Final Copy End Term Evaluation Report

8/10/2019 Final Copy End Term Evaluation Report

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THE ROTARY CLUB OF KITGUM

END TERM EVALUATION REPORT

MOTHER AND CHILD HEALTH project-MCH-p

BY FRANCIS ODWONG AND ROBERT BABU

7/22/2014

An end-term/terminal evaluation report for a mother and child health project implemented by the Rotary

Club of Kitgum in hard to reach rural locations within the district. The project lasted for sixteen months (April

2013-June 2014. The evaluation was meant to demonstrate the successes, challenges, best practices and

lessons learnt in the project implementation for future programming by the club and its stakeholders as well

as to offer accountability on the performance of the club in this project.


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1)

AcknowledgementNen Anyim Skyline Uganda acknowledges all those who participated in the end term evaluation exercise in Lamit

Pajong, Akuromo and Okuti parishes in Kitgum district for offering their time for the activity. We also acknowledge the

leadership of the Rotary Club of Kitgum and the technical staff who worked in the Mother and Child Health project fo

the cooperation and support rendered to the evaluation team during the exercise. We highly appreciate the projectsdonor representative for her invaluable contribution to the evaluation exercise.

Our heartfelt appreciation also goes to the field data collection team including Atimango Vicky, Komakech Moses, Ochan

Francis, and Ogwal Tom Peter for their dedication in the exercise.

This Evaluation would not have happened without the technical and financial assistance from Mount Airy Rotary

Foundation through the Rotary Club of Kitgum. Your continued support to relief world suffering including in Northern

Uganda is highly acknowledged.


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2)Executive summarya)

Background:

The Rotary Club of Kitgum with part funding from Mount Airy Rotary Club implemented a Mother and Child Health

project in Akwang, Mucwini and Orom Sub Counties in Kitgum districts from April 2013 to June 2014. In order to

maximize the work of the project with the target communities, the Club in June 2014 contracted Nen Anyim Skyline Co

Limited (a development consultancy company) to undertake an end term evaluation to document successes, challenges

lessons learnt and best practices registered by the project.

b)

Purpose:

To establish objective information on the successes and lessons learnt among others by Rotary Club Kitgum in the

implementation of this project. The information shall be used to determine the efficiency and effectiveness of the

strategies used by Rotary Club Kitgum in planning and implementation of the project for replication, improved

programming, accountability and reference.

c)

Objectives:

To report on the level of achievement of the project objectives according to the expected results listed in the logica

framework. To highlight lessons learnt, best practices, and challenges faced during the implementation of the Mothe

and Child Health project.

d)

Methodology:

The evaluation applied the survey (cross-sectional) study design using both quantitative and qualitative data collection

and analysis techniques. Data were collected through beneficiary interviews, Focus Group Discussions (FGDs), Key

Informant Interviews (KIIs), review of the projects statistics and official health recordsplus other relevant documents. A

sum of 3 FGDs, 15 KIIs and 76 beneficiary interviews were conducted.

e) Key findings, conclusion and recommendations:

Most of the end of project output targets on Mother and Child Health were attained. However there were serious

shortfalls in the performance for some important targets. The Maternal and Child Health project greatly contributed to

the improvement of maternal and child health through increased ANC attendance, vaccination, family planning and

deliveries at the health facilities. The mothers have been empowered in better hygiene practices and seek timely healt

care for themselves and their children.

The project performed satisfactorily on the targets it set prior to the intervention. Some of the achievements registered

in the project far exceeded the targets such as awareness on family planning, change in the health seeking behaviors o

women, and use of the referral system for women at risk and in emergency. A couple of other targets were

unfortunately not attained especially the one on vaccination for DPT3 and measles.

The project also applied a lot of innovation and creativity in its approach by engaging key stakeholders and

partners which ensured synergy, efficiency and effectiveness.


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TABLE OF CONTENT

1) Acknowledgement ..............................................................................................................................................2

2) Executive summary .............................................................................................................................................3

3) Acronyms ...........................................................................................................................................................6

1. CHAPTER I ..........................................................................................................................................................7

1.1 Background ....................................................................................................................................................7

1.2 The project background .......................................................................................................................................... 7

1.3 Project Objectives ................................................................................................................................................... 7

1.4 Project Activities ..................................................................................................................................................... 8

1.5 Objectives of the Evaluation ............................................................................................................................9

1.6 Scope of work .................................................................................................................................................9

1.6.1 Project Design ..................................................................................................................................................... 9

1.6.2 Project Implementation ...................................................................................................................................... 9

1.6.3 Project Performance and Impacts .................................................................................................................... 10

1.6.4 Conclusions and Recommendations for Future Activities ................................................................................ 10

2. Chapter II: Methodology ................................................................................................................................... 11

2.1 Study Design .......................................................................................................................................................... 11

2.2 Study area and Population: ................................................................................................................................... 11

2.3 Sample Size ........................................................................................................................................................... 11

2.4 Data Collection Methods ...................................................................................................................................... 11

2.5 WCA Interviews ..................................................................................................................................................... 12

2.6 Focus Group Discussions (FGDs) ....................................................................................................................... 12

2.7 Key Informant Interviews (KII) .......................................................................................................................... 12

2.8 Data Management, Analysis and report writing ................................................................................................... 12

2.9 Quality control ...................................................................................................................................................... 12

2.10 Ethical considerations ........................................................................................................................................... 13

3. CHAPTER III ...................................................................................................................................................... 14

3.1 FINDINGS AND ANALYSIS .............................................................................................................................. 14

3.2 Demographic information ..................................................................................................................................... 14

3.3 THE PROJECT DESIGN ............................................................................................................................................ 14

3.4 IMPLEMENTATION ................................................................................................................................................ 15


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3.5 RELATIONSHIP WITH STAKEHOLDERS ............................................................................................................... 18

3.6 Challenges faced during the project implementation ...................................................................................... 21

3.7 PROJECT PERFORMANCE AND IMPACTS .............................................................................................................. 22

3.7.2 State of the local referral system .................................................................................................................. 24

3.8 The level of sustainability/self-reliance achieved by the project ......................................................................... 28

4. CHAPTER IV ...................................................................................................................................................... 30

4.1 CONCLUSION AND RECOMMENDATIONS ............................................................................................................. 30

4.2 Performance on targets .................................................................................................................................... 30

4.2.4 The project design ......................................................................................................................................... 31

4.2.5 The project implementation ......................................................................................................................... 31

4.2.8 Project performance and impact .................................................................................................................. 32

4.3 RECOMMENDATIONS, INSIGHTS AND LESSONS LEARNT...................................................................................... 34

APPENDICES ............................................................................................................................................................ 36

ANNEX I ............................................................................................................................................................................. 36

ANNEX II ............................................................................................................................................................................ 37

ANNEX III ........................................................................................................................................................................... 39

ANNEX IV ........................................................................................................................................................................... 43


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3)AcronymsS/NO ACRONYMS IN-FULL

1.

AIDS Acquired Immune Deficiency Syndrome

2.

ANC Ante Natal Care

3.

ARTI Acute Respiratory Tract Infection4.

CAO Chief Administrative Officer

5.

DHO District Health Officer

6.

DSC District Services Commission

7.

FGD Focus Group Discussion

8.

HC Health Centre

9.

HIV Human Immune Virus

10.

KDLG Kitgum District Local Government

11.

KII Key Informant Interview

12.

LC Local Council

13.

LQAS Lot Quality Assurance Sampling

14.

MC Management Committee15.

MCH Mother and Child Health

16.

