Mid-term Review of the Somali Joint Health and Nutrition Programme

124 Pages·2016·1.61 MB·English

2015:50 Sida Decentralised Evaluation
Bernt Andersson
Zohra Lukmanji
Hassan W. Nor
Jessica Rothman
Mid-term Review of the Somali Joint Health and
Nutrition Programme (JHNP)
Final Report

Mid-term Review of the Somali
Joint Health and Nutrition
Programme (JHNP)
Final Report
December 2015
Bernt Andersson
Zohra Lukmanji
Hassan W. Nor
Jessica Rothman
Sida Decentralised Evaluation 2015:50
Sida
Authors: Bernt Andersson, Zohra Lukmanji, Hassan W. Nor and
Jessica Rothman
The views and interpretations expressed in this report are the authors’ and
do not necessarily reflect those of the Swedish International Development
Cooperation Agency, Sida.
Sida Decentralised Evaluation 2015:50
Commissioned by The Embassy of Sweden in Kenya
Copyright: Sida and the authors
Date of final report: December 2015
Published by Sitrus 2015
Art. no. Sida61950en
urn:nbn:se:sida-61950en
This publication can be downloaded from: http://www.sida.se/publications
SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION AGENCY
Address: S-105 25 Stockholm, Sweden. Office: Valhallavägen 199, Stockholm
Telephone: [phone]. Telefax: [phone]
E-mail: [email protected]. Homepage: http://www.sida.se
Table of contents

Table of contents ...................................................................................................................... i
Abbreviations and acronyms ................................................................................................. iii
Preface ...................................................................................................................................... v
Executive Summary ................................................................................................................ vi
1 Introduction ......................................................................................................................... 1
1.1 Background .................................................................................................................. 1
1.2 The programme ............................................................................................................ 2
1.3 The evaluation .............................................................................................................. 4
1.4 Methodology ................................................................................................................. 5
1.5 Limitations .................................................................................................................... 8
2 Findings ............................................................................................................................... 9
2.1 Programme design ....................................................................................................... 9
2.2 Effectiveness .............................................................................................................. 12
2.3 Relevance .................................................................................................................. 21
2.4 Efficiency .................................................................................................................... 22
2.5 Risk management ....................................................................................................... 31
2.6 Gender equality .......................................................................................................... 32
2.7 Sustainability .............................................................................................................. 33
2.8 Future programming ................................................................................................... 36
3 Conclusions ...................................................................................................................... 39
4 Recommendations ............................................................................................................ 42
Annex 1 – Terms of Reference.............................................................................................. 44
Annex 2 – Inception report .................................................................................................... 48
Annex 3 - Output 3 indicators assessment.......................................................................... 49
Annex 4 - Assessment of outcome indicators .................................................................... 51
Annex 5 – Results from survey to TCG members ............................................................... 53
Annex 6 – Detailed findings for outputs .............................................................................. 56
Annex 7 – Summary of district field interviews ................................................................... 76
Annex 8 – Data collected on malnutrition and birth spacing clients ................................. 92
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TABLE OF CONTENTS
Annex 9 – Survey to patients ................................................................................................ 94
Annex 10 – MTR schedule and list of informants ............................................................... 92
Annex 11 – Selected reference documents ....................................................................... 100

List of tables
Table 1: The use of the evaluation
Table 2: Districts and health facilities in each Somali zone visited by the MTR
Table 3: Informants interviewed by the MTR
Table 4: Assessment of Output indicators
Table 5: Attributions from JHNP to outcome indicators
Table 6: JNHP budget for outputs and expenditure 2012 - 2016 (MUSD)
Table 7: JHNP Prioritized plan allocations as agreed by the TCG 28 July 2015
Table 8: Comparison of the JHNP and the HCS

List of Figures
Figure 1: JHNP Theory of change
Figure 2: The MTR process
Figure 3: JHNP Governance arrangement
Figure 4: Government survey responses
Figure 5: Health Sector investment through Public System in 2014

