BGD/00/51/USA International Labor Organization (ILO) Women ... · Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB) IO 1– Increase the number of poor women

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BGD/00/51/USA International Labor Organization (ILO)

Women’s Empowerment through Employment and

Health (WEEH) Project Dhaka, Bangladesh

Final Evaluation 13-21 July 2005

Dil Prasad Shrestha Lisa Wong-Ramesar

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Table of Contents

Page

List of Abbreviations 3

Executive Summary 4

I. Country Context 6

II. Project Description 6

III. Purpose of Evaluation 10

IV. Evaluation Methodology 10

V. Project Status: Summary of WEEH Project Achievements 11

VI. Findings 17

Findings based on key evaluation questions 17

Validity of the project strategy, objectives and assumptions 17

Impact/benefits accrued to target groups 17

Implementation status 17

Sustainability of project results 18

Effectiveness of project management 18

Effectiveness of project performance monitoring 19

Conclusions 19

Sub-Project 1: Women’s Empowerment through Decent Employment (WEDE) 19

Sub-Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB)

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VII. Lessons Learnt 23

VIII. Overall Conclusions 23

IX. Recommendations 26

References 27

Appendices: 28

Appendix 1: Terms of Reference (TOR) 28

Appendix 2: List of Persons Met During the Evaluation 35

Appendix 3: Project Monitoring Plan (PMP) 38

Appendix 4: Interview Questions and Summary Responses 42

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List of Abbreviations

BASC Business Advisory Services Centers

BCSU Bangladesh Cha Sramik Union

BRAC Bangladesh Rural Advancements Committee

BTA Bangladesh Tea Association

CBO Community Based Organization

CBSG Capacity Building Service Group

CCDA Center for Community Development Assistance

DFID Department for International Development

DOL Department of Labor

DSK Dustha Sasthya Kendra

EDBM Enterprise Development and Business Management

G&E Gender and Employment

GK Grameen Kalyan

HCs Health Centers

IGA Income Generating Activities

ILO International Labor Organization

ITP Indigenous and Tribal People

KDA Knowledge Development and Advocacy

MHIB Micro-Health Insurance for Poor Rural Women in Bangladesh

MHIS Micro-Health Insurance Schemes

MOHFW Ministry of Health and Family Welfare

MOLE Ministry of Labor and Employment

MOWCA Ministry of Women and Children Affairs

MSB Marie Stopes, Bangladesh

NGOs Non-Governmental Organizations

PAC Project Advisory Committee

PITF Project Implementation Task Force

PSI Private Sector Initiatives

TOR Terms of Reference

TOT Training of Trainers

USDOL United States Department of Labor

WEDE Women Empowerment through Decent Employment

WEEH Project Women’s Empowerment through Employment and Health

YPSA Young Power in Social Action

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Executive Summary

The International Labor Organization (ILO) with financial support from the United States Department of Labor (USDOL) implemented a Project in Bangladesh in July 1, 2001 on Women’s Empowerment through Employment and Health (WEEH), which will come to a close on 30 September 2005. The overall development objective of the project is to empower poor women in Bangladesh through increasing their access to decent employment and viable health insurance systems.

The project has two sub-projects, namely:

a. Women’s Empowerment through Decent Employment (WEDE) b. Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB)

The WEDE sub-project has two components – Gender and Employment (G&E) and Public Sector Initiatives (PSI). The MHIB sub-project also has two components – Micro-Health Insurance Schemes (MHIS) and Knowledge Development and Advocacy (KDA).

The main purpose of the final evaluation is to assess whether the WEEH project has been successful in achieving its key objectives and overall goal mentioned in its project document and strategic plan.

The primary methods for gathering information/data included interviews and interaction meetings with stakeholders. The evaluator designed broad evaluation guidelines/checklist in consultation with project staff to facilitate these interviews and interaction meetings. In order to encourage widespread stakeholder participation, the evaluation team conducted interaction meetings and interviews in four locations: Dhaka, Srimongal, Narshingdi, and Manikganj.

The evaluator reviewed relevant documents, collected primary and secondary data, analyzed data/information, and presented preliminary findings at the end of the field visits.

The overall findings indicate that the WEEH project largely achieved its main objectives. As a result of the project's inputs, most of the target groups showed an improved ability to manage daily tasks and apply some skills such as planning, marketing, account keeping, monitoring, and so on. In addition, most trained members were aware of and practicing some of the principles of ‘decent work’, e.g., workplace environment. A few women entrepreneurs with the help of partner NGOs had considerably expanded their business and were switching over from ‘income generating activities (IGA) to enterprise operations’. Moreover, the project seemed largely successful in providing poor women’s group access to MHI services through upgraded health centers/clinics and increased number of policy cardholders. Similarly, many partner organizations showed a high likelihood of continuing their current activities after the WEEH project's closure in September 2005. In addition to improved management abilities, a key reason for their likely continuation was their ability to network at both domestic and international levels.

However, several factors impeded the WEEH project from achieving greater success. Most important was that the WEEH project tried to provide too many services to too many diverse beneficiaries. Next, the scope of the WEEH project's objectives, strategies and activities seemed too broad, complicated and ambitious. Finally, it faced difficulties in focusing on its core competencies and satisfying diverse targeted beneficiaries.

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The project largely achieved its goals of improved staff development and communication with the major stakeholders. It has also helped build the foundation for its current partnership work with some NGOs. The project’s components - G&E, KDA, MHIS, and PSI are new concepts, which require a longer timeframe to gain momentum and achieve sustainability. Sustaining these interventions and further promoting the principles of ‘decent work’ require continued follow-up, monitoring and training. Given that the partner organizations and the WEEH project pioneered the new concepts like ‘MHIS’ and ‘decent employment’ respectively, it will continue for some years.

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I. Country Context

Bangladesh, with a population of 140 million is one of the poorest countries in the world. Some 50% of the population lives below the poverty line and 36% in extreme poverty. The majority (87%) of the labor force is employed in the informal economy in which most women’s invisible contribution to the economic development of the country is made. Women workers in rural areas are mostly engaged in agriculture as unpaid family helpers, day laborers and self-employed. Women’s limited access to education and skills training opportunities leaves women and girls ill prepared for entering the labor market. Women’s wages are estimated on average to be about one third those of men. To combat poverty, women are increasingly seeking paid employment outside the home but, for women and men alike, opportunities for decent employment are very limited. Unemployment and especially under-employment are even more common for women than for men. Even though recent rapid growth in the ready-made garments sector has substantially expanded employment opportunities for women, decent formal sector jobs remain scarce. Direct and indirect discrimination against women is widespread. Sexual harassment and abuse of women in the workplace are reported to be common, and women are severely under-represented in decision-making positions in both public and private sectors, including in workers’ and employers’ organizations/associations.

II. Project Description

To address the economic and employment situation in Bangladesh, in FY 2000, the United States Department of Labor (USDOL), within the framework of the Dhaka Declaration1, initiated and agreed to fund the Women’s Empowerment through Employment and Health (WEEH) project in the amount of $3,222,307. This project which was implemented by the International Labour Organization (ILO), .began on1 July 2001 and had an original completion date of 30 September 2004. Several minor budget revisions re-allocating funds to different Budget Lines (BLs) were approved during the course of project implementation. In September 2004, following the departure of CTA in July 2004, the total budget was reduced by $156,002 (with a new total revised budget of $3,066,305) and the end date extended to September 30, 2005.

The overall development objective of the project was to empower poor women in Bangladesh through increasing their access to decent employment and viable health insurance systems, hence contributing to the nation’s poverty alleviation and economic development programs.

The project had two sub-projects, namely:

a. Women’s Empowerment through Decent Employment (WEDE)

b. Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB)

Initially, there were two separate project proposals for each project, which were merged at the request of USDOL because two separate individual proposals were not considered “big” enough to gain political mileage in support of the “Dhaka Declaration”.

The WEDE sub-project had two main components: Gender and Employment (G&E), and Private Sector Initiative (PSI). The G&E component aimed at promoting decent work in rural

1 In March 2000, the then US President Bill Clinton visited Bangladesh and announced support to a poverty alleviation and health program (popularly known as the Dhaka Declaration).

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areas by promoting skills development and awareness raising, and providing training for micro and small women entrepreneurs. Similarly, the PSI component aimed to promote decent work in the formal sector, i.e., tea plantation in particular, through training and awareness on gender and women’s rights at work, and supporting local dialogue between employers and employees.

The MHIB sub-project also had two main components: Micro-Health Insurance Schemes (MHIS), and Knowledge Development and Advocacy (KDA). The MHIS component aimed to provide affordable and quality primary health care services to targeted poor rural women and their families through micro-health insurance schemes. The component tested different MHIS approaches and packages at new and/or upgraded health centers (HCs) of two of Bangladesh’s main Non Government Development Organizations – Grameen Kalyan (GK) and BRAC. Similarly, the KDA component aimed at increasing support for MHI policy makers and partner organizations, and promoting the application of MHI best practices and lessons learned in Bangladesh and other STEP-countries.

In order to integrate various sub-objectives under different components, the project developed the following immediate objectives (IO) in the project document:

Project 1: Women’s Empowerment through Decent Employment (WEDE)

IO 1 – Provide decent employment for women and at the same time improve family and children’s welfare.

IO 2 – Enhance the capacity of the concerned ministries to ensure respect for women workers’ rights and promote women’s employment.

IO 3 – Promote gender equality in private sector employment.

IO 4 – Strengthen women’s participation and leadership in trade unions.

Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB)

IO 1– Increase the number of poor women and their families enjoying access to primary health care through existing and new micro health insurance schemes managed by Grameen Kalyan (GK).

IO 2 – Increase the number of poor women and their families enjoying access to primary health care through existing and new micro health insurance schemes managed by Bangladesh Rural Advancements Committee (BRAC).

IO 3- Increase awareness and knowledge among policy makers, the ILO social partners, selected NGOs and local community members of the concept and management of micro health insurance and how such schemes can form part of national poverty alleviation programs targeting poor women.

IO 4 – Promote the gained knowledge and experience on the functioning of micro health insurance schemes for poor women for use and adaptation by other organizations/ structures in Bangladesh and elsewhere.

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Development of a Performance Monitoring Plan (PMP)

During a brainstorming session in October 2002, the project staff developed a first draft of the PMP using a format supplied by the USDOL/Declaration. Following consultations with the national partner organizations, a final document was adopted in April 2003 with the following indicators:

WEDE Component:


• Women enrolled in WEDE enterprise development activities • Women attended skills and management training through WEDE • Women have better opportunities for decent work (Cumulative) • Women have better access to healthcare services (to primary health care through operation

of MHIS) • Regular attendance of women’s children to school • Groups conducting meetings independently • Groups maintain their own group level records independently • Groups perform other activities, like conflict resolution, problem solving independently


• WEDE initiated meetings / workshops/major briefings with participation from MoLE/ DoL/ MoWCA/PLAGE officials organized

• Concrete actions in gender sensitization and/or EEO carried out by MoLE or MoWCA (e.g. monitoring/inspection format & IRI curriculum reviewed and gender issues included

• MoLE endorses 3 key gender-sensitive instruments (e.g. improved monitoring, inspection format and IRI curriculum)

IO 3 – Promote gender equality in private sector employment.

• WEEH partners (or garden management) are in agreement on starting to implement gender issues

• WEEH partner management carry out social protection actions benefiting women workers • Target workers in the WEEH partner tea gardens claim to have benefited (from above

actions)

IO 4 – Strengthen women’s participation and leadership in trade unions.

• Increase of number of women in: o Union structures (formal and informal) o Decision-making (these includes Mother’s Club members, Panchayet members &

women trainers of BCSU etc.) • Men actively promote women in leadership position and gender equality

• Management implements plans developed by workers

MHIB Component

IO 1– Increase the number of poor women and their families enjoying access to primary health care through existing and new micro health insurance schemes managed by Grameen Kalyan (GK).

• Health care service utilization rate among MHIB/GK enrollees increased (by 5% annually)

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• Reduction of deliveries with complications at MHIB/GK Health Centers • Average infection rate after deliveries at MHIB/GK Health Centers is not more than 5% • MHIB/GK-assigned prescription medicines is available in stock of all operating Health

Centers

IO 2 – Increase the number of poor women and their families enjoying access to primary health care through existing and new micro health insurance schemes managed by Bangladesh Rural Advancements Committee (BRAC).

• Health care service utilization rate among MHIB/BRAC enrollees increased (in general health service packages)

• Increase women enrolled in MHIB (pre paid) pregnancy package program, and receiving services

• Reduction of deliveries with complications at MHIB/BRAC Health Centers • Average infection rate after deliveries at MHIB/BRAC Health Centers is not more than 5% • Prices for BRAC provided medicines to MHIB beneficiaries is maintained at 80% of market

prices

IO 3- Increase awareness and knowledge among policy makers, the ILO social partners, selected NGOs and local community members of the concept and management of micro health insurance and how such schemes can form part of national poverty alleviation programs targeting poor women.

• 45 communications and interactions in which MHI/STEP is explained with partners (other than BRAC and GK)

• Partners initiate and/or facilitate their members’ access to STEP/MHI schemes • National health policy (i.e. the Health Policy Strategy Paper) reflects inclusion of MHI


• MHI promotional messages and activities presented in the media • Dissemination of STEP/MHIB materials to other organizations and 5 other “STEP

countries” • Organizations put at least 1 MHI “best practice” or “lesson learned” into action

III. Purpose of Evaluation

The purpose of the final evaluation was to:

a. determine if the project had achieved its stated objectives and explain why and why not;

b. assess and document the effects of the project activities and outputs;

c. assess the likelihood of sustaining the project outputs; and

d. report on major lessons learned.

To achieve the evaluation’s purpose, the Evaluation Team examined the following key evaluation questions:

• Validity of project strategy, objectives and assumptions • Impact/benefits accrued to the target groups

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• Implementation status, specifically as concerns planned activities, materials, schedule and budget

• Sustainability of project results • Effectiveness of management performance by DOL, ILO, CTA and NPC • Effectiveness of project performance monitoring • Stakeholder buy-in, support and participation in the project • Efforts of the stakeholders to achieve sustainability of the project and its activities

In addition, the WEEH project’s major successes and shortcomings in each of the immediate objectives of the sub-projects were examined.

IV. Evaluation Methodology

Prior to undertaking the mission, a pre-trip meeting was held via conference call with all parties concerned (Evaluator, USDOL, ILO/DECLARATION, and ILO/WEEH NPM). The purpose of the meeting was to review the TORs, discuss the state of logistics, agree on deadlines, and methodology. In addition, beforehand, the evaluator received and reviewed relevant documents including the project document, technical, status, mission, and mid-term evaluation reports, the project budget, the project monitoring plan, and the project’s work plan. During the actual visit to the project, the primary methods for gathering information/data included interviews and interaction meetings with stakeholders. The evaluator designed broad evaluation guidelines/checklist in consultation with project staff to facilitate interviews and interaction meetings. All interview and workshop questions emphasized the immediate objectives from the WEEH project document and terms of reference (TOR). See Appendix 1 for the complete TOR for the evaluation.

