One Thing at a Time Doesn’t Work for Women

By: Sia Nowrojee, Program Director, 3D Program for Girls and Women

Photo Credit: Sia Nowrojee, September 2017, Pune District, Maharashtra State, India

“There is no thing as a single-issue struggle because we do not live single-issue lives.”                     -Audre Lorde, activist and poet

Early in my career, I worked in a women’s health clinic as a counselor, supporting clients as they made and acted on their reproductive choices. It was a good way to learn how medical and psychosocial services combine to provide an overall experience of quality of care. It was an even better way to learn about the impact of gender on the decisions that women make.

Appointments often took hours, during which the women lamented the lost time they could have used to meet their many responsibilities: child care, working, attending classes, and more. They came from a variety of backgrounds – young and old, poor and wealthy, working in the home and outside the home – and they all had to make health and life decisions rooted in complex realities.

Those women have stayed with me through my career, infusing my work in gender and development with the understanding that life is complicated and multi-layered. Choices are made, sometimes with support and information, sometimes alone, with little to go on. Often you have little control over the decisions that affect you most. One decision is impacted by – and impacts – others. Most of us know this firsthand, as we juggle work schedules with those of our partners and children, and balance personal needs with professional and financial concerns.

I was reminded of this at a numeracy training I attended, organized by the waste pickers’ cooperative SWaCH, in Pune City, India. SWaCH members, mostly women, were learning to better manage their finances. The adult educator skillfully wove together math concepts with messages about dignity and agency, reinforcing that the women, who are family breadwinners, brought seasoned math skills they could build on, despite not being formally educated. For these busy women, an afternoon training session was as much a chance to get together as it was an opportunity to learn something new. The women were well served because that educator understood that numeracy was just one component of what they needed.

This reality was echoed outside Pune City, where I met with village women leaders organized by the NGO MASUM. Engaged in the political life of their community, these women respond to domestic violence, address health concerns, advocate for better bus service so their daughters can go to school, and run savings groups, among other things. On top of this, they tend to fields, maintain impeccable homes and the village temple, and are raising daughters with aspirations and sons committed to gender equality. Doing one thing at a time, individually, doesn’t make sense – safety, health, education and economic assets are all priorities, linked to their wellbeing and survival, and that of their families.

Women often organize this way because government and development programs fail to, requiring them to make impossible choices and overcome numerous barriers to access vital services and basic entitlements. Women are busy, negotiating the world around them and the decisions they face because they are women. To better serve women, and to achieve their own objectives, government and development programs need to accommodate those realities. Through our partnerships across government, civil society and the private sector, this is what the 3D Program for Girls and Women seeks to achieve.

Accelerating evidence-based south-south collaboration to reach the extreme poor

By: Emily Coppel and Isabel Whisson, BRAC

Careful adaptation of proven programs in new contexts is key to achieving SDG 1: End poverty in all its forms everywhere

In January of 2017, five officials from the Government of Kenya, The Boma Project, and CARE International traveled to Bangladesh. Their aim? To understand how BRAC, one of the world’s largest NGOs, headquartered in Dhaka, ‘graduated’ 1.7 million of its very poorest households out of destitution into those with sustainable livelihoods. This trip was part of a larger initiative, funded by the International Fund for Agricultural Development, whereby BRAC is providing technical assistance to Kenya’s government and its two partners on how to develop and roll out more effective, targeted social protection services for its most severely marginalized citizens.

BRAC’s Graduation approach has been implemented widely in the years since Science published seminal research with evidence demonstrating its effectiveness. Evaluating the approach in eight countries, researchers found that participants increased their savings, consumption, and assets one year after the program ended. The approach itself is complex, neither a laundry list of services, nor a formulaic implementation plan, that can be stamped across various regions. As the Kenyan delegation soon came to understand, the adaptation – in both the delivery of services and the services themselves – is much more nuanced.  

What is Graduation? 

Graduation programs have several different components. First, a rigorous targeting and market analysis exercise to identify a particular vulnerable population. This process also identifies participants who exhibit the potential to undertake and expand an income-generating activity or small business. Another component is livelihood development, which can be in the form of cash or a loan for a stipulated purpose, livestock or tools of trade to start a business, linkage to employment, or any productive income-generating activity. This is accompanied by technical training to assist the participant in growing her business. Wraparound services are incorporated, and could include a combination of healthcare, food stipends, financial literacy training, financial services, and savings to provide integrated support to the participant. Mentorship or coaching throughout the program is key to supporting the participant with social assistance, life skills training and in all aspects of the program for its duration. Finally, Graduation criteria must be in place, which consist of specific indicators that illustrate the participant’s economic, social, and personal progression, for example, sending their children to school. 

Graduation Approach
Copyright BRAC/Amplifier Strategies

BRAC launched its Ultra Poor Graduation Initiative to provide technical assistance and advisory services to governments, NGOs, and multilaterals interested in designing effective Graduation programs for extremely poor and marginalized populations. This initiative fosters South-South collaboration, whereby a strong evidence-backed program in Bangladesh can serve as an approach for other regions. 

BRAC’s Initiative assists partners to develop programs that are carefully targeted and time-bound, with sequenced interventions that promote livelihoods, financial inclusion, food security, basic health, social capital, and, most importantly, self-empowerment. Together, they contribute to uplifting households from extreme poverty. Critical to the success of Graduation programming is the fine-tuned contextualization of the approach in each environment.  

Adaptations in Kenya, Lesotho, and the Philippines are underway and these partnerships are already offering insight on how to improve services for the extreme poor living in drastically different contexts. 

Livelihoods and market access: When giving cash works better 

Historically, BRAC has been a strong proponent of providing in-kind assets, like goats, cows, or goods to sell, to help women start their businesses, rather than cash. But in Kenya, early indications show a different approach could be as effective. In Bangladesh, the women served through BRAC’s Graduation programming, have limited interaction with markets. For example, if given a cash transfer to buy and re-sell a cow, a program participant would not know the market price of a healthy cow, and risks being overcharged. In Kenya, women have better understanding of markets and could navigate these challenges with less support. As a result, they may be able to effectively take on a cash transfer to launch their enterprise. For implementers, this cuts down on staff time to purchase assets on behalf of participants.  