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Abbreviations and acronyms

AA Administrative Agent
APR Annual Progress Report
AWP Annual Work Plan
BCC Behavioural Change Communication
BEmOC Basic Emergency Obstetric Care
CEmOC Comprehensive Emergency Obstetric Care
CHW Community Health Worker
CPR Contraceptive Prevalence Rate
DAC Development Assistance Committee
DPT Diphtheria, Pertussis (whooping cough), and Tetanus (vaccine)
EPHS Essential Package of Health Services
EPI Expanded Programme on Immunization
FGM Female Genital Mutilation
FGS Federal Government of Somali
FHW Female Health Worker
FSNAU Food Security and Nutrition Analysis Unit
GAVI Global Alliance on Vaccines and Immunizations
GDP Gross Domestic Product
GFATM Global Fund against AIDS, TB and Malaria
HA Health Authorities
HAB Health Advisory Board
HC Health Centre
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HPER Health Public Expenditure Review
HR Human Resources
HS Health Systems
HSC Health Sector Committee
HSAT Health Systems Analysis Team
HSS Health Systems Strengthening
HSSP Health Sector Strategic Plan
ICCM Integrated Community Care Management
IP Implementing Partner
NEZ North East Zone
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ABBREVIATIONS AND ACRONYMS
NHPC National Health Professions Commission
NWZ North West Zone
IMAM Integrated Management of Acute Malnutrition
JAR Joint Annual Review
JCU Joint Coordination Unit
JHNP Joint Health and Nutrition Programme
LMIS Logistics Management Information System
MCH Mother and Child Health
MICS Multiple Indicator Cluster Survey
MoH Ministry of Health
MPTF Multi Partner Trust Fund
MTR Mid Term Review
NGO Non-Government Organisations
NHA National Health Accounts
OECD The Organisation for Economic Cooperation and Development
PCA Partner Cooperation Agreement
RH Rural Health
RMNCH Reproductive, Maternal, Newborn and Child Health
SBA Skilled Birth Attendant
SC Steering committee
SDRF Somali Development and Reconstruction facility
SOP Standard Operational Procedure
TA Technical Assistance
TCG Technical Coordination Group
THET Tropical Health and Education Trust
ToR Terms of Reference
ToT Training of Trainer
UNICEF United Nations Children’s fund
UNFPA United Nations Populations fund
USAID United States Agency for International Development
VfM Value for Money
WASH Water, Sanitation and Hygiene
WB World Bank
ZHSC Zonal Health Sector Committee
ZWG Zonal Working Group
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Preface
This Mid-term Review of the Somali Joint Health and Nutrition Programme (JHNP)
was commissioned by the Embassy of Sweden in Kenya through Sida’s framework
for evaluations, on behalf of the Steering Committee of the JHNP.
Indevelop (www.indevelop.se) carried out the evaluation in collaboration with the
Benadir University, from June to December 2015. The independent evaluation team
consisted of:
- Mr. Bernt Andersson, Team Leader and member of Indevelop’s Core Team of
Professional Evaluators
- Ms Zohra Lukmanji, Technical Expert
- Mr. Hassan Nor, Technical Expert
- Jessica Rothman, Evaluation Manager and Evaluator
- 17 national data collectors:
 Somaliland: Abdikadir Mohamud Se’ad, Abdisalam Sa’ed Hassan, Mo-
hamud Abdimajid Mohamud, Noura Ali Haddi, Hani Abdi Ali
 South and Central Zone: Dr Alia Hassan Rage, Dr Osman Muhyadin
Abdulle, Mr Abdiqani Ali Ahmed, Mohamed Ahmed Alasow, Abdiaziz
Hashi Abdi, Hussein Shire Jimale, Abdullahi Ali Heyle
 Puntland: Abdifitah Mohamed Yusuf, Ali Mohamed Salah, Qali Abdo
Naji, Iman Mukhtar Isse, Omar Bashir Muse

Ian Christoplos provided quality assurance to the evaluation methodology and re-
ports.
The evaluation manager was Ms. Barni Nor at the Embassy of Sweden. Coordination
was provided by Mr. Raza Zaidi at the JHNP Joint Coordination Unit.
The role of the Steering Committee of the JHNP was to provide leadership of the
Mid-term Review as well as approval of all outputs.

Note: The term “evaluation” and “Mid-Term Review” (MTR) are used interchange-
ably throughout the report.

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Executive Summary
Background
The Somali Joint Health and Nutrition Programme (JHNP) is an UN-led programme
overseen by the Ministries of Health (MoH) of the governments of Somaliland, Punt-
land and the Somali Federal Government together with a steering committee chaired by
UN Resident Coordinator/Humanitarian Coordinator.
The main objectives of this Mid-term Review (MTR) are to assess the progress of
JHNP against expected results as well as assessing the relevance, efficiency, effective-
ness of JHNP. The MTR covers the period from February 2012 until September 2015.
The evaluation has been conducted in four phases (between June – December 2015). In
the inception phase (3 months) the evaluation team clarified the evaluation criteria, the
questions and the scope of the evaluation, and undertook an initial overview of availa-
ble data. The inception report was shared with the evaluation stakeholders for com-
ments and discussion at an inception meeting in Nairobi. During the data collection
phase (4 weeks), visits were undertaken to Somaliland, Puntland and South/Central
Zone, and to organisations‘ headquarters in Nairobi. In the data analysis phase (three
weeks), the collected data was analysed and synthesised and the draft report was pre-
pared.
Effectiveness
Governance and leadership
The main achievements by JHNP so far are the initial set-up of a functioning pro-
gramme structure, including coordination and support to develop policy frameworks
and a planning system. The annual planning processes that have been established for
the Somali health sector include all stakeholders in all elements of planning; including
assessment of the sector, prioritisations, costing, budgeting and follow-up. The process
is still being developed. The planning system provided a foundation for the delivery of
services through the roll-out of the Essential Package of Health Services (EPHS).
Public sector financing is limited and implementation of policies and plans remain
largely dependent on the donors’ financing. The implementation is to a large extent
carried out by the international agencies, such as procurement and distribution of medi-
cines by UNICEF, or NGOs as implementing partners for service delivery.
A functioning programme structure has been set up. The Steering Committee, the
Technical Coordination Group and the Joint Coordination Unit comply with their
TORs. Some of the issues raised in the Governance review in 2014 remain, like the
need for strengthening the health authorities, both in the JHNP governance arrange-
ments and in ownership of the programme, as well as the need for further strengthening
of the zonal level. There are no findings of the MTR that indicate a need for any major
change in the governance structure of the JHNP.
Human resources
The target about training of health service providers is on track to be achieved, but
even if health workers have been trained, neither the programme nor the health authori-
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