Global Poverty Action FundANNUAL PROGRESS REPORT 2015

Please read the following instructions carefully.

This annual report template includes DFID reporting requirements for 2015. It is designed to:

provide assurance on project progress and management; check compliance with the terms and conditions of your grant; inform a wider analysis of all GPAF projects; communicate the successes and challenges of your project; and contribute to learning on emerging results.

What has changed from last year’s (2014) template?The template has been reviewed in response to the Fund Manager’s experience from previous rounds, input from the GPAF Evaluation Manager and DFID requirements and considerations. It also reflects feedback from grant holders reporting in 2014 and attending the Results and Learning seminars in January 2015. Some revisions have been made to strengthen the document, whilst maintaining a high degree of continuity with last year’s report.

The key changes are:

clarifications to guidance and clearer wording of some questions, for example on logframes, risk and value for money

two new sections on a) the new requirement in grant arrangements for a visibility statement and b) methodological tools

a revised and more open section on learning some different questions on project accountability to stakeholders, to avoid repetition

from last year a few new questions, for example on assumptions, beneficiary data and use of the

DFID logo removal of a few questions, for example on beneficiaries

What is required?

How? Where relevant, refer back to your 2014 Annual (or Interim) Report feedback letter Use the Annual Report template (this document) without altering its structure. Cover the period between 1st April 2014 and 31st March 2015 Keep within the page length limits. Submit your Annual Report and all accompanying documentation, including separate

annexes as WORD / Excel documents, rather than PDF files. Send all required documents by email to gpaf@tripleline.com. Hard copies are not

required.

When? Your report is due by 30th April 2015

GPAF Annual Report Template 2015 1

What to send? (Use as checklist)

1. Narrative Report (this document)

Mark with

an “X”Section and Title

Page

limitNotes

X 1 Basic Information 2 Basic project data.

X 2 Summary, Progress & Achievements 6 A narrative summary of progress and

results.

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

X 4 Sustainability 1 Progress towards ensuring sustainability

X 5Project Accountability to Stakeholders

1 Information on project mechanisms to enable beneficiary feedback.

X 6 Learning 2 Lessons from project implementation for learning and dissemination.

7Responses to Due Diligence Recommendations

1Information on actions undertaken following Due Diligence review (if not already reported).

X Annex A

Outcome and output scoring 12

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

X Annex B

Consolidated beneficiary table 2 A summary of the number of individual

project beneficiaries.

X Annex C Portfolio Analysis 3

Some basic information about your project to feed into an analysis of the whole portfolio of GPAF projects.

2. Project Documents (attachments)

Mark with

an “X”Document Notes

X Photograph(s) and notes

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

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

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

GPAF Annual Report Template 2015 2

Mark with

an “X”Document Notes

X Reporting Logframe

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

Please label this document: “GPAF (ref. no.) Reporting Logframe (+ date prepared)”.

Revised Logframe

To be submitted if you are proposing a revision to the logframe – see section 2.9 of the report. Highlight the changes you have made. Please also include a narrative Word document, maximum 2 A4 pages at Font 12, which explains why revisions are requested and what the revisions are.

Please label this document: “GPAF (ref. no.) Revised Logframe – Proposed (+ date prepared)”.

X Revised Risk Matrix Highlights any new risks, if applicable - see section 2.10 of the report.

Up to date asset register

The register you use to record all capital items of equipment purchased with project funds.

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

Mark with

an “X”Document Notes

X Annual Financial Report + Variance Notes

Two worksheets on Excel template showing expenditure over 2014/15, compared to budget.

X Financial SummaryWorksheet on Excel template showing a summary of expenditure over the life of your project, compared to budget.

It is very important to note that:

Project expenditure must be reported against the full budget agreed by Fund Manager and not the summary budget used for expenditure claims.

Any variances in excess of 10%, either positive or negative, (or transfers between main budget-sub-headings) must be explained.

You should show any variances both in terms of total amount in GBP (£) and as a percentage of budget.

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Information and References:

Purpose of the GPAF

The Global Poverty Action Fund (GPAF) is a demand-led fund supporting projects which are focused on:

poverty reduction and pursuit of the Millennium Development Goals (MDGs)

through tangible changes to poor people’s lives including through:

service delivery empowerment and accountability work on conflict, security and justice

Further Guidance documents that may help with the completion of this annual report include:

Gender and Diversity: Gender guidelines prepared specifically for the GPAF: Gender and the Global Poverty

Action FundNote that these guidelines are due to be updated, after which the hyperlink above will not work. The new guidelines, once uploaded, will be on the GPAF page of www.gov.uk under ‘project documents’. 

DFID Disability Framework 2014

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

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

Any Questions?

If you have any questions about the completion of your annual reporting requirements, please contact the Fund Manager at gpaf@tripleline.com or on 0208 788 4680.

Common questions with answers and further guidance are being circulated as Frequently Asked Questions (FAQs) alongside this report, drawing on the issues raised by grant holders at the Results and Learning seminars held at the end of January 2015.

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GPAF ANNUAL NARRATIVE REPORTSECTION 1: BASIC INFORMATIONThis information is needed to update the Fund Manager’s records1.1 Grant Holder Organisation

NameAdventist Development and Relief Agency (ADRA) UK

1.2 Grant Holder Organisation Address

Stanborough Park, Watford, Hertfordshire, WD25 9JZ, UK

1.3 Project partner(s) List implementation partners. Highlight any changes to

partners. For multi-country projects,

please indicate which partner is in which country

Adventist Development and Relief Agency (ADRA) Zimbabwe

1.4 Project Title Improved maternal health care services for 7,500 women of childbearing age in Gokwe, North Province, Zimbabwe

1.5 GPAF Number IMP-03-CN-18101.6 Countries ZIMBABWE1.7 Location within countries GOKWE NORTH1.8 Project Start & End Dates Start: November 2013

End: October 2016

1.9 Reporting Period April 2014 to March 20151.10 Project Year (e.g. Year 1, Year

2)Year 2

1.11 Total project budget £ 975,547.001.12 Total funding from DFID £ 721,904.811.13 Financial contributions from

other sourcesPlease state all other sources of funding and amounts in relation to this project. Sources should be listed in brackets, e.g.:£75,000 (ABC Foundation)

Total £ 253,642.46

List all contributions

£ 253,642.46 (ADRA UK)

1.14 Date report produced 15/04/20151.15 Name and position of

person(s) who compiled this report

Name: Josphat KutyauripoPosition: Project ManagerName: Judith MusvosviPosition: Programmes DirectorName: Judith MusvosviPosition: Country Director

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

Name: Milimo NinvallePosition: Programmes OfficerEmail 1: mninvalle@adra.org.ukEmail 2:

1.19 Secondary contact person (optional)

Name: Howa Avan-NomayoPosition: Chief Programmes OfficerEmail 1: howa@adra.org.ukEmail 2:

1.20 Acronyms

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

Acronym ExplanationDA District Administrator

DHE District Health Executive

DMO District Medical Officer

DEHO District Environmental Health Officer

DNO District Nursing Officer

MCH Maternal and Child Health

MoHCC Ministry of Health and Child Care

MoU Memorandum of Understanding

PEHO Provincial Environmental Health Officer

PHE Provincial Health Executive

PNO Provincial Nursing Officer

PMD Provincial Medial Director

PWD Department of Public Works – Ministry of Local Government

OPC Office of the President and Cabinet

RDC Rural District Council

VHW Village Health Worker

WCBA Women of child Bearing Age

WHC Ward Health Committee

ZRP Zimbabwe Republic Police

MNCH Maternal, New-born and Child HealthWMS Waiting Mothers’ ShelterTOT Training of Trainers

NGOs Non-Governmental OrganisationsM&E Monitoring and EvaluationRBF Results Based Funding

SECTION 2: SUMMARY, PROGRESS AND RESULTS (Up to 6 pages)2.1 PROJECT SUMMARY (max 10 lines)

Please provide a brief project summary including who will benefit, the overall change the initiative is intending to achieve and a brief summary of the approach.

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The project contributes to MDG 5A, improving the maternal mortality rate in Zimbabwe by increasing the capacity of the Gokwe district health sector. ADRA is working to improve maternal health care services for 7,500 women (including pregnant women and girls of reproductive age) in 5 wards of Gokwe North District.. ADRA’s interventions are through; Improved maternal health facilities at 4 clinics – construction of Waiting Mother’s Homes at 4

clinics, provision of clean water through borehole drilling and solar powered electricity; transport provision for emergency cases.

Improved delivery of maternal health service by health care providers – capacity building through training of health staff village health workers, Ward Health Committees and facilitation of the NGO forum at district level.

Increased awareness and utilisation amongst women of maternal health services in target clinics - maternal and reproductive health awareness sensitisation to the target groups for behaviour change.

Increased awareness on health risks and services amongst communities – capacity building for communities: boys, men, WCBA, girls, schools through clubs and forums to enhance participation and involvement.

2.2 RELEVANCE TO CONTEXTHas the context changed? Does your GPAF project remain relevant to the context where you are working? How do you know? Please explain what you have done to ensure that the interventions represented in the logframe and activity log continue to respond to the priorities and needs of the target population.

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The context has not changed and the approach is still relevant. The project is still addressing the 3 Delays (as outlined in the proposal) that reduce access of pregnant mothers to antenatal, delivery and postnatal care services. The MoHCC has not established new health centres to combat the challenge of long distances from home to clinic for pregnant women. Transportation to the health centre is still required especially in emergencies making the provision of the E- ranger service still relevant. The setup of WMSs has been critical in addressing long distances and also overcrowded rooms at the health centres. Previously, pregnant mothers slept on the floor whilst waiting to deliver their babies.

At the end of year 2 ADRA conducted a Participatory Review and Reflect process, Behaviour Change index survey and CHC monitoring surveys to collect their feedback, ascertain the needs of the community as well as asses the operational context and progress. In addition, ADRA has been running a pilot beneficiary feedback mechanism (BFM) funded by DFID and managed by World Vision UK to foster community participation and ownership of the project interventions. Results of the PRR and BCI reveal that an increasing proportion of WCBA now deliver at health facilities even though knowledge levels in key maternal health issues appear to be low. This is an indication that the project is working towards achieving its objectives. However, the BFM has highlighted the need for ADRA to review its dissemination of knowledge approach to the beneficiaries to plug the knowledge gap and address other issues that will impact the improvement of service delivery.

Throughout the implementing year, the project team has conducted extensive meetings with the stakeholders through the district quarterly stakeholder forum, bilateral discussions with MoHCC, other relevant government departments and NGOs from ward up to national level thus picking the needs and concerns of stakeholders with regards to the project. Participation at health cluster coordination meetings with government, NGOs, traditional leaders, Church leaders and representatives of the community (CHC) also assisted in picking the real priorities from the grassroots. Such meetings assisted to avoid overlap with other funding channels such as HTF and RBF. During the logframe review process, all key changes received approval by the District Medical Officer. Outside of coordination meetings, training and setup of health clubs and forums, a large proportion of the project’s team time was invested in the setup of infrastructure e.g. waiting mothers’ shelter, borehole drilling, and solar electricity.

Improving clinic facilities and providing an emergency transport system at the clinic level will result in the reduction of maternal mortality at the ward level. The inclusion and implementation of these items have strengthened the commitment of stakeholders and beneficiaries to supporting the project, as the requested needs of the community are being met. Only a few programmatic changes have been made due to some slight changes in the operational modalities of partners at district level. The project had designed to train school health masters who were in turn to form school health clubs, which would be the strategy to reach adolescents with knowledge on MNCH. However, due to rising dropout rates of secondary school children in the district, the MoE have focused on its school curriculum on key subjects only. Extra- curricular activities are no longer incorporated into the school day the MoE strategy now focuses on keep children in school and increasing the low pass rates within the schools. The same target age group will be accessed through faith-based institutions such as the church. The model of ToT training remains the same, the church will select adolescent trainers to form clubs within the villages. Selection criteria will be open to all adolescents in the village and not just those linked to or attending the church.

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

Yes X No To some extent:a. Please explain your response in the space below including reference to the gender and other

power relations encountered by the project, and to any socio-economic analysis:

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The baseline survey revealed the men in the household, including decisions relating to MNCH, took 50% of the household’s decisions. The community is maintains strong traditional patriarchal customs, cultural and religious practices that create a barrier to women’s equality in rights and entitlements of human social, economic and cultural development. In order to tackle the root of inequity in the project, the project has brought the discussion of gender equality to the dominant gender; men. The needs assessment acknowledged men must be a part of the discussion in order to challenge gender inequities and cultural norms that marginalise women. This year the project trained 253 men and boys (including local leaders) through a local organisation called PADARE in order to challenged pre-existing nuances that maintain gender equity and equality. The impact has been positive. The 253 men and boys are now disarmed and promoting the rights of women in the decision-making process within their households and community. Local leaders are instrumental in addressing community perceptions. The project expects to capture the full impact of this activity in year 3.

At the end of year 2, the project has assessed its approach to beneficiary empowerment and has identified ways of strengthening its intervention. For example, conducting a gender analysis will help project staff to identify the entry points in the target community to bring about long-lasting change. For example, the project’s direct target beneficiaries (7,500 women of childbearing age) are disempowered by a variety of external factors such as child marriages, early first pregnancies and incompletion of secondary school. ADRA identifies these factors as bottlenecks, which limits beneficiaries’ economic and social opportunities. In order for ADRA to strengthen its intervention it will work with other stakeholders to contribute towards increased equity for all members of the community. More emphasis will also be placed on targeting young people and wider community approaches addressing household decisions in health. Parents and adolescents will be targeted in the same forum to increase awareness in sexual reproductive health decision-making.

b. What has the project done this year to ensure that it is designed, implemented and monitored in such a way that gender needs and issues are addressed or mainstreamed, and that it delivers and tracks improvements in the lives of women and girls? What analytical tools do you use, if any, to do this? (Please refer to the guidance note ‘Gender and the GPAF’)

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The project has utilised the Behaviour Change Index (BCI) tool and BFM surveys to capture beneficiary feedback and track satisfaction of WCBA and men. Both tools capture how men and women are participating and whether or not their needs are being met. At the end of year 2, beneficiaries revealed that one of their numerous needs is being met as they now have decent WMSs. The BCI tool captures disaggregated beneficiary feedback on an annual basis and the BFM captures disaggregated beneficiary feedback for 3 wards on a monthly basis. Both tools feed into a robust monitoring system allowing the project team to address issues raised. As mentioned previously, a Participatory Review and Reflect process is conducted at the end of every implementing year with stakeholders and beneficiaries. Participants have the opportunity to reflect the past year’s activities and feed into the DIP for the upcoming year. Also provide feedback on the project’s overall approach and methodology to addressing maternal health issues in the District, this is an opportunity for participants to contribute innovative ideas or best practices. Women’s participation on this scale is often reduced due to the cultural context and fear of disproval when sharing their views, therefore the project captured women’s feedback through women FGDs and feedback boxes that were more private.

As a result of data analysis, ADRA will work effectively in the remaining life of the project to engage the Tonga group. The Tonga group are a minority group in Zimbabwe, maintaining distinctive cultural patterns, norms and language. Needs and priorities of this group are different to the Shona culture.The project also captures the shift in gender roles and perceptions through the data produced from the HIV programmes rolled out in the target wards by the Health Transition Fund. Data captured included the number of men accompanying their spouses to ANC appointments and the number of women participating in Option B+ (providing lifelong ART to all pregnant and breastfeeding women living with HIV regardless of CD4 count). Women accessing option B+ is a positive reflection of their empowerment and contribution towards decisions made within the household; in this cultural context there are stigmas attached to HIV diagnosis. Such data better helps the project to capture an increase in men’s engagement in maternal health issues and the increased utilisation of supporting services.

This project is a community-rooted project, which incorporates existing members and structures into its activities. The project is not in a position to advise on the selection of committee members but has encouraged the existing structures to incorporate the participation of women in its committees. Ward health committees have at least 50% representation of women while the majority of ToT’s and VHWs are women. Women engaging with other women reduce cultural barriers associated with men and women interaction outside of the household space. As mentioned previously, the men’s forum has educated and desensitised cultural taboo’s regarding maternal health and women’s roles. A total of 148 male ToT’s have been trained to be lead fathers in the community with respect to maternal health. Community meetings are also an opportunity for the project team to discuss gender and HIV/AIDS issues with the full hearing of men, women, boys and girls. The purpose is to increase awareness amongst the community promote women’s health and wellbeing.

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

i) Identification of the gender dynamics in this project, ADRA Zimbabwe has realized the need for a gender focal person and organisational capacity building in civil society’s engagement on gender issues. ADRA is undertaking the process of improving through the review of its Gender Policy to incorporate disability issues and formulation of a Gender Strategy which ADRA staff are bound to comply too. The project team is composed of 7 members of which 1 field officer is a woman.

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ii) The location of Gokwe North makes it tough to attract women to apply for such post. Further challenges include the physical terrain of Gokwe and the mode of transport; field officers will be required to cope with motorcycle riding. The inclusion of a female field officer has immensely benefitted the team in the planning and implementation of project activities. The project had identified the need for specific capacity and skill set in maternal health, which was included in the budget during proposal stage and is being provided by a female maternal health advisor. The participation of disabled persons in the project has not been documented in year 2; this was an oversight. At all gatherings gender and disability issues are talked about through public addresses. ADRA plans to intensify its data collection to capture disability.2.4 KEY ACHIEVEMENTS

Please provide a heading and summary of the three most significant project achievements over the last year (up to 10 lines each) with particular reference to the objectives of the GPAF. This section provides you with an opportunity to tell the story of the project’s successes and what you are most proud of this year. Please be as specific as possible in describing the target groups; how many citizens benefitted (men/women; girls/boys); and how they have benefitted. Also make it clear where the achievements were made in coalition or partnership with other, non-project actors.

1. Construction of the 4 waiting mother shelters (Nenyunka (Ward 28), Zhomba (Ward 29), Vumba (Ward 30) and Simchembo (Ward 1 and Ward 31)

The construction of the 4 waiting mother’s shelters that will serve the 5 wards and 7,500 women of child bearing age is a key achievement for the project. The purpose of the WMS is to reduce travel distance for pregnant women to the clinic during labour. Pregnant women can wait at the shelters up to 2 weeks before their delivery with health staff nearby to assist them if required. The WMS’s are equipped with modern beds and lockers, flush toilets, electricity powered through solar, outdoor kitchen and running water for consumption and personal hygiene. The construction of the WMS contributes towards the government’s strategy of reducing the barriers to the third delay outlined in the ‘three delays model’; Delays of pregnant women reaching health care centre. The project built local capacity by mobilising local builders to build and maintain the structures. The public works department of the government has inspected its construction at every level and the WMS’s have been signed off as suitable and sustainable. ADRA is especially proud of this achievement since this was as identified as a priority by beneficiaries and stakeholders in the initial needs assessment. ADRA through DFID funding has met the needs of the beneficiaries and stakeholders. Due to the construction delay, the WMS were not fully completed at the end of year 2 therefore only an estimated 5% pregnant mothers utilised the structure this year.

2. Provision of e- ranger ambulance services

The E-Ranger ambulance service has been in operation since October 2014. Over 45 women with obstetric emergencies have been ferried from home to the clinic for medical attention reducing the second delay: Delay in reaching health care facilities by pregnant women. This activity is a key achievement as pregnant women travel up to 25km to reach health facilities in emergency situations. Many are challenged by financial resources and have no option but to birth at home. The provision of transport at the clinic level also provides transport for emergency cases from the clinic to the District Hospital if required. This intervention has contributed towards the reduction in time taken by pregnant women with complications to arrive at health clinics. The project provided training on the usage of the E-Rangers to health staff at each clinic.

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3. Improved awareness in maternal health and its services

The project has implemented key strategies to build the capacity of MoHCC and community to plan and setup systems that will address maternal health issues including mainstreaming gender issues. Indirectly, the MOHCC is benefiting on data collection, surveillance and growth monitoring at community level through ToTs trained under this project. The project developed the first participatory maternal health tool-kit and training manual for ToT’s at community level. This tool can be easily replicated and disseminated amongst other stakeholders at a reasonable cost. 241 ToT’s were trained in maternal health issues resulting in the formation of 140 community health clubs with total membership of 2,440 men and 4,411 women including 156 (145M: 11F) local leaders and 39 VHW (20F:19M).

Heath club members have increased maternal health knowledge from the tool-kits and manuals. Five community health campaigns were held to increase awareness reaching 3,282 beneficiaries (1,121 males and 2,161 females).

The Padare training for men and boys tackled cultural traditions reinforcing gender inequity; the training was a means of reaching out to men and engaging their participation. The trainings established five men’s chapters and five boys’ chapters in the five wards reaching 263 males.

In year 3, the project will conduct a gender assessment; focus its efforts on the Tonga group and target parents and adolescents.2.5 PROGRESS AGAINST DELIVERABLE AND TIMESCALES

How would you describe the current status of project progress in relation to the original time-scale? (Mark with an “X” in the appropriate box)a. This project is on track against its deliverables and original timescaleb. This project is off track but expected to be back on track in the next

reporting periodX

c. This project is off track and not expected to be back on track in the next reporting period

Please list key factors that have contributed positively to progress:

Community leaders’ commitment to work (in particular the councillors and headman) - these leaders effectively mobilized communities for both work and training or campaign sessions. They personally participated in these activities.

Constant engagement of all stakeholders. Support and ownership from partners (MOHCC, PWD and ADRA UK) allowed for positive feedback.

The introduction of the RBF system by the MOHCC motivated nurses to accommodate more patients per given time hence contribute positively to the project. The RBF system rewards health centres based on performance using key health indicators.

Quick disbursement of funds from the donor- the project activities moved smoothly as the disbursement of funds was quick.

List key challenges or factors impacting negatively on progress, and how they have been addressed:

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Change of policy by Ministry of Education limiting involvement of NGOs in schools required ADRA to change its approach away from school health clubs. The approach is now targeting adolescent through churches and church based clubs. These clubs will raise awareness and contribute to behaviour change in relation to MNCH. The approach offers an opportunity for Parent Child Communication in Sexual reproductive health, a gap that has been identified by the government as a missing link in improving sexual reproductive health among young people and giving them skills and support for delayed sexual debut and early pregnancies.

Planned activities involving MoHCC were at times postponed due to commitment to other national programmes by stakeholders.

The project sites geological formation is made up of shifting sand. Construction took longer to complete and the budget was strained due to inclusion of steel reinforcement on the foundation, which was not originally planned. This impacted the budget line. The WMS will be fully functional beginning of year 3.

Limited access to two sites (Simchembo and Vumba) during the rainy season due to bad road networks. Monitoring frequency to these sites was thus minimal. All resources and material were delivered to the sites before the rain season and communication lines were left open during most of the inaccessible period.

Construction of one of the WMS on a new site at Nenyunga as advised by the MOHCC is likely to delay functionality of this structure as it has emerged the new site is not yet ready for use. The new site still needs to be completed to allow for full transfer of clinic activities to the new site. All stakeholders have been engaged and plans are underway to speed up the completion and transfer process.

If the project is considered to be ‘off track’ please explain what measures are being taken to get the project back ‘on track’:The project is slightly off track with regards to construction of WMS and associated installations. This emanated from the delays caused by the introduction of the reinforced steel concrete. All materials have been delivered to sites and construction has completed at some sites. Final touch ups on installations and equipping of the WMS is underway and is expected to complete in April 2015. Communities have been mobilised to ensure all the required materials and labour is on site. Once completed, they will open for use and monitoring will be intensified to track related milestones.On the Nenyunga site, the construction of the WMS was built on a new site away from an old site which is being abandoned due to environmental degradation. The old site is currently too close to a gully/river and with the rise in the water levels and soil degradation, the MoHCC is concerned by the risk posing major flooding or the clinic being swept away completely. A new clinic is in the process of being built but there are delays in operationalising it due to funding challenges faced by the responsible authorities – the Baptist Church. A dialogue is taking place with the responsible authorities to drive forward the completion of the maternal health section of the clinic at the new site and make it functional. Developments are being followed closely so that the WMS is functional in good time.2.6 CHANGES TO PROJECT STATUS

In the last reporting period have there been any significant changes in relation to the following? Tick the boxes as appropriate. (Mark with an “X” in the appropriate box)a. Project design Xb. Partner(s)c. Contextd. Availability of match-funding (where relevant)Provide a brief explanation of what has changed, when and why:

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The project had designed to train school health masters who were in turn to form school health clubs, which would be the strategy to reach adolescents with knowledge on MNCH. However, the MoE could not allow any extra- curricular activities within the school because they were promoting only curricular related activities as a response to low pass rates within the schools. The project had to change the strategy and is now targeting the same age group through church based adolescent trainers. These trainers will in turn form clubs within the villages and will not only target adolescents attending church but also every adolescent who are willing to join the club.The project was using conventional M&E systems to gather feedback on progress. The BFM has been introduced through recommendation from World Vision UK as a pilot to gather feedback using predetermined questions thus strengthen the accountability loop. BFM provides a learning experience and will inform expansion and adoption in other projects if it proves to work.

2.7 UNINTENDED (POSITIVE) OUTCOMESAre there any unintended outcomes that have been observed as a result of your project implementation during this reporting period? Please list below. If these require a revision to the project logframe, please incorporate into your response to question 2.9.

There has been an increase in CHC participating households using shallow protected wells. Through training in PHHE and formation of clubs, it is thought that members were motivated to protect their wells and have safe drinking water.