Group vs. Individual livelihoods 

Another divergence from BRAC’s traditional design is operating group livelihoods packages in one of the Kenya pilot sites, by The Boma Project who are experienced with this approach. In the past, Bangladesh pilots, group businesses have not been successful, with some members feeling that others freeload off their hard work. But in Kenya, BOMA’s participants combine their efforts to create an enterprise, which also enables them to support one another with family and domestic responsibilities. When one member is working, another is available to assist with childcare for the group. An evaluation comparing individual with group livelihoods will generate more insight into when one approach may be more effective than the other. 

‘It may work here, but it can’t work there’ 

While skillful adaptation often means making tweaks to a model, it also requires knowing what to keep. When BRAC’s NGO partners from Kenya observed BRAC’s participatory process for identifying the most vulnerable in a community, they expected it would not work in Kenya. Because of the remoteness of the pilot sites they thought community members would not show up to participate in the exercise.  After testing it in Kenya earlier this year in January, BRAC found that community members were much more receptive and involved than the government officials had predicted. This method proved more effective and operationally efficient than those they previously used to identify the poorest members of a community.   

In Rangpur, Bangladesh, Haimanti, Anwara, and Aheja attend a final workshop for BRAC’s Targeting the Ultra Poor graduation program in which the instructor taught savings management. They will graduate from the program this December.

Achieving the SDGs will require sharing successful anti-poverty solutions, drawing on lessons learned across contexts and fostering South-South collaboration. To do this effectively, implementers and program designers will need to understand why each program component exists, what purpose it serves, and how the root causes of poverty vary across contexts. In the next several years, BRAC’s Ultra Poor Graduation Initiative team will continue to work with others to understand the elements of a successful approach, design adaptations, and, through careful iteration, ensure these Graduation programs take root and successfully grow into effective anti-poverty solutions.  

When the Evaluation Plan Doesn’t Reflect the Context

By: Aga Khan Foundation

When a partnership offers an opportunity to improve an important value chain

Aga Khan Foundation in Mozambique started the MozaCaju project with USDA funding in late 2013/early 2014, as a subcontractor to TechnoServe. The 3-year project aimed to improve the value chain for cashew production and marketing in Mozambique, providing training and support for cashew producers in growing techniques, harvest and post-harvest improvements, and connections to processing and marketing.

The evaluation plan outlined in the contract was ambitious: It called for baseline, midline and endline evaluations all conducted during the 3-year span, at the tail end of annual cashew sales campaigns. Furthermore, the evaluation design stipulated a more rigorous quasi-experimental approach, with designation of control and beneficiary groups for comparison and attribution of outcomes to project activities. Such an intensive investment in evaluation of a relatively short project was higher than what many non-US donors require in Mozambique and was new to AKF.

We accepted the donor’s plan, however, and the project got underway. Our team had good experience with farmers’ groups in the project area; the cashew project allowed us to leverage that experience with farmers to introduce techniques that would help them improve their production. It appeared to be a promising relationship for improving value chain connections. And in fact, farmer peer-to-peer adoption of the techniques introduced by the project spread faster than we expected.

Project profiling of beneficiaries took time, as did the rollout of project activities and the design of tailored trainings to target smallholder farmers, mid-sized farms, as well as larger and even commercial farm operations. Because there was no random allocation of farmers into beneficiary and non-beneficiary groups at the beginning of the project, there was no scope for a truly experimental research design. However, we were still expected to ensure that the project midline and endline evaluations were done on the basis of a beneficiary vs. control comparison, requiring us to try and ‘match’ non-beneficiaries to our beneficiary sample on characteristics such as household size, number of productive cashew trees and whether farmers sold individually or in a group.

Because our intervention targeted specific administrative posts within a district, our non-beneficiaries were identified in adjacent administrative posts where the project had not targeted its activities.

In theory, this approach could have worked. In reality, it led to problems later.

AKF across its many offices has been grappling with the challenges of Monitoring and Evaluation, creating tools across the organization for better assessment of our impact against key indicators. This case provided useful basis for examination of those tools and shared measurements.

When the donor’s research methods pose a challenge

From the start of MozaCaju, the AKF project team faced difficulties implementing the quasi-experimental methods for evaluation required by the donor. The M&E team lacked experience with this kind of survey design and the program staff and prime grantee decided to accept this design prior to AKF hiring an M&E Director and project M&E Assistant. Additionally, the project planning documents did not provide for training the project team in quasi-experimental research methods. External consultants were hired to oversee the overall project studies, while AKF was responsible for the specific farmer survey. Upon reflection, we determined that while the evaluation design may be appropriate for certain conditions, few AKF teams have the manpower, available time or capacity for implementing it or adjusting such designs in the field.

Compounding the technical challenge of the design was a communications challenge: As a sub on the project, the AKF team didn’t have a direct relationship with the donor and so we couldn’t revisit the evaluation plan directly with the donor. That discussion might have averted later problems.

As noted above, the baseline survey did not make a distinction between control or intervention groups because the survey took place before beneficiary selection. At the time when we chose control and intervention groups for the midline and endline evaluations, we began to note a few problems. First was the fact that our project targeted a high proportion of the cashew farmers in the project districts, leaving a control population that was relatively small from which to draw a sample and which contained a lot of outliers (e.g. low or high production farmers with little interest in being part of the project). This made ‘matching’ rather difficult.

But we did the fieldwork, analyzed the data and found that, in some areas, the control group that we were able to create was dramatically outperforming our beneficiaries. We took a number of steps to try and figure out why this was the case, including re-verifying some of the data in the field, but we were still left with this finding. We eventually realized that when establishing a control group, we forgot to ask non-beneficiaries two very basic questions: 1) have you received any information or training from other farmers on good agricultural practices; and 2) are there are other cashew interventions in this area?

What we found was as: a) there is a strong network between cashew farmers and a number of our beneficiaries were communicating the production techniques they had learned in our project to farmers who were not part of the project (‘contamination’ and ‘spillover’); and b) more important, another NGO was implementing a smaller project focused on some of the same interventions as us, but also on the distribution of chemical pesticides, which we were not. This project also included some of our farmers – which we didn’t realize because farmers thought they were the same project – but was heavily targeting some of the administrative posts where we weren’t working. Chemical pesticide turns out to be absolutely key to improving per tree productivity and this is what we concluded was likely explaining better results in our control group.

These two complicating factors – spillover and the existence of complementary interventions – made it extremely difficult later to isolate factors between the control and intervention groups.

As a result, the midline and endline report analysis showed the control group outperforming the intervention. The project team assessed the results and realized that survey participant selection had failed to reckon with those key contexts.

What lessons went on to inform other programming?

Lessons Learned

One lesson from this experience, in terms of M&E planning, is to recognize the capacities and limitations of your project team at the project’s outset, before accepting donor-driven evaluation procedures and designs. Where there is a relationship and a communication channel for adjusting the evaluation plan given a project’s duration or other tools available, pursue that conversation.

A second lesson is to account for the wider context of the project area or study area to determine whether a specific research design is truly feasible. Context will largely determine the extent to which a quasi-experimental design will be able to capture the project impact or whether alternative approaches would be preferable. For example, spillover effects between beneficiary and control groups can muddy the analysis by bringing into question the degree to which a true control group, isolated from project interventions, can be identified. External factors – such as overlapping and comparable government or other NGO projects in the same sector but implemented in geographies where a control sample is intended to be selected – can also make a quasi-experimental approach of questionable value. As an alternative, mixed method approaches that combine rigorous quantitative data collection among project beneficiaries with good qualitative research to understand the stories behind the numbers, may be a better approach to understanding the impact of project activities.

More broadly for an international NGO is the lesson that project teams need better tools for M&E. This lesson reinforced the need for AKF-wide standards for shared measurements, and for support to ensure teams have the capacity to measure the key indicators. AKF has been conducting a global exercise in M&E shared measurements for this purpose, developing tools for indicators at the global and country level, and standards for benchmarks.

Conclusion

Documenting program impact is important but that documentation is only as good as the methods adopted and the skills of the people doing the evaluations. The methods for monitoring and evaluation of programs must be adapted to the program environment and team capacities. Where a project starts with a donor-driven evaluation plan that is not aligned with team capacities, these must be addressed early, with some combination of: renewed discussion with the donor to adjust the evaluation tools to the project setting and context; reinforcement of team capacity for the resulting adjustment; and continued sharing of M&E measurement experience, tools and standards.

 

Photo Credit: TechnoServe/Antonio Filippi de Castro

Show me the evidence: Cultivating knowledge on governance and food security

By: Tessa Ahner-McHaffie, FHI 360

https://researchforevidence.fhi360.org/show-me-the-evidence-cultivating-knowledge-on-governance-and-food-security

I recently participated in a salon on integrating governance and food security work to enhance development outcomes. Convened by the LOCUS coalition and FHI 360, the salon gathered experts in evaluation, governance and food security to review challenges and best practices for generating evidence and knowledge. A post-salon discussion recorded with Annette Brown and Joseph Sany speaks to the gaps in evidence and the need to more accurately measure how governance principles influence food security outcomes.

I came out of the salon conversation thinking that while there was a hunger for evidence, there are still large gaps and significant differences within the literature on things as basic as definitions. That being said, I wanted to dig a bit more into what evidence was actually out there and think about what needs to be done to move this budding evidence base forward. In this post, I highlight three pieces of interesting research that contribute to the evidence base on governance and food security integration, and then propose a few suggestions on how to grow that knowledge base.

What evidence currently exists?

Numerous studies propose conceptual relationships between food security and governance, but there are a few rigorous pieces of evidence that demonstrate governance work has supported positive food security outcomes. I provide you with three examples here.

  1. Mercy Corps has an excellent report – Pathways from Peace to Resilience – that examines a natural resource management and peacebuilding program in the Mandera triangle of East Africa and a program including health and governance components in Uganda. Both programs build dispute resolution capacity and platforms with actors and institutions that are involved in conflict management within and between communities, and utilize both quantitative and qualitative methods. The study found that across study sites, strong conflict management capacities in institutions and communities contributed to greater food security for households that experienced shocks. This evaluation is excellent because it not only measures specific food security outcomes within a governance program (which is rare), but it also attempts to identify enabling factors between different programs that could facilitate the same kinds of outcomes in other governance programs.
  2. Another interesting report from the International Institute for Environment and Development showcases how farming is affected by governance and policy using case studies from Bolivia, Brazil, India, Kenya, Pakistan, Senegal, South Africa and Thailand. The case studies were undertaken to identify sustainable agricultural practices, and then to identify the policy and non-policy causes of those practices. The report argues that public policies had little involvement in many areas of success; instead local civil society and human capital proved the drivers of agricultural success in many places. In Senegal, for example, although the state has largely withdrawn from participating in local agriculture since liberalization in 1994, it has created enabling agricultural policy and legal environment for NGOs, producer organizations, and rural development institutions. This has allowed these organizations to fill the coordination and advocacy roles that the government does not provide and to support more beneficial policies for small-holder farmers.Additionally, other case studies (in Bolivia, India and Pakistan) show that building social capital through NGOs or producer organizations, or through local decentralization of natural resources management, supports the power of communities to directly advocate for their rights and interests to achieve agricultural outcomes. Policies identified through these case studies that supported improved agricultural outcomes – like improving natural resource management, improving technology, improving market access – all were achieved by strengthening farmers’ bargaining power.
  3. Finally, a study on land tenure and food security provides a framework to understand the link between governance and food security. Maxwell and Wiebe present the links between land and food as a linear relationship of resources, production, income, consumption and nutrition status. Using this as a jumping off point, they examine the land tenure literature. Among other topics, the authors present multiple sources showing a quantitative link between access to food and access to land in an agrarian economy. Using a study from Thailand, the authors show that increased tenure security leads to increased demand for land improvements from farmers and increased formal credit supply because farmers have access to collateral (land). Both effects resulted in short- and long-term investment in agriculture and production.There are also ripple effects to bad policymaking that can be felt when households experience shocks. A study in Ethiopia documents that during food crises, insecure land tenure causes people to delay moving in search of food assistance. This reluctance may have increased the death toll in Ethiopia during the 1984-1985 famine. Maxwell and Wiebe utilize this and other evidence to propose a more circular, dynamic relationship between food security and land tenure, and offer suggestions for researchers and policymakers given the dynamic relationship. This paper is valuable as it serves as a literature overview for land tenure and food security, as well as detailing conceptual relationships that can be tested and measured.

