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Dinajpur Safemother Initiative Final Evaluation Report

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Dinajpur Safemother Initiative Final Evaluation Report Dinajpur SafeMother Initiative Final Evaluation Report Anita Barbey, CNM, DrPH Abu Jamil Faisel, MBBS, DPM, MP Juliana Myeya, AD Diploma MH Vivi Stavrou, MSocSc Clin Psych Jaime Stewart, MPH Susan Zimicki, ScM, PhD July 19, 2001 Table of Contents Table of Contents Acknowledgments Acronym List Executive Summary I. BACKGROUND .........................................................................................................13 A. Bangladesh Health Care System............................................................................13 II. INTRODUCTION .......................................................................................................16 A. Scope of Work for this Evaluation.........................................................................16 B. Methodology of the Final Evaluation ....................................................................16 III. ASSESSMENT OF RESULTS AND PROGRAM IMPACTS...................................20 A. Summary Charts of Final Project Data ..................................................................20 B. Case Fatality Rates.................................................................................................20 C. Technical Approach: Project Description and Methodology.................................23 D. Evaluation of Key Project Interventions................................................................24 1. Birth Planning..................................................................................................24 a. Description of the Birth Planning Intervention..........................................24 b. Objectives of Birth Planning......................................................................25 c. Method of Evaluation of Birth Planning....................................................25 d. Results of Implementation of the Birth Planning Intervention..................26 e. Factors Facilitating Achievement of Birth Planning Objectives ...............30 f. Factors Hindering Achievement of Birth Planning Objectives .................30 g. Special Outcomes and Unexpected Results in Birth Planning ..................31 h. Lessons Learned regarding Birth Planning................................................31 2. Community Support System (CmSS) ..............................................................31 a. Description of the Community Support System Intervention....................31 b. Objective of the Community Support System Intervention.......................32 c. Method of Evaluation of the Community Support System Intervention ...32 d. Results of Implementation of Community Support Systems.....................33 e. Factors Facilitating Achievement of Objectives regarding Community Support Systems...................................................................................40 f. Factors Hindering Achievement of Objectives regarding Community Support Systems...................................................................................41 g. Special Outcomes and Unexpected Results regarding Community Support Systems...................................................................................41 h. Lessons Learned regarding Community Support Systems ........................42 3. Quality of Care (QoC) .....................................................................................42 a. Overview of the Quality of Care Intervention ...........................................42 b. Objective(s) of the Quality of Care Intervention .......................................43 c. Method of Evaluation of the Quality of Care Intervention........................43 d. Results of the Implementation of the Quality of Care Intervention...........43 DSI Final Evaluation Report 2 e. Factors Facilitating Achievement of Objectives related to Quality of Care......................................................................................................45 f. Factors Hindering Achievement of Objectives related to Quality of Care......................................................................................................46 g. Special Outcomes and Unexpected Results regarding Quality of Care.....46 h. Lessons Learned regarding Quality of Care ..............................................47 3. Violence Against Women(VAW)....................................................................48 a. Description of the Violence Against Women Intervention........................48 b. Objective(s) of the Violence Against Women Intervention ......................49 c. Method of Evaluation of the Violence Against Women Intervention .......49 d. Results of the Implementation of the Violence Against Women Intervention..........................................................................................49 e. Factors Facilitating Achievement of the Violence Against Women Intervention..........................................................................................54 f. Factors Hindering Achievement of Objectives related to the VAW Intervention..........................................................................................54 g. Lessons Learned regarding the Violence Against Women Intervention ...55 E. Tools and Innovative Methods Applied during the Project...................................56 F. Cross Cutting Themes............................................................................................57 1. Capacity Building............................................................................................57 2. Sustainability....................................................................................................58 3. Replicability.....................................................................................................60 4. Partnership .......................................................................................................60 5. Gender..............................................................................................................61 IV. CONCLUSIONS AND RECOMMENDATIONS ......................................................63 A. Conclusions............................................................................................................63 1. Birth Planning..................................................................................................63 2. Community Support Systems ..........................................................................63 3. Quality of Care.................................................................................................63 4. Violence Against Women................................................................................63 5. Project-wide Conclusions................................................................................64 B. Recommendations..................................................................................................64 1. Birth Planning..................................................................................................64 2. Community Support Systems ..........................................................................64 3. Quality of Care.................................................................................................65 4. Violence Against Women................................................................................65 5. Project-wide Recommendations......................................................................66 V. ANNEX........................................................................................................................67 A. References..............................................................................................................67 B. Persons Interviewed/Met.......................................................................................69 C. DSI Quality of Care Observation Checklist...........................................................73 D. Dinajpur Safe Mother Initiative Training Summary..............................................74 E. Highlights of DSI Project Final Evaluation Debriefing.........................................78 F. DSI List of Materials Developed During 1998-2001 ............................................82 DSI Final Evaluation Report 3 Acknowledgments The DSI Final Evaluation Team would like to especially thank Mr. Steve Wallace, Country Director and Ms. Susan Ross, Assistant Country Director from CARE- Bangladesh, Dr. Baki, Line Director-ESP from the Government of Bangladesh and Dr. Yasmin Ali Haque, Project Officer-Health and Nutrition, from UNICEF for their encouragement and support throughout our evaluation of this project. We also wish to thank the organizations these individuals represent for the funding of this important work which we are honored to evaluate. We also wish to thank Dr. Abul Barkat, the Human Development Research Centre and Mr. M. Sekander H. Khan, PhD, Associates for Community and Population Research for their assistance in helping us better understand the baseline and final DSI survey data which they respectively collected and to Dr. Ann Levin for her responsiveness to our queries regarding the cost-effectiveness of the DSI. Further thanks to the DSI staff and the UHC staff of the three study areas for their untiring help in providing us with the documents and data which we requested. Also, we particularly wish to express our deep appreciation to the individuals and families who permitted us to interview and observe them during our visits to the field. This report would not have been possible without them.
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