Child and Maternal Health
Development Initiative for Northern Uganda (DINU) Mid Term Evaluation
This Assignment was commissioned by CARE DENMARK – the Lead Partner of the Consortium of five (5) Partner Institutions (namely, CARE; Catholic Relief Services (CRS); Gulu Agricultural Development Company (GADC); Dynamic Agro-Pastoral Development Organization (DADO); and SORUDA) – to carry out the Mid-term Evaluation (MTE) of the “Inclusive Market-based Development for Smallholder Farmers in Karamoja, Teso and Acholi Sub-regions” Project – implemented by the Consortium. The Project is supported by the European Union (EU) – under the Supervision of the Office of the Prime Minister (OPM), through the 11 Project Area District Local Governments of: Abim, Kotido, Karenga, Kaabong, Moroto, Amudat, Nakapiripirit, Nabilatuk, Napak; as well as Katakwi and Kitgum – in partnership with other stakeholders – on behalf of the Government of Uganda.
The Overall Objective of the Mid-term Evaluation (MTE), was to: “review the implementation of the project, since its inception – with the aim of generating evidence towards promoting project performance improvement, accountability, learning and evidence-based decision-making and management”. In particular, the Evaluation was intended to: “assess results achieved to date in comparison with the outcome indicators outlined in the Project Monitoring, Evaluation, Accountability and Learning framework”. Accordingly, the MTE report documents: the background to the Assignment; the general approach to work and methodology employed; Project design (including relevance and coherence); as well as Project management systems, processes and operational environments. It also documents: Project performance and effectiveness during the period under review – up to its mid-term point; as well as the identified major achievements; challenges; constraints; risks; weaknesses and threats that characterized the Project. Lastly, it, further, documents resource management and efficiency in Project implementation; project “impact”; sustainability of Project Interventions and outcomes; the major conclusions; recommendations for the way forward; as well as lessons learnt – over the period under review. Read More...
The Overall Objective of the Mid-term Evaluation (MTE), was to: “review the implementation of the project, since its inception – with the aim of generating evidence towards promoting project performance improvement, accountability, learning and evidence-based decision-making and management”. In particular, the Evaluation was intended to: “assess results achieved to date in comparison with the outcome indicators outlined in the Project Monitoring, Evaluation, Accountability and Learning framework”. Accordingly, the MTE report documents: the background to the Assignment; the general approach to work and methodology employed; Project design (including relevance and coherence); as well as Project management systems, processes and operational environments. It also documents: Project performance and effectiveness during the period under review – up to its mid-term point; as well as the identified major achievements; challenges; constraints; risks; weaknesses and threats that characterized the Project. Lastly, it, further, documents resource management and efficiency in Project implementation; project “impact”; sustainability of Project Interventions and outcomes; the major conclusions; recommendations for the way forward; as well as lessons learnt – over the period under review. Read More...
N utrition Knowledge Attitude and Practice (KAP) Survey for DINU Program in North and North-Eastern Uganda
Background: The Development Initiative for Northern Uganda (DINU) is a Government of Uganda integrated programme. It is implemented in districts that include the 11 of Kitgum (Acholi), Nakapiripirit, Amudat, Nabilatuk, Napak, Moroto, Kotido, Kaabong, Karenga and Abim (Karamoja), and Katakwi (Teso) sub-regions for three years from 2020 – 2022. The overall supervision is with the Office of the Prime Minister through local governments in partnership with a wide range of stakeholders. DINU supports interventions in three specific interlinked programs: (1) Food Security, Nutrition and Livelihoods (2) Transport Infrastructures and (3) Good Governance. The CARE consortium focusses on the sector of food security, nutrition and livelihoods with specific emphasis on community-based interventions. A survey was launched by the CARE Consortium partners with the overall objective of generating comprehensive gender sensitive Nutrition Knowledge, Attitude and Practices (KAP) information in the targeted 11 CARE consortium districts. It is intended to help inform the implementation of the nutrition component of the DINU project.
Methodology: The KAP survey was conducted from 17th November to 8th December 2020 in the 11 districts. The study populations were mothers and/or caregivers in household with children aged 0-23 months, adolescent girls aged 10 to 19 years with or without children 0-23months. Key district, subcounty and community leaders who played crucial role in programming for MIYCAN related interventions were reached. A cross-sectional survey utilising both quantitative and qualitative data collection methods was used. Sample size estimation was based on WHO Vaccination Coverage Cluster Survey guidance, July 2015. Household questionnaire comprising of 5 modules was adapted from the FAO manual for assessing nutrition related KAP. Semi-structured interview guides were used to facilitate the Key Informants Interviews and Focus Group Discussions. Quantitative data collection was done using mobile phones through Computer Assisted Personal Interviewing (CAPI) working on the Open Data Kit (ODK) platform and hosted on the ONA platform. Quantitative Data analysis was done using SPSS 26. Qualitative data analysis was done based on the interpretative approach that involved eliciting meanings from the collected information. A total of 164 clusters were reached, 1,139 households, 1,158 children aged 0 to 23months, 1,112 women and 452 adolescents from all the 11 districts. Meanwhile, 22 FGDs and 44 key informant interviews were conducted. Read More...
