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Private Sector Health Facility Assessment USAID Adolescent Reproductive Health (ARH)

USAID Adolescent Reproductive Health (ARH) is a youth co-led initiative to empower girls and boys,10-19 years old, including the most marginalized, to attain their reproductive rights. The project's primary goal is to support adolescents to reach their full potential and strengthen public systems and private entities to create an enabling environment for healthy reproductive health (RH) behaviors by ensuring the readiness of private health facilities to provide adolescent-responsive services.

OBJECTIVES
The study's main objective is to assess most private health facilities meeting USAID ARH specific criteria and identify gaps in providing high-quality services to adolescents. Read More...

USAID ADOLESCENT REPRODUCTIVE HEALTH A Baseline Study Report

USAID Adolescent Reproductive Health (ARH) is a youth coled initiative to empower girls and boys of 10-19 years,
including the most marginalized, to attain their reproductive health (RH) rights. The goal of the program is to support
Nepali adolescents to reach their full potential by choosing and practicing healthy reproductive behaviors together with the support of their community members.
The baseline study aims to assess the current situation of adolescents' sexual and reproductive health in USAID ARH
working areas (11 districts and 60 municipalities), with specific objectives:
* to identify family planning (FP) and reproductive health (RH) knowledge and practices among adolescents,
exploring mass media exposure and preference among adolescents,
* assess menstrual hygiene practices among adolescents,
* identify factors affecting the age at marriage, and
* identify gender and social norms related to adolescent
SRH issues in the community. Read More...

Qualitative Monitoring Improvement Initiative Pilot for the SHOUHARDO III Program in Bangladesh

Strengthening Household Abilities to Respond to Development Opportunities (SHOUHARDO) III was a five-year multisectoral and integrated program implemented by CARE Bangladesh between 2015 and 2020 and funded by USAID and the Government of Bangladesh. The objective of the program was to improve the lives and livelihoods of 549,000 people living in poor and extreme poor communities in eight districts in the Deep Haor and Remote Char region of northern Bangladesh. The program focused on community-based asset development and women’s empowerment, building the capacity of local government and community-service organizations, increasing resilience to frequent shocks and stressors, and improving nutrition and health outcomes for mothers and children under two-years of age. SHOUHARDO III was extended for two years (2020 to 2022) and a second extension phase (SHOUHARDO III Plus) was funded for an additional two years (2022 to 2024). During this period the program will focus on engaging with and linking local service providers with the government and the private sector. Read More...

OUTCOME MAPPING ASSESSMENT REPORT RESILIECE IN PASTORAL AREAS (RIPA – NORTH)

Gender transformation is a major cross-cutting approach of the Mercy Corps-led RIPA-North program which aims to build resilience in the lowlands of Ethiopia. A key pillar of this approach is to address restrictive gender and social norms which limit female participation in market opportunities, exclude women from having an active voice in community institutions, and undermine nutrition improvements. The approach, led by CARE International, is a process of Social Analysis and Action (SAA) in which participants in RIPA-North community and market platforms engage in dialogue with their communities to identify and ultimately address the restrictive norms.
RIPA-North’s ‘Gender Outcome Mapping' Study, conducted in February 2023, aimed to assess how communities themselves measure theirprogress towards gender equality. The findings indicate very positive signs of progress, with almost 75% of women reporting 'high' or 'medium' levels of change for all eight main categories of gender norm that pose a challenge for women's participation and gender equity. Read More...

Ghana: Inequalities in Food Insecurity

Food insecurity is a global health challenge, especially among low- and middle-income countries. The Sustainable Development Goal (SDG) 2.1 targets to: “End hunger and ensure access by all people, in particular the poor and vulnerable people, including infants, to safe, nutritious and sufficient food all year round by 2030.” In Ghana, the situation worsened in 2022. The number of individuals in food crisis surged from 560,000 in 2021 to 823,000 in 2022, marking a 47% increase in individuals suffering from lack of food access, availability, and utilization. As per the Food and Agricultural Organization, in terms of the prevalence of moderate or severe food insecurity in Ghana, 12.9 million people, or 39.4% of the total population, were affected in 2022. Read More...

