COUNTRY CASE STUDY END LINE EVALUATION OF THE H4+ JOINT PROGRAMME CANADA AND SWEDEN (SIDA) 2011-2016 DEMOCRATIC REPUBLIC OF THE CONGO ____________________________________ EVALUATION OFFICE NEW YORK 2017 End line evaluation of the H4+ Joint Programme Canada and Sweden (Sida) 2011-2016 Evaluation Management Group: Louis Charpentier UNFPA Evaluation Office (Chair) Beth Ann Plowman UNICEF Evaluation Office Pierre J. Tremblay Global Affairs Canada Evaluation Division DRC National Reference Group members Patrice Badibanga H6+ Focal Point WFP Sandra Chouffani Head of Cooperation Embassy of Canada Thierno Diouf M&E Specialist UNFPA Dr Baudouin Kalume Director MoH (D10) Brigitte Kini H6+ Focal Point WHO Eugene Kongnyuy H6+ Coordinator UNFPA Marguerite Kunduma H6+ Focal Point UNFPA Dr Thérèse Kyungu Director MOH (PNSR) Priya Lerberg H6+ Focal Point UNAIDS Dr Alain Iyeti Director MoH (DEP) Daniel Magnusson First Secretary (health) Embassy of Sweden Bernadette Mbu H6+ Focal Point WHO Jules Mulimbi H6+ Focal Point UN Women Michel Muvudi H6+ Focal Point World Bank Alladji Osseni H6+ Focal Point UNAIDS Freddy Salumu H6+ Focal Point UNICEF Annie Simard First Secretary Embassy of Canada Susie Villeneuve H6+ Focal Point UNICEF Euro Health Group Evaluation Team Camilla Buch von Schroeder Country team leader Prince Kimpanga National evaluation specialist Léon Tshiabuat National evaluation specialist Ted Freeman Evaluation team leader The analysis and recommendations of this report do not necessarily reflect the views of the United Nations Population Fund. This is an independent publication by the independent Evaluation Office of UNFPA. Any enquires about this evaluation should be addressed to: Evaluation Office, United Nations Population Fund E-mail: [email protected] Phone number: +1 212 297 5218 Full document can be obtained from UNFPA web-site at: http://www.unfpa.org/admin-resource/evaluation-h4-joint-programme-canada-and-sweden-2011- 2016 i TABLE OF CONTENTS 1 INTRODUCTION ..................................................................................................................... 1 1.1 Objectives of the field country case studies ............................................................................ 1 1.2 Approach and methodology .................................................................................................... 1 1.3 Nature of the field country case studies .................................................................................. 2 1.4 Carrying out the field country case study in DRC .................................................................... 2 1.5 Limitations ............................................................................................................................... 4 2 THE CONTEXT OF RMNCAH IN DRC ........................................................................................ 5 2.1 Trends in RMNCAH - 2011 to 2016 .......................................................................................... 5 2.2 National plans and priorities.................................................................................................... 6 2.3 External support to RMNCAH .................................................................................................. 7 2.4 Mechanisms and processes for coordinating action ............................................................. 10 2.4.1 National mechanisms for coordinating support to the health sector in the DRC ............................ 10 2.4.2 H4+ programme coordinating mechanisms and processes ............................................................. 10 2.5 The H4+ programme in the DRC ............................................................................................ 11 2.5.1 Programme expenditures ................................................................................................................ 11 2.5.2 Programme content ......................................................................................................................... 13 3 THEORY OF CHANGE FOR H4+ JPCS IN THE DRC .................................................................... 14 4 EVALUATION QUESTIONS AND FINDINGS ............................................................................. 17 4.1 Strengthening health systems ............................................................................................... 17 4.1.1 Testing causal assumptions for health systems strengthening ....................................................... 18 4.1.2 Contributing to health systems strengthening for RMNCAH in the DRC ......................................... 28 4.2 Expanded access to integrated care ...................................................................................... 30 4.2.1 Testing causal assumptions for expanding access to integrated care ............................................. 31 4.2.2 Contributing to expanded access to integrated care ....................................................................... 42 4.3 Responsiveness to national needs and priorities .................................................................. 43 4.3.1 Testing causal assumptions for responsiveness to national needs and priorities............................ 44 4.3.2 Responding to national needs and priorities ................................................................................... 48 4.4 Innovative approaches to programming in RMNCAH ........................................................... 49 4.4.1 A theory of change for innovation in the DRC ................................................................................. 49 4.4.2 Testing causal assumptions for innovation ..................................................................................... 51 4.4.3 Contributing to innovation for RMNCAH in DRC .............................................................................. 55 4.5 Division of labour ................................................................................................................... 56 4.5.1 Testing causal assumptions for the division of labour ..................................................................... 56 4.5.2 Achieving an effective division of labour ......................................................................................... 60 4.6 Value added for advancing the Global Strategy .................................................................... 62 4.6.1 Testing causal assumptions for value added ................................................................................... 62 4.6.2 The value added of H4+ JPCS ........................................................................................................... 66 5 CONCLUSIONS ..................................................................................................................... 68 5.1 Conclusions ............................................................................................................................ 68 5.2 Implications for the H6 partnership ...................................................................................... 70 ii 6 ANNEXES ............................................................................................................................ 71 Annex 1 Evaluation Matrix ................................................................................................................. 72 Annex 2 Vocabulary of medical terms used in the report ............................................................... 208 Annex 3 Financial profile of H4+ JPCS in THE DRC ........................................................................... 209 Annex 4 Outcomes of RMNCAH ....................................................................................................... 210 Annex 5 People Met ......................................................................................................................... 212 Annex 6 Bibliography ....................................................................................................................... 219 Annex 7 Key causal Assumptions for the DRC THEORY OF CHANGE ............................................... 226 List of Tables: Table 1: Selected Indicators of RMNCAH in the DRC - 2005 to 2015 ...................................................... 5 Table 2: Key programmes in HSS and RMNCAH operating in H4+ target provinces in the DRC ............. 7 Table 3: H4+ JPCS Expenditures by H4+ member in the DRC 2011-2015 ............................................. 11 Table 4: H4+ JPCS Expenditures in US $ by Output Category (2012-2015) ........................................... 12 Table 5: Output data on selected RMNCH services in the nine H4+ JPCS health zones (2011-2015) .. 26 Table 6: H4+ members and their roles and contributions in the H4+ JPCS, DRC programme (2014- 2016) ..................................................................................................................................................... 58 Table 7: H4+JPCS Expenditures in the Democratic Republic of the Congo ......................................... 209 List of Figures: Figure 1: Map of H4+ JPCS active districts and field visits in DRC ........................................................... 4 Figure 2: Maternal mortality ratio trend in the DRC since 1985 ............................................................. 6 Figure 3: Programme expenditures by H4+ members in the DRC (2012 – 2015) ................................. 12 Figure 4: