CONSOLIDATED REPORT FOR THE 2013 OUTCOME MEASUREMENT by Plan Nederland

Unite For Body Rights Malawi Programme (UFBR)

CONSOLIDATED REPORT FOR THE 2013 OUTCOME MEASUREMENT Alfred M. Dzilankhulani Lilongwe, Malawi

20 NOVEMBER 2013

TABLE OF CONTENTS ACRONYMS EXECUTIVE SUMMARY SECTION ONE: INTRODUCTION SECTION TWO: OM METHODOLOGY 2.1 OM Goal and Process Overview 2.2 Data Collection and Sampling 2.3 Data Management and Quality Control 2.4 Ethical Considerations 2.5 Data Entry, Cleaning and Analysis 2.6 Assessment Team SECTION THREE: RESULTS 3.1 SUMMARY DEMOGRAPHICS OF OM RESPONDENTS 3.1.1 KAP Youth Respondents 3.1.2 Exit Interview Respondents-Young People 3.1.3 Exit Interview Respondents-Women 3.1.4 People Living with HIV (PLHIV) 3.1.5 Sex Workers 3.2 RESULT AREA 1: STRENGTHENING SRHR EDUCATION 3.2.1.1.1 Mean Scores on Knowledge 3.2.1.1.2 Mean Scores on Rights-Based Sexuality Attitudes 3.2.1.1.3 Mean Scores on Behaviour 3.2.1.1.4 Mean Scores on Total Capacity 3.2.1.1.4.1 Among All Respondents 3.2.1.1.4.2 Among Young People who ever had Sex 3.3 RESULT AREA 2: STRENGTHENING SRHR SERVICES 3.4 RESULT AREA 3: STRENGTHENING ENABLING ENVIRONMENT SECTION FOUR: CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS 4.1 CONCLUSIONS 4.2 LIMITATIONS 4.3 RECOMMENDATIONS REFERENCES ANNEXES Annex 1: Roadmap for UFBR OM in Malawi Annex 2: Details of UFBR Programme in Dedza, Mangochi and Chikhwawa Annex 3: Interview Tools Annex 4: Questionnaire for People Living with HIV Annex 5: Sex Workers Questionnaire Annex 6: Youth Friendliness of Health Facilities Annex 7: Quality of Maternal Health Services Annex 8: Exit interview satisfaction services-Women Annex 9: Exit interviews satisfaction services - young people Annex 10: Use of SRHR services by young people and women, including Antenatal care and skilled birth attendance Annex 11: Partner Organization Program Staff Annex 12: Focus Group Discussions with Community Leaders Annex 13: Focus Group Discussions with Parents (Gender-disaggregated)

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

3 4 6 9 9 9 10 10 11 11 12 12 12 12 13 13 13 14 14 15 16 17 17 17 19 2 8 8 8 9 10 1 1 3 1 10 11 15 18 22 26 31 33 34 36

Page 2

ACRONYMS ACT ADC AIDS AMREF ANC ART CAVWOC CBDA CHRR CSE CSO EFM FGD FPAM GVH HIV HTC ICPD IPPF KAP LGBTI MDG MSM NGO OCA OM PLHIV PME RAPID SGBV SPSS SRH SRHR STI TA TBA UFBR VCT VDC VH VSU WHO WPF WSW YECE YFHS

Acyl CoA-Thioester-Hydrolase Area Development Committee Acquired Immuno-Deficiency Syndrome African Medical and Relief Foundation Antenatal Clinic Anti-Retroviral Therapy Centre of Alternatives for Victimised Women and Children Community-Based Distribution Agent Centre for Human Rights and Rehabilitation Comprehensive Sexuality Education Civil Society Organisation Early and Forced Marriage Focus Group Discussion Family Planning Association of Malawi Group Village Headman Human Immuno-Deficiency Virus HIV Testing and Counselling International Conference on Population and Development International Planned Parenthood Federation Knowledge, Attitude and Practice Lesbian, Gay, Bisexual, Transgender and Inter-sex Millennium Development Goal Men who have Sex with Men Non-Governmental Organisation Organisational Capacity Assessment Outcome Measurement People Living with HIV Planning, Monitoring and Evaluation Resource for Awareness of Population Impacts on Development Sexual and Gender-Based Violence Statistical Package for Social Scientists Sexual Reproductive Health Sexual Reproductive Health and Rights Sexually Transmitted Infection Traditional Authority Traditional Birth Attendant Unite for Body Rights Voluntary Counselling and Testing Village Development Committee Village Headman Victim Support Unit World Health Organisation World Population Fund Women who have Sex with Women Youth Empowerment and Civic Education Youth Friendly Health Services

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 3

EXECUTIVE SUMMARY A. INTRODUCTION Sexuality Reproductive Health and Rights (SRHR) Alliance has been implementing Unite for Body Rights (UFBR) Programme in Malawi since 2011. Mid-way through the project period, the Alliance conducted an Outcome Measurement (OM) process. The OM in 2013 serves to take stock of the effects of the programme; is the programme on the right track? Is the programme progressing towards the intended changes according to plan? Results of the OM are intended to provide important insights in the programmeâ&#x20AC;&#x2122;s effectiveness, planning and where relevant the need for changes to be able to reach intended results. In Mangochi and Chikhwawa, two Traditional Areas were sampled while three were sampled in Dedza. Project target groups interviewed included programme staff, young people (10-24), women, sex workers, parents, People Living with HIV (PLHIV) community leaders and health workers. The 2013 OM field data collection was conducted in August 2013 (August 12-30) with the assistance of 4 independent research assistants and 5 research assistants from alliance partner organisations (except in Dedza where there were 10 partner staff - 5 FPAM and 5 YECE) under the overall technical leadership of a consultant. Quantitative data was captured and analysed in Statistical Package for Social Sciences (SPSS) while qualitative data collected through focus group discussions (FGDs) were analysed through content analysis and triangulation procedures. Secondary data statistics were analysed and presented through summations and averaging. In some cases, secondary data statistics were presented through Microsoft Excel graphs. Two hundred and eighty (280) young people, 54 People Living with HIV (PLHIV) and 27 sex workers were sampled and interviewed using Knowledge, Attitude and Practice (KAP) questionnaires. To assess satisfaction with health facility services, exit interviews were conducted with (89) youth and 64 women. Five health facilities were assessed regarding their quality of YFS and maternal health. Forty-six (46) Focus Group Discussions with youth, community leaders and parents were conducted in sampled communities. B. OM 2013 RESULTS Overall, the programme is on track on 6 out of 12 outcome indicators assessed (2.1a under Strengthening SRHR Education; 2 out of 8 outcomes under strengthening SRHR Services and 3 out of 3 outcomes under Strengthening Enabling Environment). For other outcomes, either there is no baseline data to conclude extent of progress or OM results show no improvement on the baseline situation. Specifically: a. Overall, there is increased capacity to make safe and informed decisions about SRHR among all respondents, with the percentage of surveyed young people who have good capacity significantly increasing from 46.3% in 2011 to 68.2% in 2013. Considering only young people who reported ever having had sex, 80.9% have good capacity at outcome measurement compared with 56.5% at baseline. Specifically: ď&#x201A;ˇ

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 4

ď&#x201A;ˇ

Overall, rights-based sexuality attitudes have generally not changed since the baseline assessment in 2011. 69.3% of surveyed young people had positive attitudes compared with 66.4% at baseline in 2011; however, these proportions are not significantly different.

ď&#x201A;ˇ

Overall, there is increased percentage of young people who have sufficient skills (empowerment) from 27.6% in 2011 to 49.6% in 2013, this difference being statistically significant. Correspondingly, the proportion of young people who have little skills (empowerment) decreased from 72.4% in 2011 to 50.4% in 2013.

b. Targeted youth friendly services are not complying with IPPF standards for youth friendly services as evidenced from the mean score 2.70 compared with a baseline mean score of 2.75. c. Targeted maternal health facilities havenâ&#x20AC;&#x2122;t increased their compliance to the national quality standards, with OM mean score (2.5) lower than baseline mean (2.9). d. Overall, there is no increase in maternal health facilities with an increase in satisfaction among women. The overall mean score decreased from 3.2 at baseline in 2011 to 3.1 at outcome measurement in 2013. e. There is increase in use of targeted SRHR services by young people and women across all ages except >24. Notably, the highest increase was with age 20-24. Overall, there was 28.8% increase in use of targeted SRHR services from 2011 baseline to 2013 outcome measurement. f. There has been an increase in girls delivering with skilled birth attendants by 26.4% and overall increase by 24.1%. The highest increase was recorded in girls (10-14) and least in girls (20-24). A review of the percentage increases shows that the percentage of girls and women delivering with skilled birth attendant is decreasing with age. g. Overall, there is 7.6% decrease (100-92.4) in the percentage of women and girls who have at least one ANC visit. There has also been decrease in percentage of women who go for the first (100-71.4%) and second visits (100-90.5%). However, there have been percentage increases in third, fourth and 4+ ANC visits of 40.6%, 123.3% and 20.0%, respectively. C. RECOMMENDATIONS a. Despite increased uptake of targeted SRHR services, evidence from this assessment point to no change in quality of YFHS and maternal services delivered at sampled health facilities. It is recommended that alliance partners critically review the current scale of programme interventions and determine the extent to which they are insufficient. Thereafter, they explore other interventions that could subscribe to achievement of the outcomes. For one, some of the quality YFHS and maternal care (e.g. drug stock-outs or equipment and other supplies) can only be influenced with upstream interventions (district and national level). This option should also explored in terms of whether this is an area of comparative advantage.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 5

SECTION ONE: INTRODUCTION 1.1

UFBR PROGRAMME DESCRIPTION

1.1.1 Background Five Dutch Non-Governmental Organisations (NGOs) and their Southern partner organizations formed an alliance to among others, implement Unite for Body Rights (UFBR) Programme. The members in the Sexual Reproductive Health and Rights (SRHR) Alliance are: Rutgers WPF (lead agent) and co-applicants AMREF, CHOICE, dance4life international and Simavi. The UFBR programme is being implemented in 9 countries, six in Africa and four in Asia: Ethiopia, Kenya, Malawi, Tanzania Uganda, Bangladesh, India, Indonesia and Pakistan. Selection of the countries was based on a mix of external and internal factors. Among the external factors the figures on Maternal Mortality Rate (MMR), Contraceptive Prevalence, Unmet Family Planning Needs, and Skilled Birth Attendants played an important role. Major internal factors were the presence of at least two Alliance members in the country and the strength and potential of existing partner organizations in the respective countries. In each country the SRHR Alliance works through local partners, including Civil Society Organisation (CSOs) and formal and informal service and education providers as well as (local) governments. In addition, SRHR international advocacy activities are being implemented to reinforce efforts at country level. In the nine countries chosen, the SRHR Alliance aims to work specifically with women, young people and marginalized groups (survivors of violence, Lesbians, Gays, Bisexuals and Trans-genders (LGBT), Men having Sex with Men (MSM), people with disabilities, people living with HIV and AIDS and people with traditional lifestyles in remote areas). Their voice is not heard in many countries where the Alliance works. They face discrimination, exclusion and stigmatization and as a result are excluded from public debate. In relation to gender identity and combating sexual and gender-based violence, the Alliance includes the concept of masculinity and encouraging male involvement as a crucial strategy: women are able to transform their lives as long as their male partners will change. So, it is equally important to involve men and boys in the discussion on sexuality education, gender roles, violence and empowerment and make clear what role they can play in positively changing (gender) perceptions and values. 1.1.2 Programme Priority Areas and Objectives The following four priority areas were identified that require urgent and increased attention in order to meet the Millennium Development Goals (MDGs) 3,5 and 6; the International Conference on Population and Development (ICPD) Programme of Action and other international agreements for promoting sustainable development: (a) improved sexual and reproductive health services; (b) Comprehensive Sexuality Education; (c) Combating sexual and gender-based violence and (d) Freedom of expression of sexual diversity and gender identity. The following are programme objectives: 1. Increased utilization and quality of comprehensive Sexual and Reproductive Health (SRH) services; 2. Increased quality and delivery of Comprehensive Sexuality Education (CSE); 3. Reduction of Sexual and Gender Based Violence (SGBV); and 4. Increased acceptance of Sexual Diversity and Gender Identity.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 6

1.1.3 UFBR Malawi Programme in Malawi The UFBR programme in Malawi is being implemented by Family Planning Association of Malawi (FPAM) and Youth Empowerment and Civic Education (YECE) in Dedza; Youth Network and Counselling (YONECO) in Mangochi and Centre of Alternatives for Victimised Women and Children (CAVWOC) in Chikhwawa. Family Planning Association of Malawi (FPAM): FPAM is a partner of Rutgers World Population Foundation (RutgersWPF) in Netherlands. It is a non-governmental organization with a focus on young people age 10-24. The role of FPAM in UFBR is service provision, capacity building in education and advocacy. Service provision of integrated and youth friendly SRHR services is done through mobile and outreach clinics, door to door service provision and capacity building of service providers in existing government and local facilities and structures. On education, main focus is to improve comprehensive delivery of life skills based education through training and orientation of teachers on new approaches of teaching the subject and capacity building of peer educators who lead youth clubs at community level for mainly out of school young people. Local advocacy mainly focuses on CSE. Youth Empowerment and Civic Education (YECE): YECE is a partner of CHOICE in Netherlands. YECE was established in 1997 and works with and for young people in selected Traditional Authorities in Lilongwe, Kasungu, Mchinji and Chiradzulu districts. YECE is involved in advocacy around Sexual Reproductive Health and Rights (SRHR), human rights and democracy, child rights and gender. It has also been able to mobilize communities to promote issues affecting young people especially those related to Sexual Reproductive Health and Rights issues. YECEâ&#x20AC;&#x2122;s role in the UFBR Programme in Dedza is advocacy intended to reduce early forced marriages through national to community level advocacy and awareness campaigns. Youth Network and Counselling (YONECO): a partner of Simavi in the Netherlands is a local non-governmental organization whose vision is a self reliant HIV and AIDS free society that respects democratic principles and values. YONECO targets young people such as domestic servants, adolescent married girls, and PLHIV and sex workers. In UFBR Programme, it promotes SRHR services and provided comprehensive sexuality education (CSE) and quality of comprehensive Sexual and Reproductive Health (SRH) services, increase quality and delivery of Comprehensive Sexuality Education (CSE) and reduce Sexual and Gender Based Violence (SGBV). The primary targets are in and out of school youth (10-14), with a specific focus on girls, women and People Living with HIV (PLHIV). Centre of Alternatives for Victimised Women and Children (CAVWOC): a partner of Simavi is implementing the UFBR programme in Chikhwawa. CAVWOC is a rights activist body promoting rights of women, orphans and children. In the UFBR programme CAVWOC brought long time experience in dealing with sexual violence and mainstreaming gender in programming intended to address main SRHR causes. The objective of the programme in Chikhwawa is to increase utilization and quality of comprehensive Sexual and Reproductive Health (SRH) services, increase quality and delivery of Comprehensive Sexuality Education (CSE) and reduce Sexual and Gender Based Violence (SGBV). The primary targets are in and out of school youth (10-14), with a specific focus on girls, women and People Living with HIV (PLHIV).

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 7

Annex 2 shows a summary of interventions that have so far been implemented by alliance partners in Dedza, Mangochi and Chikhwawa. 1.2 THE 2013 OUTCOME MEASUREMENT The outcome measurement in 2013 serves to take stock of the effect of the programme; is the programme on the right track? Is the programme progressing towards intended outcome changes as planned? Results of the outcome measurement are intended to provide important insights in the programme’s effectiveness, planning and where relevant, the need for changes to be able to reach the intended results. 1.2.1 Main OM Consultancy Tasks SRHR Alliance planned to measure outcomes for UFBR Programme in Malawi. To facilitate and support the process, Malawi SRHR Alliance engaged the services of a consultant. The consultant was expected to cooperate in complex alliance structure, work with young people, facilitate workshops and conduct training on qualitative data collection skills. 1. Work with Dutch Planning, Monitoring and Evaluation (PME) team in Malawi to prepare outcome measurement training and process for Malawi. This includes studying the support tool, studying baseline data for Malawi and Malawi partners’ support. 2. Co-facilitate the outcome measurement workshop in Malawi, including joint responsibility for achieving workshop objectives in Malawi. 3. Facilitate and support outcome measurement data collection process for Malawi partners involving the following tasks: 4. Specific tasks on the qualitative outcome measurement were as follows:         

Facilitate and support data collection on service outcomes relating to service statistics already measured at output level; Facilitate and support data collection on quality of services; Facilitate and support data collection on satisfaction with services for all facilities Facilitate and support data collection on non-availability of ART, ACT, contraceptives and antibiotics; Conduct focused analysis of changes achieved through lobby and advocacy if activities of partners; Critically assess involvement of community leaders; Critically assess acceptance of SRHR at community level using same tools as at baseline; Critically assess capacity building outcomes using OCA tool; CSE to include development of questionnaire for pre and post measurements, on basis of the KAP from the baseline and choice of questions from a prepared menu; and qualitative data collection to support interpretation of results of pre-post tests and for the capturing of at least 5 stories of change.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 8

SECTION TWO: OM METHODOLOGY 2.1

OM Goal and Process Overview

As shown in Annex 1 (Roadmap), an OM Workshop was conducted in Dedza from 29 July-2 August during which SRHR Alliance partners (FPAM, CAVWOC, YECE and YONECO) and a potential alliance partner (Centre for Human Rights Rehabilitation (CHRR) participated. The workshop was co-facilitated by Teun Visser, Bertiene Dunning (Rutgers WPF) and Alfred Dzilankhulani (UFBR Malawi OM Consultant). The overall goal of the workshop was to enable partners to measure outcomes as defined through the outcome indicators in the UFBR programme. Objectives of the OM workshop were to  Clarify difference between OM, mid-term evaluation and final evaluation;  Establish common understanding of the methodologies to measure outcomes;  Adapt and finalise country (Malawi) specific data collection tools;  Build capacity of partners to use the methodologies;  Develop work plan for measuring the outcomes in 2013; and  Pre-testing of the data collection tools 2.2

Data Collection and Sampling

The OM was designed to, as much as possible; methodically mirror the 2011 UFBR baseline survey in terms of methodology and interview guides. Data collection methods included focus group discussions; questionnaire, exit and other interviews with project target groups and secondary data collection (statistics). Baseline survey guides were adapted to conform to the need for a focused but detailed outcome measurement able to depict progress through substantive outcome measurement process. The OM was “lighter than” than the programme baseline survey and interview guides were adapted from the baseline survey based on SRHR Alliance UFBR Support Tool for OM Support (final, May 2013). Table 1: Planned and Attained Sampling and Sample Size, in Surveyed Districts Outcome Indicator 1.

Tool

Actual Sample Size

STRENGTHENING SRHR EDUCATION

2.1a-Exposed target groups has an increased capacity to make safe and informed decisions (on SRHR)

2.2a- Targeted youth friendly services increasingly comply with IPPF standards for YFHS 2.2b-Increase in the number of young people satisfied with SRHR services 2.2c- Targeted maternal health services increase their compliance to

KAP Survey

Questionnaire interview with sex workers Questionnaire interviews with PLHIV Checklist on compliance with guidelines for YFHS

In school (167)  10-14 : 22 boys, 32 girls  15-19: 44 boys, 58 girls  20-24 : 6 boys, 5 girls Out of school (113)  10-14: 5 boys, 7 girls  15-19: 28 boys, 23 girls  20-24: 24 boys, 24 girls  >24: 0 boys, 2 girls Total =280 27 sex workers 54 PLHIV 5 facilities (4 government, 1 mission)



For every facility: 1 service provider for YFHS was interviewed

Exit interviews on client satisfaction with young people

5 facilities (4 government, 1 mission)-89

Checklist on compliance with maternal guidelines

5 facilities (4 government, 1 mission)

 

10-24:40 10-24: 49

For every facility: 1 service provider for maternal health was interviewed

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 9

Outcome Indicator national quality standards 2.2d- Increase in the number of women satisfied with SRHR services 2.

