SHE FINAL EVALUATION Report

SEXUAL HEALTH AND EMPOWERMENT [SHE]

FINAL EVALUATION REPORT

SHE is undertaken with the financial support of the Government of Canada provided through Global Affairs Canada

Sexual Health and Empowerment (SHE) Final Report

Implementer: Oxfam Canada

November 2024

Contact: Kimberly Quach, Program Officer kimberly.quach@oxfam.org

Cover: An Oxfam Pilipinas staff member walking in Brgy Bulawan, Prieto-Diaz, Sorsogon during one of the SHE Project’s community visits. Oxfam Pilipinas has partnered with the Mayon Integrated Development and Alternative Services (MIDAS) to reach communities in the Bicol Region. (credit: Neal Igan Roxas)

Oxfam Canada

39 McArthur Avenue, Ottawa, ON K1L 8L7

1-800-466-9326

www.oxfam.ca

oxfamcanada

SHE is funded by the Government of Canada through Global Affairs Canada

Acknowledgements

First and foremost, we extend our heartfelt gratitude to Oxfam Canada for placing their trust in Progress Inc. to conduct this evaluation.

A special thank you goes to Pushpita and Kimberly for their unwavering support throughout all phases of the evaluation. We would also like to thank Oxfam Philippines, Jhpiego, and all associated team members (especially Michelle and Jeremiah) for their continuous support and guidance, which contributed to the smooth execution of the evaluation. Your coordination efforts and the information you shared were instrumental in shaping this evaluation. The weekly meetings with you provided invaluable guidance and illuminated our path at every turn.

We extend a sincere thank you to all participants, including those from CSO partners, WROs, and CSOs (both under Pillar 1 and Pillar 2), for their willingness to engage in conversations and share their invaluable insights. We are also grateful to all survey and interview participants, as well as those who took part in discussions. Your cooperation has been indispensable in documenting the findings and gaining a deeper understanding of the project.

We also wish to express our appreciation to the field researchers from all regions for their unwavering commitment to delivering quality work within a tight timeframe. Your dedication has been instrumental in the success of this evaluation.

A special thank you to Maya and Pia for coordinating all the work smoothly throughout; your hard work has not gone unnoticed. We also thank Dr. Joselito for your continuous check-ins and support in advocating for sustainability. Your attention to detail in data comparison was very helpful. Lastly, thank you to Sue for providing an SRHR and gender perspective, which prompted us to explore new ways forward and delve deeper into the issues.

Pooja Koirala Founder/Director Progress Inc.

August, 2024

Progress Inc. prepared this report for Oxfam Canada as part of the external evaluation of the SHE project. A combination of quantitative and qualitative data collection methods was employed to derive the findings. Primary data collection for this evaluation took place in June, July, and August 2024. The viewpoints presented in the evaluation reflect those of the evaluation team.

For any inquiries regarding the evaluation, please feel free to contact Progress Inc. using the information below:

Pooja Koirala (Author)

Email: poojak@progressinccompany.com contact@progressinccompany.com

Team Members:

Pooja Koirala – Team Leader

Sue Newport - SRHR Expert (Consultant)

Dr. Joselito Vital - SRHR Expert (Consultant)

Maya Vicencio – Field Coordinator (Consultant)

EXECUTIVE SUMMARY

Sarah, a Barangay Health Worker, from Bulusan, Sorsogon, Bicol.

PHOTO: CAROLINE LEAL/OXFAM

EXECUTIVE SUMMARY

This report presents an evaluation of the Sexual Health and Empowerment (SHE) project, a seven-year initiative funded by Global Affairs Canada (GAC) in partnership with Oxfam Canada (OCA), Oxfam Pilipinas(OPH), Jhpiego, and eleven local women’s rights organizations (WROs) and civil society organizations (CSOs) in the Philippines. The project aims to empower women and girls in six disadvantaged and conflict-affected regions of the country to secure their Sexual and Reproductive Health and Rights (SRHR).

The evaluation focuses on the following objectives:

• Assess whether the project has met its targets as outlined in the Performance Measurement Framework (PMF).

• Evaluate the validity of the project’s assumptions based on its Theory of Change, considering contextual shifts and the project’s adaptability over time.

• Identify challenges or limitations in the project’s theory of change and programming, and propose improvements for future SRHR programs in the Philippines.

• Highlight lessons learned and best practices in SRHR from project partners.

• Facilitate cross-organizational exchange of experiences and learnings.

Methodology

The evaluation employed a mixed-methods approach, combining both qualitative and quantitative techniques, guided by the Organization for Economic Cooperation and Development- Development Assistance Committee (OECD/DAC) criteria. A concurrent embedded design was used, with qualitative methods as the primary focus and quantitative data supporting these findings. The evaluation was both summative—assessing the achievement of project objectives—and formative, identifying lessons learned and the effectiveness of strategies. Key areas assessed included relevance, efficiency, effectiveness, impact, and sustainability., with an outcome harvesting method used to trace achievements and causal pathways.

The evaluation covered six regions in the Philippines: Bicol, Eastern Visayas, BARMM, Zamboanga Peninsula, Northern Mindanao, and Caraga. The sample included 13 of the 21 municipalities supported by the project. A total of 52 barangays were selected using stratified sampling.

A comprehensive review of baseline, midterm, and pulse survey data was conducted, alongside an analysis of annual reports, learning documents, and outcome harvesting reports. For the quantitative survey, a sample size of 1710 was reached, including boys and girls (aged 15-20) and women and men (aged 20-50). 60 Focus Group Discussions (FGDs_ were held with diverse groups, including adult women, men, adolescents, peer educators, and Lesbian, gay, bisexual, transgender, queer, intersex, asexual plus (LGBTQIA+) participants. Moreover, 53 Key Informant Interviews (KIIs) and 8 In-Depth Interviews (IDIs) were conducted with stakeholders, including Rural Health Units (RHU) representatives, Women Right Organizations (WROs), Local Government Units (LGUs), and project partners, to assess the availability, accessibility, and effectiveness of Sexual and Reproductive Health and Rights (SRHR) services.

Key findings:

The project was structured around two major pillars, with the first pillar focused on engaging rights holders, community members, and healthcare practitioners to support gender-responsive and youth-friendly sexual and reproductive health information and services. The evaluation revealed improvements across all outcomelevel indicators envisioned by the project, particularly in addressing the unmet need for Family Planning (FP).

The unmet need for FP among women decreased from 32.2% at baseline to 22% at the endline, and among girls, it dropped from 13.3% to 4%. The target was set at 25% for women and 4% for girls, indicating the target being achieved. Qualitative findings suggest that the decrease in unmet FP needs can be attributed to the project’s support in demand creation through outreach and awareness initiatives, as well as the strengthening of supply-side parameters by enhancing human resource capacity.

Another positive outcome was a reduction in the teenage pregnancy rate. The total count of teenage pregnancies decreased from 2,281 in 2020 to 1,598 in 2023. The average teenage pregnancy rate (10-19 years) across all project sites in 2023 was 18.51 reported by the Field Health Service Information System (FHSIS) data from 2023 This is a reduction of 5.92 from 2022. However, the 2023 TPR appears to be higher by 8.67 compared to 2019 due to differences in the source of projected teenage population (TPR denominator) across the years. A proxy indicator used during the survey showed that only 2.9% of teenagers reported being pregnant at the time of the endline survey compared to the target of 3.2%. This is a notable decline from the 7.4% reported at baseline. Enhanced awareness among adolescents about the negative implications of teenage pregnancy, including its consequences on mental and physical health, is one of the factors that led to the decrease. This improvement is largely due to the awareness sessions conducted at the community and school levels.

The project also sought to assess the community’s perception of SRHR. This was measured using composite indexes of reproductive autonomy, sexual autonomy, and economic autonomy. The endline results indicated improvements: 68% of girls, 62% of women, 62% of boys, and 63% of men demonstrated positive attitudes toward SRHR, compared to 48% of girls, 50% of women, 47% of boys, and 46% of men at baseline. This indicator has also met the target that was set at 57% for girls, 60% for women, 58% for boys and 60% for men. The project has effectively fostered attitudinal change within the community. Through awareness sessions and dialogues, it has worked to shift gender dynamics by emphasizing the importance of equality and shared household responsibilities. As a result, women and girls have gained confidence in their bodies and decisions, leading to a shift in overall perceptions. The project’s engagement of men, boys, women, and girls is commendable and has been pivotal in changing attitudes.

At the intermediate outcome level, there was an increase in new FP acceptors by the end of the project, with 24,787 new acceptors reported over the period between 2019-2024. The project surpassed its Year 6 endline target of 5,209 by 31%, reaching 6,824. A survey proxy indicator showed a decline in FP usage from baseline to endline: girls (87% to 79%), women (68% to 65%), boys (40% to 32%), and men (69% to 32%). Both FHISIS and survey data report showed mixed trends in FP acceptors. BARMM and Sta. Margarita in Region 8 saw increases due to PSI services and outreach, while declines occurred in Ganassi, Mobo, and Region 9 due to low FP prioritization, limited training, and stockouts. Region 10 had mixed results, with Ozamiz excelling from PSI training, and Region 13 declined after reaching its target population.

The number of women accessing quality and genderresponsive reproductive health services reached 65,994 by Year 5, surpassing the target of 62,342 by approximately 5.9%. However, the number of men who accessed these services, 2,266, was below the target of 2,509 by about 9.7%. Modern contraceptives like oral pills (36%-38%), injectables (20%-24%), and PSI (17%) remained most popular, while permanent methods had low uptake, limited to medical missions. COVID-19 efforts, including PSI distribution and provider training, boosted usage.

Immediate outcomes also showed a progress. The survey data revealed that 87.9% of the targeted population knew where to access SRHR services, including contraceptive commodities, an improvement from the baseline. Specifically, 87.8% of girls, 93.8% of women, 81.6% of boys, and 87.7% of men were aware of where to access these services, compared to targets of 54.3% for girls, 77.4% for women, 64.1% for boys and 81.5% for men. Furthermore, the percentage of females able to make reproductive health choices independently increased to 68.5% at the endline, with 60.7% of girls and 75.2% of women reporting autonomy in their reproductive health decisions, a significant rise from the baseline, and exceeding the target set at 43.1% for girls and 66.7% for women.

The perception of reproductive autonomy also improved, with the overall reproductive autonomy index at endline reaching 72%, with women at 71%, girls at 78%, men at 68%, and boys at 71%, all showing marked improvements from baseline levels. The targets set has also been achieved. Public declarations and actions in support of SRHR exceeded expectations, with 75 declarations made against a target of 42. Additionally, all 19 RHUs met the 80% benchmark for providing gender-responsive SRHR services as of March 2024.

Lastly, the availability of modern contraceptives in RHUs fell a little short of expectations, with 16 RHUs having at least three modern contraceptives available on the day of the visit, opposed to target set at 17.

Pillar 2 of the project was dedicated to building knowledge and strengthening the capacity of WROs, institutions, and alliances to influence and advance the full implementation of SRHR-related laws, policies, and programs. By the end of the reporting period, there were 21 documented cases of inter-agency collaborations, meeting the target of 21, which is expected to be increased until Year 7 quarter 2 (end of activities). One key indicator measured the autonomy and awareness of organizations in their performance. According to the CAT4ARHR data reported in the PMF at the endline, all 10 partners and WROs expressed confidence in their ability to deliver effective programs on SRHR and GBV prevention, meeting the target of 10. In terms of partners and WROs being on track with their action plans to increase capacity, the target of 10 was also achieved by the endline as all 10 SHE implementing partners received grants to implement their institutional strengthening action plans, with all showing significant progress in completing their planned activities. Additionally, regarding the development of learning agendas, 18 learning agendas were created by the end of the project, representing an 180% accomplishment of the indicator. Another important indicator measured the capacity of WROs and networks to engage the public and policymakers in advocacy and influencing campaigns. The PMF reported a total of 47 advocacy and public engagement activities conducted, significantly surpassing the target of 10. Lastly, the indicator on WROs and networks reporting improved influencing skills showed that all organizations reported to have improved their influencing skills, exceeding the target was set at 20.

The evaluation highlights the project’s success in transforming attitudes, increasing knowledge, and boosting demand for FP services through community outreach, Usapan sessions, and school engagement. Key achievements include a significant reduction in unmet FP needs among both girls and women, attributed to peer educators, school sensitization, and improved service provision. The project has also contributed to a decrease in teenage pregnancy rates and a positive shift in attitudes toward SRHR. Notable outcomes include enhanced reproductive autonomy among women and girls, a shift in community attitudes facilitated by engagement with influencers and religious leaders, and increased openness to discussing SRHR. The involvement of men and boys has been crucial in influencing attitudes and fostering positive social norms.

KEY HIGHLIGHTS FROM THE ENDLINE SURVEY

Regarding HIV/AIDS awareness, 93.1% of respondents had heard of HIV/AIDS, with awareness rates of 90.1% among boys, 95.8% among girls, 92.2% among men, and 93.6% among women.

Sexual experience was reported by 48% of respondents: 20.5% of boys, 22.2% of girls, 69.1% of men, and 77.1% of women.

Most respondents (77%) recognized condoms as effective for preventing pregnancy, and 80% disagreed with reusing condoms. Condoms were viewed as more suitable for casual relationships (57%) than steady ones (45%). About 75% agreed that either partner can suggest condom use, though 44% found purchasing condoms embarrassing, indicating social stigma. Additionally, 31% were uncertain about condom use in steady relationships, highlighting the need for further education.

Over half of the respondents (54.3%) reported making their own reproductive decisions, with consistent responses across boys (52.7%), girls (50.4%), men (53.9%), and women (59.4%).

A strong engagement with formal healthcare services was evident, as 65.3% of respondents reported visiting a hospital, clinic, or doctor.

All respondents were aware of at least one FP method, with 100% knowing about male condoms, 84.9% about pills, and 54.4% about implants. Among all respondents, 28.9% had used a FP method at some point, including 9.6% of boys, 13% of girls, 33.6% of men, and 56.4% of women. At the time of the survey, 13.9% were currently using a method.

A high proportion of respondents (87.9%) knew where to access FP services, with the highest awareness among women (93.8%). Barangay Health Centres (72.2%) and RHUs (14.6%) were the most common locations for accessing services.

In assessing attitudes towards domestic violence, over 90% of respondents disagreed or strongly disagreed with justifications for a husband beating his wife, while less than 5% agreed with these justifications.

Regarding intimate partner violence, 80% of respondents reported not engaging in violent behaviours. However, 29.7% admitted to yelling, cursing, or insulting their partner. Other violent actions included slapping or spanking (2.3%), throwing objects or pushing (1.2%), restricting work or earnings (1.4%), and controlling money (1.2%).

In terms of experiences, over 70% of respondents had not encountered violence. The most common form was verbal abuse, with 4.4% experiencing it frequently. Slapping or spanking was reported by 2.1% as occurring often. More than 50% of reported violence cases involved a one-time occurrence.

Efforts to address GBV have strengthened through the reestablishment of Multi-Disciplinary Teams (MDTs) and effective community awareness initiatives. Additionally, capacity-building for healthcare providers, including training on gender transformation and adolescent care, has improved service delivery. Overall, the project’s comprehensive approach has led to substantial improvements in FP uptake, SRHR attitudes, and GBV response.

Strategies that worked:

The project employed several successful strategies to promote SRHR and gender equality. Engaging youth through adolescent peer educators proved highly effective in creating a comfortable environment for open discussions, fostering trust, and disseminating information, leading to a ripple effect in communities. Engaging male members was crucial for promoting women’s reproductive autonomy, with gender sensitivity training enhancing men’s understanding and support. Practical skills training for peer educators, aligning SRHR education with religious perspectives, and engaging religious leaders in Muslim-majority areas like BARMM further strengthened community acceptance. Family conversations and tailored group sessions for men, women, and youth addressed specific needs, while leveraging existing community programs like the Pantawid Pamilyang Pilipino Program (4Ps)1 ensured broader reach and impact without additional resources. These strategies collectively contributed to the project’s success in changing mindsets and enhancing SRHR awareness in the target communities.

Coherence:

The SHE project effectively aligned with national and local policies, such as GAD planning guidelines and family planning programs, ensuring relevance and complementarity with existing health and development initiatives. By tailoring activities to regional needs, such as in BARMM and Eastern Visayas, the project addressed resistance and fostered crucial discussions on SRHR and GBV. Its alignment with broader national health goals and SDGs facilitated the integration of SRHR services into local policies and health systems.

Project design and relevance:

The SHE project’s design aligns well with the SocioEcological Model, addressing SRHR challenges at individual, community, and societal levels through its two-pillar approach. Pillar 1 focuses on empowering individuals and communities, while Pillar 2 targets systemic change by engaging WROs and CSOs in advocacy and policy work. A key strength of the SHE project is its inclusive design, incorporating input from local partners and stakeholders. The project was tailored to address context-specific challenges in the Philippines, such as GBV, poor access to health services, and cultural norms.

Sustainability:

The SHE project incorporated several effective sustainability elements that should be continued. A key factor was the investment in local government units (LGUs) and health service providers, such as midwives and barangay health workers. This approach has ensured that health providers are well-equipped and knowledgeable, supporting the continuation of SRHR services beyond the project’s lifespan. Community education and training have also had a lasting impact, empowering individuals with the knowledge and skills to sustain the project’s objectives. Adolescent healthfriendly centres, established within communities, will continue to serve the population, supported by the enhanced capacity of health workers. LGU engagement varied across regions, with some areas showing strong support and even advancing policies, while others rely more on external funding.

Programmatic recommendations for future:

• Future programs should focus specifically on Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual Plus (LGBTIQ+) communities, moving beyond general inclusion to address their unique needs. This includes targeted outreach and messaging to combat stigma around HIV testing and family planning services.

1 4Ps is a conditional cash transfer program of the Department of Social Welfare and Development in the Philippines.

• Future programming should normalize discussions on women’s sexual rights through culturally sensitive messaging and media campaigns. Strengthening couple counseling and relationship sessions will foster mutual respect, emphasizing women’s legal rights to bodily autonomy.

• Strategies to engage religious and faith-based leaders should be developed, including mapping key community influencers and providing capacitybuilding workshops on SRH and GBV to align their messaging with public health goals.

• Programs should specifically address the needs of adolescents aged 10-19, expanding beyond the current focus (15-19). Targeted interventions should tackle stigma surrounding SRH services and build trust through reliable communication, enhancing adolescent engagement in family planning and sexual health.

• Engaging parents is crucial for supporting their children’s decision-making in sexual and reproductive health. Future initiatives should empower parents to create a supportive environment, helping young people navigate issues like early marriage and educational pursuits.

• Schools should be utilized as stigma-free spaces for SRHR education. Future programming should expand training for teachers on gender transformation and coordinate with school administrations for regular access to SRHR information.

• A strong push for integrating CSE into school curricula is essential, as its full implementation is lacking. This should be a priority advocacy agenda to equip students with necessary knowledge for informed decision-making regarding their sexual health.

• Continued advocacy is needed for the stalled Adolescent Pregnancy Prevention Bill. Successful passage of this legislation could significantly improve adolescent health outcomes and support prevention measures. Reinforcing advocacy strategies will be crucial to advance this critical bill.

Design level recommendations:

• Future program designs should ensure alignment between Pillar 1 and Pillar 2 outcomes to achieve overall project goals. While Pillar 2’s organizational strengthening efforts, like CAT4SRHR, have effectively supported Pillar 1 partners, there was a lack of clear synergies in knowledge generation and advocacy. To enhance integration, involve both pillars in the design phase, co-design the Theory of Change, and establish regular communication and joint planning mechanisms. This will help ensure that knowledge and advocacy efforts from Pillar 2 effectively support and build capacity in Pillar 1 partners.

• Future programs should balance breadth (reach) with depth to maximize impact. While broad reach is important, deep, sustained engagement is crucial for addressing complex issues like SRHR and GBV. Focus on fostering repeated, in-depth interactions and long-term involvement to create lasting change in social norms and behaviours.

Management level recommendations:

• Implement a robust coordination mechanism between core partners like Jhpiego and OPH, including regular joint planning sessions, an integrated reporting system, feedback loops, and a stakeholder engagement plan to ensure alignment and effective collaboration.

• Design future projects with built-in flexibility to adapt to changing circumstances. Include provisions for revising timelines, adjustment of targets and indicators, reallocating resources, and implementing a tiered approach to service delivery. Establish clear protocols for rapid response and contingency planning.

• Start the project with a clear MEAL plan to align all partners and avoid confusion. Establish robust tracking, define M&E guidelines, and prevent overlapping activities through clear communication.

• When managing a project with core partners like Jhpiego and OPH, a strong coordination mechanism is essential. A formal meeting involving all partners and the OCA would ensure alignment, prompt information sharing, and effective collaboration. This approach would prevent isolated efforts, enhance joint analysis in reporting, and improve understanding of how each partner’s outcomes affect the other.

List of abbreviations and acronyms

4Ps Pantawid Pamilyang Pilipino Program

ABR Adolescent Birth Rate

ADA Adolescent Job Aid

ASRH Adolescent Sexual and Reproductive Health

BARMM Bangsamoro Autonomous Region in Muslim Mindanao.

BTL Bilateral Tubal Ligation

CEDAW Committee on the Elimination of Discrimination against Women

CEFM Child, Early, and Forced Marriage

CSE Comprehensive Sexuality Education

CSO Civil Society Organization

FGDs Focus Group Discussions

FP FP

GAC Global Affairs Canada

GAD Gender and Development

GBV Gender-based Violence

GTH Gender Transformation for Health

KII Key Informant Interviews

LGU local government unit

MDT Multi-Disciplinary Team

NSV No-scalpel Vasectomy

NYA Nortehanon Youth Advocates

OCA Oxfam Canada

OH Outcome Harvesting

OPH Oxfam Pilipinas

PCW Philippine Commission on Women

PMF Performance Measurement Framework

PSI Progestin-only Subdermal Implants

RHAN Reproductive Health Advocacy Network

RHU Rural Health Unit

SHE Sexual Health and Empowerment

SK Sangguniang Kabataan

SRHR Sexual and Reproductive Health and Rights

ToT Training of Trainers

TPR Teenage Pregnancy Rate

UPR Universal Periodic Review

VAW Violence against Women

WRA Women of Reproductive Age

WROs Women’s Rights Organizations

INTRODUCTION 1

A healthcare worker in Dangcagan, Bukidnon discusses family planning outreach activities at her Rural Health Unit.

PHOTO: APRIL ANN BULANADI

INTRODUCTION

1.1 ABOUT THE PROJECT

The Sexual Health and Empowerment (SHE) project is a seven-year initiative funded by Global Affairs Canada (GAC) in collaboration with Oxfam Canada (OCA) and Oxfam Pilipinas(OPH), alongside Jhpiego and eleven local women’s rights organizations (WROs) and civil society organizations (CSOs) in the Philippines. This project is designed to empower women and girls in six disadvantaged and conflict-affected regions of the country to secure their Sexual and Reproductive Health and Rights (SRHR). It has three main objectives:

a. to increase awareness and knowledge of SRHR, particularly among women and girls, including measures to prevent gender-based violence (GBV);

b. to enhance health systems and community structures to deliver comprehensive, rights-based Sexual and Reproductive Health (SRH) information and services; and

c. to strengthen the effectiveness and capacity of WROs and women’s movements to promote SRHR and prevent GBV.

The project operates through two interconnected pillars, based on an integrated socio-economic approach outlined in its Theory of Change.

Pillar 1: Engaging Rights Holders and Community Members

This pillar aims to involve rights holders, community members, and healthcare practitioners in promoting genderresponsive and youth-friendly SRH information and services. It seeks to foster positive norms around gender and sexuality, improving health-seeking behaviors within the target population. The project works with seven local partner organizations—AMWA, FP Organization of the Philippines (FPOP), Mayon Integrated Development Alternatives and Services (MIDAS) Inc., Pambansang Koalisyon ng Kababaihan sa Kanayunan (PKKK), Sibog Katawhan Alang sa Paglambo (SIKAP) Inc., and United Youth of the Philippine-Women, Inc. (UnYPhil Women)—and one international partner, Jhpiego, to implement activities in the targeted provinces and municipalities. These partners ensure SRH services are accessible and tailored to the needs of women, girls, men and boys, creating an environment where they can freely and safely exercise their SRHR.

Pillar 2: Building Capacity and Influencing Policy

This pillar focuses on enhancing the knowledge and capacity of WROs, institutions, and alliances to influence and advance the implementation of SRHR-related laws, policies, and programs. It collaborates with four local partner organizations and networks— Davao Medical School Foundation Inc (DMSFI), Friendly Care Foundation, University of the Philippines Centre for Women’s and Gender Studies (UPCWGS), and Women’s Global Network for Reproductive Rights (WGNRR)—to undertake advocacy and capacity-building activities. These efforts aim to empower women’s organizations to lead SRHR advocacy and policy implementation. The goal is to foster an environment at multiple

levels—individual, community, institutional, and societal—where SRHR policies and laws are effectively enforced and promoted.

1.2 OBJECTIVES OF THE EVALUATION

The specific objectives of the evaluation were:

• Determine whether the project has achieved its targets for outcomes as outlined in the Performance Measurement Framework (PMF).

• Evaluate the project’s assumptions as per the Theory of Change over time, determining their validity, exploring contextual shifts, and assessing the project’s adaptability, while examining the process of change if assumptions held true and identifying potential limitations if they did not.

• Identify challenges or limitations in the project’s theory of change and programming that hindered changes or improvements over time, and propose improvements for future SRHR programs in the Philippines.

• Identify lessons learned and exemplary best practices in SRHR from project partners.

• Facilitate cross-organizational exchange of experiences and learnings.

APPROACH AND METHODOLOGY 2

PHOTO: APRIL ANN BULANADI

APPROACH AND METHODOLOGY

2.1 EVALUATION APPROACH

The evaluation employed a mixed-methods approach, incorporating both quantitative and qualitative techniques, and adhered to the Organization for Economic Cooperation and Development’s Development Assistance Committee (OECD/ DAC) criteria. It utilized a concurrent embedded design, prioritizing qualitative methods while embedding quantitative aspects within these findings. The evaluation was both summative, assessing whether the project’s objectives and outcomes were achieved, and formative, focusing on lessons learned and the effectiveness of strategies.

Key aspects of the evaluation included:

• Relevance: Examined how well the Theory of Change aligned with the diverse needs of women and girls in various regions of the Philippines, considering gender-specific needs and the involvement of local WROs and institutions.

• Coherence: Evaluate the compatibility of the project’s activities with national and local policies, other SRHR programs, and broader development goals.

