Final evaluation of the Child Wellbeing Program in North and North Eastern Uganda
RESEARCH TEAM Eddy. J. Walakira, PhD (Principal Investigator) Ddumba-Nyanzi Ismail, MSc (Co-investigator) Jimrex Byamugisha, MSc (Statistician) Joshua Kayiwa MSc (Statistician) Clare Byaruhanga
Contact Person Eddy Joshua Walakira, PhD Senior Lecturer, Children and Youth Ag. Chair Department of Social Work and Social Administration, Makerere University, Department of Social Work and Social Administration P .O. Box 7062, Kampala T +256 772 490 330 |T +256 702 490 330 Email: ewalakira@ss.mak.ac.ug Alt email: ewalakira@gmail.com |ewalakira@hotmail.com
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TABLE OF CONTENTS List of Tables .................................................................................................................................................................................................... iv List of Figures .....................................................................................................................................................................................................v List of Acronyms and Abbreviations ..................................................................................................................................................... vi Executive summary ...................................................................................................................................................................................... vii 1. INTRODUCTION .................................................................................................................................................................................... 1
1.1. Bernard van Leer Foundation’s support to children ..................................................................... 1 1.2. The programme under evaluation ................................................................................................ 1 1.2.1. Programme Delivery Framework .......................................................................................... 2 1.3. Evaluation questions ..................................................................................................................... 6 2.
3.
4.
EVALUATION METHODOLOGY ...................................................................................................................................................... 7
2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. 2.9. 2.10.
Evaluation process ........................................................................................................................ 7 Research design ............................................................................................................................ 7 Study areas.................................................................................................................................... 7 Study population and sample size ................................................................................................ 7 Sampling procedure ...................................................................................................................... 9 Data collection ............................................................................................................................ 10 Quality control measures ............................................................................................................ 10 Data management and analysis .................................................................................................. 11 Ethical procedures ...................................................................................................................... 11 Limitations................................................................................................................................... 11
SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE POPULATION ............................................................................13
3.1.
Respondent’s background characteristics .................................................................................. 13
PERFORMANCE MEASUREMENT ...............................................................................................................................................14
4.1. Result Area 1: Prevention of violence against women and children ........................................ 14 4.1.1. Violence against women .................................................................................................... 14 4.1.2. Child discipline practices.................................................................................................... 18 4.1.3. Attitudes towards physical punishment ............................................................................ 20 4.1.4. Perceptions about rates of violence in community ........................................................... 20 4.1.5. Attitudes towards reporting violence ................................................................................ 22 4.2. Result Area 2: Reducing child mortality and morbidity through improved demand, access and utilization of MCH services ..................................................................................................................... 23 4.2.1. Expectant mothers’ health seeking behaviour .................................................................. 24 4.2.2. Improvement in Child Health indicators ........................................................................... 26 4.3. Result Area 3: Improving livelihoods and food security ............................................................. 30 4.3.1. The VSLA interventions ...................................................................................................... 30 4.3.2. Agricultural support .......................................................................................................... 38 4.4. Result Area 4: Improved access to water and sanitation facilities ............................................ 40 4.5. Result Area 5: Early childhood care, learning and development .............................................. 47 4.6. Result Area 6: Capacity Building for Grass Roots Structures and District Local Government ... 50
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5.
6.
7.
REFLECTION ON PROGRAMME DESIGN AND ROLES OF PARTNERS ........................................................................54
5.1. 5.2. 5.3.
Programme scope, benefits and targeting ................................................................................. 54 Reflection on the roles of project partners................................................................................. 55 Effective and Weak Practices ...................................................................................................... 58
PROGRAMME MONITORING AND EVALUATION .................................................................................................................61
6.1. 6.2. 6.3. 6.4.
Data collection and management ............................................................................................... 61 Data quality ................................................................................................................................. 62 Use of monitoring data ............................................................................................................... 63 Other Concerns ........................................................................................................................... 63
PROGRAMME SUSTAINABILITY ..................................................................................................................................................64
7.1 7.2 7.3
Working with district and sub-county technical staff ................................................................. 64 Use of community structures...................................................................................................... 64 Managing the cost of implementation ....................................................................................... 65
8.0 RECOMMENDATIONS ..........................................................................................................................................................................66
9.0 APPENDICES ...........................................................................................................................................................................................68
List of Tables Table 1: Project areas with population estimates………………………………………………………………………. Table 2: Profile of VHTs involved in BvLF activities……………………………………………………………………… Table 3: Estimating sample size ………………………………………………………………………………………………….. Table 4: Study participants and data collection method …………………………………………………………….. Table 5: Socio-demographic characteristics of evaluation participants ………………………………………. Table 6: Prevalence of violence against women aged 15 to 49 years …………………………………………. Table 7: Child discipline practices ………………………………………………………………………………………………. Table 8: Percentage of caregivers who believe that a child should be physically punished for better upbringing ………………………………………………………………………………………………….. Table 9: Attitudes towards reporting violence ……………………………………………………………………………. Table 10: Changes in Maternal and Health indicators ……………………………………………………………….. Table 11: Child morbidity indicators …………………………………………………………………………………………… Table 12: Nutritional status of children 0-59 months …………………………………………………………………. Table 13: Table showing VSLA savings for 9 months ………………………………………………………………….. Table 14: Membership to Village Savings and Loans Associations (VSLAs) …………………………………. Table 15: Accessibility to credit facilities from VSLA ………………………………………………………………….. Table 16: ……………………………………………………………………………………………………………………………………. Table 17: Water-related indicators, by district …………………………………………………………………………… Table 18: Household hygiene facilities and practices …………………………………….…………………………… Table 19: Disposal of child stool ………………………………………………………………………………………………… Table 20: Household living condition …………………………………………………………………………………………
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2 5 9 9 13 14 19 20 21 23 26 27 30 33 34 38 41 42 43 44
Table 21: Early childhood care and learning indicators ……………………………………………………………… Table 22: Capacity building for program personnel …………………………………………………………………… Table 23: Logistical Support to district …………………………………………………………………………………….… Table 24: Process indicators, by Result Area …………………………………………………………………………….. Table 25: Roles of project partners ………………………………………………………………………………….……….. Table 26: M&E tools developed ………………………………………………………………………………………………..
46 49 50 52 54 60
List of Figures Figure 1: Key actors in the district child wellbeing programme……………………………………………………. 4 Figure 2: proportion of women aged 15 to 49 who experienced any form violence…………………….. 15 Figure 3: forms of violence experienced by women 15-49 at baseline and evaluation…………………. 15 Figure 4: Self-reported violence among women 15-49, by marital status……………………………………. 17 Figure 5: Perpetrators of violence against women 15-49 years……………………………………………………. 17 Figure 6: Self-reported violence among women 15-49 by age group…………………………………………… 18 Figure 7: Perceived rate of child abuse, compared to 12 months ago………………………………………….. 20 Figure 8: Proportion of women delivering in health facilities……………………………………………………….. 24 Figure 9: Prevalence of child morbidity…………………………………………………………………………………………. 25 Figure 10: Use of the loan taken out of the VSLA members………………………………………………………….. 31 Figure 11: Use of payout from last saving cycle……………………………………………………………………………. 32 Figure 12: Proportion of households with access to improved functional drinking water sources………………………………………………………………………………………………………………… 40
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List of Acronyms and Abbreviations BVLF CAO CBCC CBR CBTs CCGs CDO CooP DHO ECCD ECD FGDs GBV IDIs IGAs LCs M&E MCH MGLSD NGOs NRDO OVC PSFU RFCs SACCOs TSO VAC VAW VAW/C VHTs VSLAs
Bernard Van Leer Foundation Chief Administrative Officer Community-Based Child Care Centers Center For Basic Research Community Based Trainers Cooperative Care Groups Community Development Officer Cycling Out Of Poverty District Health Officer Early Childhood Care And Development Early Childhood Development Focus Group Discussion Gender Based Violence In-Depth Interviews Income Generating Activities Local Councils Monitoring And Evaluation Maternal Child Health Ministry Of Gender Labour and Social Development Non-Government Organizations Nascent Research And Development Organization Orphans And Vulnerable Children Private Sector Foundation Uganda Responsive Fatherhood Clubs Savings And Credit Associations Technical Service Organizations Violence Against Children Violence Against Women Violence Against Women/Children Village Health Teams Village Saving And Loan Associations
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Executive summary Executive summary This report describes the process, findings and recommendations of the final evaluation of the Child Wellbeing Program implemented in North and North Eastern Uganda. The Child-wellbeing program, supported by The Bernard van Leer Foundation (BvLF) and implemented by Private Sector Foundation Uganda sought to reduce violence against children and women; improve child health indicators; enhance child stimulation and learning within community based care spaces; improve the care environment by building capacities of care givers; and enabling access to basic necessities such as water and food. The program is in line with the BvLF Uganda Country Programme Strategy 2011-2015, and was implemented in three districts, namely: Kumi, Apac and Nakapiripirit. The programme was initially approved as a one year pilot; from February 2012 to January 2013 and later extended for a period of 4 months to enable completion of remaining pilot activities. The evaluation was undertaken by Makerere University (Department of Social Work and Social Administration, Children and Youth Program). The evaluation used a mixed methods design benefiting from the strengths of quantitative as well as qualitative approaches. Data was collected through a household survey, focus group discussions and in-depth interviews with different stakeholders, and a review of program documents. A: MAIN FINDINGS Performance measurement
Result Area 1: Prevention of Violence against women and children
There is a 16 % decline in the prevalence of self-reported violence against women aged 15 to 49 years across the three districts (baseline: 66%; end-line: 50%). The percentage of women who experienced physical assault and sexual violence declined by 27% and 4 % respectively. The proportion of households reporting use of non-violent methods of child discipline increased by 32% (baseline: 28%; end-line: 60%). The use of physical violence within households declined from 59 percent to 32 percent. There is a 25% decline among caregivers who believed in the use of physical punishment as a method child discipline. Decline was registered mainly in Nakapiripirit (25%) and Apac districts (20%).
Result Area 2: Reducing child mortality and morbidity through Improving improved demand, access and utilization of MCH services Results show an improvement in a range of maternal and child health indicators including: Uptake of ANC services and delivery at health facilities Access to ANC services is nearly universal (97%) at the most recent birth with a 2 percent increase (Baseline: 95%; end line: 97%). The percentage of women who made 4+ ANC visits increased from 55 percent at baseline to 60 percent at end line. Women delivering in a health facility increased by 17%; from 63 % to 80 %; 73 % women reported being escorted their spouse for at least one ANC at evaluation vs. 63% at baseline. Child Health and nutrition Morbidity of <5 years declined by 11 percent; from 79% at baseline to 68% at end-line. Improvements in health care seeking behavior for childhood illness were also reported, as well as recognition major childhood illnesses. There was marginal improvement in the nutritional status of children 0-59 months across the 3 project districts. For example, the prevalence of Global Acute Malnutrition (z-scores <-2) and severe acute malnutrition (SAM) declined by only 1%. The prevalence of severely under-weight children also declined by 2%.
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Result Area 3: Improving livelihoods and food security Activities under this result area were two-fold: (i) Formation of village savings and loans association (VLSA), and (ii) agricultural support- through provision of loan seeds, oxen and ploughs to critically vulnerable households. Records indicated that 229 VSLA were formed in the three districts, with a total membership of over 6,270. The cumulative savings for the last nine months before the survey totaled up to UGX 863,898,250 (USD 344,183). 58 % of the households were not members of any saving scheme before the VSLA formed under the project. VSLA were recognized for improvement in household participation in income generating activities, improvements in savings, incomes, participation in child care activities, and smoothening of household response to emergency financial needs for education, health care and social obligations. VSLAs were further reported to have contributed a reduction of domestic violence incidents, improvements in health care seeking for children and women, social capital, social status and self-confidence of VSLA members. Support towards agricultural production was appreciated though its contribution to food production could not easily be ascertained.
Result Area 4: Improving access to water and sanitation facilities
Households using improved water sources for drinking water increased slightly; from 81% at baseline to 84%. There was a 9% increase in the percentage of households that treat water for drinking (Baseline-13%; Endline22%). Households with improved toilet facilities increased by 12% (baseline: 12%; end-line: 24%); those with facility for washing hands after latrine use increased from 11% at baseline to 38%; bath shelter and rack for drying utensils increased by 25 % and 13% respectively. Households that safely dispose children stools increased by 19 percent; from 68% at baseline to about 87%.
Result Area 5: Early childhood care, learning and development The focus of this result area was on supporting communities to create safe and stimulating learning environments for their children of 0-8 years. Activities around this result area centered on: (i) creation of safe and stimulating spaces/play centers for children 0-6 years, and (ii) formation of cooperative care groups.
A total of 171 Community-based child care centers (CBCC) were established in the 3 districts. In addition 166 cooperative care groups (CCGs) were established (each comprising of 15-30 caregivers) to ensure the day-today running of the community-based child care centers. About 1440 children 0-8 years have been enrolled in the community based child care centers. Through the above interventions, the project has been able to mobilize and generate commitment from the care givers, and communities to support child play and learning using local materials.
Reflection on Programme Design and Roles of Partners Program relevance and logic: The program was very relevant to the needs of children and care givers in the selected communities. The program ethos underlined community involvement and ownership, response to multifaceted challenges children face, and an over aching desire to build safe physical and social environments for children. Design strength: The integrated nature of the program made it possible to multiple vulnerabilities children face. The use of TSOs made it possible to utilize different forms of expertise needed for the program. Working with district structures at various levels increases buy-ins and potential for programme sustainability. Strong reliance on grassroots structures increases ownership and sustainability. Limitations/weakness: Too many programme components being implemented in a short time did not allow time for reflection and learning; exerted too much demands on PSFU assigned staff and district officials. No well-defined criteria for identification of the most vulnerable children and families, and to avoid danger of exclusion of most needy. Monitoring and evaluation function remains weak. The use of monitoring data for program management remains one of the weakest areas of intervention.
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Reflection on the roles of project partners: Role assignment underlined the need to use expertise from different service providers, obtaining political support (local government structures), and prudent management (Use of PSFU). The performance of roles was satisfactory in most of the cases with the exception of a few cases some of which were beyond the control of the service providers. Program Sustainability: Many program elements such as VSLAs, use of VHTs, efforts against VHTs remain sustainable in the long term. Others such as provision of basic services are also catered for in the district development plans which will ensure their continued provision. The use of community structures remains a key ingredient in ensuring the long term sustainability of the programme. B: RECOMMENDATIONS Violence against children and women: Sensitization combined with dialoguing should be continued and extended to other areas; An emerging integration of violence prevention activities within VSLA should be strengthened; Should engage cultural and religious leaders in the prevention efforts; Selected VHTs, CBTs and local leaders should have child protection training with key emphasis placed on case management, referral (reference to the Nationally Certified Child protection Curriculum) and prevention of violence in other settings; Greater attention should be paid to eradication of FGM practice Strengthening the family to provide effective care through economic empowerment VSLA participants need more guidance on undertaking common IGAs, increasing production and working towards collective marketing and utilization of benefits of economies of scale; VSLA need to be linked to formal banking; Develop guidelines and regulations on activities of members particularly to exclude involvement in alcohol production, and involvement of children in hazardous work; More technical assistance on book keeping, business development Child care, stimulation, learning and safe spaces The centers will need to graduate from being informal to some level of formality where more structured care, learning and play can be organized; Facilities including shelter, toilets and other services will need to be taken into consideration by the community. Training for a designated trainer (s) is necessary to create consistence; Parents need to plan for feeding of children and access to other services such as water; Age segmentation should be taken into consideration as some centers admit very young and older children Improving care environment through improved access to basic services More supervision of water user committees and support to improve maintenance of services Follow up borehole supplier to finalise works regarding fitting two pipes per borehole (Apac district) Enable access to services under this component through referral or other private sector providers Maternal and child health interventions Care givers need more training on child survival, feeding and development Program design Develop criteria for identification and accessing benefits to the most vulnerable households (children) Use of specialized agencies in providing services should be maintained Accelerate efforts to bring on board private sector actors to support selected components of the program
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1.
INTRODUCTION
This report presents findings of the external evaluation of the Child Wellbeing Improvement Program supported by Bernard van Leer Foundation and implemented by Private Sector Foundation Uganda and the three district local Governments in north and north eastern Uganda namely; Apac, Kumi and Nakapiripirit districts. At the time of field data collection in October 2013, the Program had been running for nearly 18 months since its inception in February 2012. The evaluation was undertaken by Makerere University Department of Social Work and Social Administration (Children and Youth Program). The report is arranged in five sections. The introductory sections (chapters 1-3) provide the background information about the program, the objectives, and the methodology employed in executing the study. Section four presents the key findings bringing out the major result areas arranged according to the program goals. The last section examines issues of program design and delivery framework, monitoring and evaluation and sustainability; and makes recommendations for improvement taking into account the extension of the life of the program and the need for scaling up.