There is not enough evidence to come to any kind of conclusion on what works and, further, there does not appear to be a cohesive direction for growing evidence and knowledge. Recognizing different research cultures, different definitions for food security and governance, and the limited number of existing studies, I find it difficult to envision how this evidence base will move forward.

However, in a world where conflict is becoming more common, and governance and food security are inextricably tied up in the resilience of communities to survive both human and climatic shocks, I think we need to understand the relationship better, and understand how integrating programs can better improve outcomes in both sectors.

How do we grow the evidence base?

Considering how other multi-sector groups have built a knowledge base in their respective areas, I propose a few first steps to expand the evidence base for governance and food security.

  1. Clarify common terms and theoretical framing.As noted in the transdisciplinary toolkit for integration methods and FHI 360’s resource package for integrated development, agreeing on common terms and theoretical frameworks is one of the first steps to conducting research that is useful across disciplines. In the case of governance and food security, multiple evidence reviews have noted the diverse concepts and frameworks used throughout the literature. Narrowing that field could go a long way to directing future research.
  2. Establish what level of evidence is necessary.Much of the evidence around governance and food security is conceptual, rather than empirical. The existing empirical evidence largely lacks the rigor present within other sectors. But is that level of rigor needed or possible in this space? If there is a consensus on what is needed, then it will be easier for the community to plan for what is necessary and move the conversation forward.
  3. Develop a targeted research agenda.Big questions were asked during the LOCUS salon including, “When is governance a necessary condition, and when is it a sufficient condition?” and “What motivates farmers to get involved and engaged in local governance?” Developing key questions can focus researchers in different locations on the same topics to generate enough evidence in targeted areas to produce broader findings.
  4. Improve formative research.Improving formative research can provide a short-term win with long-term benefits. Using multi-criteria assessment, root-cause analysis, and other methods to assess food security or governance from a multi-sector perspective from the beginning will affect what outcomes are reported. By being more deliberative about what we are measuring early in the project, we can use the data from projects to better illustrate where governance is contributing to development outcomes and evaluate that more rigorously in the future.
  5. Explore non-traditional evaluation methods.Using alternative evaluation methods can also help us better understand how food security and governance are related, and where investing in governance for food security is more necessary. Methods like contribution analysis or complexity-aware monitoring can provide results that are not available through more traditional means.
  6. Form integrated teams and procedures.Engaging multi-sector stakeholders, ensuring a place for multi-sector perspectives on a team, and inserting decision points to ask about integration have been successful in other multi-sector spaces (documented here in a nutrition-sensitive agriculture program). Ensuring that there is space for those kinds of discussions could ensure that other perspectives are included in the evaluation process.

These steps can close the gaps and expand the evidence base for governance and food security. What do others think is necessary? How can we continue to move this conversation forward? What other evidence in governance and food security do you find compelling?

Photo caption: Northern Thai farmers work under the Royal Initiative Project, which promotes alternative crops in Thailand as a means to generate income.
Photo credit: © 2016 Hansa Tangmanpoowadol, Courtesy of Photoshare

Program Review: A Chance to Learn & Adapt

By Anne Guillen, Rebecca Farmer, and Jimmy Leak, Nuru International

This blog was originally posted on the USAID Learning Lab website on November 7, 2017 at https://usaidlearninglab.org/lab-notes/program-review-chance-learn-adapt.

Setting goals is a key component of project planning. When establishing a new project, it is customary to set the overarching goal and objectives for the project and then work backwards developing timelines, milestones, and indicators to track progress towards this goal. As the project begins, progress is assessed based on whether milestones are reached and mid-term assessments. Eventually, the project comes to an end and the final endline report determines if the goal of the project has been successfully achieved.

At Nuru International, an NGO with an integrated programming model working with farmers and their families in Kenya and Ethiopia, we have a different approach. While our project’s goal remains constant, the method used to achieve that goal is flexible within the timeline of the project. A systematic project design process allows us to create program models that are based on community needs, combining local and expatriate staff input. This process allows a strong starting place for programs based on research and best practices. Instead of stopping there and running stagnant programming until the end of the program or funding cycle, Nuru learns and adapts along the way.

Program Review Process

In summer 2017, Nuru’s Ethiopia project piloted a process called “Program Review” for the first time.  The Program Review concept was developed by Nuru’s senior leadership team after the collection of first year impact evaluation data for all programs. The Program Review process was developed locally to align with Nuru’s philosophy of making data-driven decisions. The Program Review process was a weeklong process where program managers from each of Nuru’s four program areas: Agriculture, Financial Inclusion, Education, and Healthcare could sit with their expatriate counterparts and Nuru’s M&E department to review monitoring and evaluation data. While it was important to see if program activities were tracking towards desired levels of impact, it was more important to have discussions about why and how activities were working (or not) and what processes and systems could be improved. Instead of walking away from the session simply saying, “Let’s work harder to accomplish our goals”, Nuru program managers were given an opportunity to adapt their future program activities based on lessons learned from the data.

Managers’  ability to change their program activities was instrumental. They used data, coupled with input from their international advisors, to inform proposals for changes and adaptations to program activities. This gave program managers a real sense of ownership, while maintaining accountability. Nuru has a mantra of “Fail Fast, Learn Fast,” and lessons are not fully learned until mistakes are corrected and changes are made moving forward.

Program Adaptations

Each of Nuru’s programs experienced successes and identified activities to continue from the data analysis phase of the process.  Additionally, each program identified areas to be improved and proposed adaptations to programming based on research and best practices.