• Efficiency: Evaluated the cost-effectiveness of the project, including whether activities were appropriately costed and identifying any efficiencies or inefficiencies.

• Effectiveness: Measured how well the project achieved its intended outcomes, including increased SRHR awareness and gender equality, and analysed factors influencing success or limitations.

• Impact: Assessed the overall effects of the project, including any unintended positive or negative outcomes, and evaluated its contribution to long-term goals and local capacities.

• Sustainability: Determined the extent to which the project’s approaches were adopted and supported at national or district levels, and evaluated the ongoing capacity of WROs and institutions.

The evaluation incorporated a feminist approach, focusing on gender equality and social justice throughout the process. It prioritized the voices of women and marginalized groups, employed inclusive and intersectional methodologies, and positioned evaluators as facilitators to empower participants. The approach emphasized safe, ethical practices, non-discriminatory methods, and cultural sensitivity to ensure respectful and meaningful engagement.

Outcome harvesting was also used to align with the project’s objectives and Theory of Change. This approach involved collecting diverse outcomes, such as enhanced SRHR knowledge and improved health system capacity, and analysing them to trace achievements and causal pathways. The process included engaging partners, identifying major outcomes, analysing them, and gathering community feedback to ensure the evaluation’s validity and effectiveness.

2.2 LOCATION OF THE EVALUATION

The evaluation of the SHE project was conducted across six regions: Bicol, Eastern Visayas, Zamboanga Peninsula, Northern Mindanao, Caraga, and BARMM. The focus was on assessing the project’s impact on SRHR knowledge, health system strengthening, and WRO capacity building.

A sample was drawn from the 21 municipalities supported by the project. The endline survey targeted 13 municipalities, over two-thirds of the total. Within each selected municipality, 4 barangays were chosen, resulting in 52 barangays for the evaluation. Municipalities were selected randomly, and barangays were chosen through stratified sampling. Details of the sampling process were outlined in the sampling section.

2.3 EVALUATION PROCESS

The evaluation was carried out in three phases: Foundation, Discovery, and Synthesis and Reporting.

In the Foundation Phase, the process began with a contract and kick-off meeting where the study team consulted with Oxfam to collect all necessary program documentation and discuss project details, challenges, and expectations. Following this, a preliminary meeting with the project implementing partners was organized to communicate the evaluation objectives and coordinate logistics. A comprehensive desk review of secondary data and project documents was conducted to develop data collection guidelines and adapt tools from previous phases. The team prepared a detailed inception report outlining methodologies and finalized data collection tools, which were then translated into the local language and digitized. Additionally, a Training of Trainers (ToT) program was implemented to ensure high-quality data collection. This training, conducted in Bicol (Bulusan, Sorsogon) included an orientation for enumerators and field piloting.

During the Discovery Phase, data collection occurred in the sampled municipalities across six regions. The core team, alongside local researchers, gathered qualitative data through Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with key stakeholders. Quantitative data was collected using SurveyCTO, and an outcome harvesting exercise was integrated into the sessions with partners. Two teams of qualitative researchers were mobilized, each covering different regions, and data collection was carried out concurrently with qualitative and quantitative methods.

In the Synthesis and Reporting Phase, the collected data was analysed, with preliminary findings synthesized into a draft report. This report was reviewed by Oxfam, and feedback was incorporated to finalize the report. A PowerPoint presentation was prepared to outline the findings, and a sharing session was conducted with Oxfam and project partners to validate and clarify results. The final study report was then submitted, adjusted as necessary based on the feedback received.

The management team comprised a Team Leader, an SRHR expert, an in-country Senior Consultant, and an in-country Coordination Consultant. To prepare for data collection, Training of Trainers sessions were organized to train local enumerators. These three-day training sessions, conducted at different times in June and July, included a day of piloting to provide enumerators with real-time practice. The tools were translated into local languages to ensure clarity. Prior to data collection, coordination calls were made with barangay officers to streamline the process. In each municipality, 2-3 enumerators were assigned, with data collection taking 10-15 days per team. Quantitative data collection began simultaneously with the mobilization of the qualitative team. The survey was completed by the first week of August, and qualitative data collection concluded in the second week of August.

2.4 DATA COLLECTION METHODS

Secondary Sources for Data Collection

For secondary data collection, a comprehensive review of various documents was conducted. This review primarily involved analysing baseline, midterm evaluation, and pulse survey data to assess the project’s progression over its tenure. These reports were meticulously examined to identify changes in trends, understand the factors contributing to these changes, and pinpoint persistent challenges. Additionally, annual and semi-annual reports were reviewed to gain insights into how project activities were implemented and to identify any operational challenges noted during these periods.

A careful review was also undertaken of annual reports, learning documents, outcome harvesting reports, and other impact stories to extract valuable lessons learned. Furthermore, the RHU assessment tool used by the project was reviewed to inform parameters from the PMF. This standardized tool provided data on various standards implemented by the project, and this data was utilized to show trends in the endline. Monitoring data was also relied upon to inform certain indicators. For example, data on contraceptive prevalence rates and teenage pregnancy rates reported by health facilities was validated during site visits. Certain aspects of these indicators were integrated into survey questions, even if they were not directly reported.

Primary Sources for Data Collection

A comprehensive survey was conducted with women, men, girls, and boys of all age groups to gather data on various aspects of SRHR. The survey addressed several key areas, including unmet need for FP, the extent of teenage pregnancy, perspectives on positive attitudes promoting SRHR and GBV prevention, knowledge and access to SRHR services, and reproductive health-related decision-making. The survey used indicators such as the proportion of women reporting an unmet need for FP, the prevalence of teenage pregnancies among respondents, and the percentage of women aware of SRHR service locations.

Focus Group Discussions were conducted to gather qualitative data on perspectives, knowledge, and practices related to SRHR and GBV prevention. These discussions provided in-depth insights and complemented survey data. FGDs were organized with adult women, adolescent and teenage girls and boys, adult men, peer educators, and community-level influencers. Participatory exercises within FGDs included service mapping, decision-making roleplays, and barrier identification charts to elicit deeper insights from participants.

Key Informant Interviews were conducted with RHU representatives, WROs, LGUs, facilitators, barangay health workers, GBV watch groups, project implementing partners, and the GAC. These interviews explored critical areas such as the availability and accessibility of SRHR services, the effectiveness of interventions, and the impact of the SHE project. Interviews with WROs and partners assessed their capacity, support received from the SHE project, and their successes and challenges. LGU interviews focused on their perceptions of SRHR and GBV issues, while facilitator and barangay health worker interviews examined their experiences and roles. The GBV watch group interview covered their management structure and experiences in handling GBV cases, and interviews with project implementing partners and GAC explored project effectiveness and recommendations.

Impact story analysis identified four key areas for focus, delving into the experiences of LGBTQIA+ groups and other individuals in accessing SRHR services, as well as the overall effectiveness of gender-responsive and adolescentfriendly services for community adults and youth. It also explored the role of the GBV Watch Group in PKKK and its efforts to address gender-based violence, alongside the evaluation of coordination with LGUs to enhance service delivery and community engagement.

2.5 SAMPLING APPROACH

Sampling for survey

The sample size was based on the population (total 86,386nos. with 57,878 female and 28,508 male population) of direct project participants provided in the Terms of Reference and calculated using the formula,

x = Z(c/100)2r(100-r)

n = N x/((N-1) E2 + x)

E = Sqrt [(N - n) x/n(N-1)]

where N is the population size, r is the fraction of responses that you are interested in, and Z(c/100) is the critical value for the confidence level c. Here, N=86,386, r= 0.5, Z= 1.96 Using the formula above for confidence interval

of 95% and 5 % margin of error, a sample size of 383 nos. shall be a significant sample to represent the population. However, the study team proposed a more rigorous and stratified simple random sampling based on the geographical regions of program analysis, and disaggregate the samples proportionately into male and female, using 90% confidence interval, 5 % margin of error in the above formula and also add a 5% non-response rate. The proposed sample was attempted to be equally distributed among four categories: adult women (20-49 years), adult male (20-49 years), adolescent girls (15-19 years old), and adolescent boys (15-19 years old).

A total of 1,710 surveys were administered across six regions in the Philippines. In each region, respondents were evenly distributed. Two municipalities were selected as representative samples from each province where the project was implemented. These municipalities were chosen at random. Additionally, within each municipality, four barangays were randomly selected. However, in the BARMM region, three municipalities were chosen to represent the three provinces involved in the project. The table below outlines the provinces and municipalities that were randomly selected for the survey.

Sampling for KIIs and FGDs

In conducting qualitative research, the sampling for KIIs and IDIs was purposive, aiming to include diverse groups supported by the project. Participants were selected to facilitate a thorough assessment and comparison of outcomes among various categories. The sampling process followed the principle of saturation, with the sample size determined by the point at which no new information emerged from additional interviews or discussions. Initially, a set number of interviews and FGDs were conducted to reach saturation. If new findings persisted beyond the planned sample size, additional participants were included to ensure comprehensive coverage of the research objectives.

Table 1: Sample size achieved for each municipality

Table 2: Qualitative sample size

Stakeholder Group

Adolescent/teenage

Peer-educators (adolescent)

Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual Plus (LGBTIQ+ group)

2.6 LIMITATIONS AND DELIMITATIONS

• There were several limitations encountered during the operationalization of data collection. Initially, the planned ToT in Bicol faced issues due to recruitment issues of the hired Training of Trainers (ToT) representatives. Consequently, the initial training sessions had to be discarded, and new trainers were hired from universities, including professors and teachers with research experience. These revised ToT sessions were provided remotely.

• Another challenge was the difficulty in finding female enumerators in certain regions. Many qualified candidates were already peer educators, leading to conflicts of interest. This necessitated additional time to identify suitable enumerators, causing delays in the data collection process, though this did not impact the final deadline or timeline.

• Weather conditions also posed challenges, particularly in BARMM, affecting field mobilization for the qualitative team and requiring rescheduling.

• Additionally, there were limitations in data analysis, particularly regarding the calculation of SRHR indexes. The evaluation team followed the reference guide provided by Oxfam, which aligned with baseline calculations, but discrepancies arose in midline and pulse surveys due to varied approaches not clearly stated in the report. Furthermore, there was confusion regarding the calculation of the indicator on the percentage of girls and women (WRA) able to make reproductive health choices alone or with partner support. The baseline, midline, and pulse surveys, as well as the reference guide, suggested considering subsets of users of FP. However, it was unclear how this was applied in calculations. For simplicity, the evaluation used a direct question to assess whether reproductive decisions were made alone, which was included in the analysis.

KEY FINDINGS 3

Nurse Dhay Jay inserts a PSI during a training in Bliss barangay, Buug, Zamboanga Sibugay, CREDIT: RACHAELA

MARUHOM

KEY FINDINGS

3.1 EFFECTIVENESS

These key findings are informed by comparative assessment against previous data collection (particularly the baseline survey and mid-term review) and against the anticipated targets for each indicator as outlined it the PMF. The design of the evaluation included the collection of both quantitative and qualitative data to allow for triangulation of findings and an increased level of confidence in the contribution made by the SHE project to the results presented. The following sections initially consider the measurable quantified changes under each pillar in comparison to the previous data, followed by discussion and verification of the findings using insights and additional evidence from the qualitative data collected.

3.1.1 Achievements under Pillar 1

Ultimate Outcomes

1000.A: % AND NUMBER OF WOMEN WITH UNMET NEED FOR FP INCLUDING MODERN METHODS, DISAGGREGATED BY AGE GROUP

Data from survey results show that among the 344 sexually active individuals, 86 are girls and 258 are women, including those who are single (with partners), married, or cohabiting. Out of the 86 girls, 25 reported that they either want to delay childbirth or do not want a baby in the near future. Of these, only 1 girl was not using contraceptives, indicating an unmet FP need of 4%. Similarly, among the 248 women, 127 expressed a desire to delay childbirth or avoid having a child altogether. Of these women, 28 were not using contraceptives, resulting in an unmet FP need of 22.0%.

Table 3: Unmet FP need (endline)

The target was set at 25% for women and 5% for girls. By the endline, the unmet need was recorded at 22% for women and 4% for girls, indicating that the target for this indicator has been achieved. Comparing various data points, the baseline data shows that 32.3% of women and 13.3% of girls had unmet FP needs. By the endline, there was a significant improvement. This trend aligns with the Pulse Survey 2023 results, where 4% of girls and 22.79% of women reported having unmet FP needs.

% of women with unmet need for FP including modern methods

Sexual activity and contraceptive use:

Among those who are sexually active, some report wanting to delay childbirth but are not using modern contraceptives . Have considered currently pregnant ones as well

Findings from the endline survey reveal that 48% of respondents reported having experienced sexual intercourse (single and married/cohabitating), with 37.1% indicating they were currently sexually active. Among the sexually active, 55.1% were women, 51.7% were men, 21% were girls, and 18.6% were boys. A significant proportion (42.9%) of the sexually active individuals (single and married/cohabitating) were not using any contraceptive methods at the time of the survey. While 55.2% of the ones who were sexually active were using contraceptives. Among those not currently pregnant, 37.2% have expressed a desire to avoid having more children, indicating a clear preference for FP options that can support their reproductive goals. Additionally, 25.3% of respondents wish to delay their next pregnancy.

Even among respondents who are currently pregnant, the data shows that 23% are considering expanding their families, while 19.2% prefer not to have more children. This diversity in FP desires, with 50% still undecided, highlights the crucial role that FP services play in providing individuals and couples with the choices they need to plan their families according to their unique circumstances and aspirations.

The survey results reveal a strong foundation of awareness and engagement with FP among respondents, reflecting the positive impact of ongoing reproductive health initiatives. All respondents were familiar with at least one modern method of FP, with universal knowledge of male condoms (100%), followed by a high awareness of pills (84.9%) and sub-dermal implants (54.4%).

Among the total respondents, 28.9% (495 individuals) reported having used a FP method at some point. This includes 9.6% of boys, 13% of girls, 33.6% of men, and 56.4% of women. At the time of the survey, 239 respondents were currently using a method, with 9 boys, 39 girls, 37 men, and 154 women. The most commonly used methods were pills (51.5%), followed by condoms (30.3%). Among those currently using FP, 50.6% were using pills, 13.4% were using condoms, 27.2% were using sub-dermal implants, 13% were using injectables, and 4.6% were using Intrauterine Device (IUDs).

Table 4: Respondents who reported wanting to delay child birth

According to the Philippine Department of Health’s Field Health Services Information System (FHSIS 2024) data, the average Contraceptive Prevalence Rate (CPR) in 2023 was 31.2%, with 36% of women being current users. From 2019 to 2023, oral pills consistently had the highest usage among FP methods, representing 36%-38% of users, followed by injectables at 20%-24%. Progestin Subdermal Implants (PSI) accounted for 17% of users in 2023. These findings align with the endline survey, where pills were the most used FP method, implants ranked second, and injectables third. FHSIS data showed implants as the third most used method, with injectables second. Permanent FP methods, such as Bilateral Tubal Ligation (BTL) and Non-Scalpel Vasectomy (NSV), remained low, at 4-5% and 0%, respectively, consistent with endline trends.

Table 5: Knowledge about, and use of contraceptives

Comparison of data points

Notably, the vast majority (95.8%) of respondents who had used or were currently using FP methods reported discussing their choice with their partner/spouse. This marks an increase from the 2020 Pulse Survey, where 85% of respondents reported such discussions, and aligns closely with the 2023 Pulse Survey, which showed a similar rate of 95%.

Comparison of data points

Corroborating the survey results, the qualitative data collection methods also highlighted positive outcomes linked to the project’s impact on unmet FP needs. Two key outcomes were the increased health-seeking behaviour of among adults regarding family planning measures.

OUTCOME: Increased health seeking behavior among women on FP

The SHE project has also significantly contributed to the improvement of health-seeking behaviours related to FP across various communities among adults. This positive outcome has been observed and validated by participants in FGDs and KIIs, particularly with representatives from RHUs. The general improvement in the community’s knowledge and attitudes towards SRHR was also noted by the FGD participants from Eastern Visayas, who observed, “Most of the youth and even married women are now knowledgeable about FP. Compared to before, where couples would have 11 to 12 children, now the numbers are becoming fewer.” The increase in awareness about SRHR has led to a noticeable rise in the number of clients accessing services and information from RHUs. This trend has been consistent across different regions, including areas with traditionally lower engagement, such as Muslim communities.

“It has improved in the sense that many community members are now accessing services from the RHU. People are empowered about their health rights compared to before, when only a few accessed these services. In fact, we are always running out of supplies because a lot of people now visit the clinic. Unlike before, when we had to reach out to the community and educate them—often facing resistance, especially regarding SRHR information—now, they come to us on their own.”

— RHU REPRESENTATIVE, GANASSI

The project has played a crucial role in normalizing the use of contraceptives and encouraging open discussions about SRH. In regions, like the Zamboanga Peninsula, women have reported improvements in communication with their male partners regarding FP, leading to more intentional and balanced FP decisions. This shift is also reflected in Eastern Visayas, where there is an increasing adoption of Long-acting reversible contraceptive, indicating a growing confidence in and commitment to sustainable FP. This trend of increased contraceptive use and proactive healthseeking behaviours is also seen in Bicol, underscoring the project’s impact on enhancing knowledge and access to SRH services. Moreover, the project has significantly reduced the stigma around seeking SRH services. In Ganassi, for example, women shared they now feel comfortable visiting clinics and asking for contraception, which was previously considered shameful.

“At

present, the pills are running out in the barangay unlike before when they would just expire, which is one of the tangible outcomes of the SHE Project.”

— COMMUNITY LEADER, BICOL

Additionally, the SHE Project’s impact on expanding community knowledge about FP practices is evident. A community leader from Bicol noted, “Previously, children were born one after another due to incorrect FP practices. At present, there has been a decrease in the number of pregnant women in our community because they have been educated.”

The positive shift in health-seeking behaviour among adults can be attributed to outreach activities that raised awareness and promoted FP. Peer educators and community facilitators played a key role by conducting tailored sessions for women, adolescents, and men, helping to change mindsets. On the supply side, enhanced provider capacity and gender-responsive services further encouraged visits to health centres, with community members validating that improved services have increased their use of FP services. The information supporting the findings on contraceptive knowledge is provided in the Annex II

1000.b: % of teen pregnancy rates among target population

Data from FHSIS2

The data on teenage pregnancies across various regions shows a general decrease over the years from 2019 to 2023. The total count of teenage pregnancies decreased from 2,281 in 2019 to 1,598 in 2023. This decline reflects a broader trend and is supported by the survey data.

A noteworthy observation is that while the flow of clients seeking SRHR services has increased, it remains higher among females and young girls compared to men . This disparity is attributed to cultural factors and the composition of service providers . The RHU representative from Eastern Visayas suggested that the presence of more female service providers might make men feel shy or embarrassed to seek services, particularly for FP . This issue is even more pronounced in Muslim areas, such as BARMM, where traditional views on masculinity play a significant role . The RHU representative from Ganassi explained,

“One of the reasons why men are not seeking services is because they feel shy and might think it is quietly insulting to ask for FP services. Many men think that FP is about stopping birth altogether, and they feel insulted by that.”

Figure 1: Average TPR (Source: FHSIS)

The average Teenage Pregnancy Rate (TPR) for all project sites was 18.51 in 2023, a reduction of 5.92 from 2022. However, the 2023 TPR appears to be higher by 8.67 compared to 2019 due to differences in the source of projected teenage population (TPR denominator) across the years.3 The average TPR for project sites in 2023 is lower than the national Adolescent Birth Rate (ABR) from 2019-2022. The TPR is decreasing but still remains higher than desired in some regions.

The survey data shows a similar trend. To substantiate the value of the TRP, a proxy indicator was set, asking adolescents in the survey if they were pregnant at the time of data collection. Of the surveyed teenagers, 16.8% (66 individuals) reported having been pregnant at some point. Out of the 66 teenagers who reported past pregnancies, only 12 (2.9% of total adolescents) were pregnant at the time of the survey, and 5.6% (23 individuals) had given birth in the past 12 months.

The target for the endline was set at 3.2% for girls reported to be pregnant during the survey, with the actual endline result achieving 2.9%. This surpasses the target, and the decrease in the reported pregnancy rate can be considered a positive outcome.

Comparison of data points

Are you currently pregnant? (Applicable to age group 15-19 girls)

Corroborating the survey findings, the qualitative data revealed a positive change in adolescents’ health-seeking behaviour.

OUTCOME: Increased health-seeking behaviour among adolescents

The impact of the SHE project on adolescents’ access to SRHR services has been notably positive, though the trend varies across different regions. In most areas, except for the BARMM, there has been a significant shift in how adolescents seek information and services related to SRHR. Adolescents have traditionally relied on close peers and family for SRHR information. However, there is a growing trend of adolescents accessing information and services through teen centres and Adolescent Friendly Health Facilities (AFHF) established by the SHE project.

“Despite facilities being available in the RHU for adolescents, none of them are accessing the services. This is likely due to the community’s negative perception when unmarried boys and girls go to the clinic, even just for counselling.”

– RHU REPRESENTATIVE, BARMM

A representative from the RHU in Clarin emphasized the importance of privacy in these facilities, stating, “The availability of private rooms within these facilities allows for open and confidential communication.” This sentiment was echoed by an RHU representative from Sta. Margarita, who noted, “Adolescents are very comfortable visiting the RHU because they are assured of their privacy. You need to empathize with the adolescent to gain their trust.” In contrast, the situation in BARMM, specifically in Ganassi, remains challenging. Adolescents in this region continue to rely on peers and parents rather than utilizing the available AFHF centres. This reluctance is largely due to the negative perception within the community regarding unmarried adolescents accessing SRHR services.

The improved service-seeking behaviours among adolescents in other regions can be largely attributed to awareness symposiums in schools and sessions facilitated by peer educators. In the event that the peer educators are unable to address any queries, the RHU staff would be consulted. These efforts have contributed to adolescents’ comfort in accessing information and services. The success of the SHE project is also evident in specific cases where adolescents have benefited directly from the SRHR services. A powerful example comes from Clarin, where an RHU representative shared, “One young woman who became pregnant at a young age is now accessing the FP program thanks to SRHR services. This access allows her to continue her education while planning her future.” This story exemplifies the positive impact the program has had on young people’s lives.

Despite challenges like stigma and shyness, adolescents expressed positive views on accessing SRHR services, appreciating respectful treatment, privacy, and confidentiality from RHU staff. In Caraga, Eastern Visayas, and Northern Mindanao, youth highlighted improvements like private consultation rooms and attentive care. While barriers remain in regions like BARMM, overall feedback underscores the importance of respectful interactions in encouraging youth access to SRHR services.

1000.c: Perspectives on positive attitudes that promote SRHR and GBV prevention among target population

CALCULATION METHOD: Based on the SHE project indicator reference guide measuring changes in perspectives uses a set of statements for participants to respond to ranking from “strongly disagree” through to “strongly agree”. For each statement, the percentage of negative attitudes (disagree and strongly disagree) is subtracted from the percentage of positive attitudes (agree and strongly agree). The result is expressed as a percentage of the total respondents for that statement. Next, the simple average of all statements is calculated for each indicator. Responses of “neither agree nor disagree” and those who preferred not to answer are not included in the calculation.

This index approach was utilized to calculate the overall average across three key areas: reproductive autonomy, sexual autonomy, and economic autonomy. The specific methodologies for measurement and the findings for each of these areas is discussed further below. In combination the three provide an index for overall attitudes that promote SRHR and GBV prevention. It is important to note that direct comparisons with mid-term data on these parameters are not feasible due to differences in calculation methods. The endline report has adhered to the baseline approach, where negative attitudes are subtracted from positive attitudes, with neutral responses being excluded. The index reveals that, on average across the three areas, perceptions of positive attitudes towards promoting SRHR are 0.62 for boys, 0.68 for girls, 0.63 for men, and 0.62 for women. The highest index value is observed among girls

The SRHR index was calculated using sub-indexes for reproductive autonomy, sexual autonomy, and economic autonomy only. However, statements intended to inform the implementation of the SRHR index were not taken into account in the calculation of the overall composite score4. While these statements were included in the evaluation, as they were in the baseline survey, they were not factored into the calculation of this dimension.

Additionally, the statements used for measuring economic autonomy in the baseline differed from those used in the endline. This change occurred because Oxfam determined that the baseline statements related to women’s economic autonomy did not have a direct linkage with SRHR. As a result, a new set of statements was developed for the endline. It is important to note that the calculation method used in the endline is similar to that of the baseline. However, the approach to calculating the overall attitude score in the mid-term and pulse surveys was different.

4 The findings for implementation of SRHR policies are presented in the Annex.

The target has been exceeded for all four groups. The target set was 60% for women, 57% for girls, 60% for men and 58% for boys. Compared to the baseline, there has been an increase in the index value in the endline for all women, girls, men, and boys. The values show that in the baseline, the index score was 50% for women, increasing to 62% in the endline. For girls, the baseline score was 48%, which rose to 68% in the endline. For men, the score improved from 46% in the baseline to 63% in the endline, and for boys, it went from 47% in the baseline to 62% in the endline.

Comparison of data points

Perspective on positive attitudes that promote SRHR and GBV prevention among target population

Reproductive autonomy index

Girls:

Boys:

Girls: 61%

Women: 64%

Boys: 61% Men: 60%

Girls: 68%

Women: 62%

Boys: 62%

Men: 63%

Calculation of the three indexes –reproductive, sexual and economic autonomy among girls and women

Please note that the index score is not simply the percentage of positive responses received; rather, it is calculated as the positive responses on attitude minus the negative responses on attitude.

Three indicators were used to measure reproductive autonomy. The first indicator, access to information and services, had an overall index score of 84%, with a score of 84% for boys, girls, and women, and 83% for men.

The second indicator, decision on whether and when to practice contraception, had an average index score of 77%, with scores of 75% for boys, 83% for girls, 76% for men, and 75% for women. Girls showed the highest agreement regarding their ability to choose and use contraceptives, though this agreement was slightly lower when considering

adults’ perspectives. The third indicator, decision on whether and when to have a baby, scored 56% overall. This lower score was influenced by the low support for the right to terminate an unplanned pregnancy, which had an index score of only 32%, with girls scoring highest at 45% and boys at 32%.

Overall, the reproductive autonomy index at endline was 72%, an increase from the baseline value of 61%.

Table 7: Reproductive index among boys, girls, men and women

Sexual autonomy Index

Please note that the index score is not simply the percentage of positive responses received; rather, it is calculated as the positive responses on attitude minus the negative responses on attitude. Since the index calculation is based on positive attitudes minus negative attitudes, the value can sometimes be negative. A negative index value indicates that the proportion of respondents with undesirable attitudes is higher than those with positive attitudes.