Some members of CHCs have formed village savings and lending groups (VSL) following discussions with ADRA staff. The VSL is not part of the training objectives but was introduced to interested members during community gatherings and club meetings.

117 additional VHWs were refreshed in maternal health issues increasing coverage and promotion of maternal health issues in non-project suites

2.8 UNINTENDED (NEGATIVE) CONSEQUENCESHas the project implementation led to any unintended negative effects during this reporting period? Please list and explain below.If these are considered to have a negative effect on the outcome of the project, do they require a revision of the project risk matrix? If so, please incorporate into your response to question 2.11.

Misunderstanding arose amongst ToTs due to the sharing of bicycles. This budget line was under budgeted, bicycles more suitable for the Gokwe terrain were more expensive but were necessary and recommended by the MOHCC,. This resulted in TOTs being paired based on their proximity to each other in the community. However, it was never anticipated that this would result in misunderstandings in their use. The project has had to continuously convene meetings to resolve bicycle related issues, some of them bordering on gender related issues. Where such issues arose, there were delays in implementation of planned activities as ToTs would not be having transport at the time or might be demotivated to the extent of not wanting to fully participate.2.9 PROJECT LOGFRAME

Note: All changes to logframes require approval from the Fund Manager.(Mark with an “X” in the appropriate boxes)Has your logframe been approved by the Fund Manager?

Yes Not yet – work in progress X Not sureIf your logframe has been approved, do you wish to make changes to it or discuss it with the Fund Manager?

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

No

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If you want to make changes to your approved logframe, as a result of changed assumptions or for other reasons, have you attached a justification and a copy of your logframe highlighting the proposed changes? Please label this document: “GPAF (ref. no.) Revised Logframe – Prepared (+ date prepared)”

Yes X NoOn the basis of your project implementation experience during this reporting period, do you consider there to be any key aspects of your project which are not sufficiently captured in your project logframe (such as hard-to-measure qualitative results)?

If yes, please use the space below to explain. Yes X No

We are challenged in measuring the number of women attending all MH and related services at the clinic. There is no one indicator at the outcome level that can capture the main target beneficiary group in which are the 7,500 women of childbearing age. Tripleline has requested this but we have not yet achieved this.2.12 RISK MANAGEMENT & MITIGATION

With reference to the project’s risk matrix, please use the table below to describe the main risks you faced in the reporting period and how you dealt with them. Ensure that you consider the challenges described in section 2.5 when completing this section.

Which risks materialized during the year?Describe briefly. Please ensure you include staff turnover and vacancies or risks relating to partnership working if this applied.

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

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

Was this action sufficient?Yes / No / To some extent

1. Women may not attend all of the recommended antenatal care visits. A significant number of pregnant women (30%) did not attend the 4 recommended ANC visits. Some registered late (at 5 months) at the clinics and only came back when it was time to deliver while some never registered their pregnancies or attended any ANC but just came for delivery.

Yes Refresher training was done with VHWs to increase follow ups in the community. Education and awareness raising continued to be given to communities at long community gatherings and at the clinic.

To some extent

2. Demotivation of ToT’s due to bicycle disagreements

yes Engagement of the concerned ToTs and dispute resolution

A few ToTs affected.

3. Ministry of Education disallowed school health clubs

Yes The children are now being targeted through churches but the overall goal maintained

Clubs still going to be formed

4. Incomplete WMS Engagement of community to provide materials.

WMS construction now complete

5 Inactive borehole pumps yes Delays due to weather conditions Installations now underway

6 Delay in joint activities with the MoHCC

yes Accept reality and plan accordingly

7 Nenyunga clinic yes Engaged Baptist and other stakeholders

High impact

2.13 Are you expecting significant new risk(s) in the next reporting period that would affect project performance or completion? If yes, tick the box and list the new anticipated risks inthe table below. Yes X No

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Anticipated risks and mitigating actions. Complete the table if relevant (maximum of 4 risks). Focus on higher level risks such as a deterioration in the operating environment. Include any unanticipated risks which occurred in the reporting period and which you expect to continue to apply in the next. Include staff vacancies and partnership working as appropriate.

Anticipated risks Intended mitigating actions

Risk rating: Your assessment of risk probability & impact

1. Non-functioning waiting mothers shelter at the Nenyunka new site

Upscale engagement with site authorities (Baptist Church), DMO, MP, RDC, Councillor and local Chief to push for timely completion of the clinic’s remaining aspects. This will thus facilitate the functionality of the waiting mother’s shelter that has been constructed at the new site.

High Probability High Impact

2.

3.

4.

2.15 If you anticipate new risks please submit a revised risk matrix.Revised risk matrix attached highlighting new anticipated risks?(Mark with an “X” in the appropriate box) Yes X No

SECTION 3: VALUE FOR MONEY (Up to 2 pages)See introductory section on page 4 for guidance and resources on Value for Money.3.1 Economy: Buying inputs of the appropriate quality at the right price. What policies and

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

Please explain and provide examples:ADRA Zimbabwe has a robust procurement policy that allows for, competitive bidding and good value for money. The procurement of project items was only green lighted after a thorough comparison of at least three suppliers for the same product. All purchases are signed off by ADRA’s ADCOM for accountability and transparency. The project procured key WMS items from South Africa e.g. beds and solar panels. Retail price and transportation costs still resulted in savings. The quality of materials remained high and approx £16,600 worth of savings were made.3.2 Efficiency: Converting inputs to outputs through project activities. What steps have you

taken this year to ensure resources (inputs) have been used efficiently to maximise the results achieved, such as numbers reached or depth of engagement? Include references to the use of any relevant cost comparisons (benchmarks) at the output level (e.g. standard training cost per trainee) and any efficiencies gained from working in collaboration with others.

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The project managed to train 106 additional VHW in the whole district following recommendation from MoHCC. 193 VHWs, including the 44 in the target wards, had been identified to be existing and had gone through the standard VHW training in the whole district hence they needed a refresher training instead. The refresher turned out to be cheaper but reaching out to more people than had been planned. A saving of £1015.50 was realised.

ADRA conducted trainings at community level instead of brining then to central points where it would be more expensive due to accommodation, food, conferencing and transportation costs. The cost per participant was calculated to be $30 when done at a central point outside the ward when compared to $10 per person when done within the ward. The project trained 263 men and 245 boys in gender and women empowerment.

The project has assisted the CFO with transport to project sites thus making savings to the BFM. In the same vein, the CFO has also collected frontline data on behalf of maternal health field officers. This too has enabled realisation of savings in transportation costs since the CFO uses a motorbike.

Collaboration with existing ADRA Zimbabwe Project: Logistical support has continued to be provided to the Maternal Health and Child Project by another ADRA project WASH and Education Project funded by Ministry of Foreign Affairs – Japan, which is operational in the same district but in different geographical area of Nembudziya where government stakeholders are based. The staffs for this project represent the Maternal and Child Health Project at various district meetings such as the full council meetings and the District Water and Sanitation and Cluster Sub-Committee (DWSCC) meetings. In addition, they have facilitated clearances for monitoring activities. Within a quarter the WASH and Education Project represents the Maternal and Child Health Project at 3 DWSSC meetings, a special meeting on Malaria which was coordinated by MoHCC, one full council meeting and one department of social service meeting. This resulted in significant savings in communication costs, a saving of 12 days man-hours and 150 litres of fuel. The team has also played a big role in facilitating information exchange with the DMO with regard to the stakeholder’s forum activity.The WASH and Education Project attended a quarterly review meetings of PWSSC (Provincial Water and Sanitation Sub-Committee) of Midlands representing both of the WASH and Education Project and the Maternal and Child Health Project. About 2 days man hours ($400 per diem for officer and driver) and 52.5 litres ($78) cost of fuel were saved. The two projects will alternate participation at the PWSSC and other health clusters.Two staff members (PM and a field officer) from the maternal health project were trained on Training for Transformation, which was facilitated by another ADRA project Action for Social Change funded by DANIDA through ADRA Denmark and implemented by ADRA Zimbabwe. Training was aimed to enhance the capacity of the officers to analyse root causes of poverty and develop tools in advocacy. The skills gained assisted the project in their activities to build committees and leadership structures, which are central in addressing the success of the project. The intervention also builds on civil society engagement in addressing developmental issues. Costs for the two staff members should be GBP 500.00, but it was free for our staff.

3.3 Effectiveness: Project outputs achieving the desired outcome on poverty reductionTo what extent do you consider the project to be achieving the anticipated changes for beneficiaries and target groups? How well are the outputs of the project working towards the achievement of the outcome?

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The inputs and outputs are largely achieving the anticipated changes for the beneficiaries. All purchased resources are in good working condition and giving desired outputs. WMS have been built and equipped with water and lights allowing waiting mothers to use them once fully completed. The 145 CHCs and 10 men’s chapters have allowed for discussion of maternal health issues within the community thus contribute to awareness raising. Frontline data has shown an increase in health facility deliveries while BCI has shown improvements in knowledge and practices in maternal health. The drilling of boreholes has enabled waiting mothers to access clean safe water from within 20m. Provision of e ranger ambulances has enabled emergency cases to be attended timely and professionally at health facilities. During the period under review, no deaths have been recorded due to complications in the community. This has reduced the time spent on collecting water thus gives women time to rest. More mothers are now coming to deliver at the health facilities thus reduce chances of maternal and neonatal deaths.3.4 Have there been or do you anticipate multiplier effects from this project? Multiplier effects

include leveraging additional funds, longer term or larger scale implementation or replication of approaches and results. Where additional project funds have already been secured, how have they been used to enhance delivery?

The BFM pilot has proven to be a useful tool to empower the community to hold the implementing agency accountable to project deliverables. There is scope for adapting the approach to other projects within the organisation. There is need to build more WMS at all sites where maternity services are supported. Evidence from the use of the e-ranger ambulances so far shows room for replication in inaccessible areas like Gokwe provided proper structures are put in place to manage the assets. The ambulances are proving to be convenient for local communities and helping the MOHCC achieve its goal on RBF.We anticipate engagement of Adventist Health Professional Association which comprises of medical and dental specialists as well as other doctors and nurses to give community service to the Four supported clinics over a week in conjunction with the MOHCC. Discussions are under way.

SECTION 4: SUSTAINABILITY (Up to 1 page)

4.1 What have you done during this reporting period / what are the plans to ensure that positive changes to peoples’ lives will be sustained beyond the lifetime of the GPAF grant?

The project has trained TOTs on MNCH who in turn will form health clubs within the communities. This capacity building of TOTs cascaded to community members will increase awareness and self-driven demand for MNCH services through improved health seeking behaviour. Personal checklist on key MNCH actions checked and signed by TOTs will cultivate the culture. Training of adolescents raises knowledge and awareness at an early age including issues of gender equality and equity. The community leaders were trained and provoked to ensure positive MNCH gains are maintained. The leaders are expected to enforce by- laws that promote positive maternal health practices e.g. Some Headman have put by- laws that forbids home deliveries with offenders being fined a goat. A total of 263 men, 245 boys and 156 community leaders were trained in gender and maternal health issues to change their perceptions and actions towards women and maternal health issues. Through Men chapters such issues are discussed and other leaders may follow suit thus promote clinic deliveries. The project has also trained and strengthened 4 ward health committees (WHCs) who plan and run the affairs of the health centres. The local based ward health committees will be responsible for the maintenance, service and running of the E- ranger and the WMS along other responsibilities given by the MOHCC. The committees are monitored by the district health executive thus will continue to operate even after the project ends. About 39 VHWs were refreshed in maternal health issues and are promoting positive maternal health practices. VHWs are monitored by the MOHCC hence will continue working even after project termination. The project has also trained 12 health staff in the management of the e ranger ambulance thus allowing them to continue using this facility. Other funding channels such as HTF and RBF may be used to sustain the plans by the WHCs.4.2 If the project is introducing new or improved services that need to continue beyond the

life of the grant, what have you done / what are the plans to ensure the sustainability of the service?

Solar powered lighting in the WMS: The asset will be managed by the trained WHC who have been

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trained to include budgetary provision for the repairs for the shelters and water system. MOHCC has developed the operational guidelines for WMS which will be used to monitor their usage and suitability for intended use. WMS are key result area for the MOHCC hence will be their management too.

E- ranger ambulance services for emergency cases: The routine maintenance and cost of fuel are likely to be the major hurdles to the use of this service. The WHC is responsible for the management of the E- ranger which has been listed under the district Health transport system. The committee members who were trained to ride the ambulance were also trained on basic maintenance. The WHC are expected to include this in their plans and source funds from other sources.

Solar powered Borehole: The boreholes provide a water system that supplies the clinic and WMS. After completion of installation, the WHC, DDF and local pump minders will be trained on basic maintenance. The WHC will include these in their plans including repair and maintenance costs.

CHCs and Men’s Chapters: Education and awareness training sessions through TOT and VHW should continue beyond project lifespan to allow for sustained behaviour change. During implementation, the VH, Chapters and TOT are linked to health centres thus provide their reports monthly to their centres. The VHWs are already employed by the MOHCC and one of their major responsibilities is sensitizing and supporting communities on maternal health.4.3 What do you consider to be the main risks to sustainability and what are you doing to

mitigate these risks?Socio-economic instability is the worst risk to the sustainability. Reduced funding may result in VHWs being neglected by the MOHCC hence their function dies. Introduction of user fees for maintenance of assets would not bring positive outcome under the circumstances. The project has trained locally based maintenance personnel who are expected to do routine maintenance. Continued engagement of MOHCC will ensure that they continually support the activities and VHWs even after the conclusion of the project.Influence by religious and cultural groups: Some religious groups discourage their members from accessing and utilising health services and even participation in CHCs and chapters. Religious leaders, men and community leaders are constantly engaged to make them understand and support MNCH so that WOCBA are free to seek for health services. Inclusion of adolescents is expected to prepare them for adulthood. Early engagement of adolescents and empowerment will likely reduce early and unwanted pregnancies and empower the girl child.

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

information and when?Beneficiary satisfaction with project entitlements: The project wants to understand if beneficiaries understand their entitlements and if they are receiving them and are satisfied with the services and process of providing services. The feedback also ascertain if the project is meeting beneficiary needs. After every two months, a beneficiary satisfaction survey is done through interviews or FGDs and data analysed. Quarterly participatory review and reflect sessions are held to gather feedback from communities. The project is also using predetermined questions on key indictors to gather feedback through the BFM. Notice boards, feedback boxes and interviews are done weekly to collect feedback.5.2 What challenges has your project faced this year in collecting feedback from its primary

beneficiaries?

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Collecting feedback from women and children has been limited because literacy levels are still very low in the project area therefore women are disempowered to want to engage in discussions and feedback on their experiences and viewpoints. Culturally decisions, question and comment are only shared by and with men. In public forums, women and children tend to agree to whatever points are put forward by the men. The project has utilised the BFM suggestion boxes to capture sensitive information however a beneficiary must be able to read and write to benefit from the mechanism as responses are provided through notice boards. Without a confidential feedback system, women will withhold feedback for fear of victimisation. Due to long distances between ward centres and clinics or other gathering points, community members are reluctant to participate in discussions or data gathering exercises that do not give incentives. Collection of feedback during the rainy season has been hampered by the rains and also by non-participation of community members who spent most of their time in the fields. Feedback would be collected only on selected days when beneficiaries were free.5.3 What challenges has your project faced this year in acting upon beneficiary feedback?

No challenges experienced in acting on feedback that directly related to the project and ADRA or was within the project’s scope. However the project’s beneficiary feedback mechanism captured feedback that related directly to MoHCC and feedback from the MoHCC was delayed or not responded to at all. Some of the feedback was deemed sensitive and there was lack of commitment from the MoHCC to act on it. It has been identified beneficiaries do not fully understand the project’s scope hence they would make misplaced demands instead of giving feedback on the project under implementation. The project has addressed this issue by continually engaging with the community and sharing project information on entitlements through discussions and project documents. Project documents and IEC materials were translated into local languages for ease of understanding.

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

The suggestion to train adolescents through churches came from ToTs who indicated that several churches have youth programs and that some of the youth leaders were involved with youths in the community and schools and some of them are members of child protection committees. This approach was adopted and the church adolescent TOTs were trained and will target all adolescents within their catchment area.

SECTION 6: LEARNING (Up to 2 pages)Please identify the top 3 lessons you have learnt from this project, including from things which have not gone well and innovative approaches. Be specific and clear in describing the lesson, and in explaining how you have applied learning to improve project delivery.

Lesson How has this led to changes or improvements in the way you (i.e. grant holder or partner) have worked?

1. Beneficiaries need to be empowered to hold implementing partner accountable

Lack of knowledge of beneficiary entitlements led to slow participation in provision materials for construction. The project team was made to continually engage the community to educate them on their role in the implementation of the project thus dispel misplaced expectations.

2. CHCs provide platform for peer to peer learning but need constant and consistent follow up for them to take off

The project has formulated participatory tools that stimulate interest and allows easier monitoring and feedback. Contact time with communities has now increased resulting in faster sharing of feedback.

3. Thorough and careful stakeholder engagement is needed in the planning and implementation of maternal health projects.

Maternal health issues are sensitive hence there was need to consider the context and then target beneficiaries appropriately.

