End of Project Evaluation for Jordan National Red Crescent ...adore.ifrc.org/Download.aspx?FileId=170052&.pdf · Figure 2: Key Stakeholders participating in the Evaluation Figure

EndofProjectEvaluationforJordanNationalRedCrescentSociety(JNRCS)CommunityBasedHealthandFirstAid

(CBHFA)andPsychosocialSupportprojectinJordan

EVALUATIONREPORT

February–March2017

Evaluator:

OfeliaGarcía

ThisevaluationwasproducedattherequestoftheInternationalFederationoftheRedCrossandRedCrescentSocieties.OfeliaGarcía,independentconsultant,ledtheevaluationexerciseandistheauthorofthisreport.DISCLAIMERThe author's views expressed in this publication do not necessarily reflect the views of theInternational Federation of the Red Cross and Red Crescent Societies or the Jordan Red CrescentSociety.

TABLEOFCONTENTSLISTOFACRONYMS 1.EXECUTIVESUMMARY

1.AEvaluationPurposeandScope

1.BIntervention’sBackground

1.CMethodology–OverallOrientation

1.DConclusions

1.E.Recommendations

2.EVALUATIONPURPOSE&EVALUATIONQUESTIONS page1

2.AEvaluationPurposeandScope

2.BEvaluationQuestions 3.BACKGROUND page3

3.AContext

3.BIntervention’sBackground

3.CIntervention’sEvolution4.EVALUATIONMETHODS&LIMITATIONS page12

4.ATimeline–PhasesandDeliverablesoftheEvaluation

4.BMethodology–OverallOrientation

4.CLimitations5.FINDINGS page15

5.A.RelevanceandAppropriateness

5.B.TargetingandCoverage

5.C.Effectiveness

5.D.Efficiency

5.E.Connectedness

6.CONCLUSIONS page43

7.RECOMMENDATIONS page47

ANNEXES

ANNEXI: TermsofReference

ANNEXII: JHAS/UNHCRHospitals

ANNEXIII: ListofConsultedDocuments-Bibliography

ANNEXIV: ListofcontactedKeyInformants

ANNEXV: OrganisationChartfortheCBHFARollout(13-March-2014)

ANNEXVI: DiagramsoftheBirthandMarriagecertificates’process

LISTOFFIGURESANDTABLES:

Table1:IFRC-JNRCSgeographiccoveragetimeframe

Table 2: IFRC - JNRCS CBHFA Historical Intervention in Jordan: Overall Objective, Target population, ProposaldurationandDonor

Table3:IFRC-JNRCSCBHFAHistoricalInterventioninJordan:Outputsevolution

Table4:CBHFA(IFRC-JNRCS)Budgetevolution(2014–2017)

Table5:Evaluationtimelineanddeliverables

Table6:Toolsandtechniquesusedinthisevaluation

Table7:HAUSJordan-SomeKeyIndicatorswithNegativeEvolution(series2014-2015and2016)

Table8:HAUSJordan-SomeKeyIndicatorswithPositiveEvolution(series2014,2015and2016)

Table9:HAUSJordan-SomeKeyIndicatorsThatAreNoLongerPublicallyAvailablefor2015and2016

Table10:CBHFAVolunteersdistributionperGovernorate(2016-2017comparison)

Table11:ReportedNationaldistributionofCommunityHealthVolunteersperGovernorate(non-campmapping)–January2017figures

Table12:Cumulativefigureoftargetedpopulation/directbeneficiariesoftheCBHFAintervention(2014–2016)

Figure1:AnnualUNHCRRegistrationtrendofSyrianrefugeesinJordan(January2011–December2016)

Figure2:KeyStakeholdersparticipatingintheEvaluation

Figure3:Syrian–JordaniansPopulationRatioperGovernorate

Figure4:UNHCRRegistrationofOutofCampSyrianRefugeesbyGovernorate(Evolution2014–2017)

Figure5:RegisteredVariations–Increase(2014-2017)ofRegisteredOutofCampSyrianrefugees

Figure6:GRChistoricalGeographicCoveragewithintheIrbid’sGovernorate(February2017)

Figure7:MinimumExpenditureBasketandSurvivalMinimumExpenditureBasketinJordan(June2015)

Figure8:MinimumExpenditureBasketandSurvivalMinimumExpenditureBasketinJordan(October2016)

Figure9:2016CBHFAvolunteers’recruitmentandselectionprocess

LISTOFACRONYMS€ Euro

4Ws WhoDoesWhatWhere

ANC AntenatalCare

AP AnnualPlan

AsylumSeekerCertificate

ASC

AUD AustralianDollar

CBHFA CommunityBasedHealthandFirstAid

CFPSs ChildandFamilyProtectiveSpaces

CHTF CommunityHealthTaskForce

CHVs CommunityHealthVolunteers

DRC DanishRedCross

ECHO Directorate-General for European Civil Protection andHumanitarianAidOperations

F Female

GoJ GovernmentofJapan

GPB BritishPound

GRC GermanRedCross

HAUS HealthAccessandUtilizationSurvey

HH Household

HIP HumanitarianImplementationPlan

HQ HeadQuarters

HR HumanResources

ICRC TheInternationalCommitteeoftheRedCross

IDPs InternalDisplacedPersons

IFRC InternationalFederationofRedCrossandRedCrescent

IHL InternationalHumanitarianLaw

IHRC InternationalHumanRightsClinic-HarvardLawSchool

iNGO InternationalNon-GovernmentalOrganization

IT InformationTechnology

ITSs InformalTentedSettlements

JHAS JordanHealthAidSociety

JNRCSorJRCS JordanNationalRedCrescentSociety

JOD JordanianDinar

JORISS JordanResponseInformationSystemfortheSyriaCrisis

JRP JordanResponsePlan

JRPSC JordanResponsePlatformfortheSyriaCrisis

KIIs KeyInformantInterviews

M Male

M&E MonitoringandEvaluation

MEB MinimumExpenditureBasket

MENA MiddleEastandNorthAfrica

MoH MinistryofHealth

MoI MinistryofInterior

MoPIC MinistryofPlanning&InternationalCooperation

MoU MemorandumofUnderstanding

MSF MédecinssansFrontières

N.A. NotAvailable

NCD Non-communicablediseases

Norwegian RefugeeCouncil

NRC

PHC PrimaryHealthCare

PHC PrimaryHealthCare

PNC PostNatalCare

PNSs PartnerNationalSocieties

PRS PalestinianRefugeesfromSyria

PSP PsychosocialSupportProgramme

RC RedCross

SMEB SurvivalMinimumexpenditureBasket

ToT TrainingofTrainers

UN UnitedNations

UNHCR UnitedNationsHighCommissionerforRefugees

UNICEF TheUnitedNationsChildren’sFund

USD USDollars

UVE UrbanVerificationExercise

VAF VulnerabilityAssessmentFramework

Water, Sanitation andHygiene

WASH

WFP WorldFoodProgramme

WHO WorldHealthOrganization

1.EXECUTIVESUMMARY1.AEVALUATIONPURPOSEANDSCOPEThisisanexternalevaluationcommissionedbytheJapaneseGovernmentthroughIFRCandhasbeenguidedbytheTermsofReference(ToR)attachedasAnnexI,andbytheInceptionreportelaboratedbytheevaluator.SpecificallytheEvaluationaimstobetterunderstandtheoveralladdedvalueoftheCBHFAapproachin the current context, providing the International Federation of the Red Cross and Red CrescentSocieties (IFRC)and the JordanRedCrescentSociety (JNRCS)withguidance for futureprogrammaticdevelopmentsinJordan.1.BINTERVENTION’SBACKGROUNDSinceFebruary2014, the JordanNationalRedCrescentSociety (JNRCS)with thesupportof IFRChasbeen implementing aholisticCommunityBasedHealthandFirstAid (CBHFA)approach tomeet theneedsoftheSyrianrefugeesandhostcommunities(currentlyinsixJordan’sGovernorates).TheCBHFAapproachseekstocreatehealthyandresilientcommunitiesworldwide,usinganintegratedapproach, volunteers are trained and mobilised to carry out activities within their communities.CommunityactivitiesplannedinJordanunderthisinterventionincluded:thedisseminationofhealthinformation at community events, and raising awareness / preventive approaches about differenthealth related topics, establishment of referral pathways and its communication to beneficiaries toimprove their access to health care and psychosocial support services, and building the capacity ofcommunitiestoreducetherisksandimpactofemergencies.1.CMETHODOLOGY–OVERALLORIENTATIONThe evaluation process was based on a mixed-methods approach, combining qualitative andquantitativemethodologies,performingbothquantitativeandqualitativeanalysis.Duringthefieldphaseandinordertocollectqualitativeinformation,IFRC,JNRCS,ICRCand PartnerNationalSocieties(PNSs)staff,aswellasabroadrangeofexternalstakeholderswereinterviewed:• Thirty-eight(19M/19F)keyInformantInterviews(KIIs)withindividualsfromdifferentinstitutions• Five Group discussionswith fifty-six CBHFA volunteers (15M / 41 F) from five different JNRCS

branches/governorateswerecarriedout.1.DCONCLUSIONSOverall the rationale in early 2014 (when it was designed) to launch the CBHFA and the IFRCprioritisationofan intervention to respond to thecommunityhealthand informationneedsof theSyrian refugees living out of campswas, from a needs-based perspective, highly relevant and fullyjustified.Therelevanceofrespondingtothemostvulnerablerefugees’healthrelatedneeds,improvingaccesstoinformationatcommunitylevelandeffectivereferralshasincreasedovertime.Thisismostlydue to: (#1) deteriorating access to the health system andworsening key health indicators (highlyinfluenced by the November 2014 policy change from free public healthcare to requiring Syrian

refugeestopayforhealthservicesinthepublicsector),(#2)theacutedeclineintheSyrianrefugees’economic situation in Jordan and their resorting to negative coping mechanisms, (#3) the risingprotection vulnerabilities and (#4) diminishing funds and changing priorities, from addressinghumanitarianneedstotheresilienceanddevelopmentagenda.In spite of its relevance, the CBHFA first design / formulation: did not sufficiently consider equityamongst different vulnerabilities/situations and was not sufficiently adapted to the targetingchallenges in urban and peri-urban settings and the foreseeable deterioration of the protectionenvironmentassociatedwithprotracteddisplacementsituationsandmorespecifically to thespecificprotectionchallengesandneedsofanon-camprefugeecaseload.ThelimitationsofwhattheCBHFAimplementer could achieve with a stand alone intervention (intangible) in terms of connectingpopulationsinhighdistresswithotherlevelsofassistance(tangible)tobedeliveredbyserviceproviders/organisations wasnot sufficiently taken into consideration in successive formulations, especially aftertheNovember2014policychange.Design choices and formulation weaknesses have enormously conditioned the interventions’possibilityofbeingeffective:• Whilstitiswidelyrecognizedthatthelargestgroupsofconcernare,since2015,refugeeswhoare

ineligibletoreceivenewMoIcardsandrefugeeswhoareeligible,buthavenotyetobtainednewMoI cards because they lack the documents necessary to receive a card through the normalissuance process, all IFRC interventions (not only CBHFA) in Jordan are addressed to registeredSyrianrefugees.

• The available information did not permit a clear picture on the intervention, as well as of thequality-outputsofthedifferentcomponents.Toomanyeffortshavebeenexertedinincreasingtheproject’s governorates coverage (that is a clear humanitarian priority), as well as CBHFAvolunteers’presenceandtrainingaccordingly.

The geographic choice of Governorates made alongside the implementation period is consideredinadequate;onthecontrary,thehistoricalandtheinformationoncommunities/areascoveredwithineach Governorate and their identification, as well as the total population per community, differentpopulation categories (registered refugees, non-registered refugees, host population), etc. is notavailable, thatdoesnotallowavalidationofanyof the interventions’ totalbeneficiaries’cumulativefigure.Non intended positive project’s effects have been identified in two main areas: (#1) the projectcontributionto“normalise”andreducethegendergapatcommunitylevel(and(#2)thedecisiontohavebothJordanianandSyriannationalsinthesamepairsandteams,showedcohesionandapositivemodelofcoexistence,thatincertainareaswithhightensionsbetweenbothcommunities,couldhavehadafurtherpositiveimpactasapositivemodel.Thispairingofdifferentnationalsinthecommunityworkseemsalsotobequiteuniquefortheproject(ifcomparedwiththeotherCommunityHealthTaskForce(CHTF)organisations’reportedworkingmodels).The major factors negatively affecting the CBHFA implementation are related to: (#1) the JNRCS’internalmanagementstructureandorganisationalculture, (#2) the insufficientlydetailed IFRC-JNRCSpartnership and (#3) the insufficient or non-existent linkwith other initiativeswithin the Red Crossmovement.Thereisalsoapartnership(IFRC-JNRCS)riskthatisnotsustainableandcouldstarthavingnegativeeffects forthe imageof IFRC inparticular.Thatrisk isgeneratedprimarilybythedifferencebetween the IFRC projection-humanitarian profile and the real JNRCS capacity to deliver a fullyorientedhumanitarianresponseaccordingtominimumstandards(thatreliesontheJRNCSwillingnesstochangeandfollowadifferentwayofmanagement).

Efficiencygainswereachieved throughanewCBHFAVolunteers’ selectionandvalidationprocedurethatwasput inplace in2016buttheoverallEfficiencyof this intervention isconsidered low,mostlyduetothenon-appropriatenessandthenon-adaptationofthechosenstrategytocopewiththemainhealthpopulationneedsandseriousinefficiencyatJNRCSmanagementanddecision-makinglevelthatinsomecases,alsoraiseethicalissues.Thealignmentwithcountrystrategiesandpriorities is, inthecurrentsituation,thebestapproachtoConnectedness. It is confirmed that thecommunityhealthand informationapproachaswell as theCBHFA approach, are fully alignedwith the current national priorities. Conversely, JNRCS Interest inInstitutionalCapacityBuildingandthedevelopmentoflong-termYouthdepartment/volunteersisnotcompatiblewiththeneedtomaintainaprojectorientationoftheCBHFAvolunteersthatwouldhavetofocusonbeingeffectiveandefficientintheshortterm(projectorientation).1.ERECOMMENDATIONSR1 CBHFA addressed to out-of camp Internal Displaced Persons (IDPs) or refugees in humanitariansettings,shouldconsider,adaptabilitytothecontext/needschangesandadifferentapproachthanthework with host-fixed population in rural environments (traditional CBHFA scenario), where usuallypopulationneedsarestructural/linkedtopoverty.IntheMiddleEastandNorthAfrica(MENA)regionevolvingspecificvulnerabilitiesandprotectionneedsof themostvulnerablerefugees,shouldensurethatthedesignandimplementationofactivitiesaimsatreducingandmitigatingthoseprotectionrisks.

R2 In the 2017 Jordancontext, a relevantCBHFAdesign requestshigh levelof flexibilityand somedegree of “out of the box” thinking (that other CHTF organisations already implemented) for: (#1)settingupaneffectivereferralsystem,eithercomplementaryoroutsidetheinitiallyavailablefreeofcharge public health system (looking beyond the traditional community mapping, expanding thereferralstowhateverreliablepartnerwithinthedistrict,Governorateorevennationallevel)and(#2)foradaptationtothespecifichealthrelatedandprotectiongapsateachGovernorateanddistrictlevel(differentcaseloadsandofferoffreeservices).

R3 The main focus of any humanitarian intervention in the current context, should be, from aprincipledhumanitarianactionperspective,onoutofcamprefugees.CBHFAshouldclearlyrefocusinthemostvulnerableandconsequently, followingthe“Onerefugeeapproach”recommendation(R4),prioritiseforgeographicintervention,theareaswherethemostvulnerableareliving.R4Prioritygroupswithintargetpopulationforthenextphaseshouldbe:

• RefugeesofanynationalityincludedintheUNHCRPopulationsofconcern:- Having more problems for any household member’s civil-legal and/or identity-recognition

(renewal of asylum certificate, difficulties in obtaining all the legal documents forMoI newcard),livinginaunsafeenvironment,etc…

- Familywithamemberwithdisabilities/estimatedataminimumofeightpercentofrefugeesinJordanhavingasignificantinjuryofwhich90%wereconflict-related(HandicapInternational/HelpAgeInternational).

- Familieswithoutofschoolchildrenatprimaryschoolageand/offamilieswithyoungchildren:thatcannotbeenrolled/followsecondaryeducation.

- Femaleheadedhouseholdswithchildren,- Familieswithbedriddenand/ormentalhealthdisorders’members.- Households with children born from teenager couples and early marriage couples (a crime

underJordanlaw).• RefugeesofanynationalitynotincludedintheUNHCRregisteredPopulationofconcernand/ornot

eligible forMoI registration/renewal for different reasons (including lacking civil documentation,left the camps without Baillout, entered illegally, etc.). ECHO estimates a minimum figure ofaround100,000Syriansrefugeesinthissituation.

R5 A feasibility cross-check needs to be carried out by the IFRC, related to the capacity and thewillingness of JNRCS (IFRCpartner) to commit to the needed institutional changes requested to beboth: aligned with the humanitarian priorities of the most vulnerable refugees’ population andeffectiveinthenewdesign.R6ToIncreaseemphasisontargetingthemostvulnerableandeasetheiraccesstokeyservices,itwillbe needed to map vulnerability zones and groups and ease their access to key components,reconsidering the size of the project and the current number of CBHFA volunteers. It will also beneeded to better plan, and assignmeans to follow and track coveragemaking use of InformationTechnology(IT)means,forabetterMonitoringandEvaluation(M&E),followupandgeoreferencing.R7.CBHFAshouldbeorganised,havingoneFieldCoordinatorperGovernorate(sameasGermanRedCross (GRC)-JNRCS in Irbid), reporting tooneanduniqueCBHFA IFRC-JNRCScoordinator in Amman.Those profiles should be selected following the best practices achieved through a new CBHFAVolunteers’selectionandvalidationprocedurethatwasputinplacein2016andtotheextentpossible,should be refugees. Each Field Coordinator per Governorate will be responsible for two differentteams:• Public health and information campaigning CBHFA teams to facilitate the entry point for the

linking with health and civil documentation referrals with priority population (activity to bedelivered by mixed Syrian and Jordanian CBHFA volunteers together: minimum of 20 hours amonthperareaofcoverage,withincentivespaidaccordingtoMEBoratleasthalfoftheminimummonthly salary). Group gatherings –campaigns for social cohesion In these areas: The First AidGRC-JNRCS Irbid’s model (training directly delivered to communities with first aid kits forenhancingbehavior)andBehaviourchangeandraisingawarenesscampaign/activitiesforkeyandbasichealthandlegal/civildocumentationtopics.

• Outreachdistrict referral teams for Identificationof themost vulnerable refugees (activity tobedeliveredpreferablyonlybyrefugees’CBHFAvolunteers,organisedbypairs,thatwouldincludehomevisits for identificationof themost vulnerablehouseholds, referrals’ needs and followup,following/adapting the International Relief & Development (IRD) Community Health Volunteers(CHVs)modelandperformancetargets.IncentivesshouldbeaminimummonthlysalaryordirectlyequivalenttothoseofIRD:higherthanthemínimumsalary).Thisapproachquestionsthestrategyof oneCBHFA attachedonly to their original area vsmobile teams for the district/subdistrict toreachmorevulnerablesubareas/population(rotatingandmovingtootherareaswhentargetsarereached).

R8.Goodpractices fromotherCHTForganisations could alsobeapplied, suchas: (#1)pretest andposttestforvolunteersandToTstrainersbeforegoingtothefield(theyneedtopassaminimuminthe tests) and retest them on regular basis (performance grid), (#2) Avoiding CHVs related to eachother in the same governorate, as a rule to reduce cheating, (#3) Use of portable devices withgeoreferenceforoutreachreferralteamsandfollow-upvisitsAND(¢)CHVsgoalsdefinedpermonthfor outreach referral teams related to the most vulnerable profiles: number of visits, number ofreferrals,numberoffollowupreferrals,etc.

Evaluationreport-Page1

2. EVALUATION PURPOSE & EVALUATIONQUESTIONS

2.AEVALUATIONPURPOSEANDSCOPE

ThisisanexternalevaluationcommissionedbytheJapaneseGovernmentthroughIFRCandhasbeenguidedbytheTermsofReference(ToR)attachedasAnnexI,andbytheInceptionreportelaboratedbytheevaluator.SpecificallytheEvaluationaimstobetterunderstandtheoveralladdedvalueoftheCBHFAapproachin the current context, providing IFRC and JNRCS with guidance for future programmaticdevelopmentsinJordan.Theanalysisthereforefocusedon:- Factors which determined the strategic choices, performance and results of the CBHFA

intervention, including the management and working procedures of the CBHFA teams and thecriteria,challengesandlimitationsofrespondingtothepriorityhealthneedsoftheSyrianrefugeesintheareasofintervention.

- Theaddedvalue,strengthsandweaknessesoftheCBHFAmodelinJordanandalsointheMiddleEastcontext,andhowbothinaconflictsettingandaprotractedcrisis,itcanbecontributingtoagoodshowcasefortheglobalCBHFA.

- A comparative element/benchmarking exercise, as far as possible, with other in country PNSs/InternationalNon-GovernmentalOrganization (iNGOs) withoutreachcommunityhealthprojectsandotherCBHFAprogrammesintheMENAregion.

- The degree of collaboration and the results obtained in the IFRC-JNRCS partnership and withotheractors:MinistryofHealth(MoH),CHTFparticipants,etc.

Audience:theresultsoftheevaluationwillbeusedtoreportbacktotheGovernmentofJapanontheachievementsoftheproject,theevaluationwillbeusedbyJRCS,IFRCandPartnerNationalSocieties(PNS)inJordan.The evaluation covers the JNRCS CBHFA programme implementation supported through IFRC fromFebruary 20141 until January 2017 in 6 Governorates of Jordan, namely: Amman, Jerash, Ajloun,Mafraq,BalqaandMadaba.2.BEVALUATIONQUESTIONSDuring the Inceptionphase, someof thequestionsof the initial ToRwere reduced innumber (fromforty-one to eight) by reformulation, merged or others converted into Indicators in the EvaluationMatrixtobettercapturetheagreedpurposeandscopeofthisEvaluation.ThesearethequestionsthattheEvaluationwillrespondto(groupedbyCriteria):

1Dateof the first CBHFAproject (a nine-monthproposal to theGovernment of Japan - 15th February to 15thNovember2014).


