As Strong as the Weakest Link

Background:
Government of Malawi (GoM) and NAD signed the first agreement of cooperation in 2002. This initial NAD-GoM agreement has since then been reconfirmed through a series  of agreements, under which NAD has provided technical and financial support to Malawi’s CBR programme with funds from Norad and the Atlas Alliance. The NAD supported CBR programme includes in total four districts, the three Southern Region districts of Machinga, Blantyre and Balaka, and Mzimba (Northern Malawi) which was included as recent as in 2007.

Malawi Council of the Handicapped (MACOHA) is the main implementing agency of the programme. NAD has an additional agreement on organisational development with the umbrella organisation of DPOs in Malawi - FEDOMA.

These current 3-year agreements with both GoM and  FEDOMA were due to expire by the end of 2009, and this, as well as the up-coming long-term planning for the period 2010-2014 , formed the background of this evaluation

Purpose/objective:
The overall purpose of this evaluation was to provide recommendations for strengthening the community based rehabilitation (CBR) programme’s response to persons with disabilities’ needs in Malawi. More than focusing on impact assessments, this evaluation focuses on relevance, efficiency, and coherence, since the evaluation was used as a tool in providing recommendations for improved approaches in the next long-term period (2010-2014).

Specific objectives (extract):
• Relevance of the CBR programme (CBRP) vs. international and national legislations and policies.
• Decentralisation in Malawi and how it will affect the CBRP in the next five years.
• Strengths and weaknesses with particular emphasis at the structural aspects
• Programme management
• Sustainability
• Coherence / connectedness between the programme and other interventions […] and provide recommendations of wider harmonization of all stakeholders involved in CBR 
• FEDOMA in the context of the CBR Programme; on what role it plays and what role it should play
• NAD’s  role in the CBR programme

Methodology:
• Consultation with stakeholders
– Around 130 stakeholders representing all levels; community workers, beneficiaries, DPOs, MACOHA, service providers, ministries, donors
– Individual and (focus) group discussions
– About 40 meetings
• Demonstration of practice
– Service delivery/community work
– District level coordination and support
– Management, monitoring and evaluation
• Document reviews

Key findings:
Relevance legislation – international/national:
• Good alignment (WHO, UN Convention, Africa decade)
• Adaptation of priorities to national/local capacities: The programme is in line with MGDS, but the MGDS is not strong on disability. The programme is well in line with the National policy and draft Bill on equalization, but the policy and bill do not specify details of a CBR programme and structure at district level.
• Main challenge is that key policies are weak or not implemented.

Relevance decentralisation
• CBRP utilises and aligns very well with decentralised structures, but the programme itself is a vertical, parallel structure - reducing the ’status’ of CBR in district
• Weak integration with district M&E

CBR within national resource allocation:
• Ministry resources, recently increased, are not allocated to MACOHA and little to CBR
• Still relatively smaller volumes of government funding to CBR
• Donor directed implementation structures (NAD, CBM, Ministry/Chikwawa)
• Potential confusion of roles ministry/MACOHA
• Potential for resource optimalization in MACOHA

Donor coordination: Geographic coordination is not optimal; makes harmonisation more difficult

Relatively high focus on awareness, but mainstreaming also requires human resources, technical know-how, implementation of policy, financial and managerial mechanisms.

The programmes ability to address different needs:
• Mobility disability and visually impaired relatively better responded to
• Deafness, learning disabilities subject to poorer response. Cerebral palsy an emerging problem – are we prepared?
• Women’s particular needs not always known and met

Programme management: Generally well managed programme. The strongest part is the highly qualified staff & volunteers with high level of committment at all levels – must be kept.

Sustainability:
• Managerially, technically, organisationally sustainable
– but heavily reliant on key personnel
• Structure/design is financially vulnerable
– MACOHA is donor dependent
– Integration in district assembly might be a safer structure
• To make CBRP sustainable and/or upscaleable one needs to experiment with cheaper structures
Implementation of policy & the action plan is crucial

Recommendations:
National:
• Address weaknesses in referral services, towards decision makers and donors.
– Parallel investments in referral services could also be considered.
• Wider range of mainstreaming measures.
• Implementation of Policy and passing of Bill.
• Re-activate NACCODI; re-consider the mandate and composition of national bodies for CBR.
• Government of Malawi should develop a national CBR plan that clearly states Malawi’s geographical, technical and thematic priorities, and preferred implementation structure

District:
• Better integration with District Assembly planning and M&E
• Consider more organisational integration with District Assembly to enhance sustainability
• Prepare for future devolvement of disability affairs to district
• Explore less costly implementation structures, utilising extension workers (CDA) at T/A level and concentrating MACOHA resources in MACOHA resource teams

Donors:
• Harmonisation between development partners – rather than geographic sharing of responsibilities.
• First step is to design next phase towards harmonisation, together with all donors
• Donor adaptation to a (future) National CBR Plan and the implementation structure prescribed by government.
• NAD deal with (and take the costs of) shift in personnel, financial/administrative issues, etc.
• Integrate better with donors to other sectors (and utilise Norwegian Embassy).

Service delivery:
• Improve the ability to respond to common types of disability that are least responded to today, including deafness, learning disabilities and cerebral palsy.
• Keep focus on gender sensitivity and find ways to communicate women’s issues when CBR personnel are male
• A decision making body for the overall programme.
• Re-visit the Disability Management Information System (DMIS) before full implementation. Learn from other countries.

Comments from the organisation, if any:

NAD and partners found the evaluation most useful and have actively incorporated recommendations in the development of the programme since 2009.

Link to full report: http://www.nupi.no/Publikasjoner/Boeker-Rapporter/2009/As-Strong-as-The-Weakest-Link