5 facilities (4 government, 1 mission)



64 women

Health facility statistics tool

5 facilities (4 government, 1 mission)



Health facility secondary statistics

Health facility statistics tool

5 facilities (4 government, 1 mission)

Health facility statistics tool

5 facilities (4 government, 1 mission)

Health facility statistics tool

Health facility secondary statistics 

Health facility secondary statistics

5 facilities (4 government, 1 mission)



Health facility secondary statistics

SRHR ENABLING ENVIRONMENT

2.4a- SRHR policies and legislation implemented, changed or adopted at local, institutional or national level, at least 2 per country 2.4b-Increased involvement of community leaders in realisation of SRHR in x% of the targeted communities 2.4c-Increased acceptance of SRHR at community level in x% of the targeted communities

2.3

Exit interviews on client satisfaction with women

Actual Sample Size

STRENGTHENING SRHR SERVICES

2.3a-Increase in young people and women using SRHR services 2.3b- Number of births attended by a skilled birth attendant is increased 2.3c-Iincrease in pregnant women who have 1-4 antenatal check-ups 2.3d - Targeted facilities have increased availability of contraceptives, ART, ACT & antibiotics 3.

Tool

Interviews with program staff

3 Programme staff completed checklist

FGDs with community leaders



14 FGDs with community leaders

Gender-disaggregated FGDs with parents

 

8 FGDs with male parents 8 FGDs with female parents

Gender-disaggregated FGDs with young people

 

8 FGDs with boys 8 FGDs with girls

Data Management and Quality Control

Various data quality control procedures were implemented to minimize errors. The consultant centrally managed all data collected. Submitted data which was found incomplete or erroneous were referred back to data collectors for correction. The following data management and quality control procedures were also enforced:  Field supervision of data collection, entry and processing procedures and physical examination of data to verify correctness and consistency.  Daily debriefing sessions to share best practices and agree actions on challenges  Random checks on completed questionnaires and focus group notes.  Practical training of data collectors to standardize interview techniques and approaches. 2.4

Ethical Considerations

Efforts were made to conduct the OM following standard ethical processes required when conducting assessments of this nature. Standard ethics considerations require that no one be coerced to participate in study interviews. In any study, consent is very critical. In this assessment, data collectors explained the purpose and scope of the outcome measurement. This was important to assist respondents make informed choice,

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 10

either to accept to participate or not. The consenting process involved explaining to respondents that: ď&#x201A;ˇ They were free to choose not to participate or to participate without attracting any penalty. This was said as they were aware that permission had been provided by the community leaders, but this permission did not mean that they had to. ď&#x201A;ˇ They were free to discontinue participation after starting, and that they were free not to answer a particular question if they did not want to 2.5

Data Entry, Cleaning and Analysis

Questionnaire data (KAP young people, KAP PLHIV, exit interviews on satisfaction with services among young people and exit interviews on satisfaction with services among women) were captured in SPSS by data entry clerks under the supervision of the consultant. Data cleaning was conducted by the consultant. Cleaning included checking that all data were entered as captured on hard questionnaire. The consultant sampled 10% of completed questionnaires and physically matched responses on hard copy and entries in the SPSS database. Where anomalies were noted, concerned data entry clerks were instructed to check all data entries and make corrections. Further, frequencies were run to identify any values that were out of range in the data entry. When a problem was spotted, relevant questionnaire was fished out and anomaly rectified. Quantitative data from questionnaire interviews were captured and analysed in Statistical Package for Social Sciences (SPSS). SPSS data analysis included descriptive and limited inferential statistics. Qualitative data collected through focus group discussions (FGDs) were analysed through content analysis and triangulation procedures. This involved, for any specific question, scanning through all data sources to which this question was asked and analysing the responses in terms of consensus, divergent views and majority or minority views. Secondary data statistics were analysed and presented through summations and averaging. In some cases, secondary data statistics were presented through Microsoft Excel graphs. 2.6

Assessment Team

Under the overall guidance of Teun Visser of Rutgers WPF, the outcome measurement (OM) was conducted under the technical leadership of a Consultant with extensive experience in assessments and monitoring and evaluation of health programmes and background in strategic management. Independent data collectors and staff from alliance partner organizations were engaged to administer questionnaires and facilitate focus group discussions (FGD). The research assistants had prior experience in research surveys and relevant qualifications.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 11

SECTION THREE: RESULTS 3.1

SUMMARY DEMOGRAPHICS OF OM RESPONDENTS

3.1.1 KAP Youth Respondents Sex Distribution: Two hundred and eighty (280) youth responded to the KAP questionnaire, comprising 46.1% boys (n=129) and 53.6% girls (n=150)1. In terms of marital status, the majority were single, with only 10.8% in marriage and the rest single. The sex distribution achieved contrasted planned sample size which sought to sample as many boys as girls. However, a limited number of youth were available for the interview. Therefore, most of those who turned up were interviewed, leaving no opportunity to achieve the desired gender-balance. Age Distribution: The mean age (years) of KAP questionnaire respondents was 17.1, with the youngest at 10 and oldest at 27 years. On average, boys (17.6 years) were significantly older than girls (16.7) [t (277) =2.052, p=.041]. Overall, 23.6% were age 1014; 54.6% were age 15-19; 21.1% were age 20-24 while only 0.7% were older than 24 years. This age distribution sharply contrasts planned sample size 2 because respondents didnâ&#x20AC;&#x2122;t turn up in the proportions they were logistically arranged for due to reasons unknown. Education Status: Although the desired plan was to sample as many in-school youth as out-of-school, 59.6% of KAP respondents were in school while 40.4% were of out of school. Of the in-school youth, the majority (69.9%) were in Standard 5-8. Approximately fifteen percent (14.7%) were in Form 1-2 while 14.1 were in Standard 3-4 and with only 1.2% in Standard 1-4. Among the out-of-school youth, 3.5% had no formal education. However, of those who had been to school, the most common highest attained education level for the out-ofschool youth was Standard 5-8 with 34.8% having attained this level; 23.5% had attained Standard 1-4. Approximately, twenty-four percent attained Form 1-2 while 13.9% had attained Form 3-4. 3.1.2 Exit Interview Respondents-Young People A total of 89 young people responded to the exit interviews on satisfaction of SRHR services. Approximately forty-five percent (44.9%) were male while 55.1% were female. This sex distribution contrasts the sample size plan to sample as many boys as girls. However, such a design plan was dependent on the assumption that there would a large sampling frame of young people. As it turned out, fewer young people turned up for services on the scheduled dates, and therefore, planned sex-balance of respondents couldnâ&#x20AC;&#x2122;t be attained. In terms of age distribution, the highest proportion were age 20-24 (48.9%) while 42.0% were between 15 and 19 years old. Only 9.1% were age 10-14.3

n=1 system missing 40% for 10-14; 40% 15-19 and 20% 3 n=1 system missing 2

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 12

The majority (83.0) of exit interviewees had been to health facility more than once while only 17.0% were visiting the health facility for the first time. Approximately, fifteen percent of girls who were exit interviewed were pregnant while the rest werenâ&#x20AC;&#x2122;t. 3.1.3 Exit Interview Respondents-Women Sixty-four (64) women responded to the exit interviews on satisfaction of SRHR services. The majority (68.8%) of women exit interviewees were older than 24; 23.4% were age 2024 while only 7.8% were age 15-19. As at the time of the interviews, 92.1% of all surveyed women had visited the health facility more than once. The majority of the respondents (87.5%) were married and only 21.9% were pregnant. 3.1.4 People Living with HIV (PLHIV) Against a target of ninety (90), 54 PLHIV were interviewed in Dedza and Chikhwawa and none in Mangochi. The majority of surveyed PLHIV were older than 24 years, 11.5% were age 20-24; 7.7% age 15-19 while 9.6% were age 10-14. The team did not achieve planned sample size because fewer PLHIV turned up for the interviews in Dedza and Mangochi despite prior logistical arrangements to ensure planned sample size was attained. 3.1.5 Sex Workers Twenty-seven (27) sex workers were interviewed in Mangochi against a target of 30. The mean age of surveyed sex workers was 27.7 with 44.4% age 20-24 while 55.6% were age twenty-five years or older. In terms of education, sixty-five percent had attained primary education, thirty-one percent had attained secondary education and only four percent had no formal education. On average, the sex workers had stayed in Mangochi for 3 years. However, the minimum and maximum stay period was one and four years, respectively.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 13

3.2

RESULT AREA 1: STRENGTHENING SRHR EDUCATION

3.2.1 Outcome Indicator 2.1a: “% of the Exposed Target Group has an Increased

Capacity to Make Safe and Informed Decisions” Summary of Key Outcome Highlights and Results: Overall, there is increased capacity to make safe and informed decisions about SRHR among all respondents, with the percentage of surveyed young people who have good capacity significantly increasing from 46.3% in 2011 to 68.2% in 2013. Considering only young people who reported ever having had sex, 80.9% have good capacity while 19.1% have low capacity. Compared with baseline, there is significant increase in proportion of young people (who reported ever having had sex) who have good capacity from 56.5% at baseline to 80.9% at 2013 outcome measurement. Specifically: 



72.9% of surveyed young people have good knowledge, an increase from 48.5% of the same proportion at baseline in 2011. Conversely, the proportion of young people with little knowledge decreased from 51.5% at baseline to 27.1% at 2013 outcome measurement Overall, rights-based sexuality attitudes have generally not changed since the baseline assessment in 2011. 69.3% of surveyed young people had positive attitudes compared with 66.4% at baseline in 2011; however, these proportions are not significantly different. Overall, there is increased percentage of young people who have sufficient skills (empowerment) from 27.6% in 2011 to 49.6% in 2013, this difference being statistically significant. Correspondingly, the proportion of young people who have little skills (empowerment) decreased from 72.4% in 2011 to 50.4% in 2013.

3.2.1.1 Comparison of Mean Scores In this outcome measurement, mean scores were calculated based on questions as given in the score calculation tables. One point each was given for a correct answer if a question only required one correct answer. However, in cases of multiple response questions, 1 point was awarded to each respondent for 1 correct answer, 2 points for 2 correct answers and 3 points for 3+ correct answers. In SPSS, the COUNT facility was used to count all correct answers per respondent. Once COUNT was done, the counts (variable) were recoded using RECODE facility to generate the scores. Using COMPUTE, scores for the questions were added to give total scores. The total scores were recoded into score categories (e.g. little knowledge or good knowledge as shown). A frequency analysis was conducted to give the respective percentages in the tables. 3.2.1.1.1

Mean Scores on Knowledge

In Malawi, 99% of men and women have heard about HIV and AIDS. However, MDHS 2010 estimates that only 41% of women and 45% of men have comprehensive knowledge in HIV and AIDS (NSO and ICF Macro, 2010, p.166). Among others, UFBR programme planned to increase knowledge of young people and women about SRHR. The baseline established knowledge of HIV and AIDS disaggregated according to sex (male, female) and age groups (10-14, 15-19 and 20-24) of these groups using mean scores (UFBR Baseline Survey, 2011). Young people responded to SRHR knowledge questions from which mean knowledge score was calculated.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 14

Considering responses to the questions on HIV and AIDS and contraception as shown in Table 2 below, 72.9% of surveyed young people have good knowledge (score 3-5), an increase from 48.5% of the same proportion at baseline survey. Conversely, the proportion of young people with little knowledge decreased from 51.5% at baseline in 2011 to 27.1% at outcome measurement in 2013. Table 2: Mean Knowledge Scores among all Respondents Knowledge Area

Knowledge of HIV and AIDS % correct answer: What is HIV? % correct answer: What is AIDS? Knowledge of Contraceptives % who knows no modern method (never heard) % knows 1 modern method % knows 2 modern methods % knows 3 or more modern methods Overall Score Knowledge (Out of possible maximum 5) % score 0 % score 1 % score 2 % score 3 % score 4 % score 5 % little knowledge (=total score 0-2)

% good knowledge (=total score 3-5)

3.2.1.1.2

2011 (N=649)

2013 (N=280)

Change

Significant? (t-tests)

63.9 46.2

76.8 61.8

+12.9 +15.6

Yes Yes

34.0 20.2 20.4 25.5

17.1 12.5 15.7 54.6

-16.9 -7.7 -4.7 +29.1

Yes

12.5 16.7 22.4 18.4 19.6 10.5 51.5 48.5

7.1 6.8 13.2 14.3 22.5 36.1 27.1 72.9

-5.4 -9.9 -9.2 -4.1 +2.9 +25.6 -24.4 +24.4

Yes

Mean Scores on Rights-Based Sexuality Attitudes

Table 3 below depicts mean scores on rights-based sexuality attitudes measured based on given questions. Table 3: Rights-Based Sexuality Attitudes among all Respondents Rights-Based Sexuality Attitudes

1. 2.

Anyone who dresses sexy wants to have sex (No) It is okay for someone to use some force or pressure on someone who is refusing to have sex (No) 3. A person can refuse to have sex with the partner if he (she) doesn’t want to (Yes) SCORE ATTITUDE (out of possible maximum 3) % score 0 % score 1 % score 2 % score 3 % with “negative” attitude (score 0-1) % with “positive” attitude (score 2-3)

Percent Giving Correct answers 2011 2013 (N=649) (N=280)

Change

Significant? (t-tests)

53.4 85.2

55.4 94.3

+2.0 +9.1

No Yes

43.7

34.3

-9.4

Yes

8.8 24.8 41.4 25.0 33.6 66.4

3.2 27.5 51.4 17.9 30.7 69.3

-5.6 +2.7 +10.0 -7.1 -2.9 +2.9

Overall, rights-based sexuality attitudes have generally not changed since the baseline assessment in 2011. Changing attitudes is known to be a slow process and therefore these results may not be entirely surprisingly. As results show in Table 3, 69.3% of surveyed young people have positive attitudes compared with 66.4% at baseline in 2011; however, these proportions are not significantly different.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 15

3.2.1.1.3

Mean Scores on Behaviour

Analysis results on mean scores on behaviour are shown in Table 4 below. Overall, there is increase in the percentage of young people who have sufficient skills (empowerment) from 27.6% in 2011 to 49.6% in 2013, this difference being statistically significant. Correspondingly, the proportion of young people who have little skills (empowerment) decreased from 72.4% in 2011 to 50.4% in 2013. Table 4: Behaviour among all Respondents Rights-Based Sexuality Attitudes

Percent Giving Correct answers 2011 2013 (N=649) (N=280)

SKILLS, BEHAVIOUR AND EMPOWERMENT 1. I am sure that I can use a condom every time if I 58.6 75.7 have sexual intercourse in the future (Yes). 2. Who will decide on the number of children you will 24.7 43.6 have (me and my partner) 3. Who will decide on whether to use a condom or 18.3 32.9 not when you have sex in future? (me and my partner) 4. Who will choose your partner? (me) 78.4 79.3 5. Who will decide whether to use contraceptives or 20.0 39.6 not? (me and my partner) SCORE BEHAVIOUR AND EMPOWERMENT (Out of possible maximum 5) % score 0 10.4 3.2 % score 1 26.2 16.4 % score 2 35.8 30.7 % score 3 12.7 18.2 % score 4 8.7 18.6 % score 5 6.2 12.9 % little skills / empowerment (score 0-2) 72.4 50.4 % sufficient skills/empowerment (score 3-5) 27.6 49.6

Change

Significant? (t-tests)

+17.1

Yes

+18.9

Yes

+14.6

Yes

+0.9 +19.6

No Yes

-7.2 -9.8 -5.1 +5.5 +9.9 +6.7 -22.0 +22.0

Yes

As depicted in the table, areas where most young people had little skills include the responsibility for deciding whether to use contraceptives or not (39.6%), responsibility for deciding whether to use a condom or not in future (32.9%) and the responsibility for the deciding the number of children the will have.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 16

3.2.1.1.4

Mean Scores on Total Capacity

Mean scores on total capacity were calculated for all respondents and only for those who reported ever having had sex. 3.2.1.1.4.1

Among All Respondents

Overall, there is increased capacity to make safe and informed decisions about SRH as shown by significant increase in the proportion of surveyed population who have good capacity to make safe and informed decisions from 46.3% in 2011 to 68.2% in 2013. Table 5: Total Capacity Score among all Respondents TOTAL SCORE CAPACITY

2011 (N=649)

2013 (N=280)

Change

Significant?