Relevance/Appropriateness2

1) DoestheProjectrespondtotheprimaryhealthcareneedsofthetargetpopulation,localcontext(incl.MoH)andspecificneeds,suchasreferralsystem?

2) Shouldthedirectionoftheprojectbechangedtobetterreflectthoseneedsandprioritiesby:a)scaling it up, b) by adapting it, and if yes, how?, c) or considering other more appropriateapproachesandisitadaptedtotherealityoftheurbandisplacementinJordan?

Targeting/Coverage3

1. IstheProjectreachingtherightareasandtherightpeople?

Effectiveness4

3) To what extent have the program objectives been achieved and what were the major factorsinfluencingtheachievementornon-achievementoftheseobjectivesandwhatotheralternativescouldbetried?

4) Hastherebeenanyunforeseenorindirecteffectseitherpositiveornegative(onthecommunities,volunteers,NationalSociety(JNRCS))?

5) DoestheProjecthaveaneffectivecoordination linkingwithother interventions, including JNRCSprogrammes such as Cash Transfer Programme (CTP), Psychsocial Programe (PSP), Youth andLivelihoods.Howcanintegrationbeimprovedinthefuture?

Efficiency5

6) InthecurrentJordancontext,aretherealternativemodelsthatcouldimproveCBHFAplanningorreducecosts?

7) Were there sufficient and appropriate resources and support from both (IFRC and the NationalSociety)toimplementtheproject?

Connectedness6

8) Dothe lessons fromthe implementationof thisproject indicateanychanges to itsdesign in thefuturetoensurethatanexitstrategyestablishesacommunitybasisfortheNationalSociety,thusbetterenhancingconnectedness/sustainability?

2Relevanceisconcernedwithassessingwhethertheprojectisinaccordancewithlocalneedsandpriorities(aswellasdonorpolicy).Appropriatenessisthetailoringofhumanitarianactivitiestolocalneeds.TargetingisconsideredabasiccriterionandassuchwillbeindependentlyanalysedunderthecriteriaTargeting/Coverage.Appropriatenessisthetailoringofhumanitarianactivitiestolocalneeds.3Theneedtoreachmajorpopulationgroupsfacinglife-threateningsufferingwherevertheyare.4Effectivenessmeasurestheextenttowhichanactivityachievesitspurpose,orwhetherthiscanbeexpectedtohappenonthebasisoftheoutputs.Implicitwithinthecriterionofeffectivenessistimeliness.5Measures the outputs – qualitative and quantitative – achieved as a result of inputs. This generally requires comparingalternativeapproachestoachievinganoutput,toseewhetherthemostefficientapproachhasbeenused.6Connectedness referstotheneedtoensurethatactivitiesofashort-termemergencynaturearecarriedout inacontextthattakeslonger-termandinterconnectedproblemsintoaccount.


3. BACKGROUND3.ACONTEXT3.A.1IntroductionDespitetheworseningsituationinSyria,Turkey,LebanonandJordan,whichinitiallymaintained‘open-border’policiestothosefleeingSyria,haveeffectivelyclosedtheirborderstothemajorityofrefugeestryingtoreachsafety.TheSyriacrisishasimpacted–bothdirectlyandindirectly–allaspectsoflifeinJordan,exacerbatingthe Kingdom’s socioeconomic vulnerabilities, security burdens and environmental challenges. Theinflux of Syrian refugees, that reached its peak in 2013, has placed ever increasing demandson thenationalhealthsystem,whereonethirdoftheJordanianpopulationdoesnothaveaccesstouniversalhealthinsurancecoverage.7

Figure1:AnnualUNHCRRegistrationtrendofSyrianrefugeesinJordan8(January2011–December2016)

Source:EvaluationcompilationbasedonUNHCRdata

With the Syrian crisis entering its seventh year, 6.6 million Jordanians9 host more than 1,2 millionSyrians,ofwhich655,73210areregisteredwithUNHCR11(49.4%M/50.6%F):• 78.5%(514,669)areoutofcamprefugees(livingoutsiderefugeecamps,incities,towns,andrural

areas)and21.5%(141,063)arecamprefugees.• 50.9%oftheregisteredrefugeesarechildren(lessthan18years).• 86%ofSyrianrefugeesinurbanareasarelivingbelowtheJordanianpovertylineandtheyfacea

continuedlackofaccesstolivelihoodsandcomplicatedregistrationprocedureswhichrestricttheiraccesstoservices12.

7JordanResponsePlan(JRP)2017-2019.8Includingboth:CampandOutofCampRefugees.9 According to the 2015 Census, the total population of Jordanwas estimated at around 9.5million, including 6.6millionJordanians.10Atotalof728,955peopleofconcernwereregisteredwithUNHCRinJordanasofJanuary2017,including655,732Syrians,61,405 Iraqis and 11,818 other nationalities including, 6,360 Yemenis, 3,322 Sudanese, and 778 Somalis. (January 2017 -UNHCRinformation).11 In Jordan, UNHCR registers Syrians as refugees, giving them “prima facie” status without the need for a statusdeterminationprocess.12FiveYearsintoExile.CareReport.June2015.

2306

122896

666411

12056941025 53624

0

100000

200000

300000

400000

500000

600000

700000

2011 2012 2013 2014 2015 2016

Syrian0Refugees0in0 Jordan0 : Annual0Registration0trend0 0UNHCR0(January020110: December02016)


Despiteyearsofassistance,humanitarianneedsinJordanforrefugeesremainacute,andaccordingtomost of the consulted sources, are worsening for an important percentage of them, whilst, on theother hand “funding constraints are becoming a major limiting factor as needs remain stable ormultiply, and contributions by development actors are still insufficient to adequately complementhumanitarianinterventionsorfullyreplacehumanitarianaidbudgetsincertainsectorsasappropriate.Populations’needslargelyoutweighandsurpassthecapacityofhumanitarianactorstorespond,bothphysicallyandfinancially”.133.A.2Refugees’legalframeworkinJordanandspecificitiesoftheSyrianrefugeesWhile the Jordan Constitution provides protection against extradition (the principle of “non-refoulement”) forpoliticalasylumseekers14, Jordanhasnotenacteddomestic legislationtodealwithrefugees(thereisnonationallegislationgoverningtheprotectionofasylum-seekersandrefugees)andisnotapartytothe1951ConventiononRefugeesor its1967Protocol.Thelegalframeworkforthetreatment of refugees is a 1998 Memorandum of Understanding signed between Jordan and theUNHCR.SinceJuly30,2012,allSyriansarrivingattheJordanianborderwithoutpassportswerebroughttooneof two refugee camps, either Zaatari, the vast expanse often described as the fourth-largest city inJordan, or the newer site at Azraq. Technically, only those who could secure a sponsor from thesurroundingJordaniancommunitieswereallowedtoleave,throughaprocedurecalleda“bailout.”For all UNHCR registered Syrian refugees residing in the camps15, UNHCR issues a “Proof ofRegistration”document,whichtheyholdwhiletheyremaininthecamps16.For Syrian refugees who live outside camps, in Jordanian cities, towns, and rural areas, and areregisteredwithUNHCR,theygetanasylumseekercertificate:adocumentthatstatesthatthoselistedon the certificate (usually a family, but in some cases just one person) are “persons of concern” toUNHCR.TheasylumseekercertificateallowsSyrianstoaccessservicesandassistanceprovidedoutsidethecampsbyUNHCRanditsimplementingpartners.

Regardless ofwhether theyhave registeredwithUNHCRas refugees, all Syrians living in Jordan arerequiredtoregisterwiththeJordanianMinistryoftheInteriorandreceiveanMoIServiceCard(“MoIcard”),whichisvalidonly iftheSyrianremains living inthedistrictwherethecardwas issued. Iftherefugeemovesfromtheinitialplaceofregistration,theyarerequiredtore-registerwiththepoliceinthenewlocationandupdatetheirMoIservicecard.3.A.3HumanitariansetupTheMinistryofInteriorisresponsibleforallrefugeerelatedissuesinJordan,includingthoserelatedtoPRS. The Minister of Planning and International Cooperation (MoPIC) approves humanitarian aidprojectsincoordinationwiththerelevantlineMinistries.UNHCR is leading the interagencycoordination for theSyrianRefugeeResponsewhileUNRWA is in

13HumanitarianImplementationPlan(HIP)ECHO2016.14Anasylumseekerissomeonewhosaysheorsheisarefugee,butwhoseclaimhasnotyetbeendefinitivelyevaluated. 15WhicharejointlyadministeredbytheGovernmentofJordanandUNHCR.16Allrefugeeslivingincampshaveaccesstoshelter,water,foodandacashforworkschemeassetupbytheUN,inadditionto access to education and health care. Services in the camps are provided by theUnitedNations (UN) and national andinternationalorganisations.Source:AmnestyInternational–“Livingonthemargins”,April2016.


chargeofthecoordinationofassistancetoPalestinianRefugeesfromSyria(PRS)17.SectorcoordinationreliesonworkinggroupswithTaskForces18establishedforthefollowingsectors:Education,Energy,Environment,Health,Justice,LivelihoodsandFoodSecurity,LocalGovernanceandMunicipalServices,Shelter,SocialProtection,TransportandWater,SanitationandHygiene(WASH).In late 2013, a Community Health Task Force (CHTF) was formed, to harmonise the approach tocommunityhealth,includingdevelopingaCommunityHealthstrategyandreachingconsensusonthedefinitionandmaintasksofCommunityHealthVolunteers.193.A.4TimelineofKeyEvents/Relevantdates(2014-2016)July2014Pursuanttoagovernmentdecision,anyrefugeewholeavesthecampswithoutbailoutafterthisdate(orpreviously leftwithoutbailoutandneverregisteredwithUNHCRinahostcommunitybeforethisdate)isineligibletoreceiveanasylumseekercertificateorMoIcard:• UNHCR stopped issuingAsylumSeekerCertificates20 (ASCs) toSyrianrefugees thathave left the

campswithoutproper“Bailout”documentation.• TheASCisindispensableforobtainingMinistryofInterior(MoI)ServiceCardforrefugeeaccessto

UNHCRimplementingpartners’(IPs)servicessuchascashandfoodassistance,aswellastopublichealthcareandeducationservicesinhostcommunities.

September2014WiththecreationoftheSyrianCrisisResponsePlatformandthelaunchoftheJordanResponsePlan(JRP)21,MoPIC requirements forprojectapprovalsbecomestreamlinedbyutilising thesamerevisionprocessforallprojects.• All projects to be implemented in the framework of the JRPwill have to be uploaded onto the

JordanResponseInformationSystemfortheSyriaCrisis(JORISS),whichcentralisesallfinancialandtechnical project information. Once uploaded onto JORISS, projects are reviewed and clearedelectronically byMoPIC and then submitted to the Inter-Ministerial CoordinationCommittee forapprovalbeforegoingtotheCabinetforfinalapproval.

