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4.2.1.1. Knowledge of Contraceptive Methods 42 4.2.1.2 I Lists of tables III Lists of Figures V ACRONYMS VI Acknowledgment VII Evaluators VIII Executive summary IX I. INTRODUCTION 1 1.1. Background 1 1.2. Context of RH/FP in Oromia Region 4 1.3. Program Description 6 1.3.1. Objective of the Project 6 1. General Objective: 6 2. Specific Objectives of ODA program: 6 1.3.2. Program Components 7 1.4. Justification of the Evaluation 9 1.5. Stakeholder Analysis 9 II. OBJECTIVE OF THE EVALUATION 11 2.1 General Objective 11 2.2. Specific objectives of the evaluation 11 2.3 Evaluation Questions 11 III. EVALUATION METHODOLOGY 15 3.1. Study area and Period 15 3.2 Evaluation Design and Data collection Methods 15 3.3. Sample size and sampling technique 16 3.4. Data management and analysis Limitations of the study 18 3.5. Ethical considerations 19 IV. RESULTS AND DISCUSSIONS 21 4.1. Degree of Program Implementation 21 4.1.2. Level of stakeholders’ involvement 22 4.1.4. Supervisory Support 24 4.1.5. Capacity Building Activities 24 4.1.6. Role of CBRHAs and their acceptance by the community 26 4.1.7. Information, Education, and Communication (IEC) 29 Evaluation of Reproductive Health/Family Planning Project Of Oromia Development Association (ODA) II 4.1.7.2. Provisions of Information and Education 30 4.1.7.3. Exposure to Family Planning messages 31 4.1.7.4. Organize/Supporting in and out-of-school youth clubs 32 4.1.8. Provisions of Contraceptives 33 4.1.8.1. Amount of contraceptive methods and Couple-year protection (CYP) generated 33 4.1.8.2. New contraceptive users 34 4.1.8.3. Contraceptive Acceptance Rate: 36 4.1.8.4. Perceived Quality of services and Client Satisfaction 37 4.1.8.5. Informed choice 40 4.2. Outcome of the project 40 4.2. 2. Family Planning 42 4.2.1.1. Knowledge of contraceptive methods 42 4.2.1.2. Use of contraceptive methods 44 4.2. 2. Age at first marriage 51 4.2.3. Utilization of Maternal Health services 51 4.2.3.1. Antenatal care 52 4.2.3.2. Delivery care 54 4.2.3.3. Postnatal Care (PNC) 56 V. CONCLUSION AND RECOMMENDATION 63 5.1. Conclusion 63 5.2. Recommendation 65 VI. REFERENCES 69 VII. ANNEXES 73 Annex I. List of documents received from ODA RH/FP project coordinating office and used for document review. 73 Annex II. Ranking of Woredas Based on their Performance 76 Annex III. Discussion guide used to facilitate of Focus Group Discussions with CBRHAs 78 Annex IV. Discussion guide for Focus Group Discussion with Adolescents 81 Annex V. Guide for Expert Interview – Health Offices 83 Annex VI. Guide for Expert Interview – ODA Coordinators 87 Annex VII. In-depth interview guide for health workers 90 Evaluation of Reproductive Health/Family Planning Project Of Oromia Development Association (ODA) III LISTS OF TABLES Table 1 List of sampled woredas per zone and distribution of samples to zones and woredas, June 2009. 17 Table 2 Planned vs. Achieved selected Capacity Building Activities goals, 2000-2008, Ethiopia, 2009. 26 Table 3 Percentage distribution of Availability of CBRHAs and type of service they provide, by project zones, Ethiopia, 2009 . 27 Table 4 IEC materials distributed to support IEC activity, 2000-2008, Ethiopia, 2009. 29 Table 5 Total number of encounters with people on RH through IEC Activities by project zones and year; 2000-2008, Ethiopia, 2009.. 30 Table 6 Total number of Contraceptive methods distributed and CYP Generated by Method and project zone; 2000-2008, Ethiopia, 2009.. 34 Table 7 Cumulative Number of New Contraceptive users by method and year; 2000-2008, Ethiopia, 2009. 35 Table 8 Information related to Perceived quality of services and client satisfaction towards RH/FP service provided, Ethiopia, 2009. 38 Table 9 Socio-demographic and socioeconomic characteristics of participants, Ethiopia, 2009.: 41 Table 10 Percentage of all women and currently married women who know any contraceptive method, by specific method, Ethiopia, 2009. 43 Evaluation of Reproductive Health/Family Planning Project Of Oromia Development Association (ODA) IV Table 11 Percentage distribution of married women by type of contraceptive methods used in the last five years, Ethiopia, 2009. 46 Table 12 Percentage of all and currently married women currently using contraceptive method by specific method, age, zone, and level of education, Ethiopia, 2009. 47 Table 13 Reasons for discontinuation of contraceptives and Future Intention of contraceptive use, Ethiopia, 2009. 51 Table 14 Distribution of women who had a live birth in the past five years and received ANC by provider during pregnancy for the most recent birth, Ethiopia, 2009. 52 Table 15 Percent of women who had a live birth in the five years by the timing of the first visit and number of ANC visits for the most recent birth, Ethiopia, 2009. 53 Table 16 Comparison of Women Receiving ANC and Number of visits made during EDHS 2005, EGFHIE 2008, and current Evaluation, Ethiopia, 2009 54 Table 17 Percent of place of delivery and person providing assistance during delivery of live births in the five years by zone and level of education, Ethiopia, 2009. 55 Table 18 Percent of mothers delivered in the last five years who received PNC and time after delivery the first PNC received for the last live birth, Ethiopia, 2009. 57 Evaluation of Reproductive Health/Family Planning Project Of Oromia Development Association (ODA) V LISTS OF FIGURES Figure 1. An Evaluation framework used to assess the implementation of the program and the achievement of operational outcomes, Ethiopia, 2009. 15 Figure 2. Number of project Woredas by zone and year, 2000-2008, Ethiopia, 2009. 22 Figure 3. Percentage distribution of source of FP information among women of reproductive age group, Ethiopia, 2009 31 Figure 4. Trends of new contraceptive users by method and year; 2000-2008, Ethiopia, 2009. 36 Figure 5. Baseline, plan and achievement of Contraceptive Acceptance rate by project zone; 2000-2008, Ethiopia, 2009 37 Figure 6. Percent of respondents who indicated the project has helped them or their family by zones, Ethiopia, 2009 . 39 Figure 7. Percentage distribution of ever use of contraceptive methods among all women and currently married woman by zone, Ethiopia, 2009. 44 Figure 8. Percentage of all women and currently married women who have used any contraceptive method in the last five years by zones; Ethiopia, 2009. 45 Figure 9. Trends in Current Use of Contraception by type of methods used, 1999-2009, Ethiopia, 2009. 48 Figure 10. Percentage distribution of sources of contraceptives among current users, Ethiopia, 2009. 49 Evaluation of Reproductive Health/Family Planning Project Of Oromia Development Association (ODA) VI ACRONYMS AIDS Acquired Immunodeficiency Syndrome ANC Antenatal care ARHS Adolescent Reproductive Health Service CBD Community-based distribution CBRHA Community Based Reproductive Health Agent CPR Contraceptive Prevalence Rate CSA Central Statistical Agency CYP Couple-year protection DHS Demographic and Health Survey EDHS Ethiopian Demographic and Health Survey EGFHIE Ethiopian Global Fund Health Impact Evaluation FGD Focus Group Discussion FP Family Planning HEWs Health Extension Workers HIV Human Immunodeficiency Virus HTP Harmful Traditional Practice ICPD International Conference on Population and Development IDI In-depth Interview IEC Information, Education and Communication IUD Intra Uterine Devise LAM Lactational Amenorrhea Method MCH Maternal and Child Health NGOs Non-Governmental Organizations ODA Oromia Development Association OCP Oral Contraceptive Pills PNC Postnatal care REB Regional Education Bureau RH Reproductive Health RHB Regional Health Bureau SRH Sexual and Reproductive Health STDs Sexually Transmitted Diseases STIs Sexually Transmitted Infections TFR Total Fertility Rate TOT Training of Trainers TTBA Trained Traditional Birth Attendant UN United Nations VSC Voluntary Surgical Contraception WoHO Woreda Health Office ZHD Zonal Health Department Evaluation of Reproductive Health/Family Planning Project Of Oromia Development Association (ODA) VII ACKNOWLEDGMENT The Evaluation Team gratefully acknowledges the David & Lucile Packard Foundation and Oromia Development Association RH project for supporting this evaluation. Particularly our appreciation goes to Ato Sahlu Haile, W/ro Yemisrach Belayneh from David & Lucile Packard Foundation and Dr Mulugeta Hawas manager of ODA RH project previous. The Evaluation Team wishes to thankfully acknowledge the Zonal, and Woreda ODA RH project offices and staffs that participated in the evaluation process and sharing information and their views. The Principal Investigator thanks Dr. Girma Azene, Dr. Carla Decotelli, W/t Dildile Yohannes, Ato Dimitri Tibebe and Ato Bisrat Birhanu for their invaluable assistance for the completion of the study. Finally, we highly appreciate all the field coordinators, facilitators, and data collectors and, more importantly, the survey respondents, who were critical to the success of this evaluation. Evaluation of Reproductive Health/Family Planning Project Of Oromia Development Association (ODA) VIII EVALUATORS Dr. Wuleta Lemma: Principal Investigator, Assistant Professor Co-Director, Center for Global Health Equity School of Public Health and Tropical Medicine Tulane University 1440 Canal St. Ste 1191 New Orleans, LA 70112 Email: [email protected] Moreira dos Santos, Elizabeth: Consultant Evaluator, Full Professor and Researcher at National School of Public Health/ FIOCRUZ, Rio de Janeiro, Brazil Jemal Aliy (MD, MPH): Consultant Evaluator, (TUTAPE) Dr. Girma Taye: Consultant Evaluator, (TUTAPE) Mr. Yibeltal Kifle: Consultant Evaluator, Lecturer
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