OVERALL INDICATOR “CAPACITY TO MAKE SAFE AND INFORMED DECISIONS” % overall score 0 18.7 8.2 -10.5 % overall score 1 35.0 23.6 -11.4 Yes % overall score 2 32.1 36.4 +4.3 % overall score 3 14.2 31.8 +17.6 % low capacity (0-1) 53.7 31.8 -21.9 Yes % good capacity (2-3)

46.3

68.2

+21.9

Notably, the total net decrease in % overall score (0-1) is equal to the total net increase in % overall score (2-3)4. This result implies respondents “graduating” from lower overall scores to higher overall scores. 3.2.1.1.4.2

Among Young People who ever had Sex

Table 6 shows mean scores on behaviour and total capacity scores for young people who reported ever having had sex. Table 6: Behaviour and Total Capacity for Young People who ever had Sex Rights-Based Sexuality Attitudes

Change

Percent Giving Correct answers

Significant? (t-tests)

2011 (N=262)

2013 (N=136)

71.8 50.4

79.4 65.4

+7.6 +15.0

Yes Yes

22.5 22.1 20.6 34.7

8.8 8.1 16.2 66.9

-13.7 -14.0 -4.4 +32.2

Yes

6.9 10.3 21.4 22.5 25.6 13.4 38.5 61.5

3.7 3.7 8.8 13.2 27.9 42.6 16.2 83.8

-3.2 -6.6 -12.6 -9.3 +2.3 +29.2 -22.3 +22.3

KNOWLEDGE Knowledge of HIV and AIDS % correct answer: What is HIV? % correct answer: What is AIDS? Knowledge of Contraceptives % who knows no modern method (never heard) % knows 1 modern method % knows 2 modern methods % knows 3 or more modern methods SCORE KNOWLEDGE (Out of possible maximum 5) % score 0 % score 1 % score 2 % score 3 % score 4 % score 5 % little knowledge (=total score 0-2) % good knowledge (=total score 3-5) 4

Yes

21.9

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 17

Rights-Based Sexuality Attitudes

ATTITUDES 1. Anyone who dresses sexy wants to have sex (No) 2. It is okay for someone to use some force or pressure on someone who is refusing to have sex (No) 3. A person can refuse to have sex with the partner if he (she) doesn’t want to (Yes)

Change

Percent Giving Correct answers

Significant? (t-tests)

2011 (N=262)

2013 (N=136)

51.8 86.3

58.1 97.1

+6.3 +10.8

No Yes

41.4

27.9

-13.5

Yes

SCORE ATTITUDE (out of possible maximum 3) % score 0 5.1 1.5 -3.6 % score 1 31.3 30.1 -1.2 % score 2 41.8 52.2 +10.4 % score 3 21.9 16.2 -5.7 % with “negative” attitude (score 0-1) 63.7 63.7 0.0 % with “positive” attitude (score 2-3) 68.4 68.4 0.0 SKILLS, BEHAVIOUR AND EMPOWERMENT 1. Did you use contraceptives last time you had sex? (Yes) 50.8 64.7 +13.9 2. Have you ever used a condom? (Yes) 61.1 83.8 +22.8 3. It is difficult for me to use condom every time we have 54.6 68.4 +13.8 sex (No) 4. I am sure that I can use a condom every time if I have 68.7 82.4 +13.7 sexual intercourse in the future (Yes). 5. Who will decide on the number of children you will have 30.9 50.0 +19.1 (me and my partner) 6. Who will decide on whether to use a condom or not 23.2 36.8 +13.6 when you have sex in future? (me and my partner) 7. Who will choose your partner? (me) 82.5 80.9 +1.6 8. Who will decide whether to use contraceptives or not? 25.5 46.3 +20.8 (me and my partner) SCORE BEHAVIOUR AND EMPOWERMENT (OUT OF POSSIBLE 8) % score 0 2.1 0.0 -2.1 % score 1 10.2 2.2 -8.0 % score 2 14.8 3.7 -11.1 % score 3 10.6 10.3 -0.3 % score 4 20.3 15.4 -4.9 % score 5 17.8 30.1 +12.3 % score 6 12.7 16.9 +4.2 % score 7 9.3 11.8 +2.5 % score 8 2.1 9.6 +7.5 % little skills / empowerment (score 0-4) 58.1 31.6 -26.5 % sufficient skills/empowerment (score 5-8) 41.9 68.4 +26.5 OVERALL INDICATOR “CAPACITY TO MAKE SAFE AND INFORMED DECISIONS” % overall score 0 15.2 5.1 -10.1 % overall score 1 28.3 14.0 -14.3 % overall score 2 32.6 36.0 +3.4 % overall score 3 23.9 44.9 +21.0 % low capacity (0-1) 43.5 19.1 -24.4 % good capacity (2-3) 56.5 80.9 +24.4

No Yes Yes Yes Yes Yes Yes No Yes

Yes

Overall, 80.9% of surveyed young people (who reported ever having had sex) have good capacity to make safe and informed decisions about SRH while 19.1% have low capacity. Compared with baseline, there has been significant increase in proportion of young people (who reported ever having had sex) who have good capacity from 56.5% at baseline to 80.9% at 2013 outcome measurement. Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 18

3.3

RESULT AREA 2: STRENGTHENING SRHR SERVICES

3.3.1

Outcome Indicator 2.2a: % of Targeted SRHR Facilities Increasingly Comply with IPPF Standards for Youth Friendly Services

Summary of Key Outcome Highlights and Results: Targeted youth friendly services are not complying with IPPF standards for youth friendly services as evidenced from the mean score 2.70 compared with a baseline mean score of 2.75. This outcome indicator measures the youth friendliness of services at Kaphuka, Golomoti, Mpondasi and Katuli health centres and Chikhwawa District Hospital. Services from each health centre were assessed on their compliance with International Planned Parenthood Federation (IPPF) standards for youth friendly services using a prepared checklist. Table 7 below shows results of the assessment. Table 7: Aggregate Mean Scores on Quality of YFHS in Surveyed Districts YFHS Assessment Checklist

Mean Scores Mpondasi Katuli 3 3

Kaphuka 3

Golomoti 4

2.4

1.0

3 2

2 2

3 2

4 2

3 2

3.0 2.0

3.0

1.0

3.4

3.2

2.4

11. Extent of stock-outs (1-5)

2.1

2.6

3.0

2.6

2.7

Overall Mean

2.6

2.4

2.5

3.0

2.7

Whether there are trained service providers to work competently, sensitively and respectfully with young people on their SRH needs Extent of privacy of service delivery

Special entrance and waiting area for young people? 4. Convenience of opening hours 5. Extent of SRH accessibility to all young people irrespective of marital status (1-2) 6. Extent to which staff are able to address needs of young people with different sexual orientations (1-3) 7. Extent to which staff address needs of young PLHIV (1-2) 8. Extent to which services are available to all young people irrespective of their ability to pay 9. Extent to which effective referral system is in place 10. Extent to which service providers involve parents and community to ensure that adolescents access to SRHR 5

Chikhwawa 3

All 3.2

The mean scores in Table 7 show that health services from the five health facilities were relatively youth-friendly. Although there were some efforts to improve service delivery in sampled facilities in the three districts, quality service gaps included inadequate privacy (#2), absence of separate entrance and waiting area for young clients (#3) and inadequate involvement of parents and community to ensure adolescentsâ&#x20AC;&#x2122; access to SRHR (#10). Stock out of drugs were also a service gap generally (2.7) and more so at Kaphuka (2.1), Golomoti (2.6) and Chikhwawa District Hospital (2.6)

1=Donâ&#x20AC;&#x2122;t know (The service provider available does not know); 2= Never (There are never stock outs); 3= Sometimes (Stock outs happen approximately once per year); 4=Frequently (Stock outs happen more than once per year); 5=(Almost) always (These drugs are almost always out of stock (more than 9 months per year) 5

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 19

Among the five assessed health facilities, only Chikhwawa was increasingly complying with IPPF Standards for Youth Friendly Services while the rest were not. Table 8: Mean Scores on Health Facility Compliance with IPPF Quality YFHS Standards 2011 Baseline Mean score

2013 Change (2011-2013) (increase, decrease or no change)

Mean Score

Name 1: Kaphuka Health Facility A:

2.75

2.6

Decrease

Name 2: Golomoti Health Facility B:

2.75

2.4

Decrease

Name 3 : Mpondasi Health Facility C:

2.75

2.4

Decrease

Name 4 : Katuli Health Facility D:

2.75

2.5

Decrease

2.75

3.0

Increase

Name 5: Chikhwawa Health Facility E: Total number of facilities assessed:

Total number of facilities with increased score Percentage facilities with an increased score

1 20.0

UFBR programme contributions to outcomes include development of Quality of Care Improvement Plans, quarterly monitoring of implementation of Quality of Care Improvement Plan and training of health workers in YFHS. However, the scope of programme interventions may be sub-optimal to significantly influence service quality in the 11 areas of YFHS assessment in Table 7.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 20

3.3.2

Outcome Indicator 2.2c: % of Targeted Maternal Health Facilities Increased their Compliance to the (National) Quality S tandards

Summary of Key Outcome Highlights and Results: Targeted maternal health facilities havenâ&#x20AC;&#x2122;t increased their compliance to the national quality standards, with OM mean score (2.5) lower than baseline mean (2.9) Surveyed health facilities were assessed using Malawi Government standards for assessing the quality of maternal health in Malawi. Table 9 below depicts results of the analysis. Table 9: Mean Scores on Quality of Maternal Health Services in Surveyed Districts Maternal Health Services Checklist

Mean Score Kaphuka

Golomoti

Mpondasi

Katuli

Chikhwawa

All

Skilled Birth Attendance: Whether there is skilled birth attendant available (Midwife, Medical Assistant, Medical Doctor or Clinical Officers) Equipment: Availability of equipment in delivery room Privacy: Extent to which privacy can be guaranteed Supplies: Availability of gloves and other essential supplies (e.g. resustair, personal protective equipment) Quality of delivery room: Availability of lighting in the delivery room at night Sanitation: Availability of sanitation facilities Water: Availability of running water

4.0

3.2

1.8

2.6

2.0

2.8

Infection prevention: Practice of infection prevention in delivery room

4 3

Frequency of outreach: Whether facility conducts outreach services for ANC, immunisation and FP 10. Referral: Facilityâ&#x20AC;&#x2122;s referral communication 11. Transport: Availability of transport for pregnant women in critical conditions 12. Extent of stock-outs (1-5)

1.6

3.4

1.4

3.1

3.0

Overall Mean (Excluding #12)

2.5

2.3

2.5

1.9

3.4

2.5

2. 3. 4. 5. 6. 7. 8. 9.

2.2

The mean scores in Table 9 show that the quality of maternal services was generally not satisfactory, particularly at Katuli where the mean score was 1.9 out of 4.0. Key areas of concern include privacy (#3), supplies (#4), sanitation (#6), infection prevention (#8), frequency of outreach (#9) and transportation (#11).

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 21

Results in Table 10 show that only 20.0% of the health facilities (Chikhwawa) has increased compliance to national quality standards, experienced decreased compliance to national quality standards on maternal health. Table 10: Comparison of Mean Scores on Quality Maternal Standards 2011 baseline

2013 OM

Mean score

Mean Score

Change (2011-2013) (Increase, decrease or no change)

Name 1: Kaphuka Health Facility A:

2.9

2.5

Decrease

Name 2: Golomoti Health Facility B:

2.9

2.3

Decrease

Name 3 : Mpondasi Health Facility C

2.9

2.5

Decrease

2.9

1.9

Decrease

2.9

3.4

Increase

Name 4 : Katuli Health Facility D Name 5: Chikhwawa Health Facility E Total number of facilities assessed:

Total number of facilities with increased score Percentage facilities with an increased score

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

1 20.0

Page 22

3.3.3

Outcome Indicator 2.2b: % of SRHR Facilities with an Increase in Satisfaction by Young People

Summary of Key Outcome Highlights and Results: Not able to determine whether SRHR facilities have experienced satisfaction by young people because there is no relevant baseline data (no relevant mean score) to inform such determination. Exit interviews were conducted with young people to assess their views and perceptions on the extent to which health services were youth-friendly. Table 11 below shows the quality of youth friendly services as assessed using Malawi Government standards. Table 11: Satisfaction with Services among Young People Area of SRHR Assessment

Mean Score

How satisfied were you with privacy of service delivery? 2. How satisfied were you with the services for which you required treatment or assistance 3. How satisfied were you with the behaviour of health workers? 4. How satisfied were you with the counselling services you received? 5. How satisfied were you with waiting time before you were treated? 6. To what extent do you agree with the opening time for the health facility? 7. How satisfied were you with the consultation time? 8. On a scale of 1-5, how do you rate the overall service delivery? Overall Mean (Excluding #8)

Golomoti

Mpondasi

Katuli

Chikhwawa

3.1

3.2

1.5

3.4

All 2.8

3.1

3.0

2.7

3.3

3.0

2.9

3.0

2.3

3.2

2.9

2.6

2.9

1.3

2.5

2.3

2.8

2.1

3.1

2.6

2.4

2.6

1.7

3.2

2.5

1.1

1.2

1.1

4.0

3.3

4.4

3.9

2.5

2.7

1.8

2.8

2.5

No Data

Kaphuka

The mean scores strongly suggest low satisfaction, generally. However, specific service quality gaps include consultation time-too short (#7), low satisfaction with counselling services received (#4) opening time-usually too late (#6) and waiting time-usually too long (#5). Table 12: Comparison of Mean Scores on Satisfaction with Services among Young People 2011 Baseline Mean score Name 1: Kaphuka Health Facility A: Name 2: Golomoti Health Facility B: Name 1 : Mpondasi Health Facility C Name 2 : Katuli Health Facility D Name 5: Chikhwawa Health Facility E 6

2013 Mean Score

Change (2011-2013) (Increase, Decrease or No change)

Not available

2.5

Not available

2.7

Not available

No data6

Not available

1.8

Not available

2.8

Exit interviews with young people didnâ&#x20AC;&#x2122;t take place because they didnâ&#x20AC;&#x2122;t turn up for services during data collection at Mpondasi

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 23

2011 Baseline Mean score

2013

Total number of facilities assessed: Total number of facilities with increased score Percentage facilities with an increased score

3.3.4

Change (2011-2013) (Increase, Decrease or No change)

Mean Score 5

Outcome Indicator: 2.2d: % of Maternal Health Facilities with an Increase in Satisfaction among Women

Summary of Key Outcome Highlights and Results: Overall, there is no increase in maternal health facilities with an increase in satisfaction among women. In fact, the overall mean score decreased from 3.2 at baseline in 2011 to 3.1 at outcome measurement in 2013. To measure the outcome, exit interviews were conducted with women to assess their satisfaction with SRHR services at sampled health facilities. Analysis results are presented in Table 13. Table 13: Satisfaction with Services among Women Mean Score

Area of Assessment Kaphuka 3.2

Golomoti 3.2

Mpondasi 3.3

Katuli 3.2

Chikhwawa 3.0

All 3.2

How satisfied were you with the counselling services you received

How satisfied were you with the services for which you required treatment or assistance

3.1

3.7

3.0

3.4

3.5

3.3

How satisfied were you with privacy of service delivery?

3.4

3.3

3.5

3.2

1.9

3.1

How satisfied were you with waiting time before you were treated?

2.6

2.9

3.3

2.9

How satisfied were you with the behaviour of health workers?

3.4

3.2

3.1

3.3

3.4

3.3

How satisfied were you with the consultation time?

3.1

2.8

3.4

3.1

3.5

3.2

To what extent do you agree with the opening time for the health facility? On a scale of 1-5, how do you rate the overall service delivery?

2.8

2.7

3.2

3.4

3.2

3.1

4.1

4.2

4.1

4.3

4.2

3.1

3.2

3.1

Overall Mean (Excluding #8)

The mean scores strongly suggest satisfaction with services at the surveyed facilities, generally. However, frequent drug stock-out7 occurring more than once a year (#8) and long waiting time (#4) are key service gaps in all surveyed health facilities. 7

4=Frequently (Stock outs happen more than once per year)

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 24

Table 14: Comparison of Mean Scores on Satisfaction with Services among Women 2011 baseline 2013 Change (2011-2013) Mean scores Mean Score (Increase, Decrease or No change) Name 1: Kaphuka Health Facility A: Name 2: Golomoti Health Facility B: Name 3 : Mpondasi Health Facility C Name 4 : Katuli Health Facility D Name 5: Chikhwawa Health Facility E Total number of facilities assessed: 2 Total number of facilities with increased score Percentage facilities with an increased score

3.2

3.1

Decrease

3.2

3.1

Decrease

3.2

No change

3.2

No change

3.2

3.1

Decrease

5 0 0.0%

Results in Table 14 show that there was either no change or there was marginal decrease in percentage of maternal health facilities with an increase in satisfaction among women in all the five surveyed health facilities.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 25

3.3.5

Outcome Indicator 2.3a: % Increase in the use of Targeted SRHR Services by Young People and Women

Summary of Key Outcome Highlights and Results: There is increase in use of targeted SRHR services by young people and women across all ages except >24. Notably, the highest increase was with age 20-24. Overall, there was 28.8% increase in use of targeted SRHR services from 2011 baseline to 2013 outcome measurement. This indicator measures if more services were provided to young people and women as compared to the baseline. One month (in 2011 and same month in 2013) data on service utilisation among young people and women were collected for targeted SRHR services. Table 15 below is aggregate SRHR utilisation data for ANC visits, condom distributions (condom distribution records for Katuli for 2011 was missing and ther efore not included), STI screening and treatment, contraceptives and births (deliveries) and Voluntary Counselling and Testing (VCT). Other SRHR services (as per relevant tool) are not included because records for such were not available. The data is only age disaggregated and not gender disaggregated because health facility data was not accordingly disaggregation, in some cases. Table 15: Use of Targeted SRHR services by Young P eople

Age category

Total nr. Baseline [A]

Percentage Increase Percentage [(B/A)*100]

Total nr. 2013 [B]

10-14

15-19

8 354

10 374

20-24

4 080

8 169

>24

3 072

1 611

15 551

20 238

1 425

1 624

16976

21 862

Total (Dedza and Mangochi) Chikhwawa* Total

186.7 124.2 200.2 52.4 130.1 114.0 128.8

*Chikhwawa data not age disaggre gated

Results in Table 15 above depict increase in use of targeted SRHR services by young people and women across all ages except >24. Notably, the highest increase was with age 20-24. Overall, there was 28.8% increase in use of targeted SRHR services from 2011 baseline to 2013 outcome measurement.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 26

3.3.6

Outcome Indicator 2.3b: % Increase in Number of Births in Targeted Areas that were Attended by Skilled Birth Attendants

Summary of Key Outcome Highlights and Results: There has been an increase in girls delivering with skilled birth attendants by 26.4% and overall increase by 24.1%. The highest increase was recorded in girls (10-14) and least in girls (20-24). A review of the percentage increases shows that the percentage of girls and women delivering with skilled birth attendant is decreasing with age. Skilled birth attendants in Malawiâ&#x20AC;&#x2122;s health delivery system include Midwives, Medical Assistants, Clinical Officer or Medical Doctor. It should be noted that record keeping in Malawian health facilities is generally poor due to lack of trained personnel in record keeping and services that are being provided by unskilled people who probably are unable to record data. Results in Table 16 show skilled birth attendance at the 5 surveyed health facilities in Dedza, Mangochi and Chikhwawa. Table 16: Number (%) of Girls and Women Delivering with Skilled Birth Attendants at Sampled Health Facilities Target Group Total nr. Total nr. Percentage Baseline [A] 2013 [B] [(B/A)*100] Girls 10-14 Girls 15-19 Girls 20-24 Total for Girls Women 24+ Overall Total

1 129 165 295 228 523

2 166 205 373 276 649

200.0 128.7 124.2 126.4 121.1 124.1

Table 16 shows that there has been an increase in girls delivering with skilled birth attendants by 26.4% and overall increase by 24.1%. The highest increase was recorded in girls (10-14) and least in girls (20-24). A review of the percentage increase in Table 16 shows that the percentage of girls and women delivering with skilled birth attendant is decreasing with age.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 27

3.3.7

Outcome Indicator 2.3c: % Increase in Targeted Health Facilities of Women who have 1-4 Antenatal Visits

Summary of Key Outcome Highlights and Results: Overall, there is 7.6% decrease (100-92.4) in the percentage of women and girls who have at least one ANC visit. There has also been decrease in percentage of women who go for the first (100-71.4%) and second visits (100-90.5%). However, there have been increases in third, fourth and 4+ ANC visits of 40.6%, 123.3% and 20.0%, respectively. This outcome indicator measures changes in the number of women who came for 1 or more antenatal consultations with health staff from targeted health facilities, compared to the baseline. Table 17: Percentage of Girls and Women having 1-4 ANCs at Surveyed 5 Health Facilities in Dedza, Mangochi and Chikhwawa (1-Month Data) Total Number of ANC Visits (1-4) 2011 Target Group

Total Number of ANC Visits (1-4) 2013

At least one

Percentage [(2013 ANC)/(2011 ANC)*100]

At least one

Girls 10-14

0.0

100.0

Girls 15-19

214

203

63.0

102.8

129.5

185.7

94.9

Girls 20-24

194

158

413

116

121

318

59.8

76.6

130.6

125.0

66.7

77.0

Total for Girls

286

229

628

175

194

121

522

61.2

84.7

130.1

147.4

100.0

83.1

Women 24+

183

170

452

121

140

108

388

66.1

82.4

131.7

336.4

83.3

85.8

Overall Total

469

399

175

1080

335

361

246

998

71.4

90.5

140.6

223.3

120.0

92.4

Overall, there is 7.6% decrease (100-92.4) in the percentage of women and girls who have at least one ANC visit. There has also been decrease in percentage of women who go for the first (100-71.4%) and second visits (100-90.5%). However, there have been percentage increases in third, fourth and 4+ ANC visits of 40.6%, 123.3% and 20.0%, respectively.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 1

3.3.8

Outcome Indicator 2.3d: Number of Facilities with Increased Availability of Contraceptives, ART, ACT and Antibiotics

Table 18 below shows mean scores on drug stock-out status at Kaphuka, Golomoti, Mpondasi, Katuli and Chikhwawa District Hospital. However, due to lack of relevant baseline targets, it is not possible to determine any outcome changes on this indicator. Table 18: Aggregate Mean Scores on Drug Availability8 at 5 Surveyed Health Facilities Drug

ACT ART Antibiotics Total

NO DATA

2011 Contraceptives

Change?