The Sexual Autonomy Index is based on two indicators: decision on sexual initiation and sexual negotiation and communication. For decision on sexual initiation, the index score was notably low at -27%, with particularly negative scores for girls initiating sexual relationships -42% and girls enjoying sexual relations -31%. This suggests that perceptions from adult men and women are less supportive compared to the views of girls and boys themselves. On the other hand, the indicator for sexual negotiation and communication scored higher at 62%, with similar values across all groups—boys, girls, men, and women. Additionally, the perception of the need for accessible counselling services scored 80%, indicating broad agreement across all groups. The overall Sexual Autonomy Index stands at 38%, reflecting a generally low level of sexual autonomy, especially in terms of initiation, while showing more support for sexual negotiation and access to counselling services. This represents an improvement from the baseline value of 23%.

Table 8: Sexual index among boys, girls, men and women

Assessing various statements, it was observed that people’s perceptions regarding decisions on sexual initiation were mostly negative. The data suggests a low value in terms of girls and women initiating and enjoying sexual relationships, indicating that the community views sexual enjoyment as more of a man’s role. Moreover, the perception becomes even more negative when girls initiate and enjoy sexual relationships. The community tends to believe that unmarried girls should practice abstinence rather than engage in sexual initiation and enjoyment. This negatively influenced the index value. Another important factor is the perception of how much girls and women can negotiate sexual experiences and communicate with their partners about when to have sex or refuse sex. Although there was generally a positive attitude, when it came to the question of whether a partner or husband having sex with others was acceptable, the index value was only 50%. This indicates a significant split, with only half of the community disapproving of sexual relations outside of marriage. Additionally, there was a noticeable community acceptance of girls and women obliging to have sex even when a partner or husband refuses to use a condom.

Economic autonomy index

Please note that the index score is not simply the percentage of positive responses received; rather, it is calculated as the positive responses on attitude minus the negative responses on attitude.

Economic autonomy was assessed using six statements as part of a single indicator. The overall score for economic autonomy was 80%, with scores of 78% for boys, 85% for girls, 81% for men, and 77% for women. The high agreement among respondents that women and girls can and should prioritize career and financial stability before having children highlights a progressive understanding of economic influences on SRHR. This perspective underscores the importance of providing women and girls with the resources and support needed to make informed decisions about their reproductive health, free from economic pressures.

It is acceptable for GIRLS AND WOMEN to avoid having more children because they cannot adequately provide the financial support it requires

Having control over financial resources allows GIRLS AND WOMEN to make better decisions about their sexual and reproductive health

Economic stability influences girls’ and women’s decision to use contraceptives

It is acceptable for GIRLS AND WOMEN to delay having children to focus on her education

More reproductive autonomy enables women to be more economically stable

Table 9: Economic index among boys, girls, men and women

Substantiating the survey findings, the community expressed positive attitudes toward SRHR during the FGDs and KIIs. The qualitative data presented below reflects the community’s general perspectives on SRHR, highlighting their attitudes and views on related topics.

OUTCOME: Increased reproductive and sexual autonomy among women

As evident from the qualitative data, one of the project’s core achievements was enhancing women’s awareness of their autonomy, both reproductive and sexual. By educating women about their right to autonomy and their ability to make decisions about their bodies, the project significantly influenced their health-seeking behaviour. Many women began making informed choices about when to have a baby and how to space their pregnancies, leading to increased utilization of RHU services. This empowerment was evident across all project areas and stands out as a major success. Through sessions discussing their bodies and their rights, women gained the confidence to exercise their autonomy. Community members shared that previously reproductive decisions were solely directed by male family members or parents. With the project’s support, women can now make their own decisions regarding the number of children they wish to have and the timing of having another baby.

In some areas like Zamboanga Peninsula and Northern Mindanao, the representatives from the partner organization explained that narratives emerged of women initiating sexual relationships with their spouses, challenging the misconception that they could not refuse their husband’s advances. In Northern Mindanao, women have experienced a significant shift towards sexual autonomy, reflecting a growing sense of empowerment and confidence in their relationships.

“I

thought before that only men can ask us for sex; now, I learned that I can also ask my husband to have sex with me if I want to.”

– WOMAN FROM NORTHERN MINDANAO

Furthermore, the women emphasized that they have learned a lot about empowerment, with one noting, “We should not shy ourselves when it comes to these matters.” One woman from Ganassi, BARMM also explained, “Understanding my right to decide when to have children allowed me to space out my pregnancies, improve my health, and provide better care for my children. I feel more confident and see the positive impact on my family’s well-being, which I believe would not have been possible without this knowledge.”

The project led to a more balanced approach to decision-making within families. Previously, there was a prevailing belief that family members should only follow the husband’s directives, which was a significant concern regarding sexual and reproductive health rights. One male participant in the FGD in Bicol highlighted, “If only the man’s wishes are followed, he might force his wife to have sex even if she doesn’t want to. This leads to abuse, not only affecting the wife but also the children.”

OUTCOME: Change in youth mindset about different SRHR issues

One of the other achievements of the project is the engagement of youth and their positive reception of the SRHR concept. The project reached young boys and girls in schools through peer educators and successfully changed their mindset.

There is a noticeable increase in knowledge about sexual and reproductive rights, which is evident in their refusal of early marriages and their willingness to discuss ASRH issues with peer educators and in Usapan sessions. Though the impact is not immediate, it is anticipated that when these young individuals become adults, they will make conscious decisions about using FP. Project partners credit the project’s activities for bringing about this change, particularly among young boys. In terms of the increase in knowledge about SRHR, different aspects of SRHR stood out more for adolescent boys and girls. Some of the aspects were HIV/AIDS and teenage pregnancy.

HIV awareness: One of the key learnings for both boys and girls during the Usapan sessions was about HIV, particularly its impact and prevention. This learning was evident across all regions, with boys from Eastern Visayas especially noting the importance of the HIV awareness activities. These sessions were highly effective, with one participant emphasizing that they led to an increase in HIV testing among peers, though adolescents noted that despite the rising number of HIV cases in the municipality, many still hesitate to seek help. They suggested that comfort levels might improve if individuals knew someone at the RHU who could assist them. Participants also observed that, while Filipino families are generally conservative, encouraging peers to use condoms is slowly becoming normalized within the community, though this acceptance is still less common among younger adolescents. Participants from Northern Mindanao noted the impact of these sessions, with one adolescent boy stating, “Through the sessions, we learned not to engage in sexual activities to avoid unexpected pregnancies. We also learned about safe sex and using condoms.” Another boy from the same region emphasized, “I learned about HIV and STIs that can be acquired through sexual intercourse, so it is important to use condoms.” In Bicol, a girl highlighted the value of the sessions, noting, “HIV/AIDS Awareness was particularly valuable …Personally, it also taught me about safe and unsafe sexual practices.” The focus on HIV prevention was also beneficial for LGBTQIA+ communities, as observed in Eastern Visayas during FGDs. An adolescent boy shared, “Sessions focused on HIV prevention and safe sex have been crucial in raising awareness among our peers, especially given the high vulnerability of LGBTQIA+ groups to such health issues.”

The survey results support these findings, showing that 93.1% of respondents were aware of HIV/AIDS. Additionally, 55.7% of participants reported that HIV/AIDS can be treated and cured, while 78.6% knew that a simple test can determine if someone has AIDS. Although there is some confusion about whether AIDS is curable, it is encouraging that over three-quarters of respondents understand that testing can identify the presence of AIDS.

Teenage pregnancy: The program’s focus on teenage pregnancy and early marriage was another area of success. Participants reported a greater understanding of the social and cultural factors that contribute to these issues, with many expressing a newfound empathy for those affected. The discussions on child, early, and forced marriage (CEFM) served as an eye-opener, particularly for adolescent boys, highlighting the severe consequences of such practices and the importance of respecting individual rights and choices. In this regard, an adolescent boy from Bicol noted, “The discussion on CEFM was an eye-opener to the social realities affecting adolescents like me in other parts of the country and the world.” Adolescent girls from all regions unanimously agreed that teenage pregnancy is not normal and were sensitized to the physical and mental health consequences it can have on young girls. They emphasized that early pregnancy is a significant issue, where girls noted that it causes problems for society and is met with judgment and negative reactions from the community. While they acknowledged that various factors, including unfortunate circumstances like rape and abuse, can lead to teenage pregnancies, they stressed that the blame should not solely fall on the young girls involved. Instead, they highlighted the importance of understanding SRH among the youth.

OUTCOME: Change in mindset about SRHR among community members

The SHE Project has also significantly transformed attitudes towards gender, sexuality, and reproductive health, fostering a more open and mature dialogue around these topics. Participants have moved from feeling uncomfortable and dismissive to embracing these discussions with greater seriousness and openness. As one female participant from Bicol reflected, “I no longer feel awkward talking about reproductive health. Before, I considered people who discussed these topics as too vulgar. Now, I am much more open.” Another woman from Caraga shared, “Initially, I found the topics inappropriate and immodest. But now, I am open and more mature in discussing such matters.”

OUTCOME: Increased knowledge and positive outlook about adolescent SRHR

“The Parent-Teen Talks have deepened the relationship between parents and teens, fostering greater empathy and understanding. It’s clear that these discussions are helping both sides gain a better grasp of each other’s perspectives.”

– COMMUNITY INFLUENCER, EASTERN VISAYAS

There has been a positive shift in the community’s attitude towards youth and adolescent SRHR. In Eastern Visayas, the discussions around SRHR, particularly during Parent-Teen Talks, have significantly enhanced the openness between parents and their children. While parental conversations traditionally centred more on issues like early marriage rather than contraceptive use, the recent initiatives have broadened this scope. Community leaders from Eastern Visayas acknowledged that although not all parents are fully informed about SRHR, efforts like the ParentTeen Talks have helped bridge this gap. Moreover, there is a noticeable openness among community influencers regarding youth access to SRHR services. Leaders are supportive of adolescent girls and boys utilizing contraceptives and other SRH resources. This progressive stance reflects a growing recognition of the importance of providing youth with the means to make informed health decisions. Traditionally, there was a significant amount of judgment and shock when high school students sought contraceptive pills. However, through the SHE Project, some community members have gained a better understanding of individuals’ rights to access these services.

In community FGDs held in Caraga, Zamboanga Peninsula, and Bicol, there was a notably positive attitude towards unmarried couples accessing contraceptives. Adult participants in these regions recognized the importance of contraception for preventing unplanned pregnancies and ensuring a better future for women. One male participant from Caraga remarked, “It’s okay because if a child becomes pregnant unprepared, she will suffer.”

In general, women from all regions expressed a highly positive attitude towards SRHR for youth, attributing this shift largely to the Usapan Serye sessions facilitated by the SHE project. Women from Bicol shared, “Thanks to the Usapan Serye sessions, I now feel confident in providing accurate information and advice about contraceptives to my two college-aged sons. I understand the importance of SRHR better and can communicate this effectively to them.” Another woman from Northern Mindanao echoed this sentiment, highlighting how the sessions have empowered her to engage in open conversations about SRHR with the younger generation. She noted, “The knowledge I gained from these sessions has been invaluable. I can now address my sons’ questions about contraception and sexual health with clarity and confidence, ensuring they are informed and making safe choices.” In Northern Mindanao, some parents even encouraged their daughters to use contraception, especially if they were already in relationships.

“I advise my daughters to use contraception because they are already in a relationship. I told her that if she is not prepared to become a mother yet, then she should take birth control pills.”

- WOMAN, NORTHERN MINDANAO

In contrast, the perception of contraceptive use among unmarried couples was more conservative in regions such as Bicol and BARMM. Adult members in these areas expressed concerns about providing adolescents with access to contraceptives. They argued that adolescents are still young, emotionally immature, and that access to contraception might encourage them to explore their sexuality prematurely. A public-school teacher in Bicol shared his view, stating that providing contraceptives could lead to unintended consequences, such as teenage pregnancy. He emphasized that no method is 100% effective aside from abstinence, reflecting a more traditional perspective on managing adolescent sexual behaviours. Many community leaders emphasized that unmarried youth should refrain from sexual activity and, by extension, the use of contraception. This perspective is often grounded in religious beliefs, with some leaders expressing that such behaviours is morally unacceptable.

Moreover, across all regions, there was significant resistance from the older generation, particularly concerning the use of implants by single women. Many older participants expressed concerns that contraceptive use could lead to moral issues, especially if parents were not informed. One participant remarked, “It could lead to problems, especially if the parents are not informed,” while others held misconceptions that implants could cause physical changes or imply sexual activity outside of marriage.

Perceptions Among Youth:

The perceptions of unmarried youth regarding contraceptive use also varied Among the boys, there was a general agreement that while contraception is acceptable, those who are not prepared for pregnancy should carefully consider whether contraception is truly the safest option For some, maintaining selfcontrol seemed a safer choice than relying on contraceptives, suggesting that concerns about the reliability of contraceptives influence their decision-making On the other hand, the girls expressed a preference for abstinence over contraceptive use They feared that relying on contraceptives might still leave them susceptible to early pregnancy, which they perceived as dangerous . This attitude highlights the persistent stigma and fear surrounding sexual activity and contraceptive use among unmarried youth, particularly among young women .

OUTCOME: Promotion of gender equality

The SHE project has played a transformative role in promoting gender equality, as evidenced by the powerful testimonies from women in project areas, specifically Northern Mindanao, Eastern Visayas, and Caraga. They shared how the project helped challenge and change their traditional views on gender roles. “We used to have gender roles,” they said, recalling a time when women were expected to stay at home, care for the children, and serve their husbands. This shift marks a significant step towards greater gender equality, empowering women to have a voice and make their own choices.

“We thought our husbands were dominant and that we should always follow them. But now, women can express themselves

and do whatever they want.”

– WOMAN FROM CARAGA

Women from Eastern Visayas noted that “regarding gender bias, the project has included teachings on women’s rights and gender sensitivity training,” which has led to a noticeable increase in knowledge reflecting a meaningful step forward in challenging traditional gender norms and empowering women with the understanding of their rights. Similarly, women from Caraga spoke of a collective awakening, describing how they have “woken up from their sleep” to embrace the importance of equality. They proudly declared, “We are all equal now,” with one woman adding, “If a husband can do it, the wife can too, so discrimination is non-existent.” These statements highlight the profound impact of the SHE project in fostering a community where gender equality is not just a concept but a lived reality. Similarly, a female participant from Northern Mindanao noted, “Because of the SRHR initiatives, we have been aware of what boundaries we have as husbands in our households. Moreover, these services allow us to know how to maintain a peaceful and happy household.”

Many male participants across the regions reported a transformative experience, noting how the sessions helped dismantle traditional stereotypes about gender roles. They gained a deeper understanding of women’s rights and the importance of shared responsibilities within the household. This not only improved their relationships with their partners but also empowered them to become better fathers and community members. A male community influencer from Bicol shared, “Men and women now have equal responsibilities in the household. The SHE Project has reminded everyone of the equal responsibilities that men and women hold both at home and in the community.” Another community leader from BARMM remarked, “Nowadays, there are families in the community where women play a dominant role in decision-making, unlike before when women were fully dependent on men in all aspects, leading to frequent issues of GBV. Now, women are more empowered, educated about their rights, and even men are becoming more aware of these changes.”

OUTCOME: Increased awareness about Gender-Based Violence

The SHE Project has made significant strides in addressing GBV within communities, with varying degrees of focus and impact across different regions. The SHE project has significantly strengthened the functionality of LGUs and health service providers in handling GBV cases. Through enhanced referral mechanisms and capacity-building initiatives, service providers have become more gender-responsive. This has led to a positive shift in the approach to managing GBV cases, improving the overall response and support systems.

Moreover, the SHE Project has successfully raised community awareness about GBV and the importance of reporting cases. The project’s training sessions have equipped community members with the knowledge needed to take appropriate steps when addressing abuse, from reporting incidents to understanding the legal processes involved.

Participatory exercise with adult women in Bulusan

One of the key reflections is the increased awareness among women and adolescents about their rights and the resources available to them, such as the VAW (Violence Against Women) desks in barangays. This heightened awareness, particularly in Eastern Visayas, is partly due to the SHE Project’s efforts and the implementation of crucial legislation like Republic Act No. 9262 (the Anti-VAWC Law). As a result, there has been a noticeable decrease in the prevalence of GBV in the community.

The impact of GBV awareness has also resonated deeply with younger participants, particularly boys who attended the symposiums. These sessions provided them with valuable insights into women’s rights and the importance of respecting those rights. For example, a boy from BARMM expressed, “It was so valuable to me because it helped me understand certain rights, especially the right of women not to be forced into marriage... their right to their body.” Another participant added, “It’s not right to hurt women, especially your wife; for instance, they have the right to report to the authorities if they are being beaten by their partners.”

Decreased Cases of Gender-Based Violence: One of the most significant positive outcomes of the project has been the noticeable decrease in cases of GBV reported by the RHUs. According to the RHU representative from San Isidro (Eastern Visayas), the number of clients seeking help for abuse has decreased, a shift attributed to the increased empowerment of individuals in the community. “Before, many clients sought help for abuse, but now, fewer do because they are more empowered,” shared the representative. This reduction in GBV cases highlights the project’s success in raising awareness and empowering individuals to protect themselves and seek help when needed. In BARMM, community leaders have also observed a decline in GBV cases as more residents become informed about where to report such incidents. The ongoing empowerment of women in the community is fostering positive changes, with women gradually influencing their partners and contributing to a safer, more supportive environment.

Strengthening the referral pathway for GBV is another significant achievement of the project.

Supported by the national ordinance to form Multi-Disciplinary Teams (MDTs) consisting of Municipal Health Officers (MHOs), Municipal Social Welfare Officers (MSWOs), women and children protection desks, and community-level stakeholders such as school authorities and CSOs, the project—specifically Jhpiego—played a key role in establishing, reinstating, or strengthening these MDTs in accordance with the ordinance . The enhancement of MDTs has been instrumental in streamlining the process of referring GBV cases, ensuring that the process remains survivor-centric This approach minimizes the trauma survivors face by reducing the need for them to recount their experiences multiple times across different stations Additionally, the engagement of peer ducators has further catalysed the process, ensuring that victims receive appropriate and timely referral services

The GBV project has made notable progress in changing community attitudes and behaviors towards gender-based violence. Survey findings show over 90% of respondents now reject justifications for violence against women, such as going out without informing a partner or refusing sex, reflecting a growing consensus that violence is unacceptable. Additionally, the frequency and severity of intimate partner violence have decreased, with most respondents reporting non-violent relationships. The project has also encouraged more individuals to seek formal help from legal and law enforcement channels, with the percentage of people approaching lawyers and police rising. This reflects increasing confidence in formal support systems, and fewer people are remaining silent about their experiences (down from 28.8% to 12.6%). However, informal networks, like friends, remain a key source of support, highlighting the continued importance of community in addressing GBV.

GBV Watch Groups: A Unique and Effective Intervention by PKKK:

One of PKKK’s unique interventions has shown remarkable outcomes: the establishment of GBV watch groups, a core priority area that no other partners have This concept originated in the aftermath of Typhoon Yolanda in 2013 in the Visayas region, where PKKK formed GBV watch groups as part of creating women-friendly spaces . This model proved successful and has been incorporated into the SHE project . There are three modules that community facilitators must go through, focusing on basic concepts of gender, SRHR, and GBV . Positive results have been observed, with GBV watch groups forming close ties with municipal social welfare development offices and multidisciplinary teams

PKKK emphasized that while multidisciplinary teams existed, it was the GBV watch groups that made the referral system effective Without them, the system would remain limited to paperwork and banners These GBV watch groups have been instrumental in recognizing, responding to, and making referrals for GBV cases, demonstrating their vital role in the community . The GBV Watch Groups have significantly increased community awareness about GBV, leading to a more informed and supportive environment This has been achieved through effective training and outreach, making GBV a central issue of concern rather than a taboo topic In Dimataling, Zamboanga Peninsula, the GBV Watch Group president said, “SHE significantly enhanced our skills and knowledge about VAWC and rape cases. Their support has been the backbone of our advocacy efforts.” Similarly, in Clarin, a representative highlighted, “SHE’s extensive training has given me the confidence to disseminate accurate GBV information effectively.”

GBV Response in Bulusan:

In Bulusan, the partnership between MIDAS and the local government has significantly enhanced the VAWC (Violence Against Women and Children) Desk Federation’s ability to address gender-based violence (GBV) . Women in the VAWC Desk Federation were trained in a rights-based approach, leading to better confidentiality practices Initially, the VAWC desk was in an open space, but now, thanks to this training, it has a dedicated room, ensuring privacy and a more survivor-centered approach

A Memorandum of Agreement (MOA) with the Mayor provided the VAWC Desk Federation with an office, counseling space, and a halfway house for survivors This partnership has improved the services and ensured quicker support for survivors . The MOA also helped stabilize the frequent turnover of VAWC Desk Officers in barangays, ensuring consistent, trained personnel are available to support GBV survivors This collaboration has strengthened Bulusan’s capacity to address GBV effectively and sustainably .

Intermediate Outcomes

1100.a:

Based on FHSIS data from 2019-2023, a total of 24,787 new acceptors of modern FP services were recorded across all SHE sites. The project surpassed its Year 6 endline target of 5,209 by 31%, reaching 6,824. Among these, progestinonly subdermal implants (PSI) were the most popular method, chosen by 48% of new users. This was followed by injectables at 28% and oral pills at 21%. The uptake of permanent methods like bilateral tubal ligation (BTL) and noscalpel vasectomy (NSV) was notably low, with only 25 acceptors for IUD, 10 for BTL, and none for NSV.

The proportion of new acceptors using PSI has consistently grown, making it the leading method over recent years, with significant increases from 33% in 2022 to 48% in 2023. This trend reflects a substantial shift towards PSI/ implants, which saw a remarkable 179% increase in 2023. Both injectables and oral pills also experienced growth, with increases of 95% and 36%, respectively, highlighting a continued preference for these methods among new FP users.

According to the findings presented in the FHSIS report 2024, across all regions, there were mixed trends in new FP acceptors. BARMM saw significant increases, especially in Bongao, due to enhanced PSI services, while Ganassi lagged due to low FP prioritization. Region 5 experienced slight growth in Prieto Diaz and Bulusan, but Mobo saw a decline due to limited health provider training. Region 8 showed the highest rise in Sta. Margarita, with outreach efforts and FP commodity distribution driving increases, despite a dip during the COVID-19 pandemic. In Region 9, new acceptors declined in 2023, particularly due to FP commodity stockouts. Region 10 had mixed results, with Ozamiz City achieving its highest level due to PSI training, while other areas saw decreases. Region 13 initially saw high numbers in 2021, but acceptors decreased afterward as most of the target population had already been reached.

In the survey, a proxy indicator was used to determine current FP usage by asking respondents if they are using any FP measures. In the baseline survey, 87% of girls, 68% of women, 40% of boys, and 69% of men reported using FP measures. By the endline survey, these figures decreased: 79% of girls, 65% of women, 32% of boys, and 32% of men reported current use of FP measures.

1100.b: # of individuals who have accessed quality and gender Responsive reproductive health services including modern contraception in the targeted health facilities, disaggregated by sex, and type of services

The monitoring report (PMF) indicates that the total number of women accessing quality and gender-responsive reproductive health services in year 5 was 65,290, exceeding the target of 62,342 by approximately 4.7%.

However, the number of men who accessed these services, 2,266, was below the target of 2,509 by about 9.7%. The FHSIS report show that the CPR across project areas showed varied trends from 2019 to 2023. Despite a 7% increase in current users in 2023 (65,780 users), the CPR declined due to a growing number of women of reproductive age, particularly in Regions 5 and 8. Modern contraceptive methods such as oral pills (36%-38%), injectables (20%-24%), and PSI users (17%) remained the most popular. Permanent methods like BTL and NSV had low uptake, primarily offered during medical missions. The COVID-19 response, including PSI distribution and health provider training, contributed to increases in current users.

Immediate Outcomes

1110.a: % and # of total target population knowing where to access SRHR services including contraceptives commodities

Survey data revealed that, on average, 87.9% of respondents knew where to access sexual SRHR services, including contraceptive commodities.

Comparison of data points

Improve sexual and reproductive health and rights for women and girls

% of targeted population knowing where to access SRHR services

Girls 24 .3%

Women 47 4%

Boys 34 1%

Men 51 5%

Girls: 37 .7%

Women: 87 3%

Boys: 30 3%

Men: 66 1%

Girls: 62 .4%

Women: 95 6%

Boys: 32 4% Men: 76 7%

Girls: 87 8%

Women: 93 8%

Boys: 81 6% Men: 87 7%

There has been a significant rise in this indicator from the baseline. At baseline, only 47.4% of women were aware of where to access SRHR services. By the endline, this number had increased to 93.8%. For girls, the percentage was quite low at baseline, but now 87.8% of girls can identify where to access SRHR services. The proportions for men and boys remained consistent, with 87.7% of men and 81.6% of boys able to identify service locations. In contrast, at baseline, only 51.5% of men and 34.1% of boys knew where to access SRHR services.

In terms of services available at RHUs, respondents were asked about their awareness of the offerings. The data showed that 47.9% were aware of FP counselling and services, 25.4% knew about modern contraceptives, and 14.5% were aware of HIV testing. Additionally, 2.9% knew about STI testing, and 23.7% were aware of maternal and child health services. Furthermore, 5% of respondents indicated that they were aware of all the aforementioned services being available at the RHUs.

Girls: 54 3%

Women: 77 4%

Boys: 64 1%

Men: 81 5%

Do you where to access FP services including contraceptives?

The most common source of FP services was Barangay Health Stations (BHS), reported by 72.2% of participants. Additionally, 14.6% obtained services from RHUs, and 7.3% accessed services from pharmacies.

At baseline, the barangay health centers were the most frequently used locations to obtain family planning methods for boys (50.6%), men (44.9%), girls (43.2%), and women (40.1%). In comparison to the baseline, the proportion of respondents accessing services from RHU was slightly higher at 18%. Specifically, women accessed RHUs more frequently (27.9%) compared to girls (21.2%), boys (13.1%), and men (12.8%). At the endline, the proportions had shifted: girls’ access dropped to 14.4%, boys increased slightly to 16.1%, women decreased to 15.3%, and men remained relatively stable at 12.6%. Fewer than 5% reported acquiring services from regional or district hospitals.

1110.b: %/total girls and women able to make reproductive health choices alone and/or supported by their partner, disaggregated by age

The survey results reveal that a significant majority of women and men have considerable control over their reproductive health decisions, with 78.8% of women and 72.8% of men reporting that these decisions are made either individually or jointly with their partner/spouse. On average, 68.4% of females share this decision-making autonomy, though the figure is notably lower for girls at 56.5%. This lower percentage for girls is largely attributed to their reliance on their mothers for reproductive decisions, as reported by 29.3% of the girls. For boys, 56.9% report similar decision-making dynamics, consistent with the broader trend observed among men.