• AllimplementationpartnersarerequestedtoreportbacktoMoPICthroughJORISSontheirprojectprogressonahalfyearlybasis.TheIFRCisnotaffectedbythisprocedure.

November2014Jordanian authorities introduced fees for Syrian refugees accessing public health centres that

17PRSare“personswhosenormalplaceofresidencewasPalestineduringtheperiod1June1946to14May1948,andwholosttheirhomesandmeansoflivelihoodasaresultofthe1948conflict”.18 Task forces are chaired by the line ministry responsible for that sector, and composed of representatives from thegovernment,theUNsystem,thedonorcommunity,andanationalandinternationalNGOwithsignificantinvolvementinthatsector(Source:JordanResponsePlanfortheSyriaCrisis2015).19 In early 2014: 1) a Strategic Advisory Group was created to provide technical and strategic support to and increaseownership and joint accountabilitywithin the Health Sector. Currently, the Health Sector is comprised of amainworkinggroup and two sub-working groups (Nutrition and Reproductive Health); a third sub-working group, Mental Health andPsycho-SocialSupport,fallsunderboththeProtectionandHealthSectors.2)ANonCommunicableDisease(NCD)TaskForcewas also formed to supportMoH in increasing the response capacity for NCDs, and for actors to share experiences andconsolidateNCDinterventions.20ThecertificateprovidesSyrianrefugeeswithproofofregistrationasapersonofconcern,aswellasaccesstoallUNHCRservicesinurbanareas.21TheimplementationoftheJRPPlans(currently2017-2019)isguidedbytheJRPSC,undertheleadershipoftheGovernmentof Jordan. The Jordan Response Platform for the Syrian Crisis (JRPSC) SecretariatWorks withMoPIC Humanitarian ReliefCoordinationUnittofacilitatetheswiftimplementationandaccuratemonitoringofJRPprojects.


previously since thebeginningof the crisis, hadbeenoffered for free (as therewas freehealthcareservicesforallSyrianrefugees)bytheJordanMinistryofHealth:• Thefeesareequaltothosepaidbynon-insuredJordaniansandSyrianrefugeesmustpresenttheir

Ministry of Interior Service Card in order to receive these subsidised rates. If a Syrian refugeeseekingcareataMinistryofHealthproviderdoesnotpossessdocumentationthroughtheMinistryofInterior,whichverifiestheirrefugeestatus,heorshemustpaythe“foreigners’rate,”whichis60%higherthanthenon-insuredJordanianrate.

January2015Thebailoutprocess22 from the camps wassuspendedwithout an official announcement inJanuary2015.February2015TheUrbanVerificationExercise(UVE)beganinthenorthofJordan:! This is an ongoing process of status verification that requires all Syrians – not just registered

refugees–toregisterwiththenearestpolicestationtoobtainaJordanianidentitycard.Withoutupdated registration or a validMoI card, refugees risk detention, forced encampment and evendeportation.

! Although childrenhave the right to register in school regardless of their legal status, in practicefamilieswithoutvalidregistrationalsostruggletoaccesseducation,otherbasicservicesandevenhumanitarian aid. They also face challenges to register births, deaths and marriages. Childrenwhose births have not been registered in Syria or Jordan are unable to receive newMoI cardsthroughthenormalUVEprocess.

November2015Thefeeforobtainingahealthcertificate(requireddocumentationintheUVE)wasreducedfromJOD30 (USD 42) to JOD 5 (USD 7) and the process of demonstrating proof of address was also madeeasier23.February2016The “JordanCompact”, anewholistic approachbetween theHashemiteKingdomof Jordanand theInternationalCommunitytodealwiththeSyrianRefugeeCrisiswaspresentedataLondonconference,setting out a series of major commitments aimed at improving the resilience of refugee and hostcommunities, focusingmainlyon livelihoodsandeducation.However, thedocumentdidnot includeanyspecificcommitmentsonprotection,includingonlegalstay.KingAbdullahsaysJordanhasreachedsaturationpointinitsabilitytotakeinmoreSyrianrefugees.June2016Despite theworsening situation, the countries of Syria, Turkey, Lebanon and Jordan, which initiallymaintained‘open-border’policiestothosefleeingSyria,effectivelyclosedtheirborders inJune2016tothemajorityofrefugeestryingtoreachsafety.JordancloseditsborderswithSyriaandIraqinthe

22 Until January 2015, Jordanian authorities allowed Syrians to apply to leave the refugee camps and move to hostcommunities througha“bailout”process involvinga Jordaniansponsor.Thesponsorhad tobea Jordaniancitizenwithnocriminalhistorywhowasagedover35years,married,andarelativeoftherefugee/sseekingbailout.Thesponsorwasrequiredtoobtainsecurityclearance,fileanapplicationwiththelocalmunicipality,providedocumentsthatshowed a family relationship with the refugee/s seeking bailout, pay a fee of JOD 15 (USD 21) for each refugee seekingbailout,andfinalisebailoutattherelevantrefugeecard.23Initially,refugeeshadtopresentacertifiedcopyoftheirleaseandacopyoftheirlandlord’sidentitydocument;later,twoadditionalalternativestoproveaddresswereestablished.


wakeofasuicideattack24againstaborderpostonJune14 in theRuqban25borderarea.Thearea ishometoademilitarisedzonethatpreventspeoplefromcrossingintoJordanbutgivesreliefagenciesaplacetoprovideassistancetorefugees.• Asaresult,morethan75,000Syrianrefugeeshavespentmorethansixmonthsstrandedonthe

Syrian-Jordanianborder, including in theRuqbanandHadalat camps. The Jordaniangovernmentsaidnonewrefugeecampswouldbebuiltandnonewouldbeexpanded.

August2016AsattheendofAugust2016,outofthe515,000refugeesregisteredwithUNHCRaslivingoutsidethecamps,nearly363,000hadobtainednewMoIcardsandtherestaroundabout152,000hadnot.TheNorwegian Refugee Council (NRC) estimates26 that at least 17,000 additional refugees living in hostcommunities27areineligibletoreceive newMoIcards.October–December2016Thereissatelliteevidence28ofrisingnumbersofSyriansstrandedattheborderin“noman’sland”justnorthofthe“berm”,whichisaraisedbarrierofsandmarkingtheJordanianlimitoftheJordan-SyriabordernearthecrossingsofRukbanandHadalat.Thenumberofrefugeesarrivingattheborderhasalso increased, fleeing from conflict escalation but they have been denied access to Jordan by theauthorities29.3.A.5HealthinJordan(forJordaniansandRefugees)Health is providedby both thepublic andprivate sectorswith public servicesmainly fundedby theMinistryofHealth,whichisthelargesthealthcareproviderforJordaniancitizens.TheUNHCRapproachtowardsrefugeesisasfollows:• UNHCR’s Public Health approach is based on the Primary Health Care (PHC) strategy whereby

UNHCR’s role is to facilitate and advocate for access through existing services and to monitoraccess.

• Essential secondaryand tertiaryhealthservicesareavailable toeligible refugeeswhohavebeenregisteredwithUNHCRandofferedthroughgovernmenthospitalsandotherhospitalssupportedby UNHCR’s referral partner, Jordan Health Aid Society (JHAS). See Annex II (JHAS / UNHCRHospitals)formoredetails.

Between2011andNovember2014,SyrianswithMoIservicecardscouldaccesshealthcareinMinistryofHealthfacilitiesforfree,andweretreatedinthesamewayasinsuredJordanians.InthewakeoftheNovember2014change(whenthegovernmentchangeditspolicyandrequiredSyrianrefugeesholding

24 It took the IslamicStatealmost twoweeks toclaimresponsibility for theattack.Thiswas the firstmajorattackagainstaJordanianborderpostsincetheeruptionoftheSyrianconflictin2011.25 A sprawling informal campon the Syrian side of the border has grown to house tens of thousands of peoplewho fledconflictinplaceslikeAleppo,HomsandPalmyra.26“SecuringStatus:Syrianrefugeesandthedocumentationoflegalstatus,identity,andfamilyrelationshipsinJordan”,NRC,November2016.27 Those that left the campwithout “bailout”, now living in host communities, but that remain officially registered in therefugeecampwheretheyresided.28AmnestyInternationalandHumanRightsWatchsources.29With only one delivery of humanitarian aid allowed between June and August 2016, desperately needed aid deliveriesresumedinOctober2016.However,suchdeliveriesremainunderthreat,asdothelivesofthecamps’residents–thecampwasreportedlystruckbyacarbombinginOctoberandanimprovisedexplosivedevice(IED),believedtohavebeenplantedbyIslamicStategroupmilitantsIEDexplodedinmid-December.


MoIcardstopaythesameratesasuninsuredJordanians),UNHCRissuedanewpolicytomitigateitsimmediate effects: All cases involving Sexual Gender Based Violence (SGBV), mental health,malnutritioninchildren,neonatalcomplicationsandobstetricemergenciesweregivenfreehealthcaresupport.InordertofacilitatethereferralprocessUNHCRhasestablishedtwolevelsofauthoritywiththeimplementingpartner:• IftheestimatedtreatmentcostislessthanJODs750perpersonperyearthentheUNHCRpartner

willmanagethereferraldirectly,;• IfthereferralcostismorethanJODs750perpersonperyear,thecasehastobeapprovedbythe

UNHCR health unit (for emergency cases) and/or the Exceptional Care Committee for non-emergencycases(beforethereferraltakesplace).

3.BINTERVENTION’SBACKGROUNDSince February 2014, the JNRCS30 with the support of IFRC has been implementing a holisticcommunitybasedhealthandfirstaidapproach(CBHFA)tomeettheneedsoftheSyrianrefugeesandhostcommunities(currentlyinsixJordan’sGovernorates).

Table1:IFRC–JNRCSgeographiccoveragetimeframe

Governorate Startingdate

Irbid 201431

Mafraq 2014

Jerash 2014

Ajloun 2014

Amman 2014

Madaba 2015

Balqa 2016

The CBHFA approach seeks to create healthy and resilient communities worldwide32, Using anintegrated approach, volunteers are trained and mobilised to carry out activities within theircommunities.CommunityactivitiesplannedinJordanunderthisinterventionincluded:

- The dissemination of health information at community events, in schools, during householdvisits and with established community groups and community based organisations throughactivitiesandprintedmaterials.

- ThepromotionofhealthylifestylesandgoodnutritiontopreventNon-communicablediseases(NCDs).

30JNRCSwasestablishedon1947andadmittedtotheInternationalRedCrossandRedCrescentMovementin1950.JRCSisactiveindifferentsectorsinJordanincludingdisasterriskreduction,communitydevelopment,healthcareandpsychosocialprogrammes.Ithas10branchesspreadallover10outofthe12GovernoratesofJordanandhasanauxiliaryroletopublicauthoritiesinthehumanitarianfield.31In2015,IrbidwashandedovertooneofthePNSs:GRC.Sincethen,theIrbidProjectismanagedindependentlyfromtheIFRCintervention:JNRCS-GRC.32TheRedCross/RedCrescentNationalSocietieshavebeenaddressingfirstaidandhealthpromotionusingthecommunity-based first aidmethod (CBFA) since the 1990s. CBFA has since been revisited, and a community participation element tohealthpromotionhasbeenintroduced.In2009,theCBHFAapproachwaslaunchedanddisseminatedaroundtheworld.


