Outcome Measurement 2013 by Plan Nederland

Outcome Measurement 2013 Addendum 1 to the UFBR Annual Report 2013

Project no. 22162 30-04-2014

UNITE FOR BODY RIGHTS PROGRAMME, SRHR ALLIANCE OUTCOME MEASUREMENT 2013

Many people do not consider comprehensive sexuality education, contraception and safe pregnancies and births to be a matter of course. The Sexual and Reproductive Health and Rights Alliance, consisting of five NGOs , AMREF Flying Doctors, CHOICE for Youth and Sexuality, dance4life, Rutgers WPF and Simavi, works with 52 organisations in nine countries to address these areas. Together, they are making a difference.

UFBR Programme, Outcome Measurement 2013

SRHR Alliance

CONTENT INTRODUCTION

CHAPTER 1

METHODOLOGY

CHAPTER 2

CIVIL SOCIETY STRENGTHENING

CHAPTER 3

MDGS 3.1 SRHR EDUCATION / COMPREHENSIVE SEXUALITY EDUCATION 3.2 SERVICES 3.3 ENABLING ENVIRONMENT

15 15 17 22

CHAPTER 4

CAPACITY BUILDING

CHAPTER 5

LOBBY & ADVOCACY 5.1 NATIONAL LEVEL OUTCOME 5.2 INTERNATIONAL OUTCOME 5.3 CONCLUSION

29 29 31 33

OVERVIEW RESULTS

ANNEX 1

ELABORATE FINDINGS FOR SRHR IN THE DUTCH BUDGET

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INTRODUCTION We use the outcome indicators to measure the changes that have resulted from the programme interventions. Output indicators are the direct results of the programme activities, while outcome indicators describe how these direct results have contributed to a change in the lives of the target group(s), their environment and society. In 2011, at the onset of the UFBR programme, a baseline study covering all indicators in all four result areas was executed. Outcome measurement in 2013 took stock of the effects of the programme up to that year, comparing the situation in 2013 with the baseline situation, and answering the questions `Are we on the right track?’ and ‘Is the programme progressing towards the intended changes according to plan?’ Results of the outcome measurement provided important insights into the programme’s effectiveness, planning and, where relevant, the changes needed in order to achieve the intended results. In 2015, at the programme’s conclusion, a new round of outcome measurement will be carried out with the aim of indicating the changes that UFBR has been able to reach during the programme’s total course. The situation in 2015 (end line) will be compared to the 2011 baseline. Differences between baseline and end line in the selected indicators will show the UFBR programme’s contribution to these changes. In this report, progress towards the UFBR programme’s outcome indicators is discussed. While the report focuses on the indicators, it is very important to note that the entire participatory process of measuring outcomes has led to additional, unforeseen results. Although it has been a demanding trajectory, staff of member organisations and partner organisations generally were very positive about the process. It has contributed to increased collaboration between partners, to an increased understanding of the Theory of Change and the synergy of working in an Alliance, and to a shift in focus from activity-based monitoring to result-based monitoring. In some cases, outcomes were disappointing, but they were generally positive and as such motivating for the coming two years of implementation of the UFBR programme.

UFBR Programme, Outcome Measurement 2013-

CHAPTER 1

SRHR Alliance

METHODOLOGY

Before the onset of the baseline in 2011, workshops were organised in all country Alliances. Here, programme indicators were discussed and tools to measure the baseline situation for the indicators were contextualised. In 2013, we re-evaluated these tools in each country. During a four- to five-day workshop, representatives of all partner organisations in each country met to discuss the tools. The programme has evolved over time, which means that some tools needed revision. For example, the survey used to measure the results of SRHR education/Comprehensive Sexuality Education (CSE) did not always reflect the programmeâ&#x20AC;&#x2122;s content. In addition, the sampling was reconsidered as well, as the programme in some cases changed its geographical focus. In some countries, time was allocated to train the participants in conducting interviews. In other settings, a pilot was implemented to test the new tools. This process proved valuable for three main reasons. First, staff of partner organisations (mostly M&E officers and programme officers) gained better knowledge of several quantitative and qualitative research methods. Secondly, the workshop led to improved understanding of the Theory of Change. And finally, all participants experienced an increased eagerness to learn from the programmeâ&#x20AC;&#x2122;s results and to focus on result-based monitoring. After the workshop, research assistants were trained to collect the data. In most countries, an external consultant was hired to coordinate the process, analyse the data and write the report. In Kenya and Tanzania, one of the partner organisations was responsible while in Bangladesh, all partner organisations had an equal share of tasks. In all countries, the partners discussed the draft report in order to gain more insight into the findings, to add interpretations and to learn key lessons while progressing towards 2015. For example, in Tanzania and Pakistan, all findings were discussed elaborately during a four-day workshop. This proved to be very valuable and partners held each other accountable for the results achieved. Tools The UFBR result chain consists of four result areas: 1) civil society strengthening; 2) Millennium Development Goals 3, 4-6 (divided into three sub-areas: SRHR/CSE education, SRH services, and enabling environment for SRHR); 3) organisational capacity strengthening and 4) international lobby and advocacy. A total of 17 outcome indicators were formulated. For each of the result areas and indicators a tool was developed. Table 1 provides the overview of all result areas, outcome indicators and tools used to assess the progress in the outcomes mid-term of the programme.

SRHR Alliance

Table 1:

UFBR Programme, Outcome Measurement 2013

UFBR result chain with outcome indicators and outcome measurement tools

RESULT AREA 1 CIVIL SOCIETY STRENGTHENING

RESULT AREA 2 MDG 3, 4-6 STRENGTHENING SRHR EDUCATION

RESULT AREA 2 MDG 3, 4-6 STRENGTHENING SRHR SERVICES

Indicator outcome Outcome Indicator 1.1a Increased strength of the SRHR sector in the Civil Society Index (CSI) dimensions

Tools OCA (light) CIVICUS reports Key Informant Interviews Annual reports Mid-term Review

Indicator outcome Outcome indicator 2.1a Increased % of the exposed target groups has sufficient capacity to make safe and informed decisions

Tools Survey Focus Group Discussions Case stories Most Significant Change (Bangladesh only)

Indicator outcome 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

Tools Checklist

Outcome indicator 2.2c % of targeted maternal health facilities increased their compliance to the (national) quality standard Outcome indicator 2.2d % of maternal health facilities with an increase in satisfaction by women

Checklist

Outcome indicator 2.3a % increase in the use of targeted SRHR services by young people and women Outcome indicator 2.3b % increase in number of births in targeted areas that were attended by skilled birth attendants

Service statistics Annual reports

Outcome indicator 2.3c % increase in targeted health facilities of women who have 1-4 antenatal consultations Outcome indicator 2.3d % of facilities with increased availability of contraceptives, ART, ACT & antibiotics

Service statistics Annual reports

Client exit interviews Mystery clients

Service statistics Annual reports

Checklist / interview

UFBR Programme, Outcome Measurement 2013-

RESULT AREA 2 MDG 3, 4-6 STRENGTHENING ENABLING ENVIRONMENT FOR SRHR

RESULT AREA 3 STRENGHTENING 5 CORE CAPABILITIES OF SRHR PARTNERS

RESULT AREA 4 INTERNATIONAL LOBBY AND ADVOCACY

SRHR Alliance

Outcome indicator Outcome 2.4a SRHR policies and legislation implemented, changed, or adopted at local, institutional or national level, at least 2 per country

Tools Review of documents

Outcome indicator 2.4b Increased involvement of community leaders in realisation of SRHR in % of the targeted communities

Assessment by partner organisations

Outcome indicator 2.4c Increased acceptance of SRHR at community level in % of the targeted communities

Focus Group Discussions

Indicator outcome Outcome indicator 3.1a % of all partner organisations have progressed in SRHR capacities and three other prioritised areas (SoV: 5C assessment)

Tools OCA (light)

Outcome indicator 3.1b % of partner organisations with improved involvement of target groups in all aspects of the programme

OCA (light)

Indicator outcome Outcome indicator 4.1a The % of the budget for Dutch development cooperation assigned to SRHR is maintained or increased

Tools Review of reports and budgets

Outcome indicator 4.1b Renewed SRHR agenda at UN level after 2014

Review of reports and budgets

Result Area 1 â&#x20AC;&#x201C; Civil Society Strengthening One of the four result areas in the UFBR programme is Civil Society Strengthening (CSS). In 2011, a baseline was conducted to assess UFBR partners and their interaction with civil society engaged in SRHR. The baseline used the CIVICUS framework, assessing its five result areas: 1) Civic engagement 2) Level of organisation 3) Practice of values 4) Perception of impact 5) Environment The baseline resulted in a qualitative description, which we felt is more insightful than using figures to describe the civil society situation. In 2013, new data were collected which helped gain insight into the occurrence of positive changes related to UFBR Alliances influencing civil society in their respective countries. A mix of data sources was used to analyse the current CSS situation, including the OCA (light) assessments executed with all partners (see result area 3); CIVICUS (where available) or other civil

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UFBR Programme, Outcome Measurement 2013

society reports in the country; information from interviews with major stakeholders (often including the RNE); data from annual reports and/or information from the Mid-term Review.1 The key informant interviews were conducted by the PMEL advisors in the Netherlands. Result area 2: Millennium Development Goals 3, 4-6 As explained and displayed in the relevant table, this result area is divided into three separate elements: education, services and enabling environment. In order to measure the effects of SRHR education/CSE, we conducted surveys in 2011 (baseline) and in 2013 (first outcome measurement) in most countries. In some countries, additional focus group discussions were held to gain in-depth insight into the programmeâ&#x20AC;&#x2122;s effects. In Pakistan and Ethiopia, the 2013 survey was not comparable to its 2011 counterpart, which is the reason why new pre- and post-tests will be carried out in the course of 2013-2015. In Bangladesh, an alternative methodology was applied: Most Significant Change, which is a qualitative method to collect stories of change. Capacity to make safe and informed decisions is operationalized according to three components: knowledge, attitudes and skills (including empowerment and confidence-related questions). For each country, all questions are reported separately. Next, an index score is calculated for each of the three components. In order to reach one final score on capacity, the three components are combined: when someone has a high score for two out of three components, this person has â&#x20AC;&#x153;good capacityâ&#x20AC;?. The cut-off points of the index scores were established for each country by the programmatic experts. In the separate country reports the scores on the individual questions are reported as well. The outcome indicator was reformulated and the target was adjusted. Originally, the outcome indicator stated that 50% of the exposed target group had an increased capacity. However, due to data limitations (e.g. lack of panel data), we are unable to report on changes on an individual level. Therefore, we now show the percentage point increase in the number of exposed persons who have a good/sufficient capacity, as defined above. As such, an increase of 50% is unrealistic, and this target consequently has been replaced by a 25% increase. One important implication is that we cannot show all changes achieved. The possibility exists that individuals increased (or decreased) slightly, but did not make it to our cut-off points, which renders them invisible in the data as presented here. For services, the outcome indicators have been divided into three types: 1) quality of services; 2) uptake of services; and 3) stock-outs. The quality of youth-friendly services and maternal health services is assessed by means of two measurements: a checklist for the health facilities and exit interviews with clients, assessing their satisfaction. In some countries, mystery clients were used as an alternative to the client exit interviews, as mystery clients are expected to be more critical than regular clients. In order to assess the increased uptake of services, formal registers were employed. In some areas, these registers appeared incomplete or unreliable and in those areas, data from annual reports were used. Regarding stock-outs, we assessed the situation for contraceptives, ART (HIV/AIDS), ACT (malaria) and antibiotics. Health personnel were asked how often they experience stock-outs on a scale from always to never. Next, we compared the scores from both 2011 and 2013. The enabling environment component includes three main elements: lobby and advocacy in the countries, involvement of community leaders, and acceptance of SRHR among community members. For each, we developed a separate tool. The consultant or partners described the results of lobby and advocacy efforts, based on policy documents or speeches. As the final outcome indicator does not provide full insight into all activities and into the smaller successes, an additional table was 1

The Mid-term review focuses on the added value and challenges of working in an alliance. The study is already finished in some countries; in other countries, the report is due within two months.

