Final Evaluation of Awash Female Genital Cutting Elimination Project

Background

The Afar Region in Ethiopia has an extremely poor health status compared to other Regional States. The communities have little knowledge about health promotion and disease prevention techniques. Harmful traditional practices like cutting/mutilating female genitalia are vastly practiced, and as a result there is high infant and maternal morbidity and mortality related to childbirth. Knowledge of family planning and HIV/AIDS within the rural Afar community is also generally low. In response to these health problems, CARE Awash, under its primary health care project started to work in Awash Fentale woreda in January 1996. The main objective of the Project was to establish sustainable community based health systems.

As a follow up to this the two year Awash Female Genitalia Cutting (FGC) Elimination Project was started in January 2003. The project focused on FGC elimination, reproductive health/family planning, HIV/AIDS and on incorporating some Primary Health Care (PHC) components. The objectives of the project were to disseminate quality information on the above mentioned issues, advocate for the elimination of FGC in any form, and establish and strengthen sustainable community based health systems. Most project activities focused on rural areas and were implemented in the villages of the woredas Awash Fentale and Amibara. The main activities undertaken were civil society advocacy, dissemination of information on the respective issues at village level, broadcasting of a radio program in the Afar language and regional level advocacy workshops was conducted in order to reach people outside the project area. The NORAD funded part of the project ended in December 2005, but the major components continued with support from CARE Austria (ADA) in 2006 (see also below).

Purpose/objective

The purpose of this evaluation was to assess the performance of CARE Awash Fentale and Amibara FGC project in relation to its' objectives and extract lessons learned for similar programmes in the future.

Methodology

The methods used for collecting information for this evaluation were reviews of diverse project documents, a quantitative survey (400 respondents) and qualitative studies such as focus group discussions (8), key informant interviews with representatives of government agencies (Women Affaires Bureau, HIV/AIDS Secretariat, Woreda Health Bureau, Wereda Administration, and Traditional Birth Attendants) and field observation. The indicators of the study were the same as those used during the base line survey.

Key findings

The comprehensive health education packages made by the project broke the silence among the community, as they now discussed health effects of female genital cutting and other harmful traditional practices in public. An important achievement of the project was the mobilisation of religious leaders, traditional leaders and government counterparts to district- and local level advocacy workshops, leding to the establishment of Anti- Female Genital Mutilation Committees in 13 villages. The religious leaders denounced the practise and clearly stated that it is not in line with Islamic teaching. The communities also denounced FGC and considered it to be a banned and punishable practise, and a draft law on FGC were awaiting finalisation in the regional constitution. However, there was still work to be done on this respective issue as lesser forms of FGC were still practices in some areas and supported by a few religious leaders, who considered it to be `suna´ (part of religious dogma). FGC is a sensitive issue, and as evident from the above mentioned, highly intertwined with societal norms, values and attitudes, reinforced by religious beliefs and gender roles. Therefore, it could not be expected that a two year sensitisation project would be able to eradicate the practice of FGC altogether.

Comparing the quantitative survey with the baseline study a remarkably increase in awareness of the community on FGC, HIV/AIDS, malaria, diarrhoea and family planning could be observed. After two years of sensitisation on these issues, most people (around 90%) knew at least two negative health effects and at least one negative psychological effect of FGC and could mention at least one method of contraceptive. Additionally, most knew how malaria and diarrhoea were transmitted and how these illnesses could be prevented. As a result of the awareness raising, some behavioural change could also be observed. According to the survey more people had started using contraceptives and around 50% of the couples now openly discussed family planning issues. Additionally, the project contributed to empowering women, as they were assisted to attend and participate in meetings, where they discussed health related issues with their male counterparts.

Recommendations

Based on the findings of the evaluation the following recommendations were forwarded:
• The Afar are said to be a traditional and homogeneous society with a communal life style and tend to conform to societal norms, values and attitudes. The practice of FGC has been deeply rooted in the community and "justified" by their religion. Therefore, CARE should continue to work with religious figures, traditional community leaders and the government, as they are better trusted, accepted and followed than any other social group and/or institution. Their involvement and support of the project would secure the sustainability of the project's achievements.
• In order to ensure the progress made in anti-FGC, it is important to do more work in remoter areas, as villages are interconnected through cross-marriages, where men from remote villages are unwilling to marry uncircumcised girls.
• Disseminate video films of FGC in all localities at large, as watching film was found to significantly enhance the feeling of anti-FGC.
• Strengthen relations with stakeholders at woreda level by involving them more in the actual activities of the project so they consider the project's success as part of their effort.

Comments from the organisation

Evaluations are principal instruments in the follow-up of a project, and CARE Norway is devoted to continuous learning and critical assessments of our results. The recommendations of this evaluation have been carried forward in the continuation of the project. The project was consolidated in 2006, receiving funding from CARE Austria and from 2007, the project will continue with direct support from the Norwegian Embassy in Addis Ababa for another five years. As this is an evaluation undertaken for CARE Norway, we urge any reader to contact us before applying this information.