In order to encourage widespread stakeholders’ participation, the evaluation team conducted interaction meetings and interviews in four locations: Dhaka (Project Office, Line Ministries, PLAGE at Department of Women Affairs, ILO Area Office, DSK Dhaka), Srimongal (BCSU, MS Clinic, Nondorani Tea State, HEED Bangladesh-Komolganj, BTA, HEED Bangladesh-Mangalpur (Monipuri group), Narshingdi (BRAC Sushashto-Madhabdi, BRAC satellite center-Birampur), and Manikganj, Sahrail village (GK Health center).

The Evaluation Team interviewed/met with the following target groups. A detailed list is attached at Appendix 2:

• Target women group members (Direct beneficiaries of the project) • Family members of the target women groups • Workers, employers and NGOs/CBOs who have been involved in the project • Line Ministries (Officials of Ministries of Labour, Health and Women’s Affairs) • WEEH project personnel • ILO Area Office Dhaka staff • Grameen Kalyan and BRAC staff • Members of the Project Advisory Committee • Consultants who worked with the project • Trainers and training program implementers • USDOL present and previous Project Managers, ILO/DECLARATION Staff and other ILO

Geneva and Delhi staff.

In addition, the following randomly selected studies prepared under the project provided important information and data: Dynamics of Internal Migration of Tea Workers, conducted by Capacity Building Service Group (CBSG) and Socio-Economic Impact Assessment of

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Interventions under the Gender and Employment Component, conducted by Business Advisory Services Center (BASC).

Challenges to Evaluation Methodology Implementation

The evaluation team encountered several limitations during the course of the field visits. First, while the evaluator received a wide range of data and information both beforehand and during the field mission, they could not be independently verified in many cases because of the time constraint, specifically, the duration of the mission was too short and the material too much to digest within the timeframe allocated in the TORs. Second, in order to properly determine the impact of the project, some project activities such as change in attitude and change in livelihoods, need to be evaluated several years after of the project termination. With this in mind, the evaluation team tried to focus more on the effectiveness of the project interventions and less on the effects/impact of the project activities. Third, the evaluation team could not spend as much time in the field as originally planned because of a Hartal which was called during the visit, and which cut short the field visits by a full day. In addition, the sample respondents’ group was neither randomly selected nor necessarily taken as representatives of the entire range of targeted stakeholders.

V. Project Status: Summary of WEEH Project Achievements

This section presents a summary of the WEEH project’s main component-wise achievements2 with details - base line data, project’s timeframe, and means of verification - provided in appendix 3:

G&E Component SN Major output indicators 2002 2003 2004 2005 1. Number of groups identified/Selected to work

with and provide them services 560 937 940 940

2. Number of group members enrolled in the group formed/identified by the project

3250 4200 4200 4238

3. Average savings (Taka/member) 650 705 2933 3731 4. Average loan size (Taka/member) 7500 8534 13286 13845 5. Percentage of entrepreneurs/member receiving

loans 25% 37% 94% 99%

6. Number of group members who received skills training

750 1500 1500 2564

7. Number of group members who received EDBM training

0 390 3488 4238

8. Number of group members who received Decent Work training

0 0 465 1223

9. Number of group members who received awareness raising training

200 1000 45001 65553

10. Number of group members participated in Book Keeping training

0 19 536 745

11. Number of Business Advisory Centers opened 0 8 14 14 12. Number of Clustery formed 0 17 57 83

2 All the data for each component-wise achievement are taken from the project record files. 3 Member received general awareness and primary health awareness training, and there were overlapping,

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13. Number of members involved in clusters 0 370 1162 1519 14. Number of organizations with which network

established 0 17 151 188

15. Number of staff received training (different training)

150 329 2695 2980

16. Number of WEDE members who received MHI services through NGOs

0 0 1900 2030

17. ITP Members (Adivasis) received WATSAN services under special initiative by DSK • Number of group members benefited from

Hand Tube Wells (29 sets) • Number of group members benefited from

Sanitary Latrines (91 sets)

300 91

PSI Component SN Major output indicators 2002 2003 2004 2005 1. Number of studies on Tea Sector (situation

analysis) 1 0 0 0

2. Number of Partnership Exploration Workshops organized

1 0 0 0

3. Number of contracts signed with partner organizations

0 5 0 0

4. Number of kitchen gardens established 0 0 125 152 5. Number of persons receiving awareness raising

training through partner NGOs 0 220 5162 9664

6. Number of persons receiving awareness raising training through trade union

0 600 1435 4238

7. Number of persons receiving Panchayet Leader training

0 0 240 336

8. Number of networks established with organizations

0 5 12 16

9. Number of partners’ staff who received training (different training)

0 16 48 52

10. Number of participants from MoLE, DoL and BIM officials/trainers receiving training

0 0 0 23

11. Number of Tea Estate management staff who received management training

0 0 27 115

12. Number of Tripartite Seminars organized 0 0 1 0 13. Number of patients who received treatment by

MSB 0 221 2804 1827

14. Number of patients who received treatment through HEED

0 38 543 886

14. Number of kitchen gardens established 0 0 125 152 * Including the managers trained by the project, the number of garden covered will be 100. MHIS and KDA Components Sl # Major output indicators 2002 2003 2004 20054

4 Including estimate up to December-2005

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18. Number of Operational HCs: (Cumulative) GK BRAC Others (YPSA, DSK & CCDA)

Total

14 02 0

16

17 02 0

19

23 02 03 28

25 02 03 30

19. Number of policyholders for MHIS: GK (Total 60,000 for four years) BRAC (Total 12,000 for four years) Others (Total 3,900 for four years) Total: (75,900 for four years)

42,0005

1,523 00

43,523

7,000 4,306

00 11,306

5,000 3,821 3,000

11,821

6,000 2,350

900 9,250

20. Number of patients receiving curative services GK (Total 803,236) BRAC (Total 65,060) Others (Total 10,200) Total: (877,489)

133,236 12,600

00 145,836

146,000 13,860

00 159,860

244,000 17,600 4,700

265,300

280,000 21,000 5,500

306,500 Major Events during the Implementation of the WEEH Project Overall Project Events • 17 May 2001 Memorandum of Understanding (MOU) between the Ministry of Labour and

Employment (MOLE) and ILO was signed • 23 July 2001 project started with the arrival of the CTA. • September 2001, draft Terms of Reference for the Programme Advisory Committee (PAC)

was prepared by the ILO and endorsed by the MOLE • 1 November 2001, two NPCs for WEDE (G&E and PSI) and one NPC for MHIB

components joined project • 1 November 2001, project office established • 5 December 2001, First PAC meeting held • 17-20 January 2002, MSI consultant and project team revise logical framework • June 2002, user friendly Database (in Access) comprising two components - Documentation

(dealing with all types of reports, books, training material, tool kits, videos, etc) and organizations (containing basic info on resource originations, local and international) developed

• September 2002, PMP developed • 6-12 October 2002, Mid-Term Review by Ms. Anne Mossige, Independent Consultant and

Mr. John Ritchotte, DECLARATION • 1 June 2003, resignation of NPC responsible for PSI component • 21 April 2003, PMP revised and finalized • 15 July 2003, new NPC for PSI component recruited • September 2003, members of Project Implementation Task Force (PTIF) for WEDE

nominated by MOLE • 15 February 2004, visit to project by US Deputy Under Secretary of Labour, Mr. Arnold

Levine • 23 July 2004, resignation of CTA • 23 July 2004, appointment of NPC of WEDE G&E component to serve as NPM • 13-21 July 2005, Final Evaluation by Mr. Dil Prasad Shrestha, Independent Consultant, and

Lisa Wong-Ramesar, DECLARATION

5 Including 31,000 pre project enrolment

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WEDE sub-project (G&E Component) • 2001, apart from three ministries (MoLE, MoWCA, MoHFW), no specific NGOs were

identified as implementing partners prior to the start of the project. • May 2002, fact-finding mission (consultancy) to rapidly investigate and identify potential

operational areas, target groups and partner organizations for the WEDE sub-project • November 2002, a total of 4,500 members of various existing groups had been identified and

from them around 3,100 selected as WEDE entrepreneurs against the target of 3,375 for the period of July - December 2002

• January 2003, seven NGOs sign agreements to strengthen the capacity of the women entrepreneurs. Three of these will also implement health micro insurance schemes.

• November 2003, 4,071 women enrolled as WEDE entrepreneurs, which is more than four times the original project target

• November 2003, 1500 beneficiaries received EDBM (business oriented training). • November 2003, DSK and YPSA implement MHI with support of the project. • January 2004, Decent Work Level-I training • May 2004, Implemented Level II (out of III) training workshops in 7 districts on ‘Decent

Work for women entrepreneurs in the informal economy’. (Level I -Training of Trainers- was completed in January with the facilitation of external training consultant).

• November 2004, one NGO started distributing drinking tube wells and sanitary (slab) latrines to the poorest beneficiaries (mostly adivasis/ITPs, namely Hajong) in Durgapur area, Netrakona district.

• May 2005, Under WATSAN activities implemented exclusively by DSK among the adivasis (ITP) since beginning of this year, 26 drinking wells (DTW) and 85 sanitary latrines utilizing a revolving fund of Taka 475,000 (of the total, project provided Taka 250,000) have been distributed on credit.

PSI Component

• May 2002, consultancy to appraise the tea sectors in Sylhet, Moulvibazar and Chittagong

districts • 17-20 November 2002, Workshop on ‘Tea Sector Partnership’, Inauguration in Dhaka and

Workshop in Rajendrapur • November 9-15 2003, study tour to Sri Lanka to share experiences with key actors and

stakeholders and to discuss these experiences in relation to the Bangladesh tea sector, and to study the prevailing industrial relations in the plantation areas with particular reference to collective bargaining, social dialogue and labour management

• November 2003, all Agreements with the partners in the tea sector were signed, the last one being a MoU with the Employers; organization in the tea sector (BTA/BCS).

• May 2004, Training Needs Assessment of BSCU staff in Srimongol • May 27-31, 2004, workshop on “Training of Trainers on Workers Education in the Tea

Plantation Sector” for the trade union (BSCU), Rajendrapur, Gazipur • 1-2 July 2004, seminar jointly organized with the BTA in Dhaka on “Social Dimension in

Tea Plantations in South Asia” • November 2004, initiated a study on the internal migration of tea workers from labour

surplus garden to deficit garden • November 2004, conducted training for 160 Panchayet leaders (8 batches) of BCSU (40%

women). • November 2004, Implemented planned awareness programmes among the tea workers (7000

women and their families) on different health and social issues

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• 29-30 March 2005, TOT on “International Labour Standards, Decent Work and ILO Conventions for the BIM (Bangladesh Institute of Business Management), MoLE Officers/Trainer”

• March 2005, two workshops for the BTA management on “Labour Standards and Its Practices for Tea Estate Management”

• April 2005 BTA Workshop on “Labour Standards and Health and Welfare Issues” for medical officers of tea estates focusing on gender and HIV/AIDS

MHIB Component • (Pre-project) September 2000, a study was initiated through the Institute of Health

Education, Dhaka University to investigate and assess the willingness of the rural poor to pay for health insurances

• 7 November 2001, BRAC & Grameen sign agreements • 11-13 March 2002, workshop on ‘Micro-Health Insurance Training and Training Materials

Development’ • November 2003, seven out of 17 Health Centers GK upgraded to maternity centers to

strengthen ‘safe motherhood’ introducing safe delivery with existing ANC and PNC. • November 2003, two HCs up-graded with surgery facilities for cataract patients (majority

income-poor women). (GK) • November 2003, no. of HMI policyholders in G.K increased to 49,000 from 47,000 May

2002, benefiting about 245,000 persons. • November 2003, 1,900 forum/meetings of village leaders, health workers, schoolteachers,

religious leaders, BRAC and NGO staff, etc have been organized up to November 03. More than 28,000 men and women participated. 12 popular theatre plays were staged to disseminate the concept of HMIS in which 4,500 villagers attended.

• November 2003, enrolment in the two BRAC HCs has increased from 5,746 in to 8,204 benefiting around 41,000 persons.

• May 2004, 3 new GK HCs opened • May 2004, the enrolment in the two BRAC HCs increased from 9,840 in February’04 to

10,754 benefiting around 54,000 persons. This (10,754) is 90% of the total three-year target of 12,000.

• May 2004, two partner NGOs –YPSA and DSK visited the HMIS of BRAC and G.K in order to learn from their experience in the replication of the HMI concept in their health schemes.

• November 2004, 8 out of 23 HCs are upgraded to maternity centres to strengthen ‘safe motherhood’ introducing safe delivery with existing ANC and PNC. Two HCs have been upgraded by adding cataract surgery facilities.

• November 2004, Exposure visit to organizations implementing MHI schemes • November 2004, number of HMI policyholders in G.K has increased to 58,000 in from

54,000 in last May, benefiting nearly 300,000 persons1 (97% of Grameen Kalyan’s target of 60,000).

• November 2004, the enrolment in the two BRAC HCs has increased from 10754 in May ’04 to 11,100. This (11,100) is 92% of the total three-year target of 12,000.

• November 2004, three WEDE partners namely DSK (in Dhaka), YPSA (in Chittagong) and CCDA (in Comilla), have introduced/replicated HMI in their project areas and already enrolled around 4,000 policy/card holders.

• May 2005, two new GK health centres (HC) were set up completing the planned total of 11.

1 Including 36,000 policy holders enrolled before start of ILO-WEEH

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• May 2005, 17 out of 25 GK HCs had been upgraded to maternity centres to strengthen ‘safe motherhood’ program.

• May 2005, number of HMI policyholders in GK increased to 59,500 (99% of Grameen Kalyan’s target of 60,000).

• May 2005, GK had rendered curative services to 627,000 patient visits from their static and satellite clinics including 500 birth delivery and 2,300 cataract surgery during the project period.

• May 2005, enrolment in the two BRAC HCs increased to 11,770, attaining 98% of the total three-year target of 12,000 and benefiting nearly 60,000 persons.

• May 2005, Curative health services rendered by BRAC MHIS through the static and satellite clinics received a total of 88,000 patient visits (more than 75% women and children) including 4,800 delivery cases.

• May 2005, health volunteers and program organizers had provided services on preventive/primary health, nutrition, sanitation, family planning, etc to more than 500,000 persons through home visits since the beginning of the project.

VI. Findings

This section describes the findings of the WEEH project’s overall evaluation based on the key evaluation questions, specifically with respect to the validity of project strategy, the impact on the target groups, implementation, project management and project performance monitoring, sustainability, and stakeholder buy-in.

The following results are summary findings from the interviews and a series of interactions conducted with the project stakeholders. Their detailed responses and justification for the findings are provided in appendix 4.

Findings based on key evaluation questions

Validity of the project strategy, objectives and assumptions

Most of the respondents interviewed during the mission stated that the objectives, strategies, and assumptions of the project were largely valid in the socio-economic situation of poor women in Bangladesh. They, however, indicated that the assumption of achieving sustainability within the 3-4 year project period seemed over ambitious, in particular since the project’s components - G&E, KDA, MHIS, and PSI are new concepts, requiring a longer timeframe to gain acceptance, momentum and achieve sustainability. In addition, many found the project set up complicated, i.e. combination of many components.. According to the project staff, the project started to implement its activities since July 1, 2001, however, some project strategies such as selection of implementing partners, selection of intervention sector (especially for the WEDE component), and development of understanding with the stakeholders of the tea sector were executed 18 months later. As a result the project was forced to postpone and/or merge certain activities.