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developed to describe these “stepping stones”. The involvement of community leaders was assessed by the partner organisations. They scored the leaders on their level of knowledge and level of involvement in community-specific SRHR issues. The group of leaders is diverse and includes not only chiefs, but also other stakeholders such as teachers, health workers, religious leaders, elders and police. In addition, for this indicator focus group discussions with community members were organised, focusing on SRHR topics and assessing whether community members’ views had changed over time. Result Area 3 – Organisational Capacity Strengthening In 2013, as part of the outcome measurement, OCA assessments were used to measure the extent to which partners’ capacities have been strengthened. The OCA concentrated on measuring the change in capacity compared to 2011 rather than measuring partners’ current strengths and weaknesses. These OCA measurements were carried out with the help of external consultants. Data were gathered by means of self-assessments and group discussions with partner organisations’ staff and management. Since OCA procedures and tools used by the various Dutch Alliance partners show some variation, not all partners were assessed by means of a similar methodology. However, all tools that have been used, measured progress on the capacities that are included in the outcome indicators (SRHR capacities, involvement of target groups and Alliance building). These were complemented by two extra capacities that partners prioritised in 2011. Some partners divided SRHR capacities into SRHR general, sexual diversity and SGBV. Result Area 4 – (Inter)national Lobby and Advocacy Apart from lobby and advocacy in each of the nine countries in Africa and Asia, lobby and advocacy activities were also carried out in the Netherlands and in international platforms. In order to measure the percentage of budget for Dutch development cooperation that was assigned to SRHR, the SRHR Alliance analysed a series of (policy) documents: 1) HGIS-nota (Homogene Groep Internationale Samenwerking); 2) Annual Report and Closing Act Ministry of Foreign Affairs (Jaarverslag en slotwet, Ministerie van Buitenlandse Zaken); 3) Spring note and Autumn note of the budget (voorjaarsnota en najaarsnota) and 4) Relevant resolutions by Parliament (amendementen in de Tweede Kamer). The HGIS nota and the Closing Act offer transparent data allowing an assessment of the SRHR budget compared to the overall ODA budget. It was decided to take the percentage as a fixed point since the overall ODA budget fluctuates over time as a result of its link with GNP, and as a result of the decrease of the overall ODA percentage. Taking a percentage makes it easier to compare increases/decreases in budget over time. The reporting systems and the relevant budget lines within the Ministry have changed since 2011 which means that a close analysis of the figures was needed to make sound comparisons. For this reason, it was decided to also report on the changes within the budget lines SRHR, HIV/AIDS and health over the years. This allowed us to determine whether an increase of the total budget lines was allocated to SRHR topics. Methods used included the checking of fluctuations in the Spring note (voorjaarsnota) and Autumn note (najaarsnota). Moreover, the total of the budget lines SRHR, HIV/AIDS and health was analysed. Over the years, these budget lines have always been intertwined, which makes it complex to determine which posts were (or should be) counted under which header. The analysis of the total budget line for SRHR, HIV/AIDS and health enables us to establish whether the general trend for these related topics is upwards or downwards. At international level, the target is a renewed progressive agenda and political (and financial) commitments for SRHR after 2014. The outcome results should be reflected in two major documents which are not yet available. 2 Hence, the resources that are assessed are the events and resources 2

The two documents are: 1) The UN report of the Operational Review of the Implementation of the Programme of Action of the ICPD and its Follow-up Beyond 2014 and the subsequent summary of the Secretary General on the Framework of

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that are part of the Operational Review of the ICPD Programme of Action, including the Global Youth Forum (2012) and its outcome document (Bali Global Youth Forum Declaration), as well as the five regional review meetings (2013) and their respective outcome documents. Also, events and resources related to the Post-2015 process were taken into account, as this process has become increasingly important for international commitments to SRHR. In this context, the following resources were analysed:  International events related to the post-2015 process in which Alliance members took part;  The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (2013);  Report of the Secretary General ‘A life of dignity for all: accelerating progress towards the MDGs and advancing the UN development agenda beyond 2015’ (2013). Challenges and lessons learned As described in the introduction of this report, the outcome measurement process was challenging, but very useful. Apart from the gains, such as increased insights in the programme’s progress, increased learning capacity, strengthened Alliance bonding and a focus on results-based monitoring, the 2013 outcome measurement poses several specific challenges that we need to take into account in the 2015 outcome measurement process. They can be categorised into four themes: capacities, tools, sampling, and attribution. First, the capacity of the external consultants or the partner organisation responsible for the study appeared not always sufficient. In some countries, the researchers had difficulties with the statistical analyses, or the qualitative materials did not provide enough depth. For 2015, we will consider improving the selection of researchers, increasing Dutch PMEL advisors’ support and bringing all researchers from all countries together for the analyses, in order to support them better. Secondly, as discussed above, some of the tools used in the baseline did not reflect the programme adequately, of which the survey to measure the effects of SRHR education/CSE is an example. After the baseline was conducted, the programme and its interventions evolved and changed. As such, the survey questions did not completely cover the content of SRHR education/CSE. During the 2013 workshop, we revised the survey so that it would better reflect the programme. This revision, however, had the additional effect of hampering the 2011-2013 comparison. As such, the results presented in this report are based on the questions that were included in both the 2011 and 2013 surveys. The results based on the new questions will be presented in 2015. Another challenge that was encountered, was the development of a survey that reflects all the different types of SRHR education within one country. In addition, official service statistics were found to be lacking, incomplete or unreliable. As an alternative, for some of the countries we presented data from the annual reports. However, as record keeping has improved significantly over the years, the upward trend is likely to be biased. We expect a better trend analysis over the years 2013-2015. Thirdly, as the geographical focus of some interventions changed after the baseline, not all data were comparable between 2011 and 2013. As a result, fewer health facilities and communities were included in the analyses for 2013. In addition, it proved difficult to create a good sampling for the students who received SRHR education/CSE. It was impossible to track the original group of respondents. But even if this had not been the case, an age effect would have biased our results (knowledge and experience on SRHR partly comes with age). Therefore, interviews were conducted Actions for the follow-up to the Programme of Action of the ICPD beyond 2014; 2) A Resolution and report on the UN General Assembly Special Session in 2014 to “assess the status of implementation of the Programme of Action and to renew political support for actions required for the full achievement of its goals and objects.”

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with a group of respondents of similar age, who were living in the area that was exposed to the programme between 2011 and 2013. Control questions indicated that still a large number of the respondents had not yet been in contact with the programme. Moreover, we learned that a percentage of the respondents in the baseline had already been exposed at that time to a similar project. Therefore, we decided to conduct pre- and post-tests in the remaining two years. A new group of students will be interviewed at the start and at the end of the curriculum/school year. The final challenge is related to attribution. As we do not have counterfactuals, and did not try to simulate them, it is impossible to attribute all effects to the programme. Alternations in government policies or, for example, other interventions running in similar locations are some of the influences that may have contributed to the results. For example, in Kenya, the government decided to make all maternal health care free of charge. This could explain the increased service uptake of ANC and delivery care. Where known, we described such forces in the country-specific outcome measurement reports. In order to get an insight into which influences specifically contributed to the programme, we included questions about the connection between changes and the programme. We do not claim that the UFBR programme is responsible for all effects, but it is likely to have made a significant contribution.

UFBR Programme, Outcome Measurement 2013-

CHAPTER 2

1.1a

SRHR Alliance

CIVIL SOCIETY STRENGTHENING

OUTCOME INDICATOR

REALISED IN 2011-2013

TARGET 2011-2015

Increased strength of the SRHR sector in the Civil Society Index (CSI) dimensions

Increased in all countries

Increase in all countries

Range change between 1 and 4 CIVICUS dimensions

ON TRACK? On track

A mix of data sources has been used to analyse the current situation on CSS. These are: the OCA (light) assessments executed with all partners; CIVICUS (if available) or other civil society reports in country; information from interviews with important stakeholders (often including the RNE), data from annual reports and/or information from the Mid-term Review. We report on the basis of the CIVICUS framework, assessing the five CIVICUS result areas: Civic engagement; Level of organisation; Practice of values; Perception of impact and Environment. For every country an elaborate description of the findings is available on request. In this overview, a programmatic summary of the results is presented. Table 2:

Country alliances with an increased influence on Civil Society in SRHR

Progress Country Alliances is increasingly influencing SRHR civil society in the CIVICUS dimensions

Table 3:

Progress 1 out of 5 dimensions 1 country Indonesia

Progress in the CIVICUS Dimensions Progress 2 out Progress 3 Progress 4 out of5 out of 5 of 5 2 countries 4 countries 2 countries Ethiopia Tanzania India Malawi Uganda Bangladesh Pakistan Kenya

Progress 5 out of 5 0 countries

Increased influence in CIVICUS dimensions by country alliances

No. of country Alliance programmes with positive impact on CIVICUS dimensions

Civic engagement 7 out of 9 countries increased 1 of out 9 countries decreased

CIVICUS Dimensions Level of Practice of Perception of organisation values impact 8 out of 9 5 out of 9 6 out of 9 countries countries countries increased increased increased

Environment No change

Civil Society Strengthening was measured in all countries by assessing whether the country Alliances are increasingly able to influence the SRHR civil society in their own country. The outcome (table 2) shows that all countries have progressed on at least one of the CIVICUS dimensions, ranging between progress in one to four dimensions. Six out of the nine countries have progressed in three or more CIVICUS dimensions. Table 3 shows in which CIVICUS components the change has been most apparent. Positive changes are mostly seen in the level of organisation (eight out of nine countries) where all but one country report a positive change, followed by civic engagement (seven out of nine countries), perception of impact (six out of nine countries) and practices of values (five out of nine countries). Civic engagement The country Alliances have made a major contribution to increasing the capacity of local NGOs, CBOs and CSOs. In the period 2011-2013, nearly 22,000 CSO staff have been trained by partner organisations. Training ranged from general SRHR to specific SRHR issues like CSE, YFS, SGBV or LGBT.