SHOUHARDO III Performance and Impact evaluation

This report evaluates the performance of the SHOUHARDO III project, which targets poor households in the char and haor (wetland) areas of Bangladesh and aims to address food and income insecurity, maternal and child health and nutrition, women’s and youth empowerment, as well as improve access to public services while building resilience capacities. This evaluation employs three methodologies: qualitative inquiry, pre-post comparison, and impact evaluation. The impact evaluation matches communities treated by SHOUHARDO III with untreated communities ex-post, using baseline stunting rates from the 2014 DHS dataset. The evaluation finds that the SHOUHARDO III project engaged more than 40% of households surveyed within target villages and successfully targeted poor and female-headed households. The analysis of baseline and endline statuses (pre-post analysis) of households in the SHOUHARDO III-targeted areas demonstrates that households from these areas improved across several indicators, including poverty levels, the nutritional status of women and children, women’s empowerment, and gender equity. From a qualitative standpoint, participants from areas where SHOUHARDO III appeared well-implemented offers insights into the potential of the interventions. The qualitative evaluation found mechanisms of change in several areas that can be built upon and enhanced. Qualitative findings show that the program succeeded in promoting multi-sectoral change at household and community levels. They also show that SHOUHARDO III effectively targeted services to the most food-insecure, Poor and Extremely Poor members of communities, and its multi-generational and gender-inclusive approach to its interventions facilitated community acceptance. From the impact evaluation, it is likely that we can credit SHOUHARDO III with improvements in women’s dietary diversity, women and children’s minimum acceptable diet, antenatal care access, and the increase in participation across several sectors. In addition, households in SHOUHARDO III villages experienced statistically significant differences in one resilience indicator, and households in program villages that experienced major shocks were better able to maintain their food consumption than similar households in comparison villages. However, the impact evaluation does not find meaningful differences between households in targeted communities and households in non-targeted communities in terms of women’s mobility and decision-making, children’s nutritional status (including child stunting and underweight status), children’s diarrhea, exclusive breastfeeding, household hunger, and improved use of health and nutrition services overall. Improvements in mostmeasured conditions in the SHOUHARDO III program areas appear to have been matched by similar improvements in non-program areas, suggesting broader forces may account for them. Ultimately understanding differences between program areas and non-program areas can help inform decisions about future chapters of the SHOUHARDO III program and other development food security programs to ensure the most effective programs for vulnerable populations. Understanding the dynamics and mechanisms of change and responses of participants to interventions can also inform future work. Salient findings are also important to highlight for action. The research team concludes this report with recommendations. Read More...

Response to increased demand on Government Service and creation of economic opportunities in Uganda (RISE)

CARE International in Uganda is currently implementing Humanitarian and Development Projects in the newly established district of Kikuube; with a population of 341,300 nationals and host to one of the fastest-growing refugee settlements known as Kyangwali found in Mid-Western Uganda. Established in the 1960s to accommodate Rwandese refugees, Kyangwali Refugee Settlement hosts a population of 160,000 refugees from seven nationalities. The overall objective of this project is to enhance the emergency preparedness of selected local governments and prepare for possible future forced displacement. Read More...

Moving Urban Poor Communities in the Philippines Toward Resilience(MOVE UP 3)

An external evaluation was conducted from 10 October 2020 to 21 December 2020for the third phase of the Moving Urban Poor Communities in the Philippines toward Resilience (MOVE UP 3) Project in the Philippines. Contributing to the resilience building of urban poor populations in highly urbanized cities that are most vulnerable to disasters, MOVE UP 3 specifically aimed at increasing the preparedness and risk reduction capacities of the local populations and government units through the replication and scaling up of interrelated urban resilience strategies on alternative temporary shelters (ATS) and resilient livelihoods (RL) including social protection and risk transfer, in hazard-prone, urban poor communities in Marikina City and Taguig City in Metro Manila, Cebu City in the Visayas, and Cotabato City in Mindanao. The external evaluation determined if the project has achieved its intended objective; identified the contextual factors that have enabled or hindered the delivery of the expected outcomes; assessed the overall performance of MOVE UP 3; and provided recommendations on how the project could further be scaled up or replicated. Read More...

