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Global Poverty Action FundPROJECT COMPLETION REPORT

PROJECTS ENDING BY MARCH 2016

Please read the following instructions carefully

This Project Completion Report template includes DFID reporting requirements for 2016. It is designed to provide a report on your project as a whole which:

enables you to communicate to DFID what GPAF funding has achieved through your project establishes a record of project achievement against its outcome and outputs draws out conclusions and lessons learnt of value and wider application contributes to learning on emerging results informs a wider analysis of all GPAF projects checks compliance with the terms and conditions of the grant.

The template is aligned to the 2015 Annual Report template where changes were made in response to the Fund Manager’s experience from previous rounds, input from the GPAF Evaluation Manager and DFID requirements and considerations. Revisions have been made to strengthen the documents, whilst maintaining a high degree of continuity with last year’s reports.

The key changes are:

strengthened guidance and clearer wording of some questions, for example on logframes, risk and value for money a new sections on methodological tools, to support GPAF evaluation a revised and more open section on learning some different questions on project accountability to stakeholders a few new questions, for example on assumptions, collection of beneficiary data and meeting the requirements of your grant arrangement removal of a few questions, for example on beneficiaries

What is required? Refer back to your most recent Annual Report feedback letter which might well contain pointers for completing the PCR. Use the 2016 Project Completion Report template (this document) without altering its structure Cover the whole period of your project Keep within page length limits Ensure that you draw on and refer to the findings of your external evaluation Submit the report and all accompanying documentation including separate annexes as WORD /Excel documents, not as PDF files Send all required documents by e-mail to your Performance and Risk Manager. Hard copies are not required Entitle your email “GPAF [reference number] PCR and closure documents”

GPAF Project Completion Report Template up to March 2016 1

The PCR report is due after your project end date (unless otherwise agreed in writing by the Fund Manager).

What to send – use as checklist:

1. Narrative Report (this document)

Checkbox Section and Title Page limit Notes

1 Basic Information 2 Basic project data

2 Summary, Progress & Achievements 6 A narrative summary of project progress and achievements including section 2.2 which, unlike

the rest of the report, specifically covers the final period of the project

3 Value for Money 2 A summary of actions and achievements in relation to value for money

4 Sustainability 1 Progress towards ensuring sustainability

5 Project Accountability to Stakeholders 1 Project mechanisms to gather beneficiary feedback and the challenges of responding

6 Learning 2 Lessons from project implementation for learning and dissemination

7 Requirements of Grant Arrangement 1 New section to ensure that the requirements of the Grant Arrangement have been met

8 Comments on Independent Final Evaluation 2 Grant Holder comments on the findings and recommendations of the project Independent Final

Evaluation

Annex A Outcome and output scoring 12

A record of progress against the milestones and targets in your project logframe. Includes an assessment of progress against each indicator and the evidence which supports the statements of achievement. Includes table to record methodological tools used.

Annex B Consolidated beneficiary table 2 An overall summary of the number of individual project beneficiaries.

Annex C Portfolio Analysis 3 Some basic information about your project to feed into an analysis of the whole portfolio of

GPAF projects


2. Project Documents (attachments)

Check box Document Notes

Reporting Logframe

Most recently approved Logframe and Activity Log in Excel format, with ‘Achieved’ boxes completed for each indicator, and each relevant milestone.

Please label this document: “GPAF (ref. no.) PCR Logframe (+ date prepared)”.Final (External) Evaluation Report Please name the document “GPAF [ref. no] final evaluation report”. For guidance please refer to

“Independent Final Evaluations – overview for GPAF grantees” and FAQs recently circulated

Photograph(s)New photograph(s) which illustrates or tells a story of your project.

Attach as a separate file(s) (i.e. do not embed into another document), preferably as a JPEG file.

Supporting statement for photograph(s)

In separate document please provide:* captions or explanations of the photo(s);* the photographer’s name, if possible;* assurance that subjects have given their consent, both for the photograph to be taken and for its possible use in learning/publicity materials.

3. Financial Report (attachment - use the most recent Excel template circulated with this report template)


Final Annual financial report Worksheet 2 of excel template showing expenditure in the project’s final financial year

Financial summary Worksheet 4 of excel template showing a summary of expenditure over the life of your project

It is very important to note that:

Project expenditure must be reported against the full detailed budget agreed by Fund Manager and not the summary budget used for expenditure claims. Any variances in excess of 10%, either positive or negative, (or transfers between main budget sub-headings) must be explained. You should show any variances both in terms of total amount in GBP (£) and percentage of your budget.

4. Closure documents



Final claim or statement of expenditure

The appropriate template will be sent separately (as dependent on nature of claims)

Inventory of disposal of assets Please use template provided with PCR document pack

Asset transfer letter Please use template provided with PCR document pack

Annual Audited Accounts (if available – see note)

A hard copy of your Annual Audited Accounts for the financial year in which your project ended must be posted to the Fund Manager four months after the end of your financial year, unless an alternative deadline has been agreed in writing by the Fund Manager.

Information and References

Purpose of the GPAF

The Global Poverty Action Fund (GPAF) is a demand-led fund supporting projects which are focused on: poverty reduction and pursuit of the Millennium Development Goals (MDGs)

through tangible changes to poor people’s lives including through: service delivery empowerment and accountability work on conflict, security and justice

Further Guidance documents that may help with the completion of this Project Completion Report:

Gender and Diversity: DFID Disability Framework 2014

Value For Money: BOND VFM Guidelines BOND – Integrating VFM into the Programme Cycle Diagram DFID VFM Guidelines

Quality of Evidence: BOND Quality of Evidence Guidelines DFID How-To-Note – Assessing the Strength of Evidence


https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/158000/HtN_-_Strength_of_Evidence.pdf

http://www.bond.org.uk/effectiveness/principles

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/67479/DFID-approach-value-money.pdf

http://bond.brix.fatbeehive.com/data/files/Effectiveness_Programme/Value_for_money_-_integration_into_the_programme_lifecycleJan2012.pdf

http://www.bond.org.uk/data/files/Value_for_money_-_what_it_means_for_NGOs_Jan_2012.pdf

https://www.gov.uk/government/publications/dfid-disability-framework-2014

Any Questions?

If you have any questions about the completion of your reporting requirements, please contact your Performance and Risk Manager.

Common questions with answers and further guidance as previously drawn up by TripleLine are being circulated as Frequently Asked Questions (FAQs) alongside this report.


GPAF PROJECT COMPLETION REPORTSECTION 1: BASIC INFORMATION This information is needed to update the Fund Manager’s records1.1 Grant Holder Organisation Name ChildHope, UK

1.2 Grant Holder Organisation Address Development House, 56-64 Leonard street, London EC2A 4LT

1.3 Project partner(s) List implementation partners. Highlight any changes to partners. For multi-country projects, please indicate

which partner is in which country

Child in Need Institute (CINI), Kolkata, India

1.4 Project Title Bringing the MDGs back on track: Improving health and nutrition outcomes for women and children among vulnerable families living in urban and rural areas of West Bengal

1.5 GPAF Number IMP 0561.6 Countries India1.7 Location within countries Kolkata (Urban Slums) and North Dinajpur (Goalpokher District), West Bengal

1.8 Project Start & End Dates Start: 12/2012End: 03/2016

1.9 Reporting Period From: 01/04/2015To: 31/03/2016

1.10 Total project budget £ 668,569

1.11 Total funding from DFID £ 522,429

1.12 Financial contributions from other sources Please state all other sources of funding and amounts in relation to this project. Sources should be listed in bracket.

Total £149,729List all contributions CINI - £92,547ChildHope - £13,494Panchayat (local self-government)- and clubs-£43,688

1.13 Date report produced 31/05/20161.14 Name and position of person(s) who compiled

this reportName: Amit ArulananthamPosition: Programme Manger, ChildHope UKName: Swapan Bikash Saha Position: Project Director, CINI


Name: Amrit Paswan and Sanchita SenguptaPosition: Learning and Impact Officer, and Nutrition Officer, CINI

1.15 Name, position & email address for the main contact person for correspondence relating to this project

Name: Amit ArulananthamPosition: Programme Manger, ChildHope UKEmail: [email protected]

1.16 Secondary contact person (optional) Name : Jill HealeyPosition: Executive Director, ChildHope UKEmail: [email protected]

1.17 Acronyms Please try not to use too many acronyms, and explain all that you do use e.g. CHW – Community Health Worker.

Acronym ExplanationANC Ante Natal Care

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AWC Anganwadi Centre

AWW Anganwadi Worker

BDO Block Development Officer

BFM Beneficiary Feedback Mechanism

CA Change Agents

CBO Community Based Organisation

CINI Child in Need Institute

DRDA District Rural Development Authority

HDI Human Development Index

HHW Honorary Health Workers

ICDS Integrated Child Development Scheme

JSY Janani Suraksha Yojana

KMC Kolkata Municipal Corporation

MCH Maternal and Child Health


mailto:[email protected]

mailto:[email protected]

MIS Management Information System

NRC Nutrition Rehabilitation Centre

NRHM National Rural Health Mission

NREP Nutrition Rehabilitation Education Programme

Nutrimix A low cost ready to cook supplementary food containing cereal pulse mixture fortified with iron and iodine developed and manufactured by CINI

PNC Post Natal Care

SAM Severe Acute Malnourished

SHG Self Help Group

ULB Urban Local Body

VHND Village Health & Nutrition Day


SECTION 2: SUMMARY, PROGRESS AND RESULTS (Up to 6 pages)2.1 PROJECT SUMMARY (max 12 lines)

a. In your own words please describe your project, its context, who has benefitted from it and how and what overall change has been achieved.

The project was a community based development intervention which aimed to increase knowledge and awareness of 45,509 targeted population of vulnerable women and children leading to their appropriate health and nutrition practices at the household level. The project also reached out the indirect beneficiaries such as extended family members, club members, local Self Help Groups, and other community representatives to play facilitators’ role for promoting health and nutrition initiatives in the community. The project empowered communities and advocated with government service delivery systems to ensure that the mandated health and nutrition entitlements reach the population. The project was operational from December 2012 to March 2016 in nine wards of Borough VII of Kolkata and 15 Gram Panchayats in Goalpokhar I block of North Dinajpur district.

The project intervened in the first 1000 days of life to improve coverage of ANC, PNC, Institutional delivery, JSY and routine immunization and infant and young child feeding practices. Community events like Annaprashan (first rice ceremony) and Swad Bhakhan (special care during last trimester of pregnancy) and initiatives like Nutrition Rehabilitation and Education program (NREP) and referral of severely under-weight children to government run NRC worked on improving infant feeding practices and child nutrition levels. Reaching feedback from communities to government service providers has been a unique initiative of the project to bridge the gaps between demand and service provision. The four identified good practices that have led to positive outcomes are Self Monitoring by mothers using Pictorial Calendar, Improved Post Natal Care due to incentivization with PNC kits, NREP sessions and the Beneficiary Feedback Mechanism. Some of the Behaviour Change Communication materials developed for this project were 1000 day pictorial calendar for use of mothers, bilingual (Bangla and Hindi) guidebook on first 1000 days care for use of field functionaries, trilingual ( Bangla, Hindi, and Urdu) pictorial leaflets for use of communities and NREP flip book for counselling session. Specifically designed MIS software aided in robust monitoring and data collection of project at all levels.

From the Baseline survey conducted in 2013 to the Final Evaluation in 2016, maternal health indicators like ANC, PNC, JSY referrals and birth attended by skilled personnel have significantly increased in both rural and urban project areas. Infant and young child feeding practices have also recorded a significant improvement in project areas. Children in the normal weight range have increased while numbers of moderate and severe underweight children have reduced significantly (Source – Project Logframe)

b. Please provide a couple of direct quotations from beneficiaries that illustrate how the project intervention has improved their lives.