Mean Scores 2013 Kaphuka

Golomoti

Mpondasi

Katuli

3.5

2.0

4.0

Chikhwawa 3

2.8

2.0

3.0

2.0

2.3

2.0

3.0

2.0

2.3

Nr. With improvement in 2013

% of facilities assessed

All

2.0

3.0

2.0

2.3

2.4

2.6

2.5

From the results in Table 18, stock-outs of Acyl CoA-Thioester-Hydrolase (ACT), ART and Antibiotics were either rare or never occurred during the reporting period. However, stock-out of contraceptives at the facilities generally occurred more than once a year.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 1

3.4

RESULT AREA 3: STRENGTHENING ENABLING ENVIRONMENT

3.4.1 Outcome Indicator 2.4a: SRHR Policies and Legislation Implemented, Changed, or Adopted at Local, Institutional or National Level, at least 2 per Country 3.4.1.1 Key Policy and Advocacy Issues Legislation refers to laws which serve to legally prohibit certain actions and ensure others are carried out. This outcome refers to government laws as well laws which are not included in national legislation such as traditional laws or by-laws (UFBR Outcome Measurement Support Tool, p.53). FPAM, YECE, YONECO and CAVWOC understood advocacy work intended at promoting access to quality SRHR services among young people and women. 

In Dedza, Youth Empowerment and Civic Education (YECE) advocacy work in Traditional Authority Kamenyagwaza focused on influencing Bembeke Health Centre (mission-owned) to provide a whole range of SRHR services including contraceptives (such as condoms). As a mission hospital (Roman Catholic), Bembeke was not providing condoms and YECE lobbied with facility management to provide condoms. YECE’s community level advocacy also focused on ending early and forced marriages in impact communities.



Family Planning Association of Malawi (FPAM) advocacy work focused on promoting pregnant women’s attendance to antenatal clinics and promoting skilled birth attendant deliveries, family planning and ending early and forced marriages



In Mangochi, YONECO’s advocacy work focused on addressing pre-arranged marriages (Chitomero), early marriages, early pregnancies and availability of contraceptives in health centres.



CAVWOC undertook some community-level advocacy work focusing on early and forced marriages, poor delivery of maternal health services and poor delivery of youth friendly health services. Advocacy around early and forced marriages focused on working with community leaders around developing actions to combat early and forced marriages (EFM). As expected, advocacy around poor maternal and youth friendly health services focused on working with the Chikhwawa District Hospital.

3.4.1.2 Key Outcome Changes The main changes resulting from the advocacy work have been formulation of community by-laws with support from community leaders. Among others, the by-laws were intended to constrain pregnant women to deliver at health facilities, husbands to accompany their wives to antenatal clinics and by-laws against early and forced marriages. In the event that the by-laws were broken, requisite punishment (fines in cash or kind). Following are other outcomes from advocacy interventions of the four partner organisations: 

Through YECE’s advocacy work, Bembeke health centre now provides contraceptives (including condoms) through Health Surveillance Assistants (HSA) and peer educators. Since it seemed that the Church’s (Roman Catholic) primary concern was providing these services from the mission infrastructure, HSAs and peer educators get contraceptives from the health centre pharmacy and provide them to the

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 2

community during outreach services. Eventually, management obliged and now stocks contraceptives at the health facility. While more needs to be done, this gesture represents a step in the right direction and therefore more concerted efforts are vital to build on these initial successes. 

In FPAM impact areas, early marriages and forced marriages have reduced because of the commitments made by community leaders to end the malpractice. There has also been increased enrolment of girls in senior primary school classes.



Through CAVWOC’s advocacy work, management at Chikhwawa District Hospital is taking substantive actions to promote access to quality services among young people and women at the facility.

3.4.2 Outcome indicator 2.4b: Increased Involvement of Community Leaders in Realisation of SRHR in x% of the Targeted Communities Community leaders are people who have the power to change opinions and habits of the community. While the definition of the community leaders in the Outcome Measurement Tool is broad, Alliance Partners restricted the definition to Group Village Headmen (GVH) and their Counsellors, Village Headmen (VH), Religious Leaders based in the community and their Counsellors, members of Village Development Committees and others recommended by the GVH and VH. 3.4.2.1 Key Outcome Changes The outcome 2.4b changes were measured retrospectively through focus group discussions (FGD) with community leaders. 3.4.2.1.1. Awareness and Knowledge of UFBR Programme Intervention Most community leaders in surveyed communities who participated in FGDs were aware of the various UFBR programme interventions being implemented in their communities. Among others, they reported that through the programme, partner organisations were implementing various SRHR education, services and enabling environment themes which were contributing to uptake of quality SRH services among young people and women. Nevertheless, community leaders in Mangochi were hardly knowledgeable in many SRHR themes, but had misconceptions which affected their support and involvement in promoting SRHR in the community. 3.4.2.1.2. Community Leadership Involvement and Support SRHR The extent to which community leadership support and involvement was assessed retrospectively. Main community leadership support and involvement included the enactment of by-laws, raising community awareness about various SRHR themes and case management when relevant violations occur. Despite some gaps, there is generally some support and involvement of community leadership in promoting SRHR. Compared with pre-project period, leadership support of and involvement in SRHR has increased, albeit marginally in some cases:  Promoting attendance to antenatal clinics and delivery at health facilities  Ending early and forced marriages and early pregnancies

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 3

 HIV Testing and Counselling  Sexual and Gender-Based Violence (SGBV) However, leadership support of and involvement in the following SRH themes remains a challenge because community leaders generally view these themes to be against cultural traditions:  Condom use among unmarried young people: is generally not supported among the leadership. Notably, community leaders in Mangochi don’t support use of condoms generally because they are considered haram (unholy) according to Islamic teachings.  Safe abortion: Community leaders generally view abortion (safe or not) as murder. In Mangochi; they viewed abortion as sin according Islamic teachings.  Condom use among unmarried young people: community leaders don’t support use of condoms generally because of misconceptions and in Mangochi, they are considered haram (unholy) according to Islamic teachings.  Use of contraceptives among young people is generally viewed as encouraging young people to engage in sex before marriage and promiscuous behaviour  Females accessing condoms: community leaders don’t encourage young people in general and girls in particular to access condoms because that would be synonymous to encouraging them to have sex. Table below shows changes in community leadership involvement in and support of SRHR in surveyed communities. Although there are some SRHR themes that don’t receive community leadership support, the overall impression is that their involvement and support has increased since project inception. Table 19: Community Leadership Involvement in and Support of SRHR in Surveyed Impact Areas Name of Community and Respondent group 1.

Kamgulitse

Khanganya

Kamenyagwaza

Alliance Partner

A lot of Support and Involvement (Score=1)

YECE YECE YECE FPAM FPAM FPAM

No Support or Involvement at all (Score =3)

No Knowledge of Issues and No Support (Score=4)

Support and Involvement 1.Increase, 3.same or 2.Decreased?

2 2 2 2 2

Chikolola

5. 6.

Kaphuka Tambwandira and Mkopoka Kabulika, Ngwimbi and Chikolorere Mponda-Chipeta

Katuli-Makande

YONECO YONECO

10.

Namila

CAVWOC

11.

Fombe

CAVWOC

12.

Pende

CAVWOC

13.

Belo

CAVWOC

14.

Chikhambi

CAVWOC

15.

Mtwana

CAVWOC

Some Support or Involvement (Score=2)

1 1 1 1 1 1

FPAM

2 2 2

1 1 1 1 1 1 1 1 1

All

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 4

3.4.3 1Outcome indicator 2.4c: Increased Acceptance of SRHR at Community Level in x% of the Targeted Communities UFBR programme interventions that implemented under this outcome indicator focused on raising community awareness and community review meetings. Through these meetings, implementing partners addressed misconceptions around SRHR and encouraged young people and women to access SRHR services. Among others, some of the SRHR themes that were covered during community meetings included need for pregnant women to go to antenatal care clinics and deliver there; ending early and forced marriages; reducing early pregnancies prevalence; family planning; condoms use among young people; condom access; male involvement in SRHR and ending Sexual and Gender-Based Violence (SGBV). 3.4.3.1 Knowledge of UFBR and SRHR In general, FGD participants were found knowledgeable of UFBR programme and the various SRHR themes. For each of SRHR themes, they were able to report on specific interventions (SRHR education, services and enabling environment) targeting young people and women. In triangulation, the interventions mentioned were the ones implemented by alliance partners in the surveyed impact areas. 3.4.3.2 Key Outcome Changes Key outcome changes were assessed retrospectively through FGDs. In general there has been increased community acceptance and support of SRHR in the surveyed areas: 

Pregnant women to go for ANC and deliver at health centre: All surveyed communities accept that women should attend antenatal clinics and deliver at health facilities rather than at Traditional Birth Attendants (TBAs) because they get examined for possible complications.



Husbands escorting their wives to antenatal clinic: while there is increased community acceptance of husbands accompanying their wives to antenatal clinics and the need for husbands to take greater roles in safe motherhood, only few husbands were reportedly accompanying their wives to antenatal clinics. It was obvious from the FGDs that community attitudes were changing and this is likely to eventually result in increased male involvement in the medium and long term.



Family planning: Generally, there is overwhelming community acceptance of family planning as community members realise the implications of large family sizes on cost of living and national development. FGDs with targeted groups showed that there were more couples using contraceptives compared with the pre-project project. However, the communities were largely opposed to young people using contraceptives before marriage because they viewed this as encouraging promiscuous behaviour among the youth.



Ending early pregnancies and early and forced marriages: Among the surveyed three districts, early and forced marriages were reportedly more prevalent in the impact areas in Mangochi than in the other two districts. FGDs showed increased community support to end early pregnancies and early and forced marriages in the impact areas. However, parents and guardians were primarily responsible but community leaders and members felt powerless to intervene in such situations. This suggests need for education on justice and referral systems for victims.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 5



Unmarried young people using condoms (and safer sex): In general, surveyed community understand that young people are having sex anyway and there is nothing that can be done to stop it. Apart from Mangochi, there is generally support for condom use among young people to prevent unplanned and unwanted pregnancies and control HIV transmission. Strong Islamic adherents view condom use as haram (unholy) and therefore should never be promoted. Although surveyed communities generally accepts that both boys and girls have the right to protect themselves from HIV and that females stand an added risk of unwanted pregnancy and possibilities child-birth complications, abortion related complications (if they decide to abort), withdrawing from school and seeing out the pregnancy. An interesting aspect is gender dimensions of who the communities perceive is the right person to collect condoms. The minority in surveyed communities said it was improper for girls to collect condoms and that this should be left to boys. According to the minority views, girls who collect condoms are more associated with promiscuity than boys.



Talking about sexuality with young people: The community accepts that it is good to educate youth on sexuality issues but in practice, it is not easy for guardians to talk with the youth about sexuality issues. Although the discussions can be vital source of information for the young people, some become curious and want to explore and try. Most of the sexuality education through traditional means occurs during and after initiation ceremonies (e.g. Jando in Mangochi) by traditional initiators (Anamkungwi). When a young person is getting married, sexuality education is also pre-arranged and it usually focuses on sexuality issues in marriage. There have been concerns that such sexuality education isn’t content appropriate and sorely focuses on sex rather than other broad sexuality issues.



Masturbation: Although the majority of surveyed young people had general awareness of masturbation, the majority didn’t have comprehensive knowledge about the theme and this may limit their ability to practice masturbation. However, the community understood that masturbation reduces transmission of STI including HIV while the person gets sexual gratification. On this basis, the community generally accepted masturbation, although it was perceived to have originated from the West.



Sexual and Gender-Based Violence (SGBV): The majority of FGD participants in surveyed communities detested SGBV and supported efforts to end it remains prevalent in surveyed communities. Common forms of SGBV include husbands physically assault and verbal abuse. With community awareness campaigns by alliance partners, there is generally increased awareness of the dangers of SGBV and communities are beginning to support efforts to reduce the practice.

In all the surveyed areas, safe abortion remains a contentious issue. While the majority of community members don’t accept and support abortion (including safe abortion) on grounds that is murder, female respondents were generally more accepting of abortion than male respondents. For some female respondents, abortion should be allowed if the life of the mother is in jeopardy. For example, women observed that some men in Mangochi impregnate and migrate to Republic of South Africa in search of employment leaving the woman behind to care for the pregnancy. Most of them don’t have the resources and would therefore prefer an abortion. Other women observed that if a woman has a young child and accidentally falls pregnant, she should have an abortion because it is difficult to carry through the pregnancy while also caring for young child.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 6

Table 20: Community Acceptance of SRHR in Surveyed Impact Areas Name of Community and Respondent Group 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. All

Kamgulitse Khanganya Kamenyagwaza Chikolola Kaphuka Tambwandira and Mkopoka Kabulika, Ngwimbi and Chikolorere Mponda-Chipeta Katuli-Makande Namila Fombe Pende Belo Chikhambi Mtwana

Alliance Partner YECE YECE YECE FPAM FPAM FPAM FPAM YONECO YONECO CAVWOC CAVWOC CAVWOC CAVWOC CAVWOC CAVWOC

Community Supports and Accepts 1 1 1 1 1

Community Doesnâ&#x20AC;&#x2122;t Support or Accept

There has been No change

1 1 1 1 1 1 1 1 1 1

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 7

SECTION FOUR: CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS 4.1

CONCLUSIONS

The 2013 OM was undertaken to take stock of the impact of the programme. Key OM questions include is programme on the right track? Is it progressing towards intended outcome changes as planned? Results from this OM show increased uptake targeted SRHR services among young people and women at health facility level. Surprisingly, this has occurred against a backdrop of quality of services either remaining at baseline level or diminishing. From the results, increased uptake of the services is partly due to community actions and bylaws that constrain members to access services from the health facilities. Overall, the programme is on track on 6 out of 12 outcome indicators assessed (2.1a under Strengthening SRHR Education; 2 out of 8 outcomes under strengthening SRHR Services and 3 out of 3 outcomes under Strengthening Enabling Environment). For other outcomes, either there is no baseline data to conclude extent of progress or OM results show no improvement on the baseline situation. With exception of Mangochi where community leadership involvement and support had marginally increased since programme inception, community leaders were greatly involved in and support the programme and SRHR in the other surveyed impact areas. Acceptance of SRHR in surveyed communities has also increased since programme inception, even though some SRHR themes are not accepted because they are perceived to be against cultural traditions. 4.2 LIMITATIONS Establishing changes from 2011 Baseline to the 2013 Outcome Measurement has been constrained by limitations in the 2011 baseline analysis and reporting. The Baseline Survey data (particularly related to indicators on Strengthening SRHR Services) were not district disaggregated but an aggregate for the three districts. For this reason, it should be noted that, where comparison has been made in this report, such comparison isn’t done on like-for-like basis (district-for-district). This was not the ideal situation but that’s what was available. In Mangochi, training of data collectors wasn’t possible and other OM activities which were scheduled on first day (KAP questionnaire interviews with young people) weren’t done in Mangochi because YONECO staff couldn’t arrive on time due to logistical hiccups between YONECO and their donor (Simavi). Due to possible cost implications, a decision was taken to proceed with the OM data collection without training data collectors. Besides, the KAP questionnaire interviews which were scheduled for day one were rescheduled. Eventually, most of the field data collection activities were achieved, albeit, under extreme work pressure. The measurement was also constrained by the following factors: a. By design, number of exit interviews conducted depends on the number of clients who turn up for services on particular day. However, in some cases the number of young people and women who turned up were inadequate for the desired sample size.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 8

b. The outcome measurement was conducted during public school holidays. In some areas, in-school young people were difficult to track and in some cases, were not available for the exercise although logistics for their availability were made in advance. c. Few People Living with HIV and AIDS (PLHIV) turned up for interviews in Dedza and Mangochi despite prior logistical arrangements and confirmations. d. Due to time and logistical limitations, it was not possible to pre-test all OM interview guides during the OM workshop which was held prior to the field OM data collection. For this reason, some few questions in the tools which were not pre-tested were either irrelevant or improperly worded and sequenced. Since it was too late for corrections, such questions were excluded from the analysis and reporting e. Men in one of the three targeted villages in TA Katuli refused to participate in focus group discussions unless they were paid allowances. Given the ethical considerations and the fact this was in fact being demanded rather than being offered as a token, the FGDs with the men in the village was cancelled. 4.3 RECOMMENDATIONS a. Despite increased uptake of targeted SRHR services, evidence from this assessment point to no change in quality of YFHS and maternal services delivered at sampled health facilities. It is recommended that alliance partners critically review the current scale of programme interventions and determine the extent to which they are insufficient. Thereafter, they explore other interventions that could subscribe to achievement of the outcomes. For one, some of the quality YFHS and maternal care (e.g. drug stock-outs or equipment and other supplies) can only be influenced with upstream interventions (district and national level). This option should also explored in terms of whether this is an area of comparative advantage

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 9

REFERENCES 1. Chirwa M., Kamkwamba D and Umar E (2011) Stigma and Discrimination Experienced by People Living with HIV and AIDS in Malawi 2. Dzilankhulani (2011) Situation Assessment of Condom use among Young People (10-24) in Malawi. UNFPA and Ministry of Youth Development and Sports. 3. Dzilankhulani (2012) Study on Rapid Assessment and Facilitation of Strengthening Quality of HTC and Referral Services for Adolescents at Sub-National Levels in Malawi. UNICEF and Ministry of Health 4. NAC (2009) National HIV Prevention Strategy (2009-2013) 5. National AIDS Commission (2011) 2011 Quarterly Reports. 6. SRHR Alliance (No date) UFBR Support Tool for Measuring Outcomes 7. Umar E (2011) Unite For Body Rights (UFBR) Malawi Programme Baseline Survey Report

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 10

ANNEXES Annex 1: Roadmap for UFBR OM in Malawi Main OM Activity 1. OM Workshop 2. Arrange logistics for OM, including field appointments and printing of final tools 3. Field data collection- FPAM and YECE (Dedza)  Audit of involvement of community leaders in SRHR activities  OCA Light  FGDs with teachers and school committees  FGD with young people (male)  FGDs with young people (female)  FGDs with adult males  FGDs with adult females 4. Field data collection – YONECO (Mangochi)  Audit of involvement of community leaders in SRHR activities  OCA Light (possibly self-administered)  FGDs with teachers and school committees  FGD with young people (male)  FGDs with young people (female)  FGDs with adult males  FGDs with adult females 5. Field data collection- CAVWOC (Chikwawa)  Audit of involvement of community leaders in SRHR activities  OCA Light (possibly self-administered)  FGDs with teachers and school committees  FGD with young people (male)  FGDs with young people (female)  FGDs with adult males  FGDs with adult females 6. Data analysis

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 1

Proposed Dates 29th July – 2nd August August 5-9 August 12-16

Responsibilities Bertienne, Alfred, all partners Alfred, partners Alfred, research assistants, partners, target groups

August 19-23

Alfred, research assistants, partners, target groups

August 26-30

Alfred, research assistants, partners, target groups

September 2-6

Alfred

Main OM Activity 7. Draft reports (3 district reports) ready and submitted to WPF Rutgers and partners 8. Feedback on draft report (from individual partners, NPC country lead, PML officer) 9. Prepare final draft with feedback 10. NPTC Meeting (to present report to review report) 11. Consolidated draft report submitted 12. Feedback on consolidated report from partners 13. Final reports (1 consolidated, 3 district reports submitted)

Proposed Dates Sept 13 Sept 20 Sept 23 Sept 30 October 5 October 10 October 14

14. Dissemination of report in Chikwawa

October 22

15. Dissemination of final draft in Mangochi

October 23

16. Dissemination of final draft report in Dedza End of OM Malawi assignment

October 24

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 2

Responsibilities Alfred WPF Rutgers and partners Alfred

Alfred, WPF Rutgers and partners, government and CBO/NGO partners Alfred, WPF Rutgers and partners, government and CBO/NGO partners Alfred, WPF Rutgers and partners, government and CBO/NGO partners

Annex 2: Details of UFBR Programme in Dedza, Mangochi and Chikhwawa PROGRAMME AREA

ACTIVITIES IMPLEMENTED

1. STRENGTHENING SRHR EDUCATION Outcome indicator 2.1a: % of the YONECO exposed target groups has an  Training of peer educators in SRHR increased capacity to make safe  Training of health workers in SRHR and informed decisions  Training of life skills teachers in CSE  Conducting peer education sessions  Conducting Aunt Stella sessions  Training of theatre artists  Counselling and SRH awareness through the National Helpline and the SMS bulk system  Orientation of teachers on the Life Skills based education in schools reaching out to many in school youth  Training of more peer educators to help FPAM increase young people’s participation in SRHR education and reach out many young people in and out of school      

110 peer educators trained in CSE 22 primary school teachers trained in CSE 12 secondary school teachers trained in CSE Conducted bi-annual review meetings Oriented 80 traditional leaders in CSE Conducted orientation meetings with School Management Committee Members  Conducted 2 Annual Girls Conferences for 60 girls  Distributed IEC materials on CSE (300 T-shirts)  Supported outreach activities for Young people  Trained of 60 PLHIV in Positive Living to address self stigma and SRH Education 2. STRENGTHENING SRHR SERVICES Outcome Indicator 2.2a: % of  Development of Quality of Care Improvement Plans targeted SRHR facilities  Quarterly monitoring of implementation of Quality of Care increasingly comply with IPPF Improvement Plan standards for youth friendly  Training of Health workers in YFHS services Quarterly quality of care supervisions were done to the health centres with help from the Safe Motherhood Coordinator from

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

ALLIANCE PARTNER

TARGET POPULATION AND OTHER DETAILS

YONECO

180 peer educators (60 each TAs Chimwala, Mponda and Katuli) 90 teachers (30 in each TAs Chimwala, Mponda and Katuli) About 15,000 young people and adults participated in SRH education 45 theatre artists trained (15 in each TA) Young people and marginalized groups in the 3 TAs.