LIVELIHOODS FOR RESILIENCE ACTIVITY ENDLINE INTERMEDIATE RESULTS (IR) ASSESSMENT

The Feed the Future Ethiopia-Livelihoods for Resilience Activity (L4R) is a 6.5-year USAID project led by CARE, with the goal of improving food security for 97,900 chronically foodinsecure households in multiple Ethiopian regions. It aims to achieve resilient livelihoods through four main objectives. Zerihun Associates was contracted to and conduct an Endline Assessment using mixed methods, and managed data collection of the endline, ensuring quality through rigorous processes. Despite challenges, Zerihun Associates successfully gathered data from 1802 out of 1849 sampled households. However, the study faced limitations due to external factors, seasonal variations, and methodological inconsistencies, potentially impacting findings' comparability. Using both cross-sectional and panel data, the study reveals a mix of success and challenges.
Income
Devaluation of the birr during the project period, combined with rising inflation and cost of inputs, negatively impacted household’s net inflation-adjust income over time. While in unadjusted terms net incomes increased 154%, when adjusted for inflation, net incomes experienced a 19% decline among cross-sectional households from baseline to endline. At endline, there was an increase in the proportion of households earning income from crop and livestock production and transfers and other sources, but a decline in households earning income from off-farm and wage employment, compared to baseline. There was a slight increase in the average number of income sources per
household between baseline and endline (1.5 and 1.7 sources respectively).
Household Assets
The longitudinal analysis of household assets among both cross-sectional and panel data reveals a generally upward trend in overall household asset values and, particularly, in livestock assets over the period from the baseline to the endline. When adjusted for inflation, the overall asset value showed a 43% increase in the cross-sectional data and a 25% increase in the panel data. Livestock assets consistently played a pivotal role in this growth. This rise is particularly notable given the challenging economic conditions, including conflicts.
On-Farm livelihoods
The cross-sectional analysis on household livelihood activities, specifically focusing on Value Chain (VC) engagement, reveals a complex pattern of participation over time. Initially, there was a promising uptick in households engaged in at least one prioritized VC, increasing from 49.5% at baseline to 71.0% in Year 3. This was followed by a decline, reaching 45.9% by the endline. However, there was a slight increase in households engaged in two or more prioritized value chains between baseline and endline, increasing from 38% to 40%. Read More...

Elevating Married Adolescents’ Voices for Responsive Reproductive Healthcare in Syria

Increases in early marriage and pregnancy resulting from Syria's humanitarian crisis highlight a critical gap in adolescents' access to life-saving sexual and reproductive health information and services, and a larger need for adolescent-specific interventions grounded in gender transformative approaches. Seeking to address this, CARE, UNFPA and Syria Relief and Development adapted global evidence-based approaches to humanitarian contexts to create the Adolescent Mothers Against all Odds (AMAL) Initiative for pregnant girls and first-time mothers aged 10 to 18 years. Designed to improve the lives of young girls through responsive health systems and enabling environments, AMAL includes three components: a Young Mothers Club for first-time mothers and pregnant girls, participatory dialogues with health providers, and reflective dialogues with girls' marital family and community members. The AMAL Initiative intends to ensure responsiveness to the unique vulnerabilities of adolescent sub-groups by co-implementing with them. Select girls undergo additional leadership training and serve as adolescent representatives on community advisory groups sharing feedback for program improvement. One hundred-four first-time mothers and pregnant girls, 219 community members, and 120 health providers participated in AMAL in northwest Syria. In a mixed methods evaluation, facilitators administered monitoring tools to identify program improvements, pre-post surveys to assess outcomes, and end-line discussions to gather perceptions of impact. Girls reported a 47% overall increase in self-esteem, confidence, health-seeking capacity, and communication ability. Community support for girls' use of family planning increased by 27% and girls' equal access to services by 35%. Findings across all participant groups demonstrate decreased expectations of early marriage and increased acceptance of family planning post-marriage. Areas that participants cited for potential improvement included programming for girls/women above the age of 18 years, and additional training for health providers on long-acting contraceptive methods. These results show that participatory adolescent-centered sexual and reproductive health programming is not only feasible in crisis settings but can improve the self-efficacy of vulnerable adolescents to overcome barriers to accessing healthcare and improving well-being. The AMAL Initiative is now being scaled up through local partners in Syria and piloted in northern Nigeria. Read More...

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