Performing Evaluation for Implementers

(Grade – 15, please take into consideration my comments)

Child Health (CH) and Immunization; the case of Al-Shawkani (IDP Camp), Yemen Comment by Author: Please develop specific evaluation questions for these technical areas. I can’t tell that you are focusing on these technical areas as I read the evaluation design. For quantitative indicators, please use indicators from the KPC. These are internationally accepted. Many of the indicators that you developed have problems. Please focus the design. Don’t use broad statements. Provide details. Eliminate things that are too hard to measure. I suggest simplifying what you are trying to measure through this design.

Table of content

Table of Contents Acronyms 2 Project Background 3 Location, time and period of the project 3 Characteristics of the target population 4 Overview of Project, Goal, Objectives (Results), Technical Interventions 5 Overview of Project Implementation Timeline 5 Project Context 5 Evaluation Purpose 6 Evaluation questions 6 Qualitative questions 6 Specific Objectives (SMART Objectives) 6 Evaluation design, methods, limitations 6 Overall design 6 Quantitative 7 Methods 7 Target population for sampling 7 Geographical area to be sampled 7 Qualitative 7 Methods 7 Target population for sampling 8 Geographical area to be sampled 8 Timeline for evaluation 8 Limitation 8 Personnel needed to carry out the evaluation 8 References 12

EA- Enumeration Area

IDP- Internally Displaced Persons

CH- Child Health

GHO- Governorate Health Office

PHC- Primary Health Care

MOH - Ministry of Health

IRB - Internal Review Board

WHO – World Health Organization

BHS – Basic Health Services

NGO – Non Profit Organization

CHW – Community Health Worker

HSS - Health Systems Support

Yemen is one of the countries that are marked as poorest in the world due to the constant wars and conflicts. The constant wars and conflict has seen the country degenerate from a state of wellness to a hunger stricken country, this has forced international organizations to intervene through humanitarian assistance (Burki, 2016). The devastating effects of the state of almost four years caused a degeneration in the health state of children those under the age of five years. This group of children are a vulnerable group because any alteration in their health would have a significant in their state of health. Even though other population ground health been affected, this project is mainly concerned about recovery and reestablishment of health and associated component if health among the children of under five years (Ballouk & Dashash 2018). The group aims at restoring the state of health among children by effectively reducing the cause of children morbidity and mortality such, severe acute malnutrition, diarrhea and pneumonia, and to reinforce intensive immunization and vaccinations among children in Al-Shawkani IDP camp. The project is more directed to IDP camp since it is one if the camos that have had the worst drawbacks in terms of children’s health. Insecurity among other factors had made it troublesome to ensure that the health facilities get to the children at designed time and season. The project will commission from December 1, 2019 to June 30, 2020. With the cooperation between the IDP residents, GHO, MOH, BHS, Stakeholders, NGOs and the local health practitioners.

One of the characteristics of the target group (children >5) is that they are malnourished. Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illness such as diarrhea, pneumonia, and malaria. Nutrition-related factors contribute to about 45% of deaths in children under-5 years of age, globally (WHO 2019). Apparently, all the children in the IDP camp are malnourished and some are struggling with some of the nutritional diseases that comes along because of lack if eating a balanced diet. According to Al-Tayar et al. (2019) children in IDP camp are facing challenges with their nutritional needs. The project aims to bring a change and enhance wellness in these children otherwise the probability of losing them one after the other is very high. The other characteristics of the target group is that they are emaciated and weak. Children need a lot of food to grow and develop strong (Dyer, 2015). Thus, is because at the age of a child, the cells are usually actively dividing is that it will develop and give forth the right outcome. It is therefore obvious that most children in IDP camp do not get access to enough food that a normal child should get; their state of body agile and development is wanting. Thus, the need to continually increase supply of food and other related needs, i.e. clean water, safe hand wash practices, etc. are very crucial for to reduce the morbidity and mortality in children under five. Lastly, the target population have also been reported to be undergoing mistreatment from violent individuals. According to Johnson (2018), the disproportionate violence cases against the children have witnessed, overtime. The violence would sometimes cause injury and in worse situations death of innocent children. Thus, there is need for physical protection of the children from uncaring violent people.

The project aims in reduction and control of diseases such as the severe acute malnutrition, diarrhea and pneumonia among children under-five in the IDP camp and maintain the same trend in months and years to follow. This will be done through addressing on causes, control, & prevention of diseases such as severe acute malnutrition, diarrhea and pneumonia, and immunization of the unimmunized children to a percentage level that would likely to promote herd immunity among the children. The project also seeks to restore the health among the children especially those that are malnourished. Moreover, the project purposes to bring sanity in the overall wellbeing of children and this could only be possible if the health of other peel is well taken care of for example the mothers that take-care of the children. This project thus, it addresses some slight concerns of the adults although this is not the main reasons why the project is in the place. It is simply to help those responsible mothers for the children with an outcome to reduce cases of morbidity and mortality of children under five in the IDP camp. Some of the technical intervention would include, 1) increased amount of literature & materials to educate the mothers on causes, control, & prevention of diseases such, severe acute malnutrition, diarrhea and pneumonia that causes morbidity and mortality in Yemen. 2) Develop WASH practices in IDP camp, providing an increased access to clean drinking water, hygiene practices, and sanitation over the period of project. 3) Increased knowledge on proper feces disposal by the household members and integrate safe disposal of feces in rural communities into national policy within the 5-year project life. 4) Offering vaccines through regular immunization outreach with and without household incentives (rewards). 5) Identifying unvaccinated children through home visits and referring them to health clinics, and integrating vaccination services with other services may lead to more children being vaccinated. 6) Increased amount of literature & materials including vaccination reminder cards to parents and community members for awareness raising purposes.

The purpose of the evaluation is to determine the project input and outcomes and cross-match them with the project goals and objectives, set targets and population. Comment by Author: I don’t under stand this statement. Please revise.

· Were all the set targets met? Comment by Author: This is not a qualitative question. This is overly broad. All evaluations what to see if targets were met.

· Was there is a significance increase in the overall health of children Comment by Author: This is not a qualitative question. Also, it is too broad.

· Is there any notable change in the state of health among the children under five? Comment by Author: This is overly broad and is the same as the second question.

· What are the five key areas that the project has enhanced in the lives of the children under five? Comment by Author: Why five. Also, enhanced the lives is overly broad. This should be defined precisely, or you can’t measure it. You don’t have to include this.

· Is there any significance impact of immunization in the lives of the students? Comment by Author: I thought the target population was children <5. What do you mean by significant impact, that the children don’t die from measles.

· How well was the project team organized to achieve the given set objectives?

· Is there any significant difference in the state of health care provision before the initiation of the project and after the completion of the project? Comment by Author: This is overly broad. I don’t think you could apply a statistical test to something this broad.

· What are the key indicators of reduced morbidity and mortality rates? Comment by Author: This is not an evaluation question. The evaluation should try to find out if the intervention accomplished what is was supposed to do.

· What are the key indicators of improvement in the state of health of the children under five? Comment by Author: Same as previous comment.

1. By the end of the project, there will be a 40% reduction in morbidity and mortality rate related to malnutrition, diarrhea and pneumonia among children in the IDP camp.

2. By the end of the project, 50% of children < 5 will receive support in treatment of certain nutritional diseases in IDP camp. Comment by Author: Specify what nutritional diseases you refer to. Does the project intend to treat 50% of all children <5 regardless of their nutritional status?

3. By the end of the project, 80% of the children < 5 will receive complete immunization in IDP camp.

Evaluation design, methods, limitations

The overall design will be a structure that will be developed to produce an unbiased appraisal of the benefits of the project. The decision of this evaluation design will be dependent on the evaluation questions and effectiveness standards but also on the available resources and the degree of the needed precision. Comment by Author: You should write the design to already address these issues.

The process would include seeking assistance from GHO, IRB, MOH, BHS to help facilitate the process and drawing of maps that will aid the sampling methods. EAs will be identified by the support of BHS and GHO; each EA will be assigned a unique identifier. Each EA will have a given number of dwelling structures. Further, geographical area from where information will be collected; level of health system to be included. Also, it would be imperative to train enumerators to reduce variability in data collection (Navanti, 2019); piloting to reduce flaws in data collection exercise; testing the instruments to expose conceivable situations; include a clear work plan; have a clear supervision strategy and have systems that also oversight the supervisors.

Surveys to determine the impact of the project

Survey will act as one of the effective way to collect the information from the respondents to answer research questions on evaluation. The main aim will be to collect information from a sample of wider population. Selection of the sample through random selection of the respondents from a sampling frame, findings could be confidently generalized to the whole population in question. The surveys will be conducted in person with a whole range of standardized questions so that every respondent gives a precise reply to the same question. Comment by Author: Spelling

Questionnaires

Once the sample population is established, the questions will be administered to the respondents. Several approaches to data collection will be used to collect the answers from the sample. It will be assumed that each approach has completed advantages and disadvantages, and may be less or more appropriate based on the cost, coverage and the context of the sample population. The most appropriate questionnaires in this case will be face to face questionnaires because of the context of the sample population. Comment by Author: This paragraph does not make sense. It seems empty.

Observations

Observation will help in explaining the behaviors and also the social context since the evaluator will be seeing what is exactly happening. For example, the evaluator will observe that upon walking in the camp, there are reduced number of children emaciated. The evaluator will also be able to determine how well the set up temporary health facilities are working. Comment by Author: This is not a valid way to assess these issues. It is not well defined and extremely subjective.

