Sowing a Healthy Future: Supporting Women to Strengthen Community Health and Livelihoods in Myanmar

Background:
The ‘Sowing a Healthy Future: Supporting Women to Strengthen Community Health and Livelihoods in Myanmar’ project was initiated as a response to the loss of livelihoods in the Kokang region of Myanmar that was the effect of the opium ban in the region. In 2003 the authorities declared Kokang an opium free region and in 2005 the Wa region declared a ban on opium cultivation. This had a devastating effect on local farmers. As their primary income source was suddenly lost, they were unable to buy inputs needed for food production. The land had also become degraded due to the poppy cultivation. The ‘Sowing A Healthy Future’ project aimed to increase food production and family income as well as increase the capacity of women to manage women’s health risks and common illnesses. The project also aimed to increase the communities’ capacity to implement development activities through community asset creation supported by the provision of immediate food assistance through FFW (food for work), and active participation and management of project activities.

Purpose/objective:
• To assess and measure the outcomes achieved and the impact of the project;
• To assess project outcomes and results for different groups;
• To assess how and to what extent the project has effectively addressed the challenges faced by the target communities;
• To assess planned activities against the work plan, using strategies and approaches in the project design document;
• To assess the efficiency and effectiveness of the project in making timely progress towards achieving impact; achieving the expected results and specific objectives (as specified in the logical framework) by project end;
• To evaluate the strengths and weaknesses of the program, and the appropriateness of project components and strategies, in relation to the overall goal of the project and assess the sustainability of these strategies;
• To capture lessons learned and good practices in all aspects of the project and to assess the prospects for sustainability of benefits from project interventions;
• To provide practical recommendations for adjustments or alternatives for future program development.

Methodology:
The study was conducted through participatory mapping exercises, focus group discussions, key informant interviews, a household questionnaire and observation, in addition to a desk review and interviews with key project staff. The study was led and partly conducted by an external consultant, however, due to travel permission restrictions, the consultant was not able to travel to the project site during the evaluation process. A national evaluation team was organised by CARE Myanmar, consisting of facilitators, note takers and technical advisers. This team carried out the evaluation activities according to the guidelines provided by the consultant. The donors agreed to this evaluation process, given the current travel restrictions.

Key findings:
Through the end of project evaluation, improvements have been seen across all four outcome indicators of the project;
• At least 50% HH report consumption of staple foods all year round, by EoP;
• At least 50% of HH have reduced need to borrow money for food by at least 50% by EoP;
• 20% reduction in number of HH in which common illnesses (ARI, malaria, diarrhea) has affected any HH member in the past 4 weeks, by EoP.
• 25 VBOs have clear plans for future activities, beyond EoP.

The target communities report a reduction in the number of food short months per year, and an increase in the number of months with sufficient or surplus food. The main coping strategy in food short months is to borrow money and there has been a 64% reduction in the number of HH who had to borrow money at the end of the project compared to previous years, exceeding the outcome indicator of a 50% reduction in HH who had to borrow money.

The health component of the project has had multiple benefits. The participation in health activities was good, referral linkages to health service providers have been facilitated and strengthened and positive health impacts have been reported by the communities. Health activities have also been a key factor in promoting women’s empowerment at the household and community levels. Reproductive health impacts of the project were unexpectedly high with reports of increased use of oral contraceptive pills, injections and condoms for family planning.

Recommendations:
Technical support
• Assess the performance of any revolving fund schemes, to ensure that fund levels are maintained and are growing, to allow more people to access the scheme and to counteract any inflationary impacts;
• Review the savings models promoted in the project and evaluate other savings approaches, taking into account the operational context in the region. 

Training, dissemination of information through community extension
• Training programmes for the various village based groups should be reviewed and updated with appropriate visual aids to address the illiteracy levels in the communities; 
• Demonstration and cross visits should be strengthened;
• Encourage successful women as role models and have opportunities to address the wider community at the VDC level, to demonstrate their contribution;
• Facilitate veterinary support linkages.

Agriculture
• Facilitate issuance of land certificates for agricultural purposes;
• Explore why composting was not adopted by all farmers, and possible ways to increase the supply of compost to replace the need for fertiliser;
• Start the trial and demonstration crops that have medium to long term returns, to further increase options available to the communities;
• Follow up with project participants who did not see any increase in their agricultural production, to ascertain whether it was due to incorrectly adopted methods, lack of interest, ability or other factors outside the project control.

Livestock
• Address key issues with regard to feeding, animal health and improved dissemination of training and extension services to further strengthen the income generating potential of this activity;
• Explore opportunities with regard to breeding, to increase income generating potential from selling piglets, and also improving the breeding stock through cross breeding. 

Income Generation
• Analyse why more people did not adopt other income generating activities, whether it was due to market demand, skill levels, access to inputs, or other reasons, and whether these could be promoted in future programs;
• Explore options to encourage women to work together, to be able to access sufficient capital as a group.

Health
• Further analysis should be undertaken to assess whether improved health practices are used away from the household, and look at ways to incorporate these messages into the health materials; 
• Review ability to distribute sufficient mosquito nets.

Comments from the organisation, if any: