Terminal/Midterm Evaluation Report (RMMP –Gamo Gofa and RMMP –Segen Zone terminal, RMMP-South omo end term, RMMP-Bale midterm evaluations)

Background

NLM and its back donor supported Reducing Maternal Mortality of the four Projects (in Gamo-Gofa Zone, Segen Area Peoples’ Zone and South Omo Zone) have been operational for the last almost 5 years, since 2012; RMMP-Bale Zone intervention started in 2013 and is in 4th year intervention.

The RMMP-Bale midterm evaluation will focus on the efficiency, effectiveness and results achieved for the last three years (2013-2015) including encountered challenges in project implementation.

The project RMMPs was intended to reduce maternal mortality at target project areas focusing on three major components; human capacity building, provision of medical equipment and joint supervisory activities.

The activities performed by the project in all the RMMPs includes training of health professional in hospitals; Health Officers, assistant anesthesia nurse, scrub nurses and midwives, on Comprehensive Emergency Obstetrics and Newborn Care (CEmONC) management in health centers.

Moreover, competence of health officers and midwives were also enhanced in basic neonatal resuscitation (BEmONC). In addition, the capacity health extension workers were also enhanced for promoting ANC and referral systems. Moreover, the supply of motor ambulance and other neonatal and maternal equipment were done by the projects.

Purpose/objective

The general objective of the assignment is to conduct RMMP –Gamo Gofa and RMMP –Segen Zone terminal, RMMP-south omo end term RMMP-Bale mid-term evaluations and to determine the relevance, effectiveness, efficiency, impact as well as sustainability of the projects and to conduct baseline survey.

Specific Objectives

• Review the Relevance of the project and its approaches in the context of the reducing material mortality project areas;
• Verify the Efficiency and Effectiveness of the results achieved and trace the changes observed in the operational capacity of the target beneficiaries.
• Critically examine the continuing validity of the assumptions on which the project's likely impact was based
• Analyse Sustainability and Replicability of the project initiatives from the point of view of local stakeholders including target beneficiaries’ participation, institutional arrangements, compatibility of project objectives and target community need and attitudinal changes, etc
• Document the project achievements over the years
• Draw lessons and give respective recommendations having strategic significance for improvement in future similar actions.

Methodology

The evaluation consisted of different methods; document review, meetings, interviews and discussions with steering committee, key informants and focus groups and finally field observations.

Key findings

The study results showed that there have been remarkable involvements of stakeholders in programme promotion, planning and implementation. As a result, there has been significant improvement of institutional deliveries whereby maternal and new born babies/neonatal death is reduced. In line with these, as the project equipped relatively accessible/nearby health institutions, the study revealed that the community saved costs and labour.

It can also be recognized from previous sections it is evident that RMMP project has satisfied the selected evaluation criteria, relevance, effectiveness, efficiency, impact and sustainability. Hence, the specific objectives are met; pregnant women were able to stay voluntarily at mother’s village/maternity waiting center for safe delivery. Maternity waiting rooms were done through a good effective referral system organized and mobilized by HEWs from community to health post/ health centers /health institutions.

The joint supportive supervision regularly made by government health department at Zonal and Woreda level was found to be the best approach in strengthening the services and providing corrective measures at the sites with the presence of all stakeholders. This helped the enhancement of the participation of all stakeholders with great responsibility. The project was extremely good coordinated where Government HEWs, health center workers and Woreda level health department and other Government workers in taking part irrespective of the efforts being made by NLM/E.

Recommendations

These are some of the recommendations to NLM:

• Experience sharing mechanisms should be more considered in future RMMP projects so that the best practices could easily be adopted from best performing sites.
• The project should design some phase-out strategies to sustain and best link with government structures on some of the components of the projects; like human resource capacity building, material capacity and joint supervision works
• Capacity building training for project seconded staffs on basic gaps needed to be incorporated.
• Training in use, installation and maintenance of Medical equipment/ machines should be well considered.
• The project need to further work with lower level of the community, through providing training to the HEWs (capacitating the HEWs).
• We recommend that the reporting system of the programme needs to be synchronized with the government HMIS system to easily communicate with government reporting arrangements;

Comments from the organisation

There was serious unrest, particularly in Bale Zone of Oromia National Regional State, where RMMP-Bale is located, the fall of 2016. The evaluation was able to be conducted, but the finalization of the report took time because the involved evaluator got imprisoned. We finally got the finished report in May 2018.

Going through the report there are several findings NLM/E will take into consideration in the planning of future project work.  NLM/E trust the findings of the evaluation team and the outcome they have provided us.