Midterm Performance Evaluation of the Bangladesh Social Marketing
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EVALUATION MIDTERM PERFORMANCE EVALUATION OF THE BANGLADESH MARKETING INNOVATIONS FOR HEALTH PROJECT April 2016 This publication was produced for review by the United States Agency for International Development. It was prepared independently by Beverly Stauffer, Md. Ayub Ali, Joan Yonkler, Nurjahan Begum, and Ahmed Mollah Mahmud through the Global Health Program Cycle Improvement Project. ACKNOWLEDGMENTS GH Pro and the evaluation team would like to extend our appreciation for the significant time and information provided by the management, staff and board chairman of the Social Marketing Company and the Marketing Innovations for Health Project partners, including the management and staff of BRAC, Concerned Women for Family Development, Population Services and Training Center, and Shimantik, as well as the management and staff of EngenderHealth, the Population Services International advisor to SMC, and training partners Obstetric and Gynecological Society of Bangladesh and AITEM Welfare Organization. Special thanks are extended to SMC area offices and BRAC and Shimantik field teams for arranging informative field visits. The evaluation team is grateful to the Ministry of Health and Family Welfare Directorate General of Family Planning office, district and subdistrict health and family planning departments, and subdistrict government administration and non-governmental organization representatives for their cooperation and support during data collection. The team thanks the Bangladesh police for ensuring security of the evaluation team during the field work. The evaluation team appreciates the insights provided by many local and international public health experts and USAID partners about critical public health needs in Bangladesh and ongoing or needed interventions. We also extend our appreciation to Dr. Sukumar Sarker and Dr. Ferdousi Begum for their guidance and assistance, as well as to the wider USAID health and program office monitoring and evaluation team, for their oversight, support and critical review of this report. Cover photo: Meeting of married women of reproductive age in Moulvibazar. Source: USAID/Bangladesh. MIDTERM PERFORMANCE EVALUATION OF THE BANGLADESH MARKETING INNOVATIONS FOR HEALTH PROJECT April 2016 Evaluation Mechanism: AID-OAA-C-14-00067 Disclaimer The views of the authors expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Documents are made available through the Development Experience Clearinghouse (http://dec.usaid.gov). Additional information can be obtained from: The Global Health Program Cycle Improvement Project 1301 Pennsylvania Avenue NW, Suite 850 Washington, DC 20004 CONTENTS Acronyms ...................................................................................................................................... iii Executive Summary ...................................................................................................................... v Background .................................................................................................................................................................. v Evaluation purpose, questions, and methodology .............................................................................................. v Findings and conclusion ........................................................................................................................................... vi Recommendations .................................................................................................................................................... vii I. Evaluation Purpose and Questions ................................................................................... 1 II. Project Background ........................................................................................................... 3 III. Evaluation Methods and Limitations ................................................................................ 5 IV. Key Findings ........................................................................................................................ 7 A. How effective is the MIH project? .............................................................................................................. 7 B. Should USAID move into new program areas? ..................................................................................... 26 C. Should USAID continue to invest in social marketing programs? ..................................................... 32 V. Conclusions ....................................................................................................................... 37 VI. Priority Recommendations ............................................................................................. 39 A. Current MIH project: immediate priority recommendations ............................................................. 39 B. Priority recommendations for follow-on MIH programming/new investments ............................. 41 ANNEXES .................................................................................................................................... 47 ANNEX A. Scope of Work ................................................................................................................................... 47 ANNEX B: Evaluation Methods and Limitations .............................................................................................. 81 ANNEX C: Original Data Collection Tools ...................................................................................................... 89 ANNEX D. Persons Interviewed or Participants in Discussions .............................................................. 105 ANNEX E. Documents Reviewed ..................................................................................................................... 109 ANNEX F. Conflict of Interest Statements .................................................................................................... 111 TABLES Table 1. Product Sales 13 Table 2. Sales Trends 14 Table 3. Household Tracking Surveys 23 BANGLADESH MARKETING INNOVATIONS FOR HEALTH PROJECT EVALUATION i FIGURES Figure 1. Product Sales by CSAs in Sylhet Division 14 Figure 2. Sales and Insertion Status of IUD by Year 15 Figure 3. Status of Sale and Insertion of Implants 15 Figure 4. Ten Essential Public Health Services 32 ii BANGLADESH MARKETING INNOVATIONS FOR HEALTH PROJECT EVALUATION ACRONYMS BCC Behavior change communication BDHS Bangladesh Demographic and Health Survey BSP Blue Star provider CBA Community birth attendant CPR Contraceptive prevalence rate CSA Community Sales Agent CWFD Concerned Women for Family Development CYP Couple-years of protection DGFP Directorate General of Family Planning DGHS Directorate General of Health Services DOTS Directly observed treatment, short-course FWA Family welfare assistant FWV Family welfare visitor FY Fiscal year GH Pro Global Health Program Cycle Improvement Project HIP High Impact Practice IEC Information, education and communication IMCI Integrated Management of Childhood Illness IT Information technology IUD Intrauterine device LAPM Long-acting and permanent methods LARC Long-acting reversible contraceptive LQAS Lot Quality Assurance Sampling M&E Monitoring and evaluation MCH Maternal and child health MIH Marketing Innovations for Health MIS Management information system MOHFW Ministry of Health and Family Welfare BANGLADESH MARKETING INNOVATIONS FOR HEALTH PROJECT EVALUATION iii MWRA Married women of reproductive age NCD Non-communicable disease NGO Non-governmental organization NHSDP NGO Health Service Delivery Project OGSB Obstetric and Gynecological Society of Bangladesh ORS Oral Rehydration Saline PCHP Private community health provider PDA Personal digital assistant PSI Population Services International PSTC Population Services and Training Center SBCC Social and behavior change communication SHOPS Strengthening Health Outcomes through the Private Sector SK Shasthya Korma SMC Social Marketing Company SS Shatha Shebika TB Tuberculosis TBA Traditional birth attendant TV Television USAID United States Agency for International Development WASH Water, sanitation and hygiene iv BANGLADESH MARKETING INNOVATIONS FOR HEALTH PROJECT EVALUATION EXECUTIVE SUMMARY BACKGROUND The goal of the Marketing Innovations for Health (MIH) Project, supported by the U.S. Agency for International Development (USAID), is to “Contribute to sustained improvements of the health status of women and children in Bangladesh by increasing access to and demand for essential health products and services through the private sector.” The Social Marketing Company (SMC) leads this initiative in partnership with EngenderHealth, BRAC, Concerned Women for Family Development, the Population Services and Training Center, and Shimantik, with technical assistance provided by Population Services International (PSI). The project began in July 2012 and will end in July 2016. Project funding includes $15.0 million in federal cash funds, provision of contraceptive commodities expected to generate $2.2 million for program use, and $112.3 million in cost share. This project builds on the long relationship between USAID, SMC and PSI to develop social marketing in Bangladesh, heralded as “one of USAID’s greatest success stories of sustainability and sustainable development,” and previous USAID-funded work to improve private sector health care,