Methodology: The KAP survey was conducted from 17th November to 8th December 2020 in the 11 districts. The study populations were mothers and/or caregivers in household with children aged 0-23 months, adolescent girls aged 10 to 19 years with or without children 0-23months. Key district, subcounty and community leaders who played crucial role in programming for MIYCAN related interventions were reached. A cross-sectional survey utilising both quantitative and qualitative data collection methods was used. Sample size estimation was based on WHO Vaccination Coverage Cluster Survey guidance, July 2015. Household questionnaire comprising of 5 modules was adapted from the FAO manual for assessing nutrition related KAP. Semi-structured interview guides were used to facilitate the Key Informants Interviews and Focus Group Discussions. Quantitative data collection was done using mobile phones through Computer Assisted Personal Interviewing (CAPI) working on the Open Data Kit (ODK) platform and hosted on the ONA platform. Quantitative Data analysis was done using SPSS 26. Qualitative data analysis was done based on the interpretative approach that involved eliciting meanings from the collected information. A total of 164 clusters were reached, 1,139 households, 1,158 children aged 0 to 23months, 1,112 women and 452 adolescents from all the 11 districts. Meanwhile, 22 FGDs and 44 key informant interviews were conducted. Read More...
Development Initiative for Northern Uganda (DINU) Value Chains and Market Assessment report
The CARE consortium comprising of partner organisations such as Catholic Relief Services (CRS), Gulu Agricultural Development Company (GADC), Dynamic Agro Pastoral Development Organization (DADO) and SORUDA are currently implementing a three-year project titled “Inclusive Market Based Development for Small Holder farmers in Northern Uganda. This project contributes to the Development Initiative for Northern Uganda (DINU) – A Government of Uganda program aimed at consolidating stability in Northern Uganda, eradicating poverty and under nutrition and strengthening the foundations for sustainable and inclusive socio-economic development. Specifically, the project under the CARE consortium contributes to DINU’s specific Objective one on: ‘Improving livelihoods through increased production of diversified food, enhanced market opportunities and better maternal and child nutrition.’ The CARE consortium currently targets 11 districts including: Abim, Kotido, Karenga, Kaabong, Moroto, Amudat, Nakapiripirit, Napak, Katakwi and Kitgum. Given this background, the study sought to:
• Map out existing and new Agricultural and non-Agricultural value chains and assess their potential to promote women and youth economic empowerment, and community-based nutrition and household incomes.
• Identify challenges, specific entry barriers for women and youth into the VC and opportunities along the Value chains of; 1) crops such as Soybean, groundnuts, nutritious potato, vegetable, etc.); 2) Honey; and 3) livestock (small ruminants, and other non-Agricultural value chain) and propose ways of addressing these challenges.
• Develop an individual VCs, including mapping of actors, actions, supporting functions, institutions, policy issues, along each chain and propose recommendations for specific gender sensitive value chain activities that promote women and Youth participation and economic empowerment (employment opportunities as well as increasing their incomes along the chain).
• Assess the market structure (players, channels, sourcing), demand and supply (product specifications, prices, volumes, preferences), trends, market opportunities and challenges for the different value enterprises above Read More...
• Map out existing and new Agricultural and non-Agricultural value chains and assess their potential to promote women and youth economic empowerment, and community-based nutrition and household incomes.
• Identify challenges, specific entry barriers for women and youth into the VC and opportunities along the Value chains of; 1) crops such as Soybean, groundnuts, nutritious potato, vegetable, etc.); 2) Honey; and 3) livestock (small ruminants, and other non-Agricultural value chain) and propose ways of addressing these challenges.
• Develop an individual VCs, including mapping of actors, actions, supporting functions, institutions, policy issues, along each chain and propose recommendations for specific gender sensitive value chain activities that promote women and Youth participation and economic empowerment (employment opportunities as well as increasing their incomes along the chain).
• Assess the market structure (players, channels, sourcing), demand and supply (product specifications, prices, volumes, preferences), trends, market opportunities and challenges for the different value enterprises above Read More...