On average, 68.5% of females—comprising 60.7% of girls and 75.2% of women—reported having the authority to make decisions about the number of children to have, either independently or jointly with their spouse. This data underscores a notable variation in decision-making autonomy between different age groups, with women showing higher levels of control compared to girls. The percentage of women and girls making reproductive choices, either singly or jointly with a partner, has increased since the baseline. At baseline, only 57.8% of women and 35.1% of girls were making such choices. By the endline, this number had risen to 75.2% among women and 60.7% among girls.

Comparison of data points

NOTE: The data point comparison between baseline and endline is problematic due to differences in calculation methods. The baseline and pulse surveys used different questions and subsets for calculating data. The baseline included questions about whether respondents had ever used or tried to delay or avoid pregnancy – but it is unclear which specific subset was considered. In contrast, the endline survey asked directly about reproductive decisionmaking—whether decisions were made singly, jointly with a spouse, or with other family members. This question was not included in the baseline or pulse surveys, though the reference guide suggested that a similar, simpler question could be asked. Due to these differences in survey questions and methodologies, direct comparison of the data points is not valid.

of girls and women able to make reproductive health choices alone and/or with partners

Outcome: Creating and empowering community changemakers

In the endline the calculation is made based on direct question of the reproductive health choices are made alone and/or with partners?

One of the other achievements of the SHE project is the development of changemakers in the form of peer educators, both adolescent and adult. The project has successfully empowered these individuals to become influential figures within their communities. During the FGDs, peer educators highlighted various technical and non-technical skills they acquired through the SHE project. These skills included leadership, communication, and the ability to report GBV cases. An adolescent peer educator from Caraga voiced their satisfaction, echoing the sentiments of all participants by stating, “10/10,” indicating a strong approval of the support they received. Another participant mentioned, “There are situations that we can handle because we can apply the SHE trainings. It is much easier to handle,” underscoring how the training equipped them to effectively navigate challenges in their work.

Some trained peer educators already held positions at the barangay level when they were first engaged. Many partners strategically collaborated with barangay officials and workers (e.g., barangay kagawad, BHW, and BNS) upon entering the area. This approach proved effective as it allowed partners to leverage the officials’ influence in recruitment and mobilization for activities. Additionally, through the SHE training they received, these individuals gained a deeper understanding of their roles within the barangay and how they could use their platforms to advance SRHR/GBV advocacy. This not only improved their capacity but also enhanced their ability to perform their roles more effectively.

In their outreach to adolescents and youth in the community, adolescent peer educators have utilized the communication and interpersonal skills they gained. They emphasized their crucial role in approaching individuals experiencing depression, leveraging their position as peer educators to provide support and understanding. Building friendships within the community was another significant outcome, fostering stronger bonds and trust.

Even though the concepts were initially new and somewhat uncomfortable for them, the project expanded their understanding of sexual and reproductive health rights, making them more knowledgeable on the subject.

“At

first, we laughed when discussing reproductive organs. We were uncomfortable using those terms. But now, we can confidently say and explain them during rollout sessions.”

– PEER EDUCATOR, ZAMBOANGA PENINSULA

Through the SHE project, adult peer educators have become vital conduits of SRHR knowledge and legal awareness, bridging the gap between services and the communities they serve. Adult peer educators have emerged as powerful change agents within their communities, thanks to the comprehensive training provided by the SHE project. These trainings, particularly in areas such as policies, legal processes, and SRHR, have been instrumental in enabling adult peer educators to effectively reach out to their communities, raise awareness, and offer critical support to those in need. Adult peer educators have reported receiving as many as 5-6 training sessions through the project. These sessions have not only deepened their knowledge of SRHR but have also equipped them with the skills to effectively disseminate this information within their communities. The impact of this training is evident in the way these educators are now seen as non-formal key resources for legal assistance and SRHR-related guidance. One participant from the Northern Mindanao FGD shared that people in their community often approach them for help with legal matters, even referring to them as “walking attorneys” due to their familiarity with the laws and provisions in their region. Similarly, peer educators from Eastern Visayas highlighted the value of the VAWC module. They noted that the training empowered them to support victims, not just as barangay officials, but as active advocates. The empowerment has led some participants to take proactive steps, such as reporting cases and utilizing established referral pathways, further enhancing their effectiveness and impact in the community.

The project has also significantly contributed to the personal and professional growth of the peer educators. Beyond benefiting the community, the project has fostered a sense of confidence and self-esteem among these young change agents. Communication was considered a key learning for all of them, with participants stressing that “self-confidence increased when it comes to public speaking.”

“I can attest how the SHE project has helped me overcome my fear of public speaking. I used to be shy and uncomfortable with speaking in front of many people, but over time, I became much more confident with sharing awareness in the community.”

– PEER EDUCATOR, NORTHERN MINDANAO

The training they received has also had a positive impact on their careers. Adolescent peer educators from Caraga shared how they highlighted their involvement in the SHE project during job interviews, using their affiliation with a well-recognized organization to advance their careers. They also mentioned receiving positive feedback on their work, which provided validation and recognition for their efforts.

Not only adolescent peer educators but also adult peer educators experienced improved self-confidence and enhanced self-esteem as a result of the SHE project. This sentiment was echoed across all FGDs, where participants emphasized how the project significantly contributed to their personal growth. One participant from Zamboanga Peninsula shared, “I was a shy person who rarely interacted with others or left my house because I didn’t know how to communicate.” Through their involvement in the SHE project, these individuals became more confident and empowered, overcoming their initial apprehensions and developing stronger communication skills.

Strengthening Community Ties

Peer educators across regions have reported stronger collaboration with RHUs and local organizations through their involvement in the project In Zamboanga Peninsula, adult peer educators valued the support from the RHU, which helped them gain critical skills like recognizing signs of abuse and knowing appropriate actions They noted the RHU’s consistent availability when needed

In Eastern Visayas, the relationship with the RHU improved significantly Before the SHE project, participants felt disconnected, but now they describe the RHU as “one call away” and have increased involvement in activities like Women’s Month events . In Caraga, peer educators highlighted successful partnerships with schools and NGOs, which have enhanced program effectiveness and access to resources . However, in Bicol, peer educators reported feeling excluded from activities like Parent Teen Talks, leading to feelings of neglect when they are not invited to such activities They suggested integrating peer educators into community health teams for greater recognition and involvement .

FGD with adult peer educators from Caraga

PEER EDUCATORS: TRANSITIONING TO AND FROM LEADERSHIP ROLES

The SHE project has played a pivotal role in the personal and professional growth of peer educators, many of whom have transitioned into or from leadership positions within their communities. The support provided by the SHE project has been instrumental in equipping these individuals with the skills, confidence, and knowledge necessary to take on and excel in leadership roles. The SHE project has provided comprehensive training programs that have been essential in preparing peer educators for leadership roles. These trainings covered a wide range of topics, including SRHR, legal frameworks, time management, communication skills, and public speaking. For many participants, this training was their first exposure to structured education on these topics, which significantly expanded their knowledge base and enhanced their ability to lead effectively.

One peer educator from Zamboanga Peninsula, who transitioned from a housewife to a Barangay Health Worker and then to a Barangay official, shared how the initial training sessions helped her overcome feelings of nervousness and inadequacy. The training provided her with the confidence to interact with clients and educate her neighbors on health and SRHR issues. Similarly, another peer educator, who also served as a Barangay Secretary, credited the SHE project with improving her time management skills and providing the technical support necessary to handle her dual roles effectively.

In addition to formal training, the SHE project facilitated exposure to practical experiences, such as leading community seminars and participating in local governance activities. These opportunities allowed peer educators to apply their newly acquired skills in real-world settings, reinforcing their learning and boosting their confidence. For instance, in Northern Mindanao, two Barangay Councillors shared how their roles as local community facilitators with PKKK organizations, combined with the support from the SHE project, inspired them to run for the council. The confidence and knowledge they gained from the project enabled them to actively participate in community initiatives, mediate disputes, and advocate for SRHR, which was a significant shift from their earlier, more passive roles. The transition into leadership roles has also created synergies and opportunities for peer educators to leverage their new positions for greater community impact. By combining their roles as peer educators with other leadership positions, such as Barangay Councillors or local facilitators, they have been able to integrate SRHR advocacy into broader community initiatives.

Challenges in transitioning to leadership roles:

Despite the substantial support from the SHE project, peer educators have encountered several challenges in their transition to leadership roles. One of the primary challenges has been the balancing act between their pre-existing responsibilities and the demands of their new roles. Many peer educators, who were already serving as Barangay Nutrition Scholar, BHW, and Purok leaders, found it difficult to manage the additional workload that came with their leadership positions. For example, a BNS described the exhaustion of managing work demands across multiple barangays while also taking on the role of a peer educator. Initially unprepared for this responsibility, she felt overwhelmed but gradually adapted, gaining valuable skills in time management and flexibility.

Another challenge has been the cultural and social barriers that some peer educators faced when stepping into leadership roles. For those who were previously housewives or had limited public interaction, the transition was particularly daunting. One peer educator shared how she initially felt alienated and nervous when facing clients and dealing with public matters. Despite these challenges, the peer educators have demonstrated remarkable resilience and adaptability. The support from the SHE project has been crucial in helping them navigate these difficulties, providing not only the technical skills needed for leadership but also the emotional and psychological support to persevere through challenging times.

1120.a: Perspectives of targeted population on positive attitudes that promote women’s reproductive autonomy

The indicator pertains to one of the sub-indexes within the reproductive autonomy index. As previously mentioned, three indicators were used to assess reproductive autonomy. Access to Information and Services: This indicator received an overall score of 84%, with equal scores of 84% for boys, girls, and women, and a slightly lower score of 83% for men. Decision on Whether and When to Practice Contraception: This indicator had an average score of 77%, with boys scoring 75%, girls 83%, men 76%, and women 75%. Girls exhibited the highest agreement regarding their ability to choose and use contraceptives, though this agreement was somewhat lower from an adult perspective. Decision on Whether and When to Have a Baby: This indicator scored 56% overall, with a notable low score of 32% for the right to terminate an unplanned pregnancy. The overall reproductive index was 72%, with women scoring 78%, girls 78%, men 68%, and boys 71%. At baseline, the values were 59% for women, 54.9% for girls, 60.5% for men, and 59.8% for boys.

Comparison

of data points

Perspective of targeted population on positive attitude that promote women’s reproductive autonomy

Girls: 78%

Women: 72%

Boys: 71%

Men: 68%

In the endline the calculation is made based on direct question of the reproductive health choices are made alone and/or with partners?

1120.b: #/total public declarations and actions by influencers to support SRHR, and in support of women’s rights and leadership

A total of 75 public declarations and actions by influencers in support of SRHR and women’s rights and leadership have been made, surpassing the original cumulative target of 42. When focusing specifically on public announcements made by partners, the number is 21.

The declarations made in 2023-24 have collectively advanced SRHR initiatives and gender equality by institutionalizing SRHR services, empowering local leadership and shifting community norms. There have been important policy enactments that have institutionalized SRHR and gender equality within local governance. Several municipalities have implemented significant policy changes, reflecting a commitment to improving GBV prevention and adolescent health services. For example, Mobo, Masbate has introduced multiple ordinances, including Ordinance No. 03-2023, which institutionalizes an anti-GBV referral system. Similarly, Sta. Margarita, Samar and Victoria, Northern Samar have

enacted policies to institutionalize comprehensive adolescent sexual and reproductive health services. Notably, in Zamboanga Sibugay, Buug has established an Adolescent Pregnancy Prevention Program through Municipal Ordinance No. 07-2022. Cagwait, Surigao del Sur has strengthened its adolescent health initiatives with Executive Order No. 2323, which supports the Adolescent Health and Development Program (AHDP). The Annex I provides an exhaustive list of changes that occurred at the policy level.

Some examples of the public declarations are that In Lanao del Sur, the enactment of the Provincial GAD Code has led to collaborations with organizations like Red Cross and UNICEF for relevant training. In Surigao del Sur, local governments have approved ordinances to strengthen adolescent health programs, ensuring comprehensive service provision. Other regions, such as Jabonga and Clarin, are also advancing youth health initiatives through new ordinances and funding allocations. Additionally, community leaders and influencers are increasingly recognizing the importance of policies against child marriage and GBV, fostering a cultural shift toward greater protection and support for vulnerable populations. These efforts exemplify a concerted push toward enhancing community engagement and institutional frameworks to address these critical issues.

Local leadership has undergone significant transformations, with leaders emerging as strong advocates for SRHR and gender equality. For instance, Genelyn Cababat, previously an advocate, has risen to the position of Barangay Kagawad and VAW Desk officer, where she now integrates GBV Watch Group initiatives into local governance. Similarly, Roldan Emong, who started as a new politician, has become a male advocate against VAW, challenging patriarchal norms within his community. These leadership transformations have been crucial in shifting community attitudes towards gender and SRHR. There has been a rise in community advocacy, with grassroots-level changes in attitudes and behaviours driven by collective efforts. For example, SIKAP Inc.’s youth leaders have approved resolutions to establish barangay-based AFHF, demonstrating the power of empowered youth in promoting SRHR at the community level. Additionally, a Barangay Peacekeeping Action Team (BPAT)5 member has transformed into an active advocate against GBV, showing how community members can play a critical role in advancing SRHR and gender equality.

1130.a: #/total facilities providing gender responsive SRHR information and services

The positive performance of RHUs, as measured by the Jhpiego Gender Service Delivery Quality Assurance Tool, which includes 20 standards across various aspects of service delivery (such as facility readiness, clinical care, access to services, and client relations), suggests that the SHE project has effectively improved SRH services and influenced health service providers’ behaviours regarding gender norms, attitudes, and practices. The tool’s 20 indicators are grouped into five key components: (1) availability and accessibility of services, (2) male engagement and family inclusiveness, (3) health service provider-client interaction, (4) key aspects of a respectful relationship, and (5) health care policies and facility management.

A key indicator of the project’s performance in delivering inclusive services is the number of facilities that achieve at least 80% of the standards for youth-friendly and gender-responsive services. By the project’s final year, 19 RHUs were offering youth-friendly and gender-responsive services out of 20 RHUs. All 19 RHUs met the 80% benchmark, with 3 RHUs achieving 100% of the standards and 8 RHUs meeting between 90-95%. The detailed results of each of the components is presented in the Annex II. In relation to the RHUs providing gender-responsive and adolescentfriendly services, the qualitative findings corroborate the data gathered from the PMF results. They emphasize how the services have become more gender-responsive and adolescent-friendly, and how the capacity of the health service providers has increased.

5 The BPAT monitors, rescues, and refers GBV victim-survivors to Barangay or RHUs for support.

OUTCOME: Empowering RHU Providers for providing Inclusive Care (Gender and Adolescent-Friendly Services)

One of the standout achievements of the SHE project has been the transformation of RHU services to become more gender-responsive and adolescent-friendly. Through targeted training and capacity-building initiatives, RHU representatives now feel more equipped to address the unique needs of diverse groups within their communities, fostering a more inclusive and supportive environment for all.

All RHU representatives reported having undergone comprehensive training on Gender Transformation on Health (GTH) which has been crucial in shaping their approach to service delivery. The RHU in Sumilao shared that the majority of their staff have been trained in adolescent-sensitive approaches. “We are confident to conduct adolescent orientations in other barangays because we are well-trained,” explained one participant. This training has empowered the staff to handle gender-related issues with the care and understanding they require.

KII with RHU representative from Sumilao

The RHU in San Isidro highlighted the significant improvements in their capacity to provide gender-responsive services. “When a client arrives, we know what to do step-by-step,” noted the RHU representative. “Before, we didn’t know how sensitive some problems are, we didn’t know what to do exactly.”

All RHU representatives emphasized the importance of offering services that are sensitive to the needs of different groups, ensuring equality for all. They noted that the skills honed through training have enhanced their ability to deliver services that respect the unique needs of each individual, fostering an environment of inclusivity and respect. When it comes to providing adolescent-friendly services, RHU representatives unanimously agreed that aspects like “privacy and confidentiality” have been paramount. These elements have been critical in gaining the trust of adolescents in the community, making them more comfortable seeking care. The commitment to confidentiality and a non-judgmental approach has made the RHUs a safe space for young people, encouraging them to access the services they need.

“We’re more sensitive now, less people gossip (there’s more privacy). No one wants to gossip. This has helped reduce stigma and build trust among clients, particularly adolescents.”

– RHU REPRESENTATIVE, EASTERN VISAYAS

This was corroborated from the voice of the community. The project has led to significant advancements in providing gender-responsive and inclusive SRH services, improving women’s experiences and perceptions of care by ensuring that their needs are met with respect and confidentiality. In Sumilao, women reported a high level of comfort and trust at health facilities, with one participant sharing, “I have been through health centres multiple times to access pap smears and IUD. I am not embarrassed to spread my legs in front of a midwife.” This indicates a positive shift in how gender-responsive care is being delivered, with women feeling respected and valued. In Buug, improvements in privacy and respect during consultations were noted, with participants saying, “We are always entertained when we visit the health facilities.” The project’s focus on gender-friendly service delivery has created a more supportive and inclusive environment for women. Women in Clarin and Dimataling also praised the accessible and attentive nature of health services, highlighting the respectful treatment they received. As one participant stated, “I can feel that I am being respected and treated with kindness.” These comments reflect the project’s success in fostering a gender-responsive approach, ensuring that women feel secure and well-cared for. In San Isidro, women appreciated the enhanced privacy and the staff’s increased training on gender-responsive care, noting that their needs were addressed with respect and understanding.

Male participants across all regions expressed satisfaction with the quality of care at RHUs, highlighting that services are respectful, confidential, and equitable for everyone, including adolescents, unmarried individuals, and LGBTQIA+ members.

All representatives from the PHO highlighted that the improved communication skills among service providers. For example, in Bukidnon, PHO representatives noted that service providers’ attitudes have shifted towards greater client-centred care and respect for diverse gender identities, including non-binary individuals. There has been a marked increase in clinical competence and communication skills, with providers now using more respectful language compared to before. “Before they used language that was very offensive, now this has changed,” remarked one representative. Additionally, the trainings on IUD and implant insertion and removal have been highly appreciated, further enhancing the skills of health service providers.

The project has been widely acknowledged and appreciated for supporting the establishment of AFHF in two municipalities of the targeted regions. Previously, there were no adolescent-friendly services in these communities. The project’s support has created safe spaces for adolescents to access health services, contributing to an increase in health-seeking behaviours among young people. In an interview with the PHO from Sorsogon it was noted that adolescents are actively visiting these centres, as evidenced by the functionality tools.6 The project has also made essential services, including counselling and testing, more accessible to LGBTQIA+ individuals. Positive feedback

6 The functionality tool is a checklist used by PHOs to monitor the services of RHUs (as shared by the PHO in Sorsogon).

highlights the respect and confidentiality provided by health services. In Zamboanga Peninsula, a participant remarked, “We do not feel any discomfort or maltreatment from our health care unit,” contrasting their positive experiences with the challenges they face in other areas of life. Another participant shared, “There was confidentiality and privacy when he visited the RHU,” emphasizing the trust built through these services.

OUTCOME: Enhanced technical capacities and skills of health service providers for service provision

The project has contributed in enhancing the competency of health service providers through targeted capacitybuilding initiatives. Health service providers received training in several key areas designed to enhance their skills and knowledge. These training programs included topics such as adolescent health, foundational and advanced FP counselling and behaviours change (FPCBT-I and FPCBT-II), gender transformation for health services, and GBV modules. The GBV modules were co-developed by Jhpiego and WHO to ensure a comprehensive understanding and effective response to gender-based violence. These specialized trainings have filled critical knowledge and skill gaps, equipping RHU workers to handle a broader range of SRHR services more effectively.

“The trainings help enhance our ability to meet the demands and needs of marginalized groups, ensuring cultural competence, specific SRH needs, communication skills, and anti-discrimination practices. This increased competence is evident in the empathetic and supportive environment now prevalent in RHUs.”

– RHU REPRESENTATIVE, CARAGA

One RHU representative shared, “We no longer have to rely solely on the government for training as SHE fulfilled all our gaps, which is commendable.” This sentiment was echoed by many others, highlighting the project’s role in providing essential training that might have otherwise been inaccessible.

The technical training has not only enhanced the skills of RHU health service providers but has also increased their confidence and self-sufficiency. With the knowledge and skills acquired, RHU workers are now better prepared to manage SRHR services independently, without the constant need for external support. The positive impact of this training is evident in the improved quality of care and the broader range of services now available at RHUs. By addressing training gaps, the SHE project has ensured that RHU workers are well-equipped to meet the needs of their communities, leading to better health outcomes and increased trust in health services.

1130.b: #/total rural health units that have at least 3 modern contraceptives available on day of assessment

According to the Monitoring Report (PMF), 16 RHUs had at least 3 modern contraceptives available on the day of the visit, falling a little short of the target set at 17. Despite this achievement, the target fell short by 6%, highlighting some challenges experienced by a few RHUs regarding commodity availability. Several RHU representatives mentioned that they occasionally experienced shortages of these commodities. Feedback from FGDs with women across different areas echoed these challenges. Women from Lianga and Santiago shared that while accessing health services and advice was relatively easy, there were inconsistencies in the availability of specific contraceptives, particularly contraceptive pills. In San Isidro, some women reported that medicines were sometimes out of stock during their visits. Similarly, in Sta. Margarita, participants noted operational difficulties, including medication being available only in the afternoon, which forced them to return multiple times to receive the contraceptives they needed. These reports highlight that while some RHUs were able to meet the contraceptive availability target, others faced operational and procurement-related hurdles affecting consistent access to these essential health commodities.

During an interview with a PHO representative in Sorsogon, it was highlighted that shortages might be linked to the implementation of the Mandanas Rule, which shifted the responsibility for procuring commodities from the province to the municipalities. While the rule allows LGUs to access more funds, many are not yet equipped to navigate the

new system. To ensure proper fund management, the law requires LGUs to establish a Special Health Fund account in a bank, ensuring transparency and accountability for all health-related expenditures. According to the PHO representative, “some municipalities are struggling with these procurement issues as it has to be acquired through municipalities and municipalities are struggling to manage resources right on time because they don’t know how to,” which has occasionally impacted the availability of modern contraceptives.

In addition to the outcomes highlighted under Pillar One, one of the most significant outcomes emphasized in the qualitative data was how the project empowered community change-makers in the form of peer educators. By building the capacity and enhancing the skills of local people, the project strengthened local capabilities. Although the primary goal was to increase community awareness, peer educators also experienced personal and professional growth in their roles as service providers.

Accessing SRHR Information and Services: Where Communities Turn

The SHE Project has influenced a shift toward formal health services, like RHUs, BHWs, and midwives, for SRHR information . This reflects growing trust in the formal healthcare system due to its reliability and convenience . However, informal sources, such as neighbors and online platforms, remain common, especially among adolescents and in some regions, highlighting the need for further integration of formal SRHR services

Men prioritize accessibility, trust, and comfort when seeking SRHR information, often turning to formal health services Women prefer local practitioners, like midwives and nurses, who provide a comfortable and empathetic environment . In regions like Caraga and Bicol, RHUs are now commonly used for SRHR support, signaling increased confidence in formal services

Despite this progress, informal sources still play a significant role, particularly in BARMM, where advice from neighbors can spread misinformation about contraception Many men also rely on online sources for SRHR information, citing privacy concerns Adolescents, especially boys, often turn to fathers or online platforms like Google and YouTube, while girls consult parents, friends, and RHUs for more accurate information .

3.1.2 Achievements under Pillar 2

Intermediate Outcomes

1200.a: #/total inter-agency collaborations between WROs, CSOs, and government agencies promoting SRHR / preventing GBV

This indicator encompasses any joint undertaking between NGOs, CSOs, WROs, and/or NGAs aimed at research or advocacy related to SRHR or the prevention of GBV. Initially, no such collaborations were reported. By the end of the reporting period, there were 21 documented cases of inter-agency collaborations, meeting the target of 21, which is expected to be increased until Year 7 quarter 2 (end of activities). This data is based on the PMF reporting.

The annual report highlights several collaborative efforts of WROs, CSOs, and government agencies in promoting SRHR while preventing GBV. These collaborations have strengthened the effectiveness of WROs in advocating for SRHR and combating GBV at regional and national levels. For instance, initiatives like GBV Watch Groups is trying to secure endorsement by the Philippine Commission on Women (PCW) and partnerships between organizations like PKKK and state universities showcase a commitment to community-based responses and gender mainstreaming efforts.

Additionally, the establishment of the Reproductive Health Advocacy Network (RHAN) by the FPOP aims to mobilize stakeholders and drive the SRHR agenda forward. Moreover, WROs have played a crucial role in influencing policy change, as evidenced by recommendations issued by the Committee on the Elimination of Discrimination against Women (CEDAW) and the Philippine Commission on Human Rights (CHR) regarding SRHR, including safe abortion care and access to comprehensive sexuality education. Overall, these collective actions highlight the pivotal role of WROs in driving transformative change and advocating for policies and programs that prioritize SRHR and GBV prevention.

Through capacity-building efforts and collaborative initiatives, WROs became more effective in engaging with national and local stakeholders, contributing to policy formulation and legislative processes. Notably, their involvement in the creation of bill for Prohibition of Child Marriage Law and the APP Bill has been instrumental. Although OPH, together with partners developed a position paper wherein majority of its recommendations were adapted in the current version of the APP Bill.

During the evaluation’s sensemaking session, partners highlighted several achievements under the outcome of interagency collaborations. The FPOP successfully organized Reproductive Health Advocates Network (RHAN) chapters across project sites to champion SRHR. During the project, FPOP also strengthened collaboration with the Department of Health’s Regional Implementation Team (RIT)7. This collaboration is significant as it aligns project efforts with national priorities, enhances coordination, and supports the effective implementation of the RPRH Law, which promotes universal access to reproductive health services and rights. MIDAS fostered collaboration with academia, particularly in three research initiatives at Bicol University, and played a key role in mainstreaming SRHR in Gender and Development (GAD) plans.

The UPCWGS shared how they partnered with CSOs like AMWA to conduct a sectoral creative workshop for the Muslim community, and with PKKK to facilitate similar workshops for adults in Negros Oriental. After the SHE project, UPCWGS further utilized feminist Psychosocial Assistance Checklist and developed a new program under GoJust, focusing on strengthening the capacity of first responders by partnering with LGUs.