MDG Millennium Development Goal

17.

M&E Monitoring and Evaluation

18.

NGOs Non-Governmental Organizations

19.

NMS National Medical Stores

20.

PC Project Coordinator

21.

PHC Primary Health Care

22.

PMTCT Prevention of Mother to Child Transmission

23.

RC Rotary Club

24.

RCK Rotary Club of Kitgum

25.

RDT Rapid Diagnostic Test26.

TBA Traditional Birth Attendants

27.

VHT Village Health Team

28.

WASH Water, Sanitation and Hygiene

29.

WCA Women of Child Bearing Age

30.

WHO World Health Organization


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1.

CHAPTER I

1.1

Background

1.2

The project backgroundSimon Lawoko, Foundation Chair of Kitgum Rotary, emailed M. Goldwasser from Rotary Club Mount Airy

about having a project focused on saving lives of mothers and children in March 2011. Nurse Practitioner

Rudolf Schachner, long experienced in working in Africa, was consulted on the best way to do this. In May

2011, the Kitgum President Sunday Abwola and project coordinator Simon Lawoko contacted and set up

meetings with the District Health Officer and District Education Officer. Several talks with the District

health Officer (DHO), representatives of health centers, an experienced local midwife, as well as members

of the Village Health Teams (VHTs) and Traditional Birth Assistants (TBAs) took place. The group approved

the project idea and assured cooperation. Kitgum Rotary Officers and the DHO determined where to begin

the project, then took the idea to the Kitgum Rotary Club for discussion and approval. The club selectedthis project from 5 project ideas. During meetings with Kitgum officers, the DHO and Health Unit

Management Committee agreed to attend seminars and oversee the Health Centers and VHT's. The DHO

offered to find an office in Kitgum for the team. Members of the assessment team submitted a plan of

action and budget for approval. In 2013 and 2014, Rotary Club Kitgum undertook the 15 months project in

Kitgum district with funds from Rotary Foundation.

1.3Project Objectives

1.3.1 The main objective of the project was to improve the health situation for mothers and children in

the rural areas of Kitgum district (Northern Uganda). The project would contribute to the

Millennium Development Goals 4 (Reducing Child Mortality Rates) and 5 (Improving materna

health). The Specific Objective of the project was to provide an increased access to Mother and

Child Health Care services to the local population in difficult to reach areas of Kitgum district by

mobile outreach.

The following three results were to be achieved:

1.3.1.1Establishment of a mobile outreach system for MCH-services in eight villages in the rural areas of

Kitgum.

1.3.1.2

Pregnant woman and mothers of young children practice hygiene and health prevention according

to WHO guidelines in eight villages in the rural districts of Kitgum.

1.3.1.3Local decision makers are aware and support the regular MCH services by the mobile Outreach

team. They will contribute to the sustainability and long term running of the ambulance.

1.3.1.4

The following indicators would be used to assess the achievement of the above mentioned

objective and results:

1.3.2 Indicators for project objective


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1.3.2.150 percent of all deliveries are attended by a skilled midwife in Kitgum district by the end of April

2014.

1.3.2.265 percent of women will have at least three ANC visits by the mobile outreach team in the rura

areas of Kitgum district by the end of April 2014.

1.3.2.3

The local population is aware of the possibility of a referral system for woman at risk and

emergencies in the rural areas of Kitgum district till the end of April 2014.

1.3.3 Indicators for result No. 1

1.3.3.1Eight pre-selected villages in the rural districts of Kitgum are visited twice per month by the mobile

outreach team till the end of April 2014.

1.3.3.2Monthly numbers of daily medical consultations of pregnant women in the rural areas of Kitgum

district till the end of April 2014.

1.3.3.3

85 percent of children have a DPT3 and measles vaccination in the rural areas of Kitgum district by

the end of April 2014.

1.3.3.430 percent of all women at a child bearing age are aware about methods of family planning.


1.3.4.1Number of education units for mothers in the rural areas of Kitgum district until the end of April

2014 performed by VHT's.

1.3.4.2 Five VHTs per parish receive a training of at least six days until the end of April 2014.

1.3.4.3

Women in the rural districts of Kitgum are aware of the basics of hygienically disease prevention.


1.3.5.1

Running costs of the ambulance are budgeted by the DHO for the financial year 2014/2015.

1.3.5.2At least four radio broadcasts will be held in local radio station to inform about the health services

the MCH-Team is providing in the rural areas of Kitgum district.

1.3.5.3Number of participatory meetings with at least 20 participants.

1.4

Project Activities1.4.1 A mobile clinic consisting of 1 midwife, 2 nursing assistants, 1 double comprehensive nurse and 1

driver offers basic health and ANC services at rural areas by mobile outreach. In total 4 parishes

were selected and in total 8 spots were visited regularly per month.

1.4.2 Activities include:

1.4.3 Training of VHTs and TBAs to provide health education in family planning, nutrition, sanitation and

vaccination to reduce infections, malnutrition, high birth rates and disease.


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1.4.4 Neonatal consultations to ensure detection of complications in pregnancy and necessary referrals

to functional health centers or hospitals.

1.4.5 Scheduled immunization, mosquito nets, counseling, retro-viral & anti-malarial drugs to reduce

illness and death, transmission of HIV-AIDS and low birth-weight infants

1.4.6

Capacity building and linkages with community based networks, upgrading and strengthening the

Health Center staff will mean better health care for women and children and sustainability of the

project.

1.5

Objectives of the Evaluation

1.5.1 Objective: To report on the level of achievement of the project objectives according to the results

listed in the logical framework.

1.5.2 The evaluation of the Project was done in order to generate objective information on the successes

and failures of Rotary Club Kitgum. The information will be used to determine the efficiency and

effectiveness of the strategies used by Rotary Club Kitgum for planning and implementation of the

current project, for the formulation of future project proposals and for the incorporation of Rotary

Club Kitgum's methodologies in other projects.

1.5.3

The recommendations of the evaluation report should further enable Rotary Foundation

International to assist Rotary Club Kitgum in improving its decision-making processes and technical

and financial management.

1.6

Scope of workThe evaluation addresses the following issues in the report:

1.6.1 Project Design

1.6.1.1Considers the effect of the project design on reducing maternal and child mortality.

1.6.1.2Considers how realistic the project objectives, as defined by the Logical Framework, were.

1.6.1.3Considers if the organizational framework was suitable for the implementation of the project and if

Rotary Club Kitgum had the right staff, budget, equipment and management capacity to achieve

the project objectives.

1.6.2

Project Implementation1.6.2.1

Comments on the implementation strategy, procedures and planning methods used by Rotary Club

Kitgum.

1.6.2.2Determines the efficiency of implementation by a comparison of the costs incurred and the results

achieved.

1.6.2.3Comments on the role and performance of RC Kitgum and local partners, the beneficiaries and

other stakeholders in the implementation of Rotary Club Kitgum.


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1.6.2.4Assesses the technical and managerial potential and efficiency of Rotary Club Kitgum and other

stakeholders.

1.6.2.5Reports on how much external factors have influenced project implementation.

1.6.2.6Assesses the monitoring and reporting competence of Rotary Club Kitgum.

1.6.2.7

Assesses the technical and managerial competence of Rotary Club Kitgum technical staff and

Rotary Club Kitgum Steering committee and make recommendations on how these may be

improved.

1.6.3

Project Performance and Impacts

1.6.3.1Determines how far Rotary Club Kitgum has realised the objectives defined by the Logica

Framework and compare the project activities with the project documents.