1.1.
Bernard van Leer Foundation’s support to children
For over sixty years, Bernard van Leer Foundation (BvLF) based at the Hague in Netherlands has championed the mission of improving the lives of young children aged 0-8 years growing up in circumstances of social and economic disadvantage, by improving their opportunities for survival, growth and development and getting them a good start in life. Since 1949, BvLF has worked with organizations across the world by extending grants and technical support, to implement culturally and contextually appropriate interventions. In addition, BvLF supports evidence based advocacy efforts and sharing of knowledge and expertise in early childhood development all of which contribute to positive policy change and improved programming for young children at local and international levels. BvLF’s work stretches over 10 years in Eastern and Southern Africa. In Uganda, BvLF has been working with several partners since 2002. BvLF’s work is financed by an endowment fund by a Dutch industrialist and philanthropist who lived from 1883 to 1958.
1.2.
The programme under evaluation
The Improved Child Wellbeing Programme is in line with the BvLF Uganda Country Programme Strategy 2011-2015. The programme was approved as a one year pilot from February 2012 to January 2013. It has since been extended up to December 2013 to enable completion of remaining pilot activities and to give time for audit and external evaluation. The programme aims at achieving three interrelated goals: i. Reduced child mortality and morbidity among young rural children growing up in unhealthy physical environment ii. Reduced violence in families with young children in physical areas iii. Young children (0-6 years) in rural areas spend their days in safe and stimulating environments near their homes.
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To realize the above objectives, the programme was designed in an integrated manner and thus addresses the multiple vulnerabilities young children experience in the areas such as inadequate child care and stimulation, exposure to violence, economic impoverishment at the household level, food insecurity, poor nutrition and lack of access to clean water, sanitation and hygiene. The programme covers 2 sub-counties in each district— Kumi: Ongino and Kumi sub counties out of 7 sub counties; Apac: Chegere and Nambieso sub counties out of 11 sub counties; Nakapiripirit: Moruita and Lorengedwat sub counties out of 8 sub counties. Table 1 provides more details about areas covered and population estimates. Table 1: Project areas with population estimates District
Apac
Sub/ Counties
Women
Children (0-5 yrs)
Nambieso
20,352
21,106
4,083
4,208
4,862
5,087
6,837
8,915
1,431
1,719
1,812
1,968
Chegere
12,554
13,028
890
942
650
710
5,203
5,501
221
223
217
220
Children (5-8 yrs)
Men
Women
Children (0-5 yrs)
Children (5-8 yrs)
32,906
34,134
4973
5150
5,512
5,797
12,040
14,416
1,652
2,042
2,029
2,188
Ongino
14,307
14,831
1678
1879
986
1,287
14307
14,831
876
913
872
991
Kumi
14,193
15,553
3,500
2,256
864
773
8419
10,789
678
810
799
913
28,500
30,384
5178
4,135
1,850
3,910
22,726
25,612
1,554
1,723
1,670
1,904
5,400
5,670
987
1,022
623
791
5,400
5,790
987
1,022
623
791
10,100 15,500
7,800 13,470
1,638 2,625
1,798 3,820
928 1,551
997 1,788
10,014 15,414
7,800 13,590
1,798 2,785
921 1,943
936 1,559
997 1,788
76,906
77,988
12,776
13,105
8,913
11,495
50,180
53,618
5,991
5,708
5,258
5,880
Total *Nakap’t
Population planned to be reached
Men
Total Kumi
General Population
Lorengedw at Mourita
Total Grand Total *Nakapiripirit
1.2.1.
Programme Delivery Framework
The Uganda district child wellbeing programme was designed in such a way that the institutional framework for delivery of benefits to the identified beneficiaries involves a partnership of three arms or actors namely; i) the public arm represented by local government structures –district, sub county and community level; ii) the private arm— represented by Technical Service Organizations (TSOs) that offer management, capacity building and other services; and iii) the grassroots structures –which involve quasi government, community groups and individuals. Each of these actors plays specific roles to ensure that the programme is effectively implemented. The roles are briefly discussed in the next sub-sections. The Local Government (LG) technical staff The program makes use of the local government (LG) institutional framework and technical staff to identify and prioritize early childhood interventions. The district technical staff are particularly responsible for; i) designing the intervention in collaboration with district and BvLF management and selected TSOs, ii) sourcing local service providers for water and sanitation facilities (sinking boreholes and maintenance) and livelihoods strengthening inputs (ox-ploughs and oxen and seeds) etc; iii) deployment and supervision of LG technical staff (those providing extension support or supervising data collection), iv) 2
ensuring that the project is integrated in the LG programs; v) preparation of progress reports and, vi) working in collaboration with PSF to ensure that the program is successfully implemented. As Figure 1 shows, in each district, the programme is coordinated by the District Health Officer (DHO) in liaison with the Community Development Officer (CDO) and Production Officer (PO) at district level. The DHO is assisted by sub county technical staff namely; the Health Assistant (HA), Assistant Community Development Officer (ACDO) and Assistant Production Officer (APO). These work directly with Village Health Teams (VHTs) and Local Council Officials to ensure that all programme elements are implemented. Data for different programme components are collected by VHTs and delivered to the Data Clerk who sits in the office of the DHO to manage. Technical services organizations (TSO) The programme assigned specialized roles to different TSOs which were mainly private non-profit making organizations. These included:
Private Sector Foundation (PSFU): The organization was assigned three roles namely; (i) acting as the financial intermediary for BvLF to distribute funds to the districts, (ii) monitoring the implementation of the programme and reporting to BvLF and other stakeholders; and (iii) advocating for young children within government and the private sector. To monitor activities, the PSFU has allocated a staff member, to work closely on-the-ground to supervise the programme.
Nascent Research and Development Organization (NRDO): The organization was charged with the responsibility of orienting and training district and sub-county technical staff, and VHTs about the programme concepts and implementation approach. NRDO was also responsible for training VHTs on their roles such as community mobilization to participate in program activities, data collection and monitoring. Orienting district staff and VHTs about the program approach and roles was expected to ease the implementation of the program.
Oracle Uganda: The organization was responsible for training Community Based Trainers (CBTs) who were expected in turn to become trainers of Community Groups in VSLA methodology. Oracle was also assigned the responsibility of training supervisors for VSLAs at sub-county level and giving them manuals to guide their day-to-day activities, training supervisors and CBTs on use of reporting tools; training district data clerks on how to install and configure the VSLA management information system, how to enter and analyze data, and how to generate the report and give feedback to district and sub-county users, and PSFU
Cycling Out of Poverty (CooP): CooP provides bicycles to the VHTs for mobilization and builds capacity for their maintenance. The VHTs were trained on bicycle use and maintenance. The bicycles are also intended as instruments for improving livelihoods of VHTs. BvLF further intended
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to provide dynamos (bike-powered mobile phone chargers) which could be used as a source of income. 
Center for Basic Research (CBR): CBR took on the Monitoring and Evaluation (M&E) responsibility. They conducted the baseline survey, developed M&E indicators and the tools that were to be used. They also developed a data base and trained district staff on how to use it.
Figure 1: Key actors in the district child wellbeing program
Source: BvLF Briefing Book, 2013:16
The grassroots structures The programme implementation takes place at the village level using VHTs, VSLAs, Cooperative Care Groups (CCGs), Responsive Fatherhood Clubs (RFCs) and Local Council (LCs) Authorities. Village Health Teams (VHTs): Two VHTs were selected per village by Local Council Officials and ACDOs to take part in this programme. The VHTs responsibilities included: mobilization of households to take part in health promotion activities; management and maintenance of water sources; access to safe water, hygiene and sanitation; safe motherhood; livelihood activities; child care and early learning through CCGs; elimination of violence against children and women through responsive fatherhood clubs; and collection of community data on a range of indicators to be used for monitoring and evaluation of programme performance. The key profiles of the VHTs are indicated in table 1.2.2: 4
Table 1: Profile of VHTs involved in BvLF activities Profile Gender
Age Education
District
Apac
Kumi
Nakapiripirit
All
Number (n)
166
108
58
332
Female
53 (31.9%)
47 (43.5%)
21 (36.2%)
121 (36.5%)
Male
113 (68.1%)
61 (56.5%)
37 (63.8%)
211 (63.6%)
Mean (sd)
37.4 (9.3)
37.6 (9.5)
-
37.5 (9.4)
None
-
-
7 (38.9%)
7 (2.5%)
Primary
31 (18.9%)
34 (34.0%)
7 (38.9%)
72 (25.5%)
Secondary
133 (81.1%)
66 (66.0%)
4 (22.2%)
203 (72.0%)
Village Savings and Loans Associations (VSLAs)1: The VSLAs are comprised of direct beneficiaries of the intervention and are based within the villages. Membership varies from 15-30 participants majority being women. There are about 229 VSLAs formed in the three districts. VSLAs are meant to augment participants’ incomes by promoting the culture of saving and investment in income generating activities. They are managed by members with technical assistance from Community Based Trainers (CBTs) and supervisors at the sub county level. Responsible Fatherhood clubs: These were initiated by the VHTs as a spin-off from other community interventions. The Fatherhood clubs are groups of fathers2 who meet regularly to address issues around domestic violence. They are responsible for mobilizing and sensitizing communities about domestic violence, mediating in cases of domestic violence. Other structures: Other structures include the cooperative care groups and Water User Committees (WUCs). WUCs were formed with the aim of promoting community ownership in the management and or maintenance of water sources.
1Initially,
villages were structured in clusters, which were groups of households, which would be served by VHTs. However, this structure has seemed to fall away and has been replaced by the VSLAs. 2 Fathers who spend time with the family, take wife to ANC, with a clean home environment, able to speak in public)
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1.3.
Evaluation questions
The evaluation sought to answer the following questions: 1. What family level changes are arising from the programme? (Including changes in parental behaviors as well as child outcomes including health, nutrition, play and violence? 2. Are all stakeholders fulfilling their responsibilities? What were the weak points and how can they be strengthened? This outcome should be a detailed performance analysis for all programme partners. 3. What has worked and not worked and what are the lessons learned from the work of BvLFfunded district VHT programmes targeting young children aged 0-8 years in the three districts of Apac, Kumi and Nakapiripirit? This should include assessment of each programme component. 4. What is the potential for sustainability of the programme? Is this programme sustainable? What are the risks and strategies for sustaining this programme
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2. EVALUATION METHODOLOGY 2.1.
Evaluation process
This evaluation was conducted in two phases. Phase I: Preparatory and limited data collection phase: The first phase relied more on documentary review and key informant interviews with selected program actors. Two objectives were to be achieved during this phase. The first concerned laying the ground work for the second phase of the study by developing an appropriate research methodology and research tools, generating sampling frames, and developing a data collection plan. The second objective required gaining an insight into issues of program design, roles of actors, program sustainability and coming up with learning lessons that would inform the next course of action. Phase II: Full program evaluation phase: The activities undertaken during the first phase, particularly relating to issues of methodology, recruitment, training of research assistants, and pretesting of the tools were finalized during this phase prior to data collection. In the sections below, we provide a brief about the research design, study areas, study population, sampling procedures and data management processes.
2.2.
Research design
The evaluation used a mixed methods design benefiting from the strengths of quantitative as well as qualitative approaches. Prior to implementation of the child wellbeing improvement program, comprehensive cross-sectional baseline data was collected in 2011 in all the three districts. The data provided a comprehensive picture of the situation of children and care givers in relation to specific indicators at the time. During the final evaluation, data collected was analysed in such a way that baseline indicators are measured and compared against outcome indicators following one and a half years of program implementation.
2.3.
Study areas
The study covered Apac district in northern Uganda, Kumi district in eastern Uganda and Nakapiripirit in north eastern Uganda. The districts represent the sites where the program was implemented. All the three districts experienced conflict and internal displacement of the population. Apac and Kumi were affected during the two decades of insurgency between the Ugandan government and the Lord’s Resistance Army (LRA), while Nakapiripirit is among the districts affected by cattle rustling and pacification (dis-armament) operation by the Uganda government forces. In all these three districts, children were among the most affected vulnerable groups.
2.4.
Study population and sample size
The primary study population comprised direct beneficiaries of the intervention in the three districts who were targeted at the household level given their circumstances of vulnerability or disadvantage. These included child caregivers aged 18 years and above, as well as children aged 0-8 years. Secondary study 7
participants included individuals and/or institutions that were targeted as indirect beneficiaries or were actively involved in the implementation of the program. These included all key actors from the three arms discussed in section 1.3. Table 4 provides details of the study participants and summarises the methods used to collect data. Sample size determination: The evaluation comprised households that benefited from the project and these were used as a basis for determining sample size. Overall, the project served 1,168 households in the three districts. The responses from sampled households were subsequently generalized to the entire population of interest, in this case, in each of the target districts (Apac, Kumi and Nakapiripirit). The sample size was determined using the method and assumptions below: The criterion of permissible error was applied in the estimate of the proportion of household with a child to have ever suffered violence3 (with probability p) and the true proportion by P. Stipulating that the probability that the margin of error is less than a quantity d is 95%, we present the following expression:
But, since P lies between zero and one, the quantity P(1-P) is less than or equal to 0.25, being certain that the sample size satisfying the criterion is less than (1.96) 2(0.25)/0.0025 = 384. In other words, the sample size to guarantee that equation (1) is satisfied, is 384 respondents, provided that the admissible margin of error in estimating the true proportion is less than 5% with probability equal to 95%. Sample Size of 384 from the three districts was distributed using proportional to size approach. This took care of the district population estimates. On average, each district was represented by about 130 households. These were drawn using systematic random sampling as the lists of the beneficiaries were availed to the researchers. Sample distribution: Using available data from project intervention areas, we noted that the number of villages under the program did not depend on the number of parishes in any given sub-county. Therefore, the sample was distributed by villages in a given sub-county. Taking the cluster sample of 30 households per village –the village being an enumeration area as per Uganda Bureau of Statistics (UBOS) approach, the sample of 384 households was distributed in 14 villages. Taking into non response, the total sample size was raised to 420 households as detailed in Table 3. Also, accessible data gave a range number of 0-8 children per household per sub-county, and when this was multiplied into the sample size, the estimated
3
Violence was used on this occasion because the program priotised it as a core activity targeting children and adult women.
8
number of children to be covered in this evaluation was 524. The children were drawn from the sampled households. Table 3: Estimating sample size Parishes
Villages
VHT (2 per village)
HHDs
Children 0-8
Av. # of children per HH
Nambieso SC
1
4
4
120
163
1/2 SC
1.4
Chegere SC
1
3
3
90
122
1/2 SC
1.4
Kumi SC
2
2
2
60
65
1/2 SC
1.1
Ongino SC
2
3
3
90
98
1/2 SC
1.1
Loreng'edwat SC
1
1
1
30
38
SC
1.3
Moruita SC
1
1
1
30
38
SC
1.3
Total
8
14
14
420
524
Apac
Kumi
Nakapiripirit
2.5.
1.2
Sampling procedure
Quantitative component: In each district, program activities were implemented in two sub-counties as indicated in Table 1.2.1 (section 1.2). Following the identification of the sub-counties, a multistage cluster random sampling approach was used to select parishes and villages from which respondents for the quantitative study component were selected. From each of the project sub-counties, a random selection of three parishes was made. From each parish three villages were randomly selected. At the village level, sampling frames comprising beneficiaries as identified from BvLF VSLA lists and verified by Local Council leaders were developed. The lists were eventually used during the random selection of household heads with children aged 0-8 years as shown in Table 4. Table 4: Study participants and data collection method Data Collection Method
Participants
Category
DISTRICT Total
Apac
Kumi
Nakapiripiti
420
204
150
60
1774
790
700
284
VSLA members
30
10
10
10
Village Health teams (VHTs)
12
6
5
1
13
3
5
5
QUANTITATIVE APPROACH Questionnaire- survey
Caregivers at household levels
Household heads/spouse
Children in sampled hhs 0-17 years QUALITATIVE APPROACHES Focus group discussion
Cooperative members
care
group
(CCG)
RFC members Key informant Interviews
13
5
3
5
District technical staff
DHO/DHE, Data clerk
10
4
4
2
Sub-county technical staff
Health assistant Production officer
11
4
4
3
12
4
4
4
4
1
2
1
Community based trainers(CBTs) Dialogue sessions with children
Children at community based centers
Girls and boys, 6-8 years
9
Qualitative component: Participants in the qualitative study component were drawn in the categories as indicated in Table 1. Household heads who participated in the survey interviews involving use of structured questionnaire were excluded from participating in the qualitative data collection. Participants in the qualitative component thus included VSLA members, VHTs, CCG members, Responsive Fatherhood Clubs (RFCs), political leaders at various levels, technical personnel at the district and lower levels and children taking part in community care and stimulating spaces.
