Christian Aid in collaboration with the Narok county government, the Narok Integrated Development Programme (NIDP), Transmara Rural Development Programme (TRDP) and Christian Health Partners (CHP), have been implementing the project “Strengthening Rural Health Systems for improved Maternal and Child Health project in Narok County, Kenya” since January 2013 and ended in December 2016. The project was implemented in Narok North, Narok South, and Transmara Districts of Narok County.  The overall objective of the action was to contribute to reach the indicators of MDG 4 and MDG 5 in Narok county, with a specific objective of reducing preventable Under 5 and maternal morbidity and mortality by 10% through increasing access the quality of MCH services and reproductive services; improving nutrition to tackle micro-nutrient deficiencies and increasing advocacy and coordination in the health sector.

The project targeted to reach 6,000 pregnant and lactating women, 10,000 Children Under five years, 8,000 Women of Reproductive age, 500 Health Workers, 2 National CSO and 3 district MOH staff. The final beneficiaries of this action were 85,000 WRA, 100,000 children under five years, 500 health workers, and general community accessing improved health services, 4 health management teams at District and County levels and health stakeholders working in Narok County.

The project had four main result areas that it sought to attain:

Result Areas

1. Improved quality of MNCH services provided in health facilities and increased demand for MNCH services at the community and facility level
2. Improved nutrition status among under-fives and pregnant women in Narok County
3. Reduced unmet needs for family planning among women of reproductive age in Narok County
4. Strengthened capacity of the County/District Health Management teams and civil society organizations to lead, coordinate and supervise health services in Narok County

The role of Evidence Frontiers was to assess the extent of achievement of results from the baseline levels against the stated objectives and implementation approaches used. The following were the specific objectives to the assignment:

1. To assess the progress made towards anticipated key project goals as per the project logical framework and any other unintended effects of the project and how the results may have been realized.
2. To demonstrate how effective key project interventions approaches (OBA, community groups, IGA, integrated health and nutrition intervention, MNCH service quality improvement) has been in improving MNCH outcomes
3. To highlight lessons learnt and provide specific, actionable and practical recommendations for future programming

The evaluation adopted both qualitative and quantitative approaches to collect data from primary and secondary sources following several techniques such as structured questionnaire survey with a representative number of women aged (15-49 years), focus group discussions (FGDs) and in-depth interviews with key informants. The household data was obtained through a random selection of households within the three target districts (Narok North, Narok south and Transmara). To enhance validity and reliability of the findings, the qualitative data were triangulated with quantitative data in the project sites. In addition, the study performed a detailed review of the individual county reports, the DHIS and other relevant literature to provide background information on the MNCH intervention sites.

Literature Review: Of interest were the project proposal, baseline and midterm reports, annual reports, the project work plans and activity reports, performance tracking tables, monitoring and evaluation framework and plan and other reports generated by project from time to time. Other documents reviewed included Narok County Development Profile (KNBS, 2013), DHIS among others.

Key Informant Interviews (KIIs): Informants were sampled purposively. A total of 24 KIIs were conducted across the three targeted Districts. These included County RH Coordinator, County Nutritionist, Community Strategy Focal Person, Midwives/Maternity nurses, Registered Clinical Officers, PNC and ANC clients, Opinion leaders and paralegals.

Focus Group Discussions (FGDs): This included discussion with a small group of respondents of 8-10 people. At least 15 FGDs were conducted. The main discussants included women and men of reproductive age, Community Health Volunteers, CHEWs and TBAs to determine MNCH demand and supply in the county within the project period.

Household Survey: Household data collection was collected by ten research assistants drawn from the three districts. The household survey was administered through face-to-face interviews among 305 respondents out of the expected 300 eligible women respondents (15-49 years), with respect to their Family Planning use, ANC and PNC attendance, place of delivery, child spacing, information on child health care and treatment amongst others. The Fischer’s (1998) Model standard formula was applied to determine the final sample size that was adopted.

The ETE established that the project was in line with the national and county strategies and policies that aim to address MNCH for the marginalized counties to which Narok county falls. In addition, the project was appropriate to respond to the needs of WRA, under-fives and was relevant to their needs. In addition, the project delivered most of the expected outputs within the specified timeframe successfully with the project making highly satisfactory progress against all the planned outputs .The ETE further established that the project had laid a strategic foundation for attainment of sustainable outcomes in its effort to create local capacity for continued service beyond the project life and beneficiary community participation and contribution and that that the project ensured that MNCH services utilization reached the intended beneficiaries. It was also established that the project approaches used contributed largely to the achievements of the positive outcomes witnessed. Some of the lessons learnt are that partnerships and networking with local stakeholders and the community are key to increase wider reach, sustainability, and ownership. In addition, creating community demand for health services must be matched with the availability of improved services within health facilities. Further, Community Participation and involvement in the strengthening of health care delivery elicits grass roots acceptance creating a sense of ownership and increased utilization of health services.

Some of the key recommendations that the evaluation puts across include the need for a robust exit strategy that clearly links the phase out project activities to the county government MNCH interventions and a robust Monitoring and Evaluation Framework, a robust risk register to track risks and mitigate them as they arise and a clear advocacy strategy linked to the project that would contribute largely to the sustainability of the project gains. The County Government should in addition uphold the lessons learned from the 30 CUs that the project supported and scale them up to all the remaining CUs thus ensuring that the whole county has equitable access to MNCH services.

Send an email to info@evidencefrontiers.com to request the full report