1.6.3.2Determines the contribution of Rotary Club Kitgum towards the accessibility to health services for

women.

1.6.3.3

Reports on the attitude of local population to participate in the project.1.6.3.4Measures the knowledge level of women at child bearing age in hygiene and disease prevention.

1.6.3.5Examines the attitude towards family planning.

1.6.3.6Examines womens attitude towards ANC1 to ANC3 visits.

1.6.3.7Examines the attitude to give birth at Health Centre.

1.6.3.8Determines the capacity of VHTs and TBAs to perform health education.

1.6.3.9Assesses the willingness of the government to take over the project.

1.6.3.10 Assesses the level of sustainability/ self-reliance achieved by the project beneficiaries.

1.6.3.11 Reports on womens participation/ involvement in the design and the realization of the project.

1.6.3.12 Assesses the effectiveness of the training courses provided by RC Kitgum to VHTs.

1.6.4 Conclusions and Recommendations for Future Activities

1.6.4.1Summarise the consultants findings on the following issues:

1.6.4.2Policies, structure, management, staffing RC Kitgum.

1.6.4.3Objectives of RC Kitgum.

1.6.4.4Reporting, monitoring and oversight,

1.6.4.5Roles of the different stakeholders and relationships with the key actors, local administration

other NGOs and donors.

1.6.4.6The effects of external factors on the implementation of RC Kitgum.


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2. Chapter II: Methodology

2.1

Study Design

The study employed the cross sectional design (survey) by applying a mix of selected qualitative and

quantitative techniques to obtain data on the process and impact of the project in selectedparishes/villages in Kitgum District. It also involved review of relevant project documents like the overal

project statistics and official statistics.

2.2

Study area and Population:

The study was conducted in the four parishes1where the project was implemented. The study population

included Women of Child Bearing Age (WCA) numbering some 2,436 women and girls, VHTs and TBAs

engaged in the project implementation. The study also interviewed various other stakeholders such as the

project staff, the project donor, the project consultant and members of the RCK management committee.

The women and girls mentioned above constituted the projects direct beneficiaries whereas the other

stakeholders provided the project with all kinds of support ranging from financial aid, oversight and

implementation.

2.3Sample Size

The LQAS sampling technique was applied to ensure that the minimum quality standards of the data

collected were met. A sample size of 83 Women/Girls of Child Bearing Age whereby each of four parishes

were set to provide at least 20 of these respondents. Given the study population size (2,436) a standard

sample size of 332 was arrived at on the basis of 95% confidence level and +/- 10% confidence interval

Since there was four study areas/parishes (referred to as lots according LQAS) the standard sample size

was divided by four to obtain the actual LQAS sample size of 83 respondents which was finally used. Onceat the study areas, the enumerators applied non-probability/purposive technique to identify suitable

respondents to realize the calculated sample size for WCA. Purposive sampling is not the best alternative

out there (due to non-existent/inadequate sampling frame) but it served the purpose well enough since

the respondents were fairly homogenous.

2.4

Data Collection Methods

Primary data were collected from the respondents by Field Research Assistants and the consultants using

specific sets of tools. FGD and Key Informant Interview guides were used for collecting qualitative data

Photo documentation and field observation of the implemented activities and changes in the behavior of

the target groups like use of WASH facilities2stemming from the projects intervention was applied.

The FGD guide was applied for qualitative data collection with VHTs and TBAs who were trained by the

project and participated actively in its implementation. A varied KII guide was used to collect qualitative

1Pajong-Mucwini, Lamit-Akwang, Okuti and Akurumo in Orom sub-county

2Latrines, rubbish pits and utensil drying stands etc.


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data from various key informants of the project including the project staff, members of the Clubs

management committee, the project donor, government focal person and the project consultant.

2.5WCA Interviews

A questionnaire was used to collect quantitative/qualitative primary data from WCA by the field researchassistants/enumerators. This tool covered issues regarding the project design, implementation and

outcomes to which the respondents competently provided responses.

The research assistants were inducted on the questionnaire through brainstorming and role plays. The RAs

were also prompted to administer the tool among themselves to clarify any lingering inconsistencies.

2.6Focus Group Discussions (FGDs)

Focus Group Discussions (FGDs) were held with the Village Health Teams (VHTs) and Traditional Birth

Attendants (TBAs) in the projects target areas. The discussions focused mostly on the implementation of

the project including the roles of these health workers within the project. Three FGDs were conducted in

Lamit, Pajong and Akurumo with an average of eight (8) participants for each session. The FGDs were

conducted by the consultants themselves.

2.7Key Informant Interviews (KII)

KIIs were addressed to Clubs Management Committee, the project staff, the Local Government Foca

Person, and the respective sub-county leaders and health center personnel. This particular interview was

intended to collect data on the project design, implementation and impact from a vantage point of view of

the respective offices.

2.8

Data Management, Analysis and report writing

Data was entered directly into the computer using Epi data software. Data entry was done daily from

commencement of data collection. The entered data were then synchronized by the consultants for

analysis. After entry and cleaning, validated data were then exported to SPSS 21.0 and analysis done. Uni-

variate analysis of the data was applied to the data producing relevant descriptive statistics. The data were

disaggregated according to project activity, demographic characteristics and target areas to get specific

details on performance of the project. The Atlas software was used for the analysis of data from FGDs and

other qualitative data.

2.9

Quality controlThis was ensured right from the design of the data collection tools through to data collection, data coding,

analysis and interpretation. The consultants recruited and inducted qualified field data

collectors/enumerators. The Lot Quality Assurance Sampling LQAS that was used for the selection of

participants for the beneficiary interviews minimized bias and ensured a representative sample size of the

target population.


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The study in the design of the relevant tools borrowed from the health industry scoring standards

including the WHO guidelines on hygienic practices.

The tools were reviewed by peers including MCH-Care practitioners from agencies working on the same to

ensure that they address the key issues in MCH-care. The tools were pre-tested for feasibility and re-designed where necessary to suit the circumstances identified.

The draft evaluation report was validated by all the relevant stakeholders and reviewed by peers before a

final copy was written.

2.10

Ethical considerations

Confidentiality was guaranteed by concealing the identity of the respondents such as not recording their

names on the tools. A cover letter was written and shared with respondents to seek their informed

consent to participate in the exercise before it commenced.

The evaluation team ensured sensitivity to local cultural and social issues which might have jeopardized

the exercise. For example young women and girls who participated in the exercise were talked to in open

places (outside the ear-shot of onlookers) to avoid antagonizing their male guardians.

The report was shared with stakeholders who participated in the exercise to reassure them that it was a

true reflection of the information they provided.


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3.

CHAPTER III

3.1

FINDINGS AND ANALYSIS

3.2

Demographic informationMost of the WCA-respondents were within the age 20-29 years (43/57% respondents) and 30-39 years

(28/37% respondents). Only five respondents were teenage girls of child bearing age. Each of the four

project sites/parishes across the three sub-counties3in Kitgum district provided a fairly equal number of

respondents. The respondents came from a sum total of fifteen villages from within the four target

parishes.

A significant number 50% of the WCA-respondents never had any formal education and a fairly large

number 42% studied only up to the primary level of education. Less than 10% attained more than primary

level of education.Over 10% of the women interviewed had produced more than eight children. The rest had between 1-7

biological children.

3.3

THE PROJECT DESIGN

3.3.1

Womens participation/ involvement in the design and the realization of the project

More than a third of the beneficiaries acknowledged that they were consulted at the design of the project

This according to them was done through community meetings organized by their local leaders in

collaboration with the local health officials and members of the Rotary Club of Kitgum.