Quotes from Mothers and Change Agents:

Swati Das, 23, mother of two children- “I wonder what would have happened to me and my baby if CINI didi (CA) had not intervened. Because of her help I got the benefits of the hospital and understand the importance of nutrition and ANC for pregnant mothers. I am so grateful to the CINI didi’s (CAs). I will continue to talk about the importance of ANC to all the young women in my locality”.

Sanam Khatun, 19, mother of one child - “I received nutrition support and counselling from CINI. I know the importance of post-natal care checkups and encourage my neighbours also to avail the same. I understand how important health care and nutrion is, so I now save money and visit the hospital on my own”.

Narseen Begam, 28, mother of two children - “At the NREP session conducted by the CINI didi's (CAs), I joined the other mothers in the cooking process (khichdi- mixture of rice, dal, vegetables, oil, and condiments) and learnt the cheaper and easy method of cooking nutritious meals. I followed the advices at home which improved my child's health”.

Piu Biswas, 32, Change Agent - “I helped people not to make the same mistakes, which I made by neglecting my child's and my own health. GPAF project is ending, but I believe with the knowledge I gained, I can continue supporting and sharing knowledge with people around me”.

2.2 PROGRESS SINCE THE PERIOD COVERED BY THE LAST ANNUAL REPORT

a. What are the dates of this final reporting period? April 2015-March 2016b. Please outline progress during this final period and any significant challenges (max 10 lines)


Some significant progress:

1. Community sensitization and empowerment was a core approach of the project to bring long lasting behavioural changes in the communities. Towards the end, the project has created 10 Empowered Community Watch Groups” which while being part of the same community are transferring knowledge and ensuring quality services from government, making duty bearers accountable.

2. The project built capacities of 114 SHGs, 351 CBOs and the local clubs around mother and child health. These groups are now playing the role of facilitators to support behaviour change drive in the community.

3. The project was engaged with the maternal and child health system in both rural and urban project areas to improve delivery of out-reach services. Though regular meetings and awareness programmes, existing convergent platforms like VHND and VHSNC were strengthened and streamlined. As a result, health and nutrition issues came out as a priority agenda for the local government functionaries and were addressed through the project’s activities.

4. Joint capacity building programme for CA and Government health workers was a multi-level and multilayered approach both with internal and external stake holders, which ensured quality of ICDS and Health services such as providing improved quality of supplementary food, post immunization follow-up and counselling for growth promotion, etc.

5. Advocacy was done at the state level for up-scaling the good practices of GPAF project to reach out the underserved urban population in the remaining boroughs/slums of Kolkata Municipal Corporation. As a result the government has considered the need for opening new ICDS centres in the underserved pockets, by adapting some good practices of GPAF project. This can be implemented by government after the election in 2016

Challenges:

1. Reaching out the underserved rural remote population in Goalpokher has been a major obstacle without appropriate government system and structure.

2. The achievement of institutional delivery, especially amongst Muslim communities at rural Goalphoker project location was a major impediment against the target. This is a sensitive issue in this conservative Muslim culture.

3. The government responses to the community needs on quality of health and nutrition services were not timely, despite the community voices/concerns raised as part of feedback mechanism.

4. There were local elections that changed the leadership within the community, this made relationship building difficult as the project was not an initial priority of newly elected officials.

c. Have there been any significant changes in relation to the following? Mark Y or N


i. Project design Nii. Partner(s) Niii. Context Niv. Availability of match-funding (where relevant) N

d. Provide a brief explanation of what changed and why: Not applicablen/a

2.3 RELEVANCE TO CONTEXT Please explain what you did to ensure that the project interventions continued to respond to the priorities and needs of the target population and any change in context. To what extent did your GPAF project remain relevant in the context where you are working?

At the beginning of the project a baseline survey was conducted to identify the community needs through which the important issues (quality of supplementary food, referral cased to hospital/health centre, counselling to families, receipt of JSY money etc) were identified. Intervention was designed to meet the identified needs with active engagement of existing government structures and workforce. The major initiatives taken during the project implementation are the community competency development, improved access to utilization of services and strengthening linkage with government development schemes to address the maternal and child health situation as mentioned in the outcome level indicators of logframe. The project was also designed to assess whether the project interventions continued to respond to the priority and needs of the target population through annual rapid assessments (3 assessments done at the end of each financial year). Recommendations from the assessments were incorporated in the programme design. The project team members had regular interactions with community and government stakeholders to re-verify the relevance of the project intervention to the local needs. Various tools such as Beneficiary feedback mechanism, stakeholder community meetings, focussed group discussions, local government convergence meetings helped to identify and acknowledge the relevance to the project context.

A lot of effort was given by the project team in year two to strengthen the existing convergent platforms and organise ward Sabhas in the urban locations. This process enabled to facilitate discussion and planning for improving health and nutrition services. However, the municipal elections in 2015, brought about a change in the local context due to change in political representation. The new elected representatives had their set political agenda with less priority in health and nutrition interventions. The project was re-strategized to ensure engagement of political representatives through frequent interaction on needs of health and nutrition issues for improving maternal and child health and nutrition.

2.4 EQUITY (GENDER & DIVERSITY)Did the project contribute to equity – i.e. equitable poverty reduction and the empowerment of men, women, girl and boys and relevant marginalised groups to participate in decisions that affect them at the local and national level and start to equalise their life chances? (Mark with an “X” in the appropriate box)

Yes X No To some extent:a. Please explain your response in the space below, including reference to the gender and other power relations encountered by the project,

and any socio-economic analysis undertaken:


The desired impact of the project was to address poverty reduction by generating awareness among marginalized and migrant populations in urban and rural project locations for accessing government services. Besides targeting women and under two children, the issue of equity was addressed by ensuring the participation of male and female adults & children, female and male front line workers, male community decision makers in the sensitization meetings/community based events. Project included the following activities:

1. Events (first rice ceremony, last trimester pregnancy ceremony, breast feeding and nutrition weeks) have been organised in all project locations, inviting people irrespective of caste and religion for creating mass awareness on improving maternal and child health and nutrition in coordination with the government functionaries with active involvement of community members and CBOs.

2. Mothers and other caregivers including male members of the families were sensitised on awareness of health and nutrition specific interventions and existing government flagship programs and schemes. The program reached to 39,357 (pregnant women and mothers or under 2 children), so that they can access to maternal and child health services.

3. 351 community based organisations like local clubs of Borough VII (162) and Goalpokhar block 1 (189) were trained on the government programmes/schemes and their roles to track the service compliance.

4. 114 Self help groups constituted with representatives from the same community, belonging to varied socio-economic and religious groups were engaged in promoting MCH services and 4 groups were engaged in packaging and supplying of post natal care kits to project, which ensured their livelihoods. This initiative also empowered the women on decision making to spend money for improved family care.

5. 10, 0059 female Community Members demonstrated increased knowledge of MCH and SRH issues (refer to Annex A) towards improving their own and their child’s health.

6. 529 Change Agents in Borough VII (298) and Goalpokhar 1 block (225) were trained from various socio – economic and religious background through incremental training during monthly meeting. The work of change agents was incentive-based; which was used for their education and other health purposes.

7. 5850 people of varied socio-economic and religious background participated in Ward sabha (510) and Gram sabha (5340) for discussing the issues and prepared action plans

b. What has the project done to ensure that it was designed, implemented and monitored in such a way that gender needs and issues were addressed or mainstreamed, and that it delivered and tracked improvements in the lives of women and girls? What analytical tools did you use, if any, to do this? (Please refer to the guidance referenced on page 4)


Following steps were taken to ensure that the project was designed, implemented and monitored in such a way that gender needs and issues were addressed or mainstreamed, and that it delivered and tracked improvements in the lives of women and girls:

1. The 2nd annual rapid assessment guided project staff to plan the interventions specific to gender disparities on male’s roles in child care. The club members and CBOs are mostly male members were oriented on their roles to support women during pregnancy period, ensuring health checkups, infant young child feeding, improving immunisation, and involvement in contraceptive choice.

2. It was found that the literacy level was low among the women in the target group, so special attention was given to ensure better information dissemination through pictorial based BCC materials. This process not only sensitized the women but sensitized the male members to promote antenatal, post-natal check-up, and institutional delivery at the family level.

3. Previously decision making power rested with influential male members of the community. Female community groups and female community watch groups were formed, who demanded and acquired the basic health and sanitation services for their localities from local councillors and PRI representatives. The key representatives of female community groups also participated in ward/gram sabha and they were part of the decision making on woman and child related issues.

4. The project MIS was designed to capture gender disaggregated data in line with the project interventions5. Special attention was given to the malnourished girl children during NREP sessions.6. Working papers prepared by GPAF project staff, revealed that there is no gender differential on feeding and care among young children. However,

there is clear evidence that gender components inherent in the social determinants such as extent of decision making power of a woman through life cycle which influences her own health and nutrition status as well as that of her child.

c. What steps did the grant holder and implementing partner(s) take to support the principles of equity, diversity and inclusion through: i) organisational policies and practice, including the staffing profile of the project?ii) promoting inclusion skills and competencies within the organisation?Please respond particularly with reference to gender and disability.


ChildHope UK's core values follow closely the equality principles and are integral to its approach. As a women led organisation, all projects managed by ChildHope promotes equality of opportunities by ensuring that children, women and people with disabilities are positively encouraged to be part of every component of the project. To promote accessibility we work with project partners and other stakeholders, including community leaders and the Government, to identify the most disadvantaged and raise awareness of opportunities to become involved in project activities. This includes using a range of communication channel as well as directly approaching those most in need, recognising that the most socially excluded often have self-stigma that prevents them coming forward for inclusion in such programmes. The implementing partners also has a Gender Policy and Sexual Harassment at Workplace Policy to ensure gender equity within the workplace.Staffing Profile:The Project Management team has a gender ratio of 50:50The Field Coordination team gender ratio is 50:50In Urban the project location, all supervisors are female, whereas the supervisors in the rural area have a gender ratio of 50:50 All Change Agents hired are female for better working relationships and sensitivity to the female target group. They all have diverse background and belong to different religion, caste, age group, qualification, etc.

ChildHope has also provided training to CINI staff and other project team members on Inclusive development which mainly focused on the inclusion of disabled. Staff members were also trained on child protection, participation. ChildHope also facilitated the learning exchange programmes with other partner organisations.

2.5 KEY RESULTS AND ACHIEVEMENTS FROM THE OUTSET OF THE PROJECT Please provide a heading and summary of the three most significant project results or achievements over the whole project period (up to 10 lines each). This section provides you with an opportunity to tell the story of the project’s success and what you are most proud of. Please be as specific as possible in describing the target groups; how many citizens benefited (men/women; girls/boys); and how they have benefitted. Make it clear where the results and achievements were made in coalition or partnership with other, non-project actors. Where possible please with particular reference to the objectives of the GPAF.


1. Increase in % of women attending at least 3 ANC during pregnancy and increase in % of women referred for JSY benefits

At the end of year 4, 98.4% women in urban and 82% women in rural areas attended at least 3 ANC during pregnancy against the baseline of 69% in urban and 55% in rural. 86% women in urban and 77 % women in rural have been referred for JSY benefits against the baseline of 17% in urban and 55% in rural.

Change Agents and Supervisors along with government frontline workers (ANM, ASHA, and HHW) generated awareness among the community during sensitization meetings regarding the importance of ANC check up and JSY benefits. As follow up of sensitization meetings, change agents in coordination with the frontline workers made home contacts to ensure next ANC check up and also track the dropout mothers due for ANC. They also help women in registering for JSY benefits. Moreover, the self monitoring calendar also helped in motivating the beneficiaries to access health services on a regular basis as they can keep track of their own and child’s health. The self- monitoring calendar was used for tracking compliance of services during first 1000 days of life. It is a calendar consisting of all the major milestones related to maternal and child health like ANC, PNC, Immunization, Infant and young child feeding practices etc.2. Increase in % of women receiving at least 3 PNC care after delivery

At the end of year 4, 67% women in urban and 50 % women in rural have received at least 3 PNC checkups against the baseline 10% in urban and 45% in rural

To improve the coverage of PNC check-ups within 42 days after delivery, PNC kit as an incentive was given to the woman post delivery. Demand of PNC kit was increased as community understood the necessity and utility of the kit. Continuous awareness generation on the importance of PNC check up by the change agents and supervisors along with government frontline workers helped a lot in motivating women to access the services.


