Mid term evaluation of the community based health and fist aid program in the occupied Palestinian territory and Lebanon

Background:
Palestinians in the West Bank and Palestinian refugees in Lebanon are marginalized and deprived of many basic human rights and have limited access to state-provided services such as health, education, social services and the judicial system.

The Community Based Health and First Aid Program (CBHFA) in the oPt and Lebanon is implemented by PRCS and PRCS Lebanon Branch (PRCS/L) and supported by the Norwegian and Swedish Red Cross from 2009 to 2012. The programs are based on the IFRC’s Community Based Health and First Aid in Action approach. The overall objective of the CBHFA program is to improve the health and well-being of the Palestinian population. In general the actions aim at raising awareness and enhancing knowledge on health and health related social aspects while at same time enabling the local communities to define and develop programs to respond to their health needs. Target groups include teenage girls, single women, women headed households, children and families in general.

In the oPt the program is mainly implemented in rural areas where the communities have been exposed to community based interventions and PRCS disposes of a sound experience in community based health programming. The entry point for the program where community groups - “Safe Motherhood Committees”.

-   The program in Lebanon is implemented in urban areas where the partner organisation and its target communities are not used to community based programming. The community committees had to be formed at the beginning of the interventions.

Purpose/objective:

The purpose of the evaluation is to “(…) to assess the relevance, efficiency, effectiveness, impact and sustainability of the CBHFA program and to make recommendations for future support.”

In the oPt the evaluation was carried out 7-28 September 2011 and in Lebanon 16-29 October 2011. In-country debriefing sessions were held at PRCS HQ and at PRCS/L HQ. A presentation of the evaluation’s findings and recommendations was given at NRC HQ on the 14th of November 2011.

Methodology:

Methods used for the evaluation:
-  Review of program documents and available statistical monitoring data
-  Semi-structured, in-depth interviews
-  Focus group discussions ( supported by mapping and ranking methods)
-  SWOT Analysis with field staff
-  Observation of program activities

Sample
-   In the oPt seven program locations in the West Bank were part of the evaluation. The sample was based on the following criteria: Start of CBHFA implementation in 2009; Locations with another health program/community based program and without; The locations was not included in the CBDP evaluation. One community (Bardallah), where implementation started only this year, was given specific attention since no Safe Motherhood Committee had existed before.

-   In Lebanon five CBHFA program camps and one gathering were part of the evaluation One gathering (Al Quasmie) where a Belgian Red Cross has supported a CBHFA program was included to compare with NRC’s program areas.

Interviewees
Stakeholders of the program in both countries taking part in the evaluation included:

-   Beneficiaries; Volunteers; PRCS staff; local authorities; Community leaders; representatives of other community based organisatins; Red Cross/Red Crescent Movement representatives

Key findings:
-   The CBHFA program can be considered a successful approach for community based health interventions since it remains relevant for the target groups and fits well into the their overall context. All interventions are based on the actual needs within the community.

-   Community Committees are an effective interface between the communities and their needs and the services and knowledge made available through PRCS / PRCS Lebanon Branch and the program.

-   While the overall number of people benefiting from the programs has increased considerably since the beginning of the program outreach to women is significantly higher than to men due to the cultural and socio-economic context.

-   Effective capacity building methods for program staff, volunteers and beneficiaries have been introduced as specific components of the CBHFA program: Excellent Training of Trainers (TOT) curriculums have been developed; repeated focus group discussion have become a powerful tool to address topics that are culturally sensitive or a taboo; drama workshops are used as a tool for awareness raising and dissemination of knowledge.

-   It is of high value that logical frameworks are used as planning tools. Still in order to efficiently monitor and evaluate outputs, outcomes and impact as part of results based management, objectively verifiable indicators need to be revised. Monitoring according to objectively verifiable indicators needs to be improved.

-   One of the weaknesses in both program designs is that no measures for sustainability and potential phase out strategies have been included.

-   The program implementation has been hampered due to delayed audit reports which in turn delayed transfers from NRC. While PRCS HQ is able and committed to finance program implementation in advance until being refunded, PRCS Lebanon Branch does not have the financial means to compensate outstanding program funds.

Recommendations:
PRCS:
-  Train and guide program staff in project cycle management regarding the development of logical frameworks with a special focus on OVIs and how to apply them for monitoring.
-  Ensure that sustainability measures and a phase out strategy are part of any program outline/proposal and that enough time is given for the implementation (at least to be started 10 months before the end of the program).
-  Consequently – even if it is planned to continue with another program phase – it is recommended to use the last year of a program period to consolidate what has been achieved and, in case of continuation, to plan the next phase.

NRC:
-  Mainstream organizational development for the Community Based Health and First Aid Programs or where NRC/SRC are supporting organizational development parallel to the CBHFA program to operationally link the CBHFA program to OD interventions at branch/community centre level.