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

GPAF Annual Report Template 2015 20

explain their wider relevance below. The MNCH project creates demand for services and information. Such services and information

should be readily available for the communities thus should be planned for once a project begins Service providers should ensure that they have sufficient commodities and supplies on hand to meet the increased demand for family planning and other reproductive health services.

Involving communities in the development of IEC (using pictures of local people and pretesting) material helps them identify with both the pictures and messages on the material.

SECTION 7: REQUIREMENTS OF GRANT ARRANGEMENT (Up to 1 page)7.1 Responses to Due Diligence RecommendationsIf this is your first Annual Report for this project, you are required under clause 37 of your original Grant Arrangement to provide an update on any actions taken during this period in response to the recommendations of the Due Diligence report prepared for your organisation by KPMG. Please note that you should not comment on recommendations included as specific terms and conditions in section 4.d. of your Grant Arrangement, as these are monitored through a separate process.If this is your second or subsequent Annual Report, please use the space below to comment on any actions taken during this period in response to any remaining Due Diligence recommendations.ADRA UK7.2 Use of DFID logoClause 58 of your original Grant Arrangement commits you, unless agreed otherwise, to explicitly acknowledge DFID's support through use of DFID's UK Aid logo in all communications with the public or third parties about your project. Please outline the ways in which you have done this during the reporting period.The DFID’s UK Aid logo has been used and acknowledged in all communications with the public and third parties. All banners and T-shirts have the logo and are used for publicity at all project gatherings and training sessions. All reproduced IEC materials, training manuals or toolkits, hats and bags have the logo. Asset stickers with the logo were printed and are stuck on all project assets including TOT bicycles, staff motor bikes and E- ranger ambulances. The project has constantly engaged all stakeholders issued with hats, T-shirts or bags bearing the logos to use them only on project related activities and avoid using them during political activities.

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ANNEX A: OUTCOME AND OUTPUT SCORING

Please read the instructions on this page carefully and complete all sections

Before working on this section, please complete the relevant indicator ‘achieved’ boxes on your ‘Reporting Logframe’ (which should be based on the most recently

approved version of your logframe).

SCORING ANNEX A asks you to score performance against your Outcome and Outputs making a judgement based on the actual achievements compared to expected results as indicated in the logframe milestones for this reporting period. Use the five-point scoring system below to rate your achievement of results.

Score Description of ScoreA++ Output/outcome substantially exceeded expectationA+ Output/outcome moderately exceeded expectationA Output/outcome met expectationB Output/outcome moderately did not meet expectationC Output/outcome substantially did not meet expectation

REPORTING PERFORMANCE

Complete what has been ‘achieved’ under each outcome and output indicator in your logframe

Within this section of the document (Annex A), provide an overall score against the outcome and each output.

Provide an explanation for each outcome and output score describing the progress, or the barriers to progress, made against the outcome or output indicators in the reporting year. Do not simply describe activities.

Back up statements of progress/achievements with references to evidence that can be checked if necessary. Be as specific as possible, avoiding general references like ‘project monitoring records’. Examples could include ‘field training reports and attendance records completed at the end of each wave of training’, ‘sample survey of heads of household in two villages from each of the project locations, February 2015’, ‘local district exam results, verified through teacher focus groups, July 2014.’ Cross refer to section A7 to avoid repetition as necessary.

Comment on the strength of evidence provided. Consider for example: how well samples represent the reference population; the extent to which the measure reflects the specific contribution of this project; triangulation of data; absence of bias; and the balance between qualitative and quantitative data.

Be sure to complete the final section (A.7) on methodological tools.

If your logframe is not yet approved, use the latest version and report anticipated progress towards the first milestones. Where your evidence base is incomplete, please explain your plans to monitor progress and when you expect to have the data you need (sections A.x.6).

GPAF Annual Report Template 2015 22

BENEFICIARY DATA

Annex A also asks you to disaggregate beneficiary data at the Outcome level. It is this data, consolidated in Annex B, which DFID uses to assess the numbers of people benefitting from GPAF projects.

DFID is also interested in finding out about the number of people engaged by the project at Output level, and the nature of their engagement. The delivery of the outputs is considered as the means of achieving the desired changes to the lives of the beneficiaries identified at the outcome level. Although many of those engaged at output level will experience positive changes (e.g. to skills, awareness or improved capacity), for the purposes of this GPAF progress reporting, they are not defined as beneficiaries.

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ANNEX A: OUTCOME AND OUTPUT SCORING(Up to 12 pages). Retain in portrait format

OUTCOMEA.0.1 Outcome: write in full your project outcome in the box belowWomen (including mothers, pregnant women and girls of reproductive age) access and utilize improved maternal health care services in 5 wards of Gokwe North DistrictA.0.2 Outcome Score: Please provide an overall outcome score (A++ – C)B

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

The average % achievement for the five indicators is 74%. Achievement for each indicator was calculated as % of observed value over planned (targeted) value. E.g. for indicator 1: 825 births were recorded against a target of 1019 giving an achievement of 825/1019*100=81%. An average for all the five was then calculated.A.0.4 For each of the indicators: Write in full each outcome indicator as included in most recently

approved logframe and provide a narrative clarification of progress achieved against the relevant indicator milestone, including an explanation of any over or under achievement.

Indicator 1: Number and percent of expected births in target wards delivered at health facilityA total of 825 (40.5%) were achieved against a target of 1,019 (50%) expected births in target wards that were delivered at the health facility. The reasons for underachievement is due to many community members still holding strong cultural traditions which encourage women to birth with local TBA’s at home. The project continues to work with the community to challenge these cultural nuances. In addition, during the rainy season, the community are challenged to reach the health facilities due to long distances, poor road networks and flooding.Indicator 2: Number and percent of women receiving post-natal care ten days after deliveryA total 1,010 (49.5%) were achieved against a target of 611 (30%) of women receiving post-natal care ten days after delivery. The milestone has been met and surpassed. An increased number of women are receiving PNC within 10 days of delivery. Dissemination of health messages in the community from various channels e.g. health clubs, local leaders and VHW’s has led more women that birth at home or outside of the project area to attend PNC in the project area.Indicator 3: Number and percent of women attending antenatal care four times during pregnancyA total 409 (20%) women attended antenatal care four times during pregnancy against a target of 611 (30%) of women. The reason for underachievement is due to the long distances for women to travel. Women are still registering for ANC late, therefore they miss out on the periodic 4 sessions recommended by the government. Some women still do not recognise the full benefits of the ANC service.Indicator 4: Estimated number and percent of women who report improved services in antenatal and post-natal care at target clinic (Zhomba and Simchembu clinics)The milestone target was 713 (35%) of women who report improved services in antenatal and post-natal care at target clinics. This data was not collected due to the construction delays of the WMS. Feedback on the WMS is a key aspect of the women’s satisfaction survey. Data will be collected in YR3 for milestone 2.Indicator 5: Number of men (e.g. men, boys, community leaders) that are promoting maternal health services amongst female family members/ friendsA total of 153 men are promoting maternal health services amongst female family members/friends against a target of 250 men. The underachievement is due to the project’s overestimation on men and boys empowerment to relay positive health messages in the community after the completion of the Padare chapters. Men and boy’s attitudes are routed in cultural traditions, therefore project staff have realised the impact of the Padare chapters will not be seen immediately. The 153 men are made up of 133 ToT’s and 20 VHW’s. It was an oversight to not include these groups in the milestone target. Many of the ToT’s and VHW have also participated in the Padare chapters and have also been disseminating positive health messages in the community.

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

AdultMale

Adult Female

Child Male

ChildFemale Total

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

Brief description(e.g. farmers)

Change/improvement(e.g. income increased)

825825 Pregnant women

delivering at health facility

Delivery by skilled personnel

10101010 Lactating women PNC services and

knowledge & awareness

409409 Pregnant women ANC services &

Increased knowledge

840840 Lactating women Growth monitoring

and health education

1865 1865 WOCBA Family planning services

19 19 Adolescent girls Family planning services

153 153 Men Maternal health promoters

Improved facilitation skills

A.0.6 0State the evidence used to measure the progress described and comment on its strength. Please refer to the preceding guidance on how to complete the section effectively.

Due to the sensitivity of health sector data in Zimbabwe, data collected for outcome indicator 1, 2 and 3 was heavily reliant on secondary data from the health clinics. For example, monthly ANC and PNC registers were used to gather and verify statistics on births and ANC and PNC visits at the clinics. In addition, monthly VHW’s verify data and collate reports. Data was compiled into the Consolidated Frontline Data Collection Report March 2015. Outcome indicator 5 is evidenced through Padare workshop attendance registers, ToT training registers, CHC registers and the Padare Training Report December 2014. There is an overlap between some of the men that participated in the Padare training and ToT’s and CHC. The project has conducted a community club audit and verification of ToT cascading trainings.