Impact/benefits accrued to target groups

Analyses of the information obtained from the field visit showed that the major impact/effects of the project activities seemed to have (a) increased awareness on health care and nutrition, (b) increased access to health care services at the highly subsidized fees and price, (c) increased number of empowered women in the rural economy, (d) reduced birth rate and child mortality, (e) increased poor women’s participation in the leadership and decision making-positions in trade unions/workers’ associations, and (f) increased awareness on the positive gender discrimination among stakeholders. However, this should be seen as positive direction only as tangible impact/effects cannot be fully determined until a few years after the project has been

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completed. Sustaining the project interventions and further promoting the principles of ‘decent work’ require continued follow-up, monitoring and training. Similarly, most partner organizations showed a high likelihood of continuing their current activities after the WEEH project's closure in September 2005 and have already drawn up their continuation plans.

Implementation status

Project staff reported that some of the project activities started too late (18 months later). The delay was caused mainly by the time taken to select the implementing partners, to identify intervention sector (especially for the WEDE component), and to reach the understanding with the stakeholders of the tea sector. Various training manuals were developed and found useful as indicated by partner NGOs, trainers and trainee respondents who indicated that various training programs such as entrepreneurship development and business management (EDBM) training, decent work training, panchayat leaders training etc substantially helped target groups establish new micro businesses, understand the principles of decent work, manage the tea workers’ unions and so on. Case studies on the Life Stories of Women Entrepreneurs in Bangladesh were prepared under the project, analyzed and found to be largely valid based on observations and discussions with project beneficiaries. Project staff said that all targeted activities were implemented on time and as scheduled except some activities under the WEDE component as highlighted above. Interestingly, all partner organizations unanimously complained that they had to renew their contract with the project every six months, and the uncertainty surrounding renewals resulted in difficulties in planning. However, the project was required to operate in this manner in order to properly monitor the quality of services, give itself the necessary time to understand the working style of partner organizations and to both parties to communicate with each other to undertake the necessary corrective measures.

Sustainability of project results

Interviews and discussions with the partners as well as other replicating NGOs revealed that most of the NGOs working under the project were likely to continue most of the training programs such as EDBM, book keeping/accounting, decent employment etc provided to women entrepreneurs. The partner NGOs and replicating NGOs explained that planning, budgeting, and monitoring practices of the project were also likely to be followed by them because they had already adjusted lessons learnt according to their environment/situation. BTA and BCSU appreciated the leadership development training they received and both the organizations were planning to apply the skills and knowledge gained from the training.

Similarly, all partner NGOs had shown their commitment and submitted sustainability plans of implementing health care services through micro-health insurance schemes using their internal resources for at least one year after the project closure. The evaluation revealed that some partner NGOs were likely to sustain the micro-health insurance concept because (a) they had taken the ownership of the program, (b) they had genuinely involved all stakeholders, and (c) they had used their own existing structures. However, this scheme, as indicated by the project staff and partner NGOs, required blending with other services and needed additional resources. They further added that the combination of workers’ rights, women empowerment and micro health insurance was rather complementary and an appropriate perspective to tackle poverty among rural poor women was required. Therefore, partner NGOs particularly emphasized that small and weak organizations would be out of the business if they failed to receive support from donor agencies.

Effectiveness of project management

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During the evaluation mission, all stakeholders indicated that they greatly appreciated the effectiveness of the project management as they perceived that the project had managed its personnel, finance, communication with stakeholders, and partners’ involvement in project activity planning effectively. Similarly, partner NGOs, replicating NGOs and other partner organizations such as BTA and tea workers’ unions noted that communication between the project and major stakeholders was quite satisfactory. One respondent said, “I have seen how the tea estate owners have been gently ‘coerced’ in a collaboration agreement, …”. Most respondents evaluated that the roles played and support provided by USDOL, ILO Declaration, and Area Office - Dhaka were effective and adequate. However, some respondents suggested that the ILO Office in Dhaka needed to facilitate the program activities more than to regulate the activities. In addition, discussions with the line ministries and project staff led to the conclusion that communication between project management and line ministries seemed rather cold. Moreover, project staff also agreed on the fact that the contribution of Project Advisory Committee (PAC) and Project Implementation Task Force (PITF) remained at the minimum level.

Effectiveness of project performance monitoring

As per discussions with the project staff, the project basically monitored its activities in three stages: input, process, and output. Base line data were collected at the initial stage. The performance monitoring data were collected from the partner NGOs on a monthly basis. Then the project compiled and prepared a summary of outputs and shared it among all stakeholders. The partner NGOs and project staff also mentioned that the system through which the data were collected and disseminated seemed cost-effective, useful and reliable. However, some project personnel realized that the development of a performance monitoring system was perhaps the gray area to which the project could not contribute much. They also mentioned that several workshops were held with the implementing partners, but a complete consensus on the development of performance indicators and database systems could not be built because of the diversity in their ongoing monitoring systems and inadequate database management systems. Hence, they added, project performance monitoring system largely seemed dependent on the partner organizations. They concluded that the project, as a result, experienced some difficulties of maintaining consistency (especially on the finance side).

Conclusions

Sub-Project 1: Women’s Empowerment through Decent Employment (WEDE)


Between 2002 and 2005 the WEEH project under its WEDE component provided capacity building/awareness creation/empowerment and skills development training programs for micro and small entrepreneurs, i.e., poor women’s groups. Based on the survey the following were the range of training programs supported by the project (not all trainings were received by all entrepreneurs):

• Decent Work Training (Level-I) module • Decent Work Training (Level-II) module • General ToT module • Marketing module • Workers Education In the Tea Plantation Sector of Bangladesh • Strategic planning module for union leaders • Panchayet Leaders Training module

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• Entrepreneurship Development and Business Management training • Account Keeping Training • Project Management Training

Most respondents who have received the training reported that the training programs conducted/supported by the project were largely useful and improved the livelihoods of the targeted groups. According to them, the training programs helped increase their awareness of labor standards, health and nutrition, education, participation in organizational activities such as mothers club, Panchayat and BCSU. Similarly, it was also reported that the training programs also helped poor women establish small and micro-businesses in the non-formal private sector.

Project records on the project status showed that of the total women entrepreneurs (4238), around 20% women entrepreneurs received ‘decent work’ training from the project/partner NGOs and it was expected that about 40% of trained women entrepreneurs were applying the concept in their workplaces. The Socio-Economic Impact Assessment of G&E component conducted in June 2005 also supported this finding that about 65% trained members were now aware of and practicing workplace environment (BASC, 2005:36). Similarly, the representatives of BTA and BCSU reported that the concept of ‘decent work’ in the PSI/tea sector was being disseminated across all levels of both BTA and BCSU management and it had greatly helped them in managing their workers and workers’ unions because workers did not put unnecessary demands when they applied new the principles of ‘decent work’.

All project staff unanimously reported that in spite of the encouraging effects seen in the targeted groups, insufficient follow-up activities prevented training programs from being more effective. This happened mainly because of the lack of project staff. Other factors included the short period of project duration, floods and political unrest.


It was reported that a batch of 23 officers from the government ministries participated in the training program jointly organized by the WEEH project and its partner organizations. Hence, some project staff and the representatives of the line ministries agreed that the capacity of concerned government ministries to ensure respect for women workers’ rights and promote women’s employment (in the areas of labor laws, fundamental rights, ILO Conventions, labor administration, social dialogue) had to some extent been increased.

Both the project and line ministries realized that one factor, among others, which substantially limited greater achievement of this objective was the lack of communication and interaction between project and concerned ministries. They further added that concerned officers of the government ministries could not contribute much in order to fully achieve this objective because of their frequent transfers to other ministries with different kind of responsibilities.

IO 3 – Promote gender equality in private sector employment

The representatives of BTA and BCSU pointed out the fact that positive gender discrimination and social protection in the formal private sector (e.g., tea gardens) had been gaining greater importance. Training programs for tea garden managers and trade union leaders had been useful in changing the attitudes of others, thus promoting gender equality in the formal private sector.

However, few women and men workers expressed their feelings that there was still an attitudinal problem of employers to provide services and facilitate women workers in both formal and informal sectors. One project staff said, “Although the project seemed able to enter the tea sector

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BCSU Training

(often called separate kingdom) and would create long-term opportunities, it has been able to produce very little impact in this sector”. However, a process has started and a platform for social dialogue also established, which will essentially create opportunities to bring about positive results in future.

IO 4 – Strengthen women’s participation and leadership in trade unions

Discussion with the informants concluded that women’s participation and leadership in workers’ associations/unions and decision-making bodies were increasing. According to the project staff, the project observed three distinct changes during its implementation as a result of the project intervention in the formal private sector. First, in the Panchayat Committee women’s participation has increased from 33% to 50%. Second, the number of women members in the Negotiation Committee has increased from four to five women members. Third, Trade Unions have been reviewing their 56 years old constitution.

The representatives of BTA, BCSU, partner NGOs, and project personnel shared their experiences that positive gender discrimination, social dialogue, women’s participation in the leadership and decision making positions were still lacking behind in the non-formal private sector (micro and small business/entrepreneurship) and that the project could not contribute much on this because of the short project timeframe.

Sub-Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB)

IO 1 & 2 – Increase the number of poor women and their families enjoying access to primary health care through existing and new micro health insurance schemes

The evaluation revealed that this component seemed largely successful in providing poor women’s groups with access to MHI services through upgraded health centers/clinics and increased number of policy cards. The project supported its partner organizations in upgrading their health centers by providing human, financial and physical resources. According to the data received during the evaluation, increased accessibility was demonstrated by increased number of policyholders. The policyholders increased from 31,700 in 2001 (pre project) to 75,900 in 2005. Number of patients’ visits in the clinic had also increased from 133,000 in 2001 (pre project) to 306,500 in 2005 benefiting about 380,000 persons (Table 1). Others (CCDA, DSK, and YPSA) have already registered 4,000 poor families under the MHI scheme and rendered services to 9,000 patients.

Partner NGOs reported that acceptance and participation by beneficiaries and communities remained a challenge, as the concept was completely new and involved prepayment before the health services were received. The target women had to buy policy cards for one year but many could not afford the policy card. It was also reported that both internal and external factors also limited the access to MHI services to the target groups. Internal factor such as difficulty to retain doctors in the rural health centers, and external factor like floods and droughts sometimes

Table 1: Number of Persons having Access to MHI Services

2001 2005 Number of MHIS policy card holders 31700 75 900 Number of patients visited in the Health Clinic 133000 306 500 Number of beneficiaries 380,000 Source: Project’s progress report

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adversely affected the speed and rate of policy registration and renewals, in particular the low renewal rates in the second and third year of the project.

IO 3- Increase awareness and knowledge of the concept and management of micro health insurance among policy makers, the ILO social partners, selected NGOs and local community members.

Awareness and knowledge of the MHI concept among policy makers, ILO social partners, selected NGOs and local community members on the concept and management of micro health insurance had significantly increased. The evaluation revealed that more and more NGOs/actors in the health sector were coming forward to introduce the MHI concept in their programs. Three NGOs had already replicated the concept. As far as the community members in the project areas were concerned the concept had been widely disseminated by the MHI partners through involving community people/leaders in meetings/forums and training. At the policy level the dissemination process was going on through participating in workshops and meetings organized by the project, partner NGOs, and other stakeholders. This was evidenced by the workshops organized by ICDDRB, institute of health economics, BRAC, GK, British Nicare/DFID, and the private and public actors.

The MHI Schemes had considerably provided opportunities to the rural poor women to have access to medical facilities at an affordable fee, thus contributing towards nation’s poverty alleviation programs (see table 1).

Line ministries, partner organizations, and community members noted that the project seemed relatively ineffective in identifying hard-core groups (poorest among the poor) and bringing them into the mainstream. One member of the line ministries clearly said, “Awareness of the new concept among the policy makers has not been fully increased”.


The MHI scheme had been an effective mechanism for providing health care services to the poor at the affordable fees especially in the rural informal economy. The concept and experiences of MHI schemes had been widely disseminated through various forums, exchange visits, videos, and dissemination of study reports both in and outside the country. The MHI experience was also disseminated at the recent ILO knowledge fair in Geneva and via ILO training workshops in Geneva, Nepal and India where participants from several countries shared experiences gained by this project. In Bangladesh, three NGOs (CCDA, DSK, and YPSA) had already replicated the concept in their working areas, thus contributing to knowledge development and advocacy (KDA).

Partner organizations (partner NGOs, replicating NGOs, BTA, BCSU) said, “Although the MHI concept is gaining popularity everywhere, many factors may hinder in its adaptation/replication. Most important factor is that it needs support to integrate with other programs because one may find very difficulty to implement this concept in isolation”. They shared their experiences that the MHI scheme had been easy to mange through blending it with other programs e.g., saving and credit. Therefore small organizations/NGOs, which had no supporting programs, might not be able to implement this concept in all situations.

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VII. Lessons Learnt

• Systems consideration (holistic approach) to bring synergic impact between health and economic activities was very essential for overall development.

• Longer and continuous financial and technical support to partner organizations was essential for achieving longer-term social goals and sustainability.

• Awareness and training were vital for promoting workers’ rights at work.

• Change in attitude was the first requisite towards applying the principles of decent work at the enterprise level.

• Community participation/involvement was very essential for the promotion of MHI concept.

• Interactions with stakeholders and their consensus were crucial at the project design phase.

• The WEEH project duration was adequate only for preparatory stage and had laid the foundation for achieving long-term social objectives.

• Good working condition was a pre-requisite for higher productivity and better quality, particularly in the tea sector.

• Since the project dealt with the “established” women’s groups, the achievement level seemed to be relatively low.

• The project, having special components such as workers’ rights, women empowerment and micro health insurance required support from many other sectors, at least for 2-3 years more.

VIII. Overall Conclusions

The overall findings indicate that the WEEH project largely achieved its main objectives. Partner organizations were implementing significant development activities in their local communities and a few were national and international leaders in their respective fields. These accomplishments were largely due to the WEEH project’s inputs. Another indicator of the WEEH project’s success was that many partner organizations had shown a strong likelihood of continuing their activities after the WEEH project's closure in September 2005. The partner organizations’ ability to network at both domestic and international levels, including funding sources, justified this conclusion. Moreover, all the partner organizations had submitted their sustainability plans and most can implement significant experiences and practices such as MHI scheme, PSI (particularly tea sector) and Women entrepreneurship development.

The women micro entrepreneurs were facing difficulties in receiving increased credit from partner NGOs. The initiatives under G&E component, to some extent, had been able to generate some income and address these difficulties that were usually not covered by the formal banks which was often referred to as the ‘missing middle’. Some women entrepreneurs with the support of partner NGOs had significantly expanded their businesses and were switching over from ‘income generating activities (IGA) to enterprise operations’.

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Women Entrepreneur

Entrepreneurs Development and Business Management (EDBM) training had significant positive impact on the development of management capacity and skills of the women entrepreneurs leading to larger scale of their enterprises, greater mobility in marketing products and increased self-confidence in managing their business and decision-making.