- Home visits to pre-natal and post-partum mothers to educate and support them achievehealthy pregnancies, exclusive breast feeding practices, to recognise the danger signs in anewbornandtopromoteimmunisations.

- Promotion of routine immunisations and for targeted children to participate in NationalImmunisationDays.

- Disseminationofaccidentpreventionmessagesandbasicfirstaidskillsinthecommunity.- Raising awareness within communities about the prevention of violence and enlisting the

supportofmenandboystopromoteacultureofnon-violenceandpeace.- Establishment of referral pathways and its communication to beneficiaries to improve their

accesstohealthcare.- Provisionofpsychosocialsupportservices33attheJNRCSPScentressupportedbytheDanish

RedCross (DRC): initially in Amman andsince2015alsothroughthenewcentres inJerash,AqabaandAjloun.

- Access toChildandFamilyProtectiveSpaces (CFPSs) for refugees’childrenandtheir familiesfromSyria(forsocialising,playing,learningandpsychosocialsupport).

- Building thecapacityofcommunities to reducetherisksand impactofemergencies throughtrainedcommunityhealthvolunteers.

3.CINTERVENTION’SEVOLUTIONAccordingtothedifferentinterviewsheld,targetpopulationintheinitial2014were,inpriority,Syrianrefugees, although group activities would be applied to both Syrian refugees and Jordan hostpopulation (men,women,boysandgirls). Thesearch foraspecific targetingprioritisationofSyrianrefugeesisdilutedthroughouttheproposals:

Table2:IFRC-JNRCSCBHFAHistoricalInterventioninJordan:OverallObjective,Targetpopulation,ProposaldurationandDonor

Proposal1

15February2014–15November2014

Proposal2

01March342015–December2015

Proposal3

October2015–March2016

Proposal4

31stMarch2016–December2016

Proposal5

March2016–December2016

Proposal toGovernmentofJapan(GoJ):9months

Proposal to GoJ: 10months

ProposaltoAustraliaRedCross:6months

ProposaltoBritishRedCross:9Months

Proposal to GoJ: 10months

Objective:TheadverseeffectsoftheSyriacrisisonthehealthoftheaffectedpopulationarereduced

Objective: Toimprove the well-being of the Syrianrefugee and hostcommunitymembers

NoObjective NoObjective Objective:Improvedwellbeing,resilienceandpeacefulco-existenceamong32,000(CBHFA:22,000andPSP:10,000)vulnerableSyrianrefugeesandhostcommunitiesinJordan

33TheJNRCSpsychosocialsupportprogrammeprovidesservicesthroughguidedworkshopsandgroupmeetingsonvarioustopics and themes addressing the different needs of the beneficiaries. These include good parenting skills, copingmechanisms, improvement of children’s playfulness, tolerance, trust and life coping mechanisms, child protection, earlymarriageandGenderBasedViolence(GBV).ThePScentresalsoactasreferralcentresforthemanagementofcasesinneedofspecific,mentalhealthandpsychosocialsupportneedsofspecialisedreferrals/casemanagement. 34Reflectedasexpectedstartdate(proposalGoJversion26thJanuary2015).


6,000beneficiaries(CBHFA&PS)

33,000beneficiaries:Syrianrefugeesandthehostcommunity

7,500 directbeneficiaries (65%female, 35% male;50% Syrian, 50%Jordanian; 375people with adisability: 5% of thetotal)

TargetedtoJNRCSvolunteersonly(complementarytrainings)

32,000beneficiaries(CBHFA&PS)35

Outcome: 6,000affectedpeoplein20Communities in theGovernorates ofAmman, Ajloun,Jerash, Mafraq andIrbid have improvedtheirhealthandwell-being throughCommunity Healthand Psychosocialsupport

Outcome: 33,000beneficiaries withinthe Syrian refugeeand the hostcommunities in theGovernorates ofAmman, Ajloun,Jerash, Mafraq andMadaba haveimproved physicaland psychologicalhealth related todisease and disasterrisk reduction,withaspecial focus onwomenandgirls

7,500 directbeneficiaries:Outcome 1:Increased healthknowledge and skillsamong Syrianrefugee and hostcommunitymembersindiseasepreventionand home andcommunitysafetyOutcome 2:IncreasedcapacityofJRCS staff andvolunteers toconduct effectivecommunity healthactivities related tohealthandhomeandcommunitysafety

NoOutcome Outcome36:Improved wellbeing,resilience andpeacefulco-existenceamong 32,000(CBHFA: 22,000 andPSP: 10,000)vulnerable Syrianrefugees and fromthe hostcommunities inJordan

TheCBHFAstrategywasdesignedalongsidethreemaincomponents/outputsthathavevariedsince2014.In2014,theOutputs’formulationwasmuchmoreresultsandproblemsolvingoriented(intermsof aiming at achieving a positive health and psychosocial support gain through improved access toassistance in a target population in distress) than in successive years, where it seemsmuchmoregearedtowardsresilienceandcapacitybuilding:

Table3:IFRC-JNRCSCBHFAHistoricalInterventioninJordan:Outputsevolution

Proposal1 Proposal2 Proposal3 Proposal4 Proposal5

Output 1: 6,000affected people in 20Communities in theGovernorates ofAmman, Ajloun,Jerash, Mafraq andIrbid have improvedtheir health and well-being throughCommunity Healthand Psychosocialsupport

Output 1: Increasedknowledge, skills andpositive copingmechanisms among33,000Syrianrefugeeand host communitymembers in diseaseprevention, homeand communitysafety andpsychological well-being, contributingtowards communityresilience

NoOutput Output 1: Increasedhealth knowledgeand skills amongSyrian refugee andhost communitymembers in diseaseprevention andhome andcommunitysafety

Output 1:37 Refugeesfrom Syria and hostcommunities aremore self-reliant andresilient to diseases,disasters and localconflicts

Output 2: 2,000refugee children and

Output 2: Increasedcapacity of JNRCS

Output 2: Increasedcapacity of JNRCS

Output 2: Theprotective

35(CBHFA22,000andPSP10,000).36AlthoughintheproposalitwasincludedasanObjective.37ThisisthefirstproposalthatincludestheindicatorsperOutput.


their families in threeout of the fivetargetedGovernorateshave access topsychosocial healthservices for improvedpsychosocial well-being38

staff and volunteersto conduct effectivecommunity healthactivities related tohealthandhomeandcommunitysafety

staff and volunteersto conduct effectivecommunity healthactivities related tohealth and homeand communitysafety

environment of themost vulnerablerefugees from Syriaand members of thehost communities(adults and children)isenhancedandtheirpsychological distressisminimized

Output 3: JNRCS/IFRCcapacity incommunityawareness and oncommunity-basedhealth and first aid isstrengthened39

Output3:JNRCShavestrengthened theircapacity andenhancedtheirabilityto reach out to themost vulnerablegroups within therefugee and hostcommunities

The overall, allocatedbudget planned for the CBHFA intervention (for the period February 2014 –March2017)isUS$1,804,58040.2016 is the yearwith thehighestbudget,which is closely related to the increase in thenumberofGovernoratescoveredandthenumberoftrainedCBHFAvolunteers:

Table4:CBHFA(IFRC–JNRCS)Budgetevolution(2014–2017)

Budgetperiod Amount Currency

February-November2014

500,000 US$

March–December2015

400,00041 US$


169,994 AUD

March2016–March201742

140,00043 GPB

March2016–March201744

607,580 US$

38 Refugee children and their families fromSyria have access to Child and Family Protective Spaces (CFPSs) for socialising,playing,learningandpsychosocialsupport.39JNRCSbenefitfromadedicatedfocalpointexperiencedincommunityandpublichealththatisabletofacilitateandtrainand leadCBHFAmethodologyand its tools.Thecapacitybuildingactivitieswillbecoordinatedwithothermembersof theMovement such as French,Danish, Italian,German, British RedCross and ICRC. Thiswill lead to build a strongerNationalSocietyatbothbranchandHeadQuarterlevels.40EstimatedamountwiththeconversionofAUDandGPBcurrencyexchanges.41ItincludedUS$48,000forthePsychosocialprogrammemanagedbyDRC.42Includingathree-monthno-costextension.43Complementaryfundsforadditionaltrainingsforvolunteers.44Includingathree-monthno-costextension.


4. EVALUATIONMETHODS&LIMITATIONS

4.ATIMELINE–PHASESANDDELIVERABLESOFTHEEVALUATION

Table5:Evaluationtimelineanddeliverables

Activities Dates(Year2017) Deliverables

DeskReviewPhase(1):

30 January – 4February

DeskreviewPlanandschedule;draftmethodology;definedatacollectiontoolsInceptionreport

FieldPhase(2): 5–20February Completevisits,complementarydatagatheringandinterviewswithkeyinformants(KIIs)Conductvalidationsessionforfeedbackatendoffieldvisit

Synthesis andReportingPhase(3):

23 February – 6March

Complementaryinformationanddatacross-checkforanalysisSubmitdraftversionofevaluationreportforIFRC-JNRCSrevision

14March Finalversion–evaluationreportsubmission

4.BMETHODOLOGY–OVERALLORIENTATIONThe evaluation process was based on a mixed-methods approach, combining qualitative andquantitativemethodologies,performingbothquantitativeandqualitativeanalysis:

Table6:Toolsandtechniquesusedinthisevaluation

Tool/Technique TargetsandActorsinvolved Comments

Compilationandanalysisofavailabledocumentsand

qualityofmonitoringinformation

! Analysis of documents (see Annex III: Listof Consulted Documents - Bibliography)provided by the IFRC and those directlycompiled by the evaluator (externalreports-documents) prior to the field visit(Phase1)

! Analysisofthecomplementarydocuments(considered relevant) that the evaluatorwasabletoobtainfromIFRCand/orotherorganisations/institutions during the visitto Jordan (Phase2)andduringPhase3ofthe evaluation (see Annex III: List ofConsultedDocuments-Bibliography)

The quantitative data came from thereports and data already collected byIFRC and already reflected in thereports and other relevant documentspertainingtotheprojects

Semi-structuredindividualkeyinformants’

interviews(seefigurewiththe

breakdownbelow–figure2)

! Key Actors present in the area ofintervention working with whom theprojects had/have any type ofcoordination: other PNSs, iNGOs,Donors,etc.

! IFRCkeystaff(RegionalandNationallevel)! JNRCSkeystaff(Nationalandfieldlevel)

The interviews with key informantsservedtocollectinformationandviewsonkey issuesoutlined inthe inceptionreportand indicators in theEvaluationmatrix,aswellastoidentifycausalitiesandbridginginformationgaps

Jointbrainstorming-analysissessions

! Joint analysis sessions with IFRC and JRCSkeystaff

For information triangulation andcontribution to learning andidentification of challenges and bestpractices


GroupDiscussions

! Group discussions with CBHFA volunteersinfive45outofthesixgovernorates(JNRCSbranches) where the project isimplemented.