The Agriculture program had success in getting farmers to adopt best agronomic practices, but also dealt with many environmental challenges such as drought and Fall Army Worm infestation, which caused farmers to have poor crop yields and, in turn, lower loan repayment. Nuru’s Financial Inclusion program had a high percentage of women savers weekly, but the money they saved was not enough to cope with shocks. In response to these challenges, Nuru Ethiopia’s Agriculture and Financial Inclusion staff developed a proposal to pilot working more through government for input loans, while strengthening training on best agronomic practices, and scaling up an animal husbandry pilot to help farmers diversify income during times of environmental shocks. By diversifying income streams and providing risk reserves to farmer cooperatives, Nuru can help ensure income and food security.

Nuru’s Education program saw increases in literacy rates through its interventions both in and outside of schools, but experienced challenges in the implementation of its community reading activities through volunteers. Nuru’s Education Program manager suggested piloting reading camp activities that  occurred after school and during school break times through after school tutorial sessions already being held by teachers at local schools that Nuru worked with.  The teachers would be more reliable and better trained facilitators, and the school system would help to ensure sustainability of the activity after Nuru staff are no longer there.

Nuru’s Healthcare Program showed positive results around maternal and child health indicators, with high percentages of mothers attending antenatal care visits and delivering in health centers, however these results seemed to be primarily driven by Nuru staff members. Nuru intended to cascade trainings on maternal and child health down to government health extension workers, but data and observations from the field showed that trainings presented too much information for government health extension workers to take in at one time. Nuru decided to break down and adapt its training curriculum so that there were fewer topics per training to facilitate better understanding of topics and long-term sustainability.

The changes and adaptations to Nuru’s programs are being implemented this year and will be monitored and evaluated in 2018 to determine their effectiveness.

Lessons Learned and the Future

The Program Review process was a great success that enabled Nuru Ethiopia leaders to make data-driven decisions to improve their programs and see themselves as agents of change. As with all of its initiatives, Nuru learned lessons from the Program Review Process.  One of the main takeaways was the need for more time between receiving data, developing new ideas, and making decisions. There were some challenges with data analysis delays, which shortened the timeline for developing new ideas, especially when it came to ideas for more integration between programs. Nuru staff resolved to add more time for data analysis and review, especially so more local stakeholders, such as government officials, could be involved. Nuru staff also learned that while there were many great ideas, not all were feasible, and the synthesis process could be refined to ensure only a few ideas remain. Finally, Nuru developed new processes that it could use to strengthen its regular quarterly reflections and reports on data.

Nuru’s Ethiopia Program Managers are excited to build upon successes and adapt their programs to achieve Nuru’s ultimate goal of lifting communities out of extreme poverty in a sustainable way. Managers now see how data can be used to influence programming and make decisions, not simply evaluate effectiveness.  Nuru will take these lessons as it scales to new areas and hopes to repeat this process every few years to evaluate progress and iterate past challenges.

Whose “Empowerment”?

By Meghna Ravishankar

In this Guest Post, blogger Meghna Ravishankar explores ideas on Western feminism, empowerment, and the development enterprise in a publication featured in The Riveter Magazine. Ravishankar interviews Locus members Donella Rapier, CEO of BRAC USA, and Ellie Price, Locus Coalition Coordinator,  among other voices. Challenges to measuring empowerment, supporting women’s resource ownership, and counter-productive performance pressures development partners face under current donor paradigms are discussed. Resonant with John Coonrod’s piece on The Hunger Project’s approach to addressing women’s time poverty, “Silos are Sexist,” Ravishankar writes, “The field of development is historically rooted in a system of paternalistic, patriarchal, and colonial interventions. Though the ideologies may not be the same now, there are still systemic issues with the way development agencies work and who holds the decision-making power.” 

To the latter statement, Locus could not agree more. Read on below:

IN THE INTERNATIONAL AID FIELD, “EMPOWERMENT”-DRIVEN INITIATIVES TOO OFTEN SIMPLIFY WOMEN’S EXPERIENCES THROUGH A WESTERN LENS.

By Meghna Ravishankar
Photo by Annie Spratt

Philanthropy is on trend and no longer reserved for those with robust bank accounts. Your neighborhood co-op, Whole Foods, and Target are stocked with fair trade chocolate bars made by women in rural Africa or shoes that give girls in India access to education. In the branding of many of these products or initiatives, a shiny word helps consumers say yes: empowerment.

For how often it is used, there is no clear consensus on the definition of “empowerment.” Consumers may think of it one way, but development practitioners think of it differently. Development practitioners—those working in the international development field—often have very complex, jargon-heavy definitions that further complicate an already malleable word. Additionally, the question of who gets to decide what empowerment means and who is impacted by that definition muddles the word and the intention behind it further—especially in international aid organizations.

Scholars like Monique Hennick have defined empowerment as a process that can occur at multiple levels—individual, community, organizational—and as relating to five facets: health, economic, political, natural resource, and spiritual. This broad yet specific definition was created for predominantly Western development organizations that need quantifiable results in order to receive funding and continue their work.

Dr. Cristina Espinosa, associate professor at the Heller School for Social Policy and Management in Waltham, Massachusetts, argues that empowerment is often focused on practical, short-term needs rather than strategic, long-term needs.

“People tend to equate participation with empowerment,” she says. “This raises two issues. One is: Who is participating? And the other is: Is the participation really expanding choices, capability, and autonomy, which are elements to empowerment?”

Ellie Price, coordinator of the Locus Coalition—a group that brings international aid organizations together to share resources, data, and strategies—says that empowerment “is a combination of having autonomy, agency, the freedom to make choices, and the resources to enact those choices. It is to not be bound to the will or opinion of any other being or entity.”

Gender issues are increasingly included in development initiatives around the world. After the UN Fourth World Conference on Women in 1995 in Beijing, the phenomenon of “gender mainstreaming”—the growing inclusion of the gender perspective—was adopted widely. This unanimous agreement to put gender equality at the forefront of development brought in more donors, and according to Espinosa, legitimized gender issues beyond access to economic opportunity, such as domestic violence and reproductive rights.