FPAM

32,577 in 2012 and 59,768 in 2013 young people were reached (Kaphuka, Chauma, Kachindamoto, Tambala and Kachere)

CAVWOC

TA Kasisi and Mlilima in and out of school young people aged 10-24

YONECO

6 health centres: Koche, Mpondasi, Asalaam, Kukalanga, Katuli, and Luwalika. About 50 health workers trained from the 6 target health facilities

FPAM

Chimoto (Kachere), Golomoti (Kachindamoto) Mganja (Kachindamoto, Mayani (Tambala) and

Page 3

PROGRAMME AREA

Outcome Indicator 2.2b: % of SRHR facilities with an increase in satisfaction by young people

ACTIVITIES IMPLEMENTED District Health Office in 2012 and with help from youth friendly health services co-ordinator in 2013 Advocating for increased supply and availability of condoms Trained 30 service providers in youth friendly health services

YECE CAVWOC



Advocacy on provision of youth friendly health facilities and services Training of health workers in YFHS Provision of resource materials to YFHS Centres

YONECO

Interface meeting Conducted a quality of care assessment developed an action plan with DHO following recommendations of quality of care exercise Conducted outreach services to offer YFHS Conducted bi-annual supervision visits of CBDAs Support capacity development of health workers (nurses, doctors, CBDAs, CRHPs and peer educators etc) to provide high quality integrated SRHR services to young people. To ensure the quality of care there is capacity building for service providers and supervision of health centres through checklist to measure compliance with the standards Conducted a quality of care assessment on maternal health services Training of health workers in maternal health Training of CBDAs

YECE CAVWOC

Developed an action plan with DHO following recommendations of quality of care exercise Conduct outreach services on HTC, ART, and Family Planning Establish Youth Drop-in centres and safe spaces for sex workers Provision of condoms and counselling services Two-week CBDA training for 25 youth from Kachindamoto The trained CBDAs work in their communities to motivate

CAVWOC

    

Outcome indicator 2.2c: % of targeted facilities increased their compliance to the (national) quality standard

  

 Outcome Indicator 2.2d: increase in the number of women satisfied with SRHR services

  

Outcome Indicator 2.3a: increase in young people and women using SRHR services

ALLIANCE PARTNER

   

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

TARGET POPULATION AND OTHER DETAILS Kaphuka (Kaphuka) health centres Health Surveillance (DHO) TA Kasisi and Mlilima 18 HSAs, nurses, clinicians, 6 teachers, 2 young people, 2 Child Protection Workers, 2 Police Officers District Health Management Team of Mangochi DHO, and centre management of the 6 health facilities Provided sporting equipment (footballs and netballs) Service providers and young people Chikhwawa District Hospital

FPAM

Thirty eight (38) service providers from facilities in 5 TAs (Chitowo in Kaphuka, Golomoti and Mtakataka in Kachindamoto)

CAVWOC

Chikhwawa District Hospital

YONECO

15 health workers trained in maternal health from the 6 target health centres and 60 CBDAs trained from the 3 TAs Chikhwawa District Hospital

YONECO

over 60000 young people and women use SRHR services i.e. family planning, condoms, counselling

FPAM

The young people were from TA Kachindamoto

Page 4

PROGRAMME AREA

ACTIVITIES IMPLEMENTED

      Outcome Indicator 2.3b: number of births attended by a skilled birth attendant is increased Outcome Indicator 2.3c: increase in pregnant women who have 14 antenatal check-ups



clients to utilize modern short acting family planning contraceptives. They also motivate clients to access other methods and refer them to the facilities. In 2012 the trained CBDAs recruited clients for short acting as well as long acting methods which were provided by the mobile clinical teams in the area. Conduct community meetings to encourage the uptake of health services Trained 21 HSAs in community mobilisation in Maternal Health Services Trained 21 HSAs in community and neonatal health (community safe motherhood) Trained 25 CBDAs to promote uptake of family planning services Distributed 8 Bicycle ambulances Conducted bi-annual Supervision visits of Safe Motherhood Committees Quarterly monitoring of implementation of quality of care improvement plans



Refreshed 400 secret mother and Village Health Committee members to conduct awareness and door-to-door campaigns to encourage antenatal check-up Outcome Indicator 2.3d: Nr of  Quarterly monitoring of implementation of quality of care facilities with increased improvement plans availability of contraceptives,  Advocacy on provision of SRHR ART, ACT and antibiotics  Conducted DHMT meetings to increase supply of essential drugs STRENGTHENING ENABLING ENVIRONMENT FOR SRHR Outcome indicator 2.4a: SRHR  Advocacy on the standardised Comprehensive Sexuality policies and legislation Education implemented, changed, or  Advocacy on adoption of safe abortion practices adopted at local, institutional or  Advocacy on delivery of YFHS in health facilities national level, at least 2 per  Enforced compliance of by-laws on early and forced country marriages and was part of a network that reinforced the passing of the gender bill in parliament.  Advocating for increased supply and availability of condoms

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

ALLIANCE PARTNER

TARGET POPULATION AND OTHER DETAILS

CAVWOC

TA Kasisi and Mlilima

YONECO

About 550 had 1-4 antenatal checkups in 3 of the 6 targeted health centres

CAVWOC

TA Kasisi and Mlilima

YONECO

6 targeted health facilities of Koche, Mpondasi, Asalaam, Kukalanga, Katuli, and Luwalika.

CAVWOC

Chikhwawa District Hospital

YONECO

1 advocacy plan for the UFBR Malawi alliance Targeting traditional leaders and Health Centres in the targeted 3 TAs

FPAM

1 Policy changed (gender bill) and compliance to bylaws on early and forced marriages reinforced in all target areas

YECE

Health Surveillance (DHO)

Page 5

PROGRAMME AREA

ACTIVITIES IMPLEMENTED 

Outcome Indicator 2.4b: Increased involvement of community leaders in realisation of SRHR in x% of the targeted communities

  



   

Outcome Indicator 2.4c: Increased Acceptance of SRHR at community level in x% of the targeted communities

     



 

ALLIANCE PARTNER

TARGET POPULATION AND OTHER DETAILS

Community dialogue meetings on early marriages, DHMT meeting to improve provision of maternal and youth friendly health services Conducting Area Development Committee (ADC) meetings Conducted the UFBR programme launch Conduct exchange visits to partner organizations (CAVWOC and FPAM)

CAVWOC

YONECO

60 ADC members (20 in TA Chimwala, 20 in Katuli and 20 in Mponda) 1 meeting conducted and attended by local and traditional leaders, District Council Officials and the Guest of Honour was the District Commissioner. 2 exchange visits conducted to CAVWOC in 2012 and FPAM in 2013

Area Development Committees (ADC) Meetings: Meetings were held to share progress on project implementation, challenges and enable the community to input into the programme. Sensitization meetings on SRHR Review meetings on leaders’ commitments

FPAM

All 5 TAs were targeted in these activities. 74 traditional leaders reached in 2012 and 316 in 2011 and 397 in 2013.

YECE

ADC Members

YECE

Community leaders, youth Clubs and other relevant stakeholders

Training of chiefs and other community members in SGBV leading to the formation of SGBV Committees Trained 30 Youths in SGBV intervention and awareness

CAVWOC

TA Kasisi and Mlilima 607 Committee members trained

Conducting Area Development Committee meetings Conducting community awareness meetings Formation of by-laws against early and forced marriages Conducting community awareness sessions on SRHR Community meetings every month to encourage women to attend antenatal care, utilise family planning methods and deliver at the hospital

YONECO

Over 75,000 community members aware and reached with SRHR By laws established in all the 3 TAs and are spearheaded by chiefs.

FPAM

12547 women attended antennal care through our interventions through.

Community Meetings. The meetings were intended to promote issues affecting youth SRH and support creation of an enabling environment for young people to exercise their sexual rights. Work with Safe motherhood committees through capacity building that encourages women to go for antenatal care and deliver in hospitals Community awareness campaigns

FPAM

19298 people were reached in 2011, in 2012 15619 were reached and in 2013 59292. Through community meetings.

FPAM

In 2012 261 safe motherhood Committee members were reached,

YECE

Community leaders, parents and young people in TA Kamenyagwaza

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

TA Kasisi and Mlilima Chikhwawa District Hospital

Page 6

PROGRAMME AREA

ACTIVITIES IMPLEMENTED 

Community dialogue circles

 

Community awareness raising meeting on SRHR themes Conduct community meetings to encourage the uptake of health services Training of 42 male motivators to increase male involvement in SRHR



Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

ALLIANCE PARTNER

CAVWOC

Page 7

TARGET POPULATION AND OTHER DETAILS TA Kasisi and Mlilima

Annex 3: Interview Tools

Outcome Indicator 2.1a: “% of the Exposed Target Group has an Increased Capacity to Make Safe and Informed Decisions”

UFBR 2013 OUTCOME MEASUREMENT KAP Questionnaire for Young People-CHICHEWA Questionnaire Number: Name of Interviewer: Date of Interview: Tribe of Respondent: Name of District: Traditional Authority: Group Village Headman: Village: Interview started at: Interview ended at: Questionnaire checked by: Questionnaire checked on (date):

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 1

MAFUNSO ZINTHU ZOMWE WOYANKHA MAFUNSO AYENERA KUDZIWA Chonde mutithandize kuyankha mafunso otsatira wa. Mayankho anu ndi ofunikira kwambiri kwa ife ndipo atithandiza kukhazikitsa ntchito ndi ndondomeko zabwino zokhudzana ndi umoyo wa achinyamata 

Sitilemba dzina lanu pa pepala la mafunsoli. Zonse zomwe tingapeze tizazisunga mwachinsinsi. Zimenezi zithandidiza kuti pasakhale munthu omwe atha kudziwa zomwe mwayankha.



Tikukupemphani kuti mukhale omasuka popereka mayankho anu chifukwa palibe yankho loona kapena lolakwika. Mutiuze zoona zokhazokha pa zomwe mukudziwa zokhudzana ndi inu komanso achinyamata ena. Zimenezi zithandiza popereka uthenga woyenelera kwa achinyamata.



Kuyankha mafunso awa kuzakhala kozipereka ndipo ngati simuli omasuka kupitiliza mutha leka kuyanka mafunso nthawi iliyonse



Ngati simunamvetsetse mafunso muli ndi ufulu kufunsa amene akukutsogolerani.



Yankhani mafunso awa mwachifatse chifukwa tili ndi nthawi yokwanira.

Kodi ndinu omasuka kuyankha mafunso otsatira wa 1 Eya 2 Ayi DEMOGRAPHICS -MBIRI YANU Tiyamba ndi mafuso okhudzana ndi inu 1. Ndinu wamuna kapena wankazi?(observe) (chongani nkabokosi) 1 Nyamata 2 Mtsikana 2. Mulindizaka zingati? _____ 3. Mmapita kusukulu? 1Eya 2Ayi 4. Ngati Eya pa funso 3, muli kalasi yanji? 1 Sitandade 1-4 2 Sitandade 5-8 3 Folomu 1-2 4 Folomu 3-4 5 Koleji kapena univesite 5. Ngati Ayi pa funso 4, kodi maphuziro munafika nawo pati? (chongani kabokosi kamodzi) 1 Sindinapite ku sukulu 2 Sitandade 1-4 3 Sitandade 5-8 4 Folomu 1-2 5 Folomu 3-4 6 Sukulu ya kwacha 7 Koleji kapena univesite

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 2

6. Ndinu okwatira panopa? (chongani kabokosi kamodzi) 1Eya 2Ayi KNOWLEDGE-KADZIWIDWE KA ZINTHU 7. Munayamba mwamvapo za matenda opatsirana pogonana 1Eya 2Ayi 8. Tchulani ena amatenda opatsirana pogonana amene mukuwadziwa 1 Mauka-Candidiasis 2 Chizonono-Syphilis 3 Mabomu- Bubo 4 Njerewere-Genital warts 5 HIV 6 Chindoko-Gonorrhoea 7 Ena (Tchulani)………………….. 9. HIV ndi chiyani? 1 Ndikachiromo koyambitsa AIDS 2 Ndimatenda 3 Sindikudziwa 4 Zina (Tchulani).............................................................................................. 10. Kodi AIDS nchani? 1 Ndim`mene thupi limakhalira pa chiopsezo kumatenda osiyanasiyana 2 Ndimatenda amene amamitsidwa ndikachilombo ka HIV 3 Ndimatenda opatsirana pogonana 4 Ndi chipwirikiti cha matenda omwe amadza chifukwa cha kuchepa cha chitetezo cha mtupi kamba ka kachilombo ka HIV 5 Sindikudziwa 6 Zina (Tchulani)..................................................................................................... 11. Ndi zizindikiro ziti zomwe zimasonyeza kuti mtsikana watha msinkhu? 1 Kukula mbina 2 Kusintha kwa mau 3 Kukula mabere 4 Kuyamba kusamba/ msambo 5 Kumera tsitsi malo obisika 6 Kumera ziphuphu 7 Tchulani zina………………………….. 8 Sindikudziwa 12. Nanga ndi zizindikiro ziti zomwe zimasonyeza kuti mnyamata watha msinkhu? 1 Kukula chokodzera 2 Kusintha kwa mau 3 Kukula chidale/ chifuwa 4 kuyamba kutulutsa umuna 5 Kumera tsitsi malo obisika ndi ndevu 6 Kumera ziphuphu 7 Tchulani zina…………………………..

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 3

8 Sindikudziwa 13. Munayamba mamvapo za kulera kapena njira za kulera 1 Eya 2 Ayi (Instruction to Interviewer: Ngati Ayi, probe more) 14. Tchulani mitunduya njira zakulera zomwe mukuzidziwa? (Musawerenge!chongani ntimabokosi timene atchulato) 1 Mapiritsi 2 Kulera kwapangozi 3 Mpira wa bambo 4 Mpira wa amayi 5 IUD/Lupu 6 Injectable / Depo-Provera-yobayitsa 7 Diaphragm/foam tablets/jelly/cream _ovalira ndi wopaka 8 Norplant/Implanon/Jadele 9 Kutseka wa abambo 10 Kutseka kwa mayi 11 Kugonana kosalowetsana chilichonse 12 Njira yofesera panja mbeu ya bambo 13 Pogwiritsa njira ya chilengedwe(ya Mkanda) 14 Njira zachikuda: (ntchulani): ___________ 15 Njira zina (Tchulani) ………………….. 15. Munayamba mamvapo za kondomu kapena chishango 1 Eya 2 Ayi 16. Ngati Eya pa funso 15, Tchulani ntchito ya kondomu 1 Kuteteza kutenga mimba 2 Kuteteza kutenga matenda opatsirana pogonana 3 Sindikudziwa 17. Munayamba mamvapo za ufulu wachibadwidwe? (chongani kabokosi kamodzi) 1 Eya 2 Ayi 18. (Ngati eya pa funso 17) Tchulani ena mwamafulu achibadwidwe omwe mukuwadziwa? (Musawerenge!chongani ntimabokosi timene atchulato) 1 Ufulu wa maphunziro 2 Ufulu wolankhula zakukhosi 3 Ufulu wa chipembezo 4 Ufulu wa kavalidwe 5 Ufulu wolandira chithanzo cha makhwala 6 Ufulu wokhala ndi moyo 7 Ufulu wa chitukuko 8 Ufulu wokwatira/wokwatiwa 9 Ufulu wolandira uthenga ndi chithandizo cha kuchipatala pa nkhani za kugonana ndi uchembere wabwino 10 Ma ufulu ena (Tchulani) …………………………………………. 19. Ngati munthu wachitiridwa nkhanza ayenela kutani? 1 Kukanena ku Polisi 2 Kukanena kwa aphunzitsi/ a Head 3 Kukanena kwa makolo 4 Kukanena ku mabungwe

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 4

5 Kukanena kwa Amfumu 6 Kukhala chete 7 Sindikudziwa 20. Munayamba mwamvapo za amuna kapena akazi ogonana okhaokha? 1 Eya 2 Ayi 21. Ngati Eya pa 20, kodi kudera kwanu kuno aliko 1 Eya 2 Ayi ATTITUDES-MAWONEDWE AZINTHU Kodi mukugwirizana ndiziganizo izi: 22. Munthu akavala mopatsa chilakolako ndiye kuti akufuna zogonana? 1 Eya 2 Ayi 3 Sindikudziwa 23. Nkwabwino kuwopseza kapena kugwiritsa ntchito mphavu kwa munthu amena sakufuna kugonana? 1 Eya 2 Ayi 3 Sindikudziwa 24. Munthu amene akufuna kugonana ndi okondedwa wake angamukanize (chongani nkabokosi kamodzi) 1 Eya 2 Ayi 3 Sindikudziwa 25. Mtsikana ayenera kuti asagonane ndi munthu asanakwatire 1Eya 2Ayi 3 Sindikudziwa 26. Mnyamata ayenera kuti asagonane ndi munthu asanakwatire 1 Eya 2 Ayi 3 Sindikudziwa 27. Mtsikana sayenera kumva za zogonana asanakwatire 1Eya 2Ayi 3Sindikudziwa 28. Mnyamata sayenera kumva za zogonana asanakwatire 1 Eya 2 Ayi 3 Sindikudziwa 29. Kodi ndi bwino kuchotsa mimba 1 Eya