Development Initiative for Northern Uganda (DINU) End of Project Report
The Development Initiative for Northern Uganda (DINU) was a 38-month project implemented between January 2020 and February 2023, with an aim to improve food security, maternal and child nutrition, and household incomes for smallholder farmers in 11 districts of Kitgum, Katakwi, Kaabong, Karenga, Kotido, Moroto, Napak, Nabilatuk, Nakapiriprit, Amudat, and Abim. The project was implemented by a consortium led by CARE Denmark, alongside partners such as Catholic Relief Services (CRS), Gulu Agricultural Development Company (GADC), Dynamic Agro-Pastoral Development Organization (DADO), and Soroti Rural Development Agency (SORUDA). The project had three major outcomes: increased production of diversified food by both men and women smallholder farmers, enhanced market accessibility for these farmers, and improved nutrition and Family Planning services through gender-responsive community-based approaches.
The Project employed an Inclusive Market Development-Based approach, emphasizing economic gender equality, women empowerment, youth engagement, and community-based nutrition, while also focusing on the value chain. This strategy involved multi-stakeholder engagement and synergizing with existing government and development partner initiatives like DADO, CRS, and SORUDA. By implementing this approach, the project provided smallholder farmers with opportunities to enhance their incomes through the cultivation of high-value crops, such as sesame, cotton, soybean, and iron-rich beans. Additionally, measures were taken to ensure sustainability, including integrating activities into the government's PDM approach, building capacity among extension staff, and linking VSLA/SILC/YSLA/PMGs groups to financial institutions and agro input service providers.
A crucial aspect of the project was empowering women and youth, often marginalized in agriculture and rural development. Women were trained in Climate-Smart Agriculture and offered access to markets and finance through VSLA/SILC groups. Furthermore, Role Model Men were involved in raising awareness on gender-responsive actions, family planning, and women empowerment within smallholder farmers' households, fostering attitudinal changes towards gender equality and encouraging women to play an active role in agricultural production.
To achieve success, the project effectively engaged both public and private extension workers, disseminating information on Climate-Smart Agriculture practices to smallholder farmers and boosting production and income. Additionally, collaboration with Tillage Service Providers promoted entrepreneurship among youth and reduced manual labor burdens for smallholder farmers.
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The Project employed an Inclusive Market Development-Based approach, emphasizing economic gender equality, women empowerment, youth engagement, and community-based nutrition, while also focusing on the value chain. This strategy involved multi-stakeholder engagement and synergizing with existing government and development partner initiatives like DADO, CRS, and SORUDA. By implementing this approach, the project provided smallholder farmers with opportunities to enhance their incomes through the cultivation of high-value crops, such as sesame, cotton, soybean, and iron-rich beans. Additionally, measures were taken to ensure sustainability, including integrating activities into the government's PDM approach, building capacity among extension staff, and linking VSLA/SILC/YSLA/PMGs groups to financial institutions and agro input service providers.
A crucial aspect of the project was empowering women and youth, often marginalized in agriculture and rural development. Women were trained in Climate-Smart Agriculture and offered access to markets and finance through VSLA/SILC groups. Furthermore, Role Model Men were involved in raising awareness on gender-responsive actions, family planning, and women empowerment within smallholder farmers' households, fostering attitudinal changes towards gender equality and encouraging women to play an active role in agricultural production.
To achieve success, the project effectively engaged both public and private extension workers, disseminating information on Climate-Smart Agriculture practices to smallholder farmers and boosting production and income. Additionally, collaboration with Tillage Service Providers promoted entrepreneurship among youth and reduced manual labor burdens for smallholder farmers.
Read More...
GAP ANALYSIS AND LINKAGE READINESS ASSESSMENT FOR YOUTH/VILLAGE SAVINGS AND LOANS ASSOCIATIONS (Y/VSLAs)
The Development Initiative for Northern Uganda (DINU), a Government of Uganda initiative with support from European Union, supervised by the Office of the Prime Minister is being implemented by a consortium led by CARE Denmark. The program is being implemented in the Karamoja sub region (covering 11 districts) as well as Kitgum and Katakwi districts. CARE Denmark commissioned gap analysis for Y/VSLA linkage to identify interventions aimed at contributing to improved access to credit through community saving and credit schemes.
The objectives of the study included gap analysis of Y/VSLAs, linkage readiness assessment for mature Y/VSLAs and evaluation “digital readiness” of group members. A representative sample of 773 Y/VSLAs from drawn from all the project districts were covered the study. The sample was classified in three categories: Mature groups totalling 350 (45.3%) Mature and ready for Linkage groups, 390 (50.5%) and Watch Category/Maturing groups and 33 (4.3%)
The analysis revealed that the gaps identified in Mature and Ready-for-linkage Y/VSLAs were closely similar to those in Watch Category (Maturing Groups) category and required more or less similar interventions.