The MHI scheme had been an effective modality for extending health care services to the rural poor and was increasingly becoming popular among the development organizations in the health sector. Moreover, the WEEH project’s initiative towards providing quality healthcare services at affordable costs to poor people (particularly women) through micro health insurance had been an eye opener to many NGOs, especially to those involved in the health sector.

All three major components (MHI, PSI and Women entrepreneurship development) were new concepts and needed a longer duration to gain momentum and achieve sustainability. Sustaining these developments and further promoting the principles of ‘decent work’ demand continued follow-up, monitoring and training.

However, several factors limited the WEEH project from achieving greater success. First, the WEEH project provided too many services to too many diverse beneficiaries. The scope of the WEEH project's objectives, strategies and activities was too broad and somewhat complicated. Eventually, it could not focus on one or two core competencies. For example, while the WEEH project supported formal private economic sector (BTA and BCSU) as well as non-formal private economic sector (rural poor women entrepreneurs’ groups) it concurrently tried to assist large network organizations (e.g., BRAC and GK) and other NGOs. The diverse needs of the targeted beneficiaries supported by these disparate groups of partner NGOs cannot easily be satisfied by one support unit – the WEEH project.

Other factors that limited the WEEH project's success were directly under WEEH project's control. One example was occasional lack of follow-up and monitoring for training and workshop activities. Another hindrance was the confusion surrounding six-month contracts issued to collaborating NGOs. Such actions suggest unclear strategies for working with partner NGOs and lack of foresight regarding the sustainability of the project’s contribution.

In addition, on the one hand, substantial time was spent to looking for consensus from the stakeholders of the tea sector (especially for the WEDE component), on the other, some project strategies such as selection of implementing partners and selection of intervention sector (especially for the WEDE component), were executed too late. Consequently, the project had to merge some activities and postpone others.

One interesting observation was that all stakeholders expressed their disappointment about the WEEH project's closure in September 2005. While these comments partly reflect the short duration of the project discussed above, they also affirmed the WEEH project’s contribution. The partner NGOs felt positive about their experience with the project and were saddened by its impending closure.

Most stakeholders expressed their views that a more thorough assessment of the WEEH project's success would be gained by examining the partner organizations' as well as target beneficiaries’ groups’ situation in about five years from now. At that time it would be more appropriate to gauge the quality of services provided and ability shown to manage projects and secure funding independently by the partner NGOs and target groups’ livelihood. Nonetheless, current evidence

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suggests that most current partner organizations (including BTA and BCSU) will continue to provide their supports to target groups for few years.

IV. Recommendations

Decent employment is a new concept and it needs a longer duration to gain momentum and achieve sustainability in both the formal and informal private sector economies. In order to sustain the project’s interventions and further promote the principles of ‘decent work, continuous follow-up, monitoring and training are required. Refresher type of follow-up, spot monitoring and additional need-based training programs would help sustain the project interventions.

Although the project seems able to enter the private sector and create long-term opportunities to promote gender equity, it has been able to produce little impact in this sector. To quote a respondent, “I would mainstream the gender activities in a more generic way and only through experiential measures”. This suggests no explicit training on gender, but gender elements introduced through practical measures.

While the partner organizations want to expand the MHI scheme to the rural areas they need to integrate it with other programs. Small organizations/NGOs may find it difficult to implement this concept in all situations, and should be supported for at least another two to three years.

The target groups for the WEEH project implementation are poor women. In the work with indigenous people, it has proven very difficult to reach the poorer segments of poor women. Some women cannot even afford to buy a policy card. In such circumstances, one must ask the question how can the poorest of the poor participate in the MHI schemes? In response, partner organizations should take up the challenge of tackling the issue of “inclusion of exclusion”.

The combination of workers’ rights, women empowerment and micro health insurance should be considered as complementary, and an appropriate perspective to tackle poverty among rural poor women is required. The government of Bangladesh with a collaborative support of international organizations such as WHO and ILO should take lead role to extend MHI scheme to rural areas. Longer and continuous financial and technical support to partner organizations would be required for achieving longer-term social goals and sustainability.

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References

ILO, (2001). “Project Proposal on Women’s Empowerment through Employment and Health (WEEH).”

Mossige, A. & Ritchotte, J. (2003). “Report on Mid-Term Review”

Otobe, Naoko (2004). “Mission Report”

WEEH Project, (2004). “A Series of Status Report on Women’s Empowerment through Employment and Health (WEEH).”

WEEH Project, (2005). “Case Studies of BRAC & GK”

WEEH Project, (2005). “Project Implementation Status” Paper

WEEH/BASC, (2005). “Socio-Economic Impact Assessment of Interventions under the G&E Component.”

WEEH/CBSG, (2005). “Dynamics of Internal Migration to Tea Workers: Problems and Potentials to generate Employment”.

WEEH/ILO, (2002). “Tea Plantation Sector in Bangladesh: Socio-Economic Review”.

WEEH/ILO, (2004/5). “A Series of Technical Reports on WEEH Project”

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Appendices

Appendix 1: Terms of Reference FINAL EVALUATION OF THE PROJECT WOMEN’S EMPOWERMENT THROUGH EMPLOYMENT

AND HEALTH 05/0405

I. Project Description

Bangladesh, with a population of 128 million, is one of the poorest countries in the world. Some 50% of the population lives below the poverty line and 36% in extreme poverty. The majority (87%) of the labor force is employed in the informal economy in which most women’s invisible contribution to the economic development of the country is made. Women workers in rural areas are mostly engaged in agriculture as unpaid family helpers, day laborers and self-employed. Women’s limited access to education and skills training opportunities leaves women and girls ill prepared for entering the labor market; women’s wages are estimated on average to be about a third those of men. To combat poverty, women are increasingly seeking paid employment outside the home but, for women and men alike, opportunities for decent employment are very limited. Unemployment and especially under-employment are even more common for women than for men. Even though recent rapid growth in the ready-made garments sector has substantially expanded employment opportunities for women, decent formal sector jobs remain scarce. Direct and indirect discrimination against women is widespread. Sexual harassment and abuse of women in the workplace are reported to be common, and women are severely under-represented in decision-making positions in both public and private sectors, including in workers’ and employers’ organizations.

The Project Women’s Empowerment through Employment and Health is funded by the United States Department of Labor (USDOL) and executed by the International Labor Organization (ILO). Through a four-year grant the project was originally awarded $3,222,307, however, on September 24, 2004, the ILO submitted a budget modification reducing the project budget by $156,002 because the CTA was no longer on staff. Due to the budget decrease, the total project budget is $3,066,307. The project began 1 June 2001 and had an original end date of 30 September 2004. A time extension was submitted for the project, extending it until 30 September 2005.

The Women’s Empowerment through Employment and Health (WEEH) Program’s overall development objective is improved Socio-Economic Well-Being and Health for Women and their Families in Target Areas in Bangladesh. The project has two major sub-projects “Women’s Empowerment through Decent Employment” (WEDE) and “Micro-Health Insurance Schemes for Poor Rural Women in Bangladesh” (MHIB). Initially, the two components constituted two separate project proposals, which were merged at the request of USDOL. The WEDE sub-project has two main components: (i) The Gender and Employment (G&E) component aims to promote decent work in rural areas by promoting skill development and awareness raising and training for small enterprise development, new and improved income-generating activities and employment for poor rural women. The component is carried out in partnership with seven selected NGOs that will provide training and other support activities to the targeted women. These NGOs will also be provided training from the project. (ii) The Private Sector Initiative (PSI) component aims to promote decent work in the formal economy, tea plantations in particular, through training and awareness on gender and women’s rights at work, and supporting local dialogue between employers and employees. PSI also aims to influence the labor legislation of Bangladesh. The PSI component is carried out in partnership agreements with all key stakeholders in the tea sector: 1) Bangladesh Tea Association (under Memorandum of Understanding); 2) Tea Workers Trade Union/BCSU (contract); 3) Two service-providing organizations/NGOs (contracts). It may be noted here that, initially project had partnership with four NGOS, after the completion of first phase of collaboration (6 months), project decided to concentrate in the Moulvibazar district, where 50% of tea estates are located and continued with two NGOs. The MHIB sub-project has two main components: (i) The MHIS component aims to provide affordable and quality primary health care services for targeted poor rural women and their families through micro health insurance schemes (MHIS). The component tests different MHIS approaches and packages at new or upgraded health centers (HC) of two of Bangladesh’s main NGOs – Grameen Kalyan (GK) and BRAC. (ii) The Knowledge Development and Advocacy component aims to increase support for MHI policy makers and partner organizations and to promote the application of MHI best practices and lessons learned in Bangladesh.

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Immediate objectives for the project are: Project 1: Women’s Empowerment through Decent Employment (WEDE)

• IO 1 – Women’s fundamental right to decent employment enhanced • IO 2 – Respect for women workers’ rights in MoLE and MoWCA policies increased • IO 3 – Gender equality and social protection improved in private sector employment • IO 4 – Women’s participation and leadership in workers’ associations and decision-making bodies

increased Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB)

• IO 1 – Increased access to quality health care services for targeted poor women and their families through MHI, managed by Grameen Kalyan

• IO 2 – Increased access to quality health care services for targeted poor women and their families through MHI, managed by BRAC

• IO 3- Increased support for MHI from policy-makers and partner organizations • IO 4 – MHI best practices and lessons learned are applied in Bangladesh and beyond

A PMP was first developed for the project in October 2002. Following consultations with the national partner organizations, a final document was adopted in April 2003 with the following indicators: WEDE Component IO 1

• Women enrolled in WEDE enterprise development activities • Women attended skills and mgt training through WEDE • Women have better opportunities for decent work (Cumulative) • Women have better access to healthcare services (to primary health care through operation of MHIS) • Regular attendance of women’s children to school • Groups conducting meetings independently • Groups maintain their own group level records independently • Groups perform other activities, like conflict resolution, problem solving independently

IO 2

• WEDE initiated meetings / workshops/major briefings with participation from MoLE/ DoL/ MoWCA/PLAGE officials organized

• Concrete actions in gender sensitisation and/or EEO carried out by MoLE or MoWCA (e.g. monitoring/inspection format & IRI curriculum reviewed and gender issues included

• MoLE endorses 3 key gender-sensitive instruments (e.g. improved monitoring /inspection format & IRI curriculum)

IO 3

• WEEH partners (or garden mgt) are in agreement on starting to implement gender issues • WEEH partner mgt carry out social protection actions benefiting women workers • Target workers in the WEEH partner gardens claim to have benefited (from above actions) • Increase of number of women in: • Union structures (formal and informal) • Decision-making (these includes Mother’s Club members, Panchayet members & women trainers of

BCSU etc.) • Men actively promote women in leadership position and gender equality • Management implements plans developed by workers

MHIB Component

IO 1 • Health care service utilization rate among MHIB/GK enrolees increased (by 5% annually) • Reduction of deliveries with complications at MHIB/GK Health Centres • Average infection rate after deliveries at MHIB/GK Health Centres is not more than 5% • MHIB/GK-assigned prescription medicines is available in stock of all operating Health Centres IO 2 • Health care service utilization rate among MHIB/BRAC enrolees increased (in general health service

packages) • Increase women enrolled in MHIB (pre paid) pregnancy package programme, and receiving services

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• Reduction of deliveries with complications at MHIB/BRAC Health Centres • Average infection rate after deliveries at MHIB/BRAC Health Centres is not more than 5% • Prices for BRAC provided medicines to MHIB beneficiaries is maintained at 80% of market prices • 45 communications and interactions in which MHI/STEP is explained with partners (other than BRAC

and GK) • Partners initiate and/or facilitate their members’ access to STEP/MHI schemes • National health policy (i.e. the Health Policy Strategy Paper) reflects inclusion of MHI • MHI promotional messages and activities presented in the media • Dissemination of STEP/MHIB materials to other organizations and 5 other “STEP countries” • Organizations put at least 1 MHI “best practice” or “lesson learned” in to action

II. Purpose of Evaluation

The purpose of the final evaluation is to:

a) determine if the project has achieved its stated objectives and explain why/why not; b) assess and document the effects of project activities and outputs on target groups; c) assess the likelihood of sustaining project outputs; d) report on lessons learned

To achieve the evaluation’s purpose, the Evaluation Team shall examine the following key evaluation questions (see Section III below):

• Validity of project strategy, objectives and assumptions • Impact/benefits accrued to the target groups • Implementation status, specifically as concerns planned activities, materials, schedule and budget • Sustainability of project results • Effectiveness of management performance by DOL, ILO, CTA and NPCs • Effectiveness of project performance monitoring • Stakeholder buy-in, support and participation in the project • Efforts of the stakeholders to achieve sustainability of the project and its activities

In addition, the final evaluation should identify lessons learned from project implementation that might inform the potential design and implementation of similar projects in the future. III. Suggested Key Evaluation Questions (sample questions in italics)

The final evaluation will:

1. Evaluate the validity of the project strategy, objectives and assumptions

Were the strategy, objectives and assumptions valid at the time of project preparation? Did they remain valid throughout the project’s lifetime?

2. Assess impact/benefits accrued to target groups

What was the quality and impact of project activities on beneficiaries?

3. Evaluate final implementation status, specifically as concerns planned activities, materials, schedule and budget

Were activities completed on time and on budget? Were materials produced under the project well received by project partners/beneficiaries?

4. Sustainability of project results

Evaluate the project’s sustainability plan. What project components or results will likely be sustained over time, how and by whom?

5. Assess the effectiveness of management performance by DOL, ILO (DECLARATION and AO), CTA and NPM and NPCs, specifically as concerns project staffing and communications

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How well did the project manage its personnel? How did the project communicate with its stakeholders? How well did the project manage its finances? Do partners feel the project met their needs in terms of services and participation in project planning?

6. Effectiveness of project performance monitoring

What type of project performance monitoring system was used? What data was collected and how? Was this system cost-effective, practical and useful to project management? Was the data that has been collected reliable?

7. Discuss lessons learned. IV. Project Framework and Current Status The mid-term evaluation was carried out between 6 and 11 October 2002. Recommendations provided in the mid-term review are as follows:

• At least a one-year extension of the PSI, the G&E, and the MHIB advocacy components; to enable the WEEH project to achieve more results, target more women beneficiaries, and ensure a greater sustainability of project achievements. The project was extended on two occasions, initially to December 2004 and eventually to September 2005.

• ILO and in particular STEP should investigate possibilities for following up GK’s and BRAC’s MHIS activities after the closing of this component. The project is pursuing with all of its partner organizations including GK and BRAC to define/make sustainability plan of their own. The ILO, through STEP is exploring the options of continuing the scheme. Further funding from potential donors is also being sought with the project’s assistance.

• The project team should make the necessary modifications of the PLF to ensure that the indicators and

outputs are more consistent with the actual project activities. The PLF was not re-visited; however a PMP was developed following the mid-term evaluation and is updated periodically.

• The project management should follow-up its proposal to invite the Policy Research Department of MoH

and MoWCA’s PLAGE project to attend the PAC meetings as observers to strengthen their participation in the project. These units are now attending in PAC meetings and are participating actively in the project.

• The proposed PITFs should only be advisory bodies and should only meet every three months, as stated in

the Project Document, and not every month as PAC has suggested. The PITFs role is advisory. The proposed three monthly meetings are however difficult to organize due to the frequent transfer of concerned government (ministry) officials, leading to institutional memory loss and time required to update new officials.