Most of the target group interviewed intimated that they were not engaged by the implementation team

to improve the project implementation process.

3.3.2

Effectiveness of the project according to various stakeholders

More than three quarters of Women and Girls of Child Bearing Age interviewed thought that the project

addressed the specific concerns pertaining to mother and child health in the target areas.

The project satisfied the pressing health needs of the target population according to the WCA interviewed

They pointed out that there was need for vaccination of children, counselling on family planning, access to

VCT services, and attendance of ANC visits by pregnant mothers which the project specifically addressed.

The projects Local Government focal person observed that the project was holistic in its approach to

mother and child health covering key components like ANC, immunization, family planning and referra

according to government policy. She also noted that despite its mandate, the project provided emergency

services to all and normal services to PWDs and the elderly. A VHT member in Okuti parish, Orom sub-

county qualified these claims in the following statements;

3Orom (Okuti and Akurumo), Mucwini (Pajong) and Akwang (Lamit/Tumangu)


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Lokom and Lachom are hard to reach areas and the implementing team penetrates up to there. You

find children of up to five years of age not immunized yet and it is through the project that we have

started reaching out to such children. There are very many patients in those areas and the project really

helped them. Other activities like ANC, PMTCT for all mothers who cannot come here, those mothers

are really glad to have the RCK operating here.

A VHT member in Pajong, Lagot Mucwini sub-county also noted;

The biggest benefit that RCK brought was accessibility to health services i.e. before they came, women

used to go for ANC up to Mucwini, and even for vaccination they had to come up to HC here but now all

this has stopped because RCK now goes to them, even those who used to complain of distance and

those who were lazy, that excuse is no longer there.

Another VHT member from Akurumo parish who participated in an FGD conducted there opined that the

maternal and child mortality rates have drastically reduced with the intervention of the project. She noted;

Prior to the project implementation the neighboring villages here experienced frequent mother and

child death resulting from risky deliveries and lack of vaccination respectively. But as I speak now this

has tremendously reduced because pregnant mothers are promptly counseled through repeated ANC

visits on what to do to ensure their safety and that of their babies before and after deliveries

The VHTs talked to in the study also noted how positively the project has changed the health seeking

behaviour of WCA. A VHT member in Tumangu/Lamit parish echoed this view in the following words;

Today with the help of the project, women are more aware aboutwhat to do in order to protect theirhealth and that of their babies. Mothers strictly follow the vaccination schedules to ensure that their

children get all the recommended vaccines. They also pay early and regular ante natal visits compared

to before the intervention

However the project did not attain its target of ensuring that 50% of all deliveries were carried out by a

qualified health worker at a health facility. By April 2014 the projects target area recorded only an average

of 20% level of professionally attended deliveries4.

3.4

IMPLEMENTATION

3.4.1

Implementation strategies and procedures

The project management team developed a work plan in consultation with the clients, government

agencies and other stakeholders to ensure effectiveness5. The beneficiaries therefore knew before hand

the time and place (designated locations) of arrival of the project treatment team.

4Official District Health Statistic ANNEX I


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The Project Coordinator pinned on her office wall a chart indicating all the activities to be implemented

under the project for specific periods of time.

The relationship among the implementing team was great. The staff members were motivated, disciplined

and professional in doing their job. The donor representative noted;

Florence(the PC) trained a cohesive and dedicated team which showed up on time for work, had open

communication with her staff, and promoted trust and loyalty. She is an excellent leader. The midwife

Alicewas an excellent role model as well, with a good work ethic. Job, the bookkeeper was bright and

believe honest.

3.4.2

Attitude of the local people towards the project

Most 68/91% of the WCA interviewed were aware of the MCH project by the RCK, the rest had no idea.

Almost all 85% of those who knew about the project were interested in it. 81% of those WCA who showed

interest in the project participated in it in one way or the other. Their participation in order of importanceinvolved receiving treatment, health education, immunization, and ANC among others.

Almost all the Key Informants interviewed indicated that they were involved in the MCH project in

different ways. For example the village leaders (LC Is) indicated that they were involved in mobilizing the

community to sweep and organize the venue for the treatment sites and to look for seats for the health

workers when they go for outreach and encouraging the community to send the women and children for

treatment. The health facility staff also indicated several ways in which they were involved in the MCH

project. A Health Assistant in one of the local HC II noted;

I go with them to the field and perform the duty of records. I conduct tallying like number of

immunization, record and register out patients. I also record child immunization card, date of return

visits and many other things in immunization card. At times I do RDT6as well as mobilization. Other

staff members handle immunization, ANC, checking children under five and sometimes Adults, relevant

of complicated cases. They pick us and we go and check patients and we also immunize children.

3.4.3

Participation gaps noted in the project by some stakeholders

The beneficiaries thought they could have participated in the project more by getting a platform within the

project to share their opinions with the implementing team. They also highlighted the idea of havingadequate access to information as another way by which they could have been better involved in the

project.

5Visits/treatment days were scheduled for the various project sites on a weekly basis; Pajong on Tuesday, Akurumo on Wednesday,

Lamit on Thursday and Okuti on Friday6Rapid Diagnostic Tests


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Most key informants interviewed expressed the opinion that they were adequately involved in the MCH

project because they were engaged in the services that they could offer. A VHT from Akurumo parish,

Orom sub-county noted;

I think the involvement is already adequate because we have always worked as a team. They havehelped us a lot because this is a hard to reach area. They were also the ones who give us gas cylinder

for the fridge, sometimes when we run out of vaccines and since they come here weekly they bring

some to us from town. We also use their data from the field as part of our outreach activities data.

However some of the Sub County and parish leaders expressed mixed feelings about their involvement in

the MCH project and its core activities and suggested not being adequately engaged. A parish leader who

took part in the interviews noted;

I think RCK feared to adequately involve the parish chiefs in their activities because of financial issues,

they imagined we would be expensive and so excluded us from their activities completely.

3.4.4

The project monitoring

To their credit, the designers of the project put together the relevant project documents one would need

to monitor a project. There was the projectslogical frame highlighting key indicators, the projects budget

outlining the different costs and the projects work plan among others. Apparently the Project Coordinator

indicated to the evaluation team that a monitoring tool (checklist) was used by the steering committee

and other stakeholders to monitor the project implementation.

The donor was adequately represented in monitoring the projects implementation which involved their

representative travelling with the field team to most of the projects locations.

However reporting on the progress of the project covered strictly the core aspects of the project i.e.

expected outputs and outcomes. The reports could have covered intervening factors during

implementation, status of the budget and other broader issues on mother and child health in the district

among others.

3.4.5

Support that WCA received from the project

56/78% of those interviewed received at least some form of support from the MCH project, 16% did not.

The support included treatment for minor ailments (38%), receipt of Primary Health Care materials like

mama-kits and immunization against TT for mothers and the five killer diseases for children under five(22%), receipt of contraceptives and access to ANC and basic medical tests. Mentioned was also made of

access to ambulance and counseling services provided by the project.


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Figure 1Source: Overall project statistics Annex II

The rate of immunization remained low for most of the project period except for de-worming and vitamin

A which started high, dipped for some 5 months and then rose again to record levels. Vaccination for the

six killer diseases did not exceed 20 children for each of the 15 project months. Crucially the project did

not reach the 85% vaccination target for children eligible for DPT-HepB+Hib1 but vaccinated only 9% by

June 2014.