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 5

2 Ayi 3 Sindikudziwa 30. Kodi ndi bwino kulera kwa munthu amene sali pa banja 1 Eya 2 Ayi 3 Sindikudziwa 31. Kodi ndi bwino kubunyula (masturbation) 1 Eya 2Ayi 3Sindikudziwa 32. Anthu ogonana amuna kapena akazi okha okha ali ndi ufulu wachibadwidwe? 1 Eya 2Ayi 3 Sindikudziwa SOCIAL NORMS–CHIKHALIDWE CHOYENERA Kodi kudera lanu ndikololedwa kuti: 33. Anthu kumabunyula ngati njira imodzi yothela chilakolako chofuna kugonana 1 Eya 2 Ayi 3Sindikudziwa 34. Anthu kuchosa mimba yosayembekezera 1 Eya 2 Ayi 3 Sindikudziwa 35. Kugonana pakati pa achinyamata asanakwatirane 1 Eya 2Ayi 3 Sindikudziwa 36. Kugwiritsa ntchito njira zolera 1 Eya 2 Ayi 3 Sindikudziwa 37. Anthu kumagonana amuna kapena akazi okha okha? 1 Eya 2 Ayi 3 Sindikudziwa BEHAVIOURS-KHALIDWE Panopa ndikufunsani mafunso okhudzana ndi za mtchitidwe wogonana 38. Kodi munayamba mapangapo mtchitidwe wogonana 1 Eya 2 Ayi

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 6

39. Nthawi imene munagonana komaliza inu kapena okondedwa anu munagwiritsapo ntchito njira ina iliyonse yakulera? (chongani nkabokosi kamodzi) 1 Eya 2 Ayi 3 Sindikudziwa 4 Sitinagonane 40. Ndi njira iti yakulera imene munagwitsapo ntchito? (chongani bokoso lilonse limene angasankhe) 1 sindinapangepo zogonana 2 Pill Mapilitsi 3 Kulera kwa pangizi 4 Mpira wa bambo 5 Mpira wa amayi 6 IUD 7 Injectable / Depo-Provera-yobayitsa 8 Diaphragm/foam tablets/jelly/cream -ovalira ndi wopaka 9 Norplant 10 Kutseka wa abambo 11 Kutseka kwa mayi 12 Kugonana kosalowetsana chilichonse 13 Njira yofesera panja mbeu ya bamboo 14 Pogwirits ntchito nsambo wa amayi 15 Njira zachikuda: (ntchulani): ___________ 16 Sindikukumbukira 17 Njira zina: (ntchulani) …………… 41. Munayamba mwagwiritsirapo ntchito kondomu? 1 Eya 2 Ayi 3 Sindikudziwa 4 Sidagonanepo ndi munthu 42. Ndi kawirikawiri bwanji pamene inu mwakhala mukupita kuchipatala kukalandira chithandizo pa za uchembere wabwino? (chongani nkabokosi kamodzi) 1 Sinapiteko 2 Kamodzi 3 Kupitirira kamodzi 43. Munapita ku chipatala kukalandira chithandizo cha uchembere wabwino chifukwa chani? (chongani nkabokosi kamodzi) 1 Sindinapite ku chipatala 2 Kukawona ngati ndiri ndi pakati 3 Kukalandira uphungu ndikukayezetsa ngati ndiri ndi HIV 4 Kukayzetsa zamatenda opatsirana pogonana 5 Kukatenga maleredwe 6 Kukalandira uthenga ndi uphungu 7 Sindikufuna kupanga zimenezo

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 7

44. Munakhutitsidwa ndichithandizocho? (chongani nkabokosi kamodzi) 1 Eya 2 Ayi 3 Sindinapiko CONFIDENCE Kodi mukugwirizana ndi ziganizochi? 45. Kwa ine kugwiritsa ntchito kondomu nthawi iliyonse tikamagonana kumandivuta (chongani nkabokosi kamodzi) 1 Eya 2 Ayi 3 Sindikudziwa 46. Ndikukhulupirira kuti ndizidzakwanitsa kugwiritsa ntchito kondomu nthawi ina iliyonse pogonana mtsogolo muno (chongani nkabokosi kamodzi) 1 Eya 2 Ayi 3 Sindikudziwa 47. Kodi mukhala omasuka kupereka maganizo anu mukhala mu gulu la achinyamata (chongani nkabokosi kamodzi) 1 Eya 2 Ayi 3 Sindikudziwa 48. Kodi anyamata ndi atsikana amatenga mbali mofanana pazochitikachitika mugulu la achinyamata (chongani nkabokosi kamodzi) 1 Eya 2 Ayi 3 Sindikudziwa INTENTIONS-ZOLINGA 49. Mumafuna mutakhala ndi ana angati?…………… (Ikani numbala ya ana) 50. Adzapange chiganizo cha chiwerengero cha ana amene mudzakhale nawo ndani? (chongani nkabokosi kamodzi) 1 Ineyo 2 Wokondedwa wanga 3 Ineyo ndi Wokondedwa wanga 4 Makolo anga kapena achibale 5 Zina …………………………………………………….. 51. Mmanganizira kuti mudzagwitsa ntchito kondomu panthawi yogonana mtsongolo muno? (chongani nkabokosi kamodzi) 1 Eya 2Ayi 3 Sindikudziwa 52. Odzapanga chiganizo chimenechi ndani kuti mugwiritse ntchito kapena ayi? (chongani nkabokosi kamodzi) 1 Ineyo

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 8

2 Wokondedwa wanga 3 Ineyo ndi Wokondedwa wanga 4 Makolo anga kapena achibale 5 Zina …………………………………………………….. 53. Adzapange chiganizo kapena kukusankhirani okondedwa wanu mtsogolo muno mndani? (chongani nkabokosi kamodzi) 1 Ineyo 2 Wokondedwa wanga 3 Ineyo ndi Wokondedwa wanga 4 Makolo anga kapena achibale 5 Zina …………………………………………………….. 54. Nditha kuzagwiritsira ntchito njira zolerera ndikafuna kugonana? (chongani nkabokosi kamodzi) 1 Eya 2Ayi 3 Sindikudziwa (not sure) kapena sindinaganizirepo zimenezi 55. Adzapange chiganizo chogwiritsakapena kusagwiritsa ntchito njira za kulera ndani? 1 Ineyo 2 Wokondedwa wanga 3 Ineyo ndi Wokondedwa wanga 4 Makolo anga kapena achibale 5 Zina ……………………………………………………..

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 9

Annex 4: Questionnaire for People Living with HIV Experiences of Stigma and Discrimination 1. Because of your HIV status, In the last 12 months, have you ever been a. Excluded from social gatherings (weddings, religious ceremonies etc) b. Excluded from family activities (cooking, eating together)? c. Aware of being gossiped about? d. Verbally insulted, harassed and or threatened? e. Physically harassed?

01. 02. 01. 02. 01. 02. 01. 02. 01. 02.

Yes No Yes No Yes No Yes No Yes No

Internal Stigma : The way you feel about yourself 2. In the last 12 months, have you experienced any of the following feelings because of your HIV status?

3. In the last 12 months, have you been afraid that someone would not want to be sexually intimate with you because of your HIV status? 4. Do you feel free to come in the open and disclose your HIV status? Condom Use 5. Have you had a sexual partner over the past 12 months 6. If yes, did or do you know their HIV status?

Condom Use 7. Have you ever used condoms? 8. If yes, how often do you use condoms when having sex? 9. Do you know of places or person from which or whom you can easily get a condom? 10. How long does it take for you to get a condom close to you?

11. What do you think needs to be done to ensure that condoms are available at all times and easily accessed?

01. 02. 03. 04. 05. 06. 07. 01. 02.

Feel ashamed Feel guilty Blame self Blame others Have low self esteem Feel should be punished Feel suicidal Yes No

01. 02. 01. 02. 01. 02.

Yes No Yes No Yes No

01. 02. 01. 02. 03. 01. 02.

Yes No Every time Sometimes Often Yes No

01. 02. 03. 04. 05. 01.

Under 1 hour 1 hour to 1 day More than 1 day Donâ&#x20AC;&#x2122;t Know No Response Condom points in Entertainment Places

02. More Peer Distribution Points

Drug compliance 12. Do you think it is important to adhere to ARV drugs

01. Yes 02. No

13. What other things do you do to keep yourself strong and healthy

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 10

Annex 5: Sex Workers Questionnaire

Name of InterviewerDzina la ofunsa Interviewer ID Numberchizindikiro cha ofunsa Supervisor ID number

|_____|_____| |_____|_____|

Tsiku lenileni la mafunso |____|____| Tsiku

|_____|_____| |_____|_____| Mwezi Chaka

INSTRUCTIONS for respondents Please help us by filling in this questionnaire. Your responses are very important to us and will help us to make good programmes for young people.  Do not write your name on this questionnaire. All the information you give us will be kept private. Nobody will know who filled in this questionnaire. Your teachers, neighbours, family and schoolmates will not see your answers.  This is not a test and there are no right or wrong answers. PLEASE BE HONEST IN YOUR ANSWERS. Do NOT give us answers that you think we want from you. We need to know what you and other young people really think, so that we can give young people in [country/region/district] the information they need.  Filling in this questionnaire is completely voluntary. If it makes you feel uncomfortable, you can stop at any time.  If you have any questions or do not understand the question, please raise your hand and ask the project staff who are present.  Take your time and answer carefully. There is enough time to complete the questionnaire. Do you agree to [complete the questionnaire/ participate in the interview]? 1 Yes 2 No

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 11

Section 1: Background Characteristics No.

Questions

Dzina la boma kumene kafukufuku akuchitikira?

Muli ndi zaka zingati?

kodi sukulu munafika nayo pati?

Mwakhala mdera lino kwa nthawi yokwana bwanji? (ntchulani deralo)

Ndinu wa ntundu wanji?

Coding Categories Skip 01. Chikhwawa 02. Mangochi 03. Dedza Zaka zimene mwakwanitsa |______|______| 01. Pulayimale 02. sekondare 03. Pamwamba 04. Sinapiteko 05. Koleji kapena univesite 01. Less a year 02. 1 â&#x20AC;&#x201C; 3 Years 03. 4 â&#x20AC;&#x201C; 6 years 04. kupitirira zaka zisanu ndichimodzi 01. Yao 02. Chewa 03. Lomwe 04. Tumbuka 05. Sena 06. Other________(specify)

Section 2: kapezedwe kamakondomu (Male and Female) 6. Kodi mumagwiritsa ntchito kondomu 01. Eya nthawi zonse? 02. Ayi 7.

Mmadziwa malo kapena anthu kumene kapena amene mungapezako makondomu mosavuta

01. Eya

Ndimadziwa kumene ndimapeza makondomu?

01. Ayi

Ndimalo ati komaso anthu ati pafupi ndinyumba yanu kumemene mungathekupeza makondomu ?

01. 02. 03. 04. 05. 06.

02. Ayi

02. Eya Shop Kogulitsa mankhwala Kunsika Clinic Chipatala chachikulu Malo otengako njira za kulera 07. Komwera mowa ndikogona alendo 08. Ophuzira azathu 09. Azanthu 010.

Drop in Centre

011.

Hair Dressing salon

012.

Sindikudziwa

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 12

Section 3: Nkhaza kwa akazi oyenda ndi amuna osiyanasiyana 10.

11.

Ilipo nthawi imene imene munachitiridwapo nkhaza chifukwa choti ndinu azimayi oyenda yenda? Nkhaza zimenezi zinali za ntundu wanji?

12.

Ndi gulu liti la anthu limakonda kukuchitirani nkhaza zimenezi?

13.

Kodi mumapeza kuti Ndichisamaliro kapena chitetenzo mukachitiridwa nkhaza zimenenzi? Kodi chimene chapangitsa kuti nkhaza zichepe zomwe zimankhudzana ndi inuyo?

14.

01. Eya 02. Ayi 01. 02. 03. 04. 05. 01. 02. 03. 04. 01. 02. 03. 04. 01. 02. 03.

15.

Amakuttezani ndi ndani mukachitiridwa nkhanza?

16.

Kodi mumapita kukanena kuti anthu akakupangirani nkhaza pogonana?

04. 01. 02. 03. 04. 05. 06. 01. 02. 03. 04. 05. 06.

Kugonedwa mwankhaza Kumenyedwa Kukhumudwa Kusapatsidwa zimene tinagwirizana Zina ntchulani Amene timagonana nawo Eniake amalo azisangaliro Anthu omwewa adera lino Apolisi Polisi Chipatala Drop in Center Any other_______Specify Kuwadziwitsa eniake amalo azisangalaro Kuphuzitsa mahule mmene angadzitetezere Kupempha kuti pakhazikitsidwe malamulo Zina (ntchulani) Polisi Bar owners Afumu Anthu akumudzi Alliance members Zina Apolisi Alliance network Chipatala Kwa a mfumu NGO Drop in Center

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 13

Section 4: Kudziwa kwanu pa nkhani ya matenda opatsirana pogonana (STI) 17.

(Osawerenga)Mungalongosoleko zina mwazizindikiro zamatenda opatsirana pogonana wa kwa munthu?

18.

Mungalongosoleko zina mwa zizindikiro zamatendawa kwa munthu ogonanayo?(osantchula)

01. 02. 03. 04. 05. 06. 07. 08. 01. 02. 03. 04. 05. 06. 07. 08.

Kupweteka kwa mimba Kutulutsa chikazi Chikazi chonunkha Kumva kuwontcha ukamakodza Zilonda za kumusi Zotupa za mbali mwa maliseche Kuyabwa Zina(ntchulani) Kupweteka kwa mmimba Kutulutsa umuna Umuna onunkha Kumva kuwontcha akamakodza Zilonda kumusi Zotupa za mbali mwa maliseche Kuyabwa Zina (ntchulani)

Section 5: Kudziwa kwanu,maganizo ndi mmene mmawo za HIV/AIDS 19.

Mauthenga okhudzana za HIV/AIDS mumawamva mwa kawiri kawiri?

01. Eya 02. Ayi

20.

Kodi mumawamvera kuti?

21.

Kodi mumapita kukalandira chithandizo chokhudzana matenda a HIV/AIDS?

01. 02. 03. 04. 05. 06. 07. 01. 02.

22.

Kodi mumapita kukalandira chithandizo chokhudzana ndi matenda opatsirana pogonana?

01. Eya

23.

Ndimatenda anji apatsirana amene mumakalandira chithandizocho?

24.

Kodi mumatengapo mbali kuphuzitsa anzanu za HIV/AIDS

01. 02. 03. 04. 05. 01. 02.

Pa wailesi Zowerenga zina Azanthu Azachipatala Drop in centre NGO Zina (tchulani)_________________ Eya Ayi

02. Ayi Chizonono Chindoko Mauka Mabomu Njelewere Eya Ayi

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 14

Annex 6: Youth Friendliness of Health Facilities Version 16 March 2011 SRHR Alliance Outcome indicator 2.2a – Targeted (youth friendly) services increasingly comply with IPPF standards for youth friendly services Output indicator 2.3.1a - Targeted facilities have increased availability of contraceptives, ART, antibiotics 1. BACKGROUND This document provides a tool to collect information related to the youth friendliness of SRHR services (in health facilities) in the intervention areas. This information will be part of the data collection for the baseline of the UFBR programme (2011-2015). 2. STEPS IN DATA COLLECTION The collection of information with the tool, includes amongst others:  Obtain national guidelines on youth friendly SRHR services. If not available obtain guideline from IPPF.  Implementing organisations select 5 to 8 topics from the national/IPPF guidelines, that they find most relevant and realistic to improve the youth friendliness of services in the project areas. All services will be rated and assessed on these selected topics.  Map official health facilities dealing with sexual and reproductive health in the target area.  Make a sample based on guidelines described above.  Selection and training of data collectors. 3. ASSESSMENT      

Data collectors will visit selected SRHR services They assess the facility for each selected topic. This assessment will be done through observation of the facility (waiting area, distance, privacy etc) and in conversation with the service provider(s). Note: the data collectors will not be present during consultations between the service providers and the clients. The data collectors will give a score on each selected topic. Scores will range from 1-4. Give narrative remark to be able to compare later. The data collectors will ask the service providers about the availability of drugs and the occurrence stock outs (PART TWO)

PART ONE Topic list Topic Baseline measurement (April 2011) Quantitative Qualitative Score 1-4 Remark 1 2 3

Outcome measurement (2013) Quantitative Qualitative Score 1-4 Remark

End term measurement (2015) Quantitative Qualitative Score 1-4 Remark

Suggested topics and their scoring:

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 15

1. Training of service provider. Are the service providers trained to work competently, sensitively and respectfully with young people on their sexual and reproductive health needs? 01. None of the service providers have ever received training on working with young people 02. Some service providers have received some/little training on working with young people 03. Most of the service providers received adequate training on working with young people 04. At least one of the service providers has received extensive training on working with young people and is able and willing to train other service providers on the job 2. Privacy. Is there a private consultation room available where young people can speak with the service provider? (Audio and Visual privacy) 01. There is no private consultation room 02. There is a private consultation room, but there are also consultations taking place in a none-private setting 03. Privacy is guaranteed almost all the time 04. Privacy is always guaranteed 3. If Yes to 2, is there a special entrance/waiting room for young clients which is separate from adult client? 01. There is no separate entrance/ waiting room for young clients 02. There is a separate entrance/waiting room but it is near the general consultation room 03. There is a special entrance/waiting room available for young clients 4. Opening hours. Are the opening hours convenient for young people? (More convenient hours include weekend, before and after school and lunch hour) 01. The opening hours are always very inconvenient (e.g. only during school time) 02. The opening hours are very inconvenient on most days 03. The opening hours are convenient 04. There are special opening hours for young people Accessibility 5. Are the SRH services accessible to all young people irrespective of their marital status? 01. The SRH services (family planning, STI screening, contraceptives) are not available for unmarried girls 02. The SRH services (family planning, STI screening, contraceptives) are available for unmarried girls 6. Are staff able to address the needs of young people with different sexual orientations e.g. Men having sex with Men( MSM), Women having sex with other women ( WSW), Lesbian, Gay, Bisexual, Transgender, Intersex, Questioning/Queer Sex workers (No assumptions of heterosexuals) 01. Staff is able to address the needs of people with different sexual orientations 02. Staff is not able to address the needs of people with different sexual orientations 03. We have never come across a case of young people with different sexual orientation 7. Are staff able to address the needs of young people living with HIV? 01. Staff is able to address the needs of young people living with HIV 02. Staff is not able to address the needs of young people living with HIV. 8. 4d. Are SRH services accessible to all young people irrespective of their ability to pay? 01. 02. 03. 04.

If a young person cannot pay, he/she will not be helped If a young person comes with an emergency, he/she will be helped and can pay later Preventative SRH services are given to young people for free All SRH services are given to young people for free

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 16

9. Referral. Is there an effective referral system in place? (Effective referral is where a client is being referred and service provider is able to get feedback) 01. 02. 03. 04.