OUTPUT 1A.1.1 Output 1 Write in fullMaternal health facilities improved at the four target clinics

A.1.2 Output 1 score (A++ – C)C

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

The average % achievement for the 3 indicators is 65%. Achievement for each indicator was calculated as % of observed value over planned (targeted) value. Eg for indicator 1: 4 functioning solar lights were recorded against a target of 12 assets (4 boreholes, 4 solar lights and 4 WMS) giving an achievement of 4/12*100=33%. An average for all the three was then calculated. WMS have been completed and are being furnished with beds while boreholes are being equipped.

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A.1.4 For each of the indicators: Write in full each indicator as included in most recently approved logframe and provide a narrative clarification of progress achieved against the relevant indicator milestone, including an explanation of any over or under achievement (add extra rows if required).

Indicator 1.1: Number of health clinics with improved and functioning maternal health facilities (e.g. working and adequate waiting mothers’ shelter, clean water and solar power) in target wards.A total of 0 functioning WMS, 0 functioning boreholes and 0 functioning solar power units were achieved against 4 functioning WMS, 3 functioning boreholes and 4 functioning solar power units of which the project achieved. The milestone has underachieved its milestone as the WMS, boreholes and solar power units do not qualify as functioning in line with the definition in the logframe (source box). Due to the dissemination of the maternal health messages through the implementation of YR2 activities, pregnant mothers have been coming to the clinics and utilising the facilities despite final completion. Delays were due to the delays of putting a steel reinforcement to ensure the structure is structurally strong to withstand the Gokwe terrain. In addition, the design of this activity required the participation of the community to contribute local building materials for the WMS. The delays ran over into the ploughing season therefore created challenges for the community to provide provision of some materials as they were committed to working in their fields. Outstanding work on the WMS is the furnishing of the WMS and installation of water system inside the WMS. Solar power units are in place.Indicator 1.2: Number of emergency cases responded to by e- ranger ambulanceA total of 45 emergency cases were responded to by the E-Ranger ambulance against the target of 40 emergency cases. The project has promoted the new ambulance service through the health clinics, VHW’s, community meetings and health clubs. This has increased the awareness of the community and the uptake of the service.Indicator 1.3: Number of WHC trained and effectively functioning (this is defined as having developed a maintenance schedule and having kept to this schedule)A total of 0 water pump maintenance schedules and 4 E-ranger maintenance schedules are functioning against of 4 water pump maintenance schedules and 4 E-ranger maintenance schedules. The WHC were trained in asset management, general planning of health clinic activities and maintenance of the E- ranger ambulances. The water pump committees will not be established as the District Medical Officer has suggested that a stand-alone committee is unsustainable. The DMO has suggested strengthening the existing WHC to undertake the maintenance of the water pumps. This will be undertaken in YR3.A.1.5 SDisaggregate the number of citizens engaged with this output in this reporting period.

Describe briefly who they were and how they were engaged.N.B. Adult = 18 years and above; Child = below 18 years.

Adult Male

Adult Female

Child Male

ChildFemale Total

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

Brief description Nature of engagement

4545

Not Known45 pregnant women with emergencies

Ambulance services

12 12 0 E ranger riders Training for riders

18 7 25 0 WHC members Trained in asset management

16 16 0 Builders Employment

A.1.6 State the evidence used to measure the progress described and comment on its strength. Please refer to the preceding guidance on how to complete the section effectively.

The information on the E- ranger responses was obtained from the clinic monthly patient logbook, the Clinic delivery register and the E- ranger log book. The activities of the WHCs are recorded in the WHC minute book and WHC training registers 2014. Records of training (capacity building) are found in the workshop register and training report compiled after the training.

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Output 2A.2.1 Output 2 Write in full:Community Health care providers have increased knowledge and skills to provide improved maternal health careA.2.2 Output 2 score (A++ – C)A

A.2.3 Justify the score: The score is based on an aggregate of actual achievement against output indicator milestones in the logframe. Please explain how you determined this score.

The average % achievement for the two indicators is 94%. Achievement for each indicator was calculated as % of the targeted milestone. E.g. for indicator 1: 39 VHWs were trained against a target of 44 giving an achievement of 39/44*100=88%. An average for the two was then calculated.A.2.4 For each of the indicators: Write in full each indicator as included in most recently approved

logframe and provide a narrative clarification of progress achieved against the relevant indicator milestone, including an explanation of any over or under achievement (add extra rows if required).

Indicator 2.1: Number of village health workers in the target wards who a) have completed the refresher training and b) have attained 70% on the post- training test.A total of 39 VHW’s have completed the refresher training and 0 VHW’s attained 70% on the post-test against 44 VHW’s that have completed the refresher training and 44 VHW’s have attained 70% on the post-test. 39 of the expected 44 VHWs from the target wards completed the refresher course. Five VHWs missed the training due to other family commitments (illness, funerals) but have since been incorporated into the pool of active health workers. The post-test was not conducted as this aspect had not previously been a standard incorporated into the Ministry of Health and Childhood trainings however, project staff had held discussions with the Ministry of Health to receive authorisation to incorporate a post-test for VHW’s refresher training during the life of the project. This has now been authorised by the Ministry and will be conducted in YR3. The Ministry now understand the need to ascertain knowledge levels and determine need for further training. Although the project monitoring tools are only capturing the impact of the target 44 VHW’s disseminating maternal health information within our target wards, Savings were made underneath this budget line and the project extended the refresher course to the surrounding wards in the district. A total of 145 VHW’s participated.Indicator 2.2: Number of village health workers in the target wards disseminating information on antenatal care, postnatal care, family planning and adolescent sexual and reproductive health within the community

A total of 44 VHW’s in the target wards disseminating information on antenatal care, postnatal care, and family planning and adolescent sexual and reproductive health within the community against the target 44 VHW’s. The project achieved its milestone with all 44 VHW’s. All VHW’s are disseminating information on ANC, PNC, and family planning; this is evidenced in the VHW’s monthly reports, which are submitted to the clinics. Although 5 VHW’s did not attend the refresher training, they are using their standard training knowledge, skills and support from the clinic staff to disseminate information just like the others. The provision of bicycles, t-shirts and hats has motivated the VHW’s to work and report their progress at monthly meetings at the health centres.A.2.5 Disaggregate the number of citizens engaged with this output in the reporting period.

Describe briefly who they were and how they were engaged.N.B. Adult = 18 years and above; Child = below 18 years.

Adult Male

Adult Female

Child Male

ChildFemale Total

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

Brief description Nature of engagement

38 68 106 0 District VHWs Refresher Training Workshop on MCH

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20 19 39 0 VHWs in target wards

Refresher Training Workshop on MCH

137 104 241 0 Adult ToTs in target wards

Training Workshop on MCH & PHHE

15 6 21 0 Adolescent ToTs in target wards

Training Workshop on MCH & PHHE

A.2.6 State the evidence used to measure the progress described and comment on its strength. Please refer to the preceding guidance on how to complete the section effectively.

VHW workshop reports 2014 and the attendance registers, TOT workshop reports March 2015 and accompanying attendance registers. The progress has been verified with the CHC club audit in November 2014, which visited all CHCs and met all ToT’s and VHWs and VHWs log book.

Output 3A.3.1 Output 3 Write in fullIncreased awareness amongst women, men, boys, girls and ward health committees of key maternal health services and issuesA.3.2 Output 3 score (A++ – C)A+

A.3.3 Justify the score: The score is based on an aggregate of actual achievement against output indicator milestones in the logframe. Please explain how you determined this score.

The average % achievement for the 3 indicators is 123%. Achievement for each indicator was calculated as % of the target milestone. E. g for indicator 3.3: 226 men were trained against a target of 250 giving an achievement of 226/250*100=90%. An average for the 3 was then calculated. The last indicator is not applicable in year 2.A.3.4 For each of the indicators: Write in full each indicator as included in most recently approved

logframe and provide a narrative clarification of progress achieved against the relevant indicator milestone, including an explanation of any over or under achievement (add extra rows if required).

