2018 Mutambara Mother and Child Survival Programme report, final evaluation

Background

The United Methodist Church in Norway and UMC in Zimbabwe has cooperated in different mission activities since 1938. In 2001, UMC in Zimbabwe started a Mother and Child Survival training program in Mutambara, with help from Norad/Digni and UMC in Norway.

The Programme concentrated on improving the health of pregnant mothers and children under 5. The Mother and child survival Programme, in partnership with the Ministry of health and childcare, tackled these challenges head-on through the outreach program, a community initiative designed to promote community-based child and maternal health.

Key activities in the early life of the programme included growth monitoring for under-fives, health education for mother and caregivers as well as support for home-based care volunteers and testing of HIV. The Mother and child survival programme empowers communities to make informed decisions about their own health by equipping them with appropriate skills and knowledge.
From 2014, a WASH program was added; including boreholes and toilets in needed communities.

Purpose/objective

2018 marks the end of the Programme with a final evaluation. Other evaluations have been conducted in 2007 and 2012, where recommendations and lessons learnt were used to develop the current programme which is coming to an end in December 2018. The United Methodist Church Norway commissioned an independent gender balanced consultant team to conduct a final evaluation of the Mother and Child Survival Programme. The evaluation sought to assess whether MCSP achieved its objectives and planned outputs as stated in the MCSP agreement’s program plan, and also to determine the level of achievement of Programme objectives, strategies, identify best practices, lessons learnt, weaknesses, strengths and recommendations. The evaluation was aimed at broadly assessing the relevance, effectiveness, efficiency, effect/outcomes and sustainability of the Programme interventions and strategies.

Specifically, the final evaluation was conducted in order to:

1. Determine the extent to which the Programme has achieved its objectives.
2. Identify the constraints and challenges faced by the project, lessons learnt and good practices.
3. Assess the extent that gender was mainstreamed in the Programme and suggestions for improvement
4. To determine the effectiveness of the project.
5. To come up with recommendations that could be explored to further strengthen similar projects in the future.

Methodology

The evaluation team used both qualitative and quantitative methods to gather data, using mixed research methods approaches including document review, Focus Group Discussions (FDGs) and Key Informant Interviews; using selective questionnaires.

During the field visit to the benefiting communities the evaluation team preferred to travel with a driver only, to get the people in the communities to speak freely without being influenced by the presence of the Norwegian partners or the local staff. However, the dialogue and the participatory process were maintained by debriefing and discussions after every visit, and a meeting where UMCN, UMCZ, the administration and program staff at Mutambara Mission Hospital, members of the project communities and other relevant stakeholders shared and discussed the preliminary findings from the evaluation.

The evaluation was participatory, and beneficial to creating a “sharing, learning, and competence building” environment for UMCN, UMCZ, including the administration and program staff at Mutambara Mission Hospital, and members of the project communities, as instructed in the ToR. The evaluation presented its findings in accordance with the expectations as spelt out in the ToR and guided by the Ethical guidelines for Digni, Criteria for evaluating development programmes as well as according to the Empowerment Assessment Tool.

Key findings

The Mother and child survival programme was established almost two decades ago, empowering communities and households to participate in the health care and nutrition of mothers, newborns and children. This was a logical way of enhancing the provision of health care, especially in communities where basic primary health care and environmental services are lacking. Looking at the achievements against the budget, it is evident that the programme was efficiently run with a primary focus on delivery.

• The programme has managed to penetrate in areas that were inaccessible, distant from health facilities bringing health care to the people. The main successes of the programme include; decentralization of health services, community empowerment, community participation, and ownership.
• Through the programme, women were encouraged to seek maternal and child health care to avoid maternal and child mortality. The programme aimed at educating women about the importance of delivering at health institutions. There has been a significant reduction in child and maternal mortality as well as home deliveries. The programme has managed to provide community-based health care.
• The programme was designed to contribute to country-level efforts towards enhancement and attainment of UN’s Sustainable Development Goals (SDG), especially goals 3 and 6 which promotes health and good wellbeing and water and sanitation for everyone. SDG 17, Partnership for the goals, is met by the partnership between the United Methodist Churches in Zimbabwe and Norway, and also by the partnership between Mutambara Mission and the Government and the communities. The MCSP activities were well aligned and in sync with the national priorities efforts in addressing health challenges and ensuring health services to for everyone especially women and their children. The interventions have also been consistent with country needs, especially the health sector priorities and addressed the HIV& AIDS-related challenges which the people of Chimanimani district were facing.
• Mutambara mission hospital did not offer any testing services for HIV prior to programme implantation. A lot of people died due to HIV/AIDS. On average it was estimated that there were at least 5 deaths per week per village. The programme through its education and awareness activities has managed to encourage members of the community to get tested early and seek medication. According to the 2017 report, out of 869 tested for HIV, only 1 tested positive.
• The MCSP has successfully managed to decentralize maternal and child health care. Decentralization of health services also comes with education and awareness which have contributed to empower and enlighten rural women to understand and appreciate the importance of seeing health care during pregnancy and even after pregnancy. According to the MSCP staff and the Hospital there has not been any recorded unattended births or home deliveries in the last 5 years.
• The programme started with 6 outreach points in 2001. By 2018 the outreach point had increased from 6 to 13 and reaching in some beyond the Mutambara mission hospital catchment areas, with 106 trained caregivers, zero caregivers from the start.
• 22 villages have benefited from the WATSAN services from 2014. 11 boreholes have been drilled and 24 standard blair toilets (26 holes) have been constructed.
• The evaluation also revealed that the programme had to a significant extent contributed to the reconfiguration of relations and gender roles. It showed that both women and men have benefited with regards to shift in perspectives towards gender roles and inclusive participation.The programme managed to contribute to the empowerment of women by improving their social status and to instil the sense of self-esteem and confidence in caregivers.

Recommendations

• The MCSP needs to take seriously all recommendations from the last 2 evaluation and the internal assessment exercises (2007, 2012 and 2017). There is a need to have a clear programme of how they will address the recommendations with timelines milestone.
• The programme going forward would require a designated coordinator who is charged with the day to day programme management. In addition, the coordinator should have the responsibility of designing a solid monitoring framework that allows for the programme to track its activities viz-a-viz mandate, budget and annual work plans.
• A robust Monitoring and Evaluation framework which is designed deliberately to capture and keep track of programme activities outputs and outcomes needs to be in place. In addition to this a proper documentation system would be most advantageous. The current state of affairs makes it difficult to tell the story of progress and impact as data is not readily available.

Comments from the organisation

The major challenge for this evaluation has been the lack of baseline.
When the programme started in 2001, there was no requirement for a baseline study. In order to show concluding results for the whole period, the evaluation team reconstructed a baseline interviewing implementing staff, retired nurses, hospital matrons and caregivers and accessed the hospital administrative records of the period 1996 to 2000. Unavailability and missing of crucial records and statistics made it difficult to rely more on quantitative data.
Quantitative results are given in the report, but the emphasis lies in the qualitative results and anecdotes told by the beneficiaries, to show the true impact of the Mother and Child Survival Programme.