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But CSOs have also been trained in organisational aspects, like PMEL, accountability, advocacy and communication. By developing the general capacity of CSOs, Alliance partners also create goodwill and mutual trust. This makes it easier to address sensitive issues like sexuality education for young people. CSOs in their turn, train other CSOs and as such the SRHR capacity of civil society is spread among more organisations. “The Alliance took us for training as trainer to other communities and CSO staff on SRHR issues. Through this we trained 290 groups on SRHR.” (example from Tanzania). In all countries, the needs of the target groups were During the course of the examined through research, needs assessments, baselines, programme in Bangladesh, the and outcome measurement. In some countries, an increased peer approach has been adopted participation of the target groups, specifically young people, by most partners. This has led to is seen in both research and planning. Working in an alliance an inclusion of young people in has been beneficial in this respect, as partners who have the implementation of experience in involving target groups, motivate and support programme activities. The peer other organisations (Tanzania). In Malawi, partners have approach proved most effective been increasingly involving the target groups through for SRHR education. Youth trainers networks at community level and community meetings in trained and supported peer which various stakeholders were engaged in programme educators, improving leadership planning. In countries like Uganda and Pakistan, young and management skills of young people participated in the development and pre-testing of people. SRHR education materials. In Kenya, involvement of the target groups has considerably improved, including downward accountability. Also in Kenya, youth have been able to organise themselves into CSOs by making use of MAREF UFBR youth mentorship. So far, nine youth CSOs have been registered with the government and four more are in the process of registration. Two of the youth CSOs wrote proposals that received funding, and are in the process of seeking more funding opportunities from the national government. Level of organisation Working in country Alliances has contributed in all but one country to a much stronger level of organisation. From the start of the programme onwards, all country partners are increasingly involved in (SRHR) networks at several levels. At the end of 2011, partners were part of 164 networks. This increased to 363 at the end of 2013. Also, in some cases one Alliance member represents the other members in certain networks, thus efficiently advocating for SRHR Example from Kenya issues and sharing the Alliance’s work and lessons learned. Partner organisations benefit The seven partner organisations are active in 30 from the networks for learning, capacity networks at local, regional and national level. building, sharing of materials and exchanging Via these networks, the organisations have skills. Networking has contributed to the access to new information on (internal) national visibility of the Alliance. In the past three years policies, government requirements and funding the programme can be characterised as a opportunities. This increases access to continuous sharing and learning process, materials, technical support and capacity facilitated through quarterly meetings, joint building, creates opportunities for joint stakeholder meetings and joint capacity advocacy and synergy between organisations. building, both within the country Alliances themselves and with external parties. In Bangladesh, the SRHR Alliance is regarded as the most important partnership which addresses young people’s information needs regarding sexuality. In Pakistan, the Alliance partners have been able to bring the voice of the smaller CSOs who are not part of the larger networks to the mainstream. According to the Dutch Embassy in Pakistan “the Alliance has contributed by bringing a significant number of organisations together, including the embassy as well as other local NGOs.”

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Practice of values In many countries, CSOs and CBOs are supported through activity-based funding or through small grants, providing them with the opportunity to address SRHR issues according to their needs, while using their own strategies. A number of the supported CBOs and CSOs are youth-led. In almost all countries, young people are Example from Indonesia involved in programmes as researchers (Kenya, Tanzania), advocates (Ethiopia) or “After joining Satu Visi Alliance, I see many people implementers (Ethiopia, Pakistan, Uganda). dare to come-out as Lesbian. Currently Ardhanary In the baseline, many partners already Institute has many new members. Through the involved the target group in one way or Alliance, Ardhanary Institute does not need to another, but participation in decision making campaign for the recognition of lesbians because was generally low. This has changed over the the principles that have been implemented by the past years. Most organisations have Alliance have created a conducive environment increased youth participation, or target for people to be themselves. “(Director of group participation by recruiting youth Ardhanary Institute) officers (Malawi) and involving the target group in planning, reviewing and decision making, for example through community meetings. In Kenya, partner organisations have increased the involvement of the target group in decision making by e.g. integrating youth involvement in the organisations’ constitutions, by appointing young people in the board or by establishing youth councils. In Bangladesh, one partner formed a mini-parliament in a democratic process at uppazilla level. Perception of impact All organisations provide services that respond to the basic needs of the target group. In Malawi, the specific target group for LGBTQ was recently addressed as well, and in Indonesia too, LGBTQ are reached by the programme. Partner organisations are appreciated for their work by community members, other CSOs and the (local) government. During the past years, governments have generally been positive and supportive of the UFBR programme and there is close collaboration with the Ministries of Health and Education at various levels. In Uganda, the districts recently invited partner organisations to attend planning meetings, which gives them a unique opportunity to influence budgeting and prioritising. “The SRHR Alliance is considered a strategic partner for development, for example in contributing to the improvement of service delivery in the education and health sector” (senior Example from Tanzania education officer at district level). In Indonesia, the Government officials remarked: “We government increasingly considers the Alliance members value the Alliance work on sexuality as valuable and respected partners. education, as the government curriculum does not provide sexuality In most countries, the Alliance partners tend to seek education comprehensively, and collaboration with the government (mainly at district hesitates to provide information on level) to create an entry point for starting interventions. condom use in schools. The Alliance This serves to raise awareness at political and government programme is seen as adding value to level and to influence policies. The strong collaboration what the Ministry does, and picks up with government entails that advocacy requires where the ministry’s component maintaining a fine balance between influencing policies ends”. without jeopardising relationships. According to key stakeholders in Kenya, this balance has been found. They mentioned the added value of the SRHR Alliance as a critical mass which includes knowledge management, networking, coordination of partners and influencing the government. Interviews with CSOs and government representatives in Tanzania showed that the Alliance is valued as an important counterpart: “They are ready to share knowledge and experiences with other stakeholders…and (are) catalysing other organisations to integrate the advocacy issues into their projects and involve other CSO in the advocacy for SRHR.” According to stakeholders in Pakistan, by sharing expertise, the Alliance has greatly contributed to

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policy drafting and policy dialogues. The Pakistan partners invited the Secretaries of Health and Education to an Alliance learning forum in Indonesia, which positively affected further collaboration in policy development in the country. Environment From the start of the UFBR programme, there has been an Alliance steering committee in every country, consisting of Alliance representatives. All major decisions and changes need to be approved at country steering committee level. Decisions involving major changes regarding the programme results and/or budget need to be approved by the Alliance members. As this structure has not changed since the start of the programme, this component has a zero score in the analysis of changes. After the first year of implementation, partner organisations discussed the country annual reports. Based on the outcome of these discussions, the programme was adjusted in line with partnersâ&#x20AC;&#x2122; realities and capacities. In fact, every year after the annual report is completed, planning and review meetings are organised to learn, and to adapt the programme where necessary. In addition, in the outcome measurement trajectory, which included the assessment of SRHR Civil Society progress, partner organisations jointly discussed and developed the methodologies used to measure these outcomes. On the basis of the lessons learned during this process, country Alliances were able to decide whether it was necessary to adapt their interventions, strategies or outcome indicators.

UFBR Programme, Outcome Measurement 2013-

CHAPTER 3 3.1

SRHR Alliance

MDGS

SRHR EDUCATION / COMPREHENSIVE SEXUALITY EDUCATION

OUTCOME INDICATOR Increased % of the exposed target groups has sufficient capacity to make safe and informed decisions

REALISED 2011-2013 Range: 21.8%- 42.0% No. of countries that meet target: 3 out of 5

TARGET 2011-2015

ON TRACK?

25 percentage point

On track

The programme aims to increase the capacity of the target group to make safe and informed decisions regarding reproductive and sexual behaviour. In order to achieve this, educational materials and programmes have been improved and educators have been trained. Up to now, over 1.5 million people have been reached. In order to measure the effects of these efforts, we conducted a survey in 2011 (baseline) and in 2013 (first outcome measurement) in most countries. The results provided in Table 4 are based on these surveys, and represent the percentage point increase. In some countries, additional focus group discussions were held to gain more in-depth insights into the achievements of the programme. In Pakistan and Ethiopia, the survey conducted was not comparable to the 2011 survey. New pre- and post-tests will be conducted in the course of 20132015. In Bangladesh, a different methodology was applied: Most Significant Change, which is a qualitative method to gather stories of change. We operationalized ‘capacity’ as a combination of knowledge, positive attitude and skills. In most countries there is a firm increase in the capacity to make safe and informed decisions, as shown in Figure 1 and Table 4. For example, in Uganda, the percentage of respondents who have a good capacity to make safe and informed decisions increased from 18% to 60%, an increase of 42 percentage points. Table 4:

Outcomes on increase capacity to make safe and informed decisions, per country Ethiopia

% increase

n/a

Kenya 21.8%

Malawi 21.9%

Tanzania 26.0%

Uganda 42.0%

Bangladesh n/a

India n/a

Indonesia 39.0%

Pakistan n/a

TOTAL

Range 21.8%42.0% 1 In India, the index scores could not be calculated, as the raw data from the baseline temporarily were not available.

Most change is found in the knowledge levels of the target group, except in Kenya (see Figure 2). Although India is not included in the table and figures, the surveys conducted in this country show a clear increase in knowledge levels on HIV/AIDS, STIs and puberty. In most countries, only minor changes were found in people’s attitude (see Figure 3). For example, in Malawi the number of people who think that it should be possible to refuse to have sex with their partner remains very low, and even slightly decreased. A strong increase was found in Uganda, where more people displayed positive attitudes, except relating to sexual diversity, which is not surprising given the context of the country. We see mixed results when it comes to skills or empowerment levels (see Figure 4). In Malawi, positive effects on this component are shown, whereas in Uganda a slight decrease is apparent. The Focus Group Discussions in Uganda, however, did report increased confidence and empowerment levels among the target groups. It is possible that the respondents answered the survey questions more critically in 2013, due to improved reflective skills. The Most Significant

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

Change stories from Bangladesh showed that adolescents were more empowered to discuss issues like early marriage with friends and parents. Figure 1: % of respondents with good capacity to make safe and informed decisions 75,4

68,2

70 50

59,2

46,3

51,3

49,2

37,4

40 30

12,3

20 10 0

Kenya

Malawi

Tanzania 2011

Uganda

Indonesia

2013

Figure 2: % of respondents with good knowledge 89 90 80 70 60 50 40 30 20 10 0

79,5

87,4

72,9 52,8

48,5

45,8

36,8

13,8

Kenya

Malawi

Tanzania 2011

Figure 3: % of respondents with positive attitudes

Uganda

Indonesia

2013

90 80 70 60 50 40 30 20 10 0

75,8

66,469,3

66 50,9

35,5 26,8

30,9

3 Kenya

Malawi

Tanzania 2011

Uganda

Indonesia

2013

Figure 4: % of respondents with good skills 70 60 50

60,5 49,3 46,2

65 55

49,6

27,6

22,2

6,5

0 Kenya

Malawi

Tanzania 2011

Uganda

Indonesia

2013

Although attributing the effects is difficult, some success factors are likely to have contributed, including the improved quality of SRHR/CSE programmes, materials, manuals and trainings. Also, a comprehensive approach has helped to create an enabling environment. SRHR information is not only provided within CSE programmes, it is intertwined with awareness-raising activities, theatre performances, and radio shows. In addition, community health workers provide SRHR information in the communities. This is combined with an investment to improve the enabling environment and to get stakeholders on board (e.g. government officials, community leaders, parents, health staff). A good example is the whole school approach in Uganda. This approach aims to increase the ownership of schools (i.e. integrating the programme in budgets, policies and systems) to involve various stakeholders and to reach more students per school.

UFBR Programme, Outcome Measurement 2013-

SRHR Alliance

“Many misunderstandings are eliminated after listening to the topic ‘Relation’ discussed in a session. I had a notion that there should not be any relation between girls and boys. I thought the girls and boys are bad who have relation with each other; they have a relation of love and engaged in many illicit activities. Now I realise that girls and boys behave normally and uphold mutual respect to each other if they have a friendly relation and that will reduce violence and eve teasing against women.” – girl from Bangladesh Challenges and implications for the programme There are challenges in achieving the results as well as in measuring the effects. The outcome measurement shows that (lack of) knowledge is relatively easy to address. It proves to be more difficult, however, to change attitudes. Therefore, in the remaining two years, more attention will be given to attitudes. Creating a good environment for SRHR education/CSE remains a challenge as well. Conservative views lead to resistance among teachers, religious leaders and parents. Abstinence only is a barrier in many schools; organisations are not always allowed to go beyond this message. However, we also see success stories. In Indonesia, a more positive environment has been instrumental in achieving successes in the CSE programmes. It is clear therefore, that continuous attention needs to be paid to involving a wide range of stakeholders. In most countries, measuring the effects proved challenging. First, it was difficult to create comparable samples in both years (e.g. people were already exposed to some part of the programme in 2011 or not exposed at all in 2013). Also, the survey questions used in 2011 did not always reflect the content of the SRHR education/CSE as it has developed since then. In addition, the survey needs to reflect different modules and curricula from different partners. To solve these issues, we reviewed the survey in 2013, and most countries will conduct new pre- and post-tests between 2013 and 2015. This implies that new groups of students or other groups will be interviewed at the start of and after the curricula. As a result, we expect to have better quality data in 2015. 3.2

SERVICES

OUTCOME INDICATOR % of targeted SRHR facilities increasingly comply with IPPF standards for youth-friendly services % of SRHR facilities with an increase in satisfaction by young people % of targeted maternal health facilities increased their compliance to the (national) quality standard % of maternal health facilities with an increase in satisfaction by women % increase in the use of targeted SRHR services by young people and women % increase in number of births in targeted areas that were attended by skilled birth attendants % increase in targeted health facilities of women who have 1-4 antenatal consultations % of facilities with increased availability of contraceptives, ART, ACT & antibiotics a

REALISED 2011-2013 54.2%

TARGET 20112015 70%

42.1%

40%

On track

70%

On track

40%

On track

33.8%

30%

Ahead

258.4%

20%

Ahead

At least 1 visit: 9.3% At least 3 visits: 14.9% Contra.: 61% ART: 31% ACT: 75% Antibiot: 47%

20%

On track

n/a

85.5%

80.0%

ON TRACK? On track

The total is skewed towards India, where a larger number of facilities was assessed, compared to the other countries.

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

All efforts of renovating clinics and training service providers share the objectives to increase the quality and uptake of care. The outcome indicators on services can be divided into four sub-topics: 1) youth-friendly services; 2) maternal health services; 3) service uptake and 4) drugs stock-outs. Below, each sub-topic is discussed separately. Youth-friendly services Two outcome indicators focus specifically on youth-friendly services. The quality is assessed with two measurements. First, a checklist is completed for the health facilities; 24 health facilities across four out of the nine countries were assessed in both 2011 and 2013. Secondly, for 19 facilities in these four countries exit interviews with clients were conducted to assess their satisfaction with the services received. Uganda has a very good score for both indicators. However, only one facility was assessed in both 2011 and 2013. Three additional clinics, trained on YFS, were assessed in 2013. They scored significantly lower than the one clinic included in both measurements. The causes are crowding, a lack of privacy as well as a lack of formalised and routine provision of youth-friendly services. This illustrates that the training of health staff alone is not sufficient to improve the youthfriendliness of services. Kenya has a high score for improved quality, but this has not yet resulted in increased client satisfaction. Satisfaction decreased in 71% of the facilities assessed. Indonesia appears more successful in increasing client satisfaction: five out of eight clinics assessed showed an increase, while the three other clinics showed a decrease. In one of these clinics, accessibility was reduced due to a renovation. In another clinic, the number of clients increased sharply, but without a matching rise in health personnel, quality deteriorated. This indicates that partner organisations in Indonesia have successfully increased demand, but that supply of services cannot keep up. This problem is also reported in Tanzania. In this country, client satisfaction decreased in all three facilities assessed. This is largely due to a lack of health personnel, resulting in long waiting hours. A high turn-over of staff adds to the problem. Experienced staff are often transferred to urban areas and sometimes, these staff members take equipment (in some cases provided by partner organisations) with them. Their positions are filled by younger, and less experienced staff, which contributes to lower client satisfaction. Table 5:

Outcome on youth friendly services per country Ethiopia

Kenya

Malawi

Tanzania

Uganda

B-desh

India

Indonesia

Pakistan

% of targeted SRHR facilities increasingly comply with IPPF standards for youthfriendly services

n/a

71.0%

n/m

50.0%

100.0%

n/m

% of SRHR facilities with an increase in satisfaction by young people

n/a

29.0%

n/m

0.0%

100.0%

n/m

Total

n/a

37.5%

n/a

54.2%

n/a

62.5%

n/a

42.1%

n/m = not measured

Quality of maternal health services To assess the quality of maternal health care services, 69 health facilities were assessed in both 2011 and 2013 across four countries. However, most of these facilities (53) were found in India, which means that the total score was skewed towards the results in this country. If India was excluded from the total score, the final result would be 62.5%, and India included it would be 85.5%. Client exit

UFBR Programme, Outcome Measurement 2013-

SRHR Alliance

interviews were conducted for 40 health facilities, and again India was overrepresented (30 out of 40 facilities). Leaving out India from the final score would reduce the result from 80.0% to 20.0%. Similar to the section on youth-friendly services, we saw a general increase in the quality of services provided, while client satisfaction appeared to lag behind, except in India. As described above, a high turn-over of staff and long waiting hours due to a lack of service provisions would be likely to contribute to low satisfaction among clients in Tanzania. Another explanation provided by most countries, was increased awareness among clients. As a result of awareness-raising activities, clients know better what quality to expect from health providers and therefore, it is likely that they answered the questions more critically in 2013. India seems to be the positive exception to the rule. Both quality and client satisfaction have increased enormously. Health services have improved as a result of advocacy at governmental level to improve performance and to allocate funds to improve services. Most services are provided through outreach, especially on Village Health and Nutrition Days (VHNDs). Before the UFBR programme, VHNDs were rare in certain areas. In all UFBR areas, the partner organisations managed to have regular and better quality VHNDs in place, including an extension of services provided. Table 6:

Outcome on the quality of maternal health services per country Ethiopia

Kenya

Malawi

Tanzania Uganda B-desh

India

Indonesia

Pakistan Total

% of targeted maternal health facilities increased their compliance to the (national) quality standard

67.0%

100%

n/m

38.0%

n/a

n/m

92.5%

n/a

85.5%

% of maternal health facilities with an increase in satisfaction by women

0.0%

40.0%

n/m

0.0%

n/a

n/m

100%

n/a

80.0%

n/m = not measured a The total is skewed towards India, where a larger number of facilities was assessed, compared to the other countries.

Service uptake With awareness-raising activities and sexuality education, partner organisations aim to increase the demand for services and the knowledge of where to receive these services. In combination with investments in the quality of care, this is expected to lead to an increased uptake of services. Recording good quality service statistics from official registers proved a challenge in Kenya and Uganda, but output data from partner organisations could be used as an alternative source. However, as record keeping has improved significantly since 2011, conclusions will be distorted. For these countries, the trend in output data between 2013 and 2015 will be assessed at end line. Among the other countries, most facilities show an increase in the uptake of services, even as high as

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

550%. However, also for Ethiopia, the figures should be considered with cautiousness as the reporting period in 2013 was longer compared to 2011. Absolute numbers as well as the percentages show strong variations per country. Between 2011 and 2013, the use of targeted SRHR services by young people and women increased in total from 32,131 to 43,006 among the facilities assessed (Ethiopia not included). Indonesia had the smallest absolute numbers with an increase from 1,218 to 3,304. The number of women that delivered their child with the assistance of a skilled birth attendant increased from 1,224 to 4,387 in the facilities assessed in Malawi, India and Indonesia. In Indonesia, the number of child deliveries was very small (28 in 2011 and 47 in 2013). India showed the strongest increase, from 673 in 2011 to 3,691 in 2013. This can be explained by two main reasons. First, as a result of the UFBR programme, more health facilities started providing these services. Secondly, the government launched a large campaign to promote institutional deliveries. The effects wee confirmed by the results from the survey used to measure effects of CSE among adult women: the proportion of women who delivered at a health facility increased from 29.4% in 2011 to 80.4% in 2013. Table 7:

Outcome on service uptake per country Ethiopia

Kenya

% increase in the use of targeted SRHR services by young people and women

550.0%

n/m

28.8%

n/a

n/m

% increase in number of births in targeted areas that were attended by skilled birth attendants

112.3%

n/m

24.1%

n/a

n/m

% increase in targeted health facilities of women who have 1-4 antenatal consultations

At least 1 visit: 187.5%

n/m

At least 1 visit: -7.6%

At least 1 visit: 17.7%

n/m

At least 3 visits: 51.2%

At least 3 visits: -52.3%

At least 3 visits: n/a

Malawi Tanzania

Uganda B-desh

India

Indonesia

Pakistan

28.0%

171.3%

n/m

33.8%

n/m

448.4%

67.9%

n/a

258.4%

n/m

At least 1 visit: n/a

n/a

At least 1 visit: a 9.3%

At least 3 visits: 46.4%

Total a

At least 3 visits: 14.9%

n/m = not measured. a In this total, Ethiopia is not included due to unreliable data.

In Tanzania, we saw an increase in the proportion of women who came to the health facilities for at least one antenatal visit. However, there was a decrease in the proportion of women receiving three or more check-ups, which was partly due to the fact that women visited the clinic rather late in their pregnancy, reducing the amount of time available to complete three or four visits. In addition, as the pregnancy advanced, women found it harder to travel long distances to access services. Contrary to Tanzania, Malawi showed a decrease in the number of pregnant women coming for at least one visit, but an increase in the percentage for three or more visits. In Malawi, there was an average increased service uptake of 28.8%. When specified according to age, we saw an increase of service uptake among young people (10-24 years) and a decrease among adults over 25. Finally, in Indonesia,

UFBR Programme, Outcome Measurement 2013-

SRHR Alliance

service uptake showed the strongest increase among girls aged 10-14 and among boys aged 10-24 years. Service statistics for adults were not available in this country at baseline and can therefore not be compared. Drugs stock-outs One of the challenges for health facilities is the stock-out of drugs. A frequent stock out directly hampers the quality of care and client satisfaction. Although within the UFBR programme most partner organisations do not directly regulate drug supply, they do work with the (local) government and encourage facilities to make stocks available. In six out of the nine countries (38 facilities in total), we assessed the stock-outs for four types of drugs: contraceptives, ART (HIV/AIDS), ACT (malaria) and antibiotics. Health personnel were asked how often they experience stock-outs on a scale from always to never. In general, the results indicated reduced stock-outs. Some of the facilities that did not show an increase, already scored well during the baseline (e.g. all five facilities in Indonesia), eliminating the possibility to improve. However, in other countries some facilities showed a deterioration of the drug supply. This could partly be explained by increased demand. Table 8:

Outcome on stock-outs per country Ethiopia Kenya

% of facilities with increased availability of contraceptives, ART, ACT & antibiotics

Contract.: ART: ACT: Antib.: Nr of facilities:

100% n/a 33% 67% 3

40% 40% 100% 60% 5

Malawi

n/a

Tanzania 38% 25% n/a 25% 8

Uganda

100% n/a n/a 100% 1

B-desh India Indonesia

n/a

88% n/a n/a n/a 16

0% n/a n/a n/a 5

Pakistan Total

n/a

61% 31% 75% 47% 38

Challenges and implications for the programme As discussed above, client satisfaction continues to be one of the challenges encountered. This is caused, among others, by the fact that an increase in demand for services is not met by a matching supply, which may discourage the uptake of services in the future. High turn-over of staff â&#x20AC;&#x201C; especially in remote areas â&#x20AC;&#x201C; contributes to this problem. In Uganda, partners concluded that training of health staff in government clinics by itself is insufficient to sustainably improve the youth-friendliness of services. Hence, more staff guidance and follow-up are needed, while weaknesses should be addressed. For example, developing and implementing a strategy to overcome stock out problems may be a good way to further improve the quality of care and client satisfaction. This element has been taken up by the ASK programme that is currently carried out in Uganda. In one region in Tanzania, demand does seem to meet supply. The intensive focus in this region on strengthening the health system through close cooperation with the government at various levels, through training and appointing SRHR focal persons at the facilities and strengthening the documentation and data collection system at community health facility level, is an example of a best practice to ensure demand is met by service provision, despite all health system challenges. This also goes for the routine training and retraining of service providers. As smaller organisations do not have the capacity or funds to implement a similar holistic approach, it is not possible to roll out this best practice in all regions. In 2014, research within learning agenda 1 (Theory of Change) will attempt to analyse the minimum interventions with which similar results can be achieved. This knowledge will be combined with exchange visits to stimulate learning. Pakistan and Bangladesh aim to strengthen the link between education and services, for instance by establishing youth-friendly centres/satellite health camps at schools. Health care workers can visit schools regularly to offer counselling services and to provide information.

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

3.3 Enabling Environment REALISED 2011-2013

TARGET 2011-2015

On track

Increased involvement of community leaders in realisation of SRHR in % of the targeted communities

65%

50%

Ahead

Increased acceptance of SRHR at community level in % of the targeted communities

65%

40%

Ahead

OUTCOME INDICATOR SRHR policies and legislation implemented, changed, or adopted at local, institutional or national level, at least 2 per country

ON TRACK?

For sexuality education programmes and investments in services to be effective, an enabling environment is vital. Within each country, lobby and advocacy activities have been undertaken with government bodies at local, regional and national level. At community level, increased involvement of community leaders and increased acceptance of specific SRHR topics (e.g. CSE for young adolescents) were sought. Country level lobby and advocacy The advocacy meetings as described in the annual report aim to raise support for the programme and to change policies and laws where needed. Although most countries only finalised their joint advocacy strategy in 2012 or 2013, quite a few successes have been achieved. In total, ten policies or laws at local, district or national level have been adjusted or newly formulated. Both in Malawi and Tanzania, local by-laws have been formulated. In Tanzania, these by-laws focus on early marriage and early pregnancy, FGC and SGBV. In Malawi, by-laws concentrate on early and forced marriages. In addition, through these new by-laws women are stimulated to give birth at a health facility, and husbands are supposed to accompany their wives during ANC visits. The Alliance in Pakistan focused its advocacy efforts on three issues: 1) inclusion of SRHR in the school curriculum; 2) increased access to quality youth-friendly services and 3) early marriage. The Alliance was successful with regard to the first issue, in the development and adaptation of policies on CSE in one of its regions. Another example comes from India, where partners focused on Adolescent SRH (ASRH). In some states, partners were able to convince the government to provide education and services to this target group. They first initiated the services in government premises and consequently handed over these activities to the government. In both states, the ASRH activities were among the first to be carried out, and several partners were selected to act as technical advisors for consultations and implementation in the evolving ASRH policies. Currently, progress in the formulations of the policies is considerable and the topic is high on the agenda. The national ASRH policies are now also reviewed and firmly incorporated into state level health policies. Involvement of leaders and acceptance at community level Awareness-raising activities, media exposure and meetings at local and district level all aim to strengthen the involvement of community leaders and to increase the acceptance of SRHR issues among community members. In order to assess these changes, we applied two research methods. First, community leaders were assessed by the partner organisations. They were scored on level of knowledge and level of involvement in community-specific SRHR issues. The group of leaders is diverse and does not only include chief, but also other stakeholders, such as teachers, health workers, religious leaders, elderly people and police. In addition, focus group discussions with

UFBR Programme, Outcome Measurement 2013-

SRHR Alliance

community members were organised, focusing on SRHR topics and assessing whether community members’ views had changed over time. As shown in Table 9, 65% of the communities assessed show an increased involvement of community leaders. However, only three countries (with 43 communities) were included in the final score. In two other countries, the score was calculated differently. Rather than reporting per community, we chose to assess types of community leaders/stakeholders. One important success factor could well be the holistic approach of working through existing community structures (e.g. Village Health Committee and community leaders), as well as through community-based distribution systems with community health workers and educators, in close cooperation with government health and educational systems. Within these structures, the UFBR partner organisations are able to raise awareness, provide information, and capacitate these bodies, as well as to enhance reciprocal accountability between decision makers, health service providers and community members. Table 9:

Outcome on enabling environment per country Ethiopia

Kenya

Malawi

100%

n/a

n/m

100%

67%

100%

Increased involvement of community leaders in realisation of SRHR in % of the targeted communities

75%

33%

Increased acceptance of SRHR at community level in % of the targeted communities

100%

60%

Tanzania

Uganda

B-desh India

Indonesia

Pakistan

Total

n/m

100%

35%

n/m

65%

n/m

30%

n/m

65%

This figure does not represent the % of communities changed; but instead it represents the number of stakeholder groups/types of leaders. b Only Malawi, India and Indonesia are included in the calculation of the final score. c This figure does not represent the % of communities changed; but instead it represents the number of stakeholder groups/types of SRHR topics. d Only Ethiopia, Malawi, Tanzania and Indonesia are included in the calculation of the final score.

The programme seems to be equally successful in increasing acceptance for SRHR issues at community level. Here, four countries (62 communities) were included in the final score. In two other countries – Kenya and Uganda – the analyses were not done per community, but by stakeholder group or SRHR topic. One of the success factors involves awareness raising among community members over a longer period of time, using various strategies and methods (e.g. meetings, radio shows, theatre, media, and billboards). This reduces people’s shyness and discomfort to talk about SRHR issues and slowly changes their opinions. For example, in Indonesia positive changes were reported regarding the issues of puberty and body changes as well as SGBV. On the other hand, condom use and LGBT acceptance remain sensitive issues due to social norms and religious beliefs. Partner organisations in Malawi have been successful in involving religious and traditional leaders in addressing harmful practices, such as initiation rites for girls. Pakistan is not included in the table, as the Alliance partners changed the selection of communities they work in after the baseline. Hence, the data from 2011 and 2013 cannot be compared. However,

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

retrospectively, it can be concluded that despite several types of activities, no significant effects have been achieved. Reasons are among others, the lack of continuity in the activities and the lack of follow-up, both of the activities themselves and with the participants. However, changes have been made within the CSOs. The CSO members are part of their communities and as such are the stepping stones to communicate information in the (near) future. Challenges and implications for the programme One theme shared by several country Alliances is the involvement of religious leaders. Social, but also religious norms make it difficult to discuss – let alone change ideas about – issues like condom use, masturbation and sexual diversity. As religious leaders are important stakeholders in these matters, it is necessary to address them more specifically. Involving them actively in the programme could be a way to address these challenges. In Ethiopia, the programme will actively seek progressive religious leaders who are able to explain that family planning is not in contradiction with religious teachings. Partners in Uganda have been involving parents, teachers, head teachers and district officials in their activities, but acknowledge that so far, they have overlooked opinion leaders – such as religious and traditional leaders – in the communities. This will be addressed in the coming years.

UFBR Programme, Outcome Measurement 2013-

CHAPTER 4

SRHR Alliance

CAPACITY BUILDING REALISED 2011- 2013

OUTCOME INDICATOR

TARGET 20112015

ON TRACK?

% of partners progressed on SRHR capacities and three other prioritised areas

92%

60%

Ahead

% of partners improved the involvement of target groups in all aspects of programming

72%

60%

Ahead

In 2013, as part of the outcome measurement, OCA assessments were executed in order to measure the extent to which the capacities of partners have been strengthened. Instead of the current strengths and weaknesses of partners, OCA measures the change in capacity compared to 2011. All partner organisations reported on progress on SRHR capacities, alliance building and involvement of the target group, plus organisation-specific prioritised capacities. Capacities that have been prioritised by partners using the 7F model are, among others, PMEL, financial management and resource mobilisation, advocacy (and networking), and programming. Partners that used the 5C model have prioritised the capacity to achieve coherence, the capacity to adapt and self-renew, and the capacity to deliver on development objectives. In order to compare partners and countries with one another, the results from all assessments have been placed in one standardised format. Partners progressed on SRHR capacities and three other prioritised areas Table 10:

Progress on capacities SRHR

Percentage of partners that have progressed on capacities # partners with increase / total # partners that measured this capacity

Sexual diversity

SGBV

Alliance building

TOTAL

81%

56%

79%

87%

92%

26 / 32 partners

9 / 16 partners

11 / 14 partners

23 / 38 partners

36 / 39 partners

Out of the 39 partners that measured their change in capacities, 92% showed an increased capacity in over half of the assessed capacities. This percentage was higher than the separate capacities because this total was measured per partner, and indicated how many partners increased on at least 50% of the prioritised capacities. The following capacities were included: SRHR capacities and alliance building capacities, two prioritised capacities and in some cases the additional elements sexual diversity and SGBV. The total shows that in general partners perceived that their capacities were strengthened during the past years. More specifically, to a large extent, alliance building has been strengthened among most partners. This is mainly due to the strong emphasis on alliance building during workshops of Dutch alliance members and the implementation of joint activities such as joint planning, joint reviewing and joint outcome measurement. While partnersâ&#x20AC;&#x2122; capacities to work on SGBV have been strengthened considerably, for a number of partners their capacities to work on sexual diversity have not been strengthened, although they did receive capacity building on this topic. Explanations vary per partner. Some of them state that there is a need for capacity building in this area since they find it difficult to discuss the subject, even among colleagues within the organisation. Other partners state

Measured by calculating per partner whether more than 50% of all capacities measured has increased.

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

that they experience political or legal restrictions and may need to address sexual diversity in their programmes more covertly. Table 11: Capacity

Progress on additional capacities 4

PMEL Financial management and resource mobilisation Governance Capability to achieve coherence Capability to deliver on development objectives HRM Capability to adapt and self-renew Advocacy (and networking) Programme management

% of partners showing increase

# partners with increase / total # partners that measured this capacity

68% 83% 75% 83% 100% 100% 50% 25% 25%

13 / 19 5/6 6/8 5/6 3/3 3/3 4/8 1/4 1/4

Most partners showed an increase in the capacities that they prioritised themselves (based on the OCA of 2011 where these were identified as elements that needed strengthening). In the areas where some partners showed little or no capacity strengthening, like PMEL and advocacy and networking, the capacity was already well established before the start of the programme, and has kept to standards. The measurement showed that for a few partners specific capacities have decreased. This is explained by the high turnover of field staff which led to well-trained personnel leaving the UFBR programme. As a solution, partners place emphasis on recruiting more experienced staff regarding SRHR programming in order to overcome this knowledge gap. Based on the findings of which capacities have not yet been strengthened and which needs the partners have, follow-up will be given by providing trainings and workshops regarding these topics. The table below shows statements from partners during the outcome measurement that illustrate how the increased capacity of partners is revealed. Capacity

Examples of increased capacity

SRHR capacities

“Staff members are capable to facilitate or talk with confidence on SRHR issues” “The programme now dedicates attention to early marriage and FGM” “Before, we only worked on HIV/AIDS, now SGBV and maternal health have been taken up in programme” “We developed a policy statement on men having sex with men” “We are still at value clarification level, but there is progress towards acceptance among staff” “We started collaboration with key players in field of gay and lesbian rights” “We are now able to convince key players in the field to integrate SGBV in programming” “We organised radio shows on SGBV for a month” “We included SGBV as permanent element into our programming” “We are developing referral networks to address incidents of SGBV and setting up referral systems for counselling and legal aid, and a telephone hotline” “We have been able to support formation of community by-laws which address issues of SGBV among others” “We are profiting from the well-known status of the other organisations in the Alliance” “It enhanced working relations with several NGOs in SRHR sector”

Sexual diversity SGBV

Alliance

Only capacities that have been prioritized by three or more partners have been taken into account.

UFBR Programme, Outcome Measurement 2013-

building

PMEL

Financial management and resource mobilisation Governance

SRHR Alliance

“It has led to new partnerships” “We have increased awareness of national and international priorities and key actors” “We have increased access to expertise of other organisations. (receiving trainings, accessing materials)” “We are increasingly approached by other organisations for our professional input on advocacy and media” “As a youth-led organisation, we feel we are more accepted and not just considered young” “We have increasingly built other alliances in the private sector” “We started partnerships with other CSOs and government” “We have formed district alliances in SRHR with CSOs, thus bringing the SRHR alliance to a local context” “Our legitimacy increased through the alliance with a research institute” “We now have weekly progress reviews” “We developed a Management Information System” “We have established a PME framework that is in our current strategic plan and is integrated in project proposals” “Monitoring is now more systematic and coordinated” “Our openness to learn has improved due to more regular staff meetings” “We have established a M&E forum to exchange ideas” “We have made a transitioning from output-based reporting to outcome-based reporting” “We are now using research for writing new proposals” “Our financial systems improved due to additional manpower for accounts” “The donor funding base expanded” “By instituting accounting software we enhanced the accounting function” “The number of funding partners increased” “We replaced some board members” “There is now regular scheduling of meetings”

Partners improved the involvement of target groups in all aspects of programming Out of the 39 partners that measured their level of target group involvement in programming, the majority (72%) shows an increased capacity to do so. Some of the partners showed no increase, but scored already high at baseline, which is especially the case for youth-led organisations in the UFBR programme. Only one partner actually showed a slight decrease in the level of involving target groups in programming, which was explained by the development of new M&E tools that were less participatory than their previous tools. Table 12:

Progress on target group involvement % of partners

Increase No increase - remained high No change Decrease No increase – unknown if decrease or no change

71.8% 5.1% 7.7% 2.6% 12.8%

# partners / partners measured 28/39 2/39 3/39 1/39 5/39

In general, most partner organisations have basic mechanisms in place for involving target groups. For example, during the planning phase partners were open towards the needs of target groups and organised stakeholder meetings or carried out needs assessments. However, with regard to having specific policies or guidelines in place for youth involvement, partners had a low score. At decisionmaking level, young people are involved only rarely, e.g. by being represented in the board of partner organisations.

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

Table 13 shows the ways in which partners are involving target groups during all aspects of programming. During programme implementation in particular, partners work closely together with communities, specifically with young people, parents and leaders. Table 13:

Practical examples target group involvement

Aspect of programming

Ways of involving target group

Planning (assessing needs)

Stakeholder dialogue meetings Target groups involved in programme priority setting Intergenerational dialogues Peer educators Peer distributors of contraceptives Youth counsellors Youth mobilisers Young people facilitating trainings and organising events for their peers Working groups in schools for teachers, parents and community leaders Data collection by young people in baseline and outcome measurement

Implementing

Monitoring and Evaluating (influencing) Decision making

Youth councils Youth pre-conference (to draw up an action plan for international conference) Youth parliament Community representatives in project teams

Attribution The increased capacities of the partner organisations in the past three years, are to a large extent the result of their participation in the SRHR Alliance. The Dutch Alliance members provided trainings. These mainly focused on SRHR-specific topics which, according to the partners, led to value clarification, clarification of myths, increased knowledge, increased acceptance, increased openness to discuss SRHR issues, and acquisition of skills to address SRHR issues and implement programmes around it. Capacity building was not only provided by the Dutch Alliance members. It was also carried out by non-Alliance members, networks and government departments as well as donors like UNFPA, IPPF, UNESCO and IPAS. Furthermore, staff members of partner organisations provided mutual training in youth involvement, SGBV and advocacy. Other activities like regional meetings, exchange visits and participation in networks and forums also contributed to partnersâ&#x20AC;&#x2122; capacity development.

UFBR Programme, Outcome Measurement 2013-

CHAPTER 5

SRHR Alliance

LOBBY & ADVOCACY

OUTCOME INDICATOR

The % of the budget for Dutch development cooperation assigned to SRHR is maintained or increased Renewed SRHR agenda at UN level after 2014

REALISED 2011- 2013

TARGET 20112015

ON TRACK?

