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Final Evaluation of Plan Laos Maternal, Newborn & Child Health

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Final Evaluation of Plan Laos Maternal, Newborn & Child Health Final evaluation of Plan Laos Maternal, Newborn & Child Health & Nutrition Program And Mid-Term Evaluation of Water, Sanitation and Hygiene Program In Meung, Paktha and Pha Oudom Districts Bokeo Province, Lao PDR Evaluation team: Dr Thongdeuane Nanthanavone, Team Leader and Primary Author Dr Khampheng Phongluxa, Ms Amphone Chanthamith July-August 2015 i Acknowledgement The consultants would like to acknowledge the support they received from the staff of Plan International Lao PDR, the Bokeo Team and District Team Leader of all three target district. The team expresses special appreciation to Hilda Winartasaputra, Dr Kalana Peiris, and Yuko Yoneda for their guidance throughout the evaluation process. Our special thanks also go to the National Managers of WASH and MNCH-N and their provincial counterparts without their supports the evaluation would not have completed successfully. The team also greatly appreciates the contributions from representatives of Plan implementation partners and other international organizations who generously gave their time to talk with the evaluation team. ii Abbreviations ANC Antenatal care BEP Basic Education Program BCC Behavioral change communication CLTS Community Led Total Sanitation CWS Community Water System DEB District Education Board DHO District Health Office DHO District health office DRDO District Rural Development Office DRDPRO District Rural Development & Poverty Reduction Office DWTs District WASH teams ECED Early Childhood Education and Development EU European Union EPI Expended project immunization FGD Focus Group Discussion GFWS Gravity Fed Water System HC Health Centre HH Household/s HP Hygiene Promotion HW Hand Washing IEC Informational and Educational Communications INGOs International Non-Government Organizations KII Key informant interview LRC Lao Red Cross LWU Lao Women's Union LYU Lao Youth Union LSIS Lao Social Indicators Survey MCH Mother and child health M&E Monitoring and Evaluation MDG Millennium Development Goal MHV Model Health Village MNCH-N Maternal neonatal and child health and nutrition MoE Ministry of Education MoH Ministry of Health MoU Memorandum of Understanding MTR Mid Term Review NCA Norwegian Church Aid iii NGO Non-Government Organization O&M Operations and Maintenance OD Open Defecation ODF Open Defecation Free PADETC Participatory Development Training Centre PCA Participatory Community Assessment PDR People's Democratic Republic PED Provincial Education Department PES Provincial Education Service PHD Provincial Health Department PNC Postnatal care PRDPRO Provincial Rural Development & Poverty Reduction Office PW Pregnant women RWSS Rural Water and Sanitation Strategy SBA Skill birth attendant S&H Sanitation and Hygiene SIDA Swedish International Development Agency SLTS School Led Total Sanitation SO Specific objective SoQ School of Quality SSHT School Sanitation and Hygiene Triggering ToR Terms of Reference ToT Trainers of Trainor TT Tetanus toxoid TWG Technical Working Group UNICEF United Nations Children's Fund U5Y Under five years VEDC Village Education Development Committee VHC Village health committee VHV Village health volunteer WASH Water, Sanitation and Hygiene WHO World Health Organization WRA Women in reproductive age WS Water System WSP Water and Sanitation Project (World Bank) iv Contents Acknowledgement ........................................................................................................... ii Executive Summary .......................................................................................................... x 1. Introduction ................................................................................................................. 1 1.1 Country Context .......................................................................................................... 1 1.2 Plan International in Lao PDR ..................................................................................... 3 1.3 The WASH and MNCH-N Programs ............................................................................ 4 1.4. The evaluation ......................................................................................................... 10 Purpose of the evaluation ................................................................................................ 10 Desk review ...................................................................................................................... 11 Primary Data Collection ................................................................................................... 11 Data management and analysis ....................................................................................... 14 Constrains and Limitations .............................................................................................. 14 2. Results, achievement and progress ............................................................................. 16 2.1 Achievements of the WASH program ....................................................................... 16 Achievements and progress toward specific objective 1 ................................................ 16 Achievements and progress toward specific objective 2 ................................................ 19 Achievements and progress toward specific objective 3 ................................................ 21 Achievements and progress toward specific objective 4 ................................................ 23 2.2 Achievements of the MNCH-N program ................................................................... 25 Achievements and outcome for specific objective 1 (SO1): ............................................ 25 Achievement and progress for specific objective 2: ........................................................ 30 Achievements and progress toward specific objective 3 ................................................ 34 3. Relevance ................................................................................................................... 36 3.1 Relevance of the WASH Program ............................................................................. 36 Relevance of the project design ...................................................................................... 36 Water supply system rehabilitation and construction .................................................... 37 Sanitation component ..................................................................................................... 38 Hygiene promotion component ...................................................................................... 38 3.2 Relevance of the MNCH-N Program ......................................................................... 39 Delivery mechanism ......................................................................................................... 40 Monitoring and reporting ................................................................................................ 40 Focus on nutrition ............................................................................................................ 40 v 4 Effectiveness ............................................................................................................... 42 4.1 Effectiveness of the WASH program ........................................................................ 42 Hygiene promotion component ...................................................................................... 42 CLTS .................................................................................................................................. 45 Construction/rehabilitation of WASH facilities ............................................................... 48 Participatory governance in WASH sector ....................................................................... 50 Working relationships with government partners .......................................................... 50 4.2 Effectiveness of the MNCH-N Program .................................................................... 52 4.3 Monitoring and Evaluation ....................................................................................... 59 5 Impacts and synergy .................................................................................................... 61 Impacts at the household level ....................................................................................... 61 Impacts at the community level ..................................................................................... 63 Impacts at the local government levels .......................................................................... 65 Synergy .......................................................................................................................... 66 6 Sustainability ............................................................................................................... 68 6.1 Sustainability of WASH ............................................................................................. 68 6.2 Sustainability of MNCH-N ......................................................................................... 74 7 Scalability .................................................................................................................... 77 7.1 WASH ........................................................................................................................ 77 7.2 MNCH-N ...................................................................................................................
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