The WGNRR partnered with MIDAS for the May 28 SRHR campaign, enabling a nationwide SRHR dialogue with various partners. PKKK, utilizing UPCWGS tools, engaged in activities such as lobbying at the UN headquarters alongside WGNRR and working on the formulation of the Implementing Rules and Regulations (IRR). WGNRR also facilitated a national SRHR dialogue, bringing together various CSOs and WROs to further promote SRHR and prevent GBV. The Friendly Care participated in Department of Education meetings on mental health PSAs, where they served as resource persons, leveraging their experience with Oxfam.

1200.b: Level of confidence of WROs on their own ability to coordinate and advocate to protect and promote the rights related to SRH and the prevention of GBV

The 2024 impact assessment of the CAT4SRHR tool underscores its effectiveness in strengthening WROs, with notable progress in strategic planning, financial management, gender sensitivity, and organizational resilience. However, the evaluation also points to areas needing improvement, particularly in documentation and follow-up, offering key lessons for future implementations.

The SHE project implemented a total of 108 activities related to CATR4SRHR to support its goals of improving SRHR services, promoting gender justice, and fostering long-term sustainability in the communities it served. Under each domain, the SHE project carried out numerous activities aimed at strengthening SRHR services and promoting gender justice. The breakdown of activities across various domains is in the Annex IV.

The impact assessment of CAT4SRHR revealed several key findings that highlight the tool’s significant contributions to WROs. Both UnYPhil Women and SIKAP experienced enhanced strategic planning processes, resulting in the creation of more gender-sensitive policies and improved financial management, which strengthened program quality and sustainability. FCFI benefited from gender sensitivity and KATROPA training, engaging men and boys as allies in SRHR advocacy, which led to more gender-balanced service delivery and inclusive community engagement.

WGNRR demonstrated increased organizational resilience, particularly during the COVID-19 pandemic, by leveraging CAT4SRHR to support member organizations and youth groups in advancing SRHR and GBV prevention efforts. These improvements were echoed in the eight Most Significant Change (MSC) stories, showcasing both individual-level transformations in knowledge and skills and organizational-level shifts in policy alignment and financial oversight. However, the evaluation noted challenges with documentation, the full implementation of capacity-building activities, and the need for ongoing follow-up and support to sustain these impacts. The findings from impact assessment showed that the CAT4SRHR tool effectively increased the commitment of WRO leadership and staff to implementing capacity-building plans. However, the documentation of these processes and their correlation with observed outcomes could be more thorough. Not all planned capacity-building activities were fully implemented, suggesting a need for better follow-up and continuous support to sustain the momentum of the interventions.

During interviews, several partners reflected on how the CAT4SRHR training and organizational development exercises have directly enhanced their ability to effectively engage in advocacy spaces, both formally and informally. For instance, a representative from SIKAP shared, “Owing it to Oxfam’s SHE now, I’m more assertive when advocating for our SRHR agenda.” Similarly, members from UnYPhil Women highlighted that they now feel equipped to lead advocacy efforts independently, noting, “After completing the CAT4SRHR sessions, we are confident to organize stakeholder forums and present our policy recommendations on our own.” The enhanced self-efficacy has also translated into improved public speaking and leadership capabilities. WGNRR members expressed how the structured approach to developing their Theory of Change and strategic MEL framework allowed them to gain clarity on their role as regional leaders. “Now, we actively participate in international forums, and we no longer just attend but shape the conversations around gender justice and SRHR,” one team member explained.

While these partners have not yet fully initiated large-scale advocacy actions except WGNRR, many stated they feel “more prepared and eager to take on these responsibilities as soon as the opportunity arises,” demonstrating increased self-confidence in their strategic roles. Overall, the organizational development support under CAT4SRHR has laid the groundwork for partners to transition from reactive participants to proactive leaders in the SRHR and GBV space. They affirm that, moving forward, they will take more initiative, whether formally through policy dialogues or informally through community-level advocacy. This shift in mindset, from hesitation to assurance, underscores that the project is not only building capacity but also cultivating a culture of self-driven advocacy and leadership within the organizations.

The CAT4SRHR was used to evaluate the partners’ capacity across six key domains to measure progress over time. These domains include: 1) SRHR Awareness and Raising and Community Mobilization, 2) Health and Support Services, 3) Advocacy and Influencing, 4) Improving Structures and Processes for Inclusion and Gender Justice, 5) Networking and Expanding the Sphere of Influence, and 6) Strengthening Organizational Resilience and Sustainability.

The assessment was conducted at three critical stages: initial, mid-term, and final, to capture the evolution of capacities and identify areas of growth or continued challenges.

The assessment results show a clear positive trajectory across all six domains from the initial to the final assessment, with the grand total average score improving from 52.4 at the initial stage to 65.2 at mid-term, and ultimately reaching 81.8 at the final stage. This progression indicates a comprehensive strengthening of capacity across the board, with partners making notable improvements.

• SRHR Awareness and Raising and Community Mobilization: The initial score for this domain was 50.2, indicating that partners had moderate capacity in raising awareness on SRHR and engaging the community in mobilization efforts. By the mid-term assessment, the score increased significantly to 64.2, reflecting enhanced engagement and more effective awareness-raising strategies. The final score further jumped to 80.3, an improvement that demonstrates strengthened capacity to mobilize the community, raise SRHR awareness, and conduct more impactful outreach activities.

• Health and Support Services: This domain had the lowest initial score of 41.9, indicating that partners faced challenges in delivering comprehensive health and support services. At mid-term, the score rose to 49.9, showing moderate improvements in service provision. However, the final assessment revealed a major increase, with the score reaching 78.9, the largest relative gain among all domains.

• Advocacy and Influencing: The capacity for advocacy and influencing began at a relatively low score of 46.5. Mid-term results showed a steady increase to 57.4, indicating that partners had begun to develop stronger advocacy strategies and were more effective in influencing policies and stakeholders. By the final assessment, the score rose to 75.6, demonstrating progress in the ability to advocate for SRHR issues, engage with decision-makers, and influence policy environments.

• Improving Structures and Processes for Inclusion and Gender Justice: Partners initially scored 55.0 in this domain, reflecting a moderate ability to create and maintain inclusive structures and gender-just processes. By the mid-term, there was a considerable improvement, with the score reaching 71.3. The final assessment showed an even greater increase, with a score of 87.0. The improvement highlights the partners’ efforts in creating more inclusive and gender-sensitive environments, enhancing gender equity within their organizational structures, and implementing more effective gender justice frameworks.

• Networking and Expanding the Sphere of Influence: Networking and influence expansion was a strong area for the partners from the beginning, as indicated by an initial score of 69.8. At mid-term, this capacity grew to 78.9, suggesting that partners were effectively leveraging existing networks and expanding their reach. By the final assessment, the score reached 88.8, the highest of all domains, demonstrating that partners enhanced their ability to network, form strategic partnerships, and extend their influence across a broader range of stakeholders.

• 6) Strengthening Organizational Resilience and Sustainability: The initial score for this domain was 49.8, indicating a need for stronger organizational resilience and sustainability planning. Mid-term results showed progress, with the score increasing to 67.8. The final assessment score of 80.4 indicates that partners made gains in building resilient organizations capable of sustaining SRHR interventions and managing resources effectively over the long term.

Immediate Outcomes

1210.a: Level of confidence partners and/or WROs in their own ability to deliver effective programs on SHRH and GBV prevention

This indicator measures the autonomy and awareness of an organization’s performance. At the endline, based on PMF reporting from CAT4SRHR data, all 10 partners and WROs supported by CAT4SRHR interventions expressed confidence in their ability to deliver effective programs on SRHR and GBV prevention. The target was set at 10, with the goal that all partners should express confidence in their ability to deliver effective programs. In this regard, the target has been met, as all 10 partners in interviews reported increased confidence.

As presented in the annual reports, this confidence is further validated by government recognition, such as the Department of Health in Caraga awarding SIKAP for its contributions to family health programs and CPD acknowledging Friendly Care’s efforts in SRHR advocacy. Friendly Care’s partnership with CPD through SHE activities has strengthened its capacity to sustain SRHR initiatives beyond the project. Additionally, organizations like AMWA and FPOP enhanced their SRHR knowledge through study sessions and institutional strengthening, resulting in improved programming and internal operations. For example, FPOP revised its financial policies, strengthening internal controls, while PKKK gained recognition for its gender mainstreaming efforts and secured funding for its GBV Watch Group.

1210.b:

#/total partners and/or WROs on target with their Action Plan to increase capacity

This indicator provides a descriptive account of the organization’s self-assessment, measuring its agency to enhance its own capacity. The target of 10 was achieved by the endline. All 10 SHE implementing partners received grants to implement their institutional strengthening action plans, with all showing significant progress in completing their planned activities.

As noted in the annual reports, key activities like SIKAP’s communication and negotiation training, FriendlyCare’s FP Competency-Based Training, and FCFI’s Gender Sensitivity Training have significantly improved staff capacities. Efforts to expand partnerships, such as MIDAS’ collaboration with Bicol University, further support organizational resilience. Capacity-building activities boosted confidence among staff, with AMWA volunteers gaining SRHR knowledge, including gender in Islam. Institutional strengthening also led to tangible improvements, such as FPOP’s Financial Policy review, which enhanced internal controls and reduced audit findings.

During the sensemaking sessions, partners elaborated on Outcome 1210. FPOP shared that they successfully capacitated personnel through midterm and final assessments, strengthening their team’s ability to deliver on SRHR initiatives. PKKK highlighted their implementation of the SHE project in four provinces, noting that Outcome 1210 enabled them to further mainstream SHE in their capacity-building efforts.

In line with Outcome 1210, the qualitative findings from the evaluation captured key positive highlights from the CAT4SRHR intervention support.

Outcome: Enhanced organizational capacity through CAT4SRHR

CAT4SRHR is perceived as one of the most effective tools for partners in terms of capacity building. One of the notable positive outcomes of the project is the strengthened organizational capacity among its partners. Through various support activities related to Pillar 2 and CAT4SRHR, there has been a significant improvement in conceptual clarity and core messaging on SRHR. The internal assessments facilitated by CAT4SRHR have enabled partners to identify their strengths and weaknesses and refine their strategic plans. Partners such as AMWA and MIDAS have praised how they have adjusted their strategies as a result of these assessments. Additionally, the ongoing support provided by Oxfam Philippines, particularly in enhancing financial management and organizational development, has been highly appreciated. “It is the first time someone has provided funding for organizational development,” remarked MIDAS.

All 10 SHE implementing partners believe that funding for capacity-building staff is essential, as it empowers the community, making them more confident and effective in implementation. This capacity-building through CAT4SRHR has made the organizations more strategic, allowing them to integrate SRHR into their mandates, visions, missions, and goals.

FGD with LGBTIQ+ groups in Clarin (top) Eastern Visayas (bottom)

“CAT4SRHR is a tool that helped us revisit our activities, values, and approaches and understand our stand on certain issues,”

– PARTNER (AMWA) REPRESENTATIVE

“Initially we doubted ourselves, but it was CAT4SRHR that cleared all our doubt by familiarizing with the content and giving us confidence.”

– PARTNER (SIKAP INC.) REPRESENTATIVE

The integration of CAT4SRHR has also led to mainstreaming these principles into their advocacy activities. “Even when staff members leave, they are better capacitated, ensuring sustained effectiveness. Monitoring, Evaluation, Accountability, and Learning processes have become more gender-responsive, reflecting a commitment to the Gender Justice Framework”, note UnYPhil Women. This has directly enhanced organizational operations, enabling them to reach more beneficiaries than initially targeted.

“We are running projects with other donors and partners as well, and because of the capacity enhancement and CAT4SRHR-related support and assessment, we have been mainstreaming these concepts across all programs. This has had a sustainable impact.”

- PARTNER (PKKK) REPRESENTATIVE

“We have become more strategic by mainstreaming gender and SRHR in our organizational mandate, vision, mission, and goals. These principles are now embedded in our activities as part of our advocacy. Our MEAL processes are now more gender-sensitive, and the gender justice framework has proven to be effective.”

- UNYPHIL

The benefits of CAT4SRHR were also experienced by Pillar 2 partners, particularly in terms of organizational development.

• University of the Philippines Centre for Women’s Studies Foundation Inc. (NGO wing of UPCWGS) which was in a nascent stage of development, received substantial support from CAT4SRHR. This assistance was crucial in facilitating institutional-level changes, such as the induction of seminars, having intergenerational conversation between feminists and the creation of various committees. The support provided by CAT4SRHR was instrumental in assessing and enhancing the foundation’s organizational capacity.

• WGNRR utilized CAT4SRHR support in their strategic planning, creating a theory of change and a strategic MEL framework. This assistance has enhanced their networking on global SRHR platforms, opening opportunities for collaboration and research. WGNRR’s strengthened presence has enabled them to lead both locally and regionally, creating spaces for CSOs to influence the SRHR discourse.

• DMSFI received comprehensive support through CAT4SRHR, which prompted a thorough review of their policies to ensure inclusivity. They have integrated a gender-just MEAL system, incorporating gender lens analysis into performance indicators. Staff members and extension workers (dealing with communities) are now trained to use sensitive language, particularly when addressing LGBTIQ+ and IP communities. This effort extends even to their financial and annual operational manuals, making them more gender-inclusive. They have also established a gender and development focal point system. There is non-discrimination in the hiring policy. There is also a sexual harassment and child protection policy.

• Friendly Care Inc has implemented an anti-discriminatory hiring policy and uses sensitive language with job applicants and patients. The organization has updated its mission and vision statements to include SRHR, reflecting a broader awareness and integration of SRHR concepts beyond FP. Friendly Care’s clinics have undergone GBV training, leading to the implementation of referral contact numbers and improved support for GBV-related issues.

This integration of enhanced capacity and knowledge into various programs ensures that the benefits of the project extend beyond its immediate scope, promoting long-term sustainability and effectiveness.

1220.a: #/total partners and/or WROs drafting their own learning agenda on SRHR

This indicator measures partners’ ability to integrate feminist MEL principles into their work. By July 2023, 18 learning agendas had been developed by SHE partners and other WROs. UPCWGS, in collaboration with the Oxfam Pilipinas SHE Project team, organized a workshop titled “Development of the Learning Agenda,” where all 15 participating organizations presented their agendas focused on SRHR advocacy, with many emphasizing the sustainability and institutionalization of the SHE project initiatives. The goal is to ensure that SRHR and GBV prevention efforts not only emphasize project implementation but also support the capture and dissemination of knowledge for organizational growth and pursuit of knowledge generation, mainly to influence practice change, policy influencing etc. Since the project’s inception, the development of 18 learning agendas represents a 180% achievement rate for this indicator. These agendas aim to advance SRHR advocacy and enhance the sustainability of SHE project initiatives. Some partners have utilized their learning agenda results to conduct additional activities aligned with their action plans.

Various activities and outputs have contributed to this progress, including arts-based research and creative workshops conducted by UPCWGS, which engaged a diverse range of stakeholders such as adolescents, Muslims, children, and indigenous peoples. Additionally, mentoring initiatives such as Feminist Research 101 by UPCWGS have empowered organizations like MIDAS to conduct gender analyses and produce research outputs addressing the SRHR issues faced by women in their communities. Furthermore, the integration of visual arts and creative movement modalities in training and awareness-raising sessions by organizations like PKKK and UNIPHYL has facilitated the sharing of lived experiences and contributed to the development of more inclusive SRHR programs.

1220.b: Perceptions of partners on their capacities to generate knowledge on women’s rights

Under Indicator 1220, UPCWGS was able to generate knowledge products, particularly as part of the nationwide research. During this process, they disseminated the findings from the research, but one of the core objectives of the indicator was also to improve the capacities of WROs in generating their own knowledge for influencing practice and policy—something that was not clearly evident in the evaluation.

There are certain positive achievements highlighted in the Annual Report (Y6 and Y5). During the reporting period Y6 and Y5, various activities significantly enhanced the capacity of partners, WROs, CSOs, and practitioners to generate knowledge and practice in SRHR and GBV prevention. Key outputs included multiple rounds of arts-based research and creative workshops with diverse groups, which pioneered innovative approaches to SRHR and GBV discourse. Participants benefited from these workshops, contributing to the development of sub-national policies and improved implementation of SRHR-related laws.

Collaborations, such as those with UPCWGS and the Candon Youth for Empowerment Movement, led to the integration of feminist media strategies and creative methods into SRHR advocacy. This included campaigns like “Read My Lips” during Women’s Month, which focused on fighting VAW, and the use of creative methods learned from the training workshops. Additionally, mentoring in feminist research and gender analysis, as seen with MIDAS, resulted in sharper gender-focused research outputs. The arts-based methodologies employed have encouraged SHE partners to develop more sex-positive and inclusive programs, integrating visual arts and creative movement modalities into their own research and advocacy efforts.

When discussions around Indicator 1220 took place during the interview with the SHE implementing partners, the major focus was on the research work conducted by UPCWGS. While there were mentions of capacity-building efforts, these seemed limited to UPCWGS involving partners in some sharing sessions and distributing research modules and preliminary findings. Although UPCWGS consistently invited WROs to participate, the timing may have hindered their ability to leverage these opportunities fully. Most knowledge products were finalized and shared only toward the end of the project, leaving limited time for them to be integrated into the partners’ capacity-building or for WROs to translate this knowledge into their own research capabilities. There was no substantial evidence showing that the partners themselves were able to generate knowledge products. In interviews conducted during the evaluation, partners attributed their capacity to generate knowledge and engage in advocacy largely to CAT4SRHR.

OUTCOME: Knowledge generation and support in SRHR and GBV

Outcome 1220 has been a central element for UPCWGS. Initially, the project provided UPCWGS with a grant to conduct extensive research aimed at identifying nuanced experiences related to SRHR among various community groups, including youth, indigenous communities, Muslims, persons with disabilities, and children. This nationwide research covered regions across the Philippines. After four years of research, a book series was launched in 2024, detailing the findings and offering a comprehensive explanation of the status of SRHR among different groups. The research utilized arts-based methodologies for data gathering, including creative movement and visual arts modules, which significantly contributed to the depth and richness of the findings.

The UPCWGS research series has yielded several positive outcomes, demonstrating its impactful application. Although the dissemination process is still ongoing (at the time of evaluation), the initial findings and methods from the research have been effectively utilized in various ways. For instance, the creative movement and visual arts modules developed during the research have been integrated into the peer education series conducted by the OPH. Additionally, the PKKK has applied these findings in advocacy efforts at the barangay level, showcasing their relevance in grassroots initiatives. Other university partners have also leveraged these research outcomes in their work.

The findings from the research have influenced capacity development programs beyond Oxfam, particularly in addressing issues such as people with disabilities and adolescent teenage pregnancy, shared UPCWGS representative during the interview. In addition to the primary outcome, UPCWGS achieved several secondary outcomes. The organization engaged and supported local partner CSOs within the SHE project by sharing research findings and tools developed during the research process. This engagement led to local CSOs adopting and utilizing these findings and modules in their own initiatives. UPCWGS also provided training on feminist research approaches to local CSO partners, resulting in independent research efforts, such as MIDAS’s study on the triple role of women during the pandemic. Moreover, UPCWGS conducted feminist SRHR research with youth groups, which led to the creation of innovative media outputs like TikTok videos and songs. These secondary outcomes reflect the broader impact of the knowledge generated, contributing to the dissemination and application of research findings across various platforms and communities.

Looking ahead, UPCWGS plans to collaborate with Oxfam Pilipinas to further disseminate these findings to local women leaders and elected representatives through policy workshops. This future initiative aims to support the drafting of local ordinances, enhancing the research’s role in influencing policy and fostering meaningful change.

1230.a: #/total advocacy and public engagement strategies by funded partners that are focused on SRHR and prevention of GBV

This indicator measures the capacity of WROs and networks to engage the public and policymakers in advocacy and influencing campaigns. According to the PMF reporting, a total of 47 advocacy and public engagement activities have been conducted, surpassing the target of 10.

The annual report takes notes of the Power Up! Initiative, spearheaded by WGNRR, which has facilitated significant advancements in the capacity of 30 organizations, who were supported with capacity building, with 15 of the

organizations even received grants. Through participation in Phases 1 and 2 of the program, these 30 organizations have honed crucial skills in analysing SRHR issues, devising advocacy strategies, and crafting impactful campaign messages. For instance, the Liyang Network effectively implemented an SRHR campaign in Cagayan de Oro, resulting in increased community engagement and empowerment, particularly among women and LGBTQIA+ individuals. Moreover, organizations like the Citizens’ Disaster Response Centre (CDRC) and the Maguindanao Alliance of Youth Advocates (MAYA) leveraged their newfound knowledge to integrate SRHR considerations into disaster response efforts and advocate for policy changes, respectively.

15 out of 30 organizations were provided with seed grants in the Phase 3 of the Power Up campaigns. These organization showcased notable improvements in their ability to influence and advocate for SRHR and GBV prevention. These organizations demonstrated enhanced skills in analysing SRHR issues, identifying advocacy access points, planning and executing effective campaigns, and crafting compelling key messages.

Most prominent Power Up! organizations’ campaigns included the ones organized by WGNRR and Oxfam annually s to commemorate key dates such as May 28 (International Day of Action for Women’s Health), September 4 (World Sexual Health Day), and September 28.

15 of the 30 organizations even received seed grants. The WGNRR report shows that as a result of these strengthened capabilities, 14 out of the 15 organizations successfully implemented their campaigns, addressing a wide range of critical SRHR issues.

The campaigns also led to stronger community engagement and partnerships, with some organizations, like Liyang Network and ILAW Shared Community, gaining recognition and support from local governments and other stakeholders. These efforts resulted in the institutionalization of SRHR-focused initiatives, such as disabilityinclusive sexuality education and SRHR integration into disaster response management. Moreover, the campaigns contributed to legislative advocacy at the national level, with CSOs successfully lobbying for the Adolescent Pregnancy Prevention Bill and gaining support for other key legislative agendas.

In the course of the project various advocacy initiatives were undertaken, contributing to increased organizational knowledge and improved influencing skills related to SRHR and GBV prevention. These efforts, including alliancebuilding activities, Women’s Month campaigns, International Day of Action for Women’s health, and World Sexual Health Day, strengthened collaboration among organizations and boosted their confidence to conduct independent activities.

1230.b: #/total WROs/networks reporting on an improved influencing skill

This indicator provides a descriptive account of the types of skills acquired or improved by project partners and WROs/networks involved in influencing activities throughout the project’s duration. The target was set at 20. By the endline, a total of 37 WROs/networks reported to have improved their influencing skills, indicating that the target was exceeded. Annual report (Y4) shows that twenty-four Philippine-based organizations, including CSOs, WROs, LGBTQI+ led, and youth-led groups, reported significant improvements in at least two influencing skills related to SRHR and GBV advocacy as a result of their participation in the Power Up program. The skills most notably developed include identifying critical SRHR and GBV issues, action planning for community organizing and advocacy campaigns, using non-stigmatizing language around HIV, AIDS, and STIs, and effectively discussing abortion within a health, rights, and justice framework. These advancements reflect the organizations’ enhanced readiness to engage in SRHR advocacy using innovative strategies. The focus on skill-building workshops in Year 4 has laid a solid foundation, and in by the end of Year 5, WGNRR shifted its focus to monitoring how these organizations apply their new skills through continued participation in the Power Up Program.

In terms of Outcome 1230, the qualitative findings also corroborate how the Power Up intervention has supported CSOs, WROs, and youth organizations. Additionally, WGNRR’s engagement has contributed to influencing policy changes at the national level.

OUTCOME: Enhanced capacity of WROs and youth led organizations through Power-Up

The SHE Project has partnered with a diverse array of CSOs. These include: ILAW Shared Community - A communitybased organization focused on advocacy and education related to SRHR and GBV; Youth Reproductive Health Awareness - An organization specializing in youth education and training on sexual and reproductive health; MAYA - A youth-led organization working on SRHR and gender issues in culturally sensitive regions.

Power Up was a distinctive program supported by the SHE project and implemented by WGNRR, aimed at enhancing the advocacy capabilities of WROs and youth-led organizations on SRHR and GBV issues. The program was structured into three distinct phases: capacity building, development of advocacy plans, and implementation of advocacy campaigns through seed grants. These organizations have received significant support through the SHE Project, including financial assistance, capacity-building activities, and strategic guidance via the WGNRR’s Power Up program. This support has enabled them to effectively implement programs and advocate for SRHR and GBV prevention in their respective communities.

Supported organizations have leveraged their increased confidence and resources to sustain and expand their advocacy efforts. ILAW Shared Community is making notable strides towards creating a city ordinance on comprehensive sexual and reproductive health, a clear indicator of the project’s enduring influence. Their advocacy has led to impactful initiatives aimed at destigmatizing and decriminalizing abortion. Youth Reproductive Health Awareness has continued to actively promote SRHR through robust community advocacy and educational programs, demonstrating the enhanced capacity and advocacy skills gained from the project. Similarly, MAYA has effectively integrated gender-responsive policies into their work, addressing cultural sensitivities and engaging stakeholders to advance SRHR in their communities. These outcomes reflect the substantial and positive impact of the SHE Project’s support.

“With the support from SHE and Power Up, we were able to enhance our advocacy skills, engage stakeholders, and address culturally sensitive issues. This has significantly improved our SRHR dialogues and outreach efforts.”

– MAYA REPRESENTATIV

The Power-Up program also facilitated the formation of robust networks and alliances across various stakeholders. ILAW Shared Community has built strong partnerships with schools and colleges through the GABAY Movement, a localized version of the POWER UP Campaign, which has empowered students to advocate for SRHR. Similarly, Youth Reproductive Health Awareness has established collaborations with local governments, youth groups, and the Department of Education to implement SRHR and GBV programs effectively; and MAYA has engaged with student leaders, young mothers, and religious leaders, forming valuable partnerships to support their advocacy and educational efforts on SRHR.

OUTCOME: Policy level changes

One of the biggest highlights of the SHE project in terms of policy changes is its pivotal role in lobbying for the prohibition of child marriage law. The project consistently advocated for this policy, working alongside partners to conduct several consultations that represented the voices of the people. Through these efforts, the SHE project significantly contributed to the progress in pushing this important policy forward. Moreover, under outcome 1230, the WGNRR has significantly advanced policy-level advocacy, fostering the capacity and confidence of local CSOs to advocate for SRHR and GBV. WGNRR’s strategic efforts have resulted in notable instances of policy-level advocacy, driving substantial legislative progress.