Yes

n/a

On track

In progress

n/a

The SRHR Alliance aims to sustain or increase political and financial commitment to SRHR in the Netherlands and at the United Nations. In the Netherlands, the SRHR Alliance works towards a favourable environment for SRHR, particularly in Dutch Parliament and with the Ministry of Foreign Affairs. By raising awareness about the importance, benefits and cost-effectiveness of investing in SRHR, and actively advocating for at least maintaining the SRHR budget, the Alliance aims to counter the risk of budget cuts, which are taking place in a context of economic crisis and general scepticism about aid effectiveness. At international level, the SRHR Alliance focuses on United Nations (review) processes that are relevant to the ICPD Programme of Action and the post-2015 framework. Advocacy at this level is always undertaken jointly with other networks and organisations, and where possible, in collaboration with our partners in the South. The SRHR Alliance advocates for reinforcing the ICPD beyond the 2014 agenda and inclusion of SRHR in the post-2015 development agenda, to ensure renewed political commitment and subsequent funding for SRHR in the future. Although officially, the International Lobby and Advocacy component of the UFBR programme was reduced due to overall budget cuts in the programme, all organisations in the Alliance committed to the agenda that was set. The organisations agreed on a distribution of labour that is complementary in expertise and focus, which resulted in an efficient and effective approach. CHOICE for Youth and Sexuality mostly aims at the international level. Rutgers WPF and dance4life focus on both levels. Simavi has mainly been focusing on national level advocacy but is also increasingly engaged in international advocacy, while AMREF has been contributing to national advocacy. Expertise ranges from youth mobilisation and participation and civil society involvement to various SRHR content issues and SRHR funding. The goals, outcome and outcome indicators of the Lobby and Advocacy component of the UFBR programme are: Goal: To create a supportive environment for the implementation of the ICPD Programme of Action and to advocate for progressive SRHR policies, including the financial support required for realising SRHR for all. Outcome: Sustained or increased political and financial commitment towards SRHR for all in the Netherlands and at UN level. Outcome indicator national level: The percentage of the budget for Dutch development cooperation assigned to SRHR is maintained or increased. Outcome indicator international level: The SRHR agenda at UN level is renewed after 2014. 5.1 NATIONAL LEVEL OUTCOME To measure the percentage of budget for Dutch development cooperation that was assigned to SRHR, the SRHR Alliance monitored: ď&#x201A;§ HGIS-note (Homogene Groep Internationale Samenwerking)

SRHR Alliance

  

UFBR Programme, Outcome Measurement 2013

Annual Report and Closing Act Ministry of Foreign Affairs (Jaarverslag en slotwet, Ministerie van Buitenlandse Zaken). Spring note and Autumn note of the budget (voorjaarsnota en najaarsnota) Relevant resolutions by Parliament (amendementen)

The following outcome was measured during the baseline in 2010:  Total spending on official development cooperation (ODA) by the Dutch Ministry of Foreign Affairs in 2010: €4,843,540.006  The realised budget spent on reproductive health in 2010: €156,639,0007  The percentage used as baseline is 3.23% Results The percentage of SRHR budget in the total spending on ODA in the Netherlands has increased from 3.2% in 2010 to 5.2% in 2014. Also, when examining the share of budget for SRHR, HIV/AIDS and health in ODA spending, the percentage has increased over the years. It can be concluded that within the time frame of this evaluation (June 2011- December 2013) there has been an increase in percentage of the budget for Dutch development cooperation assigned to SRHR from 3.2% in 2011 to 5.2% in 2014. This occurred despite the fact that during this period, MFS2 budgets were taken out of the budget lines under review, and that total spending on ODA dramatically decreased. A point of attention was that due to the changing reporting systems and budget lines within the Ministry of Foreign Affairs, clear monitoring of percentages spent on SRHR was rather difficult. Table 14 and calculations in Appendix 1 show a clear trend. However, the changing methods of reporting and budgeting do not support a clear-cut comparison of figures over time. Table 14: Year

2010 2011 2012 2013 2014

Results national lobby & advocacy SRHR budget

€ 187 million € 162 million € 113 million € 172 million € 185 million

Percentage SRHR of ODA 3.2 % 2.9 % 3,4 %. 4.0 % 5.2 %

SRHR, HIV/AIDS and health budget € 425 million € 392 million € 377 million € 382 million € 415 million

Percentage SRHR, HIV/AIDS and health of ODA 8.7 % 8.3 % 8.7 % 9.1 % 11.2 %

Lessons learned Strong support for SRHR exists within the Dutch government as well as among opposition parties in Parliament. However at the same time, the position of SRHR can be considered fragile due to shifting budgets and lack of transparency in reporting, which calls for continued advocacy by the SRHR Alliance towards Dutch parliament and government. The increase in percentage for SRHR did not happen without the consistent monitoring by the SRHR Alliance advocacy group and their advocacy to restore budget cuts. For instance, as a result of their monitoring efforts, deviations in the budget for 2012 were pointed out, questioned and corrected. A constant monitoring of the SRHR budget, combined with a consistent briefing of Parliament on the role and importance of SRHR in sustainable development is therefore of the utmost importance. Changes in reporting systems within the Ministry were pointed out as a possible weakness for good monitoring, which turned out to be the case. This called for a strict and detailed unwinding and deciphering of the budget into clear-cut figures for the different topics, SRHR, general health and HIV/AIDS to ascertain that stated increases were real and not cosmetic.

UFBR Programme, Outcome Measurement 2013-

5.2

SRHR Alliance

INTERNATIONAL OUTCOME

The baseline for the measurement of the SRHR Alliance international advocacy is the existing language on SRHR, most importantly the ICPD Programme of Action. The target value for the international level is a renewed progressive agenda and political (and financial) commitments for SRHR after 2014. The Alliance focuses on enhancing and expanding relations with likeminded international advocacy networks and delegations, reviews of CSW and CPD meetings, and language in resolutions of CSW and CPD meetings. The resources reviewed for this evaluation are:  International events related to the post-2015 process in which Alliance members took part;  The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (2013);  Report of the Secretary General ‘A life of dignity for all: accelerating progress towards the MDGs and advancing the UN development agenda beyond 2015’ (2013). Results Networking The Alliance’s relations with likeminded international advocacy networks and delegations have increased and intensified during the past years. The SRHR Alliance collaborates with international SRHR, youth and women’s organisations through the SRHR Platform Beyond 2015, CSW-CPD listservs, the International Sexual and Reproductive Rights Coalition (ISRRC), European networks, Dutch civil society and our networks of civil society organisations in Africa, Asia and the MENA region. This resulted in more effective and streamlined advocacy efforts. To give some examples:  In 2013, the CSW-CPD group developed language mark-ups for the negotiations on the resolutions, which were shared among SRHR organisations for their in-country advocacy towards their governments.  In 2011, 2012 and 2013 one of the Alliance members organised and facilitated, in collaboration with ISRRC, training and strategy sessions prior to and during CPD.  Another Alliance member is actively working with fellow youth-led organisations and has organised youth meetings (youth caucuses) on several occasions to prepare and strategize for CSW and CPD meetings with other young people present at the event.  This Alliance member has taken up a leadership role in the preparation for the Bali Global Youth Forum and is a member of the international Youth Leadership Working Group.  An Alliance member developed the CPD simulation game.  The Alliance organised, facilitated and participated in a training on the 47th session of CPD in 2014 prior to the EuroNGOs meeting in 2013. This training was crucial in building the capacity of different Alliance members and in strategizing towards CPD47.  One of the leading information-sharing and strategy-development listservs on the Post-2015 Development Agenda is the SRHR Platform Beyond 2015 listserv, moderated by Rutgers WPF. The listserv currently has 237 civil society members representing different constituencies and regions. The Platform has a Coordinating Committee in which Rutgers WPF represents EuroNGOs. The Coordinating Committee held conference call meetings in 2013, and met face- to-face at the Women Deliver and EuroNGOs conferences.  Alliance members increasingly engage with organisations working within the post-2015 process, for example the Women’s Major Group and the Major Group for Children and Youth. Additionally, the SRHR Alliance invested in the relationship with the Dutch Ministry of Foreign Affairs. This resulted in the inclusion of staff of Alliance members in the Dutch delegation during CPD45 and CPD46, and again during CPD47. Additionally, staff of Pakistan and Indonesia Alliance organisations have been part of their countries’ delegations during CPD 45 and 46.

SRHR Alliance

UFBR Programme, Outcome Measurement 2013

Review of the annual CSW and CPD meetings and the resulting outcome documents  The 45th session of the CPD in 2012 was a major event, given its thematic focus on youth and adolescents. Preparations by the SRHR Alliance and its international partners started well in advance. These concerted efforts, including on language, contributed to the progressive outcome document. In addition, the strong presence of young people at the event highlighted the importance of meaningful youth participation in the ICPD process. The outcome document of the 45th session featured powerful language on young people’s SRHR.  The 2013 session of the CSW resulted in an outcome document with powerful language on SRHR. The outcome document on violence against women, was a breakthrough in itself after failed negotiations during CSW 2012 and intense negotiations prior and during the conference. Alliance members were among the civil society organisations that contributed to the positive outcome.  The 46th session of CPD on migration in 2013 revolved mostly around the highly politicisedissue of international migration. Some successes were achieved regarding references to SRHR in the outcome document. The ICPD Operational Review process The ICPD Operational Review process which has taken place during the past years, featured national surveys on implementation as well as thematic and regional review conferences.  All five regional conferences that were held as part of the ICPD Operational Review process had progressive outcome documents. Alliance members took part in the UNECE meeting, including the youth strategy meeting. One Alliance staff member was included in the Dutch delegation to UNECE, and another one in the Pakistani delegation to UNESCAP. Several partner organisations participated in their respective regional meetings, as well as in several youth strategy meetings.  The thematic review conference on youth, the Global Youth Forum held in Bali in December 2012, was a major success both in content and process. The conference’s organisation was youth-led and a very progressive outcome document was developed by young people and policy makers from all over the world.  Alliance members actively participated in the ICPD International Conference on Human Rights. The conference identified gender equality as a prerequisite for any advancement of women’s and girls’ human rights and also stated that rights related to sexuality and reproduction are human rights. It also stated that ensuring sexual and reproductive rights requires an enabling environment where people can exercise autonomy and choice. And there were strong calls on men and boys to act on their responsibility for eliminating discrimination and violence against women and girls. Alliance members contributed to developing and disseminating the “The Hague Civil Society Call to Action on Human Rights and ICPD Beyond 2014: All Different, All Human, All Equal”. The post-2015 process  Alliance members took part in several events related to the post-2015 process, including meetings of the High Level Panel (2012), sessions of the Open Working Group on Sustainable Development (2013, 2014) and the UN General Assembly Special event towards achieving the Millennium Development Goals (2013). At these events, Alliance members advocated for the inclusion of SRHR in the post-2015 framework and engaged with other networks, including the Women’s Major Group and the Major Group for Children and Youth, to strengthen their joint efforts and to increase support for SRHR among other networks.  UN Secretary-General Ban Ki-Moon mentions in his 2013 report ‘A life of dignity for all’ that women and girls “must have access to the full range of health services, including in the area of sexual and reproductive health and reproductive rights.”  Universal Access to SRHR is mentioned as a target under a Health Goal in the High Level Panel report.

UFBR Programme, Outcome Measurement 2013-



SRHR Alliance

In the OWG on Health there was strong cross-regional support from member states for SRHR, illustrated in the statement on SRHR signed by 24 UN Member States. In OWG8, during the session on gender equality, a statement was presented by Argentina on behalf of 49 UN Member States, showing strong support for SRHR . Unlike during the session on Health, this time the Co-Chairs presented a number of bullet points that referred to gender equality and sexual and reproductive health and rights.

Lessons learned It is clear that the process, which will determine the renewed progressive agenda and political (and financial) commitment for SRHR after 2014 is still in full swing. On-going advocacy efforts are of vital importance for the outcome of this process. Crucial are the outcomes of both the CSW (March 2014), 47th session of the CPD (April 2014) and the UN General Assembly Special Session (September 2014). This in turn should fuel the development of the post 2015 framework. Thus far, the following analysis can be made:  Being part of an international network is vital to the success of the Alliance’s advocacy efforts, though it creates methodological challenges regarding the attribution of results;  Cooperation with international Alliance partners has been instrumental in spreading our efforts, especially regarding the Operational Review’s regional and thematic conferences;  The ICPD, Beijing and Post-2015 processes all thematically extend beyond SRHR. This means that we operate in a politicised context, which requires the ability to link SRHR to other topics.  As 2015 approaches, linking the ICPD, Beijing and Post-2015 processes is becoming more important. This requires further cooperation with other networks and coordination between SRHR advocates to increase their impact. 5.3

CONCLUSION

The mid-term outcome evaluation shows positive results on the outcome indicators that were set. The Dutch government demonstrates continued political and financial commitment to SRHR; and internationally, networks are strengthened for effective advocacy in favour of a progressive SRHR agenda after 2014 and inclusion of SRHR in the post-2015 Development Agenda. A number of successes has already been achieved, with new progressive language in a number of international conferences despite increasing conservative dynamics. Although attribution remains a challenge, it is clear that the SRHR Alliance members have played an important role in the achievement of these outcomes. Despite these positive results, the overall decreasing commitment to development cooperation and the resulting ODA budget cuts in the Netherlands should be acknowledged. The Dutch government (Rutte II) has let go of the internationally agreed 0.7% norm, and will structurally cut its ODA with €1 billion in the coming years. Public support for development aid seems at its lowest point. Moreover, a link was established between development cooperation and foreign trade, which fits less well with a topic such as SRHR. This makes continued advocacy for SRHR towards the Dutch government indispensable. The international arena is rather volatile and influenced by many different interests and actors. Besides the annual sessions of the CSW and CPD and the ICPD Operational Review, the post-2015 process has become crucial. To ensure future political and financial commitment for SRHR at international level, the renewed SRHR agenda has to be effectively linked to the post-2015 process, as this will be the main agenda guiding future global development efforts.

UFBR Programme, Outcome Measurement 2013-

SRHR Alliance

OVERVIEW RESULTS The table below presents the overview of the progress on all outcome indicators. Please note that not all indicators were measured in all countries. Hence, the results do not reflect the situation in all countries. OUTCOME INDICATOR

REALISED 2011-2013

TARGET 2011-2015

ON TRACK?

Increased in all countries Range: change between 1 and 4 CIVICUS dimensions

Increase in all countries

On track

Range: 21.8%42.0% Nr of countries that meet target: 3 out of 5 54.2%

25% (percentage point)

On track

70%

On track

42.1%

40%

On track

85.5%

70%

On track

80.0%

40%

On track

33.8%

30%

Ahead

258.4%

20%

Ahead

At least 1 visit: 9.3% At least 3 visits: 14.9% Contra.: 61% ART: 31% ACT: 75% Antibiot: 47% 10

20%

On track

RESULT AREA 1 - CIVIL SOCIETY STRENGTHENING 1.1a

Increased strength of the SRHR sector in the Civil Society Index (CSI) dimensions

RESULT AREA 2 â&#x20AC;&#x201C; MDGS 2.1a

Increased % of the exposed target groups has sufficient capacity to make safe and informed decisions

2.2a

% of targeted SRHR facilities increasingly comply with IPPF standards for youth-friendly services % of SRHR facilities with an increase in satisfaction by young people % of targeted maternal health facilities increased their compliance to the (national) quality standard % of maternal health facilities with an increase in satisfaction by women % increase in the use of targeted SRHR services by young people and women % increase in number of births in targeted areas that were attended by skilled birth attendants % increase in targeted health facilities of women who have 1-4 antenatal consultations

2.2b 2.2c 2.2d 2.3a 2.3b 2.3c

2.3d

% of facilities with increased availability of contraceptives, ART, ACT and antibiotics

2.4a

SRHR policies and legislation implemented, changed, or adopted at local, institutional or national level, at least 2 per country Increased involvement of community leaders in realisation 65% of SRHR in % of the targeted communities Increased acceptance of SRHR at community level in % of 65% the targeted communities RESULT AREA 3 - INCREASED CAPACITY OF PARTNER ORGANISATIONS

2.4b 2.4c

3.1a

% of all partner organisations have progressed on SRHR capacities and three other prioritised areas (SoV: 5C assessment)

92%

n/a

On track

50%

Ahead

40%

Ahead

60%

Ahead

SRHR Alliance

3.1b

UFBR Programme, Outcome Measurement 2013

% of partner organisations with improved involvement of target groups in all aspects of the progr amme

72%

60%

Ahead

Yes

n/a

On track

In progress

n/a

RESULT AREA 4 â&#x20AC;&#x201C; (INTER)NATIONAL LOBBY & ADVOCACY 4.1a

The % of the budget for Dutch development cooperation assigned to SRHR is maintained or increased

4.1b

Renewed SRHR agenda at UN level after 2014

UFBR Programme, Outcome Measurement 2013-

ANNEX 1

SRHR Alliance

ELABORATE FINDINGS FOR SRHR IN THE DUTCH BUDGET

All amounts x 1.000.000 Year

ODA

Original budget SRHR

Changes to the budget SRHR

Total budget SRHR

SRHR % of ODA

2010

€ 4,847,354 (HGIS Annual Report 2010)

€ 187,480 (National budget 2010)

Minus € 30,841 (Najaarsnota 2010): decrease of expenses (reproductive) health country-related and on general health

€ 156, 639 (Annual Report en slotwet 2010)

3.2%

2011

€ 4.692,894 (HGIS Annual Report 2011)

€162,886 (HGIS Annual Report 2011)

Minus €26,218 Due to: Minus € 29 budget-neutral shift of MFS2 (voorjaarsnota 2011) Plus €11 for GAVI and increases in the country programmes for health. (Najaarsnota/ 2de suppletoire 2011) Minus € 7,9 for health programme in Zambia and delay general reproductive health programmes (slotwet 2011)

€ 136, 668 (jaarverslag en slotwet 2011)

2.9% Without the budget for MFS2 3.5 % (including part of the budget for MFS2 that was taken out of the SRHR-HIV/AIDShealth budget line) 3.0 % (including part of the SRHR Alliance budget)

Total budget budget SRHRHIV/AIDShealth and % of ODA € 425,891 8.7 %

€ 392,568 8.3 %

Remarks

There are 2 separate budget lines for reproductive health and HIV/AIDS. The budget line for reproductive health also included general health programmes. Hence, strictly speaking SRHR budget should read: SRHR budget plus health budget. There is still no distinction made between health and reproductive health. All general health programmes are still under the budget line of reproductive health. Also, the increase of the budget for GAVI is counted under SRHR. It is unclear why a total of € 29 million of MFS2 budget was counted under reproductive health. The SRHR Alliance receives € 44 million for a total of 5 years. Conservatively counted, we have taken € 8.8 million to be added for the calculations in the following years, since otherwise no comparisons could be made.

SRHR Alliance

2012

€ 4,325,983 (HGIS Annual Report 2012)

2013

€ 4,175,7 (On the basis of HGIS 2014. Exact figures can be found in HGIS annual report 2013 to be published in May 2014)

UFBR Programme, Outcome Measurement 2013

€ 337. Of which €113 million will be reserved for SRGR, €113 million will be reserved for HIV/AIDS and €111 million will be reserved for general health programmes. (Rijksbegroting 2012)

€380,957 (total budget line) €172,534 (SRHR)

1 ste suppletoire: Article 5.4 Plus €24.2 million for SRHR programmes in countries Plus €8 million for SRHR Amendementen De Caluwé/Ferrier Plus € 2 million SRGR prostitution. Amendement Van der Staaij/ Ferrier 2de suppletoire: plus € 6,292 (SRGR tender; increase GAVI and HIF, decrease general health programmes) SRGR budget=115 + 24. 2 + 10 million = € 149.2 million (voorjaarsnota, 1ste suppletoire, pp. 12) Minus €10,8 (voorjaarsnota 2013) Due to a mistake.

€ 149,2

3.4 % Plus € 8,8 million of MFS2 (see remarks above)= 158 million =3.6 %

€ 377,004 (jaarverslag en slotwet 2012) 8.7 % -or + € 8.8 million= € 385,793 8.9 %

After an intense lobby trajectory, the budget for SRHR was increased in 2012. (see resolutions of Parliament and letter 5 of State Secretary Knapen ). However, the exact amount for SRHR is still difficult to determine and comparisons are not clear-cut due to the MFS2 shifts.

€ 382,160 Of which SRHR: €168,573 (1ste suppletoire begroting. Final figures can only be confirmed in 2014)

€ 382,160 9,1 %

This is the only budget with a clear distinction between SRHR, health and HIV/AIDS.

Amendement De Caluwé/Ferrier 33000 V nr. 32 beoogt via een toekenning van 8,0 miljoen euro aan artikel 5.4 de bezuinigingen die de regering heeft voorzien op SRGR/ Hiv-Aids te beperken en 33000 V 25 Amendement van de leden van der Staaij en Ferrier; Kamerbrief begrotingsbehandeling ontwikkelingssamenwerking - toelichting SRGR en Gender (22-11-2011) Staatssecretaris Ben Knapen.

UFBR Programme, Outcome Measurement 2013-

2014

€ 3.714, 563 (HGIS 2014)

€ 382 million (total budget line) € 185 million (SRHR)

Plus € 33 million (amendement 6 Voordewind) € 20 million for global fund € 8 million for SRHR-gendereducation € 5 million Unicef aids orphans

SRHR Alliance

€ 193 million (Final figures will be published later in 2014)

5,2 % (SRGR)

€ 415,756 11,2%

Due to a general government agreement, the total ODA is decreasing in 2014, 2015 and 2016 with € 750 million and in the following years structurally by € 1 billion. In the budget of 2014 it is again difficult to determine the exact figures for SRHR. The figures are based on an estimate, adding up the budget of all the organisations and budget lines which are SRHR-focused.

Amendement nr 17-33 750 XVII van de leden Voordewind C.S bij de Vaststelling van de begrotingsstaat van Buitenlandse Handel en Ontwikkelingssamenwerking (XVII) voor het jaar 2014.