3.5RELATIONSHIP WITH STAKEHOLDERS

3.5.1

Government

The project had a good relationship with relevant government agencies like the DHO, the political

leadership and the local health centres. The government assigned to the project one of its senior nursing

officer to ensure that the projects intervention addresses the districts health priorities regarding MCH

and collaborated with RCK Kitgum during the entire process of project design and recruitment of staff. A

member of RCK management committee noted;

They (government) were very supportive, during the initial planning we plann ed together as a team

even the project design we did together. We also did the interview for staff recruitment t together, the

CAO, the DSC, the DHO and even the traffic police sent representatives when we were recruiting the

driver and the other staff as well.

0

100

200

300

400

500

600

NUMBEROFCHILDRENVACC

INATED

PROJECT DURATION 2013/14

RATE OF IMMUNIZATION DURING THE PROJECT IN THE TARGET AREAS

BCG

DPT-HepB+Hib1DPT-HepB+Hib2

DPT-HepB+Hib3

Measles

Polio "0"

Polio 1

Polio 2

Polio 3

Vitamin A < 5yrs.

Deworming < 5 yrs.


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The project was offered a well furnished office space at the district health department as well as two

nursing assistants/midwives. The district paid the bill for office utilities such as electricity and water for the

entire project period and helped to build a solid relationship with Rotary club international. The clubs

treasurer noted;

The DHO and the LC5 also wrote to the donor an acknowledgement letter that they received the

money in the Bank Account of Rotary Club of Kitgum and also that they have received the vehicle

bought which was a very good gesture of cooperation.

The project worked in collaboration with the relevant district health staff in the target areas whereby it

provided these personnel the necessary facilitation. The projects Local Government Focal person noted;

The project management gave allowances to the district health staff it engaged in some of its

activities hence motivating them to dedicate themselves to the project

The district also provided the project with drugs and antigens needed during some of its field visits. One of

the projects Nursing Assistant noted;

When we were procuring drugs from the NMS, the CAO gave us the Tin number for the district because

NMS does not sell drugs to anyone.

The local government further facilitated the project to secure an ambulance for its operations. The clubs

treasurer pointed out;

When we were buying the vehicle, we used the local government and we were exempted from paying

tax and we saved over 52 million Uganda shillings. The local government also helped us to register the

car as an ambulance further helping us to save a lot of money.

3.5.2

The donor

The donor was closely involved with the project right from the design through to implementation. The

donor representative from Mount Airy Rotary Club expressed the functional relationship she had with the

Kitgum team in the following terms;

Rudolf Schachner, myself and Simon Lawoko, past President and Club Foundation Chair for Kitgum

Rotary discussed various possibilities for projects and presented them to the Rotary Club Kitgum whichselected the Mother/Child Mobile Clinic project

The donor representative also revealed how they fully played their role as an important stakeholder of the

project to ensure its success. She noted;


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I filled the Rotary Application form and raised the needed 30,000, which our District matched, as did

the Foundation. Mr. Sunday Abwola, the project point person and Past President of Rotary Kitgum and

I corresponded by email on various hiring and payment issues

However on one occasion the implementing team crucially omitted the donors opinion on the need todivert funds within the project.

3.5.3

The local health structures

The project worked with the existing health structure including the local health centre staff, VHTs and

TBAs. These health personnel helped the project implementing team in vaccination, dispensing medicine,

counselling and health education among others. One of the projects Nursing Assistants noted;

The local health facilities and personnel have been very supportive of our work, we normally notify the

VHTs of our coming so they can mobilize the community in time. They also willingly came with us for

the outreach program in the community. I do not think we could have realized the project outcomes if it

were not for them

3.5.4

The Management Committee-MC of RCK

The Project Coordinator noted how supportive the management committee had been during the course of

the projects implementation. She underlined the MCs willingness to provide them the necessary

autonomy at the same time offering support supervision both at office and in the field, as well as giving

feedback on their periodic monthly reports. She intimated;

The Management Committee has been so reliable, they responded fast to our calls ensuring that

activity implementation goes on smoothly

A Nursing Assistant also noted;

Most of the committee members were committed because when we make a work plan we follow it

through. What I like most is that sometimes members surrendered their own vehicles and we would use

them to go to the field to conduct our monitoring activities.

However it was also indicated that the committee did not adequately execute all of its oversight roles for

example in monitoring field activities. A committee member pointed out;

May be we did not support them enough in one way or the other, we were supposed to have a

monthly support visit but we turned it to quarterly instead. You know we are a loose group like

Teachers, bankers, business men and because of that we do not have much time to go about all this

activities but at least we managed to do it quarterly.

Staff appraisal was also not well followed through by the Management Committee. An MC member noted;


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Theother thing was on the staff appraisal. In the first year we failed to do this, we were supposed to

receive appraisal from the Project Coordinator of the lower staff which she did in the second year and

she gave us a report. Then the PC who was supposed to be appraised by the Rotarians was never

appraised. She was later appraised by the consultant but we never got the report.

3.6

Challenges faced during the project implementation

The target group for the most part did not experience any serious challenge during the implementation of

the project safe for lapses in time keeping by the treatment team, limited access to the services by adults

(especially adult males), limited drugs, and long distances to the treatment centers.

The Project Coordinator (a Registered Nurse, with over twenty years of experience) indicated that the

staffing for the project was rather low as they had to do several assignments including consultation, clinica

work, immunization and dispensing of drugs every other treatment day.

The PCs view resonated with those of the projects clients on drug shortages. She noted;

Sometimes during implementation we could not offer patients the drugs they needed after diagnosis

and prescription which was rather frustrating for all those involved

At the same time, she lauded the indefatigable district offices and relevant personnel who came to the aid

of the project in this regard from time to time.

The Technical staff and the steering committee also cited some challenges faced during the implementation o

the program. One of the project staff noted;

We nearly gave up going back to certain areas because mobilization was very poor. You go there and

meet no body which is quite a waste of resources. When the team brings us the statistics from the field,

areas like Pajong had zero attendance twice. We then moved fast and held stakeholders meetings

which made us realize it was as a result of misinformation because the community thought we were

only doing immunization but when we clarified then they started coming in big numbers.

The project also encountered some political challenges as well as conflicting with the local health priorities

in Lamit (one of its target areas) where there was an ongoing epidemic of the nodding syndrome disease.

A key informant from the area noted;

In otherareas like Tumangu there was political interference because their priority was in managing

nodding syndrome so they refused to make a shelter for us at first. Then when we went and talked to

them they realized our work was also important.

The VHT for their part noted inadequate facilitation as a major challenge they experienced during the

project implementation. This included limited operational gears (transport means/bicycles, gumboots,


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torches, raincoats, and umbrella), low stipends and little or no refreshments on treatment days, though

they conceded that the Club provided them with eight pieces of soap as token of appreciation on a regular

basis. A VHT participant in an FGD in Akurumo noted;

During rainy seasons the mud in this area is at knee level which makes our operation especially duringemergency at night quite nightmarish. It would have been quite helpful if the Club considered providing

us with gumboots, torches, umbrellas and rain coats for operations of this nature

Some of the planned activities were not fully implemented due to one reason or another. An important

stakeholder of the project pointed out the low level of implementation of planned seminars for loca

stakeholders in MCH in service training. She noted;

The budget for the Project Manager in Germany was high. He did not complete the 4 Seminars for

local stakeholders in MCH in service training for which 2920 was allocated, but completed one only. He

said that he was going to do the other three in May, a month before the project ended. I expected theseminars to be spread out over the length of the project so they could impact the success of the

project.