• The project should involve ILO’s Social Dialogue, Normes and Sectoral Activities Departments, when

appropriate, for support to the PSI component. This is taking place. As recently as March 2005, ILS training was organized under the project for MOLE and DOLE officials and conducted by officials of NORMES

• While the project enjoys political support from the AO, it would benefit from increased administrative

facilitation and support, specifically in the approval of contracts, but in other areas as well. Synergies could be found from increased collaboration, facilitated by the AO, among the three Declaration projects, IPEC and other ILO projects.

30

Initially there were problems of coordination between the project and the AO. This has since changed and is now running smoothly. Cooperation is however limited to administrative and financial support. Relationships with other projects on the ground is good, but this is also limited to informal relations. Professional sharing is weak.

• The implementation of MHIB’s advocacy component should be sped up, in particular with regard to MHI

advocacy at the level of policy makers and partner organizations At the grass root or partners level the advocacy component is more successful than that of policy level. Three partners of G&E components have replicated/introduced the MHI system. Many more are asking for the support. Because of some ‘superiority’ complex (in-fighting between the ministries), bureaucracies and attitudinal problems, it was very difficult to form a PITF for MHI component. However, after a momentum was built up, officials of the health ministry became interested, but subsequently the relevant officials in both of the ministries (health and labour) got transferred

• The project’s PLF should reflect the fact that the G&E component’s achievements are more related to skill

development and income generation than to job creation. This has been reflected accordingly in the relevant monitoring reports. However, also noted in the reports in the fact that when the enterprise expanded after the training, additional jobs were automatically created.

• The PSI component should concentrate its efforts in the tea sector; concerning labor legislation the PSI

should examine future actions that will be involved in the labor provisions and look for possibilities for influencing these. The PSI component has been dealing primarily with the tea sector focusing on the development of women leadership (among the workers) and awareness about legislation for all stakeholders, ranging from workers, managers/employers to government. A new SPROUT is being discussed between ILO HQ (Dialogue) and the SRO New Delhi, India which will presumably be developed based on the experience we gained so far.

V. Evaluator An independent evaluator with specific skills in international project evaluation, familiar with international project implementation, and preferably with experience in South Asia, will carry out the evaluation. VI. Evaluation Team The evaluation team will be comprised of: (i) an independent evaluator and (ii) one representative from the ILO. The independent evaluator shall serve as the team leader of the evaluation team. The Team Leader is responsible for conducting the evaluation according to the terms of reference (TOR). He/she will:

• Review the TOR and provide input, as necessary; • Review project background materials (e.g., project document, progress reports). • Review the sample evaluation questions and work with the donor and ILO/DECLARATION to

develop/refine questions, as necessary; • Develop and implement an evaluation methodology (i.e., conduct interviews, review documents) to answer

the evaluation questions; • Conduct preparatory meeting with USDOL, ILO/DECLARATION and WEEH NPM prior to the

evaluation mission; • Prepare an initial draft of the evaluation report, circulate it to USDOL and ILO/DECLARATION for

comments, and prepare final report; and • Participate in Post-Trip Debriefing.

The USDOL Project Manager is responsible for:

• Drafting the evaluation TOR; • Finalizing the TOR with input from the ILO/DECLARATION and the evaluator; • Providing project background materials; • Participating in preparatory meeting prior to the evaluation mission;

31

• Assist in the implementation of the evaluation methodology, as appropriate (i.e., participate in interviews, review documents, observe committee meetings) in a way as to minimize bias in evaluation findings.

• Reviewing and providing comments of the evaluation report; • Approving the final draft of the evaluation report; and • Participating in Post-Trip Debriefing.

ILO is responsible for:

• Reviewing the TOR and providing input, as necessary; • Providing project background materials; • Reviewing the evaluation questions and working with the donor to refine the questions, as necessary; • Participating in preparatory meeting prior to the evaluation mission; • Scheduling all meetings for the field visit; • Assist in the implementation of the evaluation methodology, as appropriate (i.e., participate in interviews,

review documents, observe committee meetings) in a way as to minimize bias in evaluation findings; • Reviewing and providing comments on the draft evaluation report • Participating in Post-Trip Debriefing

VII. Evaluation Methodology Document Review. The evaluator will review the following documents before conducting any interviews or trips to the region.

• Project Document • Quarterly reports • Reports from events • Training Materials from the events • Trip Reports • Mid-term evaluation report • Strategic Framework and PMP • Work plans • Any other relevant documentation

Pre-Trip Meeting. The evaluator will have a pre-trip meeting (via conference call) with the USDOL Project Manager, OFR Evaluation Coordinator, ILO/DECLARATION and field project staff. The objective of the pre-trip meeting is to reach a common understanding among the evaluator, USDOL and ILO/DECLARATION regarding the status of the project, the priority evaluation questions, the available data sources and data collection instruments and an outline of the final evaluation report The following topics will be covered: status of evaluation logistics, project background, key evaluation questions and priorities, data sources and data collection methods, roles and responsibilities of evaluation team, outline of the final report. Individual Interviews. Individual interviews (either in person, via telephone, or via e-mail) will be conducted with the following:

a. USDOL present and past Project Managers (Tia Gonzalez and Zhao Li) in Washington b. ILO/DECLARATION Staff and other ILO Geneva staff involved with the project WEEH project personnel and ILO Area Office Dhaka staff and selected individuals from the following groups: • (Community people) Workers, employers and NGOs who have been involved in the project • Members of the Project Advisory Committee • Labor Ministry and Women’s Ministry staff who have worked with the project • Consultants who have worked with the project • Beneficiaries of the project • UNDP (if applicable) • US Embassy

Field Visit. Meetings will be scheduled in advance of the field visits by the ILO project staff, in accordance with the evaluator’s requests and consistent with these terms of reference. The evaluator will determine if it is appropriate for the other evaluation team member and/or field project staff to participate in each of the scheduled interviews. Debrief in Field. On the final day of the field visit, the evaluator will present preliminary findings, conclusions, and recommendations to the ILO Area Office and project staff and possibly include employer, government, and union representatives.

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Post-Trip Meeting Upon completion of the draft report, the evaluator will provide a debriefing to ILAB and ILO/DECLARATION on the evaluation findings, conclusions, and recommendations as well as the evaluation process, via either Conference Call or e-mail. VIII. Duration and Milestones of Evaluation

The following is a schedule of tasks and anticipated duration of each:

Tasks No. of Days Preparatory Research (document review, pre trip conference call and interviews)

3 Before trip

Field Research 7 13-21 July 2005 Travel days 3 Draft Report 6 1 August 2005

Post Trip Meeting 1 3 August 2005 Finalization of Document 3 12 August 2005 IX. Deliverables A. Pre-Evaluation Trip meeting with Evaluation Team Leader, USDOL project manager, OFR Evaluation

Coordinator, ILO/DECLARATION and WEEH project staff to discuss roles, responsibilities, and TOR by 20 June 2005.

B. Interviews with USDOL staff between 4-8 July 2005. C. Draft Report by 1 August 2005 D. Post-Trip Debriefing with USDOL and ILO/DECLARATION by 3 August 2005 E. A Final Report, original plus 5 copies, will be submitted to USDOL by 12 August 2005 after receiving final

comments from USDOL and ILO/DECLARATION. The final report should also be submitted to USDOL and ILO/DECLARATION electronically.

X. Report The evaluator will complete a draft of the entire report following the outlines below, and share electronically with the USDOL Project Manager, OFR Evaluation Officer and the ILO member of the evaluation team by 1 August 2005. USDOL and ILO will have 5 working days to provide comments on the draft report. The evaluator will produce a re-draft incorporating USDOL and ILO comments where appropriate, and provide a final version by 12 August 2005. The final version of the report will follow the format below (page lengths by section illustrative only) and be no more than 20 pages in length, excluding the annexes:

1. Title page (1) 2. Table of Contents (1) 3. Executive Summary (2) 4. Acronyms (1) 5. Background and Project Description (1-2) 6. Purpose of Evaluation (1) 7. Evaluation Methodology (1) 8. Project Status (1-2) 9. Findings, Conclusions, and Recommendations (no more than 20 pages)

This section’s content should be organized around the TOR questions, and include the findings, conclusions and recommendations for each of the subject areas to be evaluated.

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Appendix 2: List of persons met during the evaluation

ILO Dhaka Office (13.07.2005) 1. Mr. Gopal Bhattacharya, Director 2. Mr. Saidul Islam, Program Assistant 3. Mr. Abul Quashem, Admin and Finance Officer

Partner NGOs (14.07.2005) 1. R.P. Boonerjee President, BCSU 2. Bijoy Boonerjee J.G. Secretary, BCSU 3. Peter R. Bala. Area Manager, Heed Bangladesh, Kamalgonj 4. Sylvester Halder, Associate Executive Director. Heed Bangladesh 5. Yasmin H. Ahmed Director, Mari Stops Clinic 6. M.H Chowdhury Manager, Service Mari Stops Clinic 7. Mohiuddin Ahmed, Coordinator, IDF 8. Abu Saleh Md. Jarzis P.c WEDE Project, 9. Bhupesh Roy, Coordinator, PME, GBK 10. Hamidul Islam Coordinator, DSK 11. Dibalok Singho Executive Director, DSK 12. Sajjad Hossain APC. WEDE Project, SSS Tangail 13. M.A. Latif Miah DY.Director, SSS 14. Md. Rafiqul Islam PC WEDE Project CCDA 15. Md. Shahjahan PC WEDE Project 16. M.A. Samad Executive Director, CCDA 17. M.A Bari Program Manager, CCDA 18. Mohammad Shahjahan Program Officer, YPSA 19. Dr. Mohammad Raisul Haque Senior Sector Specialist, BRAC Health Program 20. Dr. Anjan Kumar Roy National Project Coordinator, MHIB, BRAC 21. Shaikh Abdud Daiyan Managing Director, Grameen Kalyan 22. Dr. Md. Nazimuddin Training Coordinator, Grameen Kalyan

Project staff (15.07.2005) 1. Mr. Syed Khairul Islam NPM, WEEH 2. Mr. Md. Abul Quashem NPC, MHIB/WEEH 3. Mr. Aminur Rahman Training cam Monitoring Specialist, WEEH 4. Ms. Hasina Inam NPC, PSI/ WEEH 5. Mr. Kawser Admin and Finance Officer, WEEH

Bangladesh Cha Sramik Union (BCSU), Srimongal, 17.07.05 1. Mr. R.P. Boonerjee, President, BCSU 2. Ms. Nobina Tati, President, Kalighat Tea Estate Panchayet 3. Ms. Kumari Mirdha Member, Kalighat Tea Estate Panchayet 4. Ms. Chaya Bunerjee Vice-President, Rajghat Tea Estate Panchayet 5. Mr. Babul Chasa Vice-President, Baraoorha Tea Estate Panchayet 6. Ms. Rajkumari Hazra Asstt. Secretary, Baraoorha Tea Estate Panchayet 7. Ms. Saroda Tati Member, Kalighat Tea Estate Panchayet 8. Ms. Bobita Tati Asstt. Secretary, Kalighat Tea Estate Panchayet 9. Mr. Obanchito Tati President, Rajghat Tea Estate Panchayet 10. Mr. Karno Tati Secretary, Kalighat Tea Estate Panchayet 11. Mr. Ranjan Gosammi Secretary, Baraoorha Tea Estate Panchayet 12. Ms. Basonti Gowala Vice-President, Rajghat Tea Estate Panchayet 13. Ms. Nirmola Devi. Program Organizer, BCSU and Trainer 14. Ms. Gita Gosammi Asstt. Secretary, BCSU and Trainer 15. Mr. Sayta Naya Naidu Deputy Branch Incharge, BCSU and Trainer 16. Mr. P.S. Baroik Branch Incharge, BCSU and Trainer 17. Mr. Bijoy Bunerjee, Joint General Secretary,BCSU and Trainer

Marie Stopes Clinic Bangladesh: Srimongal, 17.07.05 1. Dr. Mohammad Hossain Chowdhury, General Manager (Services) 2. Dr. Rafiqun Nahar Pervin, Medical Officer, Srimongal Clinic 3. Mr. Md. Zakir Hossain, Progeamme Officer, Srimongal Clinic 4. Ms. Shamima Akhter, Paramedic

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5. Ms. Nirmola Devi, Union worker and Volunteer

Nondorani Tea Estate, Srimongal, 17.07.05 1. Mr. Bappi, Director (Tea estate owner), M.R. Khan Group 2. Mr. Zhiruddin Ahmed, Manager, Nondorani Tea estate 3. Ms. Joymoni Gar, Tea worker, direct beneficiary, Nondorani Tea Estate 4. Ms. Aroti Chettry, Tea worker, direct beneficiary, Vice president of Nondorani Tea Estate

Panchayet 5. Mr. Kanto Tanti, Family member of a beneficiary 6. Mr. Tota Hajra, Family member and Secretary of Nondorani Tea estate panchayet 7. Ms. Rita Boonerjee, Volunteer, Marie Stopes PSI activities

HEED Bangladesh, Adampur, Komolganj, Srimongal, 17.07.05 1. Mr. Piter Bala, Area Manager, HEED Komolganj 2. Mr. Dinesh Sinha, HEED PSI Project Coordinator 3. Ms. Majida (Entrepreneur) 4. Ms. Sujata (khukumoni) 5. Ms. Firoja (Entrepreneur group leader) 6. Ms. Rashida (Entrepreneur

Bangladesh Tea Association (BTA), Srimongal, 17.07.05 Mr. M. Wahidul Haque, Chiarman, BTA

HEED Bangladesh, Mangalpur (Monipuri group), Srimongal, 18.07.05 1. Ms. Chandra Gini, (Entrepreneur) 2. Ms. Dinaboti, (Entrepreneur) 3. Ms. Minoty, (Entrepreneur) 4. Ms. Rohini, (Entrepreneur) 5. Ms. Tapasi, (Entrepreneur) 6. Ms. Anidra, (Entrepreneur) 7. Ms. Padmabati, (Entrepreneur) 8. Ms. Kunjabati, (Entrepreneur) 9. Ms. Sanoi Sinha, Group Leader

BRAC Sushashto (Health Centre), Madhabdi, Norshingdi, 18.07.05 1. Ms. Sobmeher, Card holder 2. Ms. Sahera, Card holder (ultra poor) 3. Ms. Najma, Pre paid pregnancy card holder 4. Dr. Moniruzzaman, Sr. Medical Officer 5. Dr. Taslima Akhtar, Medical Officer 6. Dr. Shampa Saha, Medical Officer

BRAC Satellite Centre, Birampur, Norshigdi, 18.07. 05 1. Dr. Anjan Kumar Nag, NPC 2. Mr. Md. Nazimuddin, Team Coordinator, MHI 3. Ms. Taslima Begum, Health Worker 4. Ms. Sahnaj, Pre paid pregnancy card holder 5. Ms. Naznin, Card holder 6. Ms. Aklima, Card holder 7. Ms. Shabana, Card holder 8. Ms. Rojina, Card holder