The project managers and the health authorities will be consulted to determine the whiter there set target were made or not. Comment by Author: This does not make sense. This is not a valid way to find out if targets were met.

The target population will be 120 individuals across all facilities in the camp. This will be facilitated through random sampling. Comment by Author: What type of facilities, health facilities?

The area to be sampled will be the area within the camp socially those that benefited from the project on child health and immunization. This will happen at the primary level of health acre. Comment by Author: I don’t understand this sentence.

Case studies Comment by Author: What cases? Do you mean individual people, families, areas of the IDP camp?

Case studies will be used to help compare the project outcome of the project in question and others. Comparing helps to establish how well the project has worked. The process for conducting the case studies will follow the process of planning, collecting data, analyzing data, and disseminate findings for the outcome. Comment by Author: Paragraph does not make sense.

Interviews

The interviews will be conducted among individuals and in groups of individuals in the camp. These interviews specifically be meant to explore some of the complex issues that occurred during the project or any anticipated situation within the camp after the project ended. The interviews will be structured to be conducted with a loose set of questions posed in manner that is open-ended question.

Target population for sampling

The people who have had the direct impact or benefit of the project. Comment by Author: Overly broad. Please define.

The geographical area for evaluation is the area within the camp and the secondary level of care would be the most appropriate level of care. Comment by Author: I don’t understand this.

Some of the limitation in the evaluation process will be concept immaturity, the commitment/buy in from the MOH, GHO and BHS would be a challenge. The project also anticipate issues related to ensuring the IDP camp families with the study team stay engaged, involved and motivated towards the end goal. All these will act as barriers to project delivery during the key post changes.

The evaluation process will consist of three administrators, two supervisors, two statisticians and four enumerators. The supervisors will take charge of the delivery of research equipment into the various sampling points and ensure that the materials are taken back to the office (Alwabr & Al-Moayed, 2016). The administrators will handle the logistical details associated with the whole evaluation process. The statistician will act as inactive co-investigators; they will give second opinion on sample size calculation and field activities (Gallagher, 2017). Comment by Author: What research equipment are you referring to?

Worksheet/ANNEX

Technical Area1: Child Health

Technical Area 2: Immunization

Alwabr, G. M., & Al-Moayed, E. E. (2016). Prevalence of intestinal parasitic infections among school children of Al-Mahweet Governorate, Yemen. European Journal of Biological Research, 6(2), 64-73.

Ballouk, M. A. H., & Dashash, M. (2018). The gingival health status of 8–12 year-old children in Damascus city in Syria during the Syrian Crisis: a cross-sectional epidemiological oral health survey. BMC research notes, 11(1), 887.

Bilbila, O., Geda, B., & Mengistie, B. (2018). Health Care Seeking Behavior on Common Childhood Illnesses and Associated Factors among Mothers with Under Five Children in Lume District East Shoa, Central Ethiopia (Doctoral dissertation, Haramaya University).

Burki, T. (2016). Yemen's neglected health and humanitarian crisis. The Lancet, 387(10020), 734-735.

Dyer, O. (2015). Yemen’s health system buckles under Saudi led bombardment and blockade.

Gallagher, G. (2017). Yemen cholera outbreak hits 500,000 cases. Infectious Diseases in Children, 30(9), 6-6.

Geleta, S., Alemu, A., Getie, S., Mekonnen, Z., & Erko, B. (2015). Prevalence of urinary schistosomiasis and associated risk factors among Abobo Primary School children in Gambella Regional State, southwestern Ethiopia: a cross sectional study. Parasites & vectors, 8(1), 215.

Gostin, L. O., & Cathaoir, K. E. Ó. (2017). Presidential immigration policies: endangering health and well-being?. Jama, 317(16), 1617-1618.

Johnson, C. (2018). Massive malnutrition deaths among children in Yemen. Australian Medicine, 30(21), 32.

Mohamed, H., Elayah, M., & Schulpen, L. (2017). Yemen between the impact of the climate change and the ongoing Saudi-Yemen war: A real tragedy. Centre for International Development Issues, Nijmegen, The Netherlands.

Navanti (2019). Fighting for Survival in Yemen's al-Shawkani IDP Camp, Retrieved from https://www.navantigroup.com/news-1/2018/10/17/multimedia-essay-survival-in-yemens-al-shawkani-idp-camp

Qirbi, N., & Ismail, S. A. (2017). Health system functionality in a low-income country during conflict: the case of Yemen. Health policy and planning, 32(6), 911-922.

Singer, N. (2018). The Effect of Watching Violence and Armed Conflicts (War Media Coverage) on Television on the Emotional State of Children: Study on Some Refugee Families. American International Journal of Social Science.

WHO (2019), Children: reducing mortality, who is most at risk? Retrieved on Oct 2019.