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The objectives of the study included gap analysis of Y/VSLAs, linkage readiness assessment for mature Y/VSLAs and evaluation “digital readiness” of group members. A representative sample of 773 Y/VSLAs from drawn from all the project districts were covered the study. The sample was classified in three categories: Mature groups totalling 350 (45.3%) Mature and ready for Linkage groups, 390 (50.5%) and Watch Category/Maturing groups and 33 (4.3%)
The analysis revealed that the gaps identified in Mature and Ready-for-linkage Y/VSLAs were closely similar to those in Watch Category (Maturing Groups) category and required more or less similar interventions.
Read More...
HAMORIS Project (Hamenus Mortalidade no Risku ba Inan Sira)
This report is an end-stage evaluation of CARE International Timor-Leste’s HAMORIS project. The HAMORIS project aims at contributing to lasting reductions in maternal mortality and morbidity by increasing the number of women accessing quality Sexual Reproductive and Maternal Health Services (SRMHS).
There are four sets of conclusions drawn from the findings:
• There is increased access and utilization of improved quality SRMHS by women and men in the targeted communities of the HAMORIS project
• Normative changes towards acceptance of Gender Equality and less tolerance for GBV, have been produced as a consequence of the project
• There are unintended consequences for marginalised voices, including PWD
• Many of the recommendations of the MTR were followed but further time, resources needed to implement them all. Read More...
There are four sets of conclusions drawn from the findings:
• There is increased access and utilization of improved quality SRMHS by women and men in the targeted communities of the HAMORIS project
• Normative changes towards acceptance of Gender Equality and less tolerance for GBV, have been produced as a consequence of the project
• There are unintended consequences for marginalised voices, including PWD
• Many of the recommendations of the MTR were followed but further time, resources needed to implement them all. Read More...
SISTEMATIZACIÓN DE EXPERIENCIA “COMEDORES PARA LA PREVENCIÓN DE LA ANEMIA EN NIÑOS Y NIÑAS DE 6 A 36 MESES DE EDAD
El proyecto de ayuda humanitaria “Alimenta su Fuerza” en su segunda etapa, fue ejecutado por CARE Perú y financiado por el Banco de Crédito del Perú (BCP); su continuidad nació de la iniciativa para dar respuesta a la crisis alimentaria generada como consecuencia de la emergencia sanitaria por COVID-19 debido a medidas restrictivas que afectaron el ingreso económico de muchas familias y con ello la posibilidad de cubrir necesidades básicas. El proyecto tuvo como finalidad mejorar la seguridad alimentaria de la población en situación de vulnerabilidad, brindando apoyo alimentario con raciones nutritivas a través de espacios estratégicos como los comedores auto gestionados adscritos al Programa de Complementación Alimentaria de los gobiernos locales, a su vez de forma complementaria se incorporó un piloto para la prevención de la anemia en niños y niñas de 6 a 36 meses, que consistió en la entrega de preparaciones que incluyeron alimentos fuente de hierro, para ello se articuló acciones con establecimientos de salud y agentes comunitarios de la zona, así mismo se brindó acompañamiento a las madres o cuidadoras de los niños y niñas para que mejoren las prácticas de alimentación y accedan a los servicios de salud para la prevención y reducción de la anemia. 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...
End line assessment of GSK supported Community Health workers (CHW) initiative in Sunamganj district, Bangladesh
In spite of improvement in maternal and child health, the Sylhet division continues to have the poorest indicators in Bangladesh. Higher mortality for both mother and child and poor utilization of healthcare services still exist in the Sylhet division. Sunamganj is one of the remotest areas in Bangladesh and belongs to the Sylhet division having the poorest maternal and child health status. Since December 2012, CARE Bangladesh together with GSK and other key stakeholders has been implementing a Community Health Workers (CHWs) Initiative, which aims to address the lack of skilled human resources in remote and underserved unions of Sunamganj district. The overall goal of the CHW initiative is to improve maternal and child health outcomes in underserved/remote and poor communities of Bangladesh by increasing their access to quality health care services. Through a unique model of Public-Private Partnership (PPP), the project developed 319 Private CSBAs who are providing maternal and child health services including primary treatment of Non-Communicable Diseases (NCDs) like diabetes and hypertension in the entire Sunamganj district. To do a robust measurement in terms of assessing maternal, neonatal and child health (MNCH) related knowledge and practices as well as documentation of learning of these innovative initiatives, icddr,b conducted a baseline study in 2012 and end-line assessment in 2018. Read More...