Mid Term Review of the Yemen Red Crescent Society’s Operational Alliance Community Based Health Development Programme (CBHD)

Background:
The YRCS, with the support of NorCross, SRC and DRC and IFRC agreed to initiate a pilot CBHD programme under a new cooperation model called the Operational Alliance, with the dual aims of: 1. Improving the health status of the population, especially women and children and 2. Enhancing the capacity of YRCS staff and volunteers at headquarters and branches, volunteers and communities to implement the CBHD programme. The programme focuses on preventive health in its widest concept and includes support to address the underlying causes for ill health such as improved water supply systems, latrine construction, combating illiteracy among women and men in selected livelihood initiatives. The target population for the programme is 12,500 beneficiaries living in Abbs dictrict in Hajja province (in 26 villages) and 10,000 beneficiaries living in Beit al Faqih district in Hodeidah province (in 33 villages).

Purpose/objective:
The purpose of the evaluation was to review the status of the current implementation of the CBHD programme after two years of implementation in two (out of  total of 15) YRCS branches (Hajja/Hodeidah) based on initial targets against actual achievements. The Mid Term Review has planned and included in the initial CBHD programme document 2008-2011), but had been postponed from 2009 to 2010 as planned due to security issues. The main objective was to identify strengths and weaknesses of the current CBHD programme and based on these findings, to develop concrete and constructive recommendations on how to redirect the programme so as to improve its approach, relevance and impact. The review aims also to identify lessons learned through the new cooperation model of the YRCS Operational Alliance (OA)  Community Based Health Development (CBHD) programme and the supporting partnership arrangements, with focus on addressing relevant issues through the findings related to the OA CBHD programme partnership, with the ultimate aim to ensure that the OA CBHD programme content and approach are improved and strengthened.
 
Methodology:
The Mid Term review (MTR) was conducted from 27 Feb to 09 March 2010 as part of a combined review with the Danish RC supported Capacity Building and Organisational Development programme. The review considered programme performance against a set of criteria that included relevance, effectiveness, efficiency, management and partnership, and sustainability. The MTR included meetings with beneficiaries volunteers and local council representatives, branch and sub branch staff from Hodeidah branch (Beit al Faqih) and Hajja branch (Abbs district).

Key findings:
Positive:
The programme is highly relevant to Yemen and the target population, with the overall direction of the programme being in alignment with YRCS health strategy and fostering OA partner development. The programme has genuinely empowered women and raised awareness of gender issues in highly difficult circumstances. The literacy classes have been one of the most successful and welcomed activities of the programme, and have contributed towards the empowerment and betterment of women. Other successful programme activities include improving mother and child health, mostly in increased vaccination coverage, improving safe births, and family planning initiatives. The programme also contributed to improved understanding among women on the importance of immunization, hygiene, clean environment and prevention of malaria.
Negative:
The implementation of the programme had lagged behind schedule according to plans. An important reason for this were repeated security threats towards delegates following the “caricature” revolts, hampering regular project visits.
The CBHD programme had included 5 important health areas (water, sanitation, maternal and child health, literacy and nutrition) within one overall CBHD programme structure, combined with organisational development at all levels. The review states that this had proved too ambitious and challenging to manage.
Although the (YRCS) selected target communities were actively involved in initial definition of needs and selected project activities in 2007, the CBHD programme implementation during 2008-09 had not adequately involved existing YRCS branch and sub branch structures in day to day management and monitoring of the activities.
Serious lack of water in the selected project areas created additional challenges regarding population’s expectations towards project delivery in providing communities with clean reliable water supplies, effective sanitation solutions and improved food security.

Recommendations:
The issue of lack of ownership was identified as an important challenge to address in the redesign of the programme, combined with the need to develop a more realistic programme in terms of community health interventions. 
There is a need to redirect the current programme to reflect the reality of the work being undertaken, alongside the real needs of the community, in the context of what the programme is realistically able to deliver.
In order to ensure that YRCS develops a strong sense of ownership for the refocused programme, the YRCS should lead the design and planning process with partner support in a fully participatory manner and with wide stakeholder support, with systematic support and capacity building to ensure YRCS ownership and accountability for the programme, especially at branch and sub branch levels, supported by systematic translation of programme documents and clarification of roles and responsibilities and reporting lines.
To support the reprogramming process, an effective programme wide monitoring system (with baseline, indicators, targets and milestones) should be established as a priority.
To ensure programmatic efficiency and sustainability, the revised programme should place volunteers at the heart of the interventions as a mechanism to ensure linkages between other YRCS programmes (Organisational Development/Capacity Building OD/CB and Integrated Capacity Building ICB).
These recommendations should be linked to similar “synergy” recommendations in the separate mid term review of the OD/CB and the CBHD/OD synergy reports.
With the programme redesign and enhancing ownership stages, clear roles and responsibilities for all aspects of programme management at all levels (hqs to branch and sub branch) need to be established, agreed and implemented before the new initiative begins.
The CBHD programme structure from hqs to branch to sub branch should have clear roles and responsibilities, and YRCS staff should be expected to hold regular meetings and provide appropriate management and monitoring levels.
To support this structure it is recommended to recruit a new team of two delegates that will have mutual responsibility for supporting this programme and also the OD/CB programme. 

Comments from the organisation, if any:
The Norwegian Red Cross is in full agreement with the Mid Term Review recommendations, which outline relevant critical issues. The MTR recommendations have identified real challenges as well as provided concrete solutions for the revised CBHD programme process both at hqs and local levels. The MTR recommendations have been translated and disseminated to YRCS managers, staff, volunteers at several workshops at both national and branch levels, which has contributed to increased YRCS understanding and involvement, and also to strengthen ownership as a prerequisite for the ongoing revision process for a new and improved CBHD programme. YRCS has already begun to act upon the recommendations through developing a more systematic dialogue with YRCS managers, staff and volunteers at all levels. Two new CBHD and OD delegates are in place and have started working as a team with YRCS at hqs and branches, ensuring that all parties get a better understanding of integrating capacity building and strengthening synergies and linkages between volunteers and programme interventions. A new revised CBHD Programme has been drafted through a participatory process, and disseminated to all concerned in translated Arabic version. YRCS has decided that they wish to expand the CBHD programme from 2 to 4 branches and build up a new approach closer to the Federation wide Community Based Health and First Aid methodology, using the CBHFA Manual and tools, available in Arabic. There is also an increasing understanding in the YRCS leadership of what ownership implies – both at national and local levels. The MTR recommendations to OA partners to ensure  systematic involvement with YRCS as stakeholders throughout the process has at this stage (mid 2011) contributed to redirect the CBHD programme in a more positive direction, and also contributed to move forward this new OA partnership as a model approach.