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Evaluation report

2002 CEE/CIS: Anaemia Prevention and Control: Mid-Term Evaluation for UNICEF CARK Regional Office

Author: Darnton-Hill, I.

Executive summary

Background:

In 1996-1997, UNICEF CARK, in collaboration with WHO and UN University, designed Anaemia Prevention and Control Project for CARK Countries. Turkmenistan is one of the countries in which the project was implemented, starting in December 1998 in Dashoguz velayat, and in 2000 in Balkan.

The project seeks to prevent and control prevalence among fertile and pregnant women, and children between the ages of twelve months and six. Key project activities are: 1) training of medical staff; 2) distribution of iron supplements for women of fertile age and pregnant women, and children between the age of six and twelve months; and, 3) communications on dietary change and flour fortification.

Purpose/Objective:

The scope of work was to review results after five years of implementation, and 2 years into the current Master Plan of Operations of the CARK countries, and to draft recommendations on the anaemia prevention and control programme (APC), including further development and strategic planning and, finally, to propose the most likely effective interventions. Building on the limited evaluation results of pilot studies in each of the countries, the tasks included identifying achievements and constraints, including why there apparently has been so little impact, and make recommendations based on these findings, with particular attention as to UNICEF's most effective role. Implicit in these issues is the design, and especially implementation of programmes and, hence, recommendations on how implementation might be improved.

Methodology:

The methods used for this report included a review of the most relevant literature, including country and agency reports (when available in English), unpublished documents, and survey and evaluation results, including situation analyses (e.g. those done for proposals for funding). UNICEF/Government MPOs were important in assessing progress against objectives, where there was information. Extensive discussions were had with the Government counterparts of UNICEF and others, national academics, implementors and researchers, UNICEF country officers and personnel from other agencies and partners (e.g. ADB, WHO etc.). Assistant Project Officers of all countries were invaluable in their comments, even when time did not permit a visit to the country, through documentation and telephone discussions.

Findings and Conclusions:

• Need for a country-by-country analysis of local constraints on why there has been less progress, and less sustainability than might have been hoped.
• While UNICEF and other partners have critical roles to play, especially in monitoring and evaluation, staffing constraints and degree of "ownership" means that the national and local authorities must take charge and see it as priority for them also.
• The fact that the activities have not yet gone national as planned, suggests pilots may have been seen as an external input and activity. This recognition and acceptance by the country of a problem, and then the ownership by the countries of any intervention, would seem to be the main challenge.
• Commitment of national funds to support such programmes in times of often decreasing support for health and education budgets in many countries.
• Extensive work needs to be done, although it would be building on a strong foundation of IEC, conviction of good will, to move ownership of the programmes to local communities, schools, local politicians, community support groups.
• There is a need to "demedicalise" the prevention side and try to ensure it as a problem to be dealt with by health as well as schools, flour millers, the media, etc.

A major role of UNICEF and other partners is therefore to facilitate:

• country ownership and emergence of IDA or micronutrient leadership
• funding to allow this to happen, e.g. GAIN
• harmonization of standards, levels, and protocols, as appropriate, across countries
• advocacy to country counterparts in government, at both central and community level
• experience sharing including from non-CARK countries and lessons learned within CARK countries
• limited support for "critical steps" operational research (e.g. to identify constraints)

Recommendations:

1. Accurate baseline data, including on household food security and dietary consumption, are needed.
2. Fortification already has a foothold with capacity in-country, and this should be further and rapidly expanded.
3. Work should commence on a proposal to the GAIN initiative.
4. Raising demand and ensuring supply is necessary at community levels and with health professionals.
5. Use of government structures to establish high programme priority.

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