Grameen Kalyan, Shah rail Health Center, Singair (19.07.2005) Staff

1. Dr. Sonamoni Duth Centre Director 2. Dr. Md Nazimuddin Head Officer 3. Abu Naeem Sarder Regional Manager 4. Shahiduzzaman Office Manager 5. Rina Rani Roy Para Medic (RoP) 6. Santosh Kumar Suthradhar Asst. Officer (Lab) 7. Shahadat Hossain Medical Technologist (Lab) 8. Jahanara Kanchi Health Assistant 9. Afroza Akhtar Health Assistant 10. Shahrina Akhtar Health Assistant 11. Rahima Akhtar

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12. Md. Tajbinur Rahman 13. Mustafizur Rahman

Patients 14. Golapi 19. Firoza Akhtar 15. Rasheda Akhtar 20. Hazera Akhtar 16. Baharjan 21. Zasmeen Akhtar 17. Rasheda Akhtar 22. Afroza Akhtar 18. Shaheda Akhtar

Line Agencies and PAC members (20.07.2005) 1. ABM Abdus Sattar Joint Secretary, MoLE 2. Md. Shafiqur Rahman Bhuiya Dep. Chief, MoLE 3. Md. Humayen Kabir Asst. Chief, MoLE 4. Md. Shahadat Hossain, Senior Asst. Secretary, MoHLW 5. Mrs. Rowshan Ara Joint Secretary, MoWCA 6. Dr. S.M.Ali Akkas Project Director, PLAGE, MoWCA

DSK, Dhaka (20.07.2005)

Staff 1. Khabirul Haque Kamal 2. Tofayel Ahmed 3. Dr. Zinat Riahana

Patients 1. Nasima 2. Ashma 3. Parvin 4. Nurjahan 5. Ajmiri 6. Firoja 7. Taslima 8. Shahana 9. Ruma

G&E Entrepreneurs 1. Alea 2. Lucky 3. Ajmaari 4. Lily Biswas

Consultants 1. Mr. Shahadat Hossain, Freelance 2. Mr. S. Hossain, BIM

Participants of Presentation on Preliminary Findings (21.07.2005) 1. Mr. Gopal Bhattacharya, Director 2. Mr. Saidul Islam, Program Assistant 3. Mr. Abul Quashem, Admin and Finance Officer 4. Lisa Wong Ramesar ILO. Geneva 5. Syed Khairul Islam NPM, WEEH 6. Md. Abul Quashem NPC, MHIB/WEEH 7. Aminur Rahman Training cum Monitoring Specialist, WEEH 8. Hasina Inam NPC, PSI/ WEEH 9. Mr. Kawser Admin and Finance Officer, WEEH 10. Mr. Dil Prasad Shrestha, Evaluator

ILO staff 1. Naoko Otobe, Senior Employment and Gender Specialist, EMP/STRAT, ILO Geneva 2. John Ritchotte, Technical Cooperation Manager, DECLARATION, ILO Geneva 3. Coen Kompier, Specialist International Labour Standard, ILO New Delhi 4. Lotta Nycander, Hagagatan 10, 113 48, Stockholm, Sweden. 5. Lisa Wong Ramesar, Technical Cooperation Officer, ILO Geneva

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Appendix 3: Project Monitoring Plan (PMP) - MHIB

Project Time Frame Means of Verification

Frequency of Data

Collection Baseline Situation

2002 2003 2004 2005 Performance

Indicator Year Value Planned Actual Planned Actual Planned Actual Planned Actual,

June 05

Immediate Objective 1: Increased access to quality health care services for targeted poor women and their families through MHI, managed by Grameen Kalyan

Health care service utilization rate among MHIB/GK enrolees increased (by 5% annually).

2001 132,000

5% 138,500

1%

133,236

10%

145,000

11% 146,000

21%

160,000

85%

244,000

127% 300,000 (Jan-Dec

2005)

112%

280,0006

Patient register Monthly

Reduction of deliveries with complications at MHIB/GK Health Centres

2003 9% - - 8% 7% 4% 3% 3% 1%

Birth & referral register (to be further analyzed)

Monthly

Average infection rate after deliveries at MHIB/GK Health Centres is not more than 5%

2003 5% - - - 5% 4% 3% 3% 1% Birth & referral register

Monthly

MHIB/GK-assigned prescription medicines is available in stock of all operating Health Centres

2001 79% 85% 83% 85% 83% 85% 85% 85% 90% Patient register Monthly

Immediate Objective 2: Increased access to quality health care services for targeted poor women and their families through MHI, managed by BRAC (a) Health care service utilization rate among MHIB/BRAC enrolees increased (in general health service packages).

2001 1000

1100% 12000

1160% 12600

1400% 15000

1286% 13860

1600% 17000

1660% 17600

1900% 20000

2000% 210007


(b) Increase women enrolled in MHIB (pre paid) pregnancy package programme, and receiving services

2002 0

(Enrolment) 0 0 1000 1291 1500 1822 0

08


Reduction of deliveries with complications at MHIB/BRAC Health Centres

2001 10% 8% 6% 5% 5% 4% 3% 3% 2%

Patient register (to be analysed further)

Monthly

6 (Including estimates for July-Dec 2005) 7 (Including estimates for July-Dec 2005) 8 (Enrolment was stopped because of discontinuation of project support from 1st July-05)

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Project Time Frame Means of Verification

Frequency of Data

Collection Baseline Situation

2002 2003 2004 2005 Performance

Indicator Year Value Planned Actual Planned Actual Planned Actual Planned Actual,

June 05

Average infection rate after deliveries at MHIB/BRAC Health Centres is not more than 5%

2001 7% 6% 5% 3% 4% 3% 4% 2% 2% Birth and referral register

Monthly

Prices for BRAC provided medicines to MHIB beneficiaries is maintained at 80% of market prices

2001 85% 85% 86% 85% 85% 85% 85% 85% 85% Sales Register Monthly

Immediate Objective 3: Increased support for MHI from policymakers and partner organizations 45 communications and interactions in which MHI/STEP is explained with partners (other than BRAC and GK)

2001 10 30 60 65 75 80 80 50 30 Notes and Correspondence

Throughout

Partners initiate and/or facilitate their members’ access to STEP/MHI schemes

2001 2 5 8 10 10 12 11 5 5 Filed Monitoring Throughout

National health policy (i.e. the Health Policy Strategy Paper) reflects inclusion of MHI

2001 (Not exactly MHI, but introduction of user fee)

MHI promotional messages and activities presented in the media

2001 0 2 1 3 3 3 3 5 5 Newspaper/video Over the year

Immediate Objective 4: MHI best practices and lessons learned are applied in Bangladesh and beyond Dissemination of STEP/MHIB materials to other organizations and 5 other “STEP countries”

2001 0 10 8 15 20 10 5 10 15

Despatch Register/Distribution list/ILO knowledge fair-2005

Throughout

Organizations put at least 1 MHI “best practice” or “lesson learned” in to action

2001 0 2 1 4 5 5 4 7 69 Exchange visits/ reports

Throughout

9 For example workshops organized by ICDDRB, Institute of Health Economics, BRAC, GK, Nicare/DFI, HEED, YPSA, DSK & CCDA

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PMP - WEDE-G&E component

Project Time Frame Baseline Situation 2002 2003 2004 2005 Performance

Indicator Year Value Planned Actual Planned Actual Planned Actual Planned Actual, June 05

Means of Verification

Frequency of Data

Collection

Immediate Objective 1: Women’s Fundamental right to decent employment enhanced Women enrolled in WEDE enterprise development activities

2001 0 300010 3250

4000

4200 4200 4200 4200 4238 Progress Reports by NGOs

Monthly

Women attended skills and mgt training through WEDE

2001 0 750 750

1500

1500 1500 1500 2500 423811 Progress Reports by NGOs

Monthly

Women have better opportunities for decent work (Cumulative)

2001 0 200 100

1300

300 2500 1000 2500 2500

Special Report, field visits (Field Monitoring)

Periodic/ Occasional

Women have better access to healthcare services (to primary health care through operation of MHIS)

2001 30% 45% 30% 70% 40% 70% 60% 70% 91% Progress Reports by NGOs

Monthly

Regular attendance of women’s children to school

2001

85% (Estimated)

70% 70% 85% 85% 90% 86% 90% 88%

Baseline survey, Field Monitoring, Observations

Periodic

Groups conducting meetings independently

2001 0 3% 3% 10% 6% 10% 7% 20% 10% Progress Reports by NGOs

Monthly

Groups maintain their own group level records independently

2001 0 1% 1% 5% 2% 5% 3% 5% 5% Progress Reports by NGOs

Monthly

Groups perform other activities, like conflict resolution, problem solving independently

2001 10% 10% 7% 15% 10% 20% 15% 20% 20%

Special Report by NGOs and Field Monitoring

Periodic

PMP - WEDE-PSI component

Project Time Frame Baseline Situation 2002 2003 2004 2005 Performance

Indicator Year Value Planned Actual Planned Actual Planned Actual Planned Actual, June 05

Means of Verification

Frequency of Data

Collection

Immediate Objective 2: Respect for women workers’ rights in MoLE and MoWCA policies increased

10 Original PP target was 1000 11 On average, each member got more than two types of training

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WEDE initiated meetings / workshops/major briefings with participation from MoLE/ DoL/ MoWCA/PLAGE officials organized

2001 0 60 109

30

10 25 15 50 55 Meeting minutes, letters, Progress report

Quarterly

Concrete actions in gender sensitisation and/or EEO carried out by MoLE or MoWCA (e.g. monitoring/inspection format & IRI curriculum reviewed and gender issues included

2003 0 0 0 3 0 0 0 0 0

MoLE endorses 3 key gender-sensitive instruments (e.g. improved monitoring /inspection format & IRI curriculum)

2003 0 0 0 3 0 0 0 0 0

Immediate Objective 3: Gender equality and social protection improved in private sector employment (Tea Sector) WEEH partners (or garden mgt) are in agreement on starting to implement gender issues

2001 0 0 0 0 0 50% 50% 60% 60%

Seminar Report BTA Workshops Reports

Occasionally

WEEH partner mgt carry out social protection actions benefiting women workers

2001 0 0 0 0 30% 15% 40% 25% Special reports

Occasionally

Target workers in the WEEH partner gardens claim to have benefited (from above actions)

2001 0 0 0 0 0 50% 25% 60% 40% Special reports, Field visits

Bi-annual

Immediate Objective 4: Women’s participation and leadership in workers’ associations and on decision-making posts increased. Increase of number of women in:

Union structures (formal and informal)

Decision-making (these includes Mother’s Club members, Panchayet members & women trainers of BCSU etc.)

2001 30 30 30 100 160 200 180 250 230 Progress report

Monthly

Men actively promote women in leadership position and gender equality

2001 0 0 0 0 0 40 33 75 60 Special Report, discussion meetings etc

Quarterly

Management implements plans developed by workers.

2001 0 0 0 0 0 2 0 0 0

Collective bargaining agreement between BTA and BCSU

Occasional (every two years)

Final Evaluation of WEEH Project, Bangladesh 40

Appendix 4: Interview questions and summary responses Target women group members (set 1) and target groups’ family members (set 2) Questions Summary of responses

What type of services did you receive from WEDE project?

a. Various trainings (awareness, A/C keeping, EDBM, marketing, decent work, skills development, group management etc)

b. Business promotional support (display and sales centers, business advisory services, marketing links etc)

c. Study visits Were training useful?

Yes 11 No • Before no idea about marketing, how to do business • Understood the roles and responsibility of workers and employers/ • Knew health and family planning, management of garden, labor law, workers’ rights, drugs

addiction, children education, decent work, • Jointly solved the problems with the labor leaders • Participation in social activities • Linkages developed with marketing and others

Do you think that your livelihood has improved?

Yes. 1,9 No. If yes, please explain how? Involved in decision making, getting more respect from family members, participated in social activities, three times income increased.

Are you aware of women’s fundamental rights to decent employment?

Yes. 1,9, No.

To what extent are women employed in the private sector particularly after the implementation of WEDE project?

a. Largely 1,9 b. To some extent c. Very little d. Not at all Before only for self employment, now created opportunity for others too.

Are you a member of any workers’ associations?

Yes. No. If yes, what is your position? a. President b. Vice President. C. Secretary/Treasurer d. General Member

Questions Summary of responses What services did you receive from partner NGOs? a. …….

b. …… Are you satisfied with the services (in terms of quality, effectiveness) provided?

Yes. No If no, why? Please explain. ………..

What sorts of problem did you face during project implementation?

• Getting bigger amount of loan • Owner doesn’t like union, do not get OT (money for overtome) • Family problem for giving more time in unions

What are the major lessons learned from the WEEH project?

• Training have been more useful for us • Earning more now and enjoying freedom • Learning is important • Before no dialogue with the managers

What suggestions do you like to provide for WEEH project?

• Needs more loans to do big business. • Needs water for gardens • Training should be more than three days • Needs training for other gardens • Needs more business management training • Needs to increase loan ceiling

Employers, Association (set 3) Questions Summary of responses WEDE: What type of services did you receive from WEDE project?

a. Technical help (expert, capacity development.) b. Workshop/training (on corporate ethics, laws and regulations, health and safety, ILO standard, gender, workplace, hazards ..) c. Exposure visits


Do you think that your livelihood has improved?

Yes. 1 No. If yes, please explain how? Increased awareness Empowered women workers Increased use of latrines, nutritious food etc

Are you aware of women’s fundamental right to decent employment? Yes. 1 No. To what extent are women employed in the private sector particularly after the implementation of WEDE project?

a. Largely 1 b. To some extent c. Very little d. Not at all Women workers are consulted by the managers

Questions Summary of responses MHIB: What services did you receive from partner NGOs? NA Are you satisfied with the services (in terms of quality, effectiveness) provided? NA Do you see the possibility of use and adaptation of the exp. Of the project ..?

Yes, social dialogue, exchange of informal sharing at corporate and management levels

Question Summary of responses WEEH Overall evaluation: Were the strategy, objectives and assumptions valid at the time of project preparation?

Not consulted

Did they remain valid throughout the project’s lifetime What did you see the effect/impact of project activities on beneficiaries? Gender issue has been focused

Awareness creation Were activities completed on time and on budget? NA Were materials produced under the project well received by project partners/ beneficiaries?

NA

Which activity(ies) supported by the project will likely be sustained over time, how and by whom?

Social dialogue, MHI Shemes

How do you assess the effectiveness of project management? Satisfactory Receptive, eager

How well did the project manage its personnel? NA How did the project communicated with to and from its stakeholders? NA How well did the project manage its finances? NA What type of project performance monitoring system was used? NA What data was collected and how? NA Was the data that has been collected reliable? NA What sorts of problem did you face during project implementation?

• Alternative job has not been taken seriously • Consultation at the initial phase was rather week • We cannot train and do anything to Mother health • There is still gap for second generation • Project deals with social aspects, but timeframe is 3/4 years. How is it possible to

achieve the objectives? What are the major lessons learned from the WEEH project? Corporate ethics is very important What suggestions do you like to provide for WEEH project?

• If ILO has to hire consultants and experts, it should be focused on the social issues, experience with the similar situation of the experts. If it needs, we are ready to support.

• Project should intervene where policy needs to be changed • Monitoring should be improved • The project should be continued even from the revenue budget of ILO • Project should be developed on the long term housing facilities for the workers if ILO

wants to do something for workers.