2.6.
Data collection
Quantitative data was collected through a household survey. Qualitative data was collected through focus group discussions, in-depth interviews (IDIs), and participatory activities with children Household survey: Quantitative data was collected from a sample of 420 households in the three project districts. Face face-to-face interviews were conducted with caregivers (or household heads) selected at the household level, using a standard multi-topic household questionnaire adjusted for the specific purpose of this project. The questionnaire covered issues linked to child care, child health, health seeking behavior, violence against children and women, livelihoods capabilities and access to basic services including food, education, water and sanitation among others. Additional information was collected on all household members but particular attention was paid to anthropometric measurements relating to child growth, nutrition status and mental health. Qualitative data: Qualitative data was collected mainly through Focus Group Discussions (FGDs) aided with an FGD interview guide. Participants included members of water user committees, VHT members, Community based trainers, Members of household cluster and Responsible Fatherhood Clubs (RFC), Cooperative care groups, Local leaders such as the Manyattas (homestead leaders) and Members of Village and Savings Associations. Child participation: Dialogue sessions with children aged 5-8 years were organized with the help of caregivers and teachers of the community early childhood development centers. Children shared their experiences about learning and the accruing benefits. Key informant interviews: KIIs were conducted with LG technical staff involved in the project and the community based trainers (CBTs).
2.7.
Quality control measures
The first draft of the data collection tools (both qualitative and quantitative) were developed by the research team. These were later on edited and perfected through email exchanges with the project implementation team at PSF Uganda. The quantitative questionnaire was edited to capture as much as 10
possible the baseline indicators, to help compare changes at baseline and evaluation. In the field, the quantitative questionnaire was administered in the local languages using interviewers who were native speakers of the local languages. A series of trainings were held for the data collection teams before setting off for field data collection. The trainings underlined collection of accurate and complete data, how to identify the eligible respondents for the evaluation, how to deal with unresponsive / uncooperative respondents, among other field-based concerns. Supervisors helped to meet with data collectors every evening after data collection to verify filled out questionnaires for completeness, accuracy of information and consideration for repeat interviews where considered necessary.
2.8.
Data management and analysis
Quantitative data: Following design of data capture customized using EpiData 2.1b (EpiData Inc., Denmark) all completed questionnaires were entered by well-trained research assistants under supervision of the statisticians. Data cleaning preceded analysis and presentation of findings. Data analysis was performed in the Stata 11.0 (Stata Inc, USA) software. Here, descriptive statistics (mean and standard deviations) were generated for all continuous variables. For categorical variables, frequencies and percentages were generated. In this report, quantitative data has been presented following the study objectives, and comparative analyses with baseline indicators have been undertaken whenever available. Multiple response analysis was also performed for variables where respondents gave more than one response to a single question. Each variable has been cross-tabulated with the respondents’ district. In the report, quantitative data has mainly been presented in tabular, graphical and text formats. Qualitative data: Following field data collection, hand written notes mainly from the FGDs and KIIs were assembled and typed into a word processing program (Microsoft Word). The notes were read with careful attention paid to emerging narratives, themes and meanings. An interpretative analysis was applied to the data following the study objectives.
2.9.
Ethical procedures
Careful attention was paid to ensuring protection of children and other study participants. Principles of confidentiality were adhered to and participation in the study was voluntary.
2.10. Limitations While the study was conducted in the most rigorous manner possible, some limitations must be acknowledged. Self-reported data: First, the evaluation uses self-report, which has the potential for social desirability bias. In addition, information on diseases and other health problems are self-reported and were not necessarily confirmed by qualified medical diagnosis. 11
Questionnaire: Because of the multiplicity of languages in Uganda, the instruments were not translated into local languages. All the enumerators had to be fluent in both English and the local language of the area surveyed. Intensive training on the use of the questionnaire and the relative simplicity of the concepts used, contributed to the reduction of potential bias or misinterpretation of the questions Data quality: Inaccurate recollection of facts such as age of children may have affected the quality of some results. The enumerators were nonetheless trained to facilitate such recollections and estimates through various methods (eg. event calendars, proportional piling).
12
3. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE POPULATION 3.1.
Respondent’s background characteristics
Of the 420 targeted households, 418 (99.5%) participated in the survey. The mean household size was 6.8 persons. On average, children 0-8 years accounted for 34 percent of the members of the households. Majority of the respondents (70%), were female (Table 3.1.1). The mean age of the respondents was 37 years. Majority of respondents were either the household head (46%) or spouse to the household head (70%). More than threequarters (77%) of the respondents were married, and 18 percent had no formal education. Table 5: Socio-demographic characteristics of evaluation participants Apac (n=200)
Districts Kumi (n=149)
Nakapiriti (n=69)
Overall (n=418)
39.5 60.5 38.2
15.4 84.6 36.7
36.2 63.8 35.6
30.4 69.6 37.2
56.5 39.0 1.0 1.0 2.5
38.9 54.4 6.7 0.0 0.0
51.1 31.9 2.9 1.5 8.8
50.0 43.3 3.4 0.7 2.6
80.5 5.0 9.5 4.5 0.5
72.5 8.1 12.8 6.0 0.7
73,9 5.8 13.0 4.4 0
76.6 6.2 11.2 5.0 0.5
47.5 37.5 7.0 3.0 4.5 0 0
34.9 45.6 4.0 5.4 4.0 1.3 4.7
64.3 26.1 4.4 2.9 0.0 1.5 0.0
45.5 38.5 5.5 3.8 3.6 0.7 1.7
89.8 10.2 (n=176) 74.9 16.6 3.4 4.6 0.6 103,112
91.3 8.7 (n=136) 77.9 18.4 0.7 2.2 0.7 119,855
38.8 61.2 (n=26) 61.5 30.8 3.9 0.0 3.9 103,108
82.0 18.0 (n=338) 75.1 18.4 2.4 3.3 0.9 109,047
Gender Male Female Average Age (yrs) of respondent Relationship of respondent to household head Household Head Spouse Son / Daughter Parent Other relative Marital status Married Separated/divorced Widowed Single Other Religious affiliation of respondent Catholic Anglican Traditional religion Orthodox Pentecostal Muslim Other Ever attended school Yes No Highest level of education Primary Secondary Diploma/degree Technical/vocational Others Mean household income (UGX)
13
4. PERFORMANCE MEASUREMENT 4.1.
Result Area 1: Prevention of violence against women and children
As part of the programme, several activities were undertaken to prevent and respond to violence against women and children. Particularly: • 214 Responsive Fatherhood Clubs (RFCs) were formed, to foster male involvement in prevention and response to violence. Members of the RFCs organize dialogue sessions on violence against women/children (VAW/C), mediate and resolve conflicts and sensitize communities through music, dance and drama. • VSLA leaders and VHTs were trained on domestic violence. VSLA leaders were trained to facilitate reflection and dialogues on violence against children and women and the ways in which VAW/C adversely affects health and wellbeing of children as part of the VSLA activities. The VHTs were expected to organize and facilitate community dialogue sessions around issues of domestic violence. Evaluation results indicate a reduction in violence against women since baseline, and an increase in the use of non-violent disciplinary methods among parents/care givers of children. In addition there is a significant decline in the proportion of mothers/primary caregivers who believe in use of physical punishment, as a child disciplinary method.
4.1.1. Violence against women Overall, there was a 16 percent decline in the prevalence of self-reported violence against women aged 15 to 49 years across the three districts (baseline: 66%; end-line: 50%). With respect to specific forms of violence, the proportion of women who experienced physical assault declined by 27 percent (baseline: 62%; end-line 35%). The proportion of women who experienced sexual violence also declined marginally, from 10.5 percent to 7.0 percent. Table 6: Prevalence of violence against women aged 15 to 49 years Apac (n=524) % of women (15 to 49 ) who experienced violence in the past 12 months Forms of violence experienced
Baseline Nakapiri Kumi pirit (n=207) (n=105)
Overall (n=836)
Apac (n=94)
Evaluation Nakapi Kumi ripirit (n=101) (n=34)
Overall (n=229)
67.9
64.3
60.0
66.0
50.0
50.5
47.1
49.8
(n=356)
(n=133)
(n=63)
(n=552)
(n=47)
(n=51)
(n=16)
(n=114)
Wife battering / physical assault Sexual violence**
57.3 5.6
71.4 14.3
71.4 30.2
62.3 10.5
36.2
35.3
31.3
35.1
12.8
2.0
6.3
7.0
Forced marriage
0.6
0.8
25.4
3.4
0.0
0.0
0.0
0.0
Denial of material, social, and political rights*
28.9
6.0
25.4
23.0
21.3
9.8
12.5
14.9
Use of abusive language
66.3
45.1
39.7
58.2
34.0 51.0 31.3 41.2 Forced labour 9.8 2.3 17.5 8.9 0.0 0.0 12.5 1.8 Denial of sex 3.4 33.8 7.9 11.2 4.3 0.0 0.0 1.8 **Includes rape, defilement, and forced sex; *Includes denial of inheritance of property, ownership of property, education, and political rights, all of which were options on the survey, as well as denial of upkeep
14
Figure 2: proportion of women aged 15 to 49 who experienced any form violence
% of women (15 to 49 ) who experienced violence in the past 12 months 80 70 60 50 40 30 20 10 0 Baseline Evaluation
Apac
Kumi
Nakapiripirit
Overall
67.9
64.3
60
66
50
50.5
47.1
49.8
Baseline
Evaluation
Figure 3: Forms of violence experienced by women 15-49 at baseline and evaluation
Forms of violence experienced by women at Baseline and Evaluation 0
Denial of sex Forced labour
1.8 8.9
1.8
Use of abusive language
58.2
41.2
Denial of material, social, and political rights*
14.9
Forced marriage
0
23
3.4
Sexual violence**
7
10.5
Wife battering / physical assault
62.3
35.1 0
10
Baseline
20
30
40
50
60
70
Evaluation
Data from FGDs and IDIs also provide some insights into the quantitative findings. Participants reported a general reduction in the level of domestic violence cases, and an increased awareness on various forms of 15
gender based violence, its consequences and available response options. The intervention has also provided a plat form for community members to engage, discuss and address community attitudes that perpetuate and exacerbate gender based violence (GBV). This has considerably generated community consciousness on GBV and significantly increased the number of people reporting GBV cases. Domestic violence has reduced because most men no longer fight their wives today and incase of any misunderstanding, we the VHTs and RFH clubs join hands together and calm the situations. (FGD with VHTs, Ayabi village, Nambieso-Apac District) ‌violence in homes has greatly reduced in fact, now days everyone feels hurt when they hear anyone involved in domestic violence so a lot has really happened. (VHT Morupeded parish, Kumi district) When you look at homes right now, we have seen joy and peace. Initially men could shout like lions or dogs in their homes, if this club was not there, most homes would have already broken down, because if you see people now in their homes, there is understanding, peace and people are clean in their homes. (Member of the RFC club in Kabata parish Kumi district) Domestic Violence cases have reduced. People confess that they are no longer fighting. The cases of domestic Violence at police and probation office are low from the parishes under the project ‌ Even at health facility; they are no longer writing medical forms for assault. Some women have come out openly and told us that these [fightings] are no longer the case. (Sub-County Technical staff, Nambieso Apac District)
Risk factors for violence against women (VAW) While violence against women cuts across socio-demographic boundaries, data suggest that some groups of women are more at risk. Several factors have been associated with a higher risk of self-reported violent victimization among women. While these risk factors cannot be considered direct causes of victimization, they can individually or collectively contribute to an increased likelihood of victimization. Identifying risk factors, therefore, can help inform the maintenance and development of preventive strategies and responses to violence against women. Married women most at risk of violent victimization Figure 2 indicates differences in the distribution of VAW by marital status. Overall, married women were, comparably, more at risk of self-reported violence—at both baseline and evaluation. This suggests a high rate of intimate partner violence.
16
Figure 4: Self-reported violence among women 15-49, by marital status
79.8
Evaluation (n=114, p-value: 0.128)
Married
Divorced
Widowed
Cohabiting
Single
0.9
1.3
4.4
2.0
0.9
2.7
4.4
4.7
9.7
5.8
Percentage
83.5
Baseline (n=552, p-value:0.164)
Others
Marital status
Women most at risk of violence from a spouse/intimate partner4 Evaluation and baseline results show that women are most at risk of violence from an intimate partner/spouse than any other type of perpetrator, including neighbors, daughters/sons among others. There is however noticeable reduction in the proportion of women experiencing violence perpetrated by an intimate partner; from 86 percent at baseline to 73% Figure 5: Perpetrators of violence against women 15-49 years
72.8% Overall (n=114)
27.2%
62.5%
37.5%
17.7% 82.4%
Nakapiripirit (n=16)
Apac (n=47)
Baseline
Kumi (n=51)
66.0%
85.9%
34.0%
14.1%
Other perpetrator
Overall(n=552)
38.1% 61.9% Nakapiripirit (n=63)
91.0% Kumi (n=133)
9.0%
88.2% Apac (n=356)
11.8%
Spouse / Partner
Evaluation
4
We define an intimate partner as a current or former spouse, boyfriend, or girlfriend, and intimate relationships include both heterosexual and same-sex relationships.
17
Age as a risk factor for violence At both baseline and evaluation there was no significant relationship between self-reported violence and age. Nonetheless, both evaluation and baseline data show that women aged 25 to 39 years appear to be more exposed to violence compared to any other age groups. Figure 6: Self-reported violence among women 15-49 by age group Baseline (n=552, p-value:0.347) 58.8%
Evaluation (n=114, p-value: 0.559)
56.0%
29.7% 21.1%
20.2%
14.3%
15-24yrs
25-39yrs
40-49yrs
4.1.2. Child discipline practices Most of the violence against children in the study communities manifests in the form of child disciplinary practices. Indeed, child discipline is an integral part of child upbringing in all cultures. According to Butchart et al., (2006), child discipline includes training directed at developing judgment, behavioral boundaries, self-control, self-sufďŹ ciency and positive social conduct.5 Child disciplinary practices have broad implications for overall child well-being, and appropriate discipline is viewed as being a necessary part of child rearing. Understanding child discipline requires an appreciation of the full range of disciplinary behaviors, including non-violent as well as violent practices. Non-violent child disciplinary practices include acts that are closely associated with authoritative parenting, such as taking away privileges or explaining why something is wrong. On the other hand, violent child discipline may be either physical or psychological in nature. Violent physical discipline (which is also known as corporal punishment) uses physical means to 5
Butchart, A., A. Phinney Harvey, M. Mian and T. FĂźrniss, Preventing Child Maltreatment: A Guide to Taking Action and Generating Evidence, World Health Organization, Geneva, 2006
18
control children, such as spanking or physically forcing children to do things. Violent psychological discipline involves the use of guilt, humiliation, the withdrawal of love, or emotional manipulation to control children. Overall, results of the evaluation indicate that more caregivers are embracing the use of non-violent methods of child-discipline. Quantitative results show that the proportion of households reporting use of non-violent methods of child discipline increased by 32% (baseline: 28%; end-line: 60%). Table 7: Child discipline practices Baseline Apac
Non-Violent Discipline Violent
Psychological
Discipline Physical
Ignored misbehavior
Kumi
Evaluation
Nakapiripi
Overall
Apac
Kumi
Nakapiripi
(n=149)
rit (n=69)
Total
(n=737)
(n=370)
rit (n=148)
(n=1255)
(n=200)
(n=418)
39.2
13.8
9.5
28.2
77.5
28.2
76.8
59.8
0
0.5
0.7
0.2
21.5
73.2
44.9
43.8
50.5
74.1
66.9
59.4
30.5
38.3
24.6
32.3
5.8
3.8
8.1
5.5
12
1.3
4.4
6.9
***Multiple response analysis
Qualitative findings illustrated that increasingly parents prefer to use ‘inductive’ (such as reasoning or discussing an issue with a child) rather than “power-assertive” child discipline strategies (see Sandberg & Hofferth, 2001). Parents are more inclined to talk or discuss with children in case they misbehave by explaining to children why the behaviour is wrong, and asking the child not to do it again. In return, parents expected children to apologize, as reflected in the voices below: We talk to children when they misbehave. Then the child should be able to apologize. Other children start to cry. I think at that time you need to hold up and then humbly stand again to talk until they listen. Nowadays we prefer discussion over physical punishments. If a child makes a mistake, we approach him or her and give advice. (FGD, community members, Koona village, Kitgum village). So many changes have happened in the relationship between parents and children, now parents motivate children to play with them as result there is a lot of respect earned from children because these children view parents as friends not as terrifying animals who shout, beat and stop them from playing. (FGD participants from Amejei parish Kumi district).