3. Number of moderately & severely malnourished children 0-2 years have reduced after accessing NREP supplementary feeding programme

Endline Evaluation BaselineBorough VII : (Total children : 8344, M- 4422, F- 3922)Male: Normal – 73.6% (3255) , Moderate – 21.4% (946), Severe - 5% (221) Female: Normal – 88.7% (3479), Moderate – 9.7% (380), Severe – 1.6% (63)

Borough VII Male: N - 65% (3148), M-19% (920), S-16% (775)Female: N -70% (3013), M-14% (603), S-16% (689)

Goalpokhar: (Total children: 18029, M – 9465, F- 8564)Male: Normal- 57% (5395), Moderate – 32.2% (3048), Severe – 10.8% (1022)Female: Normal -77.7% (6654) , Moderate – 17.1% (1464), Severe -5.2% (445)

Goalpokhar Male: N- 54% (3502), M-34% (2205), S-12% (779) Female: N -72% (3978), M-20% (1105), S-8% (442)

With the initiative of GPAF, 12 days Nutrition Rehabilitation Education Programme (NREP) sessions were conducted jointly with government peripheral workers and community based organisations for the mothers/caregivers of malnourished children on feeding demonstration, care and personal hygiene. The NREP sessions were also conducted in the non ICDS areas by supervisors and change agents with the initiative of community. These children were followed up for a period of 18 days through home contacts to track behavioural practice at home. Children who were not gaining weight within 2-3 months were referred to government runs Nutrition Rehabilitation Centre (NRC) for institutional care. CINI introduced a roaster to track the attendance of visit to these sessions and weight monitoring. The mascot drawn by mothers is a baby and every visit will lead to drawing of one part of the body. If someone is absent one day, that part will not be drawn (for example hands) and it will be shown that the baby would not be normal. This helped in creating peer pressure and motivating the mothers to come for these sessions.

a. Please list key factors that contributed positively to your overall achievements

1. Engagement of government functionaries and local key stakeholders was there right from the project planning, implementation, and monitoring of project activities. Micro plan was prepared in each ward and Gram Panchayat with active involvement of government peripheral workers and community based groups.

2. IEC & BCC materials and feedback tools were developed based on the local context analysis and community inputs. 3. Sensitised local community based organisations were actively engaged in identifying the issues related to poor service delivery. The groups also

apprised the government key personnel to improve service delivery.4. Mothers with support of family members were involved to track the service compliance using self monitoring calendar during first 1000 of life

b. List key challenges or factors which impacted negatively on progress and how they were addressed


1. Challenge - Communities didn’t give much priority on health and nutrition issues; rather their interest was more on basic amenities and livelihood.Mitigation – Communities and families were sensitized repeatedly on the importance of health and nutrition issues and the burden of ill health on family economy. This was mainly done by Change Agents (Community Volunteers).

2. Challenge - Migrant population without proper identity card was not able to opt for JSY benefits Mitigation – Local councillors were sensitised through regular meetings with the help of local community leaders to issue a letter of identity equivalent to identity proof for opting JSY benefits

3. Challenges: Low coverage of services among the migrant populations in unregistered slums.Mitigation – NREP sessions were organised in un-served pockets in consultation with ICDS government officials. The unregistered families through CA were motivated to bring their children to areas where the government services (ANC check up and Immunization) were present.

4. Challenge: Government never made attempt to receive feedback from community to improve the service quality Mitigation – BFM as a pilot initiative was started in four wards of Borough VII to collect feedback on services from the community. BFM was used as a communication and advocacy tool to give feedback and demand services from government departments. Learning from BFM has also been shared with community members to motivate and continue the good work.

2.6 UNINTENDED (POSITIVE) OUTCOMESWere any unintended outcomes that have been observed as a result of your project implementation during the project period? Please list and explain below.

Issues such as immunisation, safe drinking water, and sanitation were not planned under GPAF project, however building knowledge around these interventions have a direct impact on maternal and child health and nutrition. These interventions were taken up with equal vigour by the project base on local needs and made an integral part of capacity building, awareness and group meetings. Additionally, the BFM pilot incorporated these indicators too in their feedback format, since these issues directly impact on the living conditions of the community.

2.7 UNINTENDED (NEGATIVE) CONSEQUENCESDid project implementation lead to any unintended negative effects during the project period? Please list and explain below.

No 2.8 PROJECT LOGFRAME

a. On the basis of your project implementation experience, do you consider there to be any key aspects of your project which have not been sufficiently captured in your project logframe (such as hard-to-measure qualitative results)? (mark box): Yes No XIf yes, please use the space below to explain.

b. Did any of the assumptions underpinning your logframe or wider ‘theory of change’ come under challenge? Please explain what happened and, broadly, the impact.


NA

2.9 RISK MANAGEMENT & MITIGATIONWith reference to the project’s risk management matrix, please use the table below to describe the main risks you faced during the project period and how you dealt with them.

Which risks materialized in the project period?

Describe briefly.

Was the risk anticipated? Yes / No / To some extent

What action did you take to address the risk?Briefly explain.

Was this action

sufficient?Yes / No / To some extent

Drop out of Change Agents from the programme (529 retained out of 600 recruited)

To some extent After regular recruitments and turnover, In year 2 a decision was taken to focus on the retention and capacity building of the remaining CA’s instead of investing a lot of time in recruiting new ones. A new position of Lead CA was created among the CA’s based on performance and additional responsibilities were given to support the field operations.

Yes

Low morale of CA due to less incentive from the project compared to government ASHA worker of NRHM programme

To some extent The incentive of Change Agents was increased from Rs 500 to Rs 600 per month. The project team lobbied with KMC for considering CA as government urban ASHA workers which can transfer learning in other communities and also help in retaining the trained workforce. It was acknowledged by a few government officials that CA had better updated knowledge and skills in comparison with other government field health workers. Government officials are reflecting on this and may take a decision after the election in June 2016.

To some extent


Involvement of urban local bodies and elected political members during convergence platform

No The project team member including CAs had regular meetings with the government officials and appraised them about the project progress. In these meetings, community members were also able to raise issues concerning them. It took a long time to get their commitment but now in a lot of communities and ward, they are happy to listen to the community members, their issue and their feedback.

To some extent

JSY, PNC services – services not reaching the community

Yes The project team had discussions in forums like ward sabha, panchayat, district and state level dissemination meetings. The process involved a lot of lobbying with the government officials to approve for joint visits of change agents and government health workers to houses in different locations, in order to identify mothers with complications and refer them to health centres. As a result of this initiative the JSY and PNC coverage was increased as can be seen by the end line survey/ evaluation figures.

To some extent

ICDS not cooperating with project staff to organised NREP session

No This was highlighted as one of the risks in the last annual report. To mitigate this, regular meetings were held with CDPO and ICDS supervisors (senior government officials), circular was issued from district headquarters to organise NREP sessions at the AWW centres where the magnitude of child was a concern.

During our field visit and interaction with 3 CDPOs, it was observed that they were keen on working on the project. All of them also recommended to continue NREP sessions.

To some extent


SECTION 3: VALUE FOR MONEY (Up to 2 pages)See introductory section on page 4 for guidance and resources on Value for Money3.1 Economy: Buying inputs of the appropriate quality at the right price. What policies and practices have been followed by the

project to ensure that funds were used to purchase inputs economically? What did the project do to drive down costs whilst maintaining the necessary standards of quality? Include references to the use of any relevant unit cost benchmarks. (DFID considers inputs to include staff, consultants, raw materials and capital to produce outputs.)

Adequate measures were followed to economize all the project related costs. All the procurements were done through a standard tendering process where a minimum of three bidders were invited and the lowest or the most reasonable bidder received the final contract. All the project staffs were highly experienced and have been working in this sector for considerable amount of time. It was also found that most of the employees have been with the organization for a long time.

The project used community infrastructure effectively. During the evaluation qualitative interviews, the club members and the Government stakeholders informed that they provided infrastructure support for some of the CINI activities. This was possible due to the good rapport established by CINI with all the stakeholders. During the interview with the Program staff, it was also reported that the organization is very prudent about out of pocket expenditures. Most of the program staff used public transport and used standard accommodation for any project related travel. CINI has been working in these areas for a very long time and thus it did not have to incur large cost in setting up the project. Many of the program staffs have been working with the organization or other projects before.

One significant achievement of the program was to achieve match funding for this project. In the current context, where DFID’s withdrawal of funding for India resulted in other donors (e.g. JOAC, GOAC, etc.) pulling out, it was very difficult to secure the necessary 25% match funding for this project. This was particularly difficult in a district such as North Dinajpur where there are limited CSR opportunities. However, ChildHope and CINI managed to raise money through various community platforms and leverage other Government funding. It managed to establish a symbiotic relationship with the state government, where they supported the government by bridging the manpower gap and the Government helped in achieve program objectives by aligning their activities to some of the program activities. Along with this, CINI contributed a large part from their own general funding reserve. The program has also been successful in motivating the community to contribute. During the discussions with club members and Self Help Groups, it was reported that the community was also contributing small amounts at individual level for improving overall maternal and child health status of the respective project locations.

3.2 Efficiency: Converting inputs to outputs through project activities. What steps have you taken during the project to ensure resources (inputs) were used efficiently to maximise the results achieved, such as numbers reached or depth of engagement? Include references to the use of any relevant cost comparisons (benchmarks) at the output level (e.g. standard training cost per trainee) and any efficiencies gained from working in collaboration with others.


The efficiency of the program was analysed by comparing the unit cost of the programme outputs with comparable national and global benchmarks or unit costs of other similar programme implemented by CINI. The analysis focused on the understanding whether the project has been an improvement in cost efficiency over time.

It was revealed in the evaluation that various steps were taken to improve the efficiency of the project in terms of cost. The managers of other projects visited the project locations during their project monitoring visits and provided technical support which reduced costs of outsourcing consultants. CINI and the Government provided space for holding meetings and workshop related to the project. IT personnel from CINI provided free/low cost services for management of the database. Project management staffs, as well as field level workers were encouraged to attend other projects training programmes on relevant issues for the development of their skills. This reduced the amount of funds the project spent on training.

Capacity building of key stakeholders and service providers.Yearly cost per program output (this data was captured from final evaluation of GPAF project, conducted KPMG, India)

S.No Output Indicator GBP per unit output2013-14 2014-15 2015-16

1 Women acquire the knowledge and skill to act as Change Agent Number of CA's trained 35.2 69.4 44.5

2

Enhanced capacity of key stakeholders and service providers (CINI staff, govt Integrated Child Development Services ICDS and National Rural Health Mission supervisors) enables quality service delivery.

Number of government health professionals trained in DFID-funded project interventions. (ICDS/ JSY social welfare schemes, proper nutrition/ feeding practices, SRH & MCH services & family planning)

8.4 1.0 .9

3Increased access to essential Ante and Post Natal Care (ANC & PNC) services for mothers and child nutrition services for 0-2 year olds

Percentage and estimated number of women receiving PNC kits 728.7 1020.3 428.0

4

Increased knowledge of and referral to the government funded Janani Suraksha Yojana (JSY) scheme for pregnant women in the target communities.

Percentage and estimated number of eligible women referred to JSY 158.2 205.5 21.0

5

Increased awareness, involvement and coordination of stakeholders in Janani Suraksha Yojana (JSY), Ante and Post Natal Care (ANC & PNC) services and Integrated Child Development Services (ICDS)

Number of Community-Based Organisations (CBOs) showing greater awareness on MCH services and related health/ social welfare schemes

41.8 137.2 7.4


3.3 Effectiveness: Project outputs achieving the desired outcome on poverty reduction.To what extent do you consider the project to have achieved the anticipated changes for beneficiaries and target groups? How well did the outputs of the project work towards the achievement of the outcome?

The expected outcome of the project was to train community based volunteers demonstrating increased knowledge for community sensitization and empowerment, to bring long lasting behavioural change among the mothers. To ensure this process the trained change agents improved the knowledge and awareness of pregnant women and young mothers on health and social welfare schemes.

Community report card was introduced which empowered the community for raising their voices to demand for and access to quality services. The government service providers were trained for better service delivery to reach out to the vulnerable population. The SHG, CBO and local clubs were trained to support families in respective communities and ensure quality service delivery by government service providers. The existing convergent platforms were strengthened and streamlined. Health and nutrition issues featured as priority agenda in these meetings.

All the above output level process led to changes at the outcome level (below), critical during the first 1000 days of life:

- Percentage/number of births attended by skilled health personnel (Baseline: R – 38%, U – 90%; Endline: R – 59%, U – 95%)- Percentage/number of women attending at least 3 antenatal care (ANC) checkups during pregnancy (Baseline: R – 55%, U – 69%; Endline: R –

82%, U – 98%)- Percentage/Number of women having completed at least 3 post-natal care (PNC) checkups within 42 days after delivery (Baseline: R – 45%, U –

10%; Endline: R – 50%, U – 67%)- Percentage/ number of children under 2 malnourished at time of baseline which reach normal weight as per WHO growth chart. (Baseline: R – M

54%, F 72%, U – M 65%, F 70%; Endline: R – M 57% F 78%; U – M 71% F 76%)- Percentage/Number of children having exclusive breast feeding up to 6 months of age (Baseline: R – 42%, U – 14%; Endline: R – 89%, U – 87%)

3.4 Have there been or do you anticipate multiplier effects from this project? Multiplier effects include leveraging additional funds, longer term or larger scale implementation or replication of approaches and results. Where additional project funds were secured, how were they used to enhance delivery? In the PCR, we are particularly interested in assessing the potential and likelihood of scale up or replication.

Government is keen to up-scale NREP and PNC kit distribution across North Dinajpur, Golpokher district after its customization, following the state government policy. There is a need to provide technical and operational management support to government at the initial stage to initiate the up-scale of these good practices of GPAF project in two districts.

GPAF Project Completion Report Template up to March 2016

SECTION 4: SUSTAINABILITY (Up to 1 page)

4.1 What have you done to ensure that project outcomes - positive changes to peoples’ lives - will be sustained beyond the lifetime of the GPAF grant?

Change Agents are an important component of the program. Change Agents will continue good maternal and child care practices at the family and community level through peer group education. In addition to this, the other stakeholders like the CBOs, local clubs and SHG groups have been empowered to demand their rights through various awareness meetings.

All the change agents of the project reported that they plan to continue with the program activities after the closure of the project as well. During the discussion they mentioned that though it would be slightly difficult to keep the women motivated but the learning from the program was immense and they would continue to perform the role of Change Agents in the community. Many women in the locality look up to them for information and they are keen on continuing with this role.

In terms of the systems and processes created under the program like NREP, Beneficiary Feedback Mechanism and Self-Monitoring Calendar, during the end line survey and evaluation about 90 percent of the Change Agents mentioned that the Government would continue to use them in their day to day learning and about 87.8 percent of the Change Agents mentioned that the community is likely to use it after the project closure. In terms of the learning and awareness created through the program, about 83 percent of the Change Agents mentioned that the community would take ownership and work towards overall improvement in maternal and child health. It was observed that Change Agents in North Dinajpur are more optimistic about the project sustainability than the Change Agents in Kolkata. This can be attributed to the difference in social networks in rural areas as compared to the urban areas. The Change Agents in Kolkata cater to a large population which is also very mobile. Further, many of these Change Agents are also engaged in other work whereas in North Dinajpur, it is a closer community and the Change Agents get more opportunities to interact with the other community members. Table below shows the perception of the Change Agents with respect to the key questions on sustainability.

Table 1: Change Agent’s opinion on Sustainability (Source: Evaluation report)

StatementsEnd line (%)

Total(N=41)

Kolkata(N=21)

North Dinajpur(N=20)

Whether planning to continue the activities under the program after it ends 100 100 100Whether the program created systems and processes for Government functionaries which will continue stay after it ends 90.2 81 100

Whether program has created systems and processes for Community which will continue after it ends 87.8 76.2 100

Whether the community will take ownership of continuing Program learnings 82.9 71.4 95

A total of seven Change Agents, out of the sample of 41 mentioned that the community will not take ownership of the project learning. Out of which, 6 reported that the community lacks the motivation to change their practice and this could only be sustained through a sustained effort to change the behaviours of the community. Out of these 7 Change Agents, 5 Change Agents are from Kolkata.

Table below depicts the distribution of the Change Agents by the reasons for which they feel that the community will not take ownership.

Statements End line (%)Total (N=7)

Community is less motivated 6External factors like lack of Government support 3The results need continuous funding 2Community leaders were not involved in the program 1

23

SECTION 5: PROJECT ACCOUNTABILITY TO STAKEHOLDERS (Up to 1 page). DFID is particularly interested in project mechanisms to enable project beneficiaries to provide feedback to project managers, and project responses to it. The purpose of beneficiary feedback is to maintain accountability to the people who the project is designed to assist or empower, and to ensure the relevance, effectiveness and sustainability of the intervention. The questions below aim to enhance understanding of the use of beneficiary feedback mechanisms within the GPAF portfolio. 5.1 Method: What feedback do you seek from primary beneficiaries, how have you collected this information and when?

The project collects feedback from beneficiaries to get information on the service delivery issues like institutional delivery, ANC and PNC check-up, PNC kit, JSY benefits, ICDS services, participation in NREP session, referral to NRC, other non project interventions like immunization and sanitation. Feedback is also collected on CAs engagement with the community and coordination with service providers. Feedback mechanism is followed to connect beneficiaries with actual services being received.

The Beneficiary Feedback Mechanism (BFM) pilot project had been rolled out under the umbrella of GPAF project, with technical assistance of World Vision UK. The goal was to provide an accessible feedback mechanism to the community so that they can raise their voices about the government service reach and its quality. Feedback was taken from the beneficiary on a regular basis during home visits by Change Agents which was further recorded in the project MIS. Community group meeting minutes were recorded regularly by staff members on a weekly basis and finally the community gave their personal feedback in the feedback boxes.

Feedback collected was consolidated and analysed, and evaluated during end of the year surveys. This was shared with stakeholders and community members during convergent meetings (ward/gram sabha) and state level meeting to rank the services of the government and make action plan for improving service delivery.

5.2 Challenge: a. What challenges did your project face in collecting feedback from its primary beneficiaries?

Community was not spontaneous to provide feedback at the initial stage since they were not used to providing feedback on government services. To overcome this challenge, continuous interactions and meetings took place with the community members to make them aware of their rights. They were informed about their entitlements of government services. As a result people started accessing services and raise their voices about the service quality and provide feedback. In a recent learning dissemination event hosted by World Vision UK, GPAF project was declared as the most successful project in accessing community feedback and government services.

Due to the problem of illiteracy, the tools of collecting feedback had to be changed a number of times to make it user friendly. At the end, pictorial feedback formats was successfully put into practise. Feedback were also collected during group meetings so as to help women who are not comfortable in writing or posting.

b. What challenges did your project face in acting upon beneficiary feedback?


The feedback was shared with government service providers and elected representatives of wards but the action to be taken was time consuming as many of the issues require change at policy level and approvals of higher authorities based outside the state, at the centre.

Political situation was a major challenge of working in the project location as there was a constant tension between political parties for power. The councillor and political party members had their own specific political agenda and were not concerned with health and nutrition issues.

5.3 Change: If you made any significant change to project design and / or delivery as a result of beneficiary feedback, please describe it here.

As a result of beneficiaries feedback some of the activities were improved:1. Changing the quality of sanitary napkin as part of the PNC kits 2. Provide variants of supplementary nutrition as part of the PNC kit and NREP session3. Regular weighing of children was a major constraint in underserved areas of ICDS due to unavailability of weighing scale. Later, this was

provided by CINI to ensure regular growth monitoring4. Drinking water and other sanitation facilities were improved significantly in Ward 56, 59 of Kolkata with the intervention of local clubs

leveraging resources from KMC (local government bodies/ council)

SECTION 6: LEARNING (Up to 2 pages)Please identify the top 5 lessons you have learnt from this project, including from things which have not gone well and innovative approaches. Be specific and clear in describing the lesson and in explaining how you applied learning to improve project delivery or wider organisational practice.


Provide each area of learning with a descriptive title and an explanation. By way of illustration, these could include: innovation – how could models tested by the project be replicated or scaled up? equity and gender – did you learn about approaches to reducing inequalities, working to challenge power dynamics; participation in decision-

making? capacity building – have you learnt how to enable civil society to address poverty or negotiate or claim their rights? What worked well? monitoring and evaluation – what have you learned about measuring results, successful tools and methods, demonstrating achievement? empowerment and accountability – what enhances these processes? How have you overcome resistance or indifference? design – did original assumptions about what would work to deliver outputs or outcomes need to be changed? How did you know? What did you

do? organisational constraints – did you encounter difficulties due to organisational culture, practice or capacity which you had to address?

Learning(Provide both a title and an

explanation)How did this lead to changes or improvements in the way you (i.e. grant holder or partner) have worked?

1.

Innovation – how could models tested by the project be replicated or scaled up?

At the commencement of the project interventions, those indicators and processes where behaviour change was most difficult were identified and intensive steps were taken to address these barriers and bring about a change. Four innovations emerged as Good Practices that not only work at the community/systemic level but are also is sustainable and easily replicable in other contexts. They are (1) Self Monitoring and Tracking by mothers leading to improved coverage of essential health and nutrition services, (2) Incentivizing Post Natal Care leading to improved awareness and coverage of PNC services, (3) Community led and managed process to manage and reduce child malnutrition and (4) Empowered Communities giving feedback to improve quality of services.

Two good practices like incentivising postnatal care and NREP session have been identified by the government for scale-up with some modifications based on the government policies.

2. Equity and gender Equity and gender differential are an undercurrent that was felt throughout every aspect of project intervention. It was visible in women’s lack of decision making power be it about the choice of having a child, or the place to deliver or about taking her malnourished child to the NRC. The annual end line assessment observed that, “there was no apparent discrimination in the feeding practices and health care of the girl child, but this was probed further and detailed


analysis was done. When it comes to nutritional status, most of the gender disaggregated data pertains to the children less than 5 years. The exact gap in the nutritional status of boys and girls under 2 years and the factors contributing to the variance, if any, was an area worthy of study further, exploration and understanding. Gender Differentials in Health and Nutrition indicators are traditionally viewed through the prism of disparate infant and young child feeding practices at the household level and incongruent health seeking behaviours for boy and girl children.

A study was conducted in order to understand the degree or extent of gender discrimination in feeding practices and health interventions for children less than 2 years and to investigate if there were any other causes that had a profound impact and bearing on the extent of malnutrition among boys and girls less than two years. The study reveled that there was hardly any discrimination between the feeding and health care practices of boy and girl children below two years. The vulnerability of children be it boy or girl in this age group to malnutrition, in households at a lower socio economic status, was compounded by the vulnerability of the mother. As long as women do not have control over resources in the family and their own reproductive choices, they will not be able to navigate their children to a state of better nutrition and health. As long as women are kept out of key decisions like when to marry, when and how many children to have and how to allocate household resources they will continue to serve as the cross bearers of the Intergenerational Cycle of Malnutrition. What is needed is a paradigm shift to integrate gender in to every single health and nutrition interventions. The woman needs to be seen as an individual in her own right and not merely a past, present or future mother.

3. Capacity building The project staff and change agents were trained initially on project indicator twice (at the beginning of the programme). But this was not adequate to uplift their knowledge and skills, as understood from their feedback to project management team. So incremental training was organised every month based on the data analysed from MIS and field observations. This resulted in improved timely delivery of the project activities as per the log frame indicators.