Some stakeholders also feared that poor timing of some of the project activities could have diminished

their impact for the project. One of the project partners noted;

The capacity building training of TBAs in 3-5 day workshops, budget 4672 USD, took place way too late

-over half-way through the project, so the effect was diluted.

The project also faced competition with other NGOs implementing similar projects in the area. In Pajongparish, Mucwini sub-county, the evaluation team witnessed Marie stopes (an NGO) providing reproductive

health services to the same target beneficiaries. The funding partner representative qualified this claim in

the following words;

The numbers served in the areas with poor roads, and the competing NGO were low. When the team

had holidays, the villagers were not served. This results in the villagers not being certain when to

attend the clinics.

3.7

PROJECT PERFORMANCE AND IMPACTS

3.7.1 Access to health services for women

More than three quarters of women asked asserted that the coming of the project resulted into significant

increase in access to health services by mothers and children. A lesser number 21% thought the project did

not bring much change in access to health services by mothers and children in the area. A woman

respondent from Pajong parish, Lagot A village in Mucwini sub-county noted;


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To a large extent most women now go to the Health Center except those who are really unable but

also those ones endeavor to go to HC after delivery.

A VHT member highlighted the gradual increase in the turnout of women on treatment days in the

following words;

I think the attendance increases by the week. When we first started you would only see 10 patients in

a day but right now you can see for yourself. In the past children would not even be vaccinated, they did

not value vaccination or ANC or even delivering at H/C but the number has increased a lot.

The intervention of the project has led to a remarkable increase in access to health services for mothers

and children according to more than half of the women interviewed. A fifth of the women interviewed also

thought the health status of mothers and their children improved as a consequence of the project. A

significant number also opined that womens attitude towards regular ANC visits has improved overtime.

Figure 2 Source: Overall project statistics ANNEX II

The chart above provides a general outlook on the trend of morbidity for mothers and children in the

project area. It indicates that the overall level of morbidity by common diseases steadily declined during

the project period especially for intestinal worms, malaria and ARTI (Acute Respiratory Tract Infection).

0

100

200

300

400

500

600

REPORTED

CASES

DURATION OF THE PROJECT 2013/14

TOP TEN CAUSES OF MORBIDITY IN THE PROJECT'S TARGET AREA

MALARIA

ARTI

INTESTINAL WORMS

ACUTE DIARRHOEA

EYE INFECTION

SKIN DISEASES

SEVERE MALNUTRITION

DYSENTRY

TRAUMA

PNEUMONIA


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Figure 3 Overall project statistics ANNEX II

The graph above shows a general rise in the health seeking behavior of women in the project target areas.

ANC re-attendance particularly skyrocketed during the project period which demonstrates the effect the

project had on the attitude of the target group.

The Local Government project focal person reechoed the above situation asserting;

Before the project was implemented, pregnant womens attitude toward attendance of ANC was very

low due to long distance from the nearest health facility but this has markedly improved with the

coming of the project

3.7.2 State of the local referral system

About three quarters of the respondents expressed awareness of an existing referral system in their

communities. This according to them involved the use of ambulance, hiring of Boda-bodaby caregivers

and writing referral letters by the VHTs among others.

The state of roads was commented on by the projectsgovernment focal person as a serious draw back onthe existing referral system. She noted;

KDLG is trying its best to achieve MDG targets 4&5 for maternal and child health but is handicapped

by poor infrastructure such as telecommunication and roads which makes referral of pregnant mothers

in hard to reach areas to deliver at the health center nearly impossible

0

10

20

30

40

50

60

70

01

-Apr

01-May

01-Jun

0

1-Jul

01

-Aug

01

-Sep

01

-Oct

01

-Nov

01

-Dec

01-Jan

01

-Feb

01

-Mar

01

-Apr

ATTENDANCERATES

PROJECT DURATION 2013/14

KEY INDICATORS FOR MOTHER AND CHILD HEALTH IN THE PROJECT AREAS

ANC 1

ANC 4

ANC re-attendance

Family planning

IPT 1

IPT 2


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Setting up a health centre nearer to where its clients are settled, building motorable access roads, and

establishing and ambulance service came out strong as some of the ways of enhancing the health seeking

behaviour among women at risk and emergency. Health education was also considered by the

respondents to be effective in getting women at risk and emergency to seek health care. Others

recommended making the existing health facilities more reliable and building a strong referral network to

encourage the above category of women to seek medical help.

The two charts above show that at the start of the project both pregnant and non-pregnant women had a

more positive attitude towards TT vaccination. A steady decline was recorded for both categories

plummeting to rock bottom mid-way the project. Thereafter a steady positive change was noted in

womens attitudes towards the end of the project.

Figure 4 Source: Overall project statistics ANNEX II

The chart above also represents a positive improvement in the attitude of women towards healthy life

choices like PMCT in the above case.

010

20

30

40

50

60

70

01-Apr

01-Jun

01-Aug

01-Oct

01-Dec

01-Feb

01-Apr

TT VACCINATION FOR

NON PREGNANT WOMENTT 1

TT 2

TT 3

TT 4

TT 5 05

10

15

20

25

30

35

01-Apr

01-Jun

01-Aug

01-Oct

01-Dec

01-Feb

01-Apr

TT VACCINATION FOR

PREGNANT MOTHERS

DURING THE PROJECT TT 1

TT 2

TT 3

TT 4

TT 5

0

5

10

15

20

25

30

35

40

NUMBER

TESTED

THE PROJECT DURATION 2013/14

PREGNANT WOMEN TESTED ON HIV IN THE PROJECT AREAS


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3.7.3

Hygiene and disease prevention

Most of the mothers in the target areas seemed to have received health education on hygiene and disease

prevention under the project as indicated by 81% of those interviewed.

The key to good personal health according to 40% of the WCA interviewed was having and properly using

the main WASH facilities i.e. pit latrine, rubbish pit, and utensil stand among others. A significant number

22% of those asked also thought personal hygiene and grooming were key ingredients to good personal

health.

In order to live in a clean and healthy environment the respondents thought it would be realized by having

the relevant WASH facilities, cleaning ones compound, proper use of the WASH facilities and cleaning

water holding containers among others.

To ensure good personal health the WCA asked intimated that one ought to in orderofimportance wear

clean clothes, bathe frequently, cut their finger nails, wash hands often, exercise, eat balanced diet, live

within a clean compound and drink clean water among others.

3.7.4

Attitude towards family planning

Three quarters of the WCA interviewed were sensitized about family planning. The key message that they

got from the sensitization included child spacing, use of contraceptives and the advantages of Family

Planning among others.

Most of the WCA interviewed indicated that to control pregnancy they would in order of importance use

pills, implants, and condoms among others. 7% of the women interviewed did not know what they would

do to control pregnancy. Another 7% interesting thought they would abstain during their menstruation

period to avoid getting pregnant.

Varied opinions were put across regarding family planning by the WCA interviewed; generally they thought

the practice is good for the health of mother and child, and for the economic well being of the family.

Some thought their husbands should be excluded from the arrangement because they would most likely

refuse to comply. Others expressed fears for the side effect of Family Planning especially the prospect of

becoming barren. The women interviewed noted that most men and the community elders are opposed to

practice citing that its against procreation which they consider a duty of man and women in a marriage.

3.7.5

Current use of family planning methods among WCA

More than half of the women questioned were using some kind of family planning method/contraceptive.Significantly 41% did not use any family planning method. The reasons why some women would not use

any family planning method range from fear of side effects, lack of awareness, their husbands refusal, and

dislike for the practice among others.