With respect to violent disciplinary practices, the proportion of households reporting use of physical violence declined, from 59 percent to 32 percent (see Table 7). However there was an increase in the percentage of households using psychological violence. This reflects a “substitution effect” with more caregivers resorting to psychological which they probably consider to be less harmful compared to physical violence. 19
4.1.3. Attitudes towards physical punishment Understanding caregivers’ beliefs about the best way to bring up a child is essential to interpreting the prevalence of violent discipline. It is also important for developing appropriate prevention protection against violence in the home. Care givers were asked at baseline and end-line if they believed that a child should physically be punished for better upbringing. Overall, the proportion of caregivers who believed in physical punishment as a child discipline method declined by 25 percent. The greatest decline was registered in Nakapiripirit district (25%), followed Apac district (20%). We found no significant association between caregivers belief in physical punishment and household size (p=0.27), income (p=0.14), and age of caregiver (p=0.7). Table 8: Percentage of caregivers who believe that a child should be physically punished for better upbringing Apac
Kumi
Nakapiripirit
Overall
Evaluation
(n=181)
(n=145)
(n=64)
(n=390)
70.17
60.7
34.4
60.8
Baseline
(n=657)
(n=229)
(n=101)
(n=987)
89.8
72.9
91.1
86.0
4.1.4. Perceptions about rates of violence in community Over all, the prevalence of child abuse was perceived to have dropped in communities, across the three study districts. About two-thirds of the participants reported that the rate child abuse in their community was comparably lower, than it was a year ago. The perceived decline in the rate of child abuse was attributed to the ongoing dialogue about the dangers of child abuse in the community.
20
Figure 7: Perceived rate of child abuse, compared to 12 months ago
Percentage
80 70 60 50 40 30 20 10 0 Apac (n=184)
Kumi (n=149)
Nakapiripirit (n=58)
Overall (n=391)
Higher
19.6
4
5.2
11.5
About the same
14.1
8.7
17.2
1.5
Lower
63.6
68.5
69
66.2
Don't Know
2.7
18.8
8.6
9.7
21
4.1.5. Attitudes towards reporting violence Over 58 percent of the caregivers say they report if they see or hear of children experiencing abuse at home or in the community (Table 9). Caregivers normally report to local council leaders (59 percent), to family and friends (31 percent). A few report to NGO workers or religious leaders—3.4% and 2.6%, respectively. The caregivers who do not report abuse confront the perpetrator (33 percent). A few comfort the child (3 percent) or do nothing (5 percent). The main reason for not reporting is the fear of retaliation or a child getting victimized (47%). Other reasons include the belief that no action will be taken (23%), not knowing where or who to report to (13%), caregivers not caring or believing that it is not their business, normalization of violence and service provider not accessible (4 percent each). Table 9: Attitudes towards reporting violence Apac (n=181)
Districts Kumi (n=148)
Nakapiriti (n=68)
Overall (n=397)
56.4 38.7 0.6 3.9 0.6
47.1 38.2 7.4 7.4 0
65.5 24.3 2.7 4.7 2.7
58.2 33.3 2.5 4.8 1.3
(n= 102)
(n=97)
(n=32)
(n= 231)
22.0 63.3 6.4 2.8 3.7 1.8
51.8 44.6 0 0 3.6 0
28.4 62.8 0 0 2.9 5.9
30.7 59.2 2.6 1.1 3.4 3.0
31.3 18.6 43.8 0.0 0.0 6.3 0.0
4.4 21.7 52.2 4.4 2.2 2.2 13.0
20 30.0 40.0 0.0 0.0 10 0.0
12.5 22.2 48.6 2.8 1.4 4.2 8.3
Caregiver’s response when they hear of child violence in the community
Report Confront the perpetrator Comfort the child Do nothing Other Where caregiver reports on learning of child violence in community
Family member / Close friend Local Council Leader Religious Leader Police NGO Workers Other Why caregiver chooses not to report cases of child violence in the community Do not where to report No action likely to be taken Fear of retaliation Not my business Service provider inaccessible Normal for this to happen Other
Challenges/limitations • Female Genital Mutilation (FGM) and forced/early marriages are still common practices in Karamoja. These are deeply engrained in cultural beliefs, and yet to be fully appreciated as forms of child abuse. • RFCs are still few and limited in outreach compared to the socio-cultural geographical space that needs outreach services. • Cultural and political leaders are not adequately engaged in the prevention and response to violence, particularly FGM and young marriages. • Lack of effective referral, and unclear case management mechanisms • Members and VHTs lack child protection training
22
4.2.
Result Area 2: Reducing child mortality and morbidity through improved demand, access and utilization of MCH services
Under this result area, 344 VHTs were trained to conduct maternal and child health promotion activities (168- Apac, 108 - Kumi and 58 - Nakapiripirit). Discussions and interviews indicate the VHTs have been involved in the promotion of maternal and child health practices through home visits and organizing community dialogue sessions on issues around utilization of antenatal care (ANC) and postnatal care (PNC), child immunizations, male involvement in maternal and child health, child nutrition, prevention and management of childhood illnesses, hygiene and sanitation practices among others. These activities were aimed at reducing childhood morbidity and mortality among young rural children in the three districts. The following voices illustrate the activities of the VHTs: My name is Amago Phoebe Mary, this project aims to reduce the child illnesses [affecting children] 0-8 years of age, encouraging pregnant women to go to hospitals for antenatal routine visits and delivering in hospitals [health facilities]. Then taking children for immunization as expected, which is why this program was initiated. (FGD with VHTs, Chegere, Apac District). We encourage husbands and wives to go together for antenatal visits on time ‌, test for HIV together and [receive] counseling so that they know their status together. (FGD with VHT members, KabataKumi district).
23
4.2.1. Expectant mothers’ health seeking behaviour Overall, results show an improvement in a range of maternal and child health indicators including uptake of ANC services, and delivery at health facilities. Nearly all pregnant women (97%) sought ANC services for their most recent birth; representing a 2 percent increase (Baseline: 95%; end line: 97%) The percentage of women who made 4+ ANC visits increased from 55 percent at baseline to 60 percent at end line. The median duration of pregnancy for the first antenatal visit is 4 months 73 percent women reported being escorted by their spouse for at least one ANC at evaluation vs. 63% at baseline The percentage of births taking place in a health facility has increased by 17percent; from 63 percent to 80 percent. The major reasons cited by women not delivering at the facility include costs associated with delivering at the health facility (71.), ‘labour progressed too fast’ (11%), distance to health facility (8.2%). 82 percent of the women received postnatal care in the first two days after their recent delivery (no comparable baseline results). Table 10: Changes in Maternal and Health indicators Apac (n=697) Attended ANC last pregnancy Once Twice Thrice Four+ Spouse accompanied you for at least one ANC visit % of women reporting delivery at health facilities Attended Post Natal Care (PNC) at least once Frequency of seeking for ANC
97.1 (n=677) 2.4 7.2 31.9 58.5 62.43 (n=698) 60.9
Baseline Nakapirip Kumi irit (n=361) (n=132) 91.7 87.9 (n=328) (n=116) 2.7 3.5 9.5 20.7 41.2 20.7 46.7 55.2 65.5
58.0
(n=133) (n=351) 71.8 53.4 No Baseline data
24
Apac (n=41)
Evaluation Kumi Nakapiripi (n=35) rit (n=22)
94.5 (n=1121) 2.6 9.3 33.5 54.7
95.1 n=39 0 10.3 30.8 59.0
97.1 n=34 2.9 0 35.3 61.8
100 n=22 0 13.6 27.3 59.1
96.9 n=95 1.0 7.4 31.6 60.0
62.9
74.4
73.5
68.2
72.6
(n=1182) 63.3
(n=39) 74.4 (n=36) 69.4
(n=34) 88.2 (n=33) 90.9
(n=20) 75.0 (n=20) 90.0
(n=93) 79.6 (n=89) 82.0
Overall (n=1190)
Total (n=98)
Figure 8: Proportion of women delivering in health facilities
Proportion of women reporting delivery at health facilities 100 80 60 40 20 0
Apac
Kumi
Nakapiripirit
Overall
Baseline
60.9
71.8
53.4
63.3
Evaluation
74.4
88.2
75
79.6
Baseline
Evaluation
The improvements in the above maternal and child health practices are corroborated by qualitative findings. For example, participants reported that women are more inclined to give birth in health facilities rather than with traditional birth attendants (TBAs). Noticeable improvements in birth preparedness were also reported. Yes, there are so many women going to hospital to give birth compared to before when they were going to the traditional birth attendants. (FGD with VHT members, Kumi district). I also want to add by saying that mothers are now well prepared when going to give birth at hospital with ‘mama kit’ and baby clothes and all the requirements needed at hospital and all these are results of the training we had with them and also most of them have joined saving groups so they are able to get some money for buying the basics needed at home. (FGD with VHT members, Kabata Village, Kumi district).
Qualitative findings also revealed that the programme had improved men’s involvement in care and support for their spouses during pregnancy and childbirth. Participants reported that men are more inclined to escort their partners to seek ANC and delivery care or provide transport to enable them access the necessary care.
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4.2.2. Improvement in Child Health indicators Evaluation results indicate a reduction in child morbidity linked to poor nutrition, malaria, poor hygiene and waterborne diseases in the targeted households and communities. Morbidity among children-under five years declined by 11 percent; from 79 percent at baseline to 68 percent at end-line. The greatest decline was recorded in Kumi district (18%), followed by Apac district (12%). However, in Nakapiripirit, the child morbidity increased marginally—by 0.5 percent. Figure 9: Prevalence of child morbidity
% of children under <5 yrs who fell sick within the past month 100 80 60 40 20 0
Apac
Kumi
Nakapiripirit
Overall
Baseline
77.8
90.7
59.8
79.4
Evaluation
65.82
72.9
60.3
67.6
Baseline
Evaluation
Evaluation results also show that the programme has resulted into adoption of positive health practices, including use of insecticide treated mosquito nets and health seeking behavior for childhood illness. Mosquito net coverage and utilization. The use of Insecticide-treated nets (ITNs) is one of the effective strategies/measures to reduce morbidity and mortality from malaria especially in children.6’7 ITNs have been shown to reduce malaria mortality by 17% in children below the age of five.8 Overall, the proportion of households (with at least one child 0-8 years) owning at least one bed net regardless of whether it was an ITN or not, decreased from 91 percent at baseline to 89 percent (with an average of 3.5 nets per net-owning household) at end-line, representing a2 percent decline in mosquito net ownership. Evaluation results also showed that in 68 percent of the households, all children 0-8 years had slept under an insecticide mosquito net the night preceding the survey, compared to 65 percent at baseline.
6
Insecticide-Treated Mosquito Nets: a WHO position statement. Geneva: World Health Organization; 2008. World Health Organization Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev. 2004:CD000363. [PubMed] 8 Ibid, 2004 7
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Table 11: Child morbidity indicators Baseline
% of children under <5 yrs who fell sick within the past month % of households with children under <5 with diarrhoea two weeks prior to the survey % households reporting malaria cases reported among young two weeks prior to the survey % of households with all children aged 0-8 years who slept under insecticide treated mosquito nets last night
Evaluation
Apac (n=690))
Kumi (n=312)
Nakapirip irit (n=127)
Overall (n=1129)
Apac (n=158)
Kumi (n=140)
Nakapirip irit (n=63)
Overall (n=361)
77.8
90.7
59.8
79.4
65.82
72.9
60.3
67.6
12.5
6.7
15.8
10.9
40.2
30.4
50.0
37.5
39.9
48.4
29.0
41.6
60.7
65.7
57.4
62.1
(n=722)
(n=366)
(n=133)
(n=1221)
(n=106)
(n=127)
(n=44)
(n=277)
69.4
58.7
62.4
65.4
60.4
75.5
65.9
68.2
Health care seeking behavior for childhood illness Evaluations results also show that the programme has resulted into improvements in care seeking behavior for common childhood illness. For example 96 and 65 percent of caregivers had sought treatment for their children 0-8 years during the most recent fever and diarrhea episode. Qualitative data also shows that, because of the on-going dialogue about child health within the communities targeted by the BVLF programme, more caregivers are able to recognize symptoms of major childhood illnesses, and seek appropriate care. Nutritional status of children The nutritional status of children 6-59 months, drawn from 418 households in the three project districts, was assessed during the evaluation. The results when compared with the baseline show marginal improvements in the nutritional status of children across the 3 project districts. Prevalence of Global Acute Malnutrition (GAM) by WFH Z-scores: Weight-for-height (WFH) is a nutritional indice that shows the current nutritional status of an individual. Inadequate nutrient intake relative to body requirements and/or episodes of illness in the short term leads to wasting, also referred to as acute malnutrition, which is reflected by a low WFH. Evaluation results indicate that both the prevalence of GAM (z-scores <-2) and severe acute malnutrition (SAM) declined by 1 percent. The proportion of children with normal nutritional status improved only slightly from 88% in baseline to 90% at end-line The prevalence of under-nutrition among the under-fives (as indicated by MUAC <12.5cm) however increased marginally —by 3 percent. In addition, the proportion of children of children at risk of malnutrition by middle upper arm circumference (MUAC) (12.5cm-<13.5) decreased by 11 percent.
27
Prevalence of Underweight by (WHO-GS): The weight-for-age (WFA) indices give a mixed reflection of both the current and past nutritional experience of the community, therefore, does not differentiate malnutrition due to current and past nutritional/health experience. As such, it is a composite measure of both wasting and stunting, thus, a useful tool in individual child growth monitoring. Evaluation results indicate a 4% reduction in the proportion of children who are under-weight. The proportion of children who are severely underweight decreased marginally, from 7% to 5%. Prevalence of Stunting: Stunting (height-for-age or HFA) measures linear growth and is thus an indicator of chronic malnutrition, which is reflective of cumulative effects of long-standing nutritional inadequacy and/or recurrent chronic illness. Unlike wasting, it is not affected by seasonality but is rather related to the effects of socio-economic development and long-standing food security situation. The prevalence of stunting declined by 5 percent.
Table 12: Nutritional status of children 0-59 months Baseline
Evaluation
Apac
Kumi
(n=784)
(n=427)
Nakapiri pirit (n=137)
Overall
Apac
Kumi (n =142)
Nakapiri pirit (n =51)
(n =192)
55.47
(n=1,34 8) 65.28
(n= 385)
Normal (HAZ≥-2)
62.88
72.83
72.4
74.7
70.6
73
Stunted (-3≤HAZ<-2)
17.22
11.71
19.71
15.73
10.9
85
15. 7
10.7
Severely Stunted (HAZ<-3)
19.90
15.46
24.82
18.99
16.7
16.9
13.7
16.4
(n=816)
(n=453)
(n=142)
(n=205)
(n=143 )
(n=56)
(n=404)
83.33
82.56
75.35
(n=1,41 1) 82.28
Normal (WAZ≥-2)
90.73
87.4
87.5
89.1
Underweight (-3≤WAZ<-2)
9.44
10.38
15.49
10.35
6.83
4.90
8.93
6.44
Severely Underweight (WAZ<-3)
7.23
7.06
9.15
7.37
2.44
7.69
3.57
4.46
(n=770)
(n=441)
(n=135)
(n=190)
(n=129)
(n=50)
(n=369)
Normal (WHZ≥-2)
88.18
90.0
79.26
(n=1,34 6) 87.89
90.53
88.37
90.0
89.7
Wasting (-3≤WHZ<-2)
6.23
4.54
8.15
5.9
4.21
6.2
4.00
4.8
Severely Wasting (WHZ<-3)
5.58
5.44
12.59
6.24
5.26
5.4
6.00
5.4
(n=829)
(n=475)
(n=143
(n=210)
(n=154)
(n=58)
(n=422)
1.0
1.7
2.80
(n=1,44 7) 1.4
2.86
3.25
15.52
4.74
2.5
4.2
11.9
4.0
4.29
3.25
20.69
6.16
15.68
17.9
18.18
16.7
6.67
5.19
13.79
7.11
Stunted status
Under-weight status
Wasting status
Prevalence of Acute malnutrition by MUAC* MUAC < 11.5cm Total malnourished (<12.5cm) 12.5- <13.5cm
Overall
Interpretation: MUAC < 11.5cm (severe acute malnutrition); <12.5cm (global acute malnutrition); 12.5- <13.5cm (at risk of malnutrition
Overall, the changes in nutritional status can be attributed to a positive shift noted in the adoption of practices pertaining primarily to infant feeding, safe drinking water, hygiene practices and sanitation as 28
well as improved management of childhood illness. However, nutritional status would have further improved if nutritional education sessions for caregivers were integrated into the programmes to promote appropriate feeding practices. In fact, correct behaviors related to feeding are relatively more critical to improving nutritional status, and hence such behaviors should be both in the short and longterm. Gaps/weaknesses/areas for improvement • VHTs may not have been fully empowered to attend to the needs of expectant and breast feeding mothers • There is not enough information/evidence on the activities of the VHTs in relation to this result area (e.g. information on how many community dialogue meetings or home visits were conducted by the VHTs), as had been envisaged in the project design.