Regular monthly reflection and review sessions of staff members ensured that data collected for monitoring purpose were used appropriately and plans were adjusted or improvised accordingly. It also helped in learning from each other. A training on participatory learning and planning exit strategy was extremely useful as it helped the team to capture learning from the project and review its exit strategy and priorities the activities which needed more attention.

Initially, the community members were not interested in health and nutrition issues as these interventions were not the immediate supportive means to their livelihood needs. The positive


deviance mothers from community were identified and they were used for peer education.

4. Monitoring and evaluation

Earlier information was collected in loose sheets (MIS sheets) which was not great for compilation and analysis. Later, it was organized in to a booklet form at a later stage. The CAs received two rounds of training on how to fill up the formats. The new formats had provision to fill in reasons for noncompliance if any, which the CAs and Supervisors think as very relevant (as this helped in identifying the reason for which any service was not being taken). Monitoring of the urban project areas was more intense because of the presence of the project management team.

End of each year, an end line survey was conducted which helped in triangulation of the data collected by Project MIS and Staff members. It was further verified through community meetings and their feedback. The entire process has been very useful in assessing the progress made as per the logframe milestones and indicators, and also to review/ revise the targets. Most of the logframe targets were increased during annual reviews and achieved during implementation.

5. Empowerment and accountability The project empowered the community about their rights and entitlements to enable them to secure the state mandated entitlements in maternal and child health and nutrition. A mechanism was initiated to collect feedback from beneficiaries to get information on the service delivery issues like institutional delivery, ANC and PNC check-up, PNC kit, JSY benefits, ICDS services, participation in NREP session, referral to NRC, other non project interventions like immunization and sanitation. Feedback was also collected on CAs engagement with the community and coordination with service providers. Feedback mechanism was followed to connect beneficiaries with actual services being received.

The purpose of the beneficiary feedback mechanism was to provide an accessible feedback mechanism to the community so that they can raise their voices about the government service reach and its quality. Feedback was taken from the beneficiary on a regular basis, during home visit by Change Agents which was recorded in project MIS, during group meetings with community members which was recorded in group meeting formats and finally the community gives their personal feedback in the feedback boxes. Feedback collected were consolidated and analysed. This was shared with government stakeholders and community members during convergent meetings (ward/gram sabha) to rank the services of the government and make action plan for improving service delivery.

The process was very slow during the initial stage since the community were not used to provide feedback on government services due to low literacy rate and lack of rights awareness. Looking at this issue, a pictorial feedback format was introduced followed by community rights awareness meetings. Feedback was also collected during group meetings, to help women who were not


comfortable in writing or filling the feedback form. These feedback was shared with government service providers and elected representatives of wards, which again took a lot of time as most of the officials didn’t like the approach of getting community feedback. However, frequent visits in small groups (community members, CA and staff) to various departments helped them to put their voice and issues collectively and strongly. Gradually, the officials started giving time, taking feedback and gave response. Some of the officials found the feedback process very useful as they have limited time and large area to cover, which they find difficult to attend. The feedback process helped in highlighting key issues to relevant departments, as a result water and sanitation issues were solved in some of the wards. The process in the presence of CAs and empowered community members is anticipated to continue after the closure of project.

Are there any other lessons (up to 3) which you have learned that you think may be particularly useful for other partners, grant holders, the fund manager or for DFID? Please describe them and explain their wider relevance below.

1. Government line departments work vertically and mostly in silo; as a result the services do not reach vulnerable groups in remote areas. Strengthening the convergent platforms at different service delivery points can help to improve service coverage.

2. Population in the un-served pockets are mostly excluded from basic services. Advocating at municipality level to organize special health camp in coordination with other existing NGO projects can help improve coverage.

3. There is a lack of BCC materials available from the government for community sensitization in local languages. Developing pictorial material in line with existing MCP card of government for the care givers in different languages can effectively influence community practice.

4. A major problem with government programmes in urban areas is that less priority is given to family contacts during home visits by government frontline workers. By NGO Change Agents making joint visits with the frontline workers they are able to model need-based counselling.

SECTION 7: REQUIREMENTS OF GRANT ARRANGEMENT (Up to 1 page)7.1 Responses to Due Diligence Recommendations Please use the space below to comment on any actions taken during this final period in response to any Due Diligence recommendations not implemented by the time of the last report.

ChildHope has closely monitored the allocation of duties to ensure that Programme Managers, supervisors, Change Agents and other team members have sufficient resources to manage their projects effectively. This has been ensured through regular Skype/Phone calls, training programmes and project visits.

Match funding of 25% plus has been secured and spent during the final year reporting period with the support of local government, panchayat and other sources of CINI and ChildHope. Total DFID fund utilised was £159,864 which was matched by another £40,413 (25.28%). The total DFID actual expenditure for all year was £506,078 match by another £149,729 (29%)

a. Use of DFID logoClause 58 of your original Grant Arrangement commits you, unless agreed otherwise, to explicitly acknowledge DFID's support through use of DFID's UK Aid logo in all communications with the public or third parties about your project. Please outline the ways in which you have done this during the reporting period.


The DFID logo has been used on event banners, web pages, process document, video documentation and BCC awareness raising materials.

SECTION 8: EVALUATION CONCLUSIONS AND RECOMMENDATIONS (Up to 2 pages)

8.1 Please enter key conclusions / recommendations from the Independent Final Evaluation report – and the project management responses

Evaluation Conclusions/ Recommendations Your response1. 1. Extension of the program activities: Majority of the stakeholders (Government

officials, elected representatives and CBOs) categorically mentioned that for any nutritional intervention to have a significant impact, it should have duration of at least 5 years. It is therefore recommended that the GPAF program should be extended for at least 2 more years.

We do agree with the recommendation given by KPMG. The project duration should be for at least for five years to ensure its long lasting impact. However, at present no funding is available to continue this important work. DFID decision to pull funding out of India in 2013 had a huge influence on other UK donors and it now very difficult of access multiyear funding for such a genuine cause. CSR (corporate funding in India) have their own agenda and goes along with the ruling parties’ priorities – currently, it is Swach Bharat (Clean India). So most of the government and CSR funds are routed towards sanitation/clean India initiatives. However, we will be applying for the AmplifyChange fund for a phase two on accessing service delivery in the rural project location.

2. 2. Leveraging Government Programs: Alternate models of implementing few crucial components of the programme (like other funding sources) should also be explored. CINI can work on leveraging existing government schemes. There is a huge shortage of manpower in the Government as highlighted by the interviewed Government respondents. The Change Agents recruited under this programme have been able to support the Government field level health functionaries and bridge the gap created by the manpower shortage. It is recommended that a funding mechanism for continuing the program for another two years should be identified and some key elements of the programme like Change Agents, Self-monitoring calendar and beneficiary feedback mechanism be retained.

It’s a good suggestion indeed. We had a number of dialogues with the senior officials of the state government to fill the vacant positions and create new centres in the 30% of the un-served areas especially in Kolkata district. National Health Mission (NHM) recruits ASHA (accredited social health activists) locally to reach out the poor in under and un-served areas of Kolkata. CINI has submitted proposals to women and child development and health and family welfare departments, Govt. of West Bengal to bridge the operational gaps and up-scaling good practices of GPAF/BFM projects through facilitation mode.

3. 3. Greater Advocacy at state level: The CINI programme has some innovative best practices like Self-monitoring calendar, Beneficiary Feedback Mechanism, NREP which have proved to be very useful. These innovations could be taken up at a larger level through advocacy at the state level. This will help in scaling up and sustainability.

We do agree with this suggestion. We have developed process documents and good practice working papers of GPAF and BFM projects for learning dissemination, and advocacy at the state level for up-scaling off good practices.


4. 4. Holistic Approach to attract CSR fund: Funding from CSR needs to be explored to a larger extent and brand CINI needs to be marketed for enhancing fund flow and implementing similar projects in future. However, it has been our experience that Corporates and PSUs are inclined towards investing in programs where there are tangible benefits which are visible and preferably in an around operating locations. Interventions that improve maternal and child health can be implemented along with other interventions on areas such as livelihood, skill development, enterprise development where there is already some amount of community mobilization.

Some good practices of GPAF and BFM projects like self monitoring through pictorial calendar, NREP session, and community feedback mechanism have been identified and introduced in other CINI projects with funding from corporates like ITC and IT company.

5. 5. Linkage with ANMs, AWWs and ASHAs: The sustainability of the program results is highly dependent on linkages with grass root level health workers. It is important that they take ownership of the program learning. CINI should ensure there is a proper knowledge transfer to these stakeholders before exiting.

In the final year, with the approval of local government authorities the project has organised numerous capacity building session for CA and government health workers. State level learning dissemination meetings were to inspire and share good practices with senior government officials. A few learning exchange meeting were organised for all the CAs. We have also plans to disseminate the evaluation findings and project learning in both the project locations beyond the project life with our own limited resources.

6. 6. Motivating the CBOs to take ownership: One major success of the programme was the investment by the Community based organization like local clubs, and SHGs etc in few of the program activities like meetings and infrastructure support. The community should be further motivated to take up ownership of few critical activities. The CBOs/ULBs/PRIs can also play a crucial role in ensuring accountability of duty bearers in providing quality services.

With the support of staff members and CA local CBOs and clubs have prepared contextual plans to continue some activities like community meetings, events like first rice ceremony/ ceremonial function in last trimester of pregnancy, and community feedback system.

7. 7. Incentivizing post natal care: Though there has been an improvement in PNC indicator, the overall PNC coverage is low. Greater communication efforts for PNC should be put in future programs. Incentivizing PNC should be explored.

There was a significant improvement of PNC coverage from 21% (baseline) to 59% (end-line) as per evaluation report of KPMG. The whole concept of PNC kit has been appreciated by the health and family welfare department, Govt. of West Bengal. As a result of regular meetings, relationship building and learning sharing, state government officials have shown commitment to continue to supply PNC kit as an incentive by adding a few more items like haemoglobin and bilirubin kits.

8.2 Please use the space below for any further comments on the Independent Final Evaluation (IFE) report, or the IFE process.


The terms of reference was designed by ChildHope in consultation with CINI India. The process of recruiting the evaluators involved a very competitive and fair process, where proposals where invited and shortlisted. Out of approx. 35 proposals, 8 agencies were shortlisted and interviewed. Based on the score, reputation and experience of working on DFID programmes KPMG India was selected, and we are happy with their quality of work and report.


ANNEX A: OUTCOME AND OUTPUT SCORING(Up to 12 pages).

OUTCOMEA.0.1 Outcome: write in full your project outcome statement in the box belowImproved maternal health of pregnant women, lactating mothers and improved nutrition of children less than two years of age in nine municipal wards (all slum settlements) of Borough VII of Kolkata District and one block (Goalpokhar 1) of North Dinajpur District of West Bengal.A.0.2 Outcome Score: Please provide an overall outcome score (A++ to C)A+

A.0.3 Justify the score: The score is based on an aggregate of actual achievement against all outcome indicator targets in the logframe. Please explain how you determined this score.

The score is justified because the target has been achieved in most of the outcome indicators, referring to the project MIS and Endline Evaluation data. 1. Community competence development2. Improved access to utilization of government services3. Strengthening linkages with government schemes (ICDS , NHM)4. Creating a community feedback system for making the service delivery more transparent by sharing feedback with service providers (KMC, ICDS, and Urban local

bodies) to improve service delivery5. Community based management of child malnutrition and its linkage with institutional based care

It should be noted that most of the targets were revised and increased last year during annual reporting. Hence, in the current year the project have exceeded the achievements compared to the original project targets.

A.0.4 For each of the indicators: a) write the outcome indicator in full, as included in the most recently approved logframe; b) state the target and report against it; and c) provide a narrative explanation of any over or under achievement.