A recent example of gender mainstreaming is seen in the new Canadian Feminist International Assistance Policy introduced earlier this year. According to the description of the new policy, women and girls are seen as “powerful agents of change.” The Canadian government has a list of ways in which they believe women and girls can positively influence the course of our future and details of their new policy approach. Espinosa critiques these sorts of feminist policies by pushing for the reframing of the definition of gender. She argues that male fundamentalism has lead to the narrow definition of gender focusing only on women.

“We are losing the opportunity to question hegemonic masculinities and open the door for subaltern masculinities [masculine identities that lie outside the normative definitions] the same way we want to challenge stereotypes about hegemonic femininities,” she says.

Varying gender and sexual identities, religious, ethnic, and cultural identities also come into play. One of the biggest issues with policy frameworks of this kind, as reported on by journalist Rafia Zakaria for the Guardian, is that progress is measured against Western standards. Also, the benefactors of the aid are almost never involved in the organization and strategy of aid implementation.

“Decision-making around programs is largely, if not exclusively, in the hands of donor governments and grant-makers rather than recipients,” Zakaria reports. “Expat staff sometimes make 900 percent more than locals with identical jobs.”

Often, development agencies carry out “feminist” interventions without much concern for the complex web of formal and informal social norms and institutions existing in a certain place. For example, rural micro-lending programs are geared toward women with the intent to boost agency and economic opportunity. However in Bangladesh, for instance, money loaned to women by the Grameen Bank is often controlled by the men in their lives. Some initiatives promote an agenda of assimilation to the culture of the dominant group. The French burqa ban, which prohibits women from wearing burqas or headscarves in order to promote secularism, is an example of a push for assimilation.

“Measuring development progress is hard,” says Price. “We have come up with many decent indicators across sectors and have come a long way in surveying and data collection sophistication, but the fact remains that it is easier to count widgets, latrines built and number of girls vaccinated or in school than it is to measure an ethnic minority’s perceived quality of life post-intervention.”

Some organizations are beginning to seriously question how to crack open standards of measurement.

Donella Rapier is the CEO of BRAC USA, an organization that provides microloans for women farmers, maternal healthcare, and higher education  through BRAC University. Donella says that international development organizations like BRAC need to “get better at measuring empowerment itself rather than proxies for empowerment.” She gives the example of an agriculture program.

“Rather than looking at whether a female farmer produces as much as a man, we should be looking at the things that contribute to her success and how these compare to her male counterpart,” she says. “If both men and women farmers say that they have the same level of ownership over resources, then this would not be an area where we need to better support women. If our evaluations show that the women report a lower level of ownership over resources than their male counterparts, then it’s an area in which we should intervene.”

Collecting appropriate data to submit for funding purposes is a huge reason cultural intricacies aren’t gathered. Price notes the competitive nature of organization-based work. “Development organizations are held accountable to meeting these indicators and targets or risk not winning that $5 million contract again from the government, which is how they earn revenue that keeps the lights on and the staff paid,” she says. “It’s tough.”

Rapier brings up the need for long-term commitment to making a difference.

“If we truly want to make lasting social change, we need long-term, sustained programming. Many donors are focused on being catalytic over a short time, say three years, and then want to move on to another pressing issue,” Rapier says. “Few donors are interested in scaling known and proven interventions that perhaps may not be cutting edge but are critically needed for our programs.”

In Espinosa’s work, she advocates for problematizing development—questioning the established structures and practices in the development world. She thinks more inward-facing analysis is crucial to organizations’ long-term success in the communities they aid. “A lot of development organizations feel or think they are neutral, so it’s more about positioning,” she says. “And that’s uncomfortable to a lot of development professionals and institutions.”

Many government agencies use the UN’s Sustainable Development Goals (SDGs) as guiding missions for their work; however, many believe these goals themselves need to be rethought, including Espinosa. Her concern is that SDGs created the impression that development is achievable using current strategies.

This is an important critique to consider. The field of development is historically rooted in a system of paternalistic, patriarchal, and colonial interventions. Though the ideologies may not be the same now, there are still systemic issues with the way development agencies work and who holds the decision-making power. According to a 2016 article by the World Economic Forum, the three countries that gave the most money to foreign aid in 2015 were the United States, Germany, and the United Kingdom. Because Western donors mostly dominate the development field, they have a lot of influence over policy.

Espinosa thinks that messaging and practice around international aid needs to “use elements of a religion or a culture to frame the women’s rights issues or the gender justice issues in a way that is palatable or acceptable.” In the same vein that the word “feminism” has become easier for some to swallow than in past decades—and easier to consume and purchase—aid organizations are at risk of oversimplifying what empowerment means, and who it’s for.

Meghna Ravishankar is a graduate student from Bangalore, India studying Sustainable International Development at the Heller School for Social Policy and Management at Brandeis University. meghnaravishankar.com.

Locus Coalition Appoints New Coordinator

In August 2017, the Locus Coalition named Ellie Price its new Coordinator, succeeding Gregory Adams in the role of leading the coalition. Ms. Price comes from FHI 360 where she was a Program Officer on the Crisis Response and Integrated Development team. While at FHI 360, Price led the Locus Coalition’s research  to quantify the impact of legislative directives in the U.S. foreign assistance budget on integrated, multi-sectoral development programming at the country level.

Locus is a coalition of organizations that is dedicated to advancing evidence-based solutions to global development challenges that are integrated, driven by local communities and based on shared measures. Our ultimate aim is to achieve a better model of development that results in greater impact to people living in poverty. Our members believe these are key pillars of effective global development practice in the Sustainable Development Goals era that will maximize development investments and impact by 2030.

As Coalition Coordinator, Price is committed to advancing the Locus Research Agenda on integrated development while ensuring Locus tools and products are practically relevant to development practitioners in the Global South.

To learn more about the Locus Coalition’s current activities, contact Ellie Price at gprice@locus.ngo.

Strengthening the global health workforce

By Hunter Isgrig, Digital Campaign Producer, Crowd 360, FHI 360

The World Health Organization estimates that the current shortage of global health care workers is 7.2 million. Without intervention, this number will soar to 18 million by 2030. Rachel Deussom, an FHI 360 expert on the health workforce and Senior Technical Officer, Human Resources for Health, Health Systems Strengthening, hosted a conversation with other FHI 360 colleagues to examine the shortage, its underlying causes and potential solutions.

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She opened the conversation with a personal experience she had while visiting an FHI 360 health project in rural Sierra Leone. When health workers saw that she was pregnant, several said they hoped that her child would study hard, become a doctor and return to Sierra Leone to save lives. Clearly, those on the front lines recognize the struggle to develop a well-trained, well-distributed health workforce.

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How do we respond to this growing crisis? Dr. Nadra Franklin, Director of Social and Economic Development, and Dr. Otto Chabikuli, Director of Global Health, Population and Nutrition, discussed the need for an integrated approach to solutions that will achieve health for all. One component of this approach is to address the root causes of the worker shortage, pinpointing where the jobs are now, where the jobs will be in the future, and the education and skills that are supplied by training institutes. Identifying and understanding the gaps between the education and training health workers currently receive and the skills that are in demand will help address this shortage.

Another component is examining all jobs along the workforce “value chain” — not just doctors and nurses providing direct services, but all workers performing jobs within a health care system. It is also important to acknowledge how technology has changed the way people work and the nature of the skills that employers seek. In addition, we must address local market forces — the distribution of health workers among rural and urban areas and among public and private sectors. Policymakers may need to step in and equalize the incentives in health care so that workers are attracted to underserved areas. Through an integrated approach, we can ensure that we are addressing the health worker shortage of today and planning for the demands of tomorrow.

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Groups like the Frontline Health Workers Coalition, of which FHI 360 is a member, have taken advocacy roles with U.S. policymakers to encourage prioritization of and investment in the global health workforce. Placing a high value on trained health workers will not only address the immediate needs of the communities they serve, but it will also contribute to global health security. World Health Workers Week (#WHWWeek) is a prime opportunity to intensify our support of health workers and the need for more integrated solutions to address the crisis of the health worker shortage. We must show that health workers count (#HealthWorkersCount) because, without them, millions of children and families around the world will never have access to proper health care.

Please help us continue this conversation in the forum:

Most will agree that health workers play an important role in health systems, eradicating diseases, empowering communities, and strengthening local economies. Yet few donor-funded projects focus exclusively on the health workforce.
• How can we do more to strengthen the national health workforce in global health projects?
• How can projects focusing on gender, youth, workforce development and education better develop the health workforce, including job creation?

The role of Community Health Workers in the heart of crisis

By Iffat Nawaz, FHI360

Community volunteers conduct hygiene promotion in Dikwa, Borno State, Nigeria. Credit: Henry Omara, IHANN project

2017 began with a new momentum for FHI 360’s Crisis Response Initiative as we launched the Integrated Humanitarian Assistance to Northeast Nigeria (IHANN) program funded by the Office of U.S. Foreign Disaster assistance (OFDA). IHANN is delivering integrated services in health, water sanitation and hygiene (WASH) and protection to victims of gender-based-violence in Borno State, where 1.3 million people are internally displaced due to the Boko Haram insurgencies.

The average length of conflict-induced displacement is 17 years, which means communities in displaced situations require support that are not just effective in the short-term but will pave a path towards resiliency for the long-term. Entering the humanitarian space, as FHI 360 does, with a robust development background can offer new insights for how to approach humanitarian problems. We are combining methods which hold the possibility of bringing sustainable solutions to traditional humanitarian delivery models that usually tackle problems with emergency in mind.

IHANN is working in Internally Displaced Persons (IDP) camps and communities in Dikwa and Ngala in Borno state. For the last few weeks there has been a constant daily influx of displaced persons in Dikwa, who are arriving with dire needs. This increase in total population of IDPs has overstretched health and other services. Many are living in congested environment in camps and host communities which hold public health risks- especially of disease outbreak. Currently disease surveillance and monitoring of the health situation as well as, expanding the delivery of health services are high priorities.  For the IHANN program health workers, specifically Community Health Extension Workers (CHWs) and Environmental Health Assistant Volunteers (EHWs) from the IDP population are engaged with just that in mind

For many decades, CHWs have been playing key roles in improving the health status of people especially women and children in rural and remote areas, where skilled Doctors, pharmacists, and midwives are absent. CHWs in the IDP camps in Dikwa and Ngala are contributing to the health sector response by providing health outreach services; treating minor ailments in the communities and IDP camps, making referrals for patients who require facility-based services like antenatal care, labor and delivery or family planning services. The CHWs, who speak the local languages, are also providing health education to change behaviors on risky practices. As many of the CHWs are part of cultural and religious groups they can encourage men and women to accept family planning and immunization in a culturally acceptable manner.

On to EHWs, the IHANN WASH sector Environmental Health Officers are working with community volunteers in the host communities and IDP camps to ensure adequate sanitation and promote hygiene. The EHWs are carrying out hygiene promotion, social behaviour change and camp clean-up campaigns to decrease the chances of a cholera outbreak, minimize environmental conditions that promote disease:  like standing water, for mosquito breeding, and unmanaged garbage which attracts rats that can carry Lassa Fever- a hemorrhagic disease like Ebola.

Since EHWs and CHWs receive trainings in same institutions and often work together in parallel settings in Nigeria, integrating health and WASH services show a direct enhancement in delivery. In the IHANN program, the CHWs and EHW work in the same communities and IDP camps. One of the roles of CHWs is to work as community health monitors. If there are a surge of diarrhea and vomiting cases it may be an early warning of fecal oral disease that could be cholera. Because diseases can spread fast in a close packed IDP camp it is important to identify these outbreaks quickly before they become severe. CHWs and EHWs work together in providing health education on communicable (air, water- or food -borne) diseases, skin diseases, and general infections prevention and control within the camps and the communities.

Similarly, as the WASH sector advices on building new tents on higher surfaces/areas, away from drainage systems or potential water-logged areas, EHWs are working with camp members to clear water paths and drainages to prevent flooding of the IDP camps during the rainy season. The health sector of the project, on the other hand, is working with health partners on cholera outbreak preparedness, and is also collaborating with Malaria programs to provide Insecticide-Treated Nets (ITN) for distribution to the IDPs by CHWs and EHWs.