29
4.3.
Result Area 3: Improving livelihoods and food security
Activities under this result area were two-fold: (i) Formation of village savings and loans association (VLSA), and (ii) agricultural support- through provision of loan seeds, and oxen and ploughs to critically vulnerable households
4.3.1. The VSLA interventions A total of 229 VSLA were formed in the three districts. Each VSLA consists of self-selected groups of 15 to members who save a small amount every week. Each VSLA was provided with a starter kit. The kit consists of a cashbox, passbooks, stamps, a calculator, three padlocks, a notebook, a ruler and pens. In addition 29 CBTs were trained to facilitate the formation and training of VSLA groups, provide on-going support and supervise the activities of the VSLA. VSLA Methodology VSLAs are self-managed associations with: Savings: weekly contributions with share-out at the end of each a 12-month cycle. Loans: members can request loans which are repaid with interest.
A welfare fund provides small, interest-free loans for emergencies.
30
Each VSLA determines its own share value and the maximum amount members can contribute each week.9 Each VSLA member is expected to contribute a specified amount every week, usually between UGX 500 (US$0.2) and UGX1000 (U$0.4) depending on the group. The group’s funds are kept in a cash box that is fitted with three padlocks, the keys of which are held by 3 different treasurers in the group. In addition to the savings fund, the cash box holds the social fund. The social fund, managed separately from the savings and loan fund, is a social support fund that every member of the group is eligible to borrow without payment of interest. It is aimed at catering for emergency financial needs such as health and educational requirements for children. After 4-5 months, the savings shares accumulated by the VSL groups become enough to launch the loan function. All members have the right to take out a loan regardless of the number of shares they have contributed, but can only take out a loan equal to at most three times the value of their shares. Most loans are short-term, generally around one month, at an interest rate determined by the group, usually 5 percent per month. . Finally, on a date chosen by the members, usually after about a year, the savings and accrued interest are divided among the members in proportion to each individual’s savings. After the disbursement of funds, the groups normally re-form immediately and start a new cycle of savings and lending.
VSLA Process Indicators Overall, the process outcomes for the first VSLA cycle are impressive. Evaluation results indicated that, as planned, all the 6 sub-counties in Apac, Kumi and Nakapiripirit are covered by the VLSA. Overall, there are 229 VSLA groups, with a total membership of over 6,270 members. The cumulative savings for the last nine months, before the survey stood at UGX 863,898,250 (USD 344,183). Table 13: Table showing VSLA savings for 9 months District
Sub County
No of VSLA Groups
Apac
Nambieso Chegere
Kumi Nakapiripirit Total
No of R.F.C
34
No of Members 1,020
32
No of Coop. Care Centers 34
Total Savings by Sept 2013 160,209,000
35
1,050
34
23
167,969,650
Ongino
44
1,020
43
40
185,392,300
Kumi
44
1,020
39
34
206,065,600
Lorengedwat
36
1,080
35
26
69,734,000
Moruita
36
1,080
31
14
74,528,000
229
6,270
214
171
863,898,250
Key Findings from the end-line survey in terms VSLA participation 94 Percent of the household reported that a member belongs to any BvLF-formed VSLA. 58 percent of the households were not members of any saving scheme before the VSLA formed under the project On average, VSLA members’ monthly savings increased by from UGX 30,496 before joining the VSLA to group to UGX 34,026 after joining a VSL group The average amount received by VSLA members at the last pay out was UGX 223,371 85 percent of those who reported VSLA membership had taken out a loan. The average loan amount taken was UGX. 142,567. About 69 percent of those who took a loan have been able to pay back.
9
The value of each share remains low so as to allow the poorest members to participate.
31
Access to and Use of loans from VSL groups VSLA offers them an opportunity to borrow money for development as well as welfare needs. Evaluation results indicate that 85 percent of those who reported VSLA membership had taken out a loan (Table 16). Most of the respondents had received a VSLA loan in the last six months and 69% of those who had received the loan had already paid back. Members appear to use the loans for a wide variety of purposes. About 48% of VSLA members who took out a loan invested in productive activities. FGD participants reported that they mainly use the loans from VSL groups for initiating relatively small-scale business activities. And many of them reported that they had been able to get loans, from their groups, to invest in business without much struggle. Evaluation results also indicate that a significant percentage of VSL members used the loans for paying school fees (33%), to meet medical expenses (24%), buying food (21%) and house construction or repair (14%). These findings are corroborated by qualitative data: For me it is easy to get a loan to improve the daily life of my family, giving them food and clothes.� Our children get school fees from these loans as it is the only bank we have nearest These loans are easy to get you don’t have to go long distance it is faster especially in cases of school fees (FGD members from Apac district) Figure 10: Use of the loan taken out of the VSLA members
Use of the loan taken out of the VSLA members Lending to another
1.2
Paid off debt
3.6
Social obligations (marriage, funeral)
4.2
Bought household assets
6.3
House construction / improvement
13.9
Bought Food
20.8
Medical expenses
23.5
School fees
33.4
Productive investment
48.2 0.0
10.0
20.0 Percentage
32
30.0
40.0
50.0
60.0
Use of Pay-out from saving cycle About 42 percent of the respondents that reported VSLA membership had received their pay out for the saving cycle. The average amount of the last pay out was approximately UGX 223,371 (US$90). VSLA Members appear to use the payout of each savings cycle to fill a variety of household needs. Overall, majority of the respondents reported that they had used the pay out to buy food (49%), pay school fees for children (45%), and for productive investment (44%). Others used their pay out to meet medical expenses (26%), buy household assets (21%), and for house construction/improvement (19%). Figure 11: Use of payout from last saving cycle
Use of pay out from VSLA cycle Bought household assets
21.2
Paid off debt
13.3
Lending to another
7.3
House construction / improvement
19.4
Social Obligations (marriage, funeral)
2.4
School fees
45.5
Medical expenses
26.1
Bought Food
49.1
Productive investment
44.2 0.0
10.0
20.0
30.0
40.0
50.0
60.0
Percentage
Concluding remarks In summary, the VSLA program offers access to relatively large sums of money, through both loans and the final savings payout. These funds are used for a variety of purposes, primary among them being food, school fees, family celebrations, housing improvements and productive investment.
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Table 14: Membership to Village Savings and Loans Associations (VSLAs) Evaluation Apac
Kumi
Nakapiripirit
Total
N
%
n
%
n
%
n
%
Any household member who belongs to a BvLF-PSFU formed VSLA No Yes
3 197
1.5 98.5
2 147
1.3 98.7
20 49
29.0 71.0
25 393
6.0 94.0
Duration of membership in VSLA Less than 3Months 3-6Months 7-12Months More than 1year
2 46 39 110
1.0 23.4 19.8 55.8
1 20 101 24
0.7 13.7 69.2 16.4
14 3 15 15
29.8 6.4 31.9 31.9
17 69 155 149
4.4 17.7 39.7 38.2
Belonged to any other savings scheme No Yes Average savings before joining BvLF/VSLA (UGX) Average Savings after joining BvLF/VSLA (UGX) VSLA shared out accumulated funds at end of last cycle (n=389) No Yes Average amount (UgX) received last pay-out (UGX)
112 58.0 81 45.0 UGX 29,140 UGX 39,758
73 50.0 73 50.0 UGX 30,252 UGX 27,468
40 81.6 9 18.4 UGX 29,816 UGX 41,357
225 58.0 163 42.0 UGX 30,496 UGX 34,026
100 51.0 96 49.0 UGX 210,866
94 64.8 51 35.2 UGX 224,373
30 62.5 18 37.5 UGX 286,528
224 57.6 165 42.4 UGX 223,371
How last pay-out was utlised* Productive investment Bought Food Medical expenses School fees Social Obligations (marriage, funeral) House construction / improvement Lending to another Paid off debt Bought household assets
39 44 26 48 1 27 4 14 8
40.63 45.83 27.08 48.96 1.04 28.13 4.17 14.58 8.33
25 25 14 19 2 1 4 5 21
47.06 49.02 25.49 37.25 3.92 1.96 7.84 9.80 41.18
10 12 4 9 1 4 4 3 6
55.56 66.67 22.22 50.00 5.56 22.22 22.22 16.67 33.33
74 81 44 76 4 32 12 22 35
44.24 49.09 26.06 45.45 2.42 19.39 7.27 13.33 21.21
Who made decision to use the pay-out Household Head Spouse Both Spouse and household head Others
27 7 60 0
28.7 7.5 63.8 0
23 4 22 2
45.1 7.8 43.1 3.9
6 2 10 0
33.3 11.1 55.6 0
56 13 92 2
34.4 8.0 56.4 1.2
*Multiple responses analysis
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Table 15: Accessibility to credit facilities from VSLA Evaluation Apac
Kumi
Nakapiripirit
Total
Aware you can take a loan from the VSLA No Yes
3 194
1.5 98.5
2 144
1.4 98.6
1 48
2.1 98.0
6 386
1.5 98.5
Ever taken a loan from the VSLA No Yes
25 170
12.8 87.2
8 139
5.4 94.6
25 23
52.1 47.9
58 332
14.9 85.1
Duration since last took a loan Less than a month 1-6 Months 7-12 Months More than one year Not applicable Average amount of loan taken
47 102 13 9 1 UGX
27.3 59.3 7.8 5.2 0.6 144,928
20 95 14 7 2 UGX
14.5 68.8 10.1 5.1 1.5 119,952
3 13 7 0 0 UGX
13.0 56.5 30.4 0 0 268,095
70 210 34 16 3 UGX
21.0 63.1 10.2 4.8 0.9 142,567
81 46 33 29 34 10 4 4 0
47.06 26.47 19.41 17.06 19.41 5.88 2.35 2.35 0.0
67 59 39 32 10 9 9 6 3
48.20 42.45 28.06 23.02 7.19 6.47 6.47 4.32 2.16
14 8 6 9 3 3 1 2 1
56.52 30.43 26.09 34.78 13.04 8.70 4.35 8.70 4.35
162 113 78 70 47 22 14 12 4
48.19 33.43 23.49 20.78 13.86 6.33 4.22 3.61 1.20
53 118 0
31.0 69.0 0
45 91 2
32.6 65.9 1.5
3 21 0
12.5 87.5 0
101 230 2
30.3 69.1 0.6
5 1 4 2 28
12.5 2.5 10.0 5.0 70.0
6 6 0 1 31
13.6 13.6 0 2.3 70.5
0 0 0 0 3
0 0 0 0 100.0
11 7 4 3 62
12.6 8.1 4.6 3.5 71.3
How loan was utilized Productive investment School fees Medical expenses Bought Food House construction / improvement Bought household assets Social obligations (marriage, funeral) Paid off debt Lending to another Been able to pay back loan No Yes NA Reasons why not been able to pay back loan Business non-profitable Diverted the loan Lost the money Not applicable Others *Multiple responses analysis
35
Benefits/Impacts of VSLA participation at the individual/household level Overall, VSLA members report an overwhelmingly positive impact from program participation. Indeed VSLA was one of the most recognized popular interventions brought in the area by BVLF in partnership with PSFU. First, BVLF were reported to give members an opportunity to save money and borrow money to invest in income generating projects and to meet welfare needs, to learn from others how to overcome poverty and other problems they faces. Others perceived the VSLAs as a genuine springboard to sustainable development because it does not encourage handouts. Rather, VSLAs emphasize self-help and mutual support. Participants also appreciated the arrangement where they could access financial support whenever they were in need—including the idea of getting the money quickly to address emergencies. To me it has helped me a lot because I have easy and quick access to borrow unlike before, when I did not belong to any VSLA group. (Ongica, Chegere, Apac District)
Participants reported their increased ability to meet basic household needs, such as feeding their families, buying seeds, paying school dues for their children, and paying for health services, as one of the major benefits of their participation in the VSL group. For example, one woman in Apac district ((Abutaber Village) was able to access a loan of UGX 100,000 to take her child (with a cleft lip) for surgery in Gulu district. From the welfare fund people have been able to attend abrupt funerals and pay their medical bills. (FGD beneficiaries). The welfare fund does not put people on pressure since there is no interest charged. It is fast as you pay without interest and it solves emergencies such as sicknesses. You don’t waste time when getting welfare fund, you just state your problem and amount and you get it. (Men and women beneficiaries FGD “I was able to pay off my child’s hospital bills very quickly as the group gave me the money without any difficulties” Participant in the men and women beneficiaries FGD “We have saved as a group and this money helps us a lot in solving our domestic problems like when a child becomes sick, we can borrow money to settle hospital bills.” (Ayom Lwor, Nambieso, Apac) What I can see as an achievement is that our children are studying because we have been able to pay school fees. (Ayom Lwor, Nambieso, Apac) For me Agnes, a widow, the money which I borrowed helps me in many ways for example paying school fees, feeding and buying clothes for my children. Even me these days I am smart [because I benefited] so it’s an achievement. (Ayom Lwor, Nambieso, Apac)
Participants also reported that the VSLAs have had significant impact on household economic and social wellbeing. For example, one participant observed: “Little by little we get out of poverty.” In addition, VSLSA were reported to have contributed to a reduction in domestic violence incidents, and
36
improvements in health care seeking for children and women—primarily because members discuss these issues. The issue of domestic violence has reduced among VSLA members. They have also improved on maternal health because after meeting/savings, RFH clubs raise the issue of taking their wives for ANC, emphasize immunization of children.
Other benefits reported related to increased personal hygiene, and pride in their appearance and selfesteem. Majority of the participants in the focus groups also noted significant positive effects of program participation on their social status and self-confidence. Women, in particular, noted their increased ability to address their own problems and provide for themselves and their families. Others noted an improvement in communication and power sharing in the decision-making process. While many women used to sit idle, waiting for their husbands to provide for them, they have now learned how to save and how to use the savings, complemented with loans they acquire and are able to undertake income generating activities (IGAs) and generate their own income. Many cited their increased contribution to household income as a source of increased power in the decision-making process. Some participants also reported increased understanding of the importance of savings as the main benefit of their participation in the VSL group. They say that now, rather than wasting the little money they do have, they are able to save and also have an accessible mechanism for obtaining financial capital for investment purposes. The benefit I have seen is that it has made us learn a good way of saving because you cannot just use the money like if you had kept it in your house. Another commonly cited benefit of the VSLA program was an improvement in social capital. The VSLA program allows the member to meet together every week in an environment where they can exchange news and ideas. It creates a feeling of cooperation and community. Several members also cited an improvement in their status in the community. These impacts will be discussed at greater detail in the following section: Self-reported perceived impacts of VSLA participation
88 percent of current members believe their household’s saving has improved since program. Only 6 percent of current members believe their household’s savings has same 84 percent of current members believe their household’s saving has improved since program. Only 7 percent of current members believe their household’s savings has same
37
joining the stayed the joining the stayed the
Impact at the Community Level It was daunting to quantitatively measure VSLA impacts at the community level. However, almost every focus group participant noted the respect given to VSLA members by the community. The participants in the VSLA program serve as self-proclaimed role models for the community. Several have even helped a neighbor start his own small business in order to generate income. While this suggests that there may be some degree of program impact on the household income of non-VSLA members in the community, without more detailed information, this conclusion cannot be considered robust. Nevertheless, as they witness the success of the current members, other members of the community have begun to express interest in joining the VSLA program Study participants also reported that, inspired by the BVLF programme, some VSL groups have been established by community members without support from any external organization. VSLA Challenges These were the shortcomings and challenges pertaining to VSLA. • Loan utilization remains a challenge. In most cases the loans are not necessarily invested but are instead used in meeting the daily needs of the households. Loans may not be used in profitable enterprises and at the end of it all there emerges the burden of loan repayment. This is partly because the individuals had pressing needs for which they used the loans and partly because the borrowers do not have clear plans on how to invest the loans into profitable ventures • Poor record keeping and documentation as VSLAs grow big & bigger. • Many VSLA members are in alcohol selling as a source of family income which in turn a source of domestic violence. • Members need to develop a business vision beyond survival • Members lack guidance on pursuing common activities that lead to benefits of economies of scale • Safety of member’s savings: Security for savings is not guaranteed as seen in some groups that have collapsed because the Chairperson colluded/conspired with the keepers of the saving box keys and robbed members of their savings • Challenges with technical support for VSLAs (recording keeping, fraud detection and control, governance, linkage banking etc)
4.3.2. Agricultural support This intervention involved the provision households with loan seeds. Three hundred and thirty six (336) households were supported with oxen and ploughs, across the three districts. These interventions were aimed at improving the food security of the programme participating households. Overall, the impact of these interventions could not be ascertained in the short term. However, both interventions have potential to improve household food security in the long term. We nonetheless, examined whether there were any changes in household food consumption and dietary diversity since baseline. The findings are summarized below:
38
 
Overall the proportion of project supported households having at least three meals a day, increased from 2.9 percent to 19.6 percent. On the other hand, a 24-hour food consumption recall was used as a proxy to assess household dietary diversity, during baseline and evaluation. Evaluation findings indicate that in 55% of the households, members had taken meals that constituted high dietary diversities.