Absent and don’t refer Absent but refer Present but not effective because of lack of transport or far distances Present and effective

10. Community and parental support: Do the service providers involve the parents and the community to ensure that adolescents have access to sexual and reproductive health services? 01. Not involved at all 02. Less involved/sometimes 03. Involved but not supportive 04. Actively involved and supportive 11. Do you think the quality of service delivery has improved in your facility between 2011- 2013 (now) – Specify/mention the improved services? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _____________________________________________________ 12. How have you benefitted from the UFBR/ Choice/Chisankho Changa, Tsogolo langa program interventions? __________________________________________________________________________________ __________________________________________________________________________________ ____________________________________________________________ PART TWO For the availability of drugs, please ask the service provider: 13. How often do you experience stock outs? And circle the answer for each drug in the table below Drug Don’t Never Sometimes know Contraceptives 1 2 3 HIV tests 1 2 3 ART 1 2 3 ACT/SP 1 2 3 STI Treatment Flagyl 1 2 3 doxyclyne 1 2 3 Gentamycine, 1 2 3 Erythromycin 1 2 3 Bezathyne 1 2 3 Post abortion care ( 1 2 3 PAC)

Frequently 4 4 4 4

(Almost) always 5 5 5 5

4 4 4 4 4 4

5 5 5 5 5 5

Comments

01. Don’t know: The service provider available does not know 02. Never: There are never stock outs 03. Sometimes: Stock outs happen approximately once per year 04. Frequently: Stock outs happen more than once per year 05. (Almost) always: These drugs are almost always out of stock (more than 9 months per year)

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 17

Annex 7: Quality of Maternal Health Services

Outcome indicator 2.2c - targeted maternal health services increase their compliance to the (national) quality standard Output indicator 2.3.1a - Targeted facilities have increased availability of contraceptives, ART, antibiotics 4. BACKGROUND This document provides a tool to collect information related to the quality of maternal health services. This information will be part of the data collection for the baseline of the UFBR programme (2011-2015) 5. STEPS IN DATA COLLECTION The collection of information with the tool includes amongst others:  Obtain national guidelines on maternal health services. If not available obtain guideline from a neighbouring country, or WHO standards.  Implementing organisations select 5 to 8 topics from the, that they find most relevantand realistic to improve in quality of maternal health services in the project areas. All health facilities will be rated and assessed on these selected topics.  Note: include a topic on the availability/stock out of essential drugs/services, such as contraceptives, VCT, ART, antibiotics  Map official health facilities dealing with sexual and reproductive health in the target area.  Make a sample based on guidelines described above.  Selection and training of data collectors. 6. ASSESSMENT  Data collectors will visit selected facilities that provide maternal health services  For each selected topic mentioned in the national guidelines they will check (through observation of the facility (waiting area, privacy etc) and in conversation with the service providers) to what extent this is available at a the selected facility  Note: the data collectors will not be present during consultations between the service providers and the clients.  The data collectors will give a score on each selected topic mentioned in the national guidelines.  Scores will range from 1-5. Give a narrative remark to be able to compare at a later stage.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 18

Topic

Baseline measurement (April 2011) Quantitative Qualitative Score 1-4

Remark

Outcome measurement (2013) Quantitativ Qualitative e Score 1-4 Remark

End term measurement (2015) Quantitativ Qualitative e Score 1-4 Remark

1 2 3

Name of Interviewer: Name of the clinic and location of the clinic: District: Sex of Respondent:

01. Male 02. Female

Date: Questions 1. Skilled attendance. Is there a skilled birth attendant available? ( e.g. Midwife, Nurse, Medical Assistants, Medical doctors, Clinical officers) 01. There is no skilled birth attendant available 02. There is a skilled birth attendant available sometimes (once per week or less) 03. There is a skilled birth attendant available most of the time (more than once per week) 04. There is a skilled birth attendant available 7 days per week 2. 01. 02. 03. 04.

Equipment. If there is a delivery room, is there a delivery bed available? There is no delivery bed available There is a delivery bed available but it cannot be used (broken or used for storage) There is a delivery bed available but it is in bad shape There is a delivery bed available all the time

3. Privacy. Can privacy be guaranteed during delivery? Privacy Category Availability available) 01. Closed and translucent windows 02. private room 03. curtains in labour ward where there are 2 beds 04. locked door 05. audio and visual privacy 01. There is no privacy at all 02. There is some privacy. 03. Privacy can be guaranteed most of the time 04. Privacy is guaranteed all the time

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

(Tick

Page 19

4. Supplies. Are gloves and other essential supplies available? (resustair kits, Personal Protective Equipmentâ&#x20AC;&#x201C; PPE) 01. Gloves and other essential supplies are not available. Women bring their own 02. Gloves and other essential supplies are sometimes/partly available 03. Gloves and other essential supplies are available most of the time 04. Gloves and other essential supplies are available all the time and women do not have to pay 5. Quality of delivery room. Is there light in the delivery room at night (kerosene or electrical light)? 01. There is no light in the delivery room 02. There is sometimes light in the delivery room at night 03. There is light most of the time in the delivery room 04. There is always light in the delivery room 6. Sanitation. Are sanitation facilities available? Sanitation Facilities Availability â&#x20AC;&#x201C; Tick if available Toilets bath rooms waste bins incinerator placenta pit 01. There are no sanitation facilities available 02. There are sanitation facilities available but they are not maintained (general cleanliness) 03. There are sanitation facilities available but they are used for other purposes 04. There are sanitation facilities available and they are well maintained 7. Is there running water? 01. There is no running water available 02. There is no running water available but there is borehole near by 03. There is a borehole connected inside the facility 04. There is running water available. 8. Is infection prevention practiced in the delivery room? ( Personal prevention equipment, disposal pails, linen, disinfectants, sterilizer, safety box) 01. Infection prevention is not practiced 02. Infection prevention is sometimes practiced 03. Infection prevention is practiced most of the times 04. Infection prevention is practiced always 9. Frequency of Outreach: Do you have outreach services for ANC, immunization and family planning at this facility? If yes, how often? ( on Monthly frequency ) 01. There are no outreach services for ANC, immunization and Family planning conducted 02. There are sometimes/limited outreach services conducted 03. There are outreach services conducted but they are irregular and community isnâ&#x20AC;&#x2122;t aware 04. Outreach is conducted on a set schedule and the community is informed

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 20

10. Referral: communication and transport 01. Communication: How is referral communication done at this facility? 02. The health facility is located in an area where there is no network 03. The service provider uses his/her own cell phone for referral and charges the patient 04. A communication system is available and free for the patient 11. Transport: Is there transport available for pregnant women in critical conditions? 01. There is no transport available to transfers a woman to the district hospital for emergency obstetric care 02. There is transport available sometimes 03. There is transport available most of the time 04. There is transport available almost all the time 12. Do you think the quality of service delivery has improved in your facility between 2011- 2013 (now) â&#x20AC;&#x201C; Specify/mention the improved services? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 13. How have you benefitted from the UFBR/ Choice/Chisankho Changa, Tsogolo langa program interventions? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 14. For the availability of drugs, please ask the service provider: How often do you experience stock outs? And circle the answer for each drug in the table below Drug Donâ&#x20AC;&#x2122;t Never Sometim Frequently (Almost) Comments know es always Contraceptives 1 2 3 4 5 HIV tests 1 2 3 4 5 ART 1 2 3 4 5 Antibiotics 1 2 3 4 5 Iron 1 2 3 4 5 Anticonvulsant 1 2 3 4 5 oxytocis 1 2 3 4 5 Antihypertensive 1 2 3 4 5 ACT/ SP (Articulate 1 2 3 4 5 combination treatment Post abortion care 1 2 3 4 5 (PAC) 01. Donâ&#x20AC;&#x2122;t know: The service provider available does not know 02. Never: There are never stock outs 03. Sometimes: Stock outs happen approximately once per year 04. Frequently: Stock outs happen more than once per year 05. (Almost) always: These drugs are almost always out of stock (more than 9 months per year)

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 21

Annex 8: Exit interview satisfaction services-Women Outcome indicator 2.2d - The number of women satisfied with SRHR services is increased by x% 1. BACKGROUND This document provides a tool to collect information related to the satisfaction of women with maternal health services. This information will be part of the data collection for the baseline of the UFBR programme (2011-2015). The tool in this document is based on an example of IPPF exit interviews. Information will provide insights in the key issues which need to be addressed to increase the quality of the services. Repeated use of the questionnaire will provide insights whether women are increasingly satisfied with the services. 2. STEPS IN DATA COLLECTION To get valid information, these data should not be gathered by clinic staff, but by an interviewer who is able to make the interviewee at ease and confident to give honest feedback. Interview should not take more than 45 minutes per respondent. 3. INSTRUCTIONS Instructions for the implementing organisations This client exit interview is designed for monitoring of progress on the above stated indicator (increase in number of young people satisfied). Therefore the questions focus on rating of satisfaction on several topics. If the respondents are not used to rating their level of satisfaction as suggested below, it is possible to adjust the questionnaire. The interviewer will in that case be responsible for the rating based on his/her interpretation of what the respondent is expressing. The interviewer should ask clarifying questions until he/she can rate the level of satisfaction. For a needs assessment it might be interesting to add the question why after each question. This can help to give an insight in the strong and weak points of services provided. You are free to ask for explanations after each question if you are interested in this kind of information. Instructions for the interviewer It is highly recommended to conduct the interview in a separate room or a quite setting to ensure that the person being interviewed is at ease. The below paragraph can be used as introduction to the interview. It is very important to explain the confidentiality of answers and the use of answers to improve the facilities. 4. TOOL Cholinga cha zokambirana zathu ndichakuti tikupanga kafukufuku wa mâ&#x20AC;&#x2122;mene zithandizo zosiyanasiyana zikupelekeredwera pa chipatala pano ndichikhulupiriro chofuna kupitisa patsogolo kaperekedwe ka zithandizo pa chipatala ichi. Tikufunsa anthu omwe amalandira chithandizo ngati amakhutisidwa ndi kapelekedwe ka chithandizo. Ndikukhulupirira kuti mutithandiza pakuvomera kuyankha mafunso omwe nditafunsewa. Sinditenga dzina lanu, komanso kutengapo mbali kwanu kapena kusatenga mbali sikukhudza mâ&#x20AC;&#x2122;mene mumalandilira chithandizo chanu, motere zikhala zachinsinsi komanso sizitenga nthawi yayitali. Mukuvomereza kutengapo mbali pa zokambirana zathu? 01. Inde 02. Ayi Name of Interviewer: Name of the clinic and location of the clinic: District: Age of Respondent (in years): Date:

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 22

Uthenga Osiyanasiyana (Chonde onesesani kuti uthengawu ukhale wachinsinsi) 1. Kodi munabwerera chithandizo chanji lero? 01. Njira za kulera 02. uphungu wa za maleredwe Uphungu ndi kuyezesa HIV/AIDS 03. Kuyezesa ndi kulandira chithandizo chokhuza matenga opasirana pogonana 04. Chithandizo chokhuza nkhanza (monga kugwiriridwa, kuvulazidwa kapena nkhaza za m’maganizo) 05. Za ubeleki (sikelo ya azimai oyembekezera, Kuchila, chithandizo cha amai ndi mwana) 06. chithandizo choperekedwa kwa munthu wochosa mimba (Post abortion care) 07. Zina ndi zina (Tchulani)__________________________________________________ 2. kodi ndikoyamba inu kubwera kuno? 01. Inde 02. Ayi 3. Ngati woyankha ali wamkazi: Ndiwoyembezera? 01. Inde 02. Ayi 4. Mulipabanja? 01. Inde 02. Ayi 5. Muli wokhutisidwa bwanji ndi uthenga/ulangizi womwe mwalandira? 01. 02. 03. 04.

Osakhutisidwa konse: Sanalandire uthenga/ulangizi wina uliwonse Osakhutisidwa: Analandira uthenga/ulangizi koma osakwanira Okhutisidwa: Analandira uthenga/ulangizi womwe ndimayembekezera Okhutisidwa kwambiri: Analandira uthenga ochuluka kuposa m’mene ndimayembekezera

Muli wokhutisidwa bwanji ndi chithandizo chomwe mwalandira molingana ndi funso 5.1? 01. Osakhutisidwa konse: Sanalandire chithandizo chilichonse 02. Osakhutisidwa: Sanalandire chithandizo chokwanira 03. Okhutisidwa: Analandira chithandizo chomwe amayembekezera 04. Okhutisidwa kwambiri: Analandira chithandizo chochuluka kuposa m’mene amayembekezera

7. Kodi nthawi yomwe amasegulira chipatala yilibwino kwa inu 01. Sakugwirizana nazo konse: Nthawi yosegulira sakugwirizana nayo konse chifukwa cha sukulu/ntchito 02. Sakugwirizanazo: Nthawi yosegulira sakugwirizana nayo koma amakwanisa 03. Akugwirizana nazo: Nthawi yosegulira yilibwino 04. Akugwirizana nazo kwambiri: Nthawi yosegulira yimandipasa mpata wokwanira kufika kuchipatala kuposa m’mene amafunira

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 23

8. Ngati asakugwirizana nazo konse: Ndinthawi yanji yomwe angagwirizane nayo yosegulira chipatala?__________________________________________________________________ 9. Kodi nthawi yomwe mwakhala mukudikirira chithandizo mukugwirizana nayo 01. 02. 03. 04.

Sakugwirizana nazo konse: Ndadikira kuposa ma ora awiri Sakugwirizanazo: Ndadikirira pakati pa ora limodzi kapena awiri Akugwirizana nazo: Ndadikirira kochepera ora limodzi Akugwirizana nazo kwambiri: Ndinathandizidwa mwachangu

11. Kodi mutathandizidwa, munalipira? 01. Inde 02. Ayi 12. Ngati analipira: Mtengo womwe munalipira, munagwirizana nawo? 01. Sakugwirizana nazo konse: Ndinalipira mopyola m’mene ndinakalipira 02. Sakugwirizanazo: Chithandizo chinali chodula 03. Akugwirizana nazo: Ndinalipira moyenerera 04. Akugwirizana nazo kwambiri: Chithandizo chinali chotsika mtengo/ cha ulere 13. Kodi mumayenera kupereka ndalama zingati? Chonde lembani mtengo:_______________ 14. Kodi ndinu okhutisidwa bwanji ndi chinsinsi chomwe chinalipo m’mene mumathandizidwa? 01. Sakugwirizana nazo konse: panalibe chinsinsi chilichonse pomwe ndimalandira chithandizo 02. Sakugwirizanazo: Chinsinsi chinalipo koma chosakwanira 03. Akugwirizana nazo: Chinsinsi chinalipo koma sindikudziwa ngati andisungirebe chinsinsi 04. Akugwirizana nazo kwambiri: Chinsinsi chinalipo ndipo ndikukhulupirira kuti andisungira chinsinsi 15. Kodi muli okhutisidwa bwanji ndi m’khalidwe wa ogwira ntchito pachipatala ndi m’mene anakuthandizirani? 01. Osakhutisidwa konse: Anandithandiza moyipa (mwa mwano, Mokalipa, moweruza, motoza) 02. Osakhutisidwa: Anandithandiza mosasangalala komanso mosakhuzidwa 03. Okhutisidwa: Anandithandiza momwe ndimayembekezera 04. Okhutisidwa kwambiri: Anandithandiza bwino kwambiri kuposa m’mene ndimayembekezera 16. Kodi mukuganiza bwanji za nthawi yomwe mumayankhulana ndi achipatala? 01. Osakhutisidwa konse: Nthawi yazokambirana yinali yambiri/yochepa 02. Somewhat dissatisfied: Nthawi yazokambirana yinali yambiri/yochepa kuposa m’mene ndimayembezera 03. Somewhat satisfied: Nthawi yazokambirana yinali yoyenerera 04. Very satisfied: Nthawi yazokambirana yinali bwino kuposa m’mene ndimayembekezera 17. Ngati simunakhutitsidwe, Nchifukwa chain? _____________________________________________________________________________ _____________________________________________________________________________

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 24

18. Kodi muli omasuka kubweranso ngati muli ndi funso kapena vuto nthawi iliyonse? 01. Inde 02. Ayi 19. Kodi muli omasuka kubweranso ngati muli ndi funso kapena vuto nthawi iliyonse problems? 01. Sakugwirizana nazo konse: Sindizabweranso 02. Sakugwirizanazo: Ndizabweranso pokhapokha pali pofunikira kwambiri 03. Akugwirizana nazo: Ndizabwera mosakaika ngati kuli kofunika 04. Akugwirizana nazo kwambiri: Ndili okondwera kubweranso ndipo ndikawauza anthu ena za chipatalachi 20. Nenani maganizo anu za mâ&#x20AC;&#x2122;mene tingapitisire patsogolo ntchito za pa chipatala pano? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 21. Ndi chani chomwe chilipo chomwe chakusangalatsani pa chipatala pano? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 22. Nanga ndi chani chomwe chilipo chomwe sichinakusangalatseni pa chipatala pano? _____________________________________________________________________________ _____________________________________________________________________________ 23. Kodi mungawalimbikitse anzanu kapena achibale ku bwera kuchipatala chino? 01. Inde 02. Ayi Ngati ayi, chifukwa chani? _____________________________________________________________________________ _____________________________________________________________________________ 24. Kodi pamuyeso wa 0 kufikira 5 , mukhoza kupereka mulingo wotani pa chithandizo chomwe mwalandira (5 kukhambiri wambiri) chonde zungulizani nambala. 01. Choipisitsa 02. Choipa 03. Pakatikati 04. Chabwino 05. Chabwino Kwambiri

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 25

Annex 9: Exit interviews satisfaction services - young people Version 16 March 2011 SRHR Alliance Outcome indicator 2.2b - The number of young people satisfied with SRHR services is increased with x%. 1. BACKGROUND This document provides a tool to collect information related to the satisfaction of young people with sexual and reproductive health services. This information will be part of the data collection for the baseline of the UFBR programme (2011-2015). The tool in this document is based on an example of IPPF exit interviews. Information will provide insights in the key issues which need to be addressed to increase the youth friendliness of the services. Repeated use of the questionnaire will provide insights whether the satisfaction of young people is increasing. 2. STEPS IN DATA COLLECTION To get valid information, these data should not be gathered by clinic staff, but by an interviewer who is able to make the interviewee at ease and confident to give honest feedback. Interview should not take more than 45 minutes per respondent. 3. INSTRUCTIONS Instructions for the implementing organisations This client exit interview is designed for monitoring of progress on the above stated indicator (increase in number of young people satisfied). Therefore the questions focus on rating of satisfaction on several topics. If the respondents are not used to rating their level of satisfaction as suggested below, it is possible to adjust the questionnaire. The interviewer will in that case be responsible for the rating based on his/her interpretation of what the respondent is expressing. The interviewer should ask clarifying questions until he/she can rate the level of satisfaction. For a needs assessment it might be interesting to add the question why after each question. This can help to give an insight in the strong and weak points of services provided. You are free to ask for explanations after each question if you are interested in this kind of information. Instructions for the interviewer It is highly recommended to conduct the interview in a separate room or a quite setting to ensure that the person being interviewed is at ease. The below paragraph can be used as introduction to the interview. It is very important to explain the confidentiality of answers and the use of answers to improve the facilities. 4. TOOL CHIYAMBI Cholinga cha zokambirana zathu ndichakuti tikupanga kafukufuku wa mâ&#x20AC;&#x2122;mene zithandizo zosiyanasiyana zikupelekeredwera pa chipatala pano ndichikhulupiriro chofuna kupitisa patsogolo kaperekedwe ka zithandizo pa chipatala ichi. Tikufunsa anthu omwe amalandira chithandizo ngati amakhutisidwa ndi kapelekedwe ka chithandizo. Ndikukhulupirira kuti mutithandiza pakuvomera kuyankha mafunso omwe nditafunsewa. Sinditenga dzina lanu, komanso kutengapo mbali kwanu kapena kusatenga mbali sikukhudza mâ&#x20AC;&#x2122;mene mumalandilira chithandizo chanu, motere zikhala zachinsinsi komanso sizitenga nthawi yayitali.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 26

1. Mukuvomereza kutengapo mbali pa zokambirana zathu? 01. Inde 02. Ayi Name of Interviewer: Name of the clinic and location of the clinic: District: Sex of Respondent:

03. Male 04. Female

Age of Respondent (in years): Date: Uthenga Osiyanasiyana (Chonde onesesani kuti uthengawu ukhale wachinsinsi) 1. Kodi munabwerera chithandizo chanji lero? Njira za kulera uphungu wa za maleredwe Uphungu ndi kuyezesa HIV/AIDS Kuyezesa ndi kulandira chithandizo chokhuza matenga opasirana pogonana Chithandizo chokhuza nkhanza (monga kugwiriridwa, kuvulazidwa kapena nkhaza za mâ&#x20AC;&#x2122;maganizo) 06. Za ubeleki (sikelo ya azimai oyembekezera, Kuchila, chithandizo cha amai ndi mwana 07. Chithandizo choperekedwa kwa munthu wochosa mimba (Post abortion care) 08. Zina ndi zina (Tchulani):________________________________________________ 01. 02. 03. 04. 05.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 27

2. Kodi ndikoyamba inu kubwera kuno? 01. Inde 02. Ayi 3. Ngati woyankha ali wamkazi: Ndiwoyembezera? 01. Inde 02. Ayi 4. Muli pabanja? 01. Inde 02. Ayi 5. Muli wokhutisidwa bwanji ndi uthenga/ulangizi womwe mwalandira? 01. 02. 03. 04.