WGNRR played a pivotal role in organizing a comprehensive CSO consultation aimed at formulating a legislative agenda for the 19th National Congress. The collaborative effort resulted in the development of seven critical legislative agendas addressing issues such as teenage pregnancy, divorce, the decriminalization of abortion, and SOGIESC

(Sexual Orientation, Gender Identity and Expression, and Sex Characteristics) equality. One significant milestone from this initiative is the effort on the passage of the Adolescent Pregnancy Prevention Bill, which is currently awaiting bicameral approval. This bill’s potential enactment reflects the collective advocacy efforts of many WROs echoing similar agendas. Another strategic achievement of WGNRR was its participation in the 4th cycle review of the Universal Periodic Review (UPR) under the Office of the High Commissioner for Human Rights. WGNRR, along with SHE partners, engaged in sectoral consultations and contributed to preparing monitoring indicators on crucial issues such as the elimination of parental consent for accessing contraceptives, the decriminalization of abortion, and SOGIESC equality. This engagement with the UN is deemed highly strategic, as it can significantly influence the Philippine government’s policies and practices.

3.2 Coherence

The SHE project was designed in close alignment with national and local policies, particularly the Gender and Development (GAD) planning guidelines, family planning programs, and GBV response frameworks. This ensured that the project’s goals and activities were relevant to the local context and could complement existing health, gender, and development initiatives at both the municipal and provincial levels. In areas such as the BARMM and Eastern Visayas, the project’s activities were tailored to align with the region-specific needs around family planning, adolescent health, and GBV. For example, in BARMM, where resistance to SRHR and GBV topics was historically high, the SHE project’s alignment with local GBV policies enabled it to foster vital discussions and interventions in this critical area.

The SHE project’s efforts were also closely aligned with broader national health goals, such as the Philippines’ commitments under the Reproductive Health Law and the Sustainable Development Goals (SDGs). By working with LGUs, the SHE project contributed to the national agenda of improving maternal and reproductive health outcomes, increasing access to family planning, and reducing gender-based violence.

One of the key successes of the SHE project was its ability to foster long-term change by embedding SRHR services into local policies and health systems. In many cases, LGUs integrated the project’s interventions into their regular services, ensuring that SRHR programs would continue beyond the project’s lifecycle. For instance, in Buug (Region 9), LGU representatives highlighted the success of the project in achieving “adolescent-friendly” status for health facilities across all barangays, enabling continued service provision to young people and women in need. By strategically aligning with local policies, the SHE project served as a catalyst for sustainable improvements in SRHR services and community health outcomes. Its success in working with LGUs to enhance their capacity, implement gender-sensitive services, and integrate SRHR into local health plans underscores the project’s relevance and longlasting impact in the regions it served.

3.3 Project design and relevance

Alignment with socio-ecological model:

The SHE project’s design, with its two-pillar structure, aligns closely with the Socio-Ecological Model (SEM), which emphasizes the interconnectedness of individual, community, and societal influences on health outcomes. By structuring the project around both grassroots and systemic approaches, the SHE project effectively addresses SRHR challenges at multiple levels of the SEM. Pillar 1 focuses on direct engagement with individuals and communities. This aligns with the individual and interpersonal and community level of the SEM, where personal behaviours and immediate social networks significantly influence health outcomes. By working with community members and targeting individuals, Pillar 1 seeks to empower people with the knowledge and resources needed to make informed decisions about their sexual and reproductive health. Pillar 2 targets WROs and CSOs, aligning with the organizational and policy levels of the SEM. This pillar aims to influence broader societal and systemic change through advocacy, policy influence, and knowledge generation. By working to shift societal norms and policies, Pillar 2 addresses the structural factors that shape SRHR outcomes on a larger scale.

Addressing the problems:

Moreover, the project was designed considering the different existing issues in the Philippines, as well as contextspecific factors relevant to various regions. The project was tailored to meet the needs of the community based on the prevailing problems in the sphere of SRHR based on a through situation analysis. The partners believe that the project has been successful in addressing some of the existing issues, although there is a common consensus that much remains to be done.

The SHE project is notably relevant as it directly addresses SRHR issues tailored to the unique challenges of various Philippine regions. For instance, in BARMM, where religious norms significantly influence attitudes towards SRHR, the project has successfully engaged religious leaders as community influencers to shift these norms. One partner highlighted, “Religious norms dominate attitudes towards SRHR in BARMM, making it crucial to involve religious leaders in changing perceptions.” In Bicol, the project has made significant strides in changing attitudes toward GBV, as noted by a partner: “Before the project, no one spoke out against GBV; now there’s a clear shift in recognizing it as unacceptable.” Despite challenges like resistance to FP methods, the project has increased health-seeking behavior and demand for FP, demonstrating its effectiveness and relevance. Partners have adapted strategies to local contexts, such as addressing myths about FP and involving local leaders to overcome cultural resistance, thereby making a significant impact on societal norms and health outcomes.

Engaging the local stakeholders and partners:

One of the notable achievements of the SHE project is its inclusive design process. The project has successfully incorporated the voices of partners and local stakeholders in its conceptualization. According to Oxfam Philippines, during the project’s initial stages, a consultant was hired to gather input from partners. Following this, the proposal was initiated with an inception and validation meeting involving local partners. During this meeting, the Theory of Change and logical framework were discussed, and Pillar 1 partners were invited to provide comments and input. These contributions were carefully considered and integrated, demonstrating a genuine commitment to inclusivity and collaboration in project design. Another strength of the SHE project is its partner-led approach. Although a standard Theory of Change guided the project, partners were given the flexibility to develop strategies and lead project implementation. In this regard, MIDAS shared that they were involved in the planning and designing phases of the project, ensuring that grassroots-level issues were effectively reflected in the project’s theory of change. Similarly, Jhpiego noted that it was involved directly in deciding the theory of change and how to operationalize the outcomes. This empowerment of partners not only fostered ownership but also ensures that the project strategies are well-suited to the local context and needs.

Relevance of ToC:

The Theory of Change can be commended for its validity and relevance. The project’s design, which addresses both the demand and supply sides, has been particularly well-regarded. The way the project has sought to change social norms to increase demand-side parameters and supported the strengthening of supply-side parameters by capacitating health service providers is commendable. In awareness sessions, the project focused on changing attitudes and surrounding norms by helping women and men understand their autonomy regarding reproductive and sexual health. At the same time, making the service provisions gender-responsive and youth-friendly covers all aspects effectively.

The ToC has proven effective, with partners and local stakeholders validating it through participatory engagement. While the focus was more on the results framework than guiding principles, partners feel a sense of ownership due to their involvement. The guiding principles, including feminist and capacity-building aspects, are widely accepted. Key assumptions of the ToC have held true: educational campaigns and role models positively influenced community attitudes towards SRHR; improved health services led to increased utilization; and empowering women enhanced their SRHR autonomy. The adoption of feminist principles in service delivery has resulted in gender-responsive care. Partnerships and advocacy have also fostered supportive SRHR environments, though there were challenges, particularly in engaging community influencers and addressing local resistance.

3.4 Efficiency

Engaging partners from the initial phase significantly contributed to smooth operations and collaboration throughout the project. Early involvement ensured that partners were well-acquainted with the project’s objectives, leading to more efficient implementation. However, the project faced some efficiency challenges. In the Tawi-Tawi region, a key CSO partner had to halt their interventions in Year 3, leading Jhpiego to take over midway. This transition posed challenges to maintaining momentum. Similarly, in Ozamiz City, the project had to adjust its strategies due to internal political situation in the city.

Staffing and budgeting:

In terms of staffing and budgeting, none of the CSO partners had complaints regarding the budget. “The budget is sufficient,” was their common standpoint. One positive aspect of the project’s efficiency was the smooth financial management. There were no complaints regarding the budget, with funds being released on a quarterly basis in tranches, ensuring that financial resources were available as needed throughout the project. This systematic approach to budget allocation contributed to the overall seamless execution of activities.

In terms of human resources, there were concerns regarding the inadequacy of MEAL staff from AMWA, a sentiment also echoed by Oxfam Philippines. The absence of dedicated M&E personnel created challenges, as program officers and managers, already burdened with implementation duties, struggled to manage reporting and monitoring simultaneously. As an interim solution, program staff took on the additional monitoring responsibilities, ensuring that the effectiveness and achievement of outcomes were maintained. However, having dedicated M&E personnel would have alleviated the strain and improved overall efficiency. Another challenge noted by Oxfam Pilipinas and Jhpiego was staff attrition. Though beyond the organizations’ control, high turnover rates required recalibration of plans and re-communication of strategies, which affected continuity and efficiency.

Timeliness:

Adapting Strategies for Local Government Buy-In:

One of the challenges that PKKK and Jhpiego confronted was securing the buy-in from the local government in Ozamiz City Although initially targeted due to the high incidence of teenage pregnancies in certain areas, it was difficult to gain the support of the local government . Both Jhpiego and PKKK recognized the need to adapt their strategy and seek alternative entry points . They focused on raising awareness among young people about SRHR by partnering with the Department of Education and collaborating with a national high school This approach allowed them to effectively reach their target audience despite the initial setback

The key learning from this experience is the importance of customizing strategies when encountering obstacles .

The project experienced a slight delay at its inception due to the COVID-19 pandemic, which necessitated halting activities. To address this, a no-cost extension was granted. All implementing partners reported no complaints regarding the revised timeline, noting that the no-cost extension facilitated smoother implementation of activities. By the time of the evaluation, all activities had been completed, and no activities were pending.

The project was initiated in 2018 in terms of design, but actual operationalization began in 2019. Just as the project was about to commence, the COVID-19 pandemic struck globally, creating significant challenges for full operationalization. Like all organizations and individuals, it took some time to adapt to the changing context, as this health-related global pandemic was unprecedented. Despite these challenges, the project navigated its pathway and adopted adaptive management to find a viable way to run the project under these circumstances. Organizations, including Jhpiego and CSOs, adapted to remote modalities for meetings and running sessions. Partners perceived this flexibility as a positive adaptive strategy - they emphasized that such adaptability should be considered in

future project designs as a contingency plan. However, partners also noted that in harder-to-reach areas with limited internet access, remote modalities did not always work effectively—especially in cases where groups had to travel to central locations to access the internet, which was particularly difficult during movement restrictions, highlighting the importance of tailoring solutions based on local realities to ensure inclusivity and smooth project implementation.

In terms of learning around efficiency, the evaluation found that Jhpiego hiring a regional coordinator culturally aware and knowledgeable of local context significantly improved coordination. This approach leveraged the coordinator’s established community connections and local cultural knowledge, leading to more effective project implementation and respect for local customs and religious practices.

The project’s results might have been more significant if not for the COVID-19 pandemic, which hindered the adoption of FP methods and access to SRHR services. The pandemic led to a shift in focus towards immediate crises like vaccination efforts. Consequently, a no-cost extension was granted to address these setbacks and allow more time to achieve the project’s objectives.

3.5 Coordination and partnership

Collaboration with Oxfam Pilipinas:

Firstly, the collaboration with Oxfam Pilipinas is highly regarded by all partners. “They have been there for us whenever we need,” reported UnYPhil Women. Similarly, PKKK noted, “OPH has been extremely responsive to our needs and in coordination all the time.” The consensus among the partners was that OPH’s constant support was invaluable. The perception of OPH as “supportive and helpful” was prevalent, highlighting their continuous communication with the implementing partners. The assurance that OPH was always available for assistance fostered open communication, making it easier for partners to work with them. AMWA, one of the implementing partners, highly appreciated OPH’s support in improving their financial management system. “When they visit our office once a year, they teach us how to best mobilize resources efficiently and help us reset our practices, which has been very helpful for us,” cited the Program Officer of AMWA.

Coordination with Oxfam Canada:

Coordination with Oxfam Canada occurred primarily through some meetings, with direct coordination facilitated by Oxfam Pilipinas. According to the OCA, engagement with OPH and Jhpiego was handled on an ad-hoc basis. This sometimes led to delays in communication and information flow, as updates were often received later through reporting rather than in real time. The OCA recommended a more systematic structure instead of the ad-hoc approach. Despite this, the team demonstrated strong capability in managing partners and effectively addressed any questions or queries.

Coordination with other stakeholders:

Additionally, partnerships have been established with various stakeholders, particularly LGUs and local agencies like RHUs, women and children child protection desk etc. Partners like UnYPhil Women, SIKAP, FPOP, and PKKK highlight the active coordination with LGUs and RHUs in the delivery of the project. The emphasis is on collaborative efforts where stakeholders are engaged in implementing the project. “We updated LGUs with monthly progress, and they have been extremely supportive in dealing with pertinent issues like teenage pregnancy,” cited FPOP representative. Regular updates to LGUs would reinforce and influence them the prioritize the issue and include them in their planning.

Coordination also extends to agencies such as the Women and Children Protection Desk, tailored to meet the specific needs of the activity. There were also noted collaborations with national and regional DoH from SIKAP Inc. Moreover, there is collaboration with the influencing individuals, especially local leaders, including Muslim Religious Group and Indigenous Population leaders, and local schools and local health boards.

Coordination with RHUs, MHOs, and PHOs. PHOs, in their interviews, noted solid collaboration with Jhpiego, where the regional coordinators have been the focal points for any communication and support. Jhpiego’s support to the PHO has been noted as “very supportive and articulative” when they have any questions or encounter any issues.

In terms of coordination, most partners, including Jhpiego, PKKK, SIKAP, and UnYPhil Women, emphasized the importance of coordination from the local to the regional level. Currently, the working relationship is very strong at the barangay and municipal levels, extending even to the provincial level. However, there is a need to strengthen coordination at the regional and national levels. Although not mandated in the project, this enhanced coordination is necessary to intensify efforts. For example, in the BARMM region, UnYPhil Women noted that a new law prohibiting child marriage has been approved at the national level. However, regional influencers and personnel oppose it, as they believe it contradicts Islamic principles. In such situations, coordination at the regional level becomes crucial.

However, there is a need to strengthen coordination at the regional and national levels. Although not mandated in the project, this enhanced coordination is necessary to intensify efforts. Without strong regional support, local ordinances and policies may face barriers in terms of resources, capacity, and alignment with national priorities. As an entry point to engage in regional coordination, the local implementing CSOs can leverage local successes- more of positive outcomes and lessons learned as case studies to showcase effectiveness; there can be regional partnership with regional authorities and networks; and there can be hosting of regional forums and workshops where both local and regional stakeholders can discuss shared challenges, policy gaps, and opportunities for collaboration. Similarly, PKKK and Jhpiego also identified a missed opportunity in not fully engaging in national-level advocacy. While there was some representation from national agencies, such as the Women’s Commission and the Department of Health and Department of Social Welfare and Development, in PCT Meetings, these efforts were not sufficiently intensified at the national level.

3.5.1 Cross-Sharing and Learning Among Partners

The PCT meetings served as a platform where partners can learn from each other and facilitate cross-learning sessions. During these meetings, partners shared their challenges and best practices. There have also been instances where partners from Pillar 2 have invited Pillar 1 partners to showcase their best practices. An example of effective cross-learning is how AMWA incorporated a practice from another partner, which involved developing religious sermons and messages and turning them into booklets. AMWA reportedly used the booklet to sensitize the community and when the concept of SRHR aligned with religious sermons were communicated, the community was positively influenced by positive messaging.

The SHE project also facilitated valuable exchanges between partners. Specifically, in Bukidnon and Bicol, Pillar 1 partners engaged in learning visits, where they observed and learned from each other’s strategies. These visits provided a platform for partners to exchange ideas and practices, leading to the adoption and adaptation of successful strategies across different regions.

There is a synergistic relationship between Pillar 1 and Pillar 2 partners, where Pillar 1 partners support Pillar 2 as needed. For instance, UPCWGS partnered with AMWA to conduct their Muslim

Cross-Affiliated Learning Between Local CSOs and Jhpiego:

The coordination of Jhpiego with other CSO partners was limited to the PCT meetings These meetings provided a platform for partners to receive updates on ongoing activities and initiatives promoted by Jhpiego, which could complement the work of Pillar 1 partners . The collaboration between local CSOs and Jhpiego enhanced both demand and supply side parameters in promoting SRHR . During learning-sharing sessions, such as Outcome Harvesting, Jhpiego commended how they could hear community perceptions through the voices of local CSOs, despite their primary focus on capacitating health service providers

“We felt that we were offering genderresponsive trainings to the RHU and health service providers, but it was from the local CSOs that we tapped into the community’s perception of what they perceived as genderresponsive services,” Jhpiego noted

This insight helped strike a balance in addressing both demand and supply side parameters Crossaffiliated learning sessions, whether during PCT Meetings or Outcome Harvesting sessions, facilitated this balance, enriching the project’s overall impact and effectiveness .

sectoral creative workshop, and also partnered with PKKK to do the negros oriental creative workshop with adults. Similarly, WGNRR partnered with MIDAS during the May 28 campaign for SRHR dialogue.

Outcome harvesting was considered significant by several partners, including MIDAS and Jhpiego. “It was the first time we had something like that done,” they remarked. “It helped us track the actual changes and explore what led to these changes together with the team. This exercise has facilitated valuable learning for us.”

From the OCA’s perspective, there was room for greater learning and sharing opportunities for a project of this scale. Implementing annual learning meetings or sessions could have enhanced knowledge exchange and overall project effectiveness.

3.5.2 Synergy Between Pillar 1 and Pillar 2

The outcomes under Pillar 1 and Pillar 2 work synergistically within the organization, creating a cohesive approach to achieving its goals. The synergy is evident as Pillar 2 outcomes have been crucial in equipping partners with the necessary conceptual clarity and capacity in SRHR concepts and themes, which they then apply in community interventions under Pillar 1. Specifically, the CAT4SRHR tool was particularly significant in this context, providing the necessary framework for understanding and applying SRHR concepts effectively. The importance of this synergistic relationship was echoed by partners, with one stating, “CAT4SRHR under Pillar 2 deepened our understanding; all that we provide to the community is because of Pillar 2.” This highlights how the outcomes of Pillar 2 have been foundational in informing and guiding the efforts under Pillar 1, ensuring that community-level interventions are both informed and impactful. Moreover, the engagement of other CSOs and WROs under Pillar 2, such as WGNRR and UPCWGS, in knowledge generation and advocacy skill enhancement, has been contributory for Pillar 1 partners. UPCWGS and WGNRR often consulted Pillar 1 partners for their strategies and messaging in terms of influencing and knowledge generation through consultations.

The exchange of knowledge and learning between Pillar 2 and Pillar 1 partners has been valuable to some extent, though no clear evidence was gathered in the evaluation to show how the efforts of other Pillar 2 partners, such as UPCWGS, were translated into the actions of Pillar 1 partners. In line with the outcome on knowledge generation, a learning workshop led to the documentation of learning materials, but more regular strategic sessions would be beneficial.

The advocacy work conducted under Pillar 2 is also inherently synergistic due to its partnership with local CSOs. The efforts made at the national and provincial levels have a direct impact on local advocacy, creating a ripple effect that influences grassroots initiatives. However, it is crucial to recognize that national and provincial advocacy efforts cannot achieve their full potential in isolation. They rely on strong local advocacy and campaigns to be truly effective. The involvement of local CSOs is essential to ensure that these broader efforts are grounded in the realities of the communities they aim to serve. While there is evident potential for synergy between the levels of advocacy, this connection needs to be strengthened and more explicitly recognized to maximize the impact of the SHE project. Despite the potential linkage between national-level policy change efforts and local-level policy changes, the evaluation found no evidence of integrated advocacy. Such efforts would help reinforce synergies.

3.6 Sustainability

The SHE project demonstrated several sustainability elements that were particularly effective and should be continued. One key aspect was the investment health service providers, including midwives and barangay health workers. This investment has shown strong evidence of how the intervention can be sustainable by ensuring that health providers are well-equipped and knowledgeable to continue their work beyond the project’s lifespan.

Additionally, the emphasis on community education has been instrumental. The education and training provided to the community have had a lasting impact, empowering individuals with the knowledge and skills to sustain the project’s objectives.

The adolescent health-friendly centres established within the community will continue to serve the population, and the enhanced capacity of health workers will be sustainable.

One of the other crucial aspects of sustainability is the level of engagement with LGUs. Positive instances have been noted in various regions, reflecting varying levels of support from local governments. In Sorsogon, the PHO highlighted that one of the local lawmakers, a board member, has been instrumental in advancing adolescent health by introducing a relevant policy. She played a crucial role in formulating an ordinance to establish adolescent-friendly facilities, significantly strengthening their implementation and support within the community. This ordinance has elevated the priority of adolescent-friendly services for the local government, ensuring these services are no longer neglected by some municipalities but are recognized as essential. The government’s focus on safe motherhood programs and FP further reinforces comprehensive support for critical health areas. In contrast, regions in BARMM show a different level of engagement. In the case of Bongao and Sapa-Sapa, there is positive engagement from the LGU. It was emphasized how the LGU is prioritizing the issue of SRHR and has embraced the idea of peer educators. One partner cited, “In the current context, we have only 10 peer educators trained from 10 barangays, but the plan of the government is to train them across all existing 35 barangays and mobilize them,” signalling positive buy-in from the LGU, which leads to the sustainability of these efforts. Apparently, the LGU has also made a positive commitment to launching teen centres, which are similar to the concept of AFHF, at the school level. This recognizes that adolescents are more comfortable exploring information about SRHR at schools rather than visiting health centres. Similarly, in Caraga, LGUs have begun integrating similar programs into their annual plans, demonstrating a commitment to long-term support. The LGUs have actively contributed by providing facilities, financial assistance, and budget allocations, ensuring that the initiatives have the resources needed to thrive. Despite the positive enthusiasm, some LGUs reported facing budget allocation limitations. For instance, in the case of Ganassi, while the local government is supportive by providing venues for activities, there is no dedicated budget allocation from the local government itself. Instead, there is a reliance on external actors to fund these initiatives.

Additional sustainability efforts can be seen where SHE peer educators leverage existing mechanisms within LGUs in their respective municipalities to gain recognition and legitimacy as organized groups for SRHR promotion and GBV prevention. For instance, as noted in the Year 5 Annual Report, the Mobo Youth Health and Empowerment Association (MYHEA) was officially registered with the Department of Labor and Employment (DOLE) on March 17, 2023, following its accreditation by the Sangguniang Bayan of Mobo on August 31, 2022. A three-year operational plan, covering 2023-2025, is already in place.

To effectively engage LGUs, it is crucial that these partnerships continue to strengthen through various activities and learning initiatives. LGUs can serve as partners in SRHR advocacy alongside the Local Youth Development Council and the National Youth Commission. Collaborations with the LGU and other accreditation agencies help formalize access to available resources and training opportunities.

Regarding the positive changes in mindset, while the awareness created is likely to persist, the ongoing momentum for spreading this awareness depends on the peer educators. Although peer educators are in place to sustain these efforts, the sustainability of their volunteerism remains a concern. The challenge lies in maintaining their enthusiasm over time. Though in the discussion, the peer

Sustainability Through Partnerships:

MIDAS highlighted the project’s approach to sustainability, emphasizing the role of partnerships established over time . They stressed that sustainability is ensured through the strong collaborations with LGUs at municipal and barangay level, and existing community mechanisms, such as schools and RHUs . Ownership of the initiatives has been effectively transferred to these established mechanisms . MIDAS noted that these partnerships have demonstrated equal commitment to carrying the initiatives forward The relationships built throughout the project have been instrumental in supporting sustainability from day one

educators are enthusiastic about continuing their volunteerism, as they recognize the value of what they have gained in terms of personal growth and agency building. They see themselves as change agents and are committed to sustaining this role.

In Northern Mindanao, participants expressed confidence that the positive attitudes toward SRHR will be sustained, thanks to the ongoing efforts of Commission on Population and Development, the local community facilitator, and the Gender-Based Violence Watch Group. These entities play a vital role in maintaining and advancing the progress made in SRHR awareness and advocacy within the community.

Positive examples of sustainability and continued impact for Pillar 1 partners

1. There are already promising cases indicating sustainability. As shared by UnYPhil Women, there is a strong sense of ownership among young advocates from BARMM. Their commitment has persisted, thanks to the meaningful participation of facilitators and peer educators, fostering a deep sense of ownership. To sustain their activities, they have formed partnerships with LGUs and have a close connection with the Local Youth Development Office, which has a minimal budget. They plan to tap into this budget to continue their efforts. Moreover, young advocates have taken the initiative to form partnerships independently, such as with the Department of Environment and Natural Resources. One notable initiative involves re-enrolling out-of-school children back into school, for which they receive 305 seedlings as appreciation. This incentive has motivated them and signals sustainability. These examples highlight the effectiveness of fostering ownership and initiative among young advocates, ensuring the continued success of their efforts.

2. In Eastern Visayas, the legacy of the SHE project continues to thrive, showcasing a model of sustainability and community engagement. Even after the project’s conclusion, peer educators in the region have maintained their momentum by holding symposiums and planning future orientations to recruit new peer educators. Their ongoing involvement in SRH-related activities across barangays reflects their strong reputation and established role in the community.

3. In a remarkable step towards sustainability, the peer educators founded the Nortehanon Youth Advocates (NYA) in February 2020. This organization aims to further SRHR advocacies, particularly targeting the youth. The NYA has already made significant strides, including gaining registration with the Sangguniang Kabataan (SK) and working towards formal recognition from the municipality. In terms of sustaining these impacts, there is support from the SK in the form of funding. Although the funding is modest, it plays a crucial role in operationalizing the group and facilitating small-scale activities. This financial backing, however limited, allows the NYA to continue its advocacy efforts and maintain its presence in the community.

4. Peer educators from Caraga emphasized the sustainability aspect of their initiatives, particularly highlighting the role of the SK as a crucial partner and supporter. They noted that the SK has been instrumental in helping them spread awareness and knowledge among their peers. Through various symposiums and educational sessions led by the peer educators, they were able to secure funding from the SK, even if it was a modest amount. This support from local youth councils like the SK not only validates the importance of their work but also ensures that the efforts to educate and empower the community can continue beyond the immediate scope of the SHE project. Moreover, Community leaders from Eastern Visayas expressed optimism about the future sustainability of SRHR initiatives, noting the crucial support provided by the SK, the local youth council. This support has been instrumental in ensuring that youth, particularly adolescent girls, are increasingly knowledgeable about SRHR topics. The active involvement of SK indicates a strong foundation for the continued empowerment and education of young people in the community.

5. A positive aspect of the project’s model is being tested by MIDAS in Bicol region through their volunteerism program, which is part of their organizational responsibility and social accountability. If MIDAS can effectively conceptualize and advance the concept of volunteerism for sustainability, it could serve as a valuable model for others to learn from and adopt.

6. Additionally, gaining the backing of religious leaders, especially in strictly religious areas like BARMM, has been crucial. Their support is demonstrated by their willingness to allow adolescent SRHR sessions to be conducted in Madrasas and Arabic schools.

The sustainability of the SHE project hinges on several key factors, demonstrating both promising avenues and challenges. In some regions, funding has been successfully secured through ongoing advocacy efforts. For instance, the PHO in Bukidnon has obtained a dedicated budget to sustain adolescent health centres, ensuring that the capacity built among health service providers will have a lasting impact. Additionally, nine other municipalities in Bukidnon have initiated similar training programs for their healthcare workers, incorporating key project components into their local health investment plans. Positive examples of sustainability and continued impact for Pillar 2 partners

7. Many partners, such as AMWA and MIDAS, have integrated CAT4SRHR principles into their strategic plans, missions, and visions. This institutionalization ensures that the capacity built through the project will continue to influence their advocacy and operations even after the project ends.

8. Organizations like SIKAP Inc. and FriendlyCare have mainstreamed SRHR across various projects. FriendlyCare, for example, has integrated SRHR into its mission and vision statements, demonstrating that SRHR will remain a core component of their work. These changes reflect the sustainability of SRHR as a focus area in organizational mandates and daily activities.

9. Partners like DMSFI and FriendlyCare have updated their policies and operational manuals to be more inclusive, incorporating gender-sensitive frameworks and non-discrimination in hiring. DMSFI’s introduction of a genderjust MEAL system and FriendlyCare’s GBV training in clinics highlight their commitment to maintaining gender justice and SRHR efforts beyond the project’s timeframe. These policy shifts are sustainable actions that will continue to impact their work culture and outreach.

10. The research conducted by UPCWGS has already been applied in various ways, such as through the peer education series conducted by OPH and advocacy efforts by PKKK at the barangay level. This demonstrates the ability of the research findings to go beyond theoretical knowledge and be effectively utilized in community-level initiatives. This practical integration is a positive indicator of sustainability, as the research insights are being used by local organizations in real-world advocacy efforts.

11. The Power-Up program successfully enhanced the advocacy capacities of WROs and youth-led organizations. Their strengthened abilities and confidence to advocate for SRHR and GBV prevention are clear indicators of sustainability, as these organizations can now independently drive initiatives and expand their efforts.

3.6.1 Challenges and threats to sustainability

While there have been many successes, there are also challenges to sustaining the progress achieved by the SHE project. One significant concern is the sustainability of the investment in peer educators and influencers. These individuals have been critical in disseminating information and improving behaviours within their communities. However, their volunteer status, especially among adolescents, raises questions about long-term commitment and support.

Peer educators, who often also benefit personally from the project, are expected to continue their educational efforts in the community. However, as volunteers, their sustained engagement is uncertain. For local officials trained by peer educators, there’s a risk of turnover due to elections, which could disrupt the continuity of these efforts. Although women of reproductive age and adolescents who have benefited from the project will remain in the community, ensuring they continue to share their knowledge is uncertain.

Moreover, the transition of adolescents to adulthood poses another challenge, as it is unclear how they will be supported in their new roles. While some barangays have recognized and supported peer educators, ensuring their integration and continued work across all regions remains a concern.

To some extent, the project has built institutions capable of delivering these services, such as schools inviting peer educators to provide comprehensive sexuality education. However, the overall sustainability of peer educators’ work is still in question. Given the voluntary nature of their roles, the extent to which Oxfam can track and support the sustainability of peer educators is also uncertain.

Another potential threat to sustainability is the upcoming re-election of LGU members. While those currently trained and engaged by the project have shown strong support, the uncertainty of who will be elected in the 2025 elections poses a risk. The transition in leadership could affect the continuity and support for the project’s initiatives.

Another threat to sustainability is the attrition of health service providers. To mitigate this, Jhpiego implemented a strategy focused on training regular LGU-employed staff in RHUs. By specifically targeting adolescent-friendly training for those less likely to be transferred, Jhpiego ensured that essential skills and knowledge remained within the community, thus supporting the long-term sustainability of the program.

Under Pillar 2, several threats and challenges to sustainability have been identified. While CAT4SRHR has enhanced organizational capacity, the loss of experienced personnel could weaken organizations if new staff are not equally trained or committed, potentially disrupting progress. Organizations like DMSFI and FriendlyCare have implemented gender-sensitive policies, but there is a risk that these policies may lose prominence over time without continuous monitoring and reinforcement. Furthermore, many initiatives, including training on feminist research and collaborations with Oxfam Pilipinas, have been supported by external funding. The challenge here lies in maintaining the capacity of local CSOs to continue research efforts or apply findings independently without ongoing financial and technical support. Although organizations like UPCWGS have integrated research into their strategies, the institutionalization of this knowledge across all local partners remains fragile. Consistent application and reinforcement of research findings are necessary to ensure their sustainability. Lastly, the seed grants and financial support from the Power-Up program have been crucial for advocacy campaigns, but there is a risk of over-reliance on external funding. Without continued financial resources, these organizations may struggle to maintain or expand their efforts as funding cycles end.

3.7 Impact

Based on the project’s achievements, several positive impacts are anticipated in the community. The notable reduction in unmet FP need among women and girls is expected to enhance reproductive autonomy, leading to improved health outcomes and greater socioeconomic participation. Increased male involvement in FP discussions may also promote more equitable gender dynamics within households.

The decrease in teenage pregnancies and improved attitudes towards SRHR suggest better reproductive health and empowerment among adolescents, potentially leading to improved educational and career prospects. Increased contraceptive use and better SRH knowledge indicate more informed reproductive choices and improved health outcomes. Training for RHU providers has fostered a more inclusive service approach, building client trust.

Youth SRHR education could drive long-term changes in societal norms, reducing early marriage and teenage pregnancies. Promotion of gender equality is shifting traditional roles, leading to healthier relationships and reduced GBV. Women’s empowerment in economic and legal rights is likely to reduce GBV and enhance community safety. Strengthened support systems and referral pathways for GBV survivors, coupled with increased peer educator engagement, are expected to improve case handling and support efficiency. The development of community changemakers will foster sustainable change, while enhanced organizational capacity through CAT4SRHR is driving broader policy and practice improvements in SRHR and GBV advocacy.

Unintended Yet Positive Effects:

While there were several intended changes as a result of the project, there have also been some solid examples of unintended yet positive effects in the community from the SHE project One such instance is the establishment of the SRHR hub at the AMWA project site Although this was not an activity planned by the project, it resulted from the positive change in mindset that recognized the importance of ASRHR for youth . School authorities and community members, including men, encouraged the establishment of the SRHR hub in one of the schools at the AMWA project site

Another unintended yet positive change was the formation of a local advocacy group in the AMWA community This group was not part of the project plan, but internalizing the importance of advocacy for SRHR, a local advocacy group was established . This group comprises students, Barangay Health Workers, teachers, and religious leaders, who are now taking forward local advocacy efforts to promote SRHR and ASRHR in the community .

LESSONS LEARNED 4

Attendees signing their pledges during the unified launching of teen centers at the Ozamiz City School of Arts and Trades on March 22, 2024

CREDIT: JHPIEGO

LESSONS LEARNED

The lessons learned from the project, informed by partners’ experiences, highlight key strategies that have proven effective.

Strategies that worked:

#1 Engagement with youth:

Engaging youth has proven to be a highly effective strategy. Moulding their perspectives early on has yielded positive results. Using adolescent peer educators has created a comfortable environment and space for youth to openly discuss ASRHR. The belief system of young people is still developing, making them eager to learn and internalize new information. Additionally, when youth learn something new, they tend to share it, creating a ripple effect.

In this regard, a strategy that worked in favour of the project was the ability of the adolescent peer educators to win the trust of the youth and adolescents in their communities. This trust was largely built on the shared experiences and similar backgrounds between the peer educators and the community members they were reaching out to. As the peer educators from Caraga shared,

“There is a sense of trust when we reach out to the adolescents. They feel we connect more, and then information gets disseminated better when we link it with practical examples and make them understand the perspectives of different people and how it links with social norms.”

The peer-to-peer approach emerged as a highly effective strategy. This method allowed all groups of peopleto engage with peers of the same age and background, creating a more comfortable environment for discussion and learning. Participants appreciated this approach, as it facilitated easier sharing and understanding. As one participant described, “It was easier to listen and share with peers. I learned additional information from them

because I felt less awkward.” Another strategy that has shown significant promise is the focus on disseminating SRHR awareness in schools. All RHU representatives agreed that moulding the young minds of students through early education is a powerful tool for long-term impact.

#2 Engagement of male members

In promoting and enhancing women’s understanding of their reproductive and sexual autonomy, the project recognized that solely targeting women would not suffice. Since reproductive decisions cannot be made by women alone, but rather must be jointly made by couples, the project emphasized the importance of engaging male members. This approach underscores a key lesson learned: the autonomy of women and girls is not only a responsibility for women themselves but also requires the active support of men and boys. By

Engaging Men as Champions in Bicol:

In the Bicol area, engaging men has proven particularly effective Initially, men were involved by the Population Commission (PopCom) in the area, but their engagement was inconsistent . The SHE project identified this opportunity and re-engaged the same men previously involved by PopCom for sessions specifically directed at men . These men became champions who, in turn, influenced other men in the community . After participating in the sessions, some of them even volunteered to become peer educators . A particularly effective session was “How to Be a Man,” which addressed various situations and responsibilities .

involving men in these advocacy efforts, the commitment to gender equality and the well-being of women and girls is strengthened, fostering a more supportive and harmonious family and community environment.

To address this, the project involved male members in dedicated sessions (Usapan Maginoo) where they were educated on how to contribute to household responsibilities traditionally shouldered by women. They were also taught to support women in making decisions about FP, including the timing and spacing of children. This approach is directly related to the health and future well-being of both mothers and children.

#4 Aligning with religious perspectives and engagement of religious leaders

In regions like BARMM, where there is a Muslim majority, aligning learning with Islamic perspectives has been advantageous. When a concept perceived as westernized is introduced, embedding it within a religious context has helped the community accept it more readily. Linking SRHR education with religious teachings has worked in favour of the project. Verses in the Holy Quran that support responsible parenting and signal birth spacing were tapped into, demonstrating effectiveness.

In areas where actions and behaviours were guided by religion, engaging religious leaders (specifically Muslim Religious Leaders) was one of the strategies to address existing myths and misconceptions surrounding SRHR, including FP. One partner from BARMM cited,

“Since nothing is explicitly stated on SRHR in the Holy Quran, it was upon the religious leaders to change the perception. The word of the religious leaders would be influential in this aspect, in making people believe what is right and what is wrong.”

The SHE Project implemented a strategy of training Ustadjs (Islamic scholars) to address sensitive topics from an Islamic perspective. By incorporating Islamic viewpoints into the discussions, the project has facilitated a more respectful and relevant dialogue on these topics, thereby improving engagement and understanding within the community.

#5 Tailored group sessions for targeted discussions

The strategy of conducting separate sessions for men, women, and youth has proven to be highly effective. Participants noted that the distinct needs and experiences of each group necessitate tailored discussions. One participant from Bicol emphasized,

“The level of experience and applicability varies among men, women, and youth. It is beneficial that the sessions are separate because the discussions are more relevant to each specific group. Additionally, the speaker or facilitator can provide appropriate examples based on the unique experiences and situations of each sector regarding sexual and reproductive health.”

At the same time involving men, women, and children in family conversations has also been a successful strategy. Initially, involving only women did not yield the desired results in SRHR-related decision-making or GBV teachings.

#6 Practical skills for peer educators

One of the most effective strategies identified by the adolescent peer educators was the use of hands-on activities, such as role plays and communication exercises. These activities provided practical experience and reinforced learning by allowing participants to apply theoretical knowledge in real-life scenarios. Additionally, the traineecentred approach, where participants were encouraged to list problems and collaboratively develop solutions, was particularly impactful. Peer educators from Zamboanga Peninsula noted that this method not only enhanced their problem-solving skills but also fostered a deeper understanding of the issues they face in their communities.

#7 Capacity building of partners

One of the strategies that received widespread recognition from all partners was under Outcome 1230, focusing on CAT4SRHR. Partners noted that it was a unique initiative that helped them identify and understand their strengths and weaknesses, allowing them to focus on areas for improvement. Moreover, as previously discussed, partners shared examples where they have adjusted their strategies and operations as a result. Additionally, the comprehensive capacity-building they received through the Comprehensive SRHR training was highly appreciated. This training has been effectively applied in their community-level work, increasing their confidence to carry out SRHR-related activities beyond just family planning.

#8 Quality of care

The project’s focus on enhancing supply-side parameters by making services more gender-sensitive and adolescentfriendly has yielded positive results in gaining community trust. There is a consensus among stakeholders that the emphasis on gender-sensitive services and adolescent care has made many people more comfortable accessing SRHR-related information and services. While it remains to be seen how service-seeking behavior will shift in the coming days, initial findings indicate an upward trend in service utilization.

#9 Leveraging existing community programs

In Eastern Visayas, one of the most effective strategies has been the integration of SRHR education and services into existing community events, particularly those associated with the Pantawid Pamilyang Pilipino Program (4Ps). The 4Ps is a conditional cash transfer program run by the Philippine government, aimed at improving the health and education of poor households. The RHU representatives and peer educators have successfully coordinated with the municipal links to capitalize on these gatherings. During 4Ps events, which are already attended by large numbers of community members, RHU staff and peer educators offer their support by conducting sessions on various health topics, including SRHR. This approach has been instrumental in raising awareness and providing critical health information to families who may otherwise not seek out these services.

Other than the strategies that worked, there were additional lessons learned from the operations and management of the project:

• Enhanced impact of adolescent SRHR education through school-based centers:

One of the lessons learned from the project is that adolescents are very inquisitive about SRHR issues and have a strong interest in the subject. They are more comfortable exploring information at school through adolescent peer educators than visiting at the formal RHU. Although there have been positive results with AFHFs, the impact would be intensified if centres were opened at the school level. Recognizing this, in BARMM the LGU, in collaboration with the Ministry of Education, plans to open teen centres in schools. Similarly, in the case of Buluan, a centre has already been established at the school level through community advocacy. Feedback from adolescents in FGDs across all regions indicates a preference for school-based teen centres. Adolescents shared that they feel comfortable visiting these centres and reaching out to their peers for SRHR-related information. In contrast, they tend to shy away from adolescent centres outside of school, often mentioning that while they haven’t visited, their friends have, signalling a higher level of comfort with school-based centres than external adolescent centres.

• Sustaining efforts through community organizing:

Lessons learned were also specific to organizations like PKKK, which focused on organizing individuals into groups to sustain their efforts. According to a representative from PKKK, it takes years to effectively organize people and communities. “Organizing the community for a cause is at the core of our activities and is in our vein. To achieve this in true essence, anything shorter than 10 years is not feasible,” she stressed.

“It is not just about forming groups and making them perform activities; we need to organize the community so they own their efforts.”

• Enhancing collaboration and unified presentation:

One of the key lessons learned is the importance of close collaboration between implementing CSO partners and the technical partner, Jhpiego. The activities carried out by Jhpiego are complementary or supplementary to those of the CSO partners. Their activities complement each other, but if they operate separately, it can cause confusion. Presenting as a unified front—where both CSOs and Jhpiego are seen as the SHE project, rather than separate entities—improves clarity and strengthens credibility, especially when engaging with local governments and stakeholders. This unified approach fosters greater efficiency and impact.

• Strategic selection of peer educators:

Another successful strategy was the project’s engagement with adolescent and adult peer educators. The adult peer educators were already respected members of the community, often involved in social work, which provided them with a level of acceptance and trust. The partners chose them well and honed their skills, ensuring no issues with trustworthiness Similarly, for adolescents, peer educators were mostly volunteers from schools, making the approach effective in reaching younger audiences.

• Partner engagement and ownership:

Engaging partners from the inception phase through to implementation has proven highly effective. Allowing partners to tailor strategies and contribute to monitoring and evaluation has increased their sense of ownership and led to smoother project execution. This has been key to the project’s success, ensuring that the strategies are well-aligned with local contexts and that partners are fully invested in the project’s goals.

• Strengthening regional coordination:

There is a critical need to strengthen coordination at both the regional and national levels to enhance the effectiveness of policy implementation. While not mandated by the project, improved coordination is essential for intensifying efforts toward systemic change. For instance, in the BARMM region, UnYPhil Women observed that a newly approved national law prohibiting child marriage faces opposition from regional influencers and personnel who argue that it contradicts Islamic principles. This situation underscores the importance of regional coordination to facilitate successful policy implementation.

FGD with adolescent boys in Mobo and FGD with adolescent girls in Buluan

CONCLUSION 5

Barangay Health Worker Renelda Rodrigo shows the free and accessible medicines available at their Barangay Health Center in the Bicol region

CREDIT: NEAL IGAN ROXAS

CONCLUSION

Under Pillar 1, three ultimate outcomes were achieved. The first outcome focused on reducing the unmet need for FP. Data revealed a significant improvement, with unmet need decreasing from 32.3% to 21.9% among women and from 13.3% to 5% among girls by the endline. The second outcome related to teenage pregnancy rates, which saw a notable decline from 2,281 cases in 2019 to 1,598 in 2023, indicating a 30% reduction. The average TPR for all project sites was 18.51 in 2023. Survey results also reflected this trend, showing varied but overall decreased pregnancy rates across different regions. Lastly, the third outcome was an enhancement in positive attitudes towards SRHR and GBV prevention. The index scores for these attitudes improved significantly from baseline to endline, demonstrating increased awareness and support among all demographic groups.

The project’s core achievement under Pillar 1 was markedly enhancing women’s reproductive and sexual autonomy. Through comprehensive education about their rights and decision-making power, women gained significant influence over their health-seeking behaviours, leading to improved use of reproductive health services. In parallel, the project made substantial strides in promoting gender equality. Women reflected a significant shift in traditional gender roles, embracing a more equitable view of responsibilities and rights. Men also experienced a shift in perspective, recognizing the importance of shared household responsibilities and gender equality, contributing to improved family dynamics and reduced gender-based violence.

Additionally, the project succeeded in changing youth mindsets regarding SRHR. Through engaging educational sessions, young people developed a better understanding of their SRHR, leading to a reduction in early marriages and increased willingness to discuss these issues openly. The SHE Project has successfully improved community attitudes and knowledge regarding SRHR. It has facilitated more open discussions between parents and children, expanded acceptance of contraceptive use, and increased health-seeking behaviours among adolescents. Despite progress, challenges remain, particularly in overcoming stigma and conservative views, especially in regions like Northern Mindanao and BARMM.

The project has also made substantial progress in increasing awareness and addressing GBV within communities. By providing targeted training and education, the project has empowered individuals with knowledge about GBV, legal processes, and reporting mechanisms, leading to a greater collective responsibility to combat violence. The project has also strengthened GBV referral pathways by establishing or enhancing MDTs, ensuring more survivor-centric and streamlined support. Community attitudes towards GBV have shifted significantly, with widespread rejection of violence justifications and a decrease in violent behaviours, reflecting a broader movement towards viewing GBV as unacceptable in all forms.

The SHE project has significantly enhanced RHU services, making them more gender-responsive and adolescentfriendly. Through comprehensive training, RHU staff are now better equipped to address the diverse needs of their communities with greater sensitivity and confidentiality.

Under Pillar 2, the SHE Project has made significant strides in enhancing the organizational capacity of its partners through the CAT4SRHR tool, which has proven essential for capacity building and strategic refinement. Partners have demonstrated improved conceptual clarity on SRHR, with notable organizational changes such as integrating SRHR principles into their mandates and developing more gender-inclusive policies. The project has also been instrumental in generating valuable knowledge on SRHR and GBV, as seen in UPCWGS’s extensive research and its influence on local ordinances and training programs. Additionally, WGNRR’s advocacy efforts have led to significant policy-level changes, including the development of critical legislative agendas and local policies. The Power-Up program has effectively strengthened the advocacy capabilities of women’s rights and youth-led organizations, fostering robust networks and enhancing their ability to address SRHR and GBV issues.

The project, designed to address various SRHR challenges across different regions in the Philippines, successfully tailored its interventions to local needs. The project’s relevance is underscored by its success in increasing demand for FP, improving health-seeking behaviours, and enhancing health systems, particularly through engagement with adolescents and youth. The project faced delays due to the COVID-19 pandemic, but adaptive measures and a no-cost extension facilitated effective implementation. Efficient financial management and adequate staffing contributed to its success, although concerns about MEAL staffing were noted. Coordination with local and national partners, particularly Oxfam Pilipinas and Jhpiego, was generally positive, though some issues with regional coordination and duplication of efforts emerged.

The SHE project has laid a strong foundation for sustainability through its investments in local health services, community education, and engagement with LGUs. The training and support provided to health workers and the establishment of adolescent health-friendly centres are crucial elements that promise continued impact. Positive examples include the successful integration of SRHR initiatives into local plans, the creation of youth advocacy groups, and the ongoing support from local councils and religious leaders. However, challenges remain, particularly concerning the sustainability of peer educators, potential turnover in local government positions, and securing consistent funding. The reliance on volunteers and the need for continuous support from newly elected officials and health service providers highlight areas of concern. The project’s success in embedding its activities into local structures and securing commitment from various stakeholders is promising, yet ongoing efforts are needed to address these sustainability challenges.

RECOMMENDATIONS 6

RECOMMENDATIONS

Programmatic recommendations for future programming

1. Future programs should place a deliberate focus on the LGBTIQ+ communities, moving beyond the general inclusion of gender-responsive services to a more targeted approach that addresses their unique needs. While there is evidence that LGBTIQ+ individuals have accessed and benefited from the project’s services, a dedicated strategy is needed to address specific barriers, such as perceived stigma around accessing HIV testing or FP services. Targeted outreach, tailored messaging, and inclusive service delivery models will help ensure that the LGBTIQ+ community feels safe and supported in accessing these critical services.

2. Future programming should prioritize changing negative attitudes towards women’s sexual autonomy by normalizing discussions on sexual rights through culturally sensitive messaging. Media campaigns and schoolbased CSE should target younger audiences, promoting respect for sexual autonomy. Additionally, while couple counselling and relationship sessions are already part of the intervention, they should be further strengthened to foster mutual respect and understanding. Emphasizing women’s legal rights to bodily autonomy will help solidify these efforts.

3. The involvement of religious and faith-based leaders and traditional leaders for IP communities has been instrumental in influencing social norms related to SRH and GBV. Future projects should develop context-specific strategies to engage these leaders across all regions. This begins with mapping key influencers within the community and religious spheres to identify potential advocates for change. Once identified, strategies can include capacity-building workshops tailored for these leaders on SRH and GBV, fostering dialogue between them and health experts, and supporting faith-based messaging that aligns with public health goals.

4. Given the high proportion of teenagers in the target populations, future programming should specifically address the needs and challenges of adolescents aged 10-19. This age group is more amenable to change and has a significant role in future decision-making. While the current project included adolescents, there is a substantial opportunity to deepen engagement, especially in promoting FP and sexual health. Programs should aim for targeted interventions that address the unique needs of this age group to foster long-term behavioural change.

5. Given the high proportion of teenagers in the target populations, future programming should specifically address the needs and challenges of adolescents aged 10-19, expanding the current focus beyond the 15-19 age group. Younger adolescents are more amenable to positive behavioural change and will play a crucial role in future decision-making. While the current project engaged adolescents, there is a clear opportunity to deepen this involvement, particularly in promoting FP and sexual health. One critical area to address is the perceived stigma teenagers face when accessing SRH services, especially regarding contraceptive use and HIV testing. The SHE project has already promoted strategies such as adolescent-centred services, peer education programs, and confidential health service pathways that protect privacy. However, to further overcome barriers, it is essential to focus on winning the trust of adolescents. Strengthening efforts to build trust through consistent, reliable communication, and ensuring that adolescents feel safe and supported when accessing services, is paramount.

6. Engaging parents in SRHR programming is crucial as they significantly influence their children’s decisions. Future initiatives should involve parents more directly, creating a supportive environment where young people can make informed decisions with family guidance. Recognizing the pivotal role of parents, future programs should focus on empowering them to support their children’s education and decision-making. Encouraging parental involvement is essential for preventing issues like early or arranged marriages and helping young people pursue their educational and personal goals.

7. Schools are an effective and neutral venue for reaching adolescents with SRHR education, serving as stigmafree spaces where accurate information is shared and trust is built. To further leverage this, future programming should consider expanding the training on gender transformation to teachers and faculty as well, ensuring that schools foster an inclusive environment. Coordinating with school administrations and the Department of Education to facilitate regular symposiums, workshops, and consistent access to SRHR information.

Policy level recommendations

8. There needs to be a strong push for the integration of CSE into school curricula, as its full implementation remains lacking. Advocating for this at the policy level should be a critical agenda for future projects, ensuring that students receive the essential knowledge and skills they need for informed decision-making regarding their sexual and reproductive health

9. The Adolescent Pregnancy Prevention Bill, which Oxfam is involved with, remains stalled at the senate level. Continued advocacy efforts are needed to advance this bill. Successful passage could lead to significant improvements in adolescent health outcomes and support for prevention measures. Advocacy strategies should be further reinforced to ensure that this critical legislation progresses through the legislative process.

Coordination level recommendations

• Local implementing CSOs should document and share positive outcomes and lessons learned as case studies. This can serve as a powerful tool to showcase effectiveness and build credibility when engaging with regional authorities.

• Develop strategic partnerships with regional authorities and networks to enhance collaboration and resource sharing. This can be done by organizing forums and workshops that bring together local and regional stakeholders to discuss shared challenges, identify policy gaps, and explore opportunities for collaboration. This creates a platform for dialogue and strengthens relationships among stakeholders.

• CSOs should increase their engagement in national-level advocacy efforts. This could involve more robust participation in meetings with national agencies such as the Women’s Commission, the Department of Health, and the Department of Social Welfare and Development. Strengthening representation at the national level is crucial for aligning local efforts with national priorities.

Design level recommendations

10. Future program designs should ensure that the outcomes of each pillar are aligned and contribute to the overall goals of the project. Specifically, outcomes under Pillar 2, such as organizational strengthening through CAT4SRHR, have demonstrated direct synergies with Pillar 1 partners by enhancing their capacities. However, other outcomes related to knowledge generation and advocacy did not show strong direct synergies. For instance, while there was significant knowledge generation, the translation of this knowledge into capacity building for Pillar 1 partners to sustain and generate their own knowledge was unclear. Similarly, integrated advocacy efforts between Pillar 1 and Pillar 2 partners were not evident. Establishing clear linkages and mechanisms for regular communication and collaboration between Pillar 1 and Pillar 2 partners can amplify the impact. Effective integration of advocacy and knowledge generation across pillars can lead to more cohesive and impactful outcomes. To ensure stronger synergies between Pillar 1 and Pillar 2, future program designs should involve both partners from the outset. Co-designing the Theory of Change can help identify interlinkages and ensure that knowledge generation and advocacy efforts from Pillar 2 directly support and capacitate Pillar 1 partners. Regular joint planning and integrated reporting mechanisms should be established to maintain alignment and foster collaboration.