Table 16:
Apac (N=736) % of Pro households having at least three meals yesterday Low diversity (<4 Househol food groups )d dietary High diversity (> 4 diversity food groups)-
Baseline Kumi Nakapiri (n=369) pirit (n=139)
Overall (n=1,244)
Apac (n=200)
Evaluation Kumi Nakapiripi (n=149) rit (n=69)
Overall (n=418)
1.6%
6.7%
0.9%
2.9%
14.0%
25.5%
23.2%
19.6%
49.0
44.2
58.3
48.6
45.9%
45.3%
43.9%
45.3%
51.0
55.8
41.7
51.4
54.1%
54.7%
56.1%
54.7%
39
4.4.
Result Area 4: Improved access to water and sanitation facilities
One of the major causes of morbidity and mortality among children under-five years is diarrhea—a fecalborne illness directly linked to inadequate water supply, sanitation, and hygiene issues. The BVLF project therefore sought to improve access to protected water supply, and enhance awareness about sanitation and hygiene across the three districts. Activities under this Result Area centered on: Construction of boreholes: A total of 13 boreholes were constructed in the three districts (Apac5, Kumi-3 Nakapiripirit-5). Promotion of hygiene and sanitation and Household and community level, through the VHTs Formation and training of water use committees to manage the boreholes. Overall, evaluation results indicated improvements across range of water, hygiene and sanitation related indicators. These changes however may not be wholly attributed the WASH-related interventions under the BVLF project indicated above.
40
Access to water and sanitation Household Water Sources and Consumption Table 4.4.1 presents indicators useful in monitoring household access to improved drinking water. The WHO defines improved drinking water sources as piped water into the dwelling, yard, or plot, protected dug well, boreholes, protected springs, and rainwater collection (WHO, 2012). Overall, evaluation results indicate that the proportion of households using improved water sources for drinking water increased slightly; from 81 percent (N=1225) at baseline to 84 percent (N=417). In effect, about 16 percent of the households continue to use unimproved water sources. The continued use of unimproved sources traditional sources is mainly explained by long distances to the improved water source. Figure 12: Proportion of households with access to improved functional drinking water sources 120 100 80 60 40 20 0
Apac
Kumi
Nakapiripirit
Overall
Baseline
80
76
99
81
Evaluation
73
97
90
84
Baseline
Evaluation
Household water treatment and safe storage (HWTS) The evaluation revealed a 9 percent increase in the percentage of households that treat their water to ensure that it is safe for drinking (Baseline-13%; Endline-22%). The most common method treating water in the three districts was boiling 22 percent. This proportion is however still lower than the national average— which stands at 44% (UBOS & ICF International Inc, 2012).
41
Table 17: Water-related indicators, by district Apac n=737
Baseline Kumi *Nakap n=370 n=148
Evaluation Kumi Nakap n-149 n=69
Overall n=1225
Apac n=199
Overall n=417
73.4 0.5 0.5 72.4
96.6 10.7 0.7 85.2
89.9 1.5 15.9 66.7
84.4 4.3 3.1 76.9
0 3.4 1.3 2.0 0 0 24.2
5.8 10.1 0 0 8.7 1.5 60.3
1.0 15.5 2.6 1.9 8.6 2.4 36.5
Source of drinking water Improved source
Private connection to pipeline Public tap / standpipe Borehole/ Protected well/spring Protected well/spring Rainwater collection Non-improved source Unprotected dug well Unprotected spring River, stream, lake Surface water / shallow well % of HHs accessing Dry season safe water within 37 minutes Wet season of households consuming at least 20 litres per day % of households that treat water for drinking Water treatment Boiled method* Bleach/chorine added Strained through cloth Ceramic, sand or other filter Solar disinfection Let it stand and settle Percentage using an appropriate treatment method** Storage of drinking water Pot Jerry Can Saucepan Drums Plastic container Water jar Other *Nakap: Nakapiripirit
79.7
75.7
99.3
80.8
0.4 78.4 0 6.2 20.4
0.3 68.7 4.3 6.0 24.3
10.1 97.3 0.7 3.4 0.7
1.5 77.8 1.4 5.8 19.2
0.8 43.2 5.4 36.3
7.3 30.0 8.1 14.0
16.2 39.2 13.5 36.1
4.5 38.8 7.2 29.8
0 26.6 4.5 2.5 15.1 4.5 37.7
28.0
13.7
39.0
25.1
39.8
62.4
60.3
51.3
99.2 4.7 1.2 1.0 2.0 0.4
98.4 33.2 1.4 3.8 3.5 0.5
87.7 4.1 2.0 0 0 0
97.6 12.9 1.4 1.7 2.2 0.4
0
22.8
2.0
6.9
98.0 21.3 8.0 5.5 10.5 0.5 1.0 0.5
98.7 29.5 6.0 26.2 0.7 0.7 0 0
100.0 5.8 1.5 0 2.9 1.5 0 0
98.6 21.6 6.2 12.0 5.7 0.7 0.5 0.2
96.7 0 0.3
98.9 0 0
14.6 3.3 0.8
89.0 0.3 0.3
92.6 6.8 00 0.6
98.0 2.0 00 0
24.5 66.0 7.6 0
85.2 13.2 1.1 1 0.6
1.9 0.3 0.8
1.1 0 0
63.4 3.3 14.6
7.9 0.5 2.0
0
0
1.9
0.3
**Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. ** Appropriate water treatment methods include boiling, adding waterguard, bleaching, straining, filtering, and solar disinfecting.
42
Household hygiene facilities and practices Ensuring adequate sanitation facilities is good public health practice. At the household level, the availability of hygienic sanitation facilities reduces the risk of exposure to illnesses and further lightens the burden on the public health delivery system. Appropriate sanitation facilities include an improved toilet and method of waste disposal that separates waste from human contact. Latrine/toilet facilities A household is classified as having an improved toilet if the toilet is used only by household members (that is, the toilet is not shared) and if the toilet separates the waste from human contact (WHO and UNICEF, 2010). Flush/pour toilets that flush to a piped sewer system, and ventilated improved pit (VIP) latrines, pit latrines with a slab, and composting toilets (which separate solid waste from water) are also classified as improved toilets. Overall, the proportion of households with improved toilet facilities increased by 12 percent (baseline: 12%; end-line: 24%). Nonetheless, more than three quarters (76%) of the households continue to use non improved toilet facilities. The highest proportion of households that use non-improved toilet facilities was found in Apac (80 percent), followed by Kumi district (73%). Table 18: Household hygiene facilities and practices Apac n=737
Baseline Kumi Nakapir ipirit n=370 n=148
Overall
Apac
n=1225
n=198
Evaluation Kumi Nakapir ipirit n-149 n=68
Overall n=415
Type of toilet/latrine facility Improved toilet/latrine facility
Flush/pour flush to piped sewer system VIP latrine Covered pit latrine with slab Composting toilet Non improved toilet/latrine facility Pit latrine without slab / open pit No facility/bush or field/Hanging toilet % of household sharing latrine facilities Other indicators % with a hand washing facility % with a bath shelter % with utensil drying rack Garbage disposal methods Thrown in empty lot / bush Dumped in rubbish pit Disposing in garden / yard Burning / burry Placed in trash bin
9.2 0.0 0.8 7.3 1.1 90.8 90.6 0.0
17.7 0.0 2.6 15.0 0.0 82.4 78.4 0.7
25.0 0.0 2.5 22.5 0.0 75.0 52.5 22.5
12.1 0.0 1.3 10.0 0.8 87.9 85.5 1.5
20.2 0.0 4.0 16.2 0.0 79.8 56.1 22.7
27.5 0.7 10.7 15.4 0.7 72.5 62.4 9.4
29.4 0.0 8.8 19.1 1.5 70.6 17.7 50.0
24.3 0.2 7.2 16.4 0.5 75.7 52.1 22.4
34.1
46.2
80.5
39.9
24.5
55.9
37.0
38.0
7.4 66.5 17.7
9.1 63.0 31.2
6.0 54.1 34.3
7.7 64.0 23.5
22.9 68.4 39.1
61.5 90.5 63.1
27.7 73.9 44.9
37.8 77.2 48.7
35.5 52.0 8.0 4.5 0.5
6.7 60.4 30.2 4.7 0.0
37.7 42.0 13.0 5.8 1.5
25.6 53.4 16.8 4.8 0.5
16.7 17.4
25.2 33.9
43
38.5 34.5
21.8 24.2
Other sanitation facilities The evaluation also revealed improvements in the proportion of households with bath shelters, racks for drying utensils utensil and hand washing facilities at the toilet. For example, the proportion of households with facility for washing hands after latrine use increased from 11% at baseline to 38%. Similarly, the proportion of households with bath shelters or a rack for drying utensils increased by 25 percent and 13 percent respectively. Before BVLF project we did not have utensil drying rack in many homes but because of the project, to-day we have drying racks in all most every homes. (FGD with VHTs, Ayabi village, Nambieso-Apac District) Disposing of stools of children < 5 yrs The proper disposal of children’s faeces is important in preventing the spread of disease. The safe disposal of children’s faeces is of particular importance because children’s faeces are more likely to be the cause of faecal contamination in the household environment than other causes, as they are often not disposed of properly and may be mistakenly considered less harmful than adult faeces. Children’s stools are considered to be safely disposed of if the child uses a toilet or latrine, the child’s stool is put in or rinsed into a toilet or latrine, or the stool is buried. Overall, the proportion of households that safely dispose children stools increased by 19 percent; from 68% at baseline to about 87 percent. Evaluation results indicate that in 20% of the households children had used a toilet or latrine, 51 percent reported that children’s stools had been rinsed in the toilet or latrine, and 16 percent had buried it. Table 19: Disposal of child stool Baseline Apac
Safe method
Unsafe method
Evaluation Kumi
Nakapiripirit
Overall
Apac
Kumi
Nakapiripirit
Overall
n
%
n
%
n
%
n
%
n
%
n
%
n
%
n
%
532
72.2
247
66.8
79
53.4
858
68.4
159
89.8
135
90.6
47
72.3
341
87.2
205
27.8
123
33.2
69
46.6
397
31.6
18
10.2
14
9.4
18
27.7
50
12.8
Hygiene & Sanitation – Awareness & Practice Qualitative data also revealed improvements in a range of household hygiene and sanitation practices, including hand washing, food protection and domestic hygiene, safer excreta disposal. This improvement in these practices was attributed to continuing sensitization and hygiene promotion, through VHTs. For example During the FGDs, majority participants reported that not only they, but the other family members as well started washing their hands before cooking and eating and after defecation. They cited, 44
“now we know, the importance of hygiene, cleanliness for good health…The VHT have been telling us a lot about cleanliness” Speaking about the role of VHTs in relation to sanitation and hygiene promotion, one participant observed: They taught us how to keep water clean in our homes, having clean pit latrines, plate stand, things that bring hygiene to families. So the project trained us on many things so that we can also come back to train in our communities. The project promised in future to bring nearer clean water to community. As we have seen that one parish has got a bole hole so we believe other places also will receive as promised in the future (FGD, Kumi District)
Household living condition Housing characteristics reflect the household’s socioeconomic status in society. The availability or lack of adequate housing facilities determines the magnitude of exposure to risks associated with air pollution and ill health. Over all, the evaluation results indicate: A decline in the proportion of households with grass thatched houses (Baseline: 89%; end line: 77%); An increase in the proportion of households with separate dwelling places for animals (Baseline: 48%; end line: 94%); A decline in the percentage of HHs using improvised wick lamps 'tadooba' for lighting (Baseline: 89%; end line: 40%); and A slight decline in the proportion of households using firewood as a cooking energy source. Table 20: Household living condition Baseline
Evaluation
Apac
Kumi
Nakap
Overall
n=737
n=370
n=148
n=1225
Apac (n=200)
Kumi (n=149)
Nakap (n=69)
Overall (n=418)
Household living condition Average number of people per HH
6.4
7.5
7.3
6.8
6.5
7.2
6.4
6.8
One
40.0
56.0
87.0
50.2
30.1
13.5
28.8
23.8
Two
33.7
25.4
6.2
28.0
32.1
30.4
39.0
32.5
Three+
26.3
18.6
6.9
21.8
37.8
56.1
32.2
43.7
2.1
1.7
1.3
1.9
2.3
2.9
2.3
2.5
Rooms used for sleeping
Average number of rooms for sleeping in A crowding index: average number of people per room
3.1
4.3
5.7
3.6
2.8
2.5
2.9
2.7
% of HHs with grass thatched roofed
86.9
94.6
87.8
88.7
73.2
82.6
78.3
77.4
% of HHs with separate dwelling places for animals
53.6
40.7
32.4
48.1
95.5
94.0
91.3
94.2
% of HHs using improvised wick lamps 'tadooba' for lighting
85.6
96
46.6
84
54.2
28.1
24.64
39.71
% of HHs using firewood for cooking
99.3
99.5
97.9
99.2
93.5
96.64
88.2
93.8
45
Challenges/Limitations  
Some communities to face challenges in accessing water , especially in Nakapiripirit and Kumi district More effort to target positive behavior and attitudinal change- hand washing, use of latrine. Too little time, perhaps, to affect more subtle behavioral outcomes
46
4.5.
Result Area 5: Early childhood care, learning and development
The focus of this result area was on supporting communities to create safe and stimulating learning environments for their children of 0-8 years. Activities around this result area centered on: (i) creation of safe and stimulating spaces/play centers for children 0-6 years, and (ii) formation of cooperative care groups. These interventions were aimed promoting play-based learning and early child stimulation. 
Community-based child care centers (CBCC): Evaluation results show that up to 171 community-based childcare spaces/centers10 had been established in the three districts. The community-based child care centers act as a convergence point for safe child care, learning, play, simulation and primary school readiness. The center could be a designated school building, community building, religious structure (e.g., church, mosque), or even a spot under a tree.

Cooperative care groups: To ensure the day-to-day running of the community-based child care centers, cooperative care groups (CCGs) were established. Each CCG consists of 15-30 caregivers. Members of CCGs care for children at the designated community-based childcare/play centers on a rotational basis, and are responsible for making play materials/toys for children using locally available resources to enhance children’s play and learning (for example, teaching aids from bottle caps, and bamboo for sorting and counting). The VHT are tasked with facilitating the formation of CCGs, training members on how to make play materials from local resources, mobilizing community support, and overseeing the daily functioning of the centers to ensure that they run smoothly. They also mobilize caregivers to provide food inputs for the children during stay at the respective centers. Table 21: Early childhood care and learning indicators
Apac
Kumi
Nakapiripirit
Total
VHTs trained
168
108
56
332
Cooperative care groups formed
59
58
49
166
Early learning centers opened
18
-
26
Caregivers trained
33
37
84
154
Caregivers not trained
41
23
48
112
Children enrolled/participation in the centers(0-3 years) Children enrolled in center (3-6 years)
610
548
536
1694
537
611
292
1440
-
1:18
Caregiver/child ratio
Overall, about 1440 children 0-8 years have been enrolled in the community based child care centers in the three districts.
10
These are essentially spaces for children to play, using local play & learning materials made from locally materials (for stimulation).