Muli wokhutisidwa bwanji ndi chithandizo chomwe mwalandira molingana ndi funso 1? 01. 02. 03. 04.

Osakhutisidwa konse: Sanalandire chithandizo chilichonse Osakhutisidwa: Sanalandire chithandizo chokwanira Okhutisidwa: Analandira chithandizo chomwe amayembekezera Okhutisidwa kwambiri: Analandira chithandizo chochuluka kuposa mâ&#x20AC;&#x2122;mene amayembekezera

7. Kodi nthawi yomwe amasegulira chipatala mumayiwona bwanji ? 01. Sakugwirizana nazo konse: Nthawi yosegulira sakugwirizana nayo konse chifukwa cha sukulu/ntchito 02. Sakugwirizanazo: Nthawi yosegulira sakugwirizana nayo koma amakwanisa 03. Akugwirizana nazo: Nthawi yosegulira yilibwino 04. Akugwirizana nazo kwambiri: Nthawi yosegulira yimandipasa mpata wokwanira kufika kuchipatala kuposa mâ&#x20AC;&#x2122;mene amafunira 8. Ngati asakugwirizana nazo konse: Ndinthawi yanji yomwe angagwirizane nayo yosegulira chipatala?_________________________________________________________________ 9. Kodi nthawi yomwe mwakhala mukudikirira chithandizo mukugwirizana nayo 01. 02. 03. 04.

10. Kodi mutathandizidwa, munalipira? 01. Inde 02. Ayi

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 28

11. Ngati analipira: Mtengo womwe munalipira, munagwirizana nawo? 01. 02. 03. 04.

Sakugwirizana nazo konse: Ndinalipira mopyola m’mene ndinakalipira Sakugwirizanazo: Chithandizo chinali chodula Akugwirizana nazo: Ndinalipira moyenerera Akugwirizana nazo kwambiri: Chithandizo chinali chotsika mtengo/ cha ulere

12. Kodi mumayenera kupereka ndalama zingati? Chonde lembani mtengo:_______________ 13. Kodi ndinu okhutisidwa bwanji ndi chinsinsi chomwe chinalipo m’mene mumathandizidwa? 01. Sakugwirizana nazo konse: panalibe chinsinsi chilichonse pomwe ndimalandira chithandizo 02. Sakugwirizanazo: Chinsinsi chinalipo koma chosakwanira 03. Akugwirizana nazo: Chinsinsi chinalipo koma sindikudziwa ngati andisungirebe chinsinsi 04. Akugwirizana nazo kwambiri: Chinsinsi chinalipo ndipo ndikukhulupirira kuti andisungira chinsinsi 14. Kodi muli okhutisidwa bwanji ndi m’khalidwe wa ogwira ntchito pachipatala ndi m’mene anakuthandizirani? 01. Osakhutisidwa konse: Anandithandiza moyipa (mwa mwano, Mokalipa, moweruza, motoza) 02. Osakhutisidwa: Anandithandiza mosasangalala komanso mosakhuzidwa 03. Okhutisidwa: Anandithandiza momwe ndimayembekezera 04. Okhutisidwa kwambiri: Anandithandiza bwino kwambiri kuposa m’mene ndimayembekezera 15. Kodi mukukhutitsidwa ndi nthawi yomwe mwakhala mwa adokotala? 01. Inde 02. Ayi 16. Ngati simunakhutitsidwe, Nchifukwa chiyani? _______________________________________________________________________________ _______________________________________________________________________________ _________________________________________________________________________ 17. Kodi muli omasuka kubweranso ngati muli ndi funso kapena vuto nthawi yiliyonse problems? 01. Inde 02. Ayi 18. Nenani maganizo anu za m’mene tingapitisire patsogolo ntchito za pa chipatala pano? __________________________________________________________________________________ __________________________________________________________________________________ ____________________________________________________________________________ 19. Ndi chani chomwe chilipo chomwe chakusangalatsani pa chipatala pano?

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 29

__________________________________________________________________________________ __________________________________________________________________________________ ____________________________________________________________________________ 20. Nanga ndi chani chomwe chilipo chomwe sichinakusangalatseni pa chipatala pano? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________________ 21. Kodi mungawalimbikitse anzanu kapena achibale ku bwera kuchipatala chino? 01. Inde 02. Ayi Ngati ayi, chifukwa chani? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 22. Kodi pamuyeso wa 0 kufikira 5, mukhoza kupereka mulingo wotani pa chithandizo chomwe mwalandira 01. 02. 03. 04. 05.

Choipisitsa Choipa Pakatikati Chabwino Chabwino Kwambiri

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 30

Annex 10: Use of SRHR services by young people and women, including Antenatal care and skilled birth attendance Version 31 July 2013 SRHR Alliance Outcome indicator 2.3a - Increase in young people and women using SRHR services Outcome indicator 2.3b - Number of births attended by a skilled birth attendant is increased Outcome indicator 2.3c – Increase in pregnant women who have 1-4 antenatal check-ups 7. BACKGROUND This document provides a tool to collect information related to the use of SRHR services by young people and women. This information will be part of the data collection for the outcome measurement of the UFBR programme (2011-2015). 8. STEPS IN DATA COLLECTION  



Data collectors will visit selected facilities Data collectors study records of the facilities on SRHR services from a period of one month from both 2011 and for the same month in 2013. For instance service statistics from March 2011, March 2012 and March 2013. NOTE: depending on the local situation, it is also possible to select another time period like a quarter. Data collectors will count number of people that used a specific service and make an overview of this. Data collectors can use a tool that is already available and used by health facilities and/or implementing organisations. If no tool is available, the tool below can be used. If during the assessment data collectors find services which have not been mentioned in the tool, these will be added to the list of services and included in the outcome measurement report.

9. TOOL Guideline for this format: only include number of people. NOT number of services. If age is a variable that is recorded at facility level, you should include it in your analysis (use agegroups that are used in the KAP survey and FGDs).

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 31

[Fill the Table twice - for a particular Month in 2011 and for same month in 2013] Facility

Explanation when relevant

Do you provideâ&#x20AC;Ś? (Answer YES or NO)

Number of people that received service Girls and women Boys and men (disaggregate age groups if (disaggregate age groups if possible: 10-14; 15-18; 18-24;>24 possible: 10-14; 15-18; 18-24; years old) >24 years old) 10-14

Pregnancy test Antenatal care

15-19

20-24

>25

1 visit 2 visits 3 visits 4 visits More than 4 visits

Delivery (birth) Post-abortion care, including incomplete abortion care, counselling and postabortion contraception Contraceptives

N/A

Pills Injectables Implants IUCD Others

Emergency contraception Condom distribution9 Voluntary counselling and testing for HIV STI screening (Syndromic approach) Counselling on safe sex, sexuality and life skills Psycho-social support for young people living with HIV Support for young victims of sexual violence Referrals for all services not provided (with follow-up mechanisms in place) Other services

10-14

15-19

20-24

Specify exactly what is provided

Stories of Change: Since 2011 to-date, has uptake of services increased, decreased or remained the same? Which services has had uptake increased and why? In which services have uptake decreased and why? In which services has uptake remained constant and why? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________

If it is not possible to mention the number of people receiving condoms, but only the number of condoms distributed, please make sure that you mention in the table that the number is about condoms not people.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 32

>25

Annex 11: Partner Organization Program Staff

Outcome indicator 2.4a – SRHR policies and legislation implemented, changed, or adopted at local, institutional or national level The interviewer is instructed to proceed as follows: 

Introduce the exercise as follows: My name is ---------. I am here to discuss with you on progress UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA program implemented by FPAM/YECE/YONECO/CAVWOC in this area. The purpose of this exercise is to learn from you about the program so that we can improve it or similar programs in future. We kindly ask you to actively participate in these discussions. Do you allow me to proceed with these discussions? [make sure they agree, otherwise you may not proceed with the discussions if they don’t). If they agree, write the names of participants and their positions in community and proceed with discussions as per questions below:

 1.

Describe the scope of UFBR program in the district – interventions, areas implemented, targeted populations from 2011 to-date (fill the table below)

PROGRAMME AREA STRENGTHENING SRHR EDUCATION

INTERVENTIONS (ACTIVITIES) IMPLEMENTED

TARGET (GEOGRAPHICAL AREA, TARGET POPULATION AND OTHER DETAILS

Outcome Indicator 2.2a: % of targeted SRHR facilities increasingly comply with IPPF standards for youth friendly services Outcome indicator 2.2b: % of SRHR facilities with an increase in satisfaction by young people Outcome indicator 2.2c: % of targeted facilities increased their compliance to the (national) quality standard Indicator 2.2d: increase in the number of women satisfied with SRHR services STRENGTHENING SRHR SERVICES Indicator 2.3a: increase in young people and women using SRHR services Indicator 2.3b: number of births attended by a skilled birth attendant is increased Indicator 2.3c: increase in pregnant women who have 1-4 antenatal check-ups Outcome indicator 2.3d: Nr of facilities with increased availability of contraceptives, ART, ACT and antibiotics STRENGTHENING ENABLING ENVIRONMENT FOR SRHR Outcome indicator 2.4a: SRHR policies and legislation implemented, changed, or adopted at local, institutional or national level, at least 2 per country Outcome indicator 2.4b: Increased involvement of community leaders in realisation of SRHR in x% of the targeted communities Outcome indicator 2.4c: Increased Acceptance of SRHR at community level in x% of the targeted communities



SPECIFICALLY-What were the key policy and advocacy issues that you focused on in the district?

What have been the changes realized in the outcome areas (SRHR Education, Services and Enabling Environment) of UFBR in the district? What have been the challenges or weaknesses? Probe for changes in SRHR policies and legislation What were the factors that hindered your policy and advocacy work? What are the factors that promoted your policy and advocacy work? What (how else) else could have been done to promote policy and legislative changes at local, institutional or national levels?

 3. 4. 5.

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 33

Annex 12: Focus Group Discussions with Community Leaders Outcome indicator 2.4b Increased involvement of community leaders in realisation of SRHR in x% of the targeted communities The facilitator and note-taker are instructed to proceed as follows: 

Introduce the exercise as follows: our names are --------- and ----------. We are here to discuss with you on progress UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA program implemented by FPAM/YECE/YONECO/CAVWOC in this area. The purpose of this exercise is to learn from you about the program so that we can improve it or similar programs in future. We kindly ask you to actively participate in these discussions. Do you allow us to proceed with these discussions? [make sure they agree, otherwise you may not proceed with the discussions if they don’t).



If they agree, write the names of participating leaders and their positions in community and proceed with discussions as per questions below:

Mukudziwapo chiyani za project ya UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA Probe pa za uchembere wabwino, early and forced marriage

Could you mention interventions (activities) of the program implemented in this area? Tchulani ntchito zina zimene zikuchitika zokhudza ntchito ya UFBR

3. Are you, as a community leader involved in the program? If no, Explain why? Kodi inuyo ngati atsogoleri mukutengapo mbali pa ntchitoyi? Ngati simukutenga mbali iliyonse, fotokozani chifukwa. 4. If you are involved, explain your involvement in the project? [PLEASE NOTE: participants should be requested to explain in detail their involvement and or support in each of issues and define how they are involved. Involvement may include (but not limited to) the following: (a) Meetings, (b) Mobilising the community, (c) passing bye-laws, (d) enforcing byelaws, (e) encouraging girls to go to school, (f) Promoting availability or accessibility of services to young people and women] Mukutengapo gawo lanji pa kayendesetsedwe ka ntchito za UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA? Probe for the following:         



Pregnant women to go for ANC and deliver at health centre (Azimai oyembekezera kupita kusikelo ndikukachilira kuchipatala) Ending Early and forced marriages (Kuthetsa kukwatiwa msanga kapena kukakamiza ana kulowa m’banja ali achichepere) Ending early pregnancies Mimba zanthete (kutenga mimba ukanali wachichepere) Family planning (including young people practicing family planning before they are married) Zakulera Unmarried young people using condoms (achinyamata kugwiritsa ntchito ma kondomu/chishango) Safe abortion (Kuchotsa mimba/pakati mwandondomeko yoyenera) Young people engaging in sex before marriage (achinyamata kugonana asanalowe m’banja) Safer sex (kukayezetsa magazi, kubunyula, kumukumbatila, kuphyophyonana) Females collecting condoms (atsikana kutenga ma kondomu) Talking about sexuality with young people (kukamba nkhani zakakulidwe, umoyo ndi ma ubwenzi achinyamata) Sexual and gender-based violence (SGBV) Nkhanza (Probe: yodzera nkugonana, zapathupi, zachuma ndi m’malingaliro) Husbands escorting their wives to antenatal clinic (abambo kupelekeza amayi ku sikelo)

Based on the responses, interviewer should score involvement and support on each of the issues as follows: 1. there is a lot of support or involvement, 2.There is some support or involvement, 3. there is no support at all 4. Leaders don’t know this issue and therefore are not doing anything to support it, 5. Others (specify).

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 34

When you compare now and before UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA project, has your involvement in SRHR in SRHR in your community increased, decreased or remained the same? Explain, your answer in detail giving reasons why involvement has increased, decreased or remained the same. Kuyerekeza panopa ndi mâ&#x20AC;&#x2122;mbuyomu isanabwere UFBR, kutengapo mbali kwanu pa nkhani za uchembere kuli pati? (probe: kwachuluka, kwachepa kapena sikunasinthe?)

6. With your involvement as community leaders, do you see change in safe motherhood and sexuality of young people in the community? If yes, what change do you see? If no, why is there no change? Kodi mukuona kuti kutenga mbali kwanu kwabweretsa kusintha pauchembere wabwino ndi moyo wabwino waachinyamata (zakakulidwe, umoyo ndi ma ubwenzi achinyamata)? 7.

How (if so) has your involvement in UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA project been promoted or hindered? Kodi pali zinthu zina zimene zinalepheletsa atsogoleri kutengapo mbali pa ntchito imeneyi? Nanga zilipo zinthu zomwe zinakulimbikitsani atsogoleri kutenga mbali pachitukuko chimenechi?

8. Besides what you already did, what else could you have done to support safe motherhood and sexuality of young people in your community? Kuonjezera zinthu mwachita/mwathandiza pa pulogaramu ya UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA, ndi zinthu zina ziti zomwe mukuona kuti mukadakhoza kupanga kuthandiza pa uchembele wabwino ndi kulimbikitsa moyo wabwino pakati pa achinyamata? 9.

Any questions or comments? Muli ndi mafunso kapena ndemanga zokhudza nkhani zomwe takambilanazi?

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 35

Annex 13: Focus Group Discussions with Parents (Gender-disaggregated) Outcome indicator 2.4c – Increased Acceptance of SRHR at community level in x% of the targeted communities The facilitator and note-taker are instructed to proceed as follows: 



If they agree, write the names of participants and their positions in community and proceed with discussions as per questions below:

1. Could you kindly explain what you know UFBR/CHOICE/ CHISANKHO CHANGA TSOGOLO LANGA project and the interventions that are being implemented in your area? Mukudziwapo chiyani za project ya UFBR/CHOICE/CHISANKHO CHANGA TSOGOLO LANGA (Probe: pa za uchembere wabwino, early and forced marriages) 2.

Currently, what are your opinions on the following SRHR issues? Kodi maganizo anu ndi wotani pankhani zili munsinzi? (Instructions: for each issue below, the interviewer is expected to probe whether respondents’ opinion accepts/supports it or not and reasons why?)          

 3.

Pregnant women to go for ANC and deliver at health centre (Azimai oyembekezera kupita kusikelo ndikukachilira kuchipatala) Ending Early and forced marriages (Kuthetsa kukwatiwa msanga kapena kukakamiza ana kulowa m’banja ali achichepere) Ending early pregnancies (Mimba zanthete (kutenga mimba ukanali wachichepere) Family planning (including young people practicing family planning before they are married) Zakulera Unmarried young people using condoms (achinyamata kugwiritsa ntchito ma kondomu/chishango) Safe abortion (Kuchotsa mimba/pakati mwandondomeko yoyenera) Young people engaging in sex before marriage (achinyamata kugonana asanalowe m’banja) Safer sex (kukayezetsa magazi, kubunyula, kumukumbatila, kupsyopsyonana) Females collecting condoms (atsikana kutenga ma kondomu/zishango) Talking about sexuality with young people (kukamba nkhani zakakulidwe, umoyo ndi ma ubwenzi achinyamata) Sexual and gender-based violence (SGBV) Nkhanza (Probe: yodzera nkugonana, zapathupi, zachuma ndi m’malingaliro) Husbands escorting their wives to antenatal clinic (abambo kupelekeza amayi ku sikelo)

For each of the SRHR issue above, have community opinions on these issues changed since 2011 (or before UFBR/CHOICE/ CHISANKHO CHANGA TSOGOLO LANGA)? Is there community accepting or supporting these issues now than before the project? Please give specific stories of changes in community acceptance in the surveyed community. [Instructions to interviewer: write down participants responses as discussed. Based on the responses, interviewer should score acceptance and support on each of the issues as follows: 1. they accept/support it 2. They do not accept or support it 3. No change] Kuyerekeza panopa ndi m’mbuyomu isanabwere UFBR/CHOICE/ CHISANKHO CHANGA TSOGOLO LANGA, kodi anthu akumvetsetsa/kugwirizana nazo/kuthandizira pa zomwe takambirani pa uchembele wabwino ndi moyo wabwino wa achinyamata?

If there have been changes, what has contributed to the changes in your opinion on these issues? (if not UFBR is not mentioned as a contributing program, probe why it is not mentioned as a contributor

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 36

particularly considering that they might have mentioned the program to have implemented various interventions) (mâ&#x20AC;&#x2122;maganizo anu, ndi zinthu ziti zabweretsa kusintha kumeneku) 5.

If there was no change in acceptance or support, what do we need to do to support safe motherhood and sexuality of young people? Kodi sipanakhale kusintha kulikonse, mukuganiza kuti tipange chiyani kuti tithandize pa uchembele wabwino ndi umoyo wabwino wa achinyamata kudera lanu?

If the community doesnâ&#x20AC;&#x2122;t still accept or support some SRHR issues, explain why? (ndichifukwa chani anthu ena sakuvomeleza nkhani za uchembere wabwino?)

Muli ndi mafunso kapena ndemanga?

Consolidated UFBR Malawi Programme 2013 Outcome Measurement Report

Page 37