Indicator 1:Percentage of births attended by skilled health personnelProgress: 94.8% (6470/6825) of births attended by skilled health personnel in Borough VII against the year 3 milestone target 95% (6484/6825) 59.3% (4793/8082) of births attended by skilled health personnel in Goalpokhar 1 against the year 3 milestone target 50% (4041/8082)

Urban –The year 3 target was almost achieved. But still there were some cases were not admitted in the government hospital, due to inadequate beds. Some families had home delivery due to lack of transport facilities at night.Rural – The project has achieved the target. However, home delivery is still highly prevalent in Goalpokhar, due to distant location of PHCs and other health facilities. Most of the time women deliver at home due to unavailability of Matri jan ( the vehicle provided by government to transport pregnant women to hospital during delivery). Very large remote areas are covered by only 1-2 government vehicles. Although, during meetings with chief medical officers and other authrorities this issues were highlighted, which will


be reflected upon by higher state level authorities after the election in June 2016. `Indicator 2:Percentage of women attending at least 3 antenatal care (ANC) checkups during pregnancy

Progress: 98.4% (6716/6825) women attending at least 3 ANC during pregnancy in Borough VII against the year 3 milestone target 95% (6484/6825)82.3% (6651/8082) women attending at least 3 ANC during pregnancy in Goalpokhar 1 against the year 3 milestone target 83% (6708/8082)

Change Agents and Supervisors along with frontline government health workers (ANM, ASHA, and HHW) have generated good awareness among the community during sensitization meetings regarding the importance of ANC check up. As follow up of sensitization meetings, change agents in coordination with the frontline workers made home contacts to ensure next ANC check up and also track the dropout mothers due for ANC.Indicator 3:Percentage of women having completed at least 3 post-natal care (PNC) checkups within 42 days after delivery:

Progress: 66.8% (4559/6825) women having completed at least 3 PNC checkups within 42 days after delivery in Borough VII against year 3 milestone target 65% (4436/6825)50.2% (4057/8082) women having completed at least 3 PNC checkups within 42 days after delivery in Goalpokhar1 against year 3 milestone target 67% (5415/8082)

The target of Goalpokhar was under achieved because some mothers were hesitant to go for the 3rd and 4th PNC check-up after delivery, since there were no health complications, and poor communication in rural area discourage them to walk miles and still wait for the public transportation. However, they went for the first two PNC check ups and PNC kit as incentive played a major role in that. All delivery cases were also visited at home by Change Agent and ASHA workers.

Indicator 4: Percentage of children under 2 malnourished at time of baseline which reach normal weight as per WHO growth chart. (The nutritional status as per WHO growth chart N=normal, M=moderately underweight, S=severely underweight)

Target (Year 3) ProgressBorough VII (Total children : 8968)Male-N-71% 3356, M-16% 756, S-13 % 615Female- N-76% 3222, M-11% 466, S-13% 551

Borough VII : (Total children : 8967, M- 4728, F- 4240)Male-Normal-73.6%(3479), Moderate-21.4% (1013), Severe- 5%(236); Female- N-88.7% (3761), M- 9.7%(411) , Severe-1.6%(68)

Goalpokhar, Block 1 (Total children : 12010)Male-N-62%-3926, M-29%-1836, S-9%-570 Female- N-82%-4655, M-14%-795, S-4%-227)

Goalpokhar: (Total children: 12007, M – 6332, F- 5675)Male- Normal- 57% (3609), Moderate – 32.2%(2039) , Severe- 10.8% (684); Female- Normal -77.7%(4411) , Moderate 17.1%(969), Severe-5.2% (295)

The figures clearly shows that better income and health facilities in the urban set up has increased normal and moderate categories, at the same time decreasing the severe cases. However, due to higher incidences of poverty, illiteracy and poor health in rural areas project such as this needs to be continued for at least a 2-3 more years to see the real progress.

Indicator 5:Percentage of children having exclusive breast feeding up to 6 months of age


Progress:89.2% (7829/8968) in Borough VII against year 3 milestone target of 74%87.3% (10712/ 12010) in Goalpokhar 1 against year 3 milestone target of 85%

Government health service providers and project staff have been trained on importance of early initiation and exclusive breastfeeding. The CAs tracked mothers for ensuring exclusive breastfeeding using the self monitoring calendar. Special events like breast feeding week and community based awareness camps were organised to create awareness on necessity of exclusive breast feeding.

A.0.5 Disaggregate the number of citizens benefitting from this outcome. Describe briefly who they were and how they benefitted. Adult = 18 years and above; Child = below 18 years.

AdultMale

Adult Female

Child Male

ChildFemale

Total How many of the total given are people with disabilities (if known)?

Brief description (e.g. farmers)

Change/improvement(e.g. income increased)The following statements have been made referring to the above data (A 0.4)

N.A. U – 6470R - 4793

N.A. N.A. 11,263 1 women

The beneficiaries are Hindu, Muslims, Schedule Caste, Schedule Tribe and migrant population from neighbouring states. (U- urban, R – Rural)

Institutional DeliveryThey are aware of the maternal health services & importance of institutional delivery.

N.A. U – 6715R - 6651

N.A. N.A. 13,366 N.A. ANC Check upThe women attended 3 ANC check-ups. As a result better health care was ensured before and after delivery

N.A. U - 4559R - 4057

N.A. N.A. 8,616 N.A. PNC Check upThe women attended3 PNC check-ups & post delivery complications were minimized

N.A. N.A. U – 4728R - 6332

U – 4240R - 5675

20,975 1 male child

Children 0-2 years

Nutritional status of childrenThere was a significant improvement in nutritional status of children in urban areas, however in Goalpokhar there was a slight increase in malnutrition of children.

N.A. N.A. U- 4134R - 5656

U- 3695R - 5056

18,541 N.A. Exclusive Breast FeedingThere was significant improvement in breast feeding practices in both the project locations.

A.0.6 State the evidence used to measure the progress described and comment on its strength. Please refer to the preceding guidance on Annex A on how to complete the section effectively.

Achievement are sourced from end line survey and evaluation of the project & calculated on the basis of Project MIS. The end line survey and evaluation was done by Independent external agency KPMG-India who are known for their credibility and have many such relevant experience of working on DFID projects.

OUTPUT 1


A.1.1 Output 1 Write in fullWomen acquire the knowledge and skills to act as volunteer Change Agents (CAs) and promote essential MCH services and increase MCH awareness among community members.A.1.2 Output 1 score (A++ to C)A +

A.1.3 Justify the score: The score is based on an aggregate of actual achievement against output indicator milestones in the logframe. Please explain how you determined this score.

Most of the target set for year three has been achieved and some exceeded.

A.1.4 For each of the indicators (add extra rows if required):a) write the indicator in full, as included in the most recently approved logframeb) state the target and report against it; and c) provide a narrative explanation of any over or under achievement.

Indicator 1.1: Number of trained CA’s demonstrating increased knowledge of MCH and SRH issues

Progress: 298 CA demonstrating increased knowledge of MCH and SRH issues in Borough 7 against year 3 milestone target 375225 CA demonstrating increased knowledge of MCH and SRH issues in Goalpokhar 1 against year 3 milestone target 275

Trained CA’s demonstrating increased knowledge of MCH and SRH issues (Source - Final Evaluation)Total% Urban % Rural %

4 ANC before delivery 80.5% 90.5% 100 % 100 IFA during pregnancy 73.2% 95.2% 50% Two TT during pregnancy 100% 100% 100% JSY provide cash after delivery 90.2% 81% 100% PNC 4th checkup at 42 days 100% 100% 100%Exclusive Breast Feeding 92.7% 95.2% 90.0%Average 89.43% 93.65% 96%

89.43% of Change Agents demonstrated increased knowledge of MCH and SRH issues.

The knowledge and skills are been strengthened of existing change agents (adolescent girls and women) through incremental learning during monthly meetings. The trained change agents sensitize and educate the mothers during sensitization camps and home visits. They also track the mothers who are defaulters and ensure compliance of services. The project created a new role of Lead Change Agents whose responsibility was to provide hand holding support to the weak and newly appointed CAs. A number of CAs left the project after being trained due to very lower incentive, household activities or getting better job opportunities. Decision was taken in year three


to not invest time in filling the vacant positions, instead motivate and build the capacity of existing CAs. Therefore, those CAs who were more proactive and educated than others, were given the new role of Lead CAs which proved to be successful. CAs were the backbone of the project and the most important resource for sustainability as they belong to the same community where the project was implemented.

Indicator 1.2: Percentage of female community members demonstrating increased knowledge of at least 3 key SRH and/or MCH issues (eg. proper hygiene, nutrition & feeding practices) as a result of peer education by CAs & Nutrition Rehabilitation Education Programme (NREP).

Progress: 77.4% (5282) female Community Members demonstrating increased knowledge of MCH and SRH issues in Borough VII against year 3 milestone target 65% (4436)75.7% (6118) female Community Members demonstrating increased knowledge of MCH and SRH issues in Goalpokhar 1 against year 3 milestone target 60% (4849)

1155 female community members (U- 578, R – 577) were assessed during the endline evaluation to understand whether they are demonstrating increased knowledge. The following table gives the % of women who have received the services (6 chosen indicators) of MCH and SRH, measured as demonstrating knowledge:

Female Community Members demonstrating increased knowledge of MCH and SRH issuesTotal % Urban % Rural %

4 ANC 90.4% 98.4% 82.3% 100 IFA during pregnancy 94.8% 92.6% 96.4%Two TT during pregnancy 98.7% 98.8% 98.6%Received money from JSY after delivery 28.5% 21% 37%Received four PNC checkups within 42 days 58.9% 66.8% 50.2%Exclusive Breast Feeding 88.2% 87.3 % 89.3%Average 76.6% 77.4% 75.7%

A.1.5 Disaggregate the number of citizens engaged with this output. Describe briefly who they were and how they were engaged. Adult = 18 years and above; Child = below 18 years.

Adult Male

Adult Female

Child Male

ChildFemale Total

How many of the total given are people with disabilities (if known)?

Brief description Nature of engagement

N.A.U- 225R - 298

N.A. N.A.

523

N.A. CAs are adolescents young girls and married women. They belong to the same communities.

CA demonstrating knowledge Change agents are incentive based local volunteers who are engaged in counselling and generating awareness amongst community members in their respective areas.


N.A.

U-5282R - 6118

N.A. N.A.

11400

N.A. The beneficiaries are Hindu, Muslims, ST, SC and migrant population from neighbouring states.

Female community members demonstrating knowledgeSensitized community members demand for services and practice good behaviour related to health and nutrition.



Output 2A.2.1 Output 2 Write in full:Enhanced capacity of key stakeholders and service providers (CINI staff, government Integrated Child Development Services ICDS and National Rural Health Mission supervisors) enables quality service delivery.A.2.2 Output 2 score (A++ to C)A +


The target was achieved and exceeded. Active engagement with government service providers and participation of communities has been a key factor.

A.2.4 For each of the indicators (add extra rows if required):a) write the indicator in full, as included in the most recently approved logframe; b) state the target and report against it; and c) provide a narrative explanation of any over or under achievement.

Indicator 2.1: Number of government health professionals trained in DFID-funded project interventions (ICDS/ JSY social welfare schemes, proper nutrition/ feeding practices, SRH & MCH services & family planning)

Progress:386 government health professionals trained in DFID-funded project interventions in Borough VII against milestone 3 target 300 1419 government health professionals trained in DFID-funded project interventions in Goalpokhar I against milestone 3 target 1019

Structural and refresher training was organised for government health professionals through different government convergent meetings. The government health functionaries (medical officers, honorary health workers, Anganwadi workers, ASHA) of ICDS and NRHM program at the district, Block and Borough have been trained on project interventions, especially on government schemes and policies. The orientation enabled them to improve service delivery in the outreach pockets based on the operational gaps identified.


Indicator 2.2:Number of community feedback report cards showing improved quantity and quality of services provided by the Government health providers(focussing on JSY and ANC/ PNC check-ups)

Progress: 9 Report cards were prepared in Borough VII against milestone 3 target of 10. This was facilitated in 17 Ward Sabhas (urban parliament)12 Report cards were prepared in Goalpokhar 1 against milestone 3 target of 10. This was facilitated in 178 Sansad level meetings.

