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Usaid/Nigeria Maternal, Child, and Reproductive Health Program Mid-Term Evaluation

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Usaid/Nigeria Maternal, Child, and Reproductive Health Program Mid-Term Evaluation USAID/NIGERIA MATERNAL, CHILD, AND REPRODUCTIVE HEALTH PROGRAM MID-TERM EVALUATION November 2009 This publication was produced for review by the United States Agency for International Development. It was prepared by Dr. Dan Blumhagen, Dr. Carol Barker, Dr. Muyiwa Oladosu, Dr. Olubunmi Olufunke Asa, and Dr. Jack Reynolds through the Global Health Technical Assistance Project. USAID/NIGERIA MATERNAL, CHILD, AND REPRODUCTIVE HEALTH PROGRAM MID-TERM EVALUATION DISCLAIMER The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. This document (Report No. 09-001-216) is available in print or online. Online documents can be located in the GH Tech web site library at www.ghtechproject.com/resources.aspx. Documents are also made available through the Development Experience Clearing House (www.dec.org). Additional information can be obtained from The Global Health Technical Assistance Project 1250 Eye St., NW, Suite 1100 Washington, DC 20005 Tel: (202) 521-1900 Fax: (202) 521-1901 [email protected] This document was submitted by The QED Group, LLC, with CAMRIS International and Social & Scientific Systems, Inc., to the United States Agency for International Development under USAID Contract No. GHS-I-00- 05-00005-00. CONTENTS Acknowledgements ......................................................................................................................... iii Abbreviations .................................................................................................................................... v Executive Summary ........................................................................................................................ vii Program Description ................................................................................................................ vii Programmatic Issues .............................................................................................................. viii Future USAID Programming ..................................................................................................... ix Conclusions ............................................................................................................................... ix Recommendations ........................................................................................................................... xi General Recommendations ...................................................................................................... xi ACCESS ................................................................................................................................... xi ACQUIRE .................................................................................................................................. xi IRHIN ....................................................................................................................................... xii 1. Introduction ................................................................................................................................ 1 1.1. Objective ......................................................................................................................... 1 1.2. Reproductive Health Situation in Nigeria ........................................................................ 1 1.3. Government and Donor Commitment ............................................................................. 1 1.4. USAID Strategic Plan ...................................................................................................... 2 1.5. Mid-Term Evaluation Scope of Work .............................................................................. 3 1.6. Methodology .................................................................................................................... 4 1.7. Team Composition .......................................................................................................... 5 2. Project Components .................................................................................................................. 7 2.1. Overview ......................................................................................................................... 7 2.2. ACCESS .......................................................................................................................... 9 2.3. ACQUIRE ...................................................................................................................... 20 2.4. Improved Reproductive Health in Nigeria (IRHIN) ........................................................ 27 2.5. Society for Family Health: IRHIN Projects .................................................................... 33 2.6. Cross-Cutting Issues: .................................................................................................... 46 Annex A: Scope of Work ................................................................................................................ 51 Annex B: Civil Society Organizations ............................................................................................. 61 Annex C. Tables ............................................................................................................................. 63 Annex D: Persons Contacted ......................................................................................................... 73 Annex E: Documents Reviewed ..................................................................................................... 79 Annex F: Recommendations Matrix ............................................................................................... 83 USAID/NIGERIA MCH/RH PROGRAM MID-TERM EVALUATION i TABLES Table 1: Facilities Currently Covered by ACCESS ........................................................................ 10 Table 2: Proportions of Population Currently Covered by ACCESS .............................................. 10 Table 3: Progress on ACCESS Project Objective Indicators ......................................................... 12 Table 4: ACCESS Supported Health Facilities as a Proportion of Health Facilities in the State ... 15 Table 5: IRHIN Project Partners CYP Contributions 2006-2009 .................................................... 32 Table 6: Mass Media Campaign Exposure .................................................................................... 40 Table 7: Coverage of Selected Contraceptives: 2008 .................................................................... 41 Table 8: Actual CYP, 2006-2008 .................................................................................................... 42 Table 9: Total Unit Sales and CYP by Type of Contraceptive, FY 2006 – 2008............................ 63 Table 10: CYP Achievement FY 2006–FY 2008 ............................................................................ 64 Table 11: CYP Targets, FY 2006–FY 2008 .................................................................................... 65 Table 12: CYP Targets vs. Achievements, FY 2006–FY 2008 ...................................................... 65 Table 13: SO Data Table ................................................................................................................ 66 Table 14: Quality Data Indicators ................................................................................................... 67 Table 15: Enabling Environment Data Table.................................................................................. 67 Table 16: Demand Data Table ....................................................................................................... 68 Table 17 A: Access Data Table ...................................................................................................... 69 Table 17 B: Additional Access Data Indicator Table ...................................................................... 70 Table 18: Mystery Client Results .................................................................................................... 71 Table 19: Client Satisfaction with FP Service ................................................................................. 71 FIGURE2 Figure 1: SO 13: Increased Use of Child Survival and RH Services (63 IR indicators Overall) ...... 8 Figure 2: ACCESS Program Results Framework .......................................................................... 11 Figure 3: ACQUIRE Program Results Framework ......................................................................... 23 Figure 4: Model Element 1: IRHIN's Results Framework with SO PMP and USAID Common Indicators ........................................................................................................ 28 ii USAID/NIGERIA MCH/RH PROGRAM MID-TERM EVALUATION ACKNOWLEDGEMENTS The evaluation team wishes to express its gratitude to the management and staff of the Society for Family Health. Its cooperation, openness, and logistical support were very much appreciated. The team also wishes to thank our two research/logistics assistants, Mr. Charles Asa and Ms. Ezedwueme Chinene of Mira Monitor, who accompanied us throughout the evaluation. All of the implementing partners, ACCESS, ACQUIRE, Pathfinder, and the Society for Family Health, graciously made themselves available to support the team in its understanding of their projects. Without this support, the team would not have been able
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