Summative evaluation of the WHO Rapid Access Expansion Initiative Volume 3: Country Briefs Corporate evaluation commissioned by the WHO Evaluation Office May 2018 This independent evaluation was funded by Global Affairs Canada as part of its grant to WHO to implement the Rapid Access Expansion Programme 2011/2012-2017/2018 and was supported by an Evaluation Management Group composed of representatives from the Global Affairs Canada, UNICEF and WHO Evaluation Offices. Evaluation Management Group Elil Renganathan, WHO Evaluation Office, Chair Beth Ann Plowman, UNICEF Evaluation Office Pierre J. Tremblay, Global Affairs Canada, Evaluation and Results Bureau Anne-Claire Luzot, WHO Evaluation Office, Technical Oversight Anand Sivasanakara Kurup, WHO Evaluation Office, Evaluation Manager Evaluation Reference Group Fred Binka, University of Health and Allied Sciences, Ghana Camille Bouillon Bégin, Global Affairs Canada, Health and Nutrition Bureau Kimberly Connolly, USAID, Washington DC Ernest Darkoh, BroadReach Health Care, South Africa Margaret Gyapong, University of Health and Allied Sciences, Ghana Chinwoke Isiguzo, Society for Family Health, Abia State, Nigeria Gomezgani Jenda, Save the Children, Malawi Elizabeth Juma, Kenya Medical Research Institute, Kenya Grace Nganga, World Vision, Niger Pascal Ngoy, International Rescue Committee, Democratic Republic of the Congo Olusola Oresanya, Malaria Consortium, Niger State, Nigeria Stefan Peterson, UNICEF, New York Salim Sadruddin, Global Malaria Programme, WHO, Geneva Marla Smith, Save the Children and Malaria Consortium, Mozambique Mark Young, UNICEF, New York Right to health & development Evaluation Team: Josef Decosas (Team Leader), Alice Behrendt, Marieke Devillé, Ingeborg Jille-Traas, Leo Devillé (quality assurance) Evaluation Team country specialists: Abdon Mukalay (Democratic Republic of the Congo), John Phuka (Malawi), Sandra Manuel (Mozambique), Mahamane Karki (Niger) and Vivian Shaahu (Nigeria) Laarstraat 43 B-2840 Reet Belgium Tel: +32 2 844 59 30 Website: www.hera.eu Email: [email protected] The analysis and recommendations of this report are those of the independent evaluation team and do not necessarily reflect the views of the World Health Organization. This is an independent publication by the WHO Evaluation Office. Any enquiries about this evaluation should be addressed to: Evaluation Office, World Health Organization Email: [email protected] TABLE OF CONTENTS Background, Approach and Methodology ........................................................................................ 1 DEMOCRATIC REPUBLIC OF THE CONGO ................................................................. 4 Context .............................................................................................................................................. 4 The RAcE programme in the DRC ................................................................................................................ 5 The country evaluation mission .................................................................................................................. 6 Main Findings .................................................................................................................................... 7 Findings of the Contribution Analysis ......................................................................................................... 7 Gender equality ........................................................................................................................................... 9 Social equity and vulnerable populations ................................................................................................. 11 Sustainability planning .............................................................................................................................. 11 Unplanned collateral outcomes ................................................................................................................ 12 Conclusions ..................................................................................................................................... 13 Theory of Change ............................................................................................................................ 14 Contribution Analysis and Process Tracing ..................................................................................... 15 Annex: Country Brief DRC ............................................................................................................... 23 References ................................................................................................................................................. 23 People met ................................................................................................................................................ 24 Tools developed by RAcE DRC ................................................................................................................... 26 MALAWI ............................................................................................................. 27 Context ............................................................................................................................................ 27 The RAcE programme in Malawi ............................................................................................................... 29 The country evaluation mission ................................................................................................................ 29 Main Findings .................................................................................................................................. 31 Findings of the Contribution Analysis ....................................................................................................... 31 Gender equality ......................................................................................................................................... 33 Community based maternal and newborn care (CBMNC) ........................................................................ 35 mHealth application .................................................................................................................................. 36 Operational research: Treatment of Young Infant infection .................................................................... 37 Sustainability planning .............................................................................................................................. 37 Conclusions ..................................................................................................................................... 40 Theory of Change ............................................................................................................................ 42 Contribution Analysis and Process Tracing ..................................................................................... 43 Annex: Country Brief Malawi .......................................................................................................... 50 References ................................................................................................................................................. 50 People met ................................................................................................................................................ 51 MOZAMBIQUE ..................................................................................................... 53 Context ............................................................................................................................................ 53 The RAcE programme in Mozambique ...................................................................................................... 55 The country evaluation mission ................................................................................................................ 56 Main Findings .................................................................................................................................. 57 Results of the contribution analysis .......................................................................................................... 57 Gender equality ......................................................................................................................................... 60 New sexual and reproductive health package .......................................................................................... 61 Sustainability planning .............................................................................................................................. 61 Conclusions ..................................................................................................................................... 63 Theory of Change ............................................................................................................................ 65 Contribution Analysis and Process Tracing ..................................................................................... 66 Annex: Country Brief Mozambique ................................................................................................. 76 References ................................................................................................................................................. 76 People met ...............................................................................................................................................