The existing convergent platforms in urban locations were strengthened. The representatives from KMC, ICDS, Urban local bodies, elected councillors of each ward were engaged in reviewing the feedback given by community members on government services. Ward wise action plan was made in presence of community members and followed up in the following meetings. The information was incorporated in the community report card to assess the progress against the plan.

In Goalpokhar, the community members and government service providers were oriented on the process and purpose of Community report card and the importance of Gram Sabha (village parliament). Feedback was collected from 178 sansads of14 panchayat. The information was shared during gram sabha which enabled them to prepare the VHSNC plan with optimal utilization of the available fund.

Indicator 2.3: Number of CINI staff (direct project staff) trained in a range of development approaches by ChildHope UK

Target: 30 CINI staff trained in Child and Young Peoples Safeguarding (Protection, Participation, etc); finance management.Progress: 30 project and organisation staff trained on Child and Young Child Participation (CYPP) and Safeguarding, finance management, Participatory learning, etc. Progress: In 2014, 30 staff were trained on finance management, child protection and young people’s participation meeting project target. However, in the final year in 2015, same number of staff were trained on participatory learning approaches, exchange of best practices and finalising the exit plan. In addition to this, 4 staff members were also part of ChildHope Global partners learning exchange and networking workshops in 2014 and 2015. A.2.5 Disaggregate the number of citizens engaged with this output. Describe briefly who they were and how they were engaged. Adult = 18 years and

above; Child = below 18 years. Adult Male Adult

FemaleChild Male

ChildFemale

Total How many of the total given are people with disabilities (if known)?


U - 8R - 12

U – 378

R –1407

N.A N.A 1805 N.A They are all government health functionaries AWW, ASHA, ANM, Medical officer, ICDS and health supervisors and CDPOs.

Government functionaries trained

These trained government officials ensured service convergence at village health nutrition day/ and supply chain management. They reviewed the progress of the project during monthly review meetings and ensured micro-plan at the outreach


pockets.U – 303R - 1246

U- 189R- 712

N.A N.A 2450 N.A Government service providers, Urban local body representatives, elected councillor and political party representatives, local club members, gram Panchayat member, community representatives, self help group members, influential local representatives

Community Report Card

These members are actively involved in identifying the service delivery gaps and outreach coverage. They make action plans based on the identified gaps and follow-up on the actions required in the subsequent meetings.

08 22 N.A N.A 30 N.A Programme Management and Field Management team

CINI staff trained by ChildHope



Output 3A.3.1 Output 3 Write in full Increased access to essential Ante and Post Natal Care (ANC & PNC) services for mothers and child nutrition services for 0-2 year olds

A.3.2 Output 3 score (A++ to C)A


Most of the target set for year three in the logframe has been achieved and some exceeded.


Indicator 3.1: Percentage of pregnant women aware of the need for antenatal care (ANC) check-upsProgress: 99.7% (6804/6825) pregnant women aware of the need for antenatal care (ANC) check-ups in Borough VII against year 3 milestone target 100% (6825/6825)98.1% (7928/8082) pregnant women aware of the need for antenatal care (ANC) check-ups in Goalpokhar 1 against year 3 milestone target 96% (7760/8082)


Change Agents jointly with government health field workers organised awareness camps on early registration and antenatal care among community members followed by home visits. Along with this, several community meetings and individual household interaction took place to raise the awareness. Indicator 3.2:Percentage of pregnant women aware of the need for Post Natal Care (PNC) check-upsProgress: 96.2% (6566/6825) pregnant women aware of the need for Post Natal Care (PNC) check-ups in Borough VII against year 2 milestone target 93% (6347/6825)86.8% (7015/8082) pregnant women aware of the need for Post Natal Care (PNC) check-ups in Goalpokhar 1 against year 2 milestone target 87% (7031/8082)

PNC awareness has improved after repeated awareness sessions by CAs on the need of PNC post delivery with the community members. Indicator 3.3: Number of moderately & severely malnourished children 0-2 years without complications accessing NREP supplementary feeding programmeProgress: 29% {465 (F- 176, M - 289)/ 1610 (identified in field) } moderately & severely malnourished children 0-2 years without complications accessing NREP supplementary feeding programme in Borough VII against year 3 milestone target 2136 (F -1004, M – 1132)Children attending NREP : Severe 93 (F – 53, M – 40) , Mod 372 (F – 123, M – 249) – 4 disabled

37% {2232 (F – 870 , M – 1362)/ 5979 (identified in field)} moderately & severely malnourished children 0-2 years without complications accessing NREP supplementary feeding programme in Goalpokhar I against year 3 milestone target 1296 (F – 660, M – 636)Children attending NREP: Severe - 416 (F-237, M-179), M 1815 (F- 632, M – 1183)

The target achieved are based on the malnourished cases identified. The participation in rural location was higher as most of the women were housewife or agricultural labour who spared time for 12 days. In urban areas the participation was lower as it was difficult for women to leave work for 12 continous days. They were made aware of government services such as ICDS with the help of CA and local clubs, and were accessing these services.

NREP sessions were conducted in all the locations during the reporting period - 77 U, 192 R. Later on, children were enrolled in government ICDS centers for supplementary nutrition. The children were screened by change agents using WHO growth chart and were referred to NREP sessions those who are moderately and severely malnourished without medical complications for special nutrition supplementation and care for 12 days. The weight of those children were taken before the NREP session started and further weight taken to see the improvement of nutritional status of children on the last day. These children were followed up for 18 days by the change agents during home visits to see the mothers practice on child care learned from NREP sessions. The impact of NREP session for reduction of child malnutrition were as follows:

Urban RuralSeverely underweight to moderately underweight

Moderately underweight to normal weight

Remarks Severely underweight to moderately underweight

Moderately underweight to normal weight

Remarks

25 out of 93 (27%)465 total Children


NREP sessions were repeated in high burden wards



NREP sessions were repeated in high burden wards

Indicator 3.4:Number of severely/ acutely malnourished children 0-2 years with complications referred to govt-run Nutrition Rehabilitation Centres (NRCs) for therapeutic food, medicine & food for mother:


Progress: 7 (F – 6, M – 1) out of 38 children identified severe/ acute malnourished children 0-2 years with complications referred to govt-run Nutrition Rehabilitation Centres (NRCs) for therapeutic food, medicine & food for mother in Borough VII against year 3 milestone target 405 (F – 215, M – 190)283 (F – 151, M – 132) out of 298 children identified severe/ acute malnourished children 0-2 years with complications referred to govt-run Nutrition Rehabilitation Centres (NRCs) for therapeutic food, medicine & food for mother in Goalpokhar 1 against year 3 milestone target 147 (F- 75, M – 72)

Number of severely malnourished children with medical complications referred to NRC by supervisors for inpatient treatment. The targets in Borough VII were underachieved due to the following reason: 1. Child admitted with 1 caregiver can stay in the NRC – women not willing to go as they have older children to take care of, along with their job2. Number of days (12) were too long for a woman to leave her household chores3. Only 1 NRC was available in the vicinity, but even this centre was far from the field locations4. Currently, in Urban areas due to shortage of bed, NRC were not admitting children immediately, they are first referred to hospital doctor and then shifted to NRC, thereby

lengthening the whole treatment timeIndicator 3.5:Percentage of women receiving PNC kitsProgress: 64.2% (4381/6825) of women receiving PNC kits in Borough VII against year 3 milestone target 49% (3345/6825)94.0% (7597/8082) of women receiving PNC kits in Goalpokhar 1 against year 2 milestone target 73% (5900/8082)To improve the coverage of 4 PNC check-ups within 42 days after delivery, PNC kit as an incentive was given by the project to the woman post-delivery. Demand of PNC kit has increased as community understands the necessity and utility of the kit. PNC kit was prepared by the project resources with some input (IFA tablets) from government. A.3.5 Disaggregate the number of citizens engaged with this output. Describe briefly who they were and how they were engaged. Adult = 18 years and above;

Child = below 18 years.

Adult Male

Adult Female

Child Male

ChildFemale Total



N.A. U- 6804R - 7928 N.A. N.A. 14732 N.A

The mothers are from marginalized population and minority groups.

Awareness on ANCThey attended meeting on importance of 4 ANC checkups. They are aware about their entitlements of government services.

N.A. U – 6566R - 7015 N.A. N.A. 13581 N.A

The mothers are from marginalized population and minority groups.

Awareness on PNCThey attended meeting on importance of 4 PNC checkups. They demand for PNC checkups from government health functionaries.

N.A. N.A. U – 289R - 1362

U – 176R - 869 2697 4

They are under 2 children of poor family and marginalized family

Children attended NREPThe mothers have participated in NREP sessions, spent time and showed interest to learn about care of malnourished


children. They shared their positive experience with neighbours.

N.A. N.A. U – 1R- 132

U – 6R - 151

290N.A

They are under 2 children screed through MUAC tape and referred to NRC

Children referred to NRCThey stayed at NRC as per guideline of government of India. The mothers actively engaged in care and stimulation of their children. They learned how to prepare low cost nutritious food for feeding children during and after illness.

N.A. U- 4381R- 7597 N.A. N.A. 11978 N.A

They are the Post Natal mothers, belongs to below poverty level.

PNC kit deliveredThey attended 4 PNC checkups to get the PNC kit as an incentive.



Output 4A.4.1 Output 4 Write in full Increased knowledge of and access to the government funded Janani Suraksha Yojana (JSY) scheme for pregnant women in the target communities.

A.4.2 Output 4 score (A++ to C)A +


The target against the logframe milestones has been achieved. Mothers were made aware of Janani Suraksha Yojana scheme and its benefits through community sensitisation meetings and change agents referred each eligible mother to sub-centre/health centre for the registration of JSY. The change agents ensured 4 ANC checkups, institutional delivery so that they get this benefit. However, in spite of good awareness and follow up, some mothers who migrated from other states, belonged to unregistered slum pockets and faced problem to get this benefit, since they do not have bank accounts as it is mandatory of government for cash transfer. To open a bank account they were unable to present local residential proof.



Indicator 4.1: Percentage of eligible women (giving birth and receiving PNC in government facilities) knowledgeable about JSY scheme - aware of the location and criteria for accessing JSY facilities

Progress: 92.6% (6320/6825) eligible women (giving birth and receiving PNC in government facilities) knowledgeable about JSY scheme in Borough VII against year 3 milestone target 78% (5324/6825)90%(7274/8082) eligible women (giving birth and receiving PNC in government facilities) knowledgeable about JSY scheme in Goalpokhar against year 3 milestone target 72% (5819/8082)Staff and CAs had to put in lot of efforts to sensitise the community on JSY scheme. The oriented club members, the panchayat and ward councillors also supported change agents to organise awareness camps

Indicator 4.2:Percentage of eligible women referred to JSYProgress: 86.3% (5890/6825) of eligible women referred to JSY in Borough VII against year 3 milestone target 55 % (3754/6825)77.3% (6247/8082) of eligible women referred to JSY in Goalpokhar 1 against year 3 milestone target 65% (5254/8082)

Change agent and ASHA jointly followed up cases and ensured referral of mothers for JSY enrolment A.4.5 Disaggregate the number of citizens engaged with this output. Describe briefly who they were and how they were engaged. Adult = 18 years and above;

Child = below 18 years.

Adult Male

Adult Female

Child Male

ChildFemale Total



N.A. U- 6320R- 7274 N.A. N.A. 13,594

The mothers who attended meeting on JSY scheme, marginalized population and minority

N.A. U- 5890R - 6247 N.A. N.A. 12,137 The mothers are from marginalized population and minority

A.4.6 State the evidence used to measure the progress described and comment on its strength Please refer to the preceding guidance on how to complete the section effectively.


Output 5A.5.1 Output Write in full


Increased awareness, involvement and coordination of stakeholders in Janani Suraksha Yojana (JSY), Ante and Post Natal Care (ANC & PNC) services and Integrated Child Development Services (ICDS)A.5.2 Output 5 score (A++ to C)A ++


The club members were sensitized frequently on their support to increasing awareness, monitoring activities. The SHG groups were actively involved to support community sensitization activities with support of change agents, most of them are part of SHGs.