Indicator 3.1: Number and percentage of women of child bearing age receiving maternal and reproductive health awareness informationA total of 4,411 (58.8%) of WCBA received maternal and reproductive health awareness information against 3,450 (46%) women. The over achievement is due to health club approach. 145 number of health clubs have been established and are currently run by ToT’s (community members). Its aim is to cascade key health messages including maternal health from ToT to club member and reach a larger number of beneficiaries in a short space of time. The data does not capture women that are accessing awareness information through the health clinics.Indicator 3.2: Estimated Number and percentage of women of child bearing age demonstrating increased knowledge in maternal health issuesA total of 2,636 (76.4%) WCBA demonstrated increased knowledge in maternal health issues against 1,750 (50%) WCBA. The 2,636 women obtained more than a 50% score in the behaviour change survey conducted in March 2015. The ToT approach has been successful in cascading information at a quicker rate to more people.Indicator 3.3: Number of men (e.g. men, boys, community leaders) registered in 15 Padare chapters (10 for adults and 5 for boys) demonstrate increased knowledgePadare trained a total of 263 men and 226 men against a milestone target of 250 men demonstrated increased knowledge in maternal health issues. Post-test evaluation by Padare revealed that 86% (226) of 263 men had increased their knowledge in maternal health care and gender issues demonstrating 44% knowledge increase from the pre-test evaluation. Training of boys and men was synchronised to reduce facilitator costs hence training of boys took place in YR2. 245 boys have now been trained and registered in Padare chapters.Indicator 3.4: Community health club members (trained by TOTs) have graduated and list 5 benefits of accessing maternal health services in the post- graduation surveyNo milestone had been set for this indicator in the second year. Graduations will be conducted in the

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second quarter of the third year.

A.3.5 Disaggregate the number of citizens engaged with this output in the reporting period. Describe briefly who they were and how they were engaged.N.B. Adult = 18 years and above; Child = below 18 years.

Adult Male

Adult Female

Child Male

ChildFemale Total

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

Brief description Nature of engagement

2440 4411 6851 Not Known Club members Club meetings facilitated by TOTs

2636 2636 Not known WOCBA with improved knowledge

Information dissemination

263 263 Not known Men registered in Padare Chapters

Training on Gender and maternal health

245 245 Not known Boys registered in Padare Chapters

Training on Gender and maternal health

A.3.6 State the evidence used to measure the progress described and comment on its strength. Please refer to the preceding guidance on how to complete the section effectively.

BCI survey report March 2015, Padare training reports December 2014 and workshop registers 2014, The figures for the club members were obtained from the club registers and verified by a club audit and evidenced in the club audit report November 2014.

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

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1. Monthly monitoring form for clinics

2. WMS and maternity checklist

3. E- ranger checklist

4. MNCH KAP

5. Club monitoring checklist

6. Barrier Analysis Survey

7. Key Informant interview

8. Behavioural Index Change Tool

To collect frontline data. Most of the data tracks the outcome indicators.

To collect information on the adequacy of equipment and other requirements of the WMS and the maternity wards

To collect information on the use of the E- ranger, its condition and the service it is providing

The questionnaire collects information on knowledge, attitudes and practices of communities on MNCH

The form collects information on membership, attendance and lessons covered by club members

To get a qualitative perspective of the different groups on community feelings and views of the interventions

Key informants will provide qualitative perspective from different key informants including community leaders, nurses and other influential or key figures

To capture the change in attitudes, practices and behaviours in the area of maternal health.

The form compiles information from ANC register, PNC register, FP registers and Delivery registers on specific information like maternal deaths or ANC registers.

The checklist is completed by the WHC. They do a physical check and record against a checklist.

The checklist is completed by the WHC. A physical check is done and the log book is checked against the admissions or maternity register

The questionnaire is administered to samples of community members’ bi- monthly to track on specific key project issues. The same is also used in the participatory review.

The tool is completed by the TOT

The tool is completed by officers who conduct these FGDs with different groups in the community

The tool is completed by the officers

A questionnaire is administered to a sample of community women on an annual basis

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ANNEX B: CONSOLIDATED BENEFICIARY TABLE:To be completed by all grant holders (Up to 2 pages)

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

If the same beneficiaries are represented in more than one of the outcome indicators and therefore benefit in more than one way, ensure you do not double count them when calculating the consolidated total.

B.1 Consolidated Beneficiary Table Gender and Age Disaggregation

OVERALL TOTAL

Adult Male(18 years +)

Adult Female(18 years +)

Child Male(under 18 yrs)

Child Female (under 18 years)

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

3298 153 3126 0 19

ii) Consolidated total number of project beneficiaries achieved since the project began

5160 153 4988 0 19

iii) Consolidated total number of project beneficiaries anticipated by the end of the project

8250 500 7400 250 100

Please explain how you have arrived at the figures given in row (i) - beneficiaries reached this reporting year- with reference to the figures reported in the outcome section of Annex A (A.0.5).Double counting has been difficult to avoid as our data is based on secondary data from the clinics, which is simply quantitative and not qualitative. Therefore, women that receive ANC and PNC in the same year are likely to be counted twice. We estimate 90% of pregnant mothers that have ANC, birth with a skilled attendant and return for PNC. We also estimate that 80% of women accessing growth monitoring services also access family planning services. Therefore its our estimation that 3145 women have been reached since the project began. 1093 accessed ANC+PNC, 840 and 1193 women accessed growth monitoring and family planning services while 19 adolescent girls accessed family planning services. 153 men were trained and were promoting maternal health issues amongst the community. Please explain how you have arrived at the figures given in row (iii) - beneficiaries anticipated by the end of the project.There are 7,500 women of childbearing age (17-49) living in the target area and therefore they are our main target beneficiaries. 100 are adolescent girls and the remainder are women over 18 years. 500 men and 250 boys are those targeted for spearheading promotion of maternal health issues through men’s clubs.Indicate or estimate the percentage or number of disabled beneficiaries reached to date in the box below.N/A

Have you disaggregated your data collection any further to better understand your beneficiaries? (Examples might include extreme poor; widows; orphaned children; older men and women, ethnic groups, socio-economic status)

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Data only disaggregated by age and sex.

What challenges and difficulties have you encountered in collecting and reporting disaggregated data (including particularly by disability)?Secondary data collected from the clinics is not always easy to access and reliable. The data is not disaggregated either. The tools, which had been developed, did not capture data disaggregated in such fashion and they will be adjusted accordingly.How has collection and analysis of disaggregated data (including by gender and disability) influenced project design, approach, delivery or learning?The collection and analysis of disaggregated data will be done in the third year.

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ANNEX C: PORTFOLIO ANALYSIS

To be completed by all grant holders (Up to 3 pages)

DFID aims to capture and compare performance and results across the whole GPAF portfolio based on the information provided in the Annual Reports.

Please answer each of the following questions.

C.1 Which of the Millennium Development Goals (MDGs) is your project contributing to directly? You may choose up to 3

Please indicate their order of importance in relation to this project (1/2/3):

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

MDG 1: Eradicate Extreme Hunger and PovertyMDG 2: Achieve Universal Primary EducationMDG 3: Promote Gender Equality and Empower Women

3 5%

MDG 4: Reduce Child Mortality 2 10%MDG 5: Improve Maternal Health 1 80%MDG 6: Combat HIV/AIDS, Malaria and Other Diseases

4 5%

MDG 7: Ensure Environmental SustainabilityMDG 8: Develop a Global Partnership for Development

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

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

3

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

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

2

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

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

1

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

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

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

C.3 Whose capacity (in the main) is being built through the project? Select (by mark with an “X” in the appropriate boxes) a maximum of 3.

a. End-beneficiaries (poor and vulnerable groups) Xb. Local leaders / change agents Xc. Local community-based organisations Xd. Civil society organisations / networkse. Local government Xf. National governmentg. Local implementing partner(s)h. Trade unionsi. Private sector organisationsj. Other (Please name below)

C.4 Environmental Impact and Climate Change Mitigationa. How would you describe the environmental impact of the project? (Mark with an “X” as

appropriate)Negative Neutral Positive X

Provide a brief justification for your choice of ranking:The major environmental impact was predicted to be land degradation occurring due to soil extraction and gravel extraction for construction. Whilst some form of degradation occurred due to these project activities, the project adhered to the construction industry guidelines to extract these resources from designated areas. The construction did not negatively impact the environment. The project motivated communities to build pit- latrines thus reducing land and water pollution.b. Describe actions the project took to reduce negative environmental impact (use bullet

points)

TOTs had lessons on PHHE which encouraged communities to build and use pit- latrine toilets.

Solar panels will provide a more sustainable source of energy and reduce the use of fossil fuel for lighting.

The construction process adhered to the set standards for stone, soil and water extraction.

c. Describe any activities taken by the project to build climate change resilience (use bullet points) Borehole water supply: The project drilled boreholes at each clinic to provide

reliable sources for clean safe water. The depth of the boreholes is over 100m thus provide water even in the driest months.

d. Does the implementing organisation have an environmental policy in place?Yes In

prepar

No X

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ation

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