Evaluation of Advocacy Projects of UNFPA s Fifth Country Programme: Summary Report

Transcription

1 Evaluation of Advocacy Projects of UNFPA s Fifth Country Programme: Summary Report Abdullahel Hadi Ehsan Matin M. Showkat Gani Amina Mahbub February 2003 Research and Evaluation Division, BRAC 75 Mohakhali, Dhaka, Bangladesh hadi.a@brac.net 1

2 1. Introduction Although the need of reproductive health care in reducing maternal mortality and morbidity has been widely reported, women have little control on their sexuality and reproductive decisions in the most developing countries. This inability of women has direct impact on fertility, maternal morbidity, sexually transmitted diseases and neonatal mortality. Although the feminists have long been struggling to improve women s condition, the issues of reproductive rights have been getting recognition in the demographic discourse in only recently. Although sex is natural part of life, ability of women to determine when they should meet to copulate has a strong positive association with the prevention of unwanted pregnancy. The International Conference on Population and Development (ICPD) in Cairo endorsed an agenda for population programmes at the global level focusing on the reproductive health, human rights and women s empowerment among others. All women were declared to have the opportunity to decide freely and responsibly the number, spacing and timing of her children. The rights of bodily integrity, sexual health and freedom from sexual coercion have been formally recognised as the core principles for the first time in history. Gender equity in sexual relations, mutual respect and consent for sexual behaviour were also recognised and endorsed. Although ICPD and others condemn the sexual rights violation and coerced intercourse, the concept of the reproductive rights of women has been hardly known to and recognised by the health providers, opinion leaders and policy-makers in Bangladesh. The government and a few other development agencies in Bangladesh have been trying to promote reproductive rights and gender issues. UNFPA has been providing assistance to Bangladesh since 1974 initially through family planning programmes. Thereafter, emphasis had shifted towards women s health, accessibility and quality of MCH/FP services in the Third and Fourth Country Programmes. In its 5 th Country Programme (CP-V), the overall goal was to contribute to the improvement of the reproductive health and family welfare of the people of Bangladesh. The main purposes of CP-V were to increase the accessibility and utilization of reproductive health services, especially by the hard-to-reach and vulnerable populations, improve the quality of reproductive health services, facilitate positive behavioural changes and create a supportive environment for improved reproductive and family welfare, and contribute to increased national technical capability to implement population policies and programmes. To achieve these objectives, three sub-programs had been designed of which advocacy was considered a major component of reproductive health. UNFPA and the Ministry of Health and Family 2

3 Welfare of the Government of Bangladesh, along with several other ministries of the government and other agencies, jointly carried out these population development projects. The projects began in the later part of 1998 and had come to its completion at the end of 2002 when end of project evaluations took place. This report is the end of project evaluation of the advocacy component of reproductive health care project. The advocacy component of the Fifth Country Programme had a number of subprojects which were carried out by different agencies. The advocacy components, focusing to improve the reproductive health and gender issues, were among the most innovative projects in Bangladesh. The projects attempted to reach a wider audience including policy and decision makers, influential groups who can become advocates for the reproductive health and gender issues, and community members identified as vulnerable and hard-to-reach groups. Public discussions had been very scarce in the media about reaching the goals set in the ICPD in Cairo. Therefore, it was necessary to foster a deeper interest and generate yielding discussions in civil society that would lead to strong, community-led efforts to improve the conditions under which women are raised, educated, married, give birth, obtain health care at home and in their workplaces. It was expected that efforts in advocacy projects would initiate a process of community dialogue and actions to reduce and prevent violence against women, advocate against early marriage and risky sexual behaviours, and promote access to better care during pregnancy and delivery. The programmes were designed to reach a number of target audiences. The underlying idea was that if a critical mass of influential people could act as pressure groups to promote improved reproductive health services in the community, achieving the ICPD goals would then be much easier. These influential groups include men who are policy makers, religious and political leaders, police and security forces, vulnerable and hard-to-reach community groups including women in the industrial sectors, and youths and adolescents. The advocacy component projects were designed to target the above-mentioned influential groups, each component focussing on a particular group of people. This component project consisted of providing advocacy activities through the IEM Unit of the Directorate of Family Planning 2. Purpose, scope and methodology The evaluation of the four projects was conducted separately for each component focusing on project efficiencies, proximate outcome assessment and the effectiveness of the project components. The specific objectives of this evaluation were to: 3

4 assess the knowledge of reproductive health and gender inequality in the participants, understand the behavioral changes in the participants, if any, assess utilization of reproductive health services by target audience and examine the effectiveness of advocacy project components in reaching the goal. Given the terms of reference outlined above and as the project has still a long way to go, it was not appropriate to focus on the contribution of advocates in creating positive environment for equity and women s reproductive rights. Also, the lack of benchmark information and the unavailability of systematic process documents have significantly reduced our scope to address these issues. A combination of several methods such as reviewing relevant documents of the project, sample survey of the participants of advocacy projects and in-depth interviews with key officials were used to collect information for this evaluation. Since there was no baseline information on most of the targeted advocacy project participants, it was difficult to determine any changes after the interventions had taken place in the project except the garment sectors. This evaluation was based essentially on retrospective survey to collect information of the knowledge of reproductive health and gender, behavioral changes, and health service utilization patterns of the target population. The lists of the eligible persons provided by the relevant projects were used as sampling frame for the survey and in-depth interviews. The sample was designed to be representative of UNFPA supported advocacy projects. However, purposive sampling technique was also used to select respondents in some cases. Data were collected in December The research and evaluation division of BRAC has conducted the evaluation of this project. 3. Key findings and implications 3.1 Project efficiencies The project had difficulties in targeting for advocates The targeting the potential advocates was poorly conceptualized and designed. It is not known why garment workers was considered appropriate target of advocacy efforts. While BGMEA has been playing a crucial role, it is argued that the garment factory owners and management 4

5 staff be targeted to be under the advocacy sub-projects of reproductive health education for garment workers rather than the factory workers IEM or advocacy revisiting the project design issues The project should not be called as advocacy for reproductive health and gender equity. The main thrust of the project appeared to be IEM rather than sensitizing the target participants to become and act as advocates. No follow-up of the performance of advocates was designed. Also, the project design had no provision for collecting benchmark information except for the garments sector. Thus, it is very difficult to assess the performance of the project components Searching alternative approach to reach the advocates The project correctly identified the parliament members as advocates since the promotion or change in policy or legislation would require their support. This goal, however, was not materialized. The project should identify alternative means to reach the parliament members and other policy makers Accountability and governance issues should receive more attention Although the Directorate of Family Planning was expected to co-ordinate all components of the project, it seems that the advocacy project has no clear owner. As a result, no coherent and systematic monitoring or follow-up of the performance of projects were designed and implemented. In many instances, the selection of advocates was not appropriate and fair. The provision of perdiem and honorarium played a role in the selection process. It was found difficult to go into details. The outcome of some project activities was not assessed for obvious reasons. These include the effects of the series of overseas study tours on the design and implementation of the projects. The use of funds and remaining balance were not assessed The efficiency of the project could have been better The curriculum used in most of the training and workshop sessions and IEC materials were quite good and appropriate. However, the projects had difficulties in selecting appropriate trainers and facilitators. In many instances, the facilitators were not capable or not well 5

6 prepared to conduct such workshop sessions. The organizers could be more innovative in selecting the venues and facilities, and careful in maintaining the workshop schedules. 3.2 Outcome assessment and effectiveness Advocacy through IEM The advocacy project has produced positive results The project goal has been to initiate a dialogue to change in policy through sensitizing the influential members of the community. The participants included the union parishad chairmen and members, opinion leaders, journalists, businessmen and local government officials. A series of training workshop and orientation meetings were conducted to address the reproductive health and gender issues. Overall, the project has produced desired outcome in terms of raising awareness of those issues. Selection of participants should be done more carefully The participants were not truly representative of the influential groups in the community. They were mostly older men with relatively better education. The proportion of women was negligible in the meetings. Teachers, politicians and officials of the non-government organizations, who had routine public contact, could have been approached to participate in such meetings. The need of reproductive health knowledge has improved but no indication of advocating new insights in the community Although the awareness level has remained poor among the participants, the advocacy played a role in raising the need of reproductive health services. The influential communities had limited opportunity to promote these issues and strengthened the health services further. It is argued that their role as potential advocates should be followed up. 6

7 The community has begun to understand gender inequality and the need of change The importance of female education was regarded as the lasting solution to promote gender equity than any other interventions. Other suggestions like raising women s voice and decision-making were also appreciated by the community. Acceptance of such issues as gender equity and reproductive rights as discussion topics in formal meetings should be considered as significant development for change. Management and implementation of the project should be more professional Average workshop duration was very short to adequately cover most of the topics planned. Only 16.3% expressed their satisfaction about the performance of the workshops. About 47% expressed their dissatisfaction that the session could not begin on time and did not follow the workshop schedule. The organizers should take note from this observation. Identify priority issues to be included in future advocacy programme Although advocacy had a positive role in raising the level of awareness, several issues such as transmission and prevention of STD and AIDS should be more focused in future advocacy activities for the opinion leaders in the communities Involvement of religious leaders Selection of Imams as advocates for this programme was less than appropriate It has been found that relatively aged Imams were largely excluded from the advocacy campaign. Assuming that older religious leaders have relatively wider influence on their communities than their young colleagues, this selection might have implications in advocating the issues like reproductive health and gender inequality. Not all participants were Imams. Also, the actual number of Imams involved in this advocacy project was much smaller than what was claimed by the ITAs. As no monitoring system were in place, such malpractice continued till the end of the project. 7

8 Awareness of gender inequality was very poor among religious leaders The level of education of Imams was very low and probably inadequate to understand many of the reproductive health gender issues. Therefore, the training modules should be revised to become more appropriate for them. Although insignificant in number, Imams have been advocating some of the health issues In some cases, Imams were reported to use their opportunity to promote issues such as STD and AIDS prevention in the community during khutba on Fridays, daily prayers, waj-mahfil, marriage ceremonies and other religious ceremonies. The other issues such as gender and reproductive rights received less priority as advocacy topic in those meetings. This finding should be taken into consideration in designing next phase of advocacy project for religious leaders. Knowledge of antenatal and post-natal care is grossly inadequate The knowledge level of reproductive health services was very poor among the Imams. Only a very small proportion of the religious leaders were aware about the need of adolescent health services and neonatal care even after participating in the project workshops. Use of condom as a method to prevent STDs should be incorporated The Imams had very limited knowledge about family planning methods other than condoms and oral pills. As Islam does not actively promote the use of contraceptives, the use of condom to prevent STD and AIDS is not included in the training curriculum. Management and implementation of the project should be better The workshop duration was very short to adequately cover most of the issues planned. A very small proportion of the participants expressed their satisfaction about the performance of the workshops. In most cases, the session could not begin on time and did not follow the workshop schedule. 8

9 3.2.3 Reproductive health education for garment workers The garment workers were too poor and vulnerable to become the advocates Most of the garment factory workers were young, women and poor. It is unlikely that such a vulnerable group could become effective advocates of reproductive health and gender inequality. The focus should be shifted from them to the owners and managers of the factories. The health workers may be used as volunteers who can disseminate reproductive health and gender related issues to their colleagues. Selection of participants should be done more carefully The members of the internal security forces who joined the project were mostly young men in their mid-twenties with a modest level of education. As a result, their scope to become the advocates was very limited. Senior officials, who had better public contacts and decision making capacity, could have been approached to participate in such advocacy meetings. Knowledge of reproductive health and gender issues has not improved much The level of awareness of reproductive health and gender inequality was poor among the garment workers. The advocacy had no significant positive effects on their knowledge level because the health workers who were expected to disseminate knowledge to workers were not adequately trained to promote the advocacy issues among the garment workers. Advocacy project helped understand gender role among workers Gender variation in preferring child, although still biased towards boys, has reduced among the garment workers. Such difference was negligible but implies that advocacy project had some positive elements to reduce inherent gender bias among women and promote equity. The factory workers should have fair access to knowledge and services Unlike other advocacy projects, the garment workers were not fortunate to participate in training or workshop sessions. Instead, they had access to the health workers only who were poorly trained and had limited capacity to disseminate major features of reproductive health 9

10 issues. It is argued that garment workers should also be given fair access to information and services. Health workers should be adequately trained to become the advocates Among the health workers contacted, only few had a clear idea about safe motherhood, sexually transmitted diseases, their risk factors, preventive measures and treatment. Even fewer of them knew about their role as advocates. As a result, they could not deliver the expected output. It is recommended that they should be adequately trained to become effective advocates for change Advocacy through the training institutes of Ministry of Home Affairs Advocacy project has produced positive results The advocacy workshops were successful in raising the level of knowledge about gender issues among the members of the security forces although the retention of such knowledge is very difficult to maintain. A series of follow-up activities focusing on the practice of such knowledge should be planned to sustain the retention of knowledge. Reproductive health issues should be more focused in the training curriculum Only a very small proportion of the members of the security forces were aware about the need of safe motherhood, adolescent health services and neonatal care. It is recommended that these issues should be given priority in conducting advocacy workshops in the new phase. The issues of STD and AIDS should receive priority for the security forces While the role of multiple sexual contacts in spreading STDs and AIDS was better understood by the security personnel, their transmission processes and the preventive measures were not well understood by most of them. Given that they are more vulnerable to such risk factors than others, it is suggested that transmission of and prevention from such diseases should receive more attention in the advocacy meetings with them in future. 10

11 4. Concluding remarks The advocacy components, focusing to improve the reproductive health and gender issues, were among the most innovative projects in Bangladesh. The government could have done pilot projects with different approaches to assess the strengths and understand the challenges of such programmes before implementing at the national level. The projects attempted to reach a wider audience including decision makers and influential groups who can become advocates for the reproductive health and gender issues. In addition, community members such as vulnerable women and hard-to-reach groups should also be targeted for the project. Overall, the advocacy projects were able to produce positive influences in sensitizing the relevant institutions and participants. This assessment suggests that the current inter-sectoral approach should be maintained and expanded. Non-governmental development organizations, who had large networks and long experience in advocacy and other community development projects should be incorporated in advocacy strategic planning processes and implementing the projects. 11