Maternal|Child 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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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...

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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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...

Siaya Maternal and Child Nutrition Nawiri Project

The Siaya Maternal and Child Nutrition Nawiri Project was a 36-months intervention on maternal and child nutrition. The project was executed in partnership with CARE (the coordinator), Family Health Options Kenya (FHOK) and the Kisumu Medical and Education Trust (KMET) in Siaya County with funding support from the European Commission (EC), the Austrian Development Agency (ADA) and CARE. The overall objective of the project was to contribute to improving maternal, infant and young child nutrition (MIYCN), including nutrition of women of reproductive age, in Siaya County.

The specific objectives of the end-term evaluation of the Nawiri Project were to: (1) assess against the project goal, objectives and expected results based on the indicators of the project log-frame; (2) assess the project objectives and proposed outcomes by measuring performance against each indicator under each result area and analyze key determinants that were positively or negatively critical for obtaining these results; (3) assess the efficiency of the process of achieving results. Under this objective, the evaluation would determine the contribution of the adopted gender equality Social Analysis and Action (SAA) Model and rights based approach project, community score card strategy for social accountability, advocacy strategies for political commitment, role of mother to mother support groups, male champion curriculum and training, role of MIYCN Trainer of Trainers (ToTs), impact of community outreaches, food demonstration sessions, public participation by CHVs during budget development process towards achieved results; (4) evaluate the efficiency of the organizational set‐up for the project (partnership arrangement) and systems used in the delivery of the project and to what extent these contributed to or inhibited the delivery of the project outcomes; (5) assess how gender aspects have been considered and included in the implementation (with specific focus on gender mainstreaming, setting of gender equality goals), inter alia, how women had participated or were represented meaningfully in decision-making and feedback; (6) assess the level of sustainability (financial, institutional and social) of the individual project components, and identify critical areas that may affect sustainability; and (7) provide recommendations on future project design including how to ensure effectiveness of log frames. Read More...

Learning From Failure 2019

Driven by a wish to learn more from what goes wrong in our programming, and to examine where changes to the broader organization and system can improve our programming and impact globally, in 2019 CARE undertook its first evaluations-based failure meta-analysis. This analysis draws learning and evidence from 114 evaluations of CARE’s work from 2015-2018 to understand the patterns and trends in what goes wrong. This helps us take a data-driven approach to strategic investments and action plans to live out CARE’s commitment to high program quality and continuous improvement across the board.
The review draws from project specific data, but deliberately anonymizes the data and focuses on overarching trends to remove blame for any specific project team or set of individuals. This exercise is designed to help us learn more about how we can change our processes and patterns of support and engagement around weak areas to improve our work. CARE is using this data to build action plans and next steps to continuously improve our programming.
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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...

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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Improving Sexual, Reproductive Health and Rights Including Maternal and Newborn Health in Bangladesh

UNICEF in collaboration with Bangladesh government launched a project “Improving Sexual, Reproductive Health and Rights including Maternal and Newborn Health in Bangladesh” to improve integrated sexual and reproductive health and rights including maternal, newborn, child and adolescent health in 5 districts. CARE was a key implementing partner in this project.

Before implementation of the project a baseline study in 5 project districts (Patuakhali, Rangamati, Sirajganj, Jamalpur and Moulvibazar) with 4 comparison districts (Barguna, Khagrachhari, Lalmonirhat and Sylhet), implemented by UNICEF and conducted by SURCH between 9th May and 18th August 2018
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Gaining Recovery: Improvement of Maternal and Child health in Return Areas of North Iraq

In 2016, Federal Ministry for Economic Cooperation and Development-Germany (BMZ) has provided funding to CARE-Iraq to implement the project titling "Gaining Recovery: Improvement of Maternal and Child health in Return Areas of North Iraq". The aim of this project was to enhance the opportunities of SRMH and child health care for the people of North Iraq specifically the returnees in Zummar, Bardiya, Rabiya and Qasir Serij areas of Ninewa Governorate of Iraq.
The overall goal of the project was "Contributing to Sustainable Development Goad (SDG) 3 – Ensure healthy lives and promote well-being for all at all ages, as well as Goal 3.1 – Reduction of maternal mortality ratio and goal 3.7 – ensure universal access to sexual and reproductive health-care services".
The project objective was "Improvement of maternal and child health in Northern Iraq". CARE-Iraq involved its partner, Harikar, for implementation of activities related to improving mother and child health through multi-dimensional approach. In CARE-Iraq’s multi-dimensional approach, mix methods of service delivery and community sensitization were adopted. Read More...

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