External evaluation of Médécins du Monde fistula programme in Mopti

Background

NCA started its collaboration with MDM concerning this fistula project in 2002. From mid 2006 MDM started a new phase of its project, since from that moment the project would be run solely by local staff. NCA wished to have an external evaluation done before the entering into a new phase of the project.

Purpose/objective

The main objective as expressed by the terms of reference to the evaluation was to evaluate the impact of NCA's contribution to the project, and come up with recommendations to a new phase.

Methodology

Qualitative.

Key findings

Since the start of the fistula programme in the Mopti hospital in 1998, it has had three main components (curative, social and preventive). The curative component consists of on the one hand the recruitment of the fistula patients and their surgery and on the other hand the training of local surgeons. The results of the evaluation show that this component has been the most successful of the three components: 88% of the patients who have undergone a surgery have recovered. The training of the local surgeons has also had success as three Malian doctors are now capable of doing the surgery. The system that has been put in place by MDM is considered technically viable as the transfer of competencies to the local doctors has been implemented as planned and as the fistula surgery has become part of the hospital's ordinary activities. The most important weakness of this component is the fact that the project has not yet managed to develop viable solutions for funding of the activities after end of programme.
As for the two other components, the social and the preventive ones, these have not had the same level of success as the curative component. The social component consists of literacy and professional training of the patients. Only two of the women having followed the literacy training (12.5% of the women participating) know how to write a letter in their mother tongue. As for the professional training, it gives the women some income, but it is too early to say whether this will help them reinsert socio-economically in their local communities. The big weakness of this component is the lack of dialogue with the patients on the psychological and social aspects of their disease.
The preventive component consists of information campaigns through local radio and theatre, in order to give information on the disease and to recruit patients for surgery. The theatre has reached out to 206 villages in the Mopti region, but the effects are difficult to measure as there has not been adequate follow up by MDM of the activity. As for the radio messages, these have been done twice annually, but this is considered by the evaluators to be insufficient in order to have a viable impact.

Recommendations

- Improve the programme documents (rephrase objectives and indicators, introduce a logical framework);
- Improve the programme's strategies and approaches (especially regarding the social and preventive components);
- Improve the programme's implementation (by doing a new baseline study in the region of Mopti, by covering the whole of Mali with information campaigns, by giving the responsibility of the social and preventive components to another organisation, increasing the budget allocated to the literacy training, introducing adequate tools for follow-up of the activities).

Comments from the organisation

NCA is in dialogue with MDM concerning the main findings of the evaluation as well as the main recommendations. Some steps have already been taken, but NCA hopes to intensify its follow up of the results of the evaluation from mid July, when our new coordinator for gender based violence will start her work.