3.7.6 Womens attitude towards ANC1 to ANC3 visits.


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All the women interviewed were pro antenatal visit citing numerous benefits among them protecting the

health of the mother and child, handling complicated pregnancies, and PMCT services to mentioned but a

few.

One VHT member from Orom subcounty, Okuti parish noted;

Yes in a way that the mothers down in the village started seeing the importance of ANC and family

planning. They started getting cards, they started coming in large numbers for revisits. If you compare

with the previous years, the numbers just keep increasing. In fact Locom and Lokom have biggest the

numbers for return dates than any other villages.

3.7.7

WCA attitude towards giving birth at the Health Centre

The study revealed that most women in the target area would pay antennal visits to the local health unit

when pregnant. The women interviewed cited sudden labor pain, long distance to the nearest health

facility and poor transport means among others as the reasons for home deliveries. The women asked did

not consider home delivery as the next best alternative but asserted that it only happened due to

unavoidable circumstances.

The women interviewed expressed a good level of appreciation of the merits of delivering at a health

facility. The advantages of Health Centre delivery according to them included limited chances of infection,

attendance by qualified and competent personnel, access to relevant materials like the mama-kits, free

counselling, and fast and quality services which reduces excessive pain.

3.7.8

The capacity of VHTs and TBAs to perform health education

VHTs trained and mentored by the project engaged in health education for the target community as

expected. The WCA 69% interviewed acknowledged that they attended health sensitization meetings

conducted by VHTs.

84% of the women who attended the health education sessions organized by VHTs seemed satisfied by

their capacity to deliver the sensitization contents. The VHT members interviewed also demonstrated their

competence to the evaluation team on how they conducted health education sessions in their

communities. A VHT member in at the FGD conducted in Akurumo parish noted;

A lot has improved regarding our work for mothers and children; we now handle them in a more

professional way compared to before, we also know how to read the symptoms and signs of common

diseases that afflict mothers and children in the area

The Key Informants interviewed at the health facilities expressed mixed feelings about the work and

commitment of VHTs. The in-charge of Akilok HC II positively noted;

They do it(their work) well because they have taken long and they are always within the community

and they are continuously trained by various agencies. Given any new disease outbreak they always get

trained so I think they are competent enough


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Others expressed reservation on the commitment and work of the VHTs. For example the Akilok in-charge

noted;

Considering that this is a rainy season many of the VHTs find it difficult to juggle between their private

work and the work of Rotary Club so normally they come late.

Some VHT members were not competent enough to deliver the services expected of them. A HC staff in

Akilok HC II, Okuti parish pointed out;

Sometimes the VHTs do not know how to administer certain drugs like vaccines whereby some of the

children get swollen arms and end up being taken to the hospital so this has to improve. There are

some VHTs who are more active than others so to me I think more effort should be put on the active

ones so they can reach more people

3.8

The level of sustainability/self-reliance achieved by the project

A third of the women interviewed thought the project initiatives would not be sustained after the closure

of the project. The remaining two thirds thought the project initiatives would be sustained or were not

sure altogether. The donor representative expressed the fears he observed in the beneficiaries should the

project leave in the following words;

The villagers themselves are quite attached to the clinic and do not want it to end.

A significant percentage 29% of the women/girls of child bearing age were of the opinion that continuity of

the projects initiatives could only be ensured by extending the timeframe of the project a little forward.

Others suggested that the government should set up a health facility in the respective areas which would

offer similar services.

When the WCA were asked about what they would do to sustain access to important supplies and

materials like the mama-kits and mosquito nets after the project, they responded that the project has to

continue for them to access these things or they would have to turn to their local health centers or

purchase them. Others mooted the idea for proper maintenance of some of the re-usable materials in this

package as a way out for them among others.

However some key informants at the health facilities noted that they would use the government PHC

funds to maintain some of the equipments that were donated to them by rotary club like the gas cylinders

A health center staff asked on this matter noted;

We have resources like the PHC funds that we can use for that and the district also helps to refill the

gas cylinder. We shall still use the PHC resources or we improvise with what the district can offer. Like

for gas cylinder we shall resort to using charcoal stove


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The projects Local Government focal person noted that KDLG will sustain the projects initiatives by re

absorbing the projects personnel especially the midwives into its mainstream structure, ensuring the

districts yearly (FY) health planning caters for these hard to reach areas/project locations. She also

pledged that the relevant government agencies would provide post project monitoring of the projects

locations.

Evidently the government was setting up health facilities in the areas where RCK implemented the MCH

project particularly in Tumangu/Lamit and Akurumo where HC IIs were under construction. The Treasurer

of RCK steering committee noted;

In areas where we have worked i.e. Akuromo and Tumangu the government has now built health

centers, and also recruited staff to work in those health centers including one of our midwives to work

there full time

The District Local Government also indicated readiness to meet some of the operation costs of RCKespecially on their ambulance services. The Clubs Treasurer intimated;

They have included fuel for our ambulance in their budget for this financial year, they already have

four ambulances that they budget for so plus this one there are now five ambulances budgeted for by

the district this financial year.


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4.

CHAPTER IV

4.1

CONCLUSION AND RECOMMENDATIONS

4.2

Performance on targets

4.2.1

Project objectives

4.2.1.1The projects target areas registered 32% safe deliveries (at HC) against the set project target of

50%. This was a commendable accomplishment on the part of the project as it achieved more than

half of its target. Regrettably the baseline data for this target at the start of the project was not

available to the evaluation team though the needs assessment conducted prior to the intervention

presented a rather needy situation.

4.2.1.2Up to 40% ANC re-attendance was recorded during the project period against the project target of

65%. This by all means is a good level of performance well over fifty percent of the project target.

Though this statistic was not specifically for all the stages of ANC visits but only for re-attendance itstill remain a good measure of this target.

4.2.1.3At least three quarters of the local population in the projects target area were aware of the

possibility of a referral system for woman at risk and emergencies. This implies a commendable

level of achievement in creating awareness on the same in the local community.

4.2.2

Result I

4.2.2.1The target parishes/treatment centers were visited once a week or four times a month unless

otherwise which demonstrates an excellent performance against the set target of two visits per

month to the project locations. The project also covered far more than the planned sixteen (16)

villages but 39-40 villages. This can be put at more than 200% coverage which was a stunningachievement by the project.

4.2.2.2A remarkably low percentage 9% (317 children


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4.2.4

The project design

4.2.4.1RCK consulted with the target community to establish the exact challenges of mother and child

health that they faced. The club did this through community meetings and a needs assessment

This kind of initiative at the formulation of a project is recommended to ensure the effectiveness of

a given intervention.

4.2.4.2The project addressed the specific needs of the target group/communities in as far as mother and

child health is concerned. This is quite reassuring of the possible positive long term outcomes for

mother and child health that the intervention promises.

4.2.4.3The project in addition to its mandate reached out to other groups including emergency cases, the

elderly and PWDs in desperate need of medical services. This demonstrates the flexibility exercised

within the project to ensure that it addresses emerging issues related to its mandate.

4.2.4.4There has been a noticeable positive change in the health seeking behavior of WCA in the target

areas of the project implying an improvement in the health situation of the mother and child.

4.2.5

The project implementation

4.2.5.1To a large extent the implementation team was transparent in its dealings during the project

implementation especially by involving most of the key stakeholders in the process. The project

implementing team was disciplined, motivated and professional under the competent leadership of

a seasoned nursing officer (PC).