47
Early childhood development (ECD) Indicators
Our evaluation generated some indicators, based on questions related to ECD from the Multiple Indicator Cluster Surveys (MICS). However, since baseline data was not available, no comparison could be done between baseline and end-line. Attendance at early childhood education: 44% of households reported that their children attend some organized learning programme (55%-Nakapitipirit; 36%-Apac; and 48%-Kumi district). 68.8% of the caregivers interviewed in the three districts belonged to a CCG formed under BvLF All stakeholders interviewed for this study, at community and district level, spoke of the benefits of the community-based childcare centers (CBCC), not just for the child, but also for the parents and the community in general. Generally, participants reported that through the child care centers and cooperative care groups the project has been able to mobilize and generate commitment from the care givers, and communities to support the healthy development of young children. Particularly, the formation of CCG was reported to have led to the re-birth of collective responsibility for child care and upbringing. Participants also reported that CBCC provide an avenue through which parents can nurture the development of the child in a safe and stimulating environment, and to engage children in learning through play-using local materials. At the CBCC, members of the cooperative care groups engage children in interactive activities that include storytelling, organized arts & crafts, singing, and games (such as skipping etc). The centers therefore provide a setting and an environment that support children’s social, physical, emotional and spiritual growth and development. When these children are singing, other children who are not part of us keep watching and admiring what these children are doing making our children feel proud of being here. We teach them spiritual ways of belief actually these children are God fearing and when they go back, they tell their friends about God. The centers are functioning well enabling children to play, interact and develop. Majority of them are, however, operating under tree shades which interrupts center activities of children whenever it rains. (CCG member, Kumi district) Participants generally reported improved school readiness among children participating in the child care centers as compared to children from the same communities and from similar socioeconomic conditions who do not participate in CBCC. It is also clear from our interviews and informal conversations with school teachers that some community-based child care centers have been able to establish links with the nearest primary schools. And some teachers reported that they could usually identify children who have come from the CBCC, as they “show a lot of skills” and these children are usually far head of their peers in terms of educational development.
48
Below, children drawings, depicting activities that take place at the community-based child care enters
Finally, being able to send their children to the CBCC allows/frees parents the freedom to go and engage in productive activities or attend to other immediate household concerns. Challenges/Limitations The majority of centres do not have a dedicated facility, operating instead in the open air or under insecure grass-thatched structures that are unsuitable during the rainy season. Others function in borrowed buildings, such as churches, which are not always available. Most of the care givers at the child care centres had not under gone any form ECD training. The lack of training of caregivers on early child learning and stimulation undermines the quality of care children receive at the centres. Intermittent care caregiver attendance. This was blamed on lack of incentives to caregivers and their need to work in the field or do piece work. At the community level, VHTs were charged with the responsibility of monitoring and supporting the cooperative care groups and community-based child care centres. However most VHTs we interviewed lacked the knowledge and skills to do this effectively. Therefore, there is a clear gap in the capacity of VHTs. Feeding of children at the childcare centres also remains a challenge; with some community member reluctant or less inclined to make food contributions to ensure that children at the child care centre always receive a meal
Evaluation results also highlight a number of health and safety issues at the community-based child care centres. Access to safe water, and improved sanitation facilities remains a challenge for most them.
Lack of reliable and diversified sources of support for sustainability
49
4.6.
Result Area 6: Capacity Building for Grass Roots Structures and District Local Government
. Activities under this result area centered on building implementation capacity for execution of the programme, through: (i) training LG staff and other grassroots actors on programme methodology and early childhood care, learning and development, and (ii) logistical support (through provision of computers and motorcycles). Training of LG staff and other actors In order to build technical capacity of programme implementation, Private Sector Foundation Uganda (PSFU) in partnerships with the technical service organization (TSOs) organized targeted training for LG (district and sub-county) staff and other grassroots actors such as VHTs and CBTs to orient them about: (i) the programme methodology and implementation management (ii) indigenous knowledge systems for early childhood care, learning, protection and development, and (iii) VSLA methodology. Some of the trainings organized are indicated in Table 4.6.1 Table 22: Capacity building for program personnel Trainings
Persons trained
Venue
Trainer
Indigenous Knowledge Systems for Early Childhood Care, Learning Protection, and Development
VHT, District and sub-county technical stAff
Nascent Research and Development Organization
Training of VHTs and district staff on data collection tools
VHT, District and sub-county technical staff
CBR
Database management
Data clerks
“
CBR
Implementation, Monitoring & Evaluation
District staff and CBTs
Kampala
MUBS
Accountability, record keeping, and data management
District and sub-county staff
Soroti
MUBS
Basics of managing growth
CBTs, VHTs & CDOs
Kampala
VSLA methodology
CBTs, VHTs & CDOs
Districts
Oracle
PPM & M&E
CBTs, VHTs & CDOs
“
Oracle
Domestic violence
RFC leaders, VHTs
“
Nascent
VSLA management
VSLA member
“
Oracle supported by CBT and VHTs
Management of cooperative care groups
Caregivers
“
VHTs, DIS, CDO & CBTs
Bike mechanics training
VHTs
“
Co-op Africa
Water source management
Water user committees
Village level
PHA
. Discussions revealed that the different trainings had enhanced the capacity of he the LG technical staff and grassroots stakeholders (especially CBTs, VHTs) to implement a range of programme interventions. 50
Nonetheless some concerns were raised regarding the adequacy of the training and the lack of adequate support supervision from the TSOs. For example, some participants reported that the trainings extended to the VHTs and CBTs were insufficient compared to their enormous roles in the implementation of the projects. Moreover minimal follow-up and supervision was done by the different TSOs such as NRDO and Oracle to ascertain whether Nascent Research and Development Organization trained VHTs, sub county technical staff and local leaders, LC 3 executive, parish chief in the indigenous technical knowledge system. However, they did not provide post-training follow up support and supervision‌ (LG technical staff, Nambieso, Apac District)
Lastly, participants also reported that no pre and post training assessments were conducted to measure the effectiveness of the training and ensure that the trainees were fully prepared for their roles. Logistical support Capacity building for the programme implementing districts also entailed provision of logistical and operational support. Particularly, the programme provided (i) motorcycles for technical staff at subcounty level, (ii) bicycles to all VHTs and field staff involved in the programme, and (ii) computers to facilitate data management and sharing at district level. In addition monthly allowances were provided to selected sub-county and district technical staff involved in the implementation of the programme. Participants reported that this support had improved the capacity of the district and sub-county to support the implementation of the programmes. PSFU has facilitated out work. They gave us motorcycles (1 per sub county), 2 computers (1 per sub county), modems – MTN (1 per sub county). They also promised to give us .digital camera but we have not seen these. (LG technical staff, Apac District) Table 23: Logistical Support to district Logistical support
Motorcycles procured
APAC
KUMI
Nambieso
Chegere
1
1
Bicycles procured and distributed Modems
Monthly allowances
2
Kumi
Ongino
2
0
168 1
1
Computers procured Bicycle dynamos
Total
NAKAPIRIPIRIT
-
-
Total
TOTAL
Moruita
Lorenged warit
Total
2
1
1
2
06
108
40
18
58
334
2
1
1
2
1
1
2
6
3
0
0
0
0
0
0
3
-
-
-
-
-
-
-
-
This ranged from UGX 80,000 (approximately US$ 32) to UGX 180,000 (US$ 72).
51
Challenges/Limitations
Limited functional literacy among some VHTs. For example, more than 70% of VHTs in Nakapiripirit cannot read and write). The data clerks seem not to have been adequately prepared (or may not have the time) to contribute to data collection, enter data and manage database at the district level. This has led to almost absence of district data which could have been useful in different evaluation activities. Urgent attention needs to be focused into this area. Transfer of trained staff from one sub-county to another greatly undermines programme activities, as new staff who have no experience in programme activities have to take time to internalize the program before making any progress. There is a need for budget flexibility to take into account follow up of the participants in the trainings and provide feedback.
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Table 24: Process indicators, by Result Area INDICATORS PER RESULT AREA
APAC
KUMI
Nambieso
Chegere
Total
NAKAPIRIPIRIT
Kumi
Ongino
Total
Mouruita
TOTAL Lorengedwart
Total
Result Area 1: Creating safe and stimulating spaces for children 0-6 years, within and around their homes under the care of responsive adults VHTs trained Cooperative care groups formed Early learning centers opened Caregivers trained Caregivers not trained Children enrolled/participation in the centers(0-3 years) Children enrolled in center (3-6 years) Caregiver/child ratio
104 29 9
64 30 9
24
68 34 13
40 25 8
16 24 18
15
18
12
25
60
24
17 369 273
24 241 264
15 220 200
18 328 411
48 175 188 1:19
0 361 104 1:17
496
336
380 68
27 40
36 16
28
12
36
Result area 2: Improved demand, access and utilization of antenatal, postnatal, birth delivery and immunization services Household clusters VHTs trained Result area 3: Prevention of violence against women and children (VAW/C) Responsible fatherhood clubs Result Area 4: Improve income and food security for vulnerable households VSLA formed Community based trainers Households provided with seeds Oxen and ox-ploughs (ox-phs) 11 Households benefiting from oxen and ox-ploughs
35 2
34 2
34 2
34 2
27 4
36 3
276 40 oxen & 20 Ox-Phs. 60
130 22 oxen & 11 Ox-Phs 33
120 22 oxen & 11 Ox-Phs 60
300 47 oxen & 23 Ox-Phs 69
40 20 oxen & 10 Ox-Phs
40 20 oxen & 10 OxPhs
3
2 19
02
0 0
0 0
1
1
01 68 01
1 40 0
1 18 0
Result area 5: Improved access to water and sanitation facilities Construction of bore holes # of WUC Result area 6: Institutional development Motorcycles procured Bicycles procured and distributed Computers procured
11
2
Each set ( 2 oxen and 1 oxen plough) is shared among the 3 families
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5. REFLECTION ON PROGRAMME DESIGN AND ROLES OF PARTNERS 5.1.
Programme scope, benefits and targeting
Design strength Integrated approach- makes the programme attractive and relevant, and appeals to the various needs of the community. It also address multiple vulnerabilities Working with district structures at various levels increases buy-ins and potential for programme sustainability Having technical service organizations (TSOs) to support district and grassroots actors was well thought out. Strong reliance on grassroots structures increases ownership and sustainability Limitations/weakness Too many programme components being implemented in a short time did not allow time for reflection and learning; exerted too much demands on PSFU assigned staff and district officials Capacities of VHTs not matching all the prescribed roles in the programme owing to limitations in education levels that affect conceptualization of programme, theory of change, and various areas of action such as data collection No well-defined criteria for identification of the most vulnerable children and families, and to avoid danger of exclusion of most needy. Discussions with PSFU and other actors revealed that the integrated nature of the programme components (i.e. the major service areas—health, water and sanitation, child care and early learning, livelihoods, capacity building, community dialogues on violence etc) made it an extremely attractive and relevant programme that appeals to the needs of the communities. The challenge however lies with the model of implementation that did not prioritize a phased implementation of the programme components and instead opted for a ‘do it all in one go’ approach. The outcome was that actors did not have time to reflect and learn which comes with phased implementation. The program also covered many components that made it broad. It is necessary to have a discussion on components of the program that ought to be prioritized in light of resource limitations and the desire to bring on board the private sector. The fact that the program translates into many varied activities on the ground, it would in addition be important to get the opinion of BvLF staff on how best to implement a multi-component strategy while championing the identity of the organization in relation to its core competencies or areas of work. Finally, while all programme areas targeted have participants with similar indicators, it will be important in the future to establish the criteria and process for identification of the most vulnerable children and or families so as to avoid the danger of exclusion of the most needy.
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Concluding remarks The design of the programme over all appears to have been innovative as it utilized public and private partnership in addition to using grassroots structures. The key elements in design that require careful thought concern the commitment and work load of district technical staff in relation to programme requirements, the workload of VHTs vis-Ă -vis their capacities, the packaging of the programme in terms of components, ensuring that TSOs provide follow up support supervision and revisiting the implementation of a user friendly M&E approach that can be used by district officials and other stakeholders.
5.2.
Reflection on the roles of project partners
During the first phase, we reported more extensively on the roles of partners. In this brief we choose to make general observations as follows: The selection of technical service organizations took into account their competencies. As such, each TSO was allocated a component as indicated below: Table 25: Roles of project partners
Organization Private sector Foundation Oracle Nascent Research and Development Organisation Cycling out of Poverty Center for Basic Research Local government staff
Component Every aspect of the program Village Savings and Loans Associations VHTs and District staff
VHTs and district staff Cross cutting Cross cutting
Role Over all management and supervision of the program Capacity building Building the capacity of VHTs Orienting district staff on program methodology Supply of bicycles and accessories Research, monitoring and evaluation Implementation management, supervision and sourcing suppliers
Each of the above partners played a crucial role during program implementation. However, as is normally the case, there were some challenges that some partners experienced during program implementation as indicated below: Private Sector Foundation (PSFU): The organisation was assigned three roles namely; (i) acting as the financial intermediary for BvLF to distribute funds to the districts, (ii) monitoring the implementation of the programme and reporting to BvLF and other stakeholders; and (iii) advocating for young children within government and the private sector. To monitor activities, the PSFU has allocated a staff member, to work closely on-the-ground to supervise the programme.
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PSFU has performed the first two roles diligently and this is well acknowledged by all the stakeholders we interviewed. Performance in relation to the third role is being given emphasis in the extension phase as most of the first year emphasis was placed on the first two roles. The major challenge PSFU experiences lies with the workload associated with the programme which places enormous demands on the two staff assigned to the programme. PSFU has a field officer exclusively assigned to the programme and spends most of his time in the districts. At the head office, there is programme manager responsible for more than one programme and despite her enormous capabilities she appears overworked. Human resource support which could be in form of volunteer staff could be considered as a temporary measure. The multi-component nature of the program activities makes it broad coupled with the requirement to work with many partners on a regular basis. PSFU – These do monitoring, supervision, overall coordination of programme activities and responsible for our facilitation and we report to them. They also gave us motorcycles (1 per sub county), 2 computers (1 per sub county), modems – MTN (1 per sub county), promised digital camera but we have not seen these. They did training on M&E, VSLA. They are also giving us airtime (30,000/-) per month per person, pay our top up allowance (160,000/- per month per person) though it is irregular. Generally they are hardworking, committed and competent, they do close supervision very regularly, they handle IEC materials like T-shirt, banners, caps, posters. They are much better than any NGOs that start and run away. They have maintained the target of reaching the actual beneficiaries. They try to deliver whatever they promised, their communication is much better than the district and they provide feedback, they have conducted several review meetings both here (in Apac) and in Kampala. And while in Kampala, facilitation is good. (Key informant, Apac district)
Nascent Research and Development Organisation (NRDO) — NRDO was charged with the responsibility of orienting and training district and sub-county technical staff, and VHTs about the programme concepts and implementation approach. NRDO was also responsible for training VHTs on their roles such as community mobilisation to participate in program activities, data collection and monitoring. Orienting district staff and VHTs about the program approach and roles was expected to ease the implementation of the program and. While the organisation successfully provided the orientation and training to VHTs and LG staff, it was not supported to undertake follow up support supervision. Oracle Uganda: Initially Oracle succeeded in accomplishing most of the assigned roles particularly related to training CBTs and supervisors, configuration of the MIS for VSLAs and providing the district with this data; formation of several groups and developed reporting tools. The organization however encountered problems and their lead trainer left for unclear reasons. As a result, they were unable to provide training to CBTs and supervisors in business management skills. It emerged that while the VSLAs are considered to be performing well, they have not received follow up assessment from any TSO. The absence of this support (notwithstanding the support provided by CBTs and supervisors) undermines the quality of groups in areas such as; record keeping, fraud detection and control, governance, and effective management of finances. PSFU program manager has prioritized addressing these problems in the extension phase and has identified CARE Uganda to replace Oracle and thus bring on board the rich experience they have in this work. 56
Cycling out of Poverty: The organization supplied the bicycles and worked with a local organization called Bicycle Sponsorship and Programme workshop based in Jinja to deliver part of its work related to bicycle maintenance. The organization experienced challenges in doing its work in especially Nakapiripirit due to remoteness of the area, poor road network and insecurity. The organization, nonetheless, succeeded in fulfilling its obligations in spite of the challenges. . Center for Basic research: The processes of baseline data collection and presentation of findings were successfully completed. Design of the monitoring and evaluation data base was also undertaken. The challenges experienced related to change of monitoring and evaluation indicators nearly midway during the implementation of the program. This affected all initial work conducted relating to capacity building for data collection and management. The processes of managing the changes appear to have affected both CBR and the contractor. LG Actors::The leadership of the DHO has made it possible to get district and lower level technical staff involved in the implementation of the programme. They have succeeded to ensure that the political leaders in the districts provide political backing necessary to implement the programme. In addition, they have played a key role in outsourcing service providers –particularly suppliers of boreholes and oxen. They have also been very instrumental in supervising ACDOs who work with VHTs, CBTs and TSOs to ensure they perform their roles. However, the greatest challenge of using the district local government institutional framework concerns bureaucracy. Timely release of program funds sent to districts is affected by delays in decision making and action which affect procurement of supplies and services such as oxen and boreholes. In all districts, the implementation of livelihoods and access to safe water activities was reportedly delayed owing to bureaucracy. The second challenge concerns the near neglect of some roles by district technical staff due to multiple commitments, even when provided with incentives to cater for their extra work load. This is particularly the case with district data clerks under the DHO office who have been unable to perform the data management roles assigned to them. Also data collection in some districts was affected due to poor supervision and the use of different instruments for which some district staff needed further training .This in turn has affected the Monitoring and Evaluation (M&E) function inbuilt within the programme..