Line agencies and PAC members (set 4 and 8) Questions Summary of responses (Not structured)12

• Project objectives were nice. • Policy makers should be made aware first and then it can be sustained • Nobody has understood the concept • Lack of project integration • Two projects are in one project so it seems coordination problem • High level of personnel are not required because objectives are simple • Management procedures and strong monitoring system should be developed • MHI should not take premium money. It should include all • Besides some flaw and others, the project has some good things to bring productivity (nothing

comes up out of nothing) • Communication has hampered to increase government capacity • Livelihood of the target families has improved gradually, but not radically • Needs to literate tea community people • Dissemination could not be up to the expected level because of the low level of literacy • Not all the project activities are completed. So far so good but it needs to be continued to gear-up

the remaining activities.

Project staff (set 5)

Question Summary of responses Project 1: Women’s Empowerment through Decent Employment (WEDE) IO 1 – Helping target groups provide employment opportunities

Substantially 1 Moderately Very little • Around 20% entrepreneurs received ‘decent work’ training from the project/NGOs and of the

total members (4238), around 53% are aware of decent work concept and some 40% applies the concept in their workplace.

• In the PSI/Tea sector, the concept of decent work is being disseminated to all levels/stakeholders through different measure such as training of staff (of both BCSU and BTA), and workers

Livelihood of targeted women’s family

Yes 1 No • Use of safe drinking water, latrine, sending children to school and practice better food habit

and grow homestead vegetables • Employed more hired and family labour, • All this helped them to earn more and eventually this has helped to improve their livelihood. • Higher HH income, savings and employment • Higher expenditure, and change in expenditure pattern like more expenses in education,

healthcare and foodstuff • Higher enrollment/attendance of schools by children • Increased procurement of lands, housing and other assets including electricity connections • Availing increased healthcare services • Increased participation mobility of women • Linkages and interaction with local resource organizations/facilities increase • Increased access to safe water and sanitation vis-à-vis general awareness on basic socio-

economic issues IO 2 – Capacity of the concerned government ministries increased?

Agree 1 Disagree Can’t say 1 (Elaboration: Provided training to the officers of Department of Labour on Declaration and Fundamental Rights and Principles at work, Labour inspection Conventions and challenges, ILO Conventions related to agriculture and rural workers, Promoting Decent Work in Bangladesh, Gender dimension, Labour administration, Conventions and issues, Social dialogue)

IO 3 – Extent of help create employment opportunities in the private/informal sector

Largely 1,1 To some extent Very little Not at all Explanation: • Increased involvement of women income earning activities • Increased contribution to family income • Increased employment of women • Increased participation in family and community affairs • Increased access to health care services and other facilities

12 Interestingly, no PAC members and line agencies’ representatives who were involved in the project could be met because of their transfer in other ministries and abroad visit. Therefore guided discussion could not be made. Only proxy views were collected.


• Improvement of leadership qualities of women IO 4 – Participation of women workers in their trade union/association

Increasing 1,1 Decreasing No idea (Elaboration: BCSU has increased the number of women member in their Panchayet committee, as associations’ mother’s club members are 100% women).

Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB) IO 1 & 2 – Extent of services provided to target groups to have access to health care through MHI services

Largely 1,1 To some extent Very little Not at all (Explanation: Increased accessibility is demonstrated by increased number of policyholders, from 31,000 in 2001 (pre project) to 59,500 in 2005 benefiting about 300,000 persons. Number of patients visit, which has increased from 132,000 in 2001 (pre project) to nearly 250,000 in 2004 and an estimated 280,000 in 2005 is also indicative of the increased access to health services. Enrolment of policyholders in BRAC MHIS increased from 700 in 2001 (pre project) to 11770 in 2005 benefiting nearly 60,000 persons. Number of patient’s visit to health centers/clinics also increased from about 1,000 in 2001 (pre project) to 21,000 in 2005. Please note that BRAC started the experiment in the selected two HCs about six months prior to ILO intervention in Nov 2001.

IO 3 – Awareness and knowledge among policy makers

Largely 1 To some extent Very little 1 Not at all (Explanation: Awareness and knowledge of the concept among the stakeholders have significantly increased. 3 NGOs have already replicated the concept. The policy makers, health ministry in particular are becoming increasingly interested in MHI but very little impact.

How such schemes can help national alleviation program targeting for rural poor women

Elaboration: Obviously, as an effective mechanism for providing health services to the poor at an affordable cost especially in the rural informal economy, the MHI schemes can substantially contribute towards increased accessibility in health care thereby contributing to the national poverty alleviation programs.

Health and socio-economic upliftment/ empowerment are directly correlated. Poor people usually are reluctant to go for treatment and initially they take locally available treatment (form quacks, for example) and finally spend/drain out a lot of money without any result. And when they go to doctor, it is either too late or the treatment is too expensive, or both. Generally, poverty is relatively more in case of women and they are being increasingly involved in both reproductive and productive activities, through different measures like micro credit and operation of IGAs.

IO 4 – Possibility for use and adaptation of the experiences gained

Yes 1 11 No (How? Besides, the concept and experiences of MHIB has been widely disseminated through forums, meetings, exchange visits, videos, and dissemination of studies and reports both in and outside the country. The MHI experience was also disseminated in the recent ILO knowledge fair in Geneva and via ILO training workshops in Geneva, Nepal and India where participants from several countries shared experiences gained by this project. The prevailing situation, concerns and growing interest of different actors including the firm commitment of government towards health for all, provide a very clear indication of the great potentials for wide replication of the MHI concept throughout as an alternative and effective mechanism/means of extending health services to the poor Already 3 NGOs (G&E partners) replicated the scheme; another one implementing in collaboration with BRAC and a number of other organizations shared/ borrowed our materials. Therefore not only the partner NGOs, few other NGOs in the country are also trying to replicate the approach/system in their own organizations.

WEEH Overall evaluation 1. Validity of the

project strategy, objectives and assumptions

Yes 1 No (In the context of prevailing socio-economic situation of the women in Bangladesh as well as the national and international commitment and priorities towards gender balance as well as social and economic empowerment of women, the objectives and assumptions of the project remain valid throughout. However, the assumption of achieving sustainability within the 3-4 year project period has proved to be ambitious and somewhat unrealistic. Most of the strategies like synergy among the components, women in the entry points etc are valid and so the assumptions and to a great extent the objectives. However, the time is too short to achieve the objectives both in terms of quality and quantity).

2. Benefits accrued to the target groups

List: • Increased awareness on health care and nutrition and socioeconomic issues • Easy access to quality healthcare at affordable cost • Empowerment of women as they are the entry point/direct primary beneficiary • Reduction of birth rate and child mortality due to increased health education and focus on

reproductive health


3. Implementation status – planned activities, materials, schedule and budget

Yes 1,1 No Most of the MHI training/promotional materials, i.e., modules, materials, flip charts, posters, leaflets, documentary films, brochures etc were produced in time by the project/partners (GK and BRAC) and well accepted by all concerned. Started about one and a half years late. This delay was caused mainly by the time taken to select the implementing partners vis-à-vis operational areas especially of the WEDE component as well as reaching an understanding with the stakeholders of tea sector. This has affected the total activities and schedule of the project and forced to postpone some activities.

4. Sustainability of project results Activity How will it be sustained? By whom will it be

sustained? Awareness raising of the general workers and capacity development of panchayet (grass roots) leaders particularly women.

The trade union will continue the awareness raising courtyard meetings using the panchayet leaders at the garden level among the general workers.

Will continue the Panchayet leaders training in a small scale- special emphasis will be given to women leaders.

Bangladesh Cha Sramik Union (Trade union)

Trained Panchayet Leaders

o Capacity development of the management staff at operational level

Project assists the owners association to develop module on labour laws, labour standards, and decent work issues. This module can be merged with the existing ‘Labour Manual’ use by the association for the managers training.

Bangladesh Tea Association

o Health care services for the tea workers (limited services)

Marie Stopes will continue the clinic at Srimongal- that was established and run by the project assistance. But it will be difficult for MSB to continue the satellite services at the tea estates.

Requires blending with other services – saving and credit

Marie Stopes Bangladesh, individual tea estate management.

(a) Training given to women entrepreneurs, particularly EDBM, Book keeping/accounting skills development and Decent Employment

NGOs are likely to implement/continue these training, organize refreshers’ courses and follow up, also look for other sources for continuation

Training given to women entrepreneurs, particularly EDBM, Book keeping/accounting skills development and Decent Employment

(b) Planning, budgeting and monitoring practices

Most lessons learned have already been grafted by the NGOs tuning to their environment/situation and these will hopefully sustain.

(c) Planning, budgeting and monitoring practices

(d) Health care services through Micro health Insurance

So far six NGOs, 5 directly and one through BRAC are implementing the scheme. All of them are in agreement with the beneficiaries to provide service for at least one year. The MHI partner NGOs will operate the scheme their own source (including income from policy registration/renewal, and other fees) and will be scouting/hunting potential sources.

(e) Health care services through Micro health Insurance

Leadership development training at target group level and ILS/tea plantation law for managers

Both BCSU and BTA appreciated the training and the lessons discussed/ learned in the training and workshops. Both the organizations are planning to apply and uphold the training contents in their daily workplace. The project has mainly provided TOT. They will continue such training on their own

Leadership development training at target group level and ILS/tea plantation law for managers

5. Effectiveness of management performance of USDOL, ILO Declaration, AO, and project management

a. Project management V. effective 111 Effective 1 V. little Not at all

b. Personnel mgmt. Satisfactory 1111 Poorly Don’t know

c. Communication with stakeholders Satisfactory 111 Poorly Don’t know

d. Financial mgmt. Effective 1111 Not so effective poorly

e. Participation of partners


Yes 1111 No (Partners are in a better position to give their assessment on this) 6. Effectiveness of project performance monitoring

a. Type of monitoring Input 111 Process 1111 Output 111

b. Type of data, how? Development of a performance monitoring system is perhaps the gray area where the project could not make much headway. Several workshops were held with the implementing partners, some of them with the assistance of external consultants. Consensus as to the indicators to be covered and database to be developed by the partners to fit the PMS could not be established due to diversity in their on going monitoring system and inadequacy in the database (required for PMS). • Base line data (for G&E in particular)

• Implementation progress/performance related data (monthly/quarterly/contract period)

• Special Impact monitoring (monthly, for G&E)

• Change/benefits at target group level (through evaluation) c. Cost effective Yes 11 No d. Reliability of data Yes 11 1 No

7. Major problems encountered - List: • MHI new concept - challenging job • It is difficult to retain doctors in the rural health centers • Low renewal rate in the second and third year • Political unrest and seasonal floods • a. Interacting and coordinating with few stakeholders such as concerned ministries was not easy in most cases • b. Change/transfer and resignation of staff 8. Major lessons learned - List: • Community participation and involvement is very essential for the promotion of MHI concept. • As a challenging concept the expansion of MHI program needs to be gradual. • Holistic approach to create synergy between health and economic activities is very essential for overall

development. • Longer and continuous financial and technical assistance to actors/partners is essential for achieving sustainability

and realizing goals. • Healthcare in village setting demands a different healthcare approach like MHI for the rural poor. • It is also necessary to link the results and impacts of MHI experiments to policies of the government as well as

other private/NGO actors in the health sector in order to give the MHI a general shape. • Stakeholders understanding and consensus are crucial. • Education and training are vital for promoting workers rights at work. • Social dialogue mechanism to create better working environment needs strengthening. • Understanding and mutual respects among the stakeholders (owners, workers and government) are steadily

increasing. • Increased interests in sustaining most activities by the stakeholders. • The continued dialogue with the major stakeholders generated interest and demand for long-term collaboration in

the plantation (tea) sector in Bangladesh. • There is an increasing attention on the working and living conditions of the workers by the BTA management. • Increased business capital led to relatively larger income and additional employment. • EDBM (Entrepreneurs Development and Business Management) training has significant positive impact on the

management capacity and skills of the women entrepreneurs leading to larger scale of their enterprises, greater mobility in marketing products and increased self-confidence in managing their business and decision-making.

• Significant change in attitude has taken place towards applying the principles of decent work in their enterprises. • Sustaining these developments and further promoting the principles of decent work demand continued follow-up,

monitoring and training. • All three major components (MHI, PSI and Women entrepreneurship development) are new concept and it needs

adequate time to get momentum and sustainability in such interventions. • Again, synergy between health and economic development is proved to be very essential for overall socio

economic development. 9. Suggestion to WEEH project - List: • Longer-term support and more resources need to be mobilized to pursue the project goal and attain sustainability. • Promotion of public-private partnership (NGO, Govt. and private sector stakeholders) needs to be further

strengthened for institutionalizing project activities and giving a general shape. • Small and medium NGOs will be encouraged to involve more in the proposed activities. • More emphasis should be given on reproductive health, health education including STI and HIV/AIDS for the

adolescents.


• Such projects should have longer duration for implementation • Mechanism for increased cooperation with the stakeholders ( from government in particular) should be developed. • Professional and technical backstopping from AO and other relevant ILO office should be

provided/ensured/enhanced


ILO Area Office, Dhaka Staff (set 6) Question Summary of responses Project 1: Women’s Empowerment through Decent Employment (WEDE) IO 1 - Major services provided to target groups None Livelihood of targeted women’s family Largely increased IO 2 – Capacity of the concerned government ministries To some extent IO 3 – Extent of help create employment opportunities in the private/informal sector

Largely

IO 4 – Participation of women workers in their trade union/association Increasing Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB) IO 1 & 2 – Extent of services provided to target groups to have access to health care through MHI services

Yes, largely

IO 3 – Awareness and knowledge among policy makers - How such schemes can help national alleviation program targeting for rural poor women

It can help directly

IO 4 – Possibility for use and adaptation of the experiences gained Most of the training programs can be continued.

WEEH Overall evaluation 1. Validity of the project strategy, objectives

and assumptions PSI was not covered previously. All were valid because they were need-based


Identified partner NGOs and implemented the project activities and achieved the objectives Partner organizations gained knowledge, developed capacity that will help provide better and quality services.


Manuals and case studies were developed, and can be used anywhere by any one.


Many activities such as TOT, trained women and linkages with entrepreneurs, skills developed by the trade union people, equipment provided, and so on will continue. Small organizations need support


Effective. SRO=MHIB, Declaraion=G&E


Area Office didn’t take part in performance monitoring

7. Major problems encountered

Some partner NGOs had some clarification on some activities The project was not linked with the government program (ADB). The project enjoyed frequently deviated activities, the how can it be sustained?

