scale-up of groups.
Original article: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01304-7
Originally published by Biomedcentral and is republished under the creative commons 4.0 license (https://creativecommons.org/licenses/by/4.0/ - https://creativecommons.org/publicdomain/zero/1.0/). Read More...
In Ethiopia's Amara region, girls encounter child marriage at a high rate. They are also less able to negotiate sex or use family planning. With the purpose of improving their lives, CARE's TESFA program delivered reproductive health and financial savings curriculum to married girls through peer-based solidarity groups to 5,000 adolescent girls. This was divided into 3 interventions: sexual and reproductive health, economic empowerment, and a combination of both. Participants reported improvement in both areas. Four years after TESFA, 88% of groups communicated meeting without continued CARE's assistance, and some of the girl participants created new groups following the TESFA model. Also, some girls that did not participate in TESFA, replicated the model to create their own groups. Despite this, there is still in question who contributed to this sustainment and scale-up of groups.
Original article: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01304-7
Originally published by Biomedcentral and is republished under the creative commons 4.0 license (https://creativecommons.org/licenses/by/4.0/ - https://creativecommons.org/publicdomain/zero/1.0/). Read More...
RAPPORT D’ANALYSE SITUATIONNELLE, CARTOGRAPHIE SOCIALE ET ANALYSE DU POVOIR SUR COVID-19 DANS LA ZONE DE SANTE DE KATWA
Une de composante de ce projet de prévention contre la propagation de la pandémie COVID-19 dans la zone de santé de Katwa, consiste à conduire une analyse situationnelle plus approfondie dans les aires de santé ciblées par le projet dans le but de pouvoir déterminer les connaissances, les perceptions, les attitudes et les pratiques des membres de la communauté y compris des partenaires étatiques vis de la pandémie elle-même et de ses mesures de prévention. Par conséquent, l’exercice consiste à ouvrir des débats sur la Covid-19 et d’autres épidémies, à faire prendre conscience du problème et à amorcer le dialogue entre les principales parties intéressées à différents niveaux pour des stratégies de lutte plus appropriées.
La réalisation de cet exercice a comporté quatre (4) moments clés à savoir :
1. Atelier d’analyse situationnelle, cartographie sociale et analyse du pouvoir avec les acteurs clés
2. Enrichissement et collecte des données de l’atelier à travers des Focus groups dans les 9 Aires de santé
3. La phase d’analyse, compilation et rédaction du rapport (première version) des données
4. Restitution, capitalisation des amendements et des résultats de l’analyse.
Ce rapport relate le cheminement méthodologique et les résultats synthèse des travaux réalisés, ils seront ensuite complétés lors de l’atelier de restitution par les résultats complets des focus groups réalisés au sein de la communauté bénéficiaire dans la ZS de Katwa. Read More...
La réalisation de cet exercice a comporté quatre (4) moments clés à savoir :
1. Atelier d’analyse situationnelle, cartographie sociale et analyse du pouvoir avec les acteurs clés
2. Enrichissement et collecte des données de l’atelier à travers des Focus groups dans les 9 Aires de santé
3. La phase d’analyse, compilation et rédaction du rapport (première version) des données
4. Restitution, capitalisation des amendements et des résultats de l’analyse.
Ce rapport relate le cheminement méthodologique et les résultats synthèse des travaux réalisés, ils seront ensuite complétés lors de l’atelier de restitution par les résultats complets des focus groups réalisés au sein de la communauté bénéficiaire dans la ZS de Katwa. Read More...
Strengthening Approaches for Maximizing Maternal and Newborn Health (SAMMAN)
The use of the family planning method enables people to achieve their desired number of children and helps to reduce unintended and high-risk pregnancies and unsafe abortions, which contributes to saving the lives of many women. The main objective of this study is to examine the post-intervention impact on the use of family planning methods among married women of reproductive age in Nepal. Read More...
Women at the last mile: How investments in gender equality have kept health systems running during COVID-19
Even before COVID-19, investments in health systems—and especially female health workers—were too low. In 2019 the world had a gap of 18 million health workers. Two years and fifteen million deaths later, we have at least 26 million fewer health workers than we need. , This leaves us severely underprepared for future pandemics and other major shocks to the health system, including conflict and climate change. We must invest in health systems that don’t just meet the needs of today, but that are also resilient in the face of future shocks.
Pandemic preparedness requires gender equality: equal recognition, support, and fair pay for ALL health workers. Globally, 70% of health workers are women, but half of their work is unpaid. We must do more to support these health workers. The glimmers of success in COVID-19 built on previous investments in women health workers, their skills, and equality in health systems. Pre-existing investments in equality helped systems respond to COVID-19. Increased investments will build better resilience for the crises that come next.
This report highlights case studies and lessons learned from 20 countries during COVID-19. The evidence shows that we must invest in gender equality in health systems to prepare for and respond to the next pandemic. Health worker training is not enough. Focusing only on health workers working within the formal health system is not enough. We need to work for equality.
Read More...
Pandemic preparedness requires gender equality: equal recognition, support, and fair pay for ALL health workers. Globally, 70% of health workers are women, but half of their work is unpaid. We must do more to support these health workers. The glimmers of success in COVID-19 built on previous investments in women health workers, their skills, and equality in health systems. Pre-existing investments in equality helped systems respond to COVID-19. Increased investments will build better resilience for the crises that come next.
This report highlights case studies and lessons learned from 20 countries during COVID-19. The evidence shows that we must invest in gender equality in health systems to prepare for and respond to the next pandemic. Health worker training is not enough. Focusing only on health workers working within the formal health system is not enough. We need to work for equality.
Read More...