In these situations, keeping close coordination is a high priority and the health and WASH sectors are working to have a forum where CHWs and EHWs share information, work together and engage camp leaders in health promotion campaigns and activities.

While IHANN’s doctors, pharmacists and midwives are working together with the Ministry of Health, WHO and UNICEF in delivering lifesaving health services at the facilities, the CHWs and EHWs are building capacity by taking leadings roles in health and WASH activities in their communities. The IHANN program is funded by OFDA for one year, but our hope is the knowledge, capacity building and awareness that are being woven into the communities through the CHWs and EHWs will increase the chances of saving more lives in the future and what could be a better ask than this, as a community volunteer, a humanitarian aid worker and most of all as a human.

Please help us continue this conversation in the forum:

Have you seen other projects where development expertise was applied to humanitarian response?  What we were the advantages?  What were the drawbacks?

Putting Vision into Focus: Lessons on scaling up a social enterprise

By Sarah King, BRAC

A community health worker leads an educational health forum on vision. Photo © BRAC

Helena Begum had a problem. Her job at a garment factory in Bangladesh paid good wages. But her eyesight was fading.

“I used to earn 6-8 thousand taka [about $100] a month working at the garment factor,” said Begum. “But when my vision deteriorated a year ago, I couldn’t thread my needle anymore and had to leave my job. Now I work as a maid earning 2,000 [$25] per month.”

Approximately 12.7 million people in Bangladesh suffer from near vision loss, a consequence of the eye’s natural aging process. Without correction, it can significantly impact a person’s productivity, with serious financial, health and social implications. Uncorrected, vision costs the global economy an estimated $227 billion in lost income-earning potential. However, there is a seemingly simple fix. Of those experiencing vision losses, 2.5 billion individuals globally can have their vision restored with just a pair of eyeglasses – and 77% of those individuals can be helped with a pair of reading glasses.

Low-cost eyeglasses provided through VisionSpring and BRAC’s partnership. Photo © BRAC

The challenge is that many Bangladeshis still do not have access to health care that can help them diagnose their vision loss, nor do they understand that it can be treated simply with eyeglasses. Many people also lack confidence in their ability to use reading glasses, making them hesitant to make the investment. In addition, a gender divide means that while many men purchases eyeglasses after receiving a diagnosis, women often do not, either because they do not have the funds available, or do not receive approval from their husbands to make the purchase.

To address this large unmet need, BRAC and VisionSpring partnered to develop an eye-care delivery system with an innovative social entrepreneurship model: selling low-cost reading glasses to low-wage earners through BRAC’s network of community health workers in Bangladesh. How does it work? VisionSpring supplies BRAC with high-quality eyeglasses and provides assistance with program design, product development and demand forecasting. The eyeglasses are affordable for the average low-income customer and are manufactured in Bangladesh to keep costs down. BRAC’s health workers are trained to offer free eye screenings, referrals for specialized eye care and sell low-cost eyeglasses for a small profit. These services are accompanied with activities to educate the community, including informational posters, handouts and health forums. Revenue from the eyeglasses provides health workers a supplemental income and also covers some of the program’s expenses.

The vision initiative began in 2006 as a two-year pilot with nearly 560 community health workers in 27 sub-districts of Bangladesh. More than a decade later, the program now reaches 61 out of 64 districts in Bangladesh with 33,000 community health workers providing vision care. To date, BRAC’s health workers have screened 4.5 million people, sold more than one million pairs of eyeglasses and referred nearly 610,000 individuals for higher level care. According to VisionSpring, the program is estimated to have created the potential for $110 million in increased income at the household level, based on a study conducted by the University of Michigan. Additionally, BRAC’s health workers have earned a total of $450,000 in supplemental income and now hold unique skillsets that create opportunities for career advancement and improved workforce retention. Due to the program’s considerable successes in Bangladesh, BRAC and VisionSpring will begin piloting a similar initiative in Uganda in June 2017.

At the conclusion of the initial pilot, BRAC’s Research and Evaluation Division conducted an independent review of the program to ensure its effective scale-up. The review revealed that the program provided sustained and increased productivity and earning power to the users of reading glasses. But the research team also identified many of the obstacles noted above: specifically that alongside access to eyeglasses, people with vision problems also need support from health workers and their community.

It was determined that to effectively scale up the initiative, the education campaigns would need to be strengthened to provide in-depth knowledge on vision loss and its treatments. Past clients would be used as role models within campaigns to provide insights into their personal experiences, the worth of eyeglasses and normalize eyeglass wearing. The program would also take gender biases into consideration and would aim to provide an equitable expansion of the program. The skills of the community health workers would also be improved through hands-on intensive training with frequent refreshers and close supervision.

BRAC community health workers engage in vision care training. Photo © BRAC

BRAC’s health workers are at the center of not just creating access to affordable eyeglasses across Bangladesh, but to generating demand. They have helped their communities to understand vision loss, the benefits of eyeglasses and how income can increase with improved vision; and also confront residual social stigma associated with wearing glasses. Over the course of ten years, BRAC and VisionSpring have iterated the program design, adjusting to take into consideration social and economic constraints that inhibit the uptake of eyeglasses. Health workers are valued, respected and trusted members of their communities. They have a deep understanding of the contexts and constraints, permitting them to respectfully address and mitigate concerns. The program continues to expand its reach because of the dedication and effectiveness of the health workers. As a result, community health workers now screen more than 1.2 million people annually, with women making up 63% of the client base.

Helen Begum, a BRAC vision customer. Photo © BRAC

Helena Begum is one of them. Her new eyeglasses are allowing her to increase both her income and her confidence. “With these glasses,” she says, “I can see clearly once again and I will soon be returning to the garment factory.”
For World Health Workers Week, it’s important to acknowledge the integral role community health workers play not only in delivering basic services, but also the extraordinary impact they have as leaders and validators in their communities.

Please help us continue this conversation in the forum:

1. how might this program have benefited from giving community health workers a greater role in design at the beginning?
2. What other community leaders (schoolteachers? Civil society leaders?) could have served as role models to encourage wider adoption of eyeglasses by community members?