11. Future program designs should balance breadth (reach) with depth to enhance overall effectiveness. While broad reach is important for widespread awareness, achieving meaningful impact on complex issues like SRHR and GBV requires deep, sustained engagement. Future interventions should focus not only on expanding the number of participants but also on fostering deeper, more impactful interactions. This involves prioritizing repeated, in-depth engagements and long-term involvement with participants to build a stronger and more lasting change in social norms and behaviors.

12. Future programs should more deliberately integrate men and boys into their design, particularly as targets for accessing FP services and measuring behavioural change. While the current project successfully engaged men and boys in shifting mindsets and attitudes, it lacked specific indicators to track their participation in accessing FP services or frequenting RHUs. Future programming should include clear objectives and pathways for engaging men and boys in a more targeted manner, ensuring their behavioural shifts towards FP and reproductive health are actively measured and captured.

Management level recommendations:

13. When two core implementing partners, such as Jhpiego and OPH, are managing a project, it is crucial to have a robust coordination mechanism in place. Effective coordination ensures that both partners are aligned in their efforts, share relevant information promptly, and work collaboratively towards common objectives. A formal coordination meeting involving all implementing partners and the OCA would have been beneficial. This approach would ensure that all parties are aligned and aware of each other’s activities and directions. It would enable OPH and Jhpiego to collaborate more effectively rather than working in isolation. Additionally, joint analysis during report submission could have been improved, allowing for a better understanding of how outcomes from one partner impacted the other. Some of the mechanism that can be employed are:

• Schedule periodic joint planning sessions between partners to review progress, align on strategies, and address any issues.

• Develop an integrated reporting system where both partners contribute to a single, cohesive report. This can include shared templates for real-time tracking of key metrics and outcomes.

• Implement feedback loops where partners can regularly provide input on each other’s work through debriefing sessions and review meetings.

• Develop a stakeholder mapping and engagement plan to identify key stakeholders, their interests, and how both partners can collaborate effectively to engage them.

14. In light of the challenges faced during the COVID-19 pandemic, future projects should be designed with built-in flexibility and adaptability. It is essential to develop project plans that can be adjusted based on real-time feedback and changing circumstances, which includes the ability to revise timelines, reallocate resources, adjust and revisit targets and indicators, and modify strategies as needed. Additionally, a tiered approach to service delivery should be implemented, where critical services are prioritized while less urgent services are scaled back or modified according to current conditions. Establishing clear protocols for rapid response, including pre-defined contingency plans for service delivery, resource allocation, and stakeholder communication, will ensure projects remain resilient and effective in the face of unforeseen events.

15. To improve the M&E system, strengthen the development of a robust participant tracking list and standardized procedures for all M&E activities. A well-defined M&E framework should guide data collection, analysis, and reporting, enabling more informed decision-making and improved project outcomes. It is crucial to communicate these guidelines clearly to all partners to ensure consistency, avoid overlapping monitoring activities, and enhance coordination. Implementing a clear timeline for M&E activities will further support planning efficiency and alignment across all stakeholders.

ANNEXES

ANNEX I: Policy level changes

Title of Ordinance/Policy

Municipal Ordinance No . 05 Series of 2020: An Ordinance Mandating the Establishment of the Barangay Violence Against Women (VAW) Desk for All Barangays in the Municipality of Mobo.

Municipal Ordinance No 05-2022: An Ordinance Mandating the Establishment of the Barangay Violence Againts Women (VAW) Desk for all Barangays in the Municipality of Mobo.

Municipal Ordinance No . 03-2023: An Ordinance Institutionalizing the Anti-Gender Based Violence (GBV)Referral System, Creating Mechanisms of Implementation and Appropriating Funds Therefore and Providing Penalties for Violations Thereof in the Municipality of Mobo.

Ordinance No 10 Series of 2023: An Ordinance Institutionalizing Key Assistance for Developing Adolescents in the provision of Comprehensive Adolescent Sexual Health and Reproductive Health Services in the Municipality of Sta. Margarita, Samar and providing funds thereof.

Ordinance No 26 Series of 2023: An Ordinance Institutionalizing Key Assistance for Developing Adolescents in the provision of Comprehensive Adolescent Sexual Health and Reproductive Health Services in the Municipality of Victoria, Northern Samar and providing funds thereof.

Resolution No . 158 Series of 2024: Localizing Executive Order No. 12 series of 2017 by Attaining and Sustaining “Zero Unmet Need for Modern FP’ through the strict implementation of the Responsible Parenthood and Reproductive Health Act in the Municipality of Victoria, Northern Samar and providing funds thereof and for other purposes.

Ordinance No . 2021-056: Gender and Development Ordinance of the Municipality of San Isidro, Northern Samar.

Executive order No 6 Series of 2024: Creating the Municipal Adolescent Health and Development Program (AHDP) Council in Victoria, Northern Samar.

Executive order No 05-A Series of 2024: Creating an implementing team of RA 0354 otherwise known as the Responsible Parenthood and Reproductive Health Act of 2012 in the Municipality of Victoria, Northern Samar

Executive Order No 05-B Series of 2024:Establishment and Mobilizing Information and Service Delivery Network for Adolescent Health and Development in the Local Government of Victoria, Northern Samar.

Executive Order No . 9A Series of 2023: An order Reorganizing the Composition of Municipal Council for the Protection of Children of the Municipality of Sta. Margarita, Samar.

Ordinance No 18-22: A municipal Revised Ordinance Enacting the Welfare Code for Children of the Municipality of Sta. Margarita, Samar.

Municipality / Barangay Status

Mobo, Masbate Implemented

Mobo, Masbate Implemented

Mobo, Masbate Implemented

Sta Margarita, Samar Implemented

Victoria, Northern Samar Implemented

Victoria, Northern Samar Implemented

San Isidro, Northern Samar Implemented

Victoria, Northern Samar Implemented

Victoria, Northern Samar Implemented

Victoria, Northern Samar Implemented

Sta . Margarita, Samar Implemented

Sta Margarita, Samar Implemented

Gender and Development Code of Sta Margarita, Samar, Victoria and San Isidro, Northern Samar

Sta Margarita, Samar, Implemented

Victoria, Northern Samar

San Isidro, Northern Samar

Executive Order creating the Municipal Committee on Anti-Trafficking and Violence Against Women and Their Children (MIACAT-VAWC) of the Municipalities of Sta Margarita, Samar and San Isidro, Northern Samar

Executive Order creating the Municipal Council for the Protection of Children of the Municipalities of Victoria and San Isidro, Northern Samar

Sta Margarita, Samar, Implemented

Victoria, Northern Samar

San Isidro, Northern Samar

Victoria, Northern Samar Implemented

San Isidro, Northern Samar

Executive No . DBL 2022-32-A Series of 2022:An Executive Order Establishing Municipal Health Office of Buug and Satellite Barangay Health Station Facilities for Adolescent Ages 10-19 years old Full Development.

Municipal Ordinance No 07-2022: An Ordinance Institutionalizing the Adolescent Pregnancy and Prevention Program of the Municipality of Buug and Providing Funds Thereof.

Resolution No . 13 Series of 2023, a Resolution Adopting the Executive Order no . DBL 2022-32-A Series of 2022 of the Municipality of Buug, Zamboanga Sibugay: An Order Establishing Municipal Health Office of Buug and Satellite Barangay Health Station Facilities for Adolescent Friendly Facilities.

Executive Order No 2023-011: An Order Creating the Municipal Implementing Team for Responsible Parenthood and Reproductive Health (RPRH) Law in the Municipality of Dimataling, Zamboanga del Sur.

Municipal Ordinance No 11-14-2023: An Ordinance Creating the Adolescent and Youth Health Council in the Municipality of Dimataling, Province of Zamboanga del Sur.

Ordinance No . 13 Series of 2023- An Ordinance Amending Ordinance No . 11 Series of 2020: Re-Establishing the Adolescent-Friendly Health Facility in the Municipality of Sumilao, Otherwise Known as Sumilao Adolescent Health and Wellness Clinic (SAHWC).

Municipal Ordinance No 3 Series of 2020: An Ordinance Establishing the “Adolescent and Youth Facility/Teen Center in Dangcagan, Bukidnon.

Department Memorandum Order No. 2014-0313 in Relation to the Implementation of Adolescent Health and Development Program (AHDP) and Establishment of Clarin Adolescent Hub, this Municipality.

Executive Order No 5A Series of 2021: An order amending Section 1 of Executive Order No. 5 Series of 2021 in the creation of the Local Committee on Anti-Trafficking and Violence Against Women and their Children (LCAT-VAWC) in the Municipality of Cagwait, Surigao del Sur [MHO was not a member of LCAT-VAWC based on the former E.O].

Buug, Zamboanga Sibugay Implemented

Buug, Zamboanga Sibugay Implemented

Buug, Zamboanga Sibugay Implemented

Dimataling, Zamboanga del Sur Implemented

Dimataling, Zamboanga del Sur Implemented

Sumilao, Bukidnon Implemented

Dangcagan, Bukidnon Implemented

Clarin, Misamis Occidental Implemented

Cagwait, Surigao del Sur Implemented

Sangguniang Bayan Resolution No 251-21A Series of 2021: A resolution adopting Local Council for the Protection of Children (LCPC) Resolution No. 01-2021 dated June 16, 2021 entitled “A Resolution Requesting the Sangguniang Bayan Member for the Approval of Local Guidelines on Case Management.

Executive Order No . 29A Series of 2021: An order designating a space within the Halfway House of the Municipal Health Office as the Holding Area in pursuant to the mandate of the law in the establishment of crises center/temporary shelter.

Executive Order No 4 Series of 2022: Creation of Technical Working Group (TWG) in Lianga to ensure the operationalization of the Adolescent Health and Development Program (AHDP) and to provide assistance in the formulation and implementation of the relevant policies, guidelines, appropriate actions, and recommendations arising from various adolescent issues and concerns.

Executive Order No 18 Series of 2022: Re-organizing the Adolescent Health and Development Program – Technical Working Group (AHDP-TWG) of the Municipality of Lianga, Surigao del Sur.

Ordinance No . 23-23: An Ordinance Strengthening the Implementation of the Adolescent and Youth Health and Development Program (AHDP), its Mechanisms, and Providing Funds thereto, in the Municipality of Cagwait, Surigao del Sur.

Resolution No 1425-23 Series of 2023 by the Office of the Provincial Council, affirming Ordinance No 23-23 dated October 24, 2023 of the Municipality of Cagwait: Ordinance Strengthening the Implementation of the Adolescent Heath and Development Program (AHDP), its Mechanisms, and Providing Funds thereto”

Ordinance No . 35: An Ordinance Strengthening the Implementation of the Adolescent and Youth Health and Development Program (AHDP), its Mechanisms, and Providing Funds thereto, in the Municipality of Lianga, Surigao del Sur.

Resolution No 1539-24 Series of 2024 by the Office of the Provincial Council, affirming Ordinance No 35 dated November 28, 2023 of the Municipality of Lianga: Ordinance Strengthening the Implementation of the Adolescent Heath and Development Program (AHDP), its Mechanisms, and Providing Funds thereto.

Endorsement of the Manual Of Operation of the Adolescent-Friendly Health Facility (AFHF) of the Rural Health Unit (RHU) of Cagwait by the Local Health Council

Adoption of the Manual Of Operation of the Adolescent-Friendly Health Facility (AFHF) of the Rural Health Unit (RHU) of Cagwait by the Sangguininang Bayan

Municipal Ordinance on the Creation of AHDP Council in Bongao, Tawi-Tawi

Cagwait, Surigao del Sur Implemented

Cagwait, Surigao del Sur Implemented

Lianga, Surigao del Sur Implemented

Lianga, Surigao del Sur Implemented

Cagwait, Surigao del Sur Implemented

Cagwait, Surigao del Sur Approved

Lianga, Surigao del Sur Implemented

Lianga, Surigao Del Sur Approved

Cagwait, Surigao Del Sur Approved

Cagwait, Surigao Del Sur Approved

Bongao, Tawi-Tawi Implemented

Executive Order on the Establishment of AHDP TWG in Buluan, Maguindanao Buluan, Maguindanao Implemented

Policy on Non-Discrimination and Zero-Tolerance Policy on GBV in RHU Buluan, Maguindanao Buluan, Maguindanao Implemented

ANNEX II : Supplemental data from survey

Knowledge about contraceptives

The survey findings reveal varying levels of knowledge about different contraceptives. Most respondents were familiar with male sterilization (77.6%), female sterilization (78.4%), and diaphragms (61.0%). Approximately 42% of respondents reported a good understanding of oral contraceptive pills, while 36.7% had good knowledge of male condoms. only 11.2% felt very knowledgeable about oral contraceptive pills and 10.9% about male condoms. Compared to the mid-term survey, there has been a modest increase in the percentage of respondents confident in their knowledge of male condoms and contraceptive pills. Notably, the proportion of those with good knowledge of condoms rose from 31% to 36.7%, and those knowledgeable about contraceptive pills increased from 29% to 42%.

Implementation of SRHR index

The SRHR index evaluates the implementation of rights related to choosing whom and when to marry, as well as the community’s acceptance of marriage at ages 18 and 16. The overall index score was 76%, with boys scoring 74%, girls 76%, men 77%, and women 77%. The lowest scores were related to girls choosing whom (59%) and when to marry (60%). These scores are lower because the community generally believes that girls should not marry early and are not wise enough to choose their spouse. In contrast, the percentage is higher for women making these decisions. Regarding the acceptance of girls marrying at ages 16 and 18, the index score for arranging marriages at age 16 was -78%, indicating a predominantly negative perception. For marriages at age 18, the index value was -80%, again reflecting a negative score signaling desirable attitude. This suggests the community holds a desirable view, opposing girls getting married at such young ages.

Table 10: Knowledge about contraceptives

Facilities providing gender-responsive SRHR information and services

Availability and accessibility of services in participating RHUs:

1. At baseline, 72% of RHUs offered adolescent/youth care services. By endline, 100% of RHUs had youth-friendly programs due to the SHE project, which created Adolescent-friendly health facility (AFHF) certified by the DOH in all RHUs.

2. All RHUs (100%) offer FP and maternal care services, with 80% having birthing centres.

3. At baseline, 86% of RHUs ensured privacy and confidentiality; by endline, 100% of RHUs maintained these conditions.

4. Registration books and and HEADSSS form are now kept in locked cabinets in all RHUs.

5. At baseline, only 5% of RHUs did not require verbal spousal consent for FP. This increased to 30% by endline. Additionally, 40% of RHUs did not require parental consent for minors seeking SRH services, apart from minors access to FP contraception..

6. At endline, 100% of RHUs had health service providers knowledgeable about contraceptive methods. While 100% of RHUs had condoms, implants, and pills available, over 70% offered IUDs, injectables, lactational amenorrhea methods, and standard days methods.

7. EC services were reported in only 1 RHU, indicating limited availability and awareness. DOH is silent in the specific guidelines on EC that leaves the HSPs confused or erring on the side of caution not to prescribe or dispense.

8. At baseline, 86% of RHUs informed clients they could choose the gender of their health service provider, but this dropped to 65% at endline due to staff turnover. About 25% of RHUs had only female health service providers.

9. At endline, 90% of RHUs ensured IEC materials were available in high-traffic areas, and 65% had IEC materials on GBV and VAWC, up from 43% at baseline.

10. All RHUs (100%) reported that they do not deny or detain clients due to their inability to pay.

Male Engagement and Family Inclusiveness

All RHUs encourage women to bring their spouses or partners to FP and SRH services, enhancing men’s awareness and support for reproductive health. After the SHE project, 100% of RHUs now encourage fathers to accompany their children to clinic visits. Additionally, 70% of RHUs now advertise SRH services for men, up from 52% at baseline, targeting traditionally male-dominated spaces. All RHUs provides male SRH services, including FP counselling and condoms. 90% offer pre-marriage counselling, 40% offer vasectomy, and 90% have referral facilities. 95% of health service providers educate male partners on supporting their female partners and children’s health, promoting joint decision-making in family health. The GTH also has modules on couple’s counselling and on male engagement.

Despite the importance, 43% of RHUs did not meet the standard for couples counselling at baseline, and improvements have been limited since then. Training and accreditation requirements for counsellors have impacted progress.

Health Service Provider-Client Interaction

1. RHUs have established a cordial and respectful relationship with clients. Health providers consistently explain procedures and ensure privacy during visits. While all RHUs maintain privacy and confidentiality, there was one reported incident of a client being left unattended due to a lack of a doctor on duty.

2. At baseline, 43% of RHUs trained providers to be non-judgmental. This increased to 65% after the SHE project. Providers now show a non-judgmental attitude towards all clients, including adolescents and LGBTQIA+ individuals, due to the training received.

3. Post-abortion care has improved significantly. The percentage of RHUs providing post-abortion contraceptive options rose from 43% at baseline to 100% at endline. Providers now offer compassionate, non-judgmental care in line with the Reproductive Health Law.

4. Health providers now routinely ask female clients about their ability to make FP decisions and check for potential risks of gender-based violence (GBV). This practice increased from 86% to 100% and from 81% to 95%, respectively.

5. All RHUs address and correct myths about FP, antenatal care, and other health services using scientific information, ensuring clients receive accurate and supportive care.

Health Care Policies and Facility Management

The percentage of RHUs with written zero-tolerance policies against abuse increased from 24% at baseline to 41% at endline, with documentation and action on abuse rising from 15% to 90%. In terms of equitable compensation for health service providers and staff of the facilities, 44% of RHU managers during the baseline assessment reported that they provide equal pay and benefits for equal work, regardless of gender. This number remained the same during the endline assessment. A greater number of health service providers reported equitable pay and benefits in the facilities, with sixty- one percent (61%) agreeing at baseline and 90% during the endline assessment. Gender equality training availability increased from 10% of RHUs at baseline to 90% at endline, addressing previous gaps in training among staff. The proportion of RHUs with actual feedback systems increased from baseline to 70% at endline, with 52% of clients being informed about these mechanisms. The use of gender-disaggregated data for FP services rose from 81% at baseline to 95% at endline, improving service tailoring and commodity management.

Impact of the SHE Project on Gender Service Delivery

There has been a significant increase in the number of RHUs respecting clients’ autonomy and ensuring that facilities are free from sexual or other forms of abuse. Notable improvements have also been observed in the Health Service Provider-Client Interaction subsection, where providers now establish more cordial and respectful relationships with clients and their companions, and offer enhanced emotional support for post-abortion care. Additionally, the number of RHUs with trained providers on gender issues has notably increased, reflecting the positive impact of the SHE project’s capacity-building activities. These improvements suggest that the SHE project has facilitated changes

in health service providers’ behaviour, including their gender norms, attitudes, and practices. However, there were slight decreases in some criteria, though not statistically significant8. For instance, infrastructure inadequacies and a shortage of IEC materials in some facilities may be attributed to increased client volumes and facility renovations. Moreover, access to emergency contraception and health providers’ knowledge about it have decreased compared to baseline levels, potentially due to restrictive regulations in the Reproductive Health Law.

ANNEX III: Key highlights from Outcome Harvesting Susbstantiation Sessions

OUTCOME

HARVESTING SUBSTANTIATION:

INCREASE IN KNOWLEDGE AND CHANGE IN ATTITUDE

The increase in knowledge and change in attitude were substantiated by all the partners during the substantiation session. Partners shared examples of how there has been an increase in the level of knowledge among community members, especially women and adolescents. The increase in knowledge is well noted in the aspects of reproductive and sexual autonomy of the women and girls. “They are more familiar with their body rights and how they can make decisions about their choices.” Partners like PKKK and FPOP credited peer educators for this change. “The peer educators, especially female, have been instrumental in sharing information about SRHR among the community women, leading to increased knowledge.” Partners like MIDAS and FPOP also credited the awareness sessions for these changes.

Additionally, there were highlights of the increase in knowledge regarding changing the norm of GBV. Initially considered a norm, the women and girls in the community are now aware that GBV is wrong. The knowledge about the role of the multidisciplinary team and how they provide one-stop service is widely internalized in the community. Jhpiego shared that although Islamic religion and FP measures do not traditionally align, the data in the RHU showing an increase in FP clearly indicates that there has been an increase in knowledge about the significance of FP. They credit outreach activities for this change.

OUTCOME HARVESTING SUBSTANTIATION: INCREASE IN HEALTH SEEKING BEHAVIOR

Substantiated in the outcome harvesting substantiation session, facility-level data shows that there has been an increase in the number of people frequenting health facilities to access services. Partners like FPOP mentioned that adolescents are visiting AFHF to acquire ASRH-related information. Moreover, the number of FP acceptors has increased. One of the partners (FPOP) in the OH substantiation session shared that there are cases where adolescents anonymize themselves and reach out to peer educators to inquire about how to get HIV testing. This indicates an increase in inquisitiveness, resulting in adolescents also showing health-seeking behaviours. FPOP particularly credits adolescent-friendly services for this change, as well as the services provided at the school and community levels by adolescent peer educators.

Partners like PKKK and MIDAS also credited the project for supporting the supply-side parameters, with support from Jhpiego. PKKK in the OH substantiation session shared how health-seeking behaviours is influenced when the relationship between couples becomes healthy, and couples together start seeking FP measures. They credit this

to the Usapan sessions and family sessions they run with the couples. Jhpiego shared data indicating an increased number of people seeking health services. Support to improve the supply-side indicators, such as competency-based training provided to health service providers, outreach activities carried out by local CSOs, and gender transformation and youth-friendly training, have been credited in this regard.

One of the challenges noted in terms of health-seeking behaviours is that the tracking of the number of males seeking health services for SRHR is not being conducted, despite efforts to include them in support activities. Although they are not the primary focus, it remains important to track and address their health-seeking behaviours.

OUTCOME HARVESTING SUBSTANTIATION: HEALTH SYSTEM STRENGTHENING

One of the key outcomes of the project has been supporting the strengthening of supply-side parameters, including building the capacity of health service providers. By providing competency-based trainings, gender-transformative trainings, and youth-friendly trainings, the capacity of health service providers has increased. Jhpiego shared that, according to GSDS data, 19 out of 20 health facility centres targeted by the project fulfilled 80% of the standards aimed at measuring the extent to which they offer gender-responsive and youth-friendly services. This is evidence of how the system has been strengthened. Compared to the baseline, where only one health service centre fulfilled the criteria, this is a huge achievement.

Local CSO partners validated this assertion and corroborated by saying they have heard positive word of mouth from community members who note a positive shift in how services are provided now compared to before. Specific mention was given to the adolescent-friendly centres supported by the project, which were highly accredited for offering a safe space for youth and adolescents to discuss matters related to ASRH.

One noteworthy example was shared by PKKK, where partners mentioned how the concept of adolescent-friendly services has been localized at the barangay level from the municipal level, showing that the LGU and community had high buy-in and saw the benefit. In the case of Bicol region, MIDAS shared examples from Prieto Diaz reaching level 2 in the competency of RHU operations.

OUTCOME HARVESTING SUBSTANTIATION: ENHANCED ORGANIZATIONAL CAPACITY

The local implementing partners acknowledged in the outcome harvesting substantiation session that the project has been instrumental in increasing their knowledge base and understanding of SRHR. Some partners noted that initially, their focus was only on “FP” and they were not familiar with the comprehensive SRHR package. However, they owe it to the training and capacity-building activities provided by the project that they now have a sound understanding of SRHR and confidence in implementing a comprehensive SRHR project. Partners shared how they are the pioneers in implementing comprehensive SRHR projects in their community, and they credit this to the capacitybuilding provided by the project. PKKK, on the other hand, shared how they have been advocating from local to provincial levels due to the capacity provided by the project in advocating for SRHR-related issues. The CAT4ARHR assessment tool was equally emphasized in helping the organizations understand their current standing, resource mobilization plan, and the areas they need to focus on. In terms of capacity enhancement, partners like FPOP, MIDAS, and Jhpiego also credited the PCT meetings for facilitating cross-affiliation learning from each other, which contributed to capacity building at the organizational level.

The capacity enhancement of the implementing partners, including CSOs and Jhpiego, was significantly supported by the project. Jhpiego commended the project for providing support beyond CAT4SRHR, noting that they received numerous technical invitations to meetings conducted by OPH and OCA, which served as valuable learning platforms. Additionally, there were regular capacity-building engagements focused on community-based monitoring and enhancing the financial management of CSOs. These efforts collectively strengthened the partners’ abilities to implement and manage the project effectively.

ANNEX IV: Breakdown of activities under CAT4SRHR

4 Domain 1 - Capacity-Strengthening, Awareness-Raising, and Community Mobilization for SRHR: A total of 19 activities were implemented under this domain. These activities focused on building the capacity of stakeholders, raising awareness within communities, and mobilizing collective action for SRHR-related issues.

4 Domain 2 - Health and Social Support Services: 13 activities were carried out to enhance the delivery and accessibility of health and social support services, particularly for women, adolescents, and marginalized populations.

4 Domain 3 - Advocacy and Influencing: The project engaged in 8 activities aimed at advocating for policy changes and influencing key stakeholders to support SRHR and gender-responsive programming.

4 Domain 4 - Structures and Processes for Inclusion and Gender Justice: This domain saw the most substantial engagement, with 22 activities focused on developing and strengthening systems, policies, and processes that promote inclusion and gender justice.

4 Domain 5 - Networking and Expanding the Sphere of Influence: A total of 7 activities were dedicated to building networks, partnerships, and expanding the project›s reach and influence among diverse stakeholders and sectors.

4 Domain 6 - Organizational Resilience and Sustainability: The project implemented 39 activities to enhance the resilience and sustainability of both the organizations involved and the systems supporting SRHR services.

The implementation of the CAT4SRHR activities equipped partner CSOs to effectively coordinate and advocate for the protection and promotion of SRHR and the prevention of GBV. This was achieved through a series of capacity-building initiatives, strategic advocacy, and community engagement efforts across various domains. For example, under Domain 1(Capacity building and training), CSO members participated in comprehensive training sessions on SRHR and GBV prevention, which included technical knowledge on reproductive health, legal frameworks, and human rights. These trainings enhanced their understanding and ability to navigate complex issues and policies related to SRHR, while fostering leadership skills to advocate effectively within their communities. Similarly, under Domain 2 (advocacy and policy engagement), the CSOs were guided on developing targeted advocacy strategies that addressed gaps in SRHR services and GBV prevention mechanisms.