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5.3.
Effective and Weak Practices
Our initial analysis based on interviews and documentary reviews indicates a number of effective practices that ought to be maintained and consolidated on one hand, and those that need to be modified or discarded in order to promote the effectiveness and efficacy of the current programme. The practices are discussed below starting with those identified as effective or good practices.
Use of Technical Service Organizations: With each TSO performing a specified role, this has proved to be a game changer particularly in relation to financial and overall management of programme (PSFU) and delivery of other specialized services and supplies (COOP, Oracle, Nascent and CBR). Improving the vetting of selected service organizations is likely to improve quality service delivery.
Use of grassroots structures: The fact that the programme relies heavily on community based structures (VHTs, CBTs, LCs, CCGs etc) to initiate and implement multiple activities aimed at improving child wellbeing helps in building an army of actors and structures that translates into an effective grassroots child welfare and protection system built from below. This lays a strong foundation for the sustainability of initiated activities.
Use of local materials for child stimulation: Members of the CCGs are engaged in production of child play materials using locally available materials. These have worked well in the established community-based play/learning centers.
Involvement of LG staff: This practice ensures political buy-in and creates a possibility for integration of selected activities under the programme into district and sub-county plans. It also builds capacity of the district and lower level governments which improves their functionality and visibility.
The mobilization power of VSLAs: Overall, the VSLAs seem to have had the greatest impact of all district-level interventions. During focus group discussions with the beneficiaries, it was evident that they are committed to the VSLA. Beneficiaries felt that VSLA was less demanding in terms of implementation since it requires mobilization of local resources and less of external ones. The idea of mobilization of savings from within is popular and considered sustainable. VLSA are also used as a platform for mobilization of caregivers to take part in other programme activities. If well managed as entrepreneurial undertakings, VSLAs have the potential to raise money that can support not only livelihoods of members, but also manage activities that promote child and maternal health. We think the project is also sustainable, because it focuses on giving people skills and knowledge to make a living, rather than giving them handouts. For many people are joining VSLA and are
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adopting a savings culture. If they can be taught how to using their savings productively, then they can increase their household incomes [and improve their economic security
Weak practices Though the project has proved to be an outstanding success from many perspectives there are still facets that could be improved in the future to ensure continuous improvement. Programme scope too broad: Although it is important to address the risks and vulnerabilities infants and young children experience in an integrated approach as is the case with the current intervention, it was a concern among all stakeholders met that the programme components were too many to be effectively implemented in a ‘one go approach’. With many components, concepts, and approaches all scheduled to be implemented or adapted in a short period, the key persons responsible for direct implementation of the programme became overwhelmed and found it difficult to internalize the programme and also implement the planned activities in a short time. Thus almost a quarter of the time was committed to understanding the programme concepts and approaches. The multicomponent nature of the programme also required many indicators to be developed for the M&E framework which further required use of many tools. All of these undermined the successful setup and operation of the M&E system, increased the work load of those involved and ultimately led to failure to implement some of the core functions like data entry. It is necessary that an intervention of this nature needed to adopt a phased approach, starting with few high impact activities which are well aligned with the identity of BvLF work and then rolling out others in the second and 3rd year of implementation. Household cluster approach has not been very effective: It was envisaged in the programme design, that programme activities would be organized around village-based household clusters. This however has not been the case in most districts, as reflected by a programme team lead who stated that: “When the programme started, we initially thought we could use the household (HH) clusters. HH clusters typically comprised of 3-4 households. We registered so many clusters. We later realized that HH clusters had a lot of expectations, which would not be effectively met. So we abandoned the idea of using HH clusters. We instead decided to use VSLA groups as a platform for all activities in the programmes.” Unrealistic assumptions about the work of VHTs: VHTs being volunteers, it is necessary that roles assigned to them are carefully assessed to ensure that their participation in the programme does not compromise their ability to work and improve the wellbeing of their own families. The current design assigns them many roles which they are likely to perform with increased expectations tied to payment. Thus concerns are raised about issues of resource support and or reimbursement for specific activities. It is important also to develop performance indicators for VHTs in addition to vetting and recruiting those with the necessary qualifications. Unfortunately, in Nakapiripirit, the qualified VHTs are likely to be very few.
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Responsible Fatherhood clubs (RFCs): While RFCs are promising initiatives they are not well linked to formal and informal child protection structures, not surprisingly there is limited attention to case management, an important prerequisite for success. Cooperative care groups: Limited capacity of VHTs to support the management of cooperative care groups and community ECD centers. Training of VHTs and other actors: The district technical staff involved in the programme need training linked to child protection; prevention, case management, referral pathways, and provision of psychosocial support services. There are already some training packages in place which are being rolled out and recommended by the Ministry of Gender Labour and Social Development (Refer to the practice oriented child protection training). Monitoring and evaluation remains weak: This remains the weakest component of the programme given the inability to enter data into the system and process it. This function could be assigned a service provider who would work hand in hand with district bio-statisticians.
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6.
PROGRAMME MONITORING AND EVALUATION
6.1.
Data collection and management
Data to support project monitoring and evaluation was collected prior to project implementation by the Center for Basic research (CBR) in four districts namely; Apac, Soroti, Kumi and Nakapiripirit. CBR used the baseline results to develop the M&E framework, which delineated the data collection tools and indicators to be tracked. Two categories of tools were developed, namely; a) monitoring tools whose data collection follows a pre-determined schedule, and b) event based tools, whose data is collected after a particular event has happened (see Table 6.1.1). In addition, a programme relational database management system was developed to store data routinely collected during programme interventions. Two categories of data were to be collected and stored in the database: (i) data related to VSLA-related activities, (ii) data collected by VHTs and sub-county technical staff relating to child/household well-being and practices, and process indicators in the M&E matrix. A biostatistician, attached to the DHO’s office, was tasked with entering the data into the database. Oracle supported the development of the management information system (MIS) for VSLA related activities. It also worked with CBR to train and orient the biostatisticians in data management (i.e., entry, cleaning, and analysis). The database was expected to generate data that the VHTS, CBTs and LG technical staff would use to make real-time decisions related to program activities. However, the evaluation revealed that the bulk of the collected data was not entered in the database. This suggests that the data has not been adequately used to inform decision-making and programming. It is also uncertain at this stage whether and how the database system will be maintained beyond the life of the BVLF project. Table 26: M&E tools developed TOOL
PERSON(S) RESPONSIBLE FOR COLLECTING DATA
Village Household Register Form
Village Health Team
Village Register Form
Community Development Officers/Health Assistants/Production Officer, Water Officer
Village Register Form: Health Facility Survey
Health Assistant
Village Register Form: Schools survey
Community Development Officer
Village Health Team Inventory Form
Sub-county staff
Sub-county Staff Inventory Form
Sub-county chief
Cluster Registration Form
Community Development Officers, Health Assistants
Cluster Households Monitoring Form
Cluster members & Village Health Teams
Cluster/Village Monitoring Form
Community Development Officer / Health Assistant / Production Officer
Water Supply Monitoring Form
Village Health Teams, Community Development Officer, Health Assistants
Household Birth Preparedness Form
Village Health Teams
Seeds Beneficiary Commitment Form
Village Health Teams, Production officers
Seeds Beneficiary Payback Form
Cluster members
Oxen and ox plough Beneficiary Commitment Form
Cluster members
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The evaluation also revealed that some of the monitoring tools were modified 4-5 months into the project. The process of modifying the tools was inspired by the inclusion of additional indicators in the M&E matrix. Interviews with the biostatisticians revealed that the process of modifying the tools, was associated with challenges. First, there were delays by CBR to update the project database to reflect the modified tools. Second, given the short life span of the programme, the modification of the tools and the introduction of new indicators several months into project implementation could not allow sufficient time for all actors to adjust accordingly and thus successfully collect and manage the data so as to allow the measurement of project progress. … They sent the modified tool late; almost in the middle of project…They first brought a tool which we [used to] train VHTs but the final one [tool] was brought in the middle of project, and had many changes. The final tool was the one used to create the database. We started collecting data in August 2012 yet the project started in February 2012 because of the delay [in finalizing] the tools. Some data was meant to be collected right from the start so we lost or missed it completely … (Key informant).
Several challenges related to data collection were also reported. Particularly: VHTs were involved in several government programmes, on top of other NGOs who are rolling out health interventions in the same regions. This competes with their available time and are often tempted to choose between those programs where facilitation is considered more favorable. VHTs were expected to fill far too many tools. The many tools present a burden to the VHTs supposed to collect this information. A considerable number of VHTs, especially in Nakapiripit district are illiterate. This compromised the quality and completeness of data collected. Local monitoring mechanisms Community leaders and local government staff often become aware of institutional or technical issues and report to PSFU for action. This is done by leaders in fulfillment of their leadership and management roles. However, the fact that is done in ad hoc manner rather than through a structured and focused system, information is not properly documented and used for overall improvement of program performance.
6.2.
Data quality
Interviews with the biostatistician at the district level revealed several concerns about the quality of monitoring data. Particularly, there are too many errors, gaps and discrepancies in the data collected by VHTs .
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6.3.
Use of monitoring data
An optimal monitoring system feeds information in both directions. It should not just extract the required data from community structures; it should regularly report back to them with information from the broader management system and database. This dimension monitoring is not yet strongly developed. The evaluation also revealed several challenges related to sharing and use of monitoring data by the different implementing partners. For example, in Kumi district data that had been entered into the relational database management system was lost when the computer on which it was entered broke down, and the district had no back-up. In Apac district, some data had been entered into the data base, using two separate computers. However the data entry clerk had not been trained on how to merge the data sets. CBR had promised to send someone to merge the data after its entry but by the time of the evaluation, it had never been done. We have not been able share the monitoring data with PSFU because of system challenges. Data was lost and we had no back up. There is need to train us so that we are equipped with the knowledge to trouble shoot and resolve some of these problems on our own. (biostatistician in Kumi distict)
6.4.
Other Concerns

Much still needs to be done to build an efficient system that can keep track of the project indicate results and the performance of the project in a structured way.

The long-term concern is whether and how the interventions will continue to be monitored effectively after the project has ended. The local government monitoring and evaluation system is not sufficiently focused
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7.
PROGRAMME SUSTAINABILITY
The value of any development intervention must ultimately be assessed in terms of the sustainability of its impact. The overarching question for this evaluation is therefore whether the benefits being achieved by the project are sustainable. This section therefore offers preliminary observations on towards sustainability, with particular reference to the evaluation questions12 that were posed by the terms of reference. These observations are directed towards the evaluation’s broad purpose of learning and sharing lessons with regard to the potential for sustainability of the child wellbeing programme and the risk ands and strategies for sustaining the project. The key elements to help us answer the question as to whether programme is sustainable relate to factors such as ownership of the programme by the implementation agencies and community structures, the cost of implementation and the availability of required manpower:
7.1
Working with district and sub-county technical staff Working with district and sub-county technical staff-creates a possibility of integration of programme activities in district and sub-county plans Involvement of technical staff from districts (LG structures) builds ownership Use of grassroots structures and direct involvement of beneficiaries
The districts technical staff formulated many of the core programme components targeting the improvement of children’s health, protection and development. When they are fully involved in the implementation of the intervention, they have a good understanding of the programme rationale; the approaches employed and appreciate both the challenges and opportunities presented. The clearest opportunity available within local governments to ensure the continuity of the programme lies with the integration of the core programme components within the districts’ five sectoral areas which receive funding from the central government namely; Health (DHO), Education (DEO), Community Development (CDO/Probation and Welfare Officer- for OVC, elimination of violence &community work) and, Agriculture (Production Officers—for livelihoods interventions). Strategically, the programme has worked with the technical staff from all of the sectoral areas which is a major step towards integration.
7.2
Use of community structures
In addition, by using the community structures such as VHTs established by government13 for purposes of promoting community health through social mobilization and health education, the programme maintained and made more vibrant, the same structure and personnel the government relies upon to implement a range of health interventions across the spectrum of health, water and sanitation, disease
12
What is the potential for sustainability of the programme? What are the risks and strategies for sustaining this programme? See Ministry of Health &Helenlouise, Taylor (2009) Village Health Teams Uganda 2009, Ministry of Health Uganda. Kampala: Ministry of Health, Republic of Uganda 13
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surveillance and carrying out simple treatment all of which directly resonate with the current programme goal of reducing child illnesses and improving maternal health outcomes. More so, the strategy of using VSLAs to improve livelihoods is well aligned with the government strategy of poverty eradication through promotion of Savings and Credit Associations (SACCOs) which are village based micro-finance focused organizations established in all districts in the country. One of the reasons the current VSLAs have been successful could be linked to the knowledge communities have about promotion of savings and IGAs through SACCOs and related initiatives in the districts. The unique aspect about the use of VSLAs in the current programme is the integration of early childhood concerns and mobilization of care givers around these concerns. The fact that in nearly all associations numbering 229 the volume of savings and uptake of loans is on the increase, the promise of sustainability is out of question. The most urgent concern though is to create linkage banking, strengthen support supervision, ensure safety of savings, improve good governance and build business mind among participants to undertake successful IGAs. The Cooperative care groups and RFCs would most likely phase out once funding dries out. The activities attached to these would find a lifeline if linked to VSLAs.
7.3
Managing the cost of implementation
At the moment, no single organization can take on the full cost of extending the implementation of the whole programme. However, as indicated, various components of the programme will continue running through government structures and at the grassroots. If BvLF were to pull out, it would necessitate that the VSLAs at the village level are linked to village banking and any other local NGOs particularly those working with the BvLF in the implementation districts to ensure continuity of support supervision and other goals linked to the programme. Bringing on board the private sector, is one of the most direct avenues to ensure direct financial flows to keep several components of the programme running and vibrant for example supporting district involvement in the supervision of the programme—should BvLF funding come to an end at the end of the programme cycle. The private sector involvement will nonetheless require identification of components that will most likely attract private sector corporate social responsibility concerns and whose outputs can easily be visible for example support towards access to water and improvement of sanitation and others linked to elimination of child illnesses and improvement of maternal health. In conclusion, the programme has great promise for sustainability once viewed from the angle of its independent components instead of the whole. The programme in its entirety would continue as long as funding from BvLF continues or if fully supported from private sector or other actors. The components have a solid foundation for sustainability given the linkages with government programmes and grassroots structures.
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8.0 RECOMMENDATIONS The results of this evaluation reinforce the worth and need for such a program as the child wellbeing programme. The pilot has responded to an unmet need and provided a valuable example of what can be achieved with dedicated resolve and resources. The following are recommendations for BVLF and partners to consider moving forward. Recommendations i)
Violence against children and women:
Senstisation combined with dialoguing should be continued and extended to other areas
An emerging integration of violence prevention activities within VSLA should be strengthened
Should engage cultural and religious leaders in the prevention efforts
Selected VHTs, CBTs and local leaders should have child protection training with key emphasis placed on case management, referral (reference to the Nationally Certified Child protection Curriculum) and prevention of violence in other settings
ii)
Greater attention should be paid to eradication of FGM practice
Strengthening the family to provide effective care through economic empowerment VSLA participants need more guidance on undertaking common IGAs, increasing production and working towards collective marketing and utilization of benefits of economies of scale
VSLA need to be linked to formal banking
Develop guidelines and regulations on activities of members particularly to exclude involvement in alcohol production, and involvement of children in hazardous work
iii)
More technical assistance on book keeping, business visualization
Child care, stimulation, learning and safe spaces The centers will need to graduate from being informal to some level of formality where more structured care, learning and play can be organized.
Facilities including shelter, toilets and other services will need to be taken into consideration by the community. Training for a designated trainer (s) is necessary to create consistence.
Parents need to plan for feeding of children and access to other services such as water.
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Age segmentation should be taken into consideration as some centers combine very young and older children
iv)
Improving care environment through improved access to basic services
More supervision of water user committees and support to improve maintenance of services
Follow up borehole supplier to finalise works regarding fitting two pipes per borehole (Apac district).
Enable access to services under this component through referral or other private sector providers
v)
vi)
Maternal and child health interventions Care givers need more training on child survival, feeding and development
Program design
Develop criteria for identification and accessing benefits to the most vulnerable households (children)
Use of specialized agencies in providing services should be maintained
Accelerate efforts to bring on board private sector actors to support selected components of the program
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9.0 APPENDICES  
List of individuals or groups interviewed or consulted and sites visited List of supporting documents reviewed
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