4.2.5.2The target beneficiaries i.e. WCA were fully aware of the project and actively participated in it

especially by attending and receiving treatment/vaccination for themselves and their babies.

4.2.5.3The project was well received and owned by the beneficiaries and their communities who

thoroughly utilized the services it offered.4.2.5.4

Notably the project fully engaged the respective health workers like in-charges, health assistants

and VHTs in its areas of operation and at the district level. This ensured quality health service

delivery coming from the project as well as enhancing its chances for sustainability.

4.2.5.5The activities that the project implemented met the expectations of the beneficiaries and other

stakeholders and largely fulfilled the promises of the project as outlined at its launch. This

underlines the trust that the Club has built in the community with the implementation of this

project.

4.2.5.6Some planned activities were not fully implemented whereas another took so long to implement.

These discrepancies would certainly diminish the desired effect expected of the respectiveactivities.

4.2.5.7The monitoring system was found to be wanting despite the availability of supporting documents

like the logical framework. This would deprive the various project stakeholders from continually

providing the right kinds of responses to challenges and opportunities that emerged during the

implementation.


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4.2.5.8The internal control system for the project needed to be tightened so as to ensure timely and

effective communication between stakeholders regarding resource utilization among others.

4.2.5.9Beneficiary opinion on the project implementation was not seriously sought on an ongoing basis

which deprived the project of valuable ideas to continuously tune itself to the needs of the target

communities.

4.2.5.10 Local leaders at the village level were more involved in the project implementation than their

sub-county level counterparts. This situation does not augur well for accountability within the

project and the necessary political support.

4.2.6

Relationship with stakeholders

The project enjoyed an excellent relationship with the government which involved sharing of personnel,

office space, medical supplies and procuring an ambulance for the project among others. This relationship

facilitated the achievement of the project goals a great deal.

The project could have done more to engage other partners involved in implementing similar interventions

in its target areas. This would have ensured even more efficiency in the delivery of its stated objectives.

4.2.7

Challenges

4.2.7.1The project had to co-opt some personnel from the district health structure to supplement its

limited staff capacity (number). This posed a potential risk for the project as these government

functionaries are expected to be at their stations full time.

4.2.7.2There was inadequate drug supply on some occasions during the project imp lementing teams field

trips/treatment days. Again the project had to rely on government to supplement its stock whichmight have turned out not quite reliable.

4.2.7.3The sub-county leaders in Akwang/lamit parish were less than impressed with the projects choice

of intervention as the apparently most feared cause of child morbidity (the nodding syndrome) did

not get the attention it deserved. This disparity in opinion between the sub-county leadership and

the project management sapped away at the opportunity for synergy.

4.2.7.4The VHTs were not adequately motivated to secure their total commitment in the project. This

probably explains their reluctance to take initiative to further the projects cause like organizing

frequent education units for mothers.

4.2.7.5

Poor infrastructure in terms of communication and transport was a barrier in the projectimplementation and will continue to jeopardize access to health services for mothers and children

even after the project.

4.2.8

Project performance and impact

4.2.8.1Overall the project performed well in terms of addressing the problem of inaccessibility to vita

health services for the mother and child in hard to reach areas.


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4.2.8.2The intervention resulted into visible positive outcomes in the health situation of mothers and

children. The rates of morbidity and mortality from common illnesses dropped markedly during the

project highlighting the success registered by the project.

4.2.8.3The counseling and sensitization that the project offered through its health workers on hygiene,

family planning and antenatal care visits significantly on a positive note changed the health seeking

behavior of WCA in the project area.

4.2.8.4The project revived the referral system in the target areas by building the capacity of the local

health service structure and offering ambulance service which will continue to operate in the

project areas long after the closure of the project.

4.2.8.5Though most women are now aware and willing to practice various family planning methods, men

and the elderly are still reluctant and sometimes against the idea of FP. This calls for continued

effort to break conservatism with regards to procreation for the benefit of individual households

and the entire community.

4.2.8.6

Despite the sensitization of community members on the maintenance of both personal and

environment hygiene there appears to be a reluctance to seriously practice the awareness that has

been imparted in these communities implying a recurrence of already diminished common

illnesses.

4.2.8.7WCA in the target areas now have adequate awareness of the benefits of HC deliveries and a

positive attitude to go with it. This is bound to cut back the rampant maternal and child mortality

that arise from poorly conducted deliveries.

4.2.9

The capacity of VHTs

The VHTs trained and mentored by the project are today better skilled and prepared to provide healthservices for the mother and child. They have acquired both soft and hard skills in their domain of work

making them more resourceful and reliable to protect the health of the mother and child.

However there is still need for further training of VHTs to provide some basic health services that they are

mandated to carry out in their areas of operation.

4.2.10

The project sustainability

The project beneficiaries do not trust the government to carry forward the projects initiatives in the

manner that the RCK conducted it.

The beneficiaries will not be able on their own to sustain the supply of some of the materials they received

from the project like the mama-kit in the short run.

The relevant government agencies have the necessary resource and political will to carry out some of the

projects initiatives like the ambulance service for hard to reach areas.


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4.3RECOMMENDATIONS, INSIGHTS AND LESSONS LEARNT.

4.3.1 The technical staff and the steering committee established that carrying out an integrated

approach to implementation of activities can produce excellent results as it was the case with this

project. The project offered a whole package for mother and child health making the intervention

quite effective and meaningful.

4.3.2 Having a good working relationship with key stakeholders is crucial for the success of a project.

Given the cordial relationship the project enjoyed with the relevant government offices, it was in

position to address so many of the challenges that it faced for better results.

4.3.3 Good collaboration with the local leadership and engaging the existing relevant structures like VHTs

and TBAs is crucial for the success of a project.

4.3.4 Concrete baseline data against which the project targets are set must be established (through a

thorough needs assessment exercise) and made accessible to all relevant stakeholders. This would

ensure effective monitoring and accountability among the projects stakeholders.

4.3.5

A project being implemented should also monitor and document the performance of otheractors/partners undertaking similar interventions in its target area/with its target beneficiaries.

This would enhance efficiency and maximize the expected project outcomes.

4.3.6 Support visits/follow-up and mentoring should be provided to trainees under every project so that

they are properly engaged in rolling out the skills and knowledge they gained for the benefit of the

community members.

4.3.7 Flexibility within a project is highly recommended as it would allow for unforeseen circumstances

and ensure that emerging needs are continually addressed within a project.

4.3.8 Adequate dialogue has to happen between stakeholders to ensure that they are on the same page

during project implementation. This would enhance collaboration, ownership of project outcomesby stakeholders and project sustainability in the long run.

4.3.9 During the implementation of this project it was noted that building of trust and confidence among

beneficiaries was important for sustenance of a project outcomes and project ownership among

beneficiaries.

4.3.10 The suitability and capacity of the personnel hired to implement the project must be carefully

considered. This is to ensure that activities are implemented adequately and on time. Untimely and

inadequate implementation of planned activities would diminish their effects for the project.

4.3.11 It is important to make community participation a reality than just for its own sake. This would

ensure undivided support and commitment by the beneficiary community to the projectscause.4.3.12 A proper monitoring plan or framework with clear baseline data, indicators, targets, responsible

persons, and timeframe among others is highly recommended for every project to measure

progress towards set objectives and goals.

4.3.13 A consumer/client feedback mechanism ought to be established within a project for timely and

appropriate response. This would enhance the effectiveness of a given intervention and ensure

that emerging challenges within the project are addressed on a continual basis.


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4.3.14 A stakeholder analysis and

Documents

Final Copy End Term Evaluation Report