8. Major lessons learned

Implementing partners should be fully briefed The WEEH project has opened big eyes to many areas and could be replicated its experiences

9. Suggestion to WEEH project

Second phase project is required because partners can play an active role in the future activities Needs to associate partners from the begging so that their input can be considered/utilized

Partner Organizations (set 7) Question Summary of responses Project 1: Women’s Empowerment through Decent Employment (WEDE) IO 1 - Major services provided to target groups

• Training (EDBM, decent work, capacity building, TOT, A/C keeping, project management, health management )

• Staff support • Exchange visits • Monitoring visits • Helping to establish collection/sales centers • Provided training materials • Provided resource persons through WEEH project • Helping to develop marketing linkages • Helping to establish business advisory centers


• Conducted action research for new businesses Improvement of livelihood of targeted women’s family (scale)

Greatly 1 Moderately3

IO 2 – Capacity of the concerned government ministries

Yes 3 No Don’t know


Largely To some extent 3 Very little Not at all

IO 4 – Participation of women workers in their trade union/association

Increasing 3 Decreasing

Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB) IO 1 & 2 –Services provided to target groups to have access to health care through MHI services

• Access to health center by the poor women and their families. • Poor women and families had opportunity to be visited by qualified health

professionals. • Services provided:-

o ANC o Safe delivery o PNC o Neonatal care (Immunization)

• Other subsidized services o Medicine o Pathology o Transportation (Referral) to higher center for all type of care and support

and all types of care and support and co-payment. o Household visit in case of severe illness of the patient

• Free service for ultra poor • Community awareness for HIV/AIDS among the poor • School health check-up • Health check-up for industrial labor • Make the life of women in micro credit-a productive

IO 3 – Awareness and knowledge among policy makers

• Concept has accepted by the local chairman, elite people, Union chairman and ward members in the community due to co-payments and affordability of services.

• Services are ensured • Quality of services are provided • It is widely acceptable among the MC operators as well as NGOs • The persons holding policy-cards influence others

How such schemes can help national alleviation program targeting for rural poor women

• Working hours for the poor are not lapsed • Earning hours and wages are not due to acute/chronic illness. • No unnecessary expenditure to visit non professionals (Village doctors/quak

doctors) • Students are well aware about health seeking behavior and provided with

antihelminthic and iron to prevent anemia. • Individual worker are engaged in productivity due to regular check-up • Through application of vouching system, organizing exchange visits, by improving

referral services. IO 4 – Possibility for use and adaptation of the experiences gained

• Lessons have been learnt to implement this sort of project in other organization (Govt./Non Govt.)

• The concept of this project is to improve the health seeking behavior of the poor women and families.

• Health security for poor is being ensured through this project. • Through organizational replication.

For overall evaluation 1. Validity of the project

strategy, objectives and assumptions

Largely


• Decreasing mortality rate • Beneficiaries have improved livelihood • Number of poor clients to get services has increased • Number of institutional deliveries has increased • Number of ANC and PNC has increased among the poor


• Services have reached the un-reached groups, meeting a social need. 3. Implementation status –

planned activities, materials, schedule and budget

• All activities were not completed on time (only 80%) due to unavailability of trained people/personnel.

• Only 80% partners and beneficiaries have received the training materials • Most of the activities were completed on time • Most of the training materials were received by partners and beneficiaries


• By using capacity developed through training • By reducing discount rate (on selling medicines) • Co-payment system will be increased • Through promotional activities


• Very effective 2 • Effective 2 2 2


• To some extent • Process monitoring was effective • Performance monitoring data were collected

7. Major problems encountered

• Difficult to retain trainers • Difficult to continue business advisory centers • No provision of revolving fund • Training materials were in English • Difficult to retain doctors in the remote areas • Non-availability of trained medical human resources. • Sometimes, renewal of card for the beneficiaries is very difficult • Demand for sophisticated services (ECG, X-ray, Ultrasound) • To convince people about the new concept • Availability of fund • Project activities were conducted with six month’s contract and created

problem in hiring staff. 8. Major lessons learned • If we cannot provide MHI services, there is no point of providing other

services. • If MHI could be blinded with other program, it would have better results. • Informal sector is big and the government has not supported it • It is possible to establish some micro enterprise businesses in specific target

areas • It did not review with the services provided • One cannot expect big impact • Rich people are also interested to get the services and have over-utilized their

cards. • It gave us opportunities to work with tea sector

9. Suggestion to WEEH project

• Needs to differentiate hard core groups • Training materials should be in local language • Like to see as united force to fight with the challenges • Develop a software for uniform MIS • Organize more exposure visits to share ideas with other partners • Needs to increase services to satisfy clients • Project’s impact would be limited because of short project timeframe. • This project may be taken as pilot project and can be extended widely.

Consultants who were involved in the project (set 9)

Question Summary of responses Project 1: Women’s Empowerment through Decent Employment (WEDE) IO 1 – Has the fundamental women’s rights to decent employment enhanced?

Yes. But stimulated mind set, but change is low

Livelihood of targeted women’s family Somehow increased. IO 2 – Capacity of the concerned government ministries

NA


To some extent Business development centers are not running well. This is the main responsibility of the NGOs, but they are not considering as primary responsibility EDBM training has impact

IO 4 – Participation of women workers in their trade union/association

Increased. Family is recognizing and women are also feeling differently.


Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB) IO 1 & 2 – Extent of services provided to target groups to have access to health care through MHI services

To somewhat effective. Counseling part is good.

IO 3 – Awareness and knowledge among policy makers NA How such schemes can help national alleviation program targeting for rural poor women

IO 4 – Possibility for use and adaptation of the experiences gained overall evaluation 1. Validity of the project strategy,

objectives and assumptions


Impact at the local level is marginal Both partner organizations and target groups have understood each other In the formal private sector, workers knew that what is fair and what’s not?


4. Sustainability of project results Skills developed will be used Decent work practices will continued


Very effective


Monitoring aspect of the project seemed rather weak

7. Major problems encountered - 8. Major lessons learned • This is a pioneering one concentrating on some aspects which

needs to support from many other sectors • The objective of bringing all together could not be feasible or

achieved because of the time constraint • Partners are also aware of many things now.

9. Suggestion to WEEH project • Business development centers should be managed in collaboration between entrepreneurs and the NGOs

• The project was a bit swampy • Project worked with single NGO in the community, but work

with many • To decent finish, The project should be continued

Trainers and Training Program Implementers (set 10)

1. What training materials did you prepare under the WEDE and MHIB component?

Project 1: Women’s Empowerment through Decent Employment (WEDE)

a. Decent Work Training (Level-I) module and Handout

b. Decent Work Training (Level-II) module and Handout

c. General ToT module and Handout

d. Marketing module and Handout

e. Workers Education In the Tea Plantation Sector of Bangladesh module and Handout

f. Strategic planning module for union leaders and Handout

g. Panchayet Leaders Training module and Handout

h. Social mobilization

i. Social dialogue

Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB)


a. Basic Training material and modules exist in Grammen and BRAC. Additional training modules and promotional materials were prepared by these organizations themselves. They are capable to conduct most basic training with their own resources. Technical training on medical issues have been given to the medical staff/personnel from the professional public and private institutions such as, Gonoshasthya Kendra and Azimpur Maternity Centre.

2. From your perspective, how do you assess the effectiveness of the following related to training program.

Parameter Effective Satisfactory Not so effective a. TNA � � b. Course development �� c. Training implementation � � d. Monitoring and follow-up support � � Project management support for training delivery a. Communication/Coordination

�

b. Decision making � c. Logistics arrangements � d. HR Management � e. Supporting environment � Community (TG) support for training delivery process a. Participants selection

�

�

b. Commitment � � c. Supportive environment � � d. Monitoring/follow-up supports � �

3. What impact of the training programs have you seen in the target group?

G&E Component: Significant impact, which include among others: • Increased awareness, skills and mobility • Better management capability • Efficient utilization of resources, • Application of decent work principles, • Increased participation in decision making at different levels- enterprise, family and community.

PSI Component: Impact created in the tea sector includes:

• Increased awareness among workers, employers (BTA) and trade union (BCSU) on labour Standards and Decent Employment.

• Increased leadership capacity of especially women workers, increased participation/ representation in organizational activities i.e. mothers club Panchayet and BCSU.

• Reduced alcoholism, increased participation in education and cultural activities. • Increased awareness on health & nutrition and improved health seeking behavior.

MHI Component : Awareness on the concept and operation of MHI has significantly increased and generated interest among the actors to introduce and intensify the MHI concept in their own organization.

4. What sort of problem did you find during the completion of the whole training cycle?

a. Political unrest disrupt maintaining training / workshop schedule b. Lack of case studies and practical sessions (too much theory) c. Difficult to manage tea managers

5. Major lessons learned

a. Partners are very cooperative and all participants are positive b. ToT recipients needs back up support c. Follow-up of training increases the effectiveness of post training activities d. Local language and terms makes training more effective e. Bangla version materials are more useful f. Interest of women workers has increased g. Awareness campaign was important h. Planning for conducting training is important


i. Confidence level is important to achieve any goal j. Collaboration among owners supporting agencies, training organizer is important k. Workers are aware of themselves in many aspects l. All depend on the positive attitude of the managers

6. What suggestions would you like to provide for WEEH project?

a. Post training follow-up by the partner NGOs should be done to enhance quantity and quality of activities

b. All the training materials must be prepared/translated in to Bengali and English version c. As training is one of key support so more ToT should be provided to NGO staff d. Incorporation of organizational capacity development e. Follow-up and monitoring is needed f. Should be selective in participant selection (managers and assistants sitting in one place doesn’t

allow healthy discussion) g. Can ILO do anything for the dependents of workers? h. Management training should be given to managers first

USDOL and ILO staff (set 11) Overall evaluation

Question Summary of responses

1. Validity of the project strategy, objectives and assumptions

Do you think that the project strategy, objectives and assumptions were valid at the time of project preparation?

Yes, although I only got involved in the project after two years, and only for training purposes. Objectives remain valid today: assumptions I do not know, but given the outreach they must have been ok. Strategy: the whole set up was a bit complicated to understand, but generally the combination of rights, women empowerment and micro insurance is complementary and a appropriate perspective to tackle poverty among women.

No – The original project proposal with a logical framework was not quite realistic - and had not been arrived at through a participatory process in Bangladesh. Later, a 3-day participatory Logical Framework Workshop organized in Dhaka enabled the project team and its main stakeholders to go through the process of rethinking and reformulating all main elements of the project, which greatly generated a better and more workable logframe.

Yes, since the project had three different components, it was not clear how all three would be accommodated into one project.

2. Validity of the project strategy, objectives and assumptions

How do you see the validity of the project strategy, objectives and assumptions?

Personally, I would have favoured a more straightforward approach, restricted to a specific area or one or two sectors. But quite honestly, I do not know enough about the background etc. Project Strategy: Valid for all components (WEEH overall, WEDE sub-project and MHIB sub-project. Objectives: Valid for all. Assumptions: 95 % valid only.

3. Impact/benef

its accrued to target groups

What do you see the effect/impact of project activities on beneficiaries? (if applicable)

a. I have seen strong performances by people being trained on entrepreneurship

b. There has been substantial impact on the tea estates and especially their owners

c. In the work with indigenous, it has proven very difficult to reach the poorer segments of women

MHIB sub-project The MHIB sub-project has been able to involve and benefit poor women and children (also some men) in rural areas, to access affordable and quality, mainly preventive, health care services. Through assistance in up-grading health services and resources of the involved organizations, the ILO WEEH project has certainly made a difference to the beneficiaries. WEDE project - Gender and Employment (G&E) component -:


Overall evaluation


Significant impact under this component includes following: - Average savings deposits increased more than three times; - Increase in average loan size; - Average monthly expenditures increased; - Average monthly income increased; - Average employment increased; - Child workers not found in an investigation in 2004, as

compared to constituting about 7% of the WEDE workforce in the Baseline Survey of 2003;

- Women’s participation and control in decision-making and business activities increased significantly, and

- Women entrepreneurs increasingly practice elements of decent work at their workplace – while their awareness before training was almost nil.

WEDE project - Private Sector Initiatives (PSI) component: Women workers in the tea plantations have been able to access improved quality, health care where they had none before. The weak trade union and its members, which includes women, have undergone extensive training and was to work on changing their constitution. An interesting outcome of last summer’s conference with the BTA (Employers) was that the project was allowed to train the managers of the tea estates on labour standards etc. Although PSI started late, it certainly managed to do an incredible amount of work and make its mark in the tea sector. It’s a great pity if this work cannot go on, in view of the fact that it was so difficult to get an entry---many have tried and failed.


Any community development project has a serious issue of sustainability. In your experience, how do you see the sustainability aspect of such a project?

Ownership and voice representation; genuine involvement of all stakeholders; use of existing structures to improve implementation capacity. MHIB sub-project: Regarding the future, it is clear that both MHIS of BRAC and GK would benefit from recognition and actual support by the national authorities, specifically the MoHFW. There could be many more advantages in bringing the issue of social protection to a national level and gain appreciation for improved and affordable community health services and reaching the poor in particular. Having the ILO (STEP-SOCPOL) as a partner social protection schemes would continue in future.

5. Effectiveness of management performance by DOL, ILO (DECLARATION and AO), CTA and NPM and NPCs, specifically as concerns project staffing and communications

How do you evaluate the effectiveness of the project management on the following aspects?

a. Human resource management

Excellent. I will ask project colleagues in the future to assist in training concerning labour standards, basically they evolved into trainers themselves. Atmosphere was always very good, high motivation and good practices of knowledge sharing The WEEH team was a great project team to manage! At my time, and I believe also afterwards, the team spirit of WEEH staff was phenomenal.

b. Communication with stakeholders

Excellent. I have seen how the tea estate owners have been gently ‘coerced’ in a collaboration agreement, an exceptional achievement given the reputation of estate owners. Indigenous women and contacts with indigenous organization are excellent. In the near future we will build on these contacts under a new small project on promotion of rights for indigenous. Excellent contacts, which were also made available for my work where necessary, with NGO’s and other international organizations. Generally, very, very good despite very weak performance support from ILO Office in Dhaka.


Overall evaluation


The Project Manager and the other staff had good communication with “their” stakeholders. Communication with others is vital for a project like WEEH. However, I do not believe he received sufficient support from the ILO office, which would have assisted him in the difficult job (my assumption). Communication is a two-way… …………………

c. Management of financial and physical resources

No insight, but all seemed very effective. I never encountered any problems regarding my missions and activities paid by the project There were established routines for all financial transactions and procedures, following the ILO administrative procedures. The admin assistant (Ms. Kawser) kept a vigilant regime of all financial matters, and had close relationship with the ILO Administration to ensure the transactions were done to the satisfaction of the ILO. ………

6. Support/role

s provided What support/role did you provide/play in order to make the project management more effective?

Not officially but informally encouraged and talked to the project staff. Provided technical services relating to gender and employment perspectives.

7. Overall observation Please provide your

overall observation/suggestion regarding the WEEH project.

I would favour a simplified structure of the project focusing, as indicated above, on one or two sectors in one or two areas with one firm main objective, eg. micro health insurance based on voice representation (through cooperatives or SHG’s). I would mainstream the gender activities in a more generic way and only through experiential measures. This entails no explicit training on gender, but gender elements introduced through practical measures, eg. tackling health issues through social dialogue in a negotiating process with stakeholders reducing health problems. This would automatically lead to other kinds of insurance beyond health. Generally, continuation of the project would be imperative in my view. The project should continue, has been a great success, mainly due to the excellent project staff who have long project experience, good judgment, worked very hard, have lots of contacts and networks which they use and are able to create good relationships with others. There have been difficulties (obstacles) both when I was there and also later, but nothing that could be overcome. I believe ILO should do more to find new donors and to ensure activities continue in some form or other. ………………

Documents

BGD/00/51/USA International Labor Organization (ILO) Women ... · Project 2: Micro-Health Insurance for Poor Rural Women in Bangladesh (MHIB) IO 1– Increase the number of poor women