FINAL EVALUATION OF JIJENGE PROJECT – FILLING THE GAP “Strengthening the right of women to receive health assistance through community sensitisation and training of Health Service Providers in Mwanza and Mara Regions” Drawn By: W & J Research Consultants and Data Solutions P. O. Box 6130, Mwanza, Tanzania. E-mail: [email protected], September 2010 TABLE OF CONTENTS ACRONYMS .................................................................................................................. iv CHAPTER 1 .................................................................................................................... 1 INTRODUCTION............................................................................................................. 1 1.1 Background Information .................................................................................... 1 1.2 Objective and Scope of the Evaluation ............................................................. 3 1.3 Evaluation Model: Theory and Framework........................................................ 4 1.4 Methodology, Sampling and Data Collection .................................................... 6 CHAPTER 2 .................................................................................................................. 10 Findings......................................................................................................................... 10 2.1 Project Intervention Logic ............................................................................... 10 2.1.1 Phase I of the Project (1996-1999) .......................................................... 10 2.1.2 Phase II of the Project (1999-2002) ......................................................... 11 2.1.3 Jijenge Extension Phase (2006-2008) ..................................................... 11 2.1.4 JIJENGE project - Filling the Gap (2008-2010)........................................ 12 2.1.4.1 Project Intervention Strategy ............................................................ 12 2.1.4.1.1 Community level Strategy............................................................. 13 2.1.4.1.2 Impact Component of the Health Facility Strategy........................ 15 2.1.4.1.3 Sustainability Component of the Strategy..................................... 16 2.2 Impact of the Training Component .................................................................. 17 2.2.1 Reactions and Perceived Learning .......................................................... 18 2.2.2 Learning and Behaviour........................................................................... 18 2.2.3 Organizational Performance .................................................................... 20 2.3 Findings from the Community Based Survey .................................................. 20 2.3.1 Demographic Characteristics of Respondents ......................................... 20 2.3.2 Spousal Selection, Bride Price and Marriage........................................... 22 2.3.3 Healthcare Service Provision ................................................................... 24 2.3.3.1 Community Reports On General Service Provision .......................... 24 2.3.3.2 Individual Characteristics of Service Users....................................... 27 2.3.3.3 Community Characteristics Affecting Service Uptake ....................... 29 2.3.3.4 Gender Based Violence .................................................................... 30 2.3.3.4.1 Attitudes towards Relationships ....................................................... 30 2.3.3.4.2 Extent and Reasons for Wife Battering ............................................ 31 2.3.3.4.3 Women’s coping Mechanisms against Mistreatment ....................... 34 2.4 Findings from the Focus Group Discussion .................................................... 35 2.4.1 Gender Based Violence. .......................................................................... 35 2.5 Findings from the Key Informant Interviews .................................................... 37 2.5.1 Gender Based Violence. .......................................................................... 37 2.6 Data from Healthcare delivery Points.............................................................. 39 CHAPTER 3 .................................................................................................................. 40 Progress towards Outcomes ......................................................................................... 40 3.1 Issues and Challenges.................................................................................... 40 3.1.1 Training .................................................................................................... 40 3.1.2 Change in Communities’ Knowledge Regarding Women’s Rights........... 41 3.1.3 Increase in the Quality of Health Facility Service Provided...................... 42 3.1.4 Domestic Violence ................................................................................... 44 3.2 Challenges towards Key Outcomes and Progress Indicators ......................... 45 3.2.1 Coordination of the Project Activities, ...................................................... 46 3.2.1 Shortage of Health Service Providers ...................................................... 47 3.2.3 Partnership Strategy ................................................................................ 48 CHAPTER FOUR .......................................................................................................... 50 CONCLUSION, LESSONS LEARNT AND RECOMMENDATIONS.............................. 50 4.1 Institutionalization of Jijenge Concept ............................................................. 50 4.2 Progress towards outcomes............................................................................ 52 4.3 Issues and Lessons ........................................................................................ 54 4.4 Recommendations .......................................................................................... 56 4.4.1 Continuity of the Current Implementation Strategy: ................................. 56 4.4.2 Support Gender Mainstreaming in Key Sectors ....................................... 57 4.4.3 Address limited connectivity of interventions ........................................... 57 4.4.4 Engage with Partners on Gender Issues ................................................. 57 4.4.5 JIJENGE to work with other partners to address weak M & E system ..... 58 ii 4.4.6 Development of Partnership Strategies and Framework for Operations .. 58 4.4.7 Strengthening of Community Based Organization ................................... 58 4.4.8 Expansion of Project activities in the District............................................ 59 References .................................................................................................................... 60 iii ACRONYMS AMREF African Medical and Research Foundation ANC Ante-natal Clinic CEDAW Elimination of All Forms of Discrimination against Women CHMTs Council Health Management Teams CORPS Community Owned Resource Persons DMO District Medical Officer DCDO District Community Development Officer FGDs Focus Group Discussions FGM Female Genital Mutilation FP Family Planning GBV Gender Based Violence HC Health Centre HIV Human Immuno-deficiency Virus HSPs Health Service Providers ICPD International Convention on Population and Development IEC Information, Education and Communication MDGs Millennium Development Goals PHC Primary Health Care RCH Reproductive and Child Health SRH Sexual and Reproductive Health STIs Sexual Transmitted Infections TASAF Tanzania Social Action Fund TOR Terms of Reference VEO Village Executive Officer WEO Ward Executive Officer WDC Ward development Committee iv CHAPTER 1 INTRODUCTION 1.1 Background Information Jijenge filling the gap project in Tanzania was implemented through AMREF Spain and funded by Junta Castila Leon to institutionalize a gender responsive approach in the primary health care services in the Lake Victoria zone. The project’s broad aim was to strengthen the right of women to receive health assistance through community sensitization and training of Health Service Providers (HSPs) in eight districts of Mwanza and Mara Regions. The districts included: Mwanza City, Sengerema, Missungwi, Kwimba, Magu, Ukerewe, Geita, and Serengeti. These districts were chosen as a focus area because of the high prevalence of violations against women in the region such as female genital mutilation (FGM), women battering and deeply rooted customs and taboos that deny women to access quality health care. Rights based gender sensitive approach was the backbone of the intervention. This project was responding directly to the two international edicts of 1994; the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Programme of Action for the International Convention on Population and Development (ICPD). Jijenge project was also addressing the Millennium Development Goals (MDGs) where among other critical issues of concern sexual and reproductive health (SRH) and human rights were sited to be key intervention areas. The Jijenge filling the gap has been operating for two years between September 2008 and September 2010 as a back up of the 3 years Jijenge extension phase that ended in June 2008. The direct beneficiaries were women of reproductive age (15-49 years) that lived in the intervention areas. Other beneficiaries