JIJENGE! PROJECT AMREF Tanzania – Lake Zone Programme FINAL EVALUATION REPORT DRAWN BY Wambura Mwita (PhD) & Gerry Mshana (PhD) P. O. Box 6130, Mwanza, Tanzania. Tel: +255 732 981264 / Cellular: +255 787 697430, E-mail: [email protected], 31st JULY 2009 1 ACRONYMS AMREF African Medical and Research Foundation CBO Community Based Organisation CEDAW Convention on the Elimination of All Forms of Discrimination against Women CHMD Council Health Management Director CMOH City Medical Officer of Health CO Clinical Officer in Charge DANIDA Danish Organisation for Development Assistance DC District Commissioner DfID Department for International Development DMO District Medical Officer FFQ Face to Face Questionnaire FGD Focus Group Discussions FGM Female Genital Mutilation FP Family Planning HIV Human Immuno-deficiency Virus ICPD International Convention on Population and Development IDI In-depth Interviews MCH Maternal and Child Health NGO Non-Governmental Organisation NIMR National Institute for Medical Research PMTCT Prevention of Mother to Child Transmission RPA Rapid Participatory Appraisal SRH Sexual and Reproductive health STI Sexually Transmitted Infections TB Tuberculosis TBA Traditional Birth Attendant TH Traditional Healer TZ Tanzania VCT Voluntary Counselling and Testing VHW Village Health Worker WEO Ward Executive Officer 2 ACKNOWLEDGEMENTS We owe any measure of success to the array of input from so many both known and unknown. In this report, we have learnt a lot from so many people. Here are just few: Our special gratitude goes to the district authorities, community leaders, in-charge of the health facilities and health facility service providers, individuals and groups within the communities and community owned resource persons (COPRS) for their time, patience, understanding and participation in this study. You were always a tremendous source of motivation and encouragement, we are forever grateful. Many thanks to Eng. Koronel Mashalla Kema (Programme Manager), Edna Matasha (Project Manager) and Zahara Swalehe (Project Staff), Obed Mrita (Administrator) for their continued and constructive advice at various phases of the evaluation. A word of gratitude goes to field teams for their efforts in data collection, data entry and data analysis. Special thanks are extended to each of the following individuals’ for their contribution in this project: Levina Mpogoma, Abel Mosha, Charles Chenha, Marygoreth Rwechungura and George Augusto. Finally, we are eternally grateful to our GOD for his providence and protection. Wambura Mwita Gerry Mshana 3 TABLE OF CONTENTS ACRONYMS ............................................................................................................................... 2 ACKNOWLEDGEMENTS .............................................................................................................. 3 LIST OF TABLES........................................................................................................................ 6 CHAPTER ONE .......................................................................................................................... 7 INTRODUCTION ........................................................................................................................ 7 1.1 Objectives and Scope of Evaluation ............................................................................ 7 1.2 Evaluation Approaches and Methods .......................................................................... 9 1.3 Choice of Tools / Techniques and Justifications ........................................................... 9 1.3.1 Documentary Review Proforma (DRP) .................................................................. 11 1.3.2 Stakeholder Analysis ............................................................................................ 11 1.3.3 Field Visits .......................................................................................................... 11 1.3.3.1 Semi-Structured Interviews .......................................................................... 12 1.3.3.2 Focus Group Discussion ............................................................................... 12 1.3.3.3 Exit Interviews ............................................................................................ 12 1.3.3.4 Structured Observation ................................................................................ 13 1.3.3.5 Key Informant Interviews ............................................................................ 13 1.4 Analysis and Structure of the Report ........................................................................ 13 CHAPTER TWO ....................................................................................................................... 15 PROJECT INTERVENTION ........................................................................................................ 15 2.0 Introduction ............................................................................................................ 15 2.1 Phase I of the Project (1996-1999) .......................................................................... 16 2.2 Phase II of the Project (1999-2002) ......................................................................... 16 2.3 Phase III of the Project (2006-2009) ........................................................................ 17 2.3.1 Pre-Intervention Survey ................................................................................... 17 2.3.2 Findings from the Pre-Intervention Survey ........................................................ 18 2.3.3 Project Intervention Strategy ........................................................................... 21 2.3.3.1 Impact Component of the Community Strategy ............................................. 22 2.3.3.2 Impact Component of the Health Facility Strategy ......................................... 23 2.3.3.3 Sustainability Component of the Strategy ..................................................... 24 2.3.4 Design Issues in the Baseline Survey ................................................................ 25 CHAPTER THREE ..................................................................................................................... 26 PROGRESS TOWARDS OUTCOMES ........................................................................................... 26 3.0 Demographic Characteristics of Respondents ............................................................ 26 3.1 Social Networks ...................................................................................................... 29 4 3.2 Service Provision ..................................................................................................... 29 3.2.1 Community Reports On General Service Provision ............................................. 30 3.2.2 Individual Characteristics of Service Users ........................................................ 33 3.2.3 Community Characteristics Affecting Service Uptake .......................................... 35 3.2.3.1 Accessibility of SRH and Counselling Services Provided .................................. 35 3.2.3.2 Knowledge and Skills of Health Care Providers .............................................. 38 3.2.3.3 Community Knowledge of Rights and Gender Sensitive SRH .......................... 40 3.2.4 Physical Improvement of Health Facilities ............................................................. 44 3.2.5 Capacity of the Districts Health Teams to Sustains Project Activities ....................... 46 CHAPTER FOUR ...................................................................................................................... 47 FACTORS AFFECTING PROGRESS............................................................................................. 47 4.1 Introduction ............................................................................................................ 47 4.2 Progress towards Key outcomes and Progress Indicators ........................................... 47 4.2.1 Change in Communities’ Knowledge Regarding Women’s Rights............................. 47 4.2.2 Increase in Health Facility Service Uptake ............................................................. 48 4.2.3 Increase in the Quality of Health Facility Service Provided...................................... 48 4.2.4 Domestic Violence ............................................................................................... 50 4.3 Challenges Towards Key Outcomes and Progress Indicators ...................................... 51 4.3.1 Coordination of the Project Activities, ................................................................... 51 4.3.2 Declining Number of Health Service Provider ........................................................ 52 4.3.3 Partnership Strategy ............................................................................................ 53 CHAPTER FIVE ........................................................................................................................ 55 CONCLUSION, LESSONS LEARNT AND RECOMMENDATIONS ..................................................... 55 5.1. Conclusion .............................................................................................................. 55 5.1.1 Progress towards outcomes ............................................................................. 55 5.1.2 Key JIJENGE! Contributions ............................................................................