Mutambara Mother and Child Survival Training and Program Development –Zimbabwe Project Evaluation

Background

The Mutambara Mother Child Survival Training Project is implemented by the United Methodist Church in Zimbabwe (UMCZ) and is supported financially by UMC in Norway (UMCN - Metodistkirkens Misjonsselskap, which includes the church's development wing). Most of the project funds come from the Norwegian Development Cooperation (NORAD) via the Norwegian Mission in Development (BN)). The project was launched in 2002. The first project period was initially for five years until end 2007. The annual project budget is around 600.000 NOK.

The project has the two following main objectives: (i) to improve the health situation of mother and children and (ii) to improve the living conditions of people affected by HIV/AIDS, in particular patients and orphans. The main project activities are immunization of children, health information, training of village health volunteers (traditional mid-wives and home-based care workers) and peer educators.

The project targets mainly 30 villages in the Mutambara area of the Chimanimani district in the Manicaland Province in Eastern Zimbabwe. The project is associated with UMC's 120 bed Mutambara hospital. The total population of the catchment area is 17,000.

The evaluation was carried out between December 2006 and February 2007. The evaluation's main scope was to assess actual project achievements, document lessons learned and come up with future recommendations.

Purpose/objective

The evaluation's main scope was to make an assessment of the project achievements in relation to initial project objectives, to document lessons learned in the project and to present recommendations for the future of the project. The evaluation addressed in particular the following issues and questions:
(i) Project relevance: Make an assessment of the project relevance in relation to the main challenges in the project area. Can the project be said to be highly relevant or less relevant in relation to the need of the people in the area; and
(ii) Project targeting: To what extent does the project successfully reach the stated target groups (children under five years old and women of child bearing age, school-children, youth, workers and the community at large and HIV-positive people and other patients and children orphaned by the HIV/AIDS pandemic
(iii) Project efficiency (an assessment about the efficiency of the resources used in the project in relation to the conducted activities): Should the activities have been carried out in another manner? Could the same activities been achieved with the use of less costly resources?
(iv) Project effectiveness: to which degree the project has achieved the project objective as stated in the project plan:
(v) Project sustainability: Make an assessment of the project sustainability. In particular give an opinion regarding the project possibilities to maintain its present work without external support.
(vi) Future development of the project.

Methodology

The evaluation team consisted of one international and one national consultant. One representative from UMC in Norway participated as an observer. The evaluation consisted of a desk review of relevant literature and a field evaluation which was divided into two periods, the first field work was carried out in December 2006 and the second and last in February 2007.

Key findings

The project objectives of improving the health situation of children under five years old, mothers and the lives of HIV affected people; in particular patients and orphans are very relevant in relation to the health needs of Mutambara's population.

The project's focus of targeting relatively remote villages in the Mutambara area complements and extends the Mutambara hospital's outreach capabilities to these communities. Currently around 60 percent of people in the district of Chimanimani live in hard to reach areas. Moreover, the DNO's office does not have transport for outreach activities in the most remote communities.

The training of home-based care volunteers to follow-up and supervise HIV positive and other patients and their primary caregivers in their homes is very relevant in a context where hospitals do not have the capacities to take care of a growing number of HIV patients. Generally, the families and local communities end up being responsible for the care of their HIV positive members. However, families and communities have scarce resources and limited experience in providing for their HIV positive patients. Moreover, the stigma of HIV/AIDS makes home-based care difficult.

The Mutambara's population need for more HIV/AIDS awareness was also addressed by the project. However, mainly women and some school children ended up being the project's main target for its HIV/AIDS awareness activities and these project activities did not reach important groups such as out-of school adolescents, men and elderly.

Recommendations

Based on the above findings and conclusions, the evaluation team recommends that UMC in Norway, with the assistance of BN and NORAD, continues to provide financial support to many of the ongoing activities, in particular immunization and health education, home visits and the supervision of the home-based care volunteers and traditional mid-wives.

The activities related to HIV/AIDS prevention and awareness, training of peer educators and assistance to HIV/AIDS support groups should be reexamined and revamped with the assistance of a local/national partner who has the required skills and experiences in these areas.

Future project activities should continue to complement and not compete with other actors' efforts in the Mutambara area. Networking and a close collaboration between the different partners and projects is necessary.

Future support from UMC in Norway would also require a much greater ownership and involvement of the UMC's Mutambara hospital in the project activities, both in terms of planning and coordinating and in carrying out the various activities. The project should not function as a small independent unit of the Mutambara hospital but be an integral part of the hospital and of the UMC in Zimbabwe.