Indicator 5.1: Number of Community-Based Organisations (CBOs) showing greater awareness on MCH services and related health/ social welfare schemes

Progress:U – 162 (total club) Community-Based Organisations (CBOs) showing greater awareness on MCH services and related health/ social welfare schemes in Borough VII against year 3 milestone target 300R – 189 (total clubs) Community-Based Organisations (CBOs) showing greater awareness on MCH services and related health/ social welfare schemes in Goalpokhar 1 against year 3 milestone target 100

In Goalpokhar I, In year 3 we had reached out to 189 clubs against the revised target of 100. However, only 162 CBOs actively participated and shown awareness on MCH and other health/social services. The main reason on underachievement in the urban areas was non-availability of the urban club members. In urban areas, most of the local clubs members are engaged either in full time job or in business, and it was difficult for them to find time for these activities – despite of follow up meetings. Also, some of them had other priorities and did not show any interest. Indicator 5.2:Number of sensitization meetings on project interventions e.g. ANC, PNC, JSY, NREP approach, etc. organised by CINI at ward, block, district and state level with key stakeholder

Progress: State level dissemination meet - 1 meeting 247 meetings (3 district+ 244 ward level) with stakeholders organised in Borough VII against year 3 milestone target 12178 meetings with stakeholders organised in Goalpokhar 1 against year 3 milestone target of 17

All the convergent meetings, 1st, 2nd, 3rd Saturday meetings, VHSNC meetings etc. have been factored to the achieved number, as a result the target is over achieved. This was important in order to phase out and hand over some of the project activities. CAs conducted meetings in the presence of staff members (mentoring process) with government and panchayat workers.


Indicator 5.3: Number of SHGs actively involved in promoting MCH services, PNC kits and welfare schemes

Progress:17 groups of 150 member SHGs actively involved in promoting MCH services, PNC kits and welfare schemes in Borough VII against year 3 milestone target of 897 groups of 1168 members SHGs actively involved in promoting MCH services, PNC kits and welfare schemes in Goalpokhar 1 against year 3 milestone target of 5

Many change agents of GPAF projects were also the active members of existing SHGs who were engaged in sensitising the community in GPAF project interventions and sensitise the other members of SHG to support their family. Also, SHG members are mostly women and where able to connect with the issues related to MCH. Therefore, the targets were easily met and exceeded.

A.5.5 Disaggregate the number of citizens engaged with this output. Describe briefly who they were and how they were engaged. Adult = 18 years and above; Child = below 18 years.

Adult Male

Adult Female

Child Male

ChildFemale Total



U – 3633R – 2615

U- 18R- 0 N.A. N.A. 6266 N.A.

They are members of local clubs and belong to different religion, socio economic background

CBO s showing greater awarenessthey provide space for meetings and participate in community group meetings (Clubs Urban - 162 and Rural – 189)

U – 312R – 1246

U – 203R - 712 N.A. N.A. 2473 N.A.

They are state government and KMC officials (Health, ICDS, Water and Sanitation)

Sensitization programme with stakeholdersThey provide training and issue government order(Meetings Urban – 247, Rural – 178)

N.A. U – 150R- 1168 N.A. N.A.

1318

N.A.

They are the local women and belong to poor and marginalized family. They form groups which are registered so that they get minor funds for pursuing small business

SHGs actively promoting MCH awareness They are engaged in community sensitisation activity. (97 SHGs in Rural and 17 in Urban)




A.7 Methodological ToolsThe table below should be used to provide the details of the specific tools that you or your implementing partner uses to measure project indicators, particularly any bespoke tools you have developed for yourself but also details of any industry standard tools you have used. Please include sufficient information to describe the methods and to enable the reader to understand how the data was derived. There is an example of a response to this section of the report in the FAQ guidance. Add more rows if needed.

Method Purpose of Tool Summary of methodologyQuantitative method Mothers’ Interview: The objective of the interview was

to assess the knowledge, attitude and practice of the mothers with respect to maternal and child health. We also assessed the health of the last child based on the weight and MUAC. The questionnaire also focused on assessing the sustainability of the programme results based on the response given by the beneficiaries.CA Interview: The objective of the Change Agent interviews was to understand the impact of the GPAF project on their knowledge of maternal and child health issues.The questionnaire also explored the Change Agent’s perception of the sustainability of the programme

The end-line study covered 1155 households, with 578 households being covered in Borough VII and 577 households being covered in Goalpokhar 1. The process of selecting the households is as defined below:-Step 1: Purposive selection of CINI agents based on number of children in the target age group they are catering to. 138 CINI Change agents were selected from across both the project areas to ensure proportionate representation from each of the wards and gram panchayats.

Step 2: Based on the list of households received from the CINI agents, mothers per CINI agent were we randomly selected, with a child in the 6-24 months age group.


Qualitative method A qualitative interview with the key stakeholders was conducted to understand the non-tangible benefits of the program. The focus of the qualitative interviews was to understand whether the government stakeholder and community are willing to take ownership of the program results and whether they think the program has led to overall improvement of the maternal and child health conditions of the project geography.

CINI and ChildHope interview: The objective of the interview was to understand how the programme was implemented, how has the programme performed with respect to the intended results, how has CINI ensured value for money, what is the sustainability plan for the programme.The interview also explored the relationship between CINI, Childhope and DFID.

Government and community based stakeholders: This discussion focused on understanding the role of external stakeholders and how effectively CINI has leveraged this relationship. The discussion also explored their perception of the programme components and results. The discussion also explored possible ways of scaling up the program.

41 quantitative interviews were also conducted with Government and community based stakeholders covered in Borough 7 and Goalpokhar 1 project locations

CINI and ChildHope officials were interviewed


ANNEX B: CONSOLIDATED BENEFICIARY DATA (Up to 2 pages)

You will need to use the beneficiary figures for the outcome level in Annex A to arrive at a consolidated total number of people benefitting.

If the same beneficiaries are represented in more than one of the outcome indicators and have therefore benefitted in more than one way, please ensure you do not double count them when calculating the consolidated total. (See FAQs for further guidance.)

B.1 CONSOLIDATED BENEFICIARY TABLE

OVERALL TOTALGender Disaggregated DataAdult Male(18 years +)

Adult Female(18 years +)

Female (below 18 years)

Child Male(under 18 years)

Child Female (under 18 years)

i) Consolidated total number of project beneficiaries achieved in this reporting year

48,732 9375 12626 358 13887 (under 2) 12486 (under 2)

ii) Consolidated total number of project beneficiaries achieved by the project as a whole

59,661 9375 25,460 358 13887 (under 2) 12486 (under 2)

a. Please explain how you arrived at the figures given in row (ii) – beneficiaries reached by the project – with reference to the figures reported in the outcome section of Annex A.0.5

The figure has been derived from the project MIS avoiding double counting. - Adult Male numbers were not counted in the previous years as the main focus was women and children, however, in the final year a lot of work has also been done with adult male through clubs and government official, hence their numbers are included in the report. - Adult female numbers are similar as reported last year as the activities implemented were in the same communities. They have benefitted from at least one of the services, e.g. Awareness programmes, NRC, NREP, ANC, PNC and Skilled Institutional delivery. Until last year, the number was 23555, increased to 25,460 in the final year. - Children (0-2 years male & female) who were assessed in the normal and moderate nutritional status in the reporting period through rapid assessment, benefiting from the project intervention. Male child until year 3 was 10,137 which increased to 13,887 in the final year. Female child until year 3 was 9226, increased to 12486 in the final year. Severe status children numbers are not included as their nutritional status were yet to be assessed as improved.

b. Provide a clear summary description of all your outcome level beneficiaries (e.g., people living with HIV/AIDS; disabled children; soapstone workers; child labourers) and how each group benefitted.


The beneficiaries of this project come from the marginalised communities in the rural location. In urban location, most of them were migrant population coming from neighbouring states in search of livelihoods. Since, they were part of the communities where the project was implemented, all of them directly or indirectly benefited from the project activities, e.g. awareness of MCH issues, JSY scheme, BFM, etc. c. Indicate or estimate the percentage or number of disabled beneficiaries reached in the box below.

As per the MIS, there were only 4 disabled children in the project.

B.2 DATA COLLECTION AND DISAGGREGATIONa. What challenges and difficulties, if any, did the project encounter in collecting and reporting

i) exact beneficiary numbersii) disaggregated data (including particularly by disability)?

No, the data were collected by staff members and recorded/analysed in the project head office MIS. Further, the year-end survey was used to triangulate the data through the support of external expert agencies.

b. Did you disaggregate your data collection any further to better understand your beneficiaries? Examples might include extreme poor, widows, orphaned children, older men and women, ethnic groups, socio-economic status). N.A.

c. How did the collection and analysis of disaggregated data (including by gender and disability) influence project design, approach, delivery or learning?

Gender disaggregate data generated from project MIS was used to reach out to deprived women and children. During the entire project implementation, only 4 disabled children were identified. Parents of these children were referred to government hospital and linked with the existing government social welfare schemes.


ANNEX C: PORTFOLIO ANALYSIS (Up to 3 pages)

DFID captures and compare performance and results across the whole GPAF portfolio based on the information provided in project reports. Please answer each of the following questions.

C1 MILLENNIUM DEVELOPMENT GOALS (MDGs)Which of the Millennium Development Goals has your project contributed to directly? Choose up to 3

Please indicate their order of importance for the project (1/2/3):

How much does the project contribute to the selected MDGs? (sum of entries should = 100%).

MDG 1: Eradicate Extreme Hunger and PovertyMDG 2: Achieve Universal Primary EducationMDG 3: Promote Gender Equality and Empower Women 3 5%MDG 4: Reduce Child Mortality 2 45%MDG 5: Improve Maternal Health 1 50%MDG 6: Combat HIV/AIDS, Malaria and Other DiseasesMDG 7: Ensure Environmental SustainabilityMDG 8: Develop a Global Partnership for Development

C.2 METHODOLOGICAL APPROACHWhat is the main methodological approach being used by the project to bring about the changes envisaged? Please select up to three factors and prioritise them as 1, 2 and 3 (with 1 being of highest significance).

a. Rights awarenesse.g. making ‘rights holders’ more aware of their rights so that they can claim rights from ‘duty bearers’ 1

b. Advocacy e.g. advocating publicly for changes in policy and/or practice on specific targeted issues 2

c. Modellinge.g. demonstrating best practice / approaches / behaviours which can be adopted or replicated by others to bring wider improvements in policy or practice

d. Policy engagemente.g. building relationships with decision-makers behind the scenes, pragmatic collaboration on policy development to achieve incremental improvements


e. Service provision in collaboration with governmente.g. working with government to enhance the services already provided 3

f. Service provision in parallel to governmente.g. providing an alternative service

g. Monitoring of government policye.g. monitoring budget-making or enforcement of rights

If you are using other methodological approaches please note in the box below.

C.3 CAPACITY BUILDINGWhose capacity (in the main) has been built through the project? Select a maximum of 3. (Mark with an “X” in the appropriate boxes)

a. End-beneficiaries (poor and vulnerable groups) ×b. Local leaders c. Local community-based organisations ×d. Civil society organisations / networkse. Local government ×f. National governmentg. Local implementing partner(s)h. Trade unionsi. Private sector organisationsj. Other (Please name below)

C.4 ENVIRONMENTAL CHANGE AND CLIMATE CHANGE MITIGATIONa. How would you describe the project’s environmental impact? (Mark with an “X” as appropriate)

Negative Neutral × PositiveNone of the project activities impact directly on environment and climate change. The PNC kit was made from bio-degradable materials. More often public transportation was used by staff members to do the local travel, where possible Skype/phone calls was used instead of travel.


b. Describe actions the project took to reduce negative environmental impact (use bullet points)

N.A

c. Describe any activities taken by the project to build climate change resilience (use bullet points) N.A.
