End Term Evaluation of CBPHC MCH, Mohulpahari, Dumka, JH IN

Background

The Congregational Based Primary Health Care project (CBPHCP) of Mohulpahari Christian Hospital of Northern Evangelical Lutheran Church (NELC) is a continuation of the Hospital Development Project started in 1999. Supported by Normisjon and Digni, the legal project holder is Northern Evangelical Lutheran Church – (NELC), a multi-lingual Lutheran Christian church that is centered mainly in four states of North India - Jharkhand, Assam, Arunachal Pradesh, and Bengal. The reach of the Church extends into Nepal and Bhutan. Mohulpahari Christian Hospital (MCH) is not independently registered. MCH is the largest NELC Hospital with 130 beds and a Nursing School that runs ANM and GNM courses. MCH went through a Hospital Development Project 1999 to 2004, and then the Congregation Based Primary Health Care Project (CBPHC) was started and went through 4 phases: 2004- 2009 (Phase II), 2011-2015 (Phase III) and 2017-2019 (Phase IV).

Purpose/objective

The key objectives of the evaluation were as follows

• To investigate changes that have happened and to what extent it was due to the project intervention.
• To what extent has the project contributed to the development goal (this includes to verify changes in the goals: improvements in the health conditions of the socially excluded communities, strengthening of the movements (PO, CBO, SHG), enabling them to be a critical mass, able to manage and sustain social capital and ensure life of dignity
• To assess to what extent this is due to other factors as well as the project. Project output should also be verified.

Methodology

Analysis and synthesis of existing reports: Program reports were reviewed against the evaluation questions to draw out the most relevant information and identify critical elements.

This process guided the development of questionnaires for subsequent evaluation elements, including FGDs (Focus Group Discussions) and semi-structured interviews.

The evaluation team examined in detail all the documents cited earlier with the help of a check list developed in agreement with the evaluation questions. In addition, semi-structured interviews were held with right holders, their family members, women’s groups, program staff and others identified from the community.

There were also focus group discussions with community organizers, field staff, nurses and hospital staff, PC committee, community members and small groups of women. Empowerment Assessment Tool were used in the evaluation. Along with the evaluation, the evaluation team and Dr. Shaliendra Awale spent a day with the NELC leadership team to learn from the evaluation findings and reflect together on the future of the healing ministry in the church.

Key findings

• Overall the project has made much headway in community empowerment with a quite a few active SHGs and Peoples organizations that are actively engaged in advocating for their community-based needs. This is facilitated by a few women leaders who are dynamic and proactively involved. Many women leaders have come up through this project, as evidenced by their active participation in gram sabhas and partaking in political processes. But they were unable to move into a border framework of engagement at policy level due dearth of leadership from other community groups like men and youth. The limited time frame of less than three years for this last phase of community mobilization for policy level engagement was another limiting factor.
• In the health component the contribution of CBPHC on Maternal Child Health of this region is difficult to assess, since government primary health services have improved over the last few years. But the project has reduced the gap between the state systems and right holders in accessing and availing government schemes
• Congregational engagement in the project was hardly visible, though the larger leadership of NELC was engaged in owning and providing governance support to the project at large
• The broader management learning and impact is mostly limited to the community and project level and has not been able to impact MCH and or NELC, at large. Though the initial phases of the project had contributed to sustainability of the hospital, this was not visible in this phase.

Recommendations

• There is an urgent need to revisit and reposition the hospital with the larger changes happening around, in health care and emerging community needs and expectations.
• Looking ahead, there is the need for ongoing community engagement to address the emerging issues of Mental health and Alcoholism, Child rights and Education, Livelihood support, focusing on Entrepreneurs training and skill development, and developing Leadership from the younger generation.
• There needs to be a thinking on how to maintain the momentum set in and support the POs, CBOs and empowered leaders to move ahead with the dream of becoming a people’s movement and policy level engagement. Gender related issues is one another area which must be explored.
• For program and financial management, there is a need to have operational guidelines. These should include financial checks and balance, conflict of interest and procurement etc. Appropriate HR policies and statuary compliances (PF & ESI) should be explored and set up.
• Any upcoming program should explore newer and innovative methods of engagement with the active participation of the church alt large, than the structures and systems followed in the last decade.
• It is urgent and critical to address the various governance, structural and management challenges of MCH and NELC. This will help in repositioning the healing ministry of the church at large, to make it relevant to the context and community, sustainable and facilitate community transformation.

Comments from the organisation

Normisjon:
2019 was the final year of the final phase of the project, but this does not mean that Normisjons partnership with NELC and MCH will stop now. Normisjon has a long- standing partnership with NELC and are supporting other initiatives and programs through this partner which will continue in the time ahead.

The evaluation gives some recommendations to MCH. These are well known to the leadership of NELC and in a meeting with the evaluators the evaluation report and topics were discussed closely with the leaders of NELC, MCH as well as staff from the hospital. Normisjon has been in close dialogue with the partner about the organisational systems, governance and structures of the hospital. We are also currently working on helping MCH to connect with the right partners in India, such as CMC Vellore, in order to revive the mission hospitals of the church. Normisjon is working with NELC on how to implement operational guidelines in the administration of the church as well as hospitals and will be following up on this for the future.

Digni:
Digni has used the evaluation report to analyse and document results of the project. Digni’s assessment of the project’s results are presented in Digni’s report to Norad in 2019. Even though Digni/Norad funding to this project is ending, Normisjonen will continue the dialog with NELC and MCH and support the process of change