The group interviews with CBHFAvolunteers served to collectinformation and views on key issuesoutlined in the inception report andindicators in the Evaluation matrix, aswell as to identify causalities andbridging information gaps. Theevaluator counted upon translatorssupporttofacilitatethedynamics

Directobservation! Cross-check of databases and existing

monitoring tools – including hardwarecopies

For information analysis and reliabilitycheck of existing Monitoring andEvaluation(M&E)system

Allthequantitative informationwasextractedfromsecondarysources(both internalandexternaltoIFRC-JNRCS).Existingdatasets,reportsandstudieswereused,andwherethesewerenotreliableoravailable, qualitative approaches were followed to compensate. The data analysis enabled theevaluator to identify/mappossible trendsandhypothesesof thisnewprogrammaticapproach tobetestedduringthefieldphase.Duringthefieldphaseandinordertocollectqualitativeinformation,IFRC,JNRCS,ICRCandPNSsstaff,aswellasabroadrangeofexternalstakeholderswereinterviewed:

- Thirty-eight (19 M / 19 F) key Informant Interviews (KIIs) with individuals from differentinstitutions

- FiveGroupdiscussionswithfifty-sixCBHFAvolunteers(15M/41F)fromfivedifferentJNRCSbranches/governorateswerecarriedout.

Figure2:KeyStakeholdersparticipatingintheEvaluation

Source:Ownelaborationbasedonevaluationdata

The IFRC, JNRCS and PNSs interviewswere reinforced through two Joint sessions (one for briefingpurposesatthebeginningoftheevaluator’svisittoJordanandasecondoneattheendofthestay).The evaluator also attended the Community Health Task Force monthly meeting in Amman, thatincluded 22 participants from 11 different institutions. The List of contacted Key Informants (KIs) isattached as Annex IV. On February 19th which was the last day of the field phase46, the evaluatorpresentedpreliminaryfindingstotheIFRC,CBHFAstaff(JNRCS)andPNSskeystaff.

45OnlyMadabacouldnotbeincludedduetotimeconstraints.46February19th.

JNRCS,'IFRC,'ICRC,'PNSs'(GRC'&'DRC)'staff;'21

CBHFA'Volunteers;'56

iNGOs;'11

MoH;'1

Donors;'2 UN;'1Others;'2

Key'stakeholders'participating' in'the'Evaluation''(breakdown'by'type'of'Institution)'


4.CLIMITATIONS− External(contextrelated):

• Theenormousburdenofexternalfactorsandthecontext(mostlypolitical)neededaconstantexercisetobalanceandanalyseitsburdentorespondtoeachoftheevaluation’squestions.

• Difficultiesinobtainingreliableandupdatedstatistics/figuresonpopulationandsocio-medicaldata(validity,consistencyandaccuracyofsecondarydatathattheevaluationhastorelyon).

• ThedifficultytointerviewtheintendedCBHFAbeneficiaries(Syrianrefugees),ledtofocusthefieldphaseonCBHFAvolunteers,dueto:

1) Limitations related to the risk of limiting livelihood opportunities that are alreadyextremely constrained (preventing them from going to work to participate in theevaluation).2)Refugeesmaybehesitanttomeet.3)Refugeesmayhavehighexpectations,oratleastexpectyoutobringassistance.4) Some refugees can feel uncomfortable talking about protection risks and/or otherpersonal issues,what leadtheevaluator torelyasmuchaspossibleonexisting internalinformation and to concentrateupon the fielddynamics (groupdiscussions)withCBHFAVolunteers.

− Internal:

• TheavailableCBHFAnarrativesdonot includeAssessments/Exploratorymissions, thatmadethe Relevance,Appropriateness, TargetingandEffectiveness’ analysis of somecomponentsdifficult. Theevaluator then includedqualitative tools/techniques andquestions thatwouldcomplement the initial research (suchas communicationwithprevious IFRCparticipating inthedesignoftheintervention,revisionofhardwarecopiesandMonitoringtools,etc.).

• Ideally and to answer some of the evaluation’s main questions (related to Effectiveness),comparisonsbetweeninitialbase-linesand“comparisongroups”shouldbemadebeforeandafter the implementation of programmes. The CBHFA project has different base lines andintermediate measurements but with important methodological limitations, that does notallow the validationof their results. Some findings are thusexpressed in termsof likelihoodratherthanproof.

Theidentifiedlimitationshavereinforcedtheimportanceofcountingoninformationcollectedduringinterviewswithkeystakeholders.Thedetectedlimitationshavebeen(intheopinionoftheevaluator)partiallyalleviated,inlargepartbythequalitativeanalysis(interviews,researchandcross-checkingofinformation)madeduringthefieldandanalysisphaseofthisevaluation,leadingtoaresultthatdoesnotcompromisetheconclusionsoftheevaluation.


5.FINDINGSTheFindings’sectionisthemostextensivepartofthereport.Inthesesections,theevaluationcriteriaare analysed in depth in response to different Questions, according to the Indicators, Sources andMethodsoutlinedintheMethodologysectionandtheEvaluationMatrixthatweredefinedduringtheInceptionphase.Themost comprehensive analysis in this Section is done for the sub sections 5.A (Relevance andAppropriateness) and 5.B (Targeting and Coverage), where there were an increased number ofsecondary and primary sources for review, and the Indicators, defined to respond to the questions,requiredfurtheranalysis.ItwasalsofoundthatdesignandformulationoftheinterventionhavebeendeterminantsintheoveralllowEffectivenessandEfficiencyoftheintervention.Given the unquestionable relevance and humanitarian value of a community based intervention ajustificationofthefindingsareneededforafuturereorientationoftheintervention.5.ARELEVANCEANDAPPROPRIATENESS5.A.1Does the Project respond to the primary health care needs of the target population, localcontext(incl.MoH)andspecificneeds,suchasreferralsystem?5.A.1.a)Relevanceatthestartoftheintervention(2013–2014)The initial project decision to intervene in the health domain for out-of camp refugees was fullyrelevantiftakingintoconsiderationthegapsandtheneedsoftheSyrianrefugeesinearly2014:• In2013,thehealthsectorresponsewasprimarilyfocusedontherefugeeslivingincamps,whilst

the majority of the Syrian refugees were living out-of camps and the health response atcommunitylevelwasinsufficient.Thepriorityneedswerechangingwithchangesindemographyand epidemiological profile, and the Jordanianhealth systemwas under hugepressure (refugeehealthcare wasprovided for free throughthe JordanianMoHstructures,whatwas, in themid-term,unsustainable).

• AccordingtoIFRCstaffthatparticipatedinthefirstproposal’sdesign,in2014theneedforanIFRChealth intervention at community level came through discussions with UNHCR47 at interagencymeetings, where UNHCR expressed concernat by the insufficient refugee health responseservicesdirectedoutsideofrefugeecamps.TheyproposedIFRCtointerveneandalsotosetupandchairaCommunityHealthTaskForce.

• Althoughnowritteninformationcouldbefound,itwasmentionedthatinearly2014,theratioofone Community Health Volunteer (CHV) to population in non-camp areas was of 1 CHV/ 4000refugees(1:4000),whilsttheSphereminimumstandardisof1CHW/1,000(1:1000).

Atthattime,theCommunityhealthmaingapswereinthefollowingareas:• PreventiveapproachtosupporttheJordanHealthsystem(whentheprojectwasformulated,MoH

was giving free access to refugees) to avoid its collapse due to refugee pressure.. The CBHFA

47UNHCRwasatthattime,theleadingagencyforhealth.TheHealthSectorisco-chairedbyWHOandUNHCR.ThesecretariatofthesectorisprovidedbyUNHCR.


interventionwasintendedtocontributetoareductioninthefinancialburdenonhealthservicesofSyrianrefugees.

• Access to Information for refugees to improve their access to health care, given that themainbarriersthathadbeenidentifiedatthattimewererelatedtobureaucratic-administrativehurdlesandfinancialconstraints:

“ThetoptwoBarrierstoCaremostmentionedintheHealthAccessAssessmentfocusgroupsweresystematicissueswithadministrativedocumentation:(#1)wastheresidencystipulationontheMoISecurityCardthatlimitsthecardholdertomedicalfacilitieswherehe/sheoriginallyregistered.(#2)wastherapidexpirationoftheUNHCRRefugeeRegistrationCardandthelengthyandcomplexrenewalprocedurethat,intheinterim,leavestherefugeewithoutaccesstofreehealthcoverage

throughtheMoH.Issuesofphysicalaccesswerethenextmostfrequentlydiscussed:longdistancestohealthfacilities(#4),lackingmeansoftransportation(#6),andthecostofwhatlittletransportationisavailable(#3).Communicationdeficienciesalsofiguredinthetop-10(includingconfusionaboutthereferral

process)48.“It isalsoworthmentioningthat in2013JNRCwasnotassociatedwithanyparticular and/orregularservice49atcommunitylevelandtheCBHFAinterventionimplementedthroughdifferentbranchesandCBHFAvolunteerscouldhelptointegratetheJNRCS’sbranchesintothecommunities.5.A.1.b)AppropriatenessoftheInitialCBHFAintervention(2014)TheinitialCBHFAdesigncontemplatedtheCBHFAimplementationthrough:• comprehensiveprogrammemanagement• strengtheningcommunitysystems• settingupofareferralsystem• integrationandpartnerships• behaviourchangecommunicationGiven the community health needswere identified at theendof 2013 and early 2014, theCBHFAapproachwas appropriate if considering it as anentry point for connectionwith the public healthsystem(MoH)anddifferentpartnershipcomplementarities50withatwofoldpurpose:

I. to reduce the Syrian refugees’ frequentation by reinforcing key behaviour change topics(preventiveapproach),

II. facilitate enhanced coordination and referral mechanisms across health (MoH) andpsychosocialsectors.

Inspiteofitsinitialrelevance(needsbasedorientation)andtheappropriatenessasanentrypointatcommunity level mentioned in the previous paragraph, the CBHFA interventionwas, in its design,partiallyappropriate.• Thiswasmostlydueto:lackingadaptioninitsformulationtothenon-camprefugeereality,what

would have been needed considering that the intervention was going to be developed with a

48The#1barriertocarecitedinthefocusgroupwithasizeableunregisteredrefugeerepresentationwaslackofknowledgeabout available health services, while lack of knowledge ranked last in the top-10 barriers most mentioned in primarilyregistered refugee focus groups. Source: “Population-Based Health Access Assessment for Syrian Refugees in Non-CampSettingsthroughoutJordan”,UNHCR,InternationalMedicalCorps,UNFPAsurvey.November2013–March2014.49Exceptofnon-regularNonFoodItems’(NFIs)distributions. 50Exceptofnon-regularNonFoodItems’(NFIs)distributions.


protracted refugee caseload, in a country that (as previously developed in the section 3 of thisreport),isnotapartytothe1951ConventiononRefugeesorits1967Protocol51.

• In areas with fixed population, it makes sense to concentrate on having a permanent CBHFAvolunteer,butthepeculiaritiesoftheurbanapproachinasmallsizecountrywithahighdensityofpopulation, easy transportation and a large refugee case load (mobile), was not sufficientlyrecognised.

5.A.1.c)EvolutionofRelevance(2014-2016)SeriousdeteriorationoftheSyrianrefugees’economicsituation:The last availableVulnerability Assessment Framework (VAF)52 data in Jordan (2016) reinforces theabovementioneddata:• TheeconomicsituationofSyrianrefugeehouseholdslivinginJordanisprecarious.Manyrefugees

haveenteredacycleofassetdepletion,withsavingsexhaustedandlevelsofdebtincreasing.• Itfoundthat93%ofrefugeesarenowlivingbelowtheJordanianpovertylineof68JODpercapita

permonth.Moreover,80%oftherefugeesreportengagingin‘crisisoremergency’negativecopingstrategies.Theseincludereducingfoodintakeandtakingchildrenoutofschool53.Thisrepresentsadeteriorationfromthepreviouslyavailabledata(UNHCRsource).

“In 2015, only 10% of Syrian refugees held a valid work permit and in November 2015, 62% ofhouseholdshadnoeconomicallyactivemembers. In2015, thenumberof Syrian refugees involved inexploitativeandhighriskjobsincreasedby29%onayear-on-yearbasis(WFP,2015).

MostSyrianrefugeefamiliesspendmorethantheyearntomeettheirneeds.In2014,theaverageexpenditurewas1.6timesgreaterthanincome(UNHCR,2014c)andthegapbetweenexpenditureandincomehasbeenprogressivelyworsening.Severalstudiesfindhouseholdsamassinghighlevelsofdebt:over67%ofrefugeesborrowmoney(CARE,2015)whileasmanyas86%ofhouseholdstookondebtin2015,comparedto77%in2014(WFP,2015).Therefore,refugeefamiliesareatanincreasedriskoftakingupunsustainablelevelsofdebtandfallingintodebttrapswithno

steadyincomestreamstobailthemout.Since2014,decreasinglevelofincomepushedtheshareofrentandutilitiesintotalexpenditureto

consistentlyincreaseovertime.Inaddition,theaveragefoodshareintotalexpendituregrewfrom24%in2014(UNHCR,2014c)to40%in2015(UNHCR,2015b),anotherindicatorofincreasedeconomic

hardship54”.TheHealthsituationevolutionsincethestartoftheinterventionin2014:IntheMay2015“HealthSectorHumanitarianResponseStrategyforJordan”,itwasreportedthatthemain health concerns with regard to Syrian refugees were: non-communicable diseases55,communicable diseases (such as measles, polio, tuberculosis and leishmaniosis), poor infant andyoungchildfeedingpractices,anaemiaandmicronutrientdeficiencies,deliveriesingirlsundertheageof18,asignificantprevalenceofdisabilityamongSyrianrefugees;mentalhealthproblems,accesstocareandinsufficientcommunityoutreachcoveragewithlimitedSyrianinvolvement56.

51Moredetailsonthespecificpointsthatwouldhavebeendesirabletoconsideraregivenunder5.A.1.d)“AppropriatenessofthesuccessiveCBHFAinterventions”.52AsurveyconductedbytheUnitedNationsHighCommissioneronRefugees(UNHCR)andHumanitarianPartnersthatalsoprovideinsightintohealthutilisationandexpenditurepatternsamongsttheSyrianregisteredrefugees’households.53ECHOFactsheet–Jordan:SyrianCrisis-January2017.54“RunningonEmpty”,UNICEF,May2016.55TheSyrianrefugeehealthprofilereflectsacountryintransitionwithahighburdenofNCDs.56HealthSectorHumanitarianResponseStrategy:Jordan2014-2015.HealthSectorWorkingGroup.UpdatedMay2015.


IntheUNHCRHealthAccessandUtilizationSurvey(HAUS)57, it ismentionedthat:“thepolicychangefrom free to subsidised care was associated with a reported decrease in access to curative andpreventative health care services among Syrian refugees living out of camps in Jordan. Householdsreportedthat themainbarrier toseekingcarewhenneeded,wastheir inability topaytherequestedfees”.Accordingtotheconsultedsources,the2015healthconcernswereverysimilartothosein2014,withincreasingevidencethatSyrianrefugeeshadlessaccesstohealthcare58:TheHAUSdatafor2016(stillprovisional)alsoconfirmsthatexpenditureonhealthhasdramaticallyincreasedand somekeyaccess andhealth indicators showadeteriorating situation for theperiod2015-2016.The 2014-2016UNHCRHAUS data comparison shows as a deterioration from2014 to 2015 (policychangerequiringrefugeehouseholdstopayforhealthservicesobtainedinthepublicsector).It is also important to take into consideration that theHAUS is conductedamong registered non-campbasedSyrianrefugeeslivinginJordan,withhouseholdsthathadalistedtelephonenumber59.Itisreasonablehowevertoassumethathouseholdswithnophoneaccess60(40%inthe2016HAUS)arelikely to bemore financially vulnerable and therefore at higher risk of not being able to access andutilizehealthservicesasneeded. It is also recognised by all actors interviewed that the situation of non-registered refugees (notsurveyedintheHAUS)couldbeworse.Inthe2014-2016HAUSdatatrend’scomparison,thesamplesizeof2015(n=411)and2016(n=400)isnotcomparablewiththesamplesizeof2014(morethantriplethanin2015and2016:n=1,550HHs),thusthemethodologyof2015and2016 is insufficientlyexplained inthepublishedreports,showingseriouspitfalls,thusonlyallowingtocompareageneraltrend.Patients must present a valid UNHCR registration certificate and security card in order to receiveservicesatsubsidisedprices. The indicatorreferringtotheproportionofhouseholds(HHs)thatdohaveaMoIsecuritycardin2015and2016onlyreferstotherespondent(notalltheHHmembers)and does not allow to identify the most relevant information, which would be, the precisepercentageofHHmembersthatobtainedthenewsecuritycard(MoIcard)atertheUVEstartedinFebruary201561.• The2015HAUSfigureforthatindicator(94%)doesnotcorrespondtothe“new”cardsduetothe

fact that theUVEprocesshadonly recentlybeen inititated (February2015)andtheSurveywasdatedonMay2015.

57 This typeof survey is designed to characterise the care-seekingbehaviourof Syrian refugees and tobetterunderstandissuesrelatedtohealthcareaccessamongtherefugeepopulation.58Theseconcernsandneedsaregenerallystillvalidin2017. 59Asrecognizedalreadyinthe2014HAUSreport,surveyfindingsmaynotbegeneralizabletorefugeehouseholdswithoutregisteredtelephonenumber,astheycouldnotbeinterviewedforthatsurvey.Itisreasonablehowevertoassumethathouseholdswithnophoneaccessarelikelytobemorefinanciallyvulnerableandthereforeathigherriskofnotbeingabletoaccessandutilizehealthservicesasneeded.60Italsoincludesinvalidphonenumbersornolongerreachablenumbers. 61Aspreviouslydetailedinsection3.A.4ofthisreport,this isaprocessofstatusverification(UVE)thatstartedinFebruary2015 and that requires all Syrians – not just registered refugees – to registerwith the nearest police station to obtain aJordanianidentitycardthatconfirmsresidencyinJordanandaffordstheholderaccesstoeducationandhealthcare.Withoutbothofthesedocuments,displacedSyrianshavenorighttoanyofthishelp.


• AttheendofAugust2016,differentiNGOreports,citingUNHCRofficialinformation,showedthat70% of urban refugees registered with UNHCR were issued the new MoI cards, but thatinformationandamorerecentupdateonthatfigurecouldnotbeconfirmedbytheevaluator62.

Table7:HAUSJordan-SomeKeyIndicatorswithNegativeEvolution(series2014-2015and2016)

Indicator 2014 2015 2016

Proportion of households thatdid not obtain the new securitycard(MoIcard)

NotAvailable(N.A.) N.A. (The HAUS indicatesthatthe94%respondentshaveaMoIcard,withoutindicationof “new”cardsout of the respondentsandHHsmembers)

97% ((The HAUSindicates that the 94%respondentshaveaMoIcard,withoutindicationof “new” cards out ofthe respondents andHHsmembers)

Reasons for not obtaining thesecuritycard

N.A. LackofIDdocuments:15%ChangedareaofresidenceUnabletofindJordanianbailer,lackofbailoutdocument,costofdiseasefreecertificate63:8%each

LackofIDdocuments:15%64Changedareaofresidency:15%UnabletofindJordanianbailer:18%Costofdiseasefreecertificate:8%

Percentage of households whoknow that refugees havesubsidisedaccesstogovernmentPHCs

96% 64% 70%

Health seeking behaviour inAdult household members (1stfacility)

Publicsector(includinghospitals):53%Privatesector:33%(privatehospitalsandclinics:31.3%,,Syriandoctors:1.7%andshops/informalproviders:0.3%)Pharmacies:5%

N.A. Privatehospital/clinic38%(includingJHAsclinics:13%)Gov.Hospital:28%Home:2%PrivatePharmacies:14%

Household spending on healththemonthprecedingthesurvey

57.0 JOD (consultation anddiagnostic fees: 32.1 JODDand spending onmedications:24.9JD)

N.A. 105JOD(nobreakdownavailablebutaccordingtotheHAUSsurvey,itrepresents45%oftheir

totalincome)Average cost of care paid in thefirstfacilityvisitedbytherefugee

32USD 46USD 57.1USD

Source:EvaluationcompilationbasedonUNHCRHAUSdataThe indicators that represent an improvement if comparing 2016 with 2015 are included in thefollowingtable,andseemtobecloselyrelatedtoeithertheknowledgeaboutaservicefreeofcharge(inmunisationforunder-fives)orapartialexemptionofantenatalcare(ANC)andpostnatalcare(PNC)thatisfreeofchargetoallrefugeeswhoholdUNHCRdocumentationaswellasvalidMoIcard,since

62 TheevaluatortriedtoreconfirmwithUNHCRthevalidityofthepercentageoramostupdatedfigurebutnoresponsewasobtainedbeforefinishingthisreport.63Aspreviouslydetailedinsection3.A.4ofthisreport,this isaprocessofstatusverification(UVE)thatstartedinFebruary2015 and that requires all Syrians – not just registered refugees – to registerwith the nearest police station to obtain aJordanianidentitycardthatconfirmsresidencyinJordanandaffordstheholderaccesstoeducationandhealthcare.Withoutbothofthesedocuments,displacedSyrianshavenorighttoanyofthishelp.64 This is also consistentwithUNICEF 2016 information: “Expensive services andmissing documents are also importantfactorsdrivingrefugee’schoiceofseekinghealthcareoutsideofgovernmentalstructures”.“RunningonEmpty”,UNICEF,May2016.


April2016:

Table8:HAUSJordan-SomeKeyIndicatorswithPositiveEvolution(series2014,2015and2016)

Indicator 2014 2015 2016

Percentage of households that know that under-fives have free access tovaccines

92% 82%65 93%

Measlesimmunisationcoverageinunderfives 87% 82% 93%66PercentageofpregnantwomenhavingdifficultyaccessingANCservices 4% 15% 9%PercentageofhouseholdmemberswithChronicHealthConditionsinadultsthatwereunabletoaccessmedicinesorotherhealthservicesasneeded

24% 58% 36%67

Source:EvaluationcompilationbasedonUNHCRdataOther key indicators that were assessed in 2014 and that could also give a clear overview on theevolutionofthesituation(presumablynegative),werenotpublicallyavailablein2015and2016.Asthedatacollectiontools-questionnairesarenotincludedinanyoftheexternallypublishedreports,it is not possible to know if the informationwas obtained but not published or if itwas simply notobtained:

Table9:HAUSJordan-SomeKeyIndicatorsThatAreNoLongerPublicallyAvailablefor2015and2016

Indicator 2014 2015 2016

HouseholdsthatreceivecashorvouchersfromtheUN-NGO in the month preceding the survey (an averagevalue)

93.7%Averagevalue:201JD

N.A. N.A.

Percentage of births taking place in public hospital,privateclinicordoctorandnon-institutional

Publichospital(51,8%)Private clinic or doctor(30,4%)Non-institutional:17,8%

N.A.butpresumablyalsonegative68

N.A.

Percentageofhouseholdsthatdidnotseekcarethelasttimecarewasneededforanadult

4% 9%69 NA

Percentageofhouseholdsthatdidnotseekcarethelasttimecarewasneededforachildandprimaryreason

9%Primaryreason-cost:68%

NA NA

Source:EvaluationcompilationbasedonUNHCRdataMore recently, UNICEF published a report focusing in the situation of Syrian children in hostcommunities in Jordan70,where thedeteriorationof theSyrian refugees situationwasclearlymadeevident,with someparagraphs (copiedbelow), givingmore information that couldhelp to interpretthepreliminary2016HAUS’information:

65Consideringthatonly76%ofchildrenunder5reportedlyhadavaccinationcard,measlescoverageislikelytobeevenlowerthanthatestimatedabovebyself-report.66Thisfigurecouldbelowerduetothesamereasonasthepreviousfootnote.UNICEFinformationfor2016alsoreportsalowfigureofvaccinationrates(thatincludemeasles):“Syrianchildrenappeartohaveslightlylowerfullvaccinationrates(84.8%)whencomparedtoJordanianchildren(93.2%).Vaccinationratesremainhigh inJordan,yetpocketsofchildrennotholdingvaliddocumentsorlivingininformalsettlementsmaynotbevaccinated”.Source:“RunningonEmpty”,UNICEF,May2016.67 This information is contradictory with: 1) the information obtained through the different interviews carried out in theevaluation,whereitwasconsistentlyreportedthattheaccessibilitytohealthcareandtreatmentforchronicconditionshasworsenedduetoitsdirectrelationwithfinancialbarriersand2)thesameinformationcollectedintheHAUS2015and2016,wherethe%ofthosewhocouldn’taffordfeesincreasedfrom57%in2015to75%in2016.68SeeinformationfromUNICEFbelow(intheparagrapahinquotationmarks’ last line),relatedtorefugeewomenwomenhavingtopayformedicallyassistedchildbirthin2015wasnearlythreetimesmorethanin2014.69Itrepresentsadeterioration/negativetrend,interpretedasdirectlyrelatedtoafinancialbarrier/costofservice.70“RunningonEmpty”,UNICEF,May2016.


“RefugeefamiliesareshiftingawayfrompublichealthcareandturningtoNGOsorprivateserviceproviders(CARE,2015),(UNHCR,2015b).Only45%offamilieswithamedicalneedinthelast6monthsaccessedthenationalhealthcaresystem(UNICEF,2016).Refugeesarenolongerchoosingpublicclinics

orhospitalsmainlybecauseofsubstandardqualityofservices;expensiveservicesandmissingdocumentsarealsoimportantfactorsdrivingrefugee’schoiceofseekinghealthcareoutsideof

governmentalstructures(UNICEF,2016).Costsconnectedwithassistingchildbirthhaverisen.Theoddsofrefugeewomenhavingtopayformedicallyassistedchildbirthin2015werenearlythreetimeshigher

thanin2014(UNICEF,2016c)”.TheVAF2016data also shows that themajority of Syrian refugee families access health services atfacilitiesoperatedbycharitableinstitutions.RelevancetointerveneinCommunityhealth:• The Community health gaps identified and that initially justified a community (CBHFA)

intervention,changedafterNovember2014,thus:" Becoming more relevant to focus on: access to information for refugees to improve their

accesstohealthcareandreferrals/connectionwithdifferentpartnershipcomplementarities(notonlyacrosshealth71andpsychosocialsectors,butalsotocoverotherbasicneeds).

" TheProjectfocusonthepreventiveactivities(thathadbeeninitiallyjustifiedbytheintentionto contribute to a reduction in the financial burden on public health services for Syrianrefugees)become less relevantafterNovember2014 (MoHwasno longergiving freehealthcaretoSyrianrefugees).

5.A.1.d)AppropriatenessofthesuccessiveCBHFAinterventionsMost of the out-of camp Syrian refugees were located outside CBHFA traditional “communityenvironments72” (inurbanorperi-urbanareas andtoa lesserextent inruralareas). Asmentionedbefore, the intervention was put in place in a country with high density of population in a smallterritory, that facilitates movement, and that compounded with the above concerns and therefugees’searchforassistanceandlivelihoods/socioeconomicopportunities,representstargetinganimportantpercentageofnon-fixedpopulation(Syrianrefugees).Thatapproachwouldhaverequiredquiteaflexibleandvulnerabilityfocusedtargetingandwouldalsoinfluencetheabilitytorecruit,trainandkeepSyrian73CBHFAvolunteers.The initial formulation (as well as successive designs/proposals), did not take into considerationneitherthespecificprotectionvulnerabilitiesassociatedwiththeout-ofcamprefugee’scondition ofthetargetpopulation,northeburdenandinfluencethatlegal/policyfactors-changescouldhaveonthem. More specifically in the non-registered refugees or in refugees either unable to register orrenew UNHCR registration and obtain “asylum-seeker” certificates, obtain/renew an MoI card orlackingcivildocuments.In the new proposal of 2015, the project design did not give enough importance to theneed forsecuring the health referral pathway in the absence of a free public health system for Syrianrefugeesandin2016,itwassimplynotconsidered(seemoredetailsinresponsetoquestion5.A.2).

71“IncludingtheprovisionofcashtorefugeestooffsetthecostofaccessinghealthservicesatMinistryofHealthfacilitiesandstrengthen linkswithagenciesprovidingcashassistance tosupport transportcosts toaccesshealthservices forvulnerablerefugees”.Recommendations’sectionofthe2015“HealthAccessandUtilizationSurvey”.72Accordingtocertainsources,fortheSyrianrefugees,thetraditionalsenseofcommunityisreplacedbynationality/originties.73Definedtobeatleast50%oftheCBHFAvolunteers(whiletheremainingpercentage,shouldbeJordanians).


On the contrary, in 2016 there was a planned a non-justified increase in the number of CBHFAvolunteers from 70 to 150, that represented a huge investment in recruitment, training andmanagementreorganisation,divertingresourcesawayfromtheneededfocusinreachingand“doingmore”forthepopulationmostinneed,thathasbeendeterminantintheoverall lossofrelevanceoftheCBHFAintervention.What can be considered positive in thewhole series of projects (2014-2016) is that the DRC-JNRCSPsychosocial Support Programme (PSP)WithPSP centres in:Ajloun,Ammanand Jerash.,whichwas partially financed by the CBHFA proposals and could have helped to facilitate certain referrals(psychosocial, violence, Sexual and Gender Based Violence, etc.) was kept inside the differentproposals.5.A.2Shouldthedirectionoftheprojectbechangedtobetterreflectthoseneedsandprioritiesbya)scalingitup,b)byadaptingit,ifyes,how?,c)orconsideringothermoreappropriateapproachesandisitadaptedtotherealityoftheurbandisplacementinJordan?SuccessiveProposalsdidnottakesufficientlyintoconsiderationtheContextchanges(externalfactorsdetailedinsection3.4.Aofthisreport:TimelineofKeyEvents/Relevantdates)thatcontributed,withadifferentdegreeofcausality,toaseriousdeteriorationintheabilityofthemostvulnerablerefugees’familiesto:(#1)haveaccesstohealthcare,(#2)tocopewithotherbasicneeds(thatweredetectedinthe 2014-2015 IFRC-JNRCS CBHFA evaluation74) and (#3) the consequent protection challenges andseverelynegativecopingmechanismsresortedandwidelydocumentedbydifferentsourcessince2015andmentionedaswellinthepreviousparagraph.There has also been an over increased protection related risk for those refugees’ groups who areineligibletoreceivenewMoIcardsandrefugeeswhoareeligible,buthavenotyetobtainednewMoIcards because they lack the documents necessary to receive a card through the normal issuanceprocess.Whilst the largest groups of concern are refugees, IFRC interventions in Jordan are addressed toregisteredSyrianrefugeesandJordanians,whentheneeds(fromaHumanitarianprincipledapproach)would request a shift in focus towards the most vulnerable populations, not based on legal ornationalitystatus.Thoserefugees’categoriesthatwereandareexposedtoarangeof humanrightsrelatedconcernsstemfromthelackofdocumentation,suchas:• gender-basedrisksforSyrianwomenandgirlswithoutdocumentation(includingearlymarriage75,

sextrafficking,sexualandphysicalviolence,socialisolation,etc.),• restrictionsonmovementandmarginalisation• restrictedaccesstoservices(particularlyhealthandeducation),• exploitationinillegal,unsafeorriskywork,

74 Thiswaswidely documented in the evaluation report of the IFRC-JNRCS CBHFAproject carried out inDecember 2015,whichstatedthatevenlackingastandardevaluationstructureandaminimumquality,it couldhavebeenusefultoidentifymainchallengesandopportunitiesoftheapproach.75InJordan,girlsneedajudge’sapprovaltomarrybetweentheagesof15and18lunaryears(thejudgemustalsoobtaintheconsent of the Chief Justice to the marriage).Syrian girls who married before 18 therefore struggle to obtain marriagecertificatesormarriageratificationcertificates,andconsequentlythechildrenofearlymarriagesoftenremainunregistered. Datafromthe2015JordaniannationalcensusindicatesthatmorethanhalfofSyrianwomeninJordanmarriedbeforetheageof18.Earlymarriage isusedasacopingstrategy foryounggirls inabusivehomeenvironmentsandpoor livingconditions.Families marry off their daughters with the idea that they are providing protection for young girls, continuing familytraditions, alleviating poverty or helping daughters escape the environment. In general, girls under 18 aremore likely toexperienceobstetricandneonatalcomplicationsanddeathassociatedwithpregnancyandchildbirthatayoungage.


• violence,• resort to other severely negative coping strategies, such as returning to Syria or taking on

unsustainabledebt,• forcedrelocationtorefugeecamps,andpossible“refoulement76”,• provingchild’sidentityandpreventionofstatelessness:

“OneincreasedriskforunregisteredSyrianchildrenisstatelessness.Everychildhastherightto

acquireanationalityandalthoughlackofbirthregistrationdoesnotalwaysleadtostatelessness,the

OfficeoftheUnitedNationsