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Evaluating an Integrated Reproductive Health Program: India Case Study

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Evaluating an Integrated Reproductive Health Program: India Case Study Lessons from the Field Evaluating an Integrated Reproductive Health Program: India Case Study This report details the methods and findings of a participatory evaluation of integrated repro- ductive health programs in two villages in India, with comparisons to a third village that had no reproductive health programming. The results suggest that the integrated approach used by World Neighbors-India and its partners is effective in achieving high rates of reproductive health knowledge and positive practices, improvements in women’s status, and significant benefits from participation in savings and credit groups. Preface World Neighbors has always been committed to learning through program experience. In the area of reproductive health, World Neighbors has had the unique opportunity to contribute to others working in the field by documenting the results of an integrated approach in which reproductive health is a central feature. The following evaluation study concerns an established World Neighbors’ program which has incorporated a repro- ductive health component. Previously, the program (in the Gulbarga District of the state of Karnataka in India) had been oriented to dry land sustainable agriculture. While women were included in the farmers’ groups, men were the primary program partners. The reproductive health component was developed based on previous World Neighbors’ experiences in Nepal. The process of establishing the reproductive health component presented multiple challenges and opportunities for the WN India team and its partners. They continually adapted what they had learned in their previous work with communities to meet these challenges. With strong leadership and a clear process for learning, the program team and partners have constructed a meaningful integrated program that has achieved the important results which are presented here. This evaluation originally was designed to examine the impact of the reproductive health component and make recommendations for modifications before the program was expanded elsewhere. However, the results of the evaluation were so compelling that World Neighbors decided to produce this document as a means of sharing both the program approach and the evaluation methodology, as both encompass unique aspects that may be valuable to others. Catharine McKaig, DrPH, MS Reproductive Health Coordinator World Neighbors Core Evaluation Team Members: Dr. Subhash Gumaste Ms. Laxmi M. Madras Ms. Kellye O’Bryan Dr. Shiva Sharanappa M. Hallad Mr. Subbanna Biradar Mr. Mallikajun Kavalagi Mr. Iranagouda Goudappa Patil Mrs. Mahadevi Kavalagi The evaluation team would like to sincerely thank the women and men of Nellur, Yelenavadgi, and Khanapur for their participation in these evaluation activities. The BSRDS staff also worked long hours to make the evaluation a success. The on-going work in these villages is truly an inspiration for others. World Neighbors’ reproductive health programs in India are funded by the Bill and Melinda Gates Foundation. The publication of this case study was also made possible with funding from the Bill and Melinda Gates Foundation. Portions of the evaluation of the reproductive health programs in India were funded by the Summit Foundation. Catharine McKaig, Evaluating an Integrated Reproductive Health Program: India Case Study; edited by Linda Temple (Oklahoma City: World Neighbors, 2002) Published by World Neighbors, Oklahoma City, Oklahoma 73120 @2002 by World Neighbors ISBN 0-942716-16-7 Reproducing this publication: We encourage users to copy portions of this publication for personal use and to share with others on a limited scale. However, we request that you cite the original text and that no attempts be made to sell this or any World Neighbors publication without permission. World Neighbors would appreciate receiving copies of any publication which draws on this material. 2 - Evaluating an Integrated Reproductive Health Program Table of Contents Map of Program Area --------------------------------------------------------------------------------------------------------------- 4 Executive Summary ---------------------------------------------------------------------------------------------------------------- 5 Background and Evaluation Rationale ---------------------------------------------------------------------------------------- 7 Operational Phases of Adding the RH Component ----------------------------------------------------------------------- 9 Evaluation Framework and Methodology A Pre-planning ------------------------------------------------------------------------------------------------------------------ 10 B. Evaluation design ----------------------------------------------------------------------------------------------------------- 10 C. Development of Evaluation Tools ---------------------------------------------------------------------------------------- 12 D. Data collection training----------------------------------------------------------------------------------------------------- 12 E. Field work --------------------------------------------------------------------------------------------------------------------- 12 F. Analysis ----------------------------------------------------------------------------------------------------------------------- 14 G. Report Writing ---------------------------------------------------------------------------------------------------------------- 14 Evaluation Findings A. Women’s Status Exercise 1: Women’s Status ---------------------------------------------------------------------------------------------- 15 Findings: Women’s Status--------------------------------------------------------------------------------------------- 16-20 B. Reproductive Health Exercise 2: RH Historical Matrix ----------------------------------------------------------------------------------------- 21 Findings: Reproductive Health --------------------------------------------------------------------------------------- 22-28 C. Capacity - Women’s Groups and BSRDS Exercise 3: Capacity Evaluation for Women Group Members ---------------------------------------------------- 29 Findings: Group and Organizational Capacity -------------------------------------------------------------------- 30-32 D. Integration Exercise 4A/4B: SSI-RH with Men’s Groups/SSI-Agri with Women’s Groups --------------------------------- 34 Findings: Integration ---------------------------------------------------------------------------------------------------- 35-37 E. Livelihood Exercise 5: Livelihood Ranking for Women Group Members ------------------------------------------------------ 38 Findings: Livelihood ----------------------------------------------------------------------------------------------------- 39-41 Evaluation Results and Limitations A. Responses to Key Questions ---------------------------------------------------------------------------------------- 41-44 B. Limitations of the Evaluation ----------------------------------------------------------------------------------------- 45-46 Lessons Learned and Conclusions A. Impact of Group Activities ------------------------------------------------------------------------------------------------ 47 B. The Evaluation Process --------------------------------------------------------------------------------------------------- 48 C. Discussion and Conclusions --------------------------------------------------------------------------------------------- 49 Appendices: Appendix A: Questionnaire ------------------------------------------------------------------------------------------------- 51-57 Appendix B: Evaluation Training Schedule ---------------------------------------------------------------------------------- 59 Appendix C: Health Services Maps -------------------------------------------------------------------------------------- 61-62 Evaluating an Integrated Reproductive Health Program - 3 Map of the Program Area Aland Subdistrict KHANAPUR YELENAVADGI NELLUR Gulbarga District Karnataka State 4 - Evaluating an Integrated Reproductive Health Program Executive Summary An evaluation of the reproductive from the wives of agriculture major achievements of the health component of the Bayalu group members and non-mem- groups. Seeme Rural Development bers in a non-intervention village Society (BSRDS) integrated (Khanapur). Approximately 200 2) There were reported changes program took place between women and 60 men from the in indicators of women’s status April 25 and May 16, 2001 in the three communities participated for intervention villages, particu- villages of Nellur, Yelenavadgi, in the evaluation exercises. larly for group members. and Khanapur in the Aland Third, the evaluation incorpo- Women noted positive changes Subdistrict of the Gulbarga rated quantitative and qualitative in decision making, property District in the southern state of methods. Both participatory ownership, girl child education, Karnataka in India. The repro- methods and a short survey and reduction of violence against ductive health component was were used to facilitate the trian- women, all largely attributed to initiated in 1998 by World Neigh- gulation of data for verification the group’s activities. bors, in partnership with and attribution. BSRDS. The objectives of the According to the women, the evaluation were to Key findings from the evaluation: groups have provided them with the confidence to organize to 1) review the reproductive 1) Significant changes were undertake a variety of initiatives health component of the reported in
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