EVALUATION REPORT EVALUATION End line evaluation of the Joint Programme Canada and Sweden (Sida) 2011-2016 Volume 2 UNFPA Evaluation Office 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 Euro Health Group Core Evaluation Team Ted Freeman Team Leader Lynn Bakamjian Deputy Team Leader and Reproductive Health Expert Dr. Allison Beattie Health Systems Strengthening Expert Camilla Buch von Schroeder Adolescent Sexual and Reproductive Health Expert Erling Høg Data Analysis and Editorial Support Jette Ramløse Evaluation Coordinator Field Country Experts Deborah Haines Liberia and Zambia Beyant Kabwe Zambia Prince Kimpanga Democratic Republic of the Congo Minnie Sirtor Liberia Thenjiwe Sisimayi Zimbabwe Léon Tshiabuat Democratic Republic of the Congo Evaluation Reference Group Åsa Andersson Sweden/ Sida Camille Bouillon Bégin Global Affairs Canada Nazneen Damji UN WOMEN Hemant Dwivedi UNFPA (H6 Global Coordinator) Dirk van Hove UNAIDS Anne Knutsson UNFPA Blerta Maliqi WHO Jeremy Veillard World Bank Willibald Zeck UNICEF Copyright © UNFPA 2017, all rights reserved. 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 Evaluation Office of UNFPA. Evaluation Office, United Nations Population Fund E-mail: [email protected] For further information on the evaluation please consult the Evaluation Office webpage: http://www.unfpa.org/evaluation TABLE OF CONTENTS ANNEX 1 EVALUATION MATRIX .................................................................................................... 1 ANNEX 2 METHODOLOGY AND DATA LIMITATIONS .................................................................. 223 ANNEX 3 VOCABULARY OF MEDICAL TERMS USED IN THE REPORT ............................................ 224 ANNEX 4 H4+ INTERVENTIONS AND INNOVATIONS BY COUNTRY .............................................. 226 ANNEX 5 FINANCIAL PROFILE OF H4+ JPCS IN PROGRAMME COUNTRIES ................................... 230 ANNEX 6 TRENDS IN INDICATORS OF RMNCAH ......................................................................... 243 ANNEX 7 LIST OF “COUNTDOWN COUNTRIES” INCLUDING H4+ JPCS ......................................... 263 ANNEX 8 PERSONS MET AND INTERVIEWED ............................................................................. 265 ANNEX 9 BIBLIOGRAPHY .......................................................................................................... 287 ANNEX 10 GLOBAL KNOWLEDGE PRODUCTS SUPPORTED BY H4+ PARTNERS ............................. 309 ANNEX 11 THEORIES OF CHANGE ............................................................................................. 313 ANNEX 12 TERMS OF REFERENCE.............................................................................................. 315 End Line Evaluation of the H4+Joint Programme Canada and Sweden (Sida) – 2011-2016 – Final Report Volume II iii ABBREVIATIONS AND ACRONYMS USED IN THE EVALUATION MATRIX Community Distribution Agent (DRC) (Agent de Distribution à Base ADBC Communautaire) ANC Antenatal Care ASRH Adolescent Sexual and Reproductive Health ART Anti-Retroviral Therapy AWP Annual Work Plan DCZS Health Zone Central Office (DRC) BEmONC Basic Emergency Obstetric and Newborn Care CAO Millennium Development Goals (DRC) CEmONC Comprehensive Emergency Obstetric and Newborn Care CHAI Clinton Health Access Initiative CHT County Health Team (Liberia) CHW Community Health Worker CNP-SS Health Sector Coordinating Committee (DRC) CPR Contraceptive Prevalence Rate CSE Comprehensive Sexuality Education CYP Couple Years of Protection DBS Dried Blood Spot (Zimbabwe) DED Deputy Executive Director DEP Department for Planning and Studies (DRC) DFID Department for International Development (United Kingdom) DHE District Health Executive DHIS District Health Information System DHS Demographic and Health Survey DIU Inter-Uterine Device (DRC) DPS Provincial Health Department (DRC) DRC Democratic Republic of the Congo D10 Division for Health and Family Groups (DRC) ECZ Eglise du Christ au Congo EGPAF Elizabeth Glazer Paediatrics AIDS Foundation EmONC Emergency Obstetric and Newborn Care ENAP Every Newborn Action Plan EpMM Ending Preventable Maternal Mortality ESO Emergency Surgery Officer (Ethiopia) EU European Union EWEC Every Women, Every Child EVD Ebola Virus Disease FP Family Planning FGD Focus Group Discussion FANC Focused Ante Natal Care FMOH Federal Ministry of Health (Ethiopia) FOSA Health Facility (DRC) GBV Gender Based Violence gCHV General Community Health Volunteer (Liberia) GE Gender Equity GAVI Global Alliance for Vaccines and Immunizations End Line Evaluation of the H4+Joint Programme Canada and Sweden (Sida) – 2011-2016 – Final Report Volume II iv GFF Global Financing Facility GIBS Health Development Partners Forum (DRC) HGR General Referral Hospital (DRC) (Hôpital Général de Référence) HBB Helping Babies Breath HCC Health Centre Committee (Zimbabwe) HCW Health Care Worker HDF Health Development Fund (Zimbabwe) HEW Health Extension Worker HIV Human Immunodeficiency Virus HMIS Health Management Information System HQ Headquarters HSDP Health Sector Development Plan (Ethiopia) HTF Health Transition Fund (Zimbabwe) HRH Human Resources for Health HZ Health Zone (DRC) H4+JPCS H4+ Joint Programme, Canada and Sweden (Sida) IFC Individual Family Community IFYC Integrated Feeding of the Young Child IESO Integrated Emergency Surgery Officer (Ethiopia) IMNCI Integrated Management of Newborn and Child Illnesses INESOR Institute for Social and Economic Research (Zambia) ISP Integrated Support Program ISTM Higher Medical Technology Institute (DRC) JANS Joint Assessment of Annual Health Strategy KII Key Informant Interview KMC Kangaroo Mother Care KOIC Korea International Cooperation Agency LARC Long Acting Reversible Contraceptive LLIN Long Lasting Insecticide Nets LTSM Liverpool School of Tropical Medicine MCH Maternal and Child Health MCHIP Maternal and Child Health Integrated Program (Zimbabwe) MDG Millennium Development Goal MDGi Millennium Development Goals Initiative M&E Monitoring and Evaluation MICS Multi Indicator Cluster Survey MINSAP Ministry of Health (French) Guinea Bissau MMR Maternal Mortality Ratio MNDSR Maternal and Newborn Death Surveillance and Response MoH Ministry of Health MoHCC Ministry of Health and Child Care (Zimbabwe) MOHS Ministry of Health and Sanitation (Ethiopia) MSH Management Sciences for Health MVA Manually Vacuum Assisted Delivery NASG Non-Pneumatic Anti-Shock Garment NGO Non-Governmental Organization NIHFA National Health Facility Assessment (Zimbabwe) NHA National Health Accounts End Line Evaluation of the H4+Joint Programme Canada and Sweden (Sida) – 2011-2016 – Final Report Volume II v OIC Officer in Charge OPHID Organization for Public Health Interventions in Development PBF Performance Based Financing PCIME Integrated Management of Child Illness (DRC) PDSS Health Systems Support Project (DRC) PESS French?) Health Facilities Equipment Programme (DRC) PLWHA People Living with HIV and AIDS PMD Provincial Medical Directorate (Zimbabwe) PMNCH Partnership for Maternal Newborn and Child Health PMTCT Prevention of Mother to Child Transmission (of HIV) PNC Postnatal Care PNDS National Health Development Plan (DRC) PoC Point of Care PPH Post-Partum Haemorrhage PSM Procurement and Supply Chain Management RBF Results Based Financing PTME Prevention of Mother to Child Transmission (PMTCT) RHB Regional Health Bureau (Ethiopia) RHC Rural Health Centre (Zambia) RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health RO Regional Office SCF Save the Children Fund SDGs Sustainable Development Goals Sida Swedish International Development Agency SMAG Safe Motherhood Action Group (Zambia) SMS Short Message Service (text message) SONU Obstetric and Neo-Natal Emergency (DRC, Guinea Bissau) STI Sexually Transmitted Infection TA Technical assistance ToR Terms of Reference ToT Training of Trainers TTM Trained Traditional Midwife TWG Technical Working Group UNDAF United Nations Development Assistance Framework UNFPA United Nations Fund for Population UNICEF United Nations Children’s Fund UHC Urban Health Centre (Zambia) USD United States Dollar USG US Government WAG Women’s Action Group (Zimbabwe) WASH Water, Sanitation, and Hygiene WB World Bank WHO World Health Organization YFC Youth Friendly Corners YFS Youth Friendly Services VHW Village Health Worker End Line Evaluation of the H4+Joint Programme Canada and Sweden (Sida) – 2011-2016 – Final Report Volume II vi ANNEX 1 EVALUATION MATRIX Strengthening Health Systems 1. Question One: To what extent have H4+JPCS investments effectively contributed to strengthening health systems for RMNCAH, especially by supporting the eight building blocks of health systems?1 a. To what extent has regional and global technical support from H4+ helped enable country teams and national health authorities to identify opportunities, develop innovative approaches and design technically sound initiatives to strengthen health systems for RMNCAH? b. To what extent have H4+JPCS programmes at country level supported health systems strengthening interventions which are catalytic and have the potential to build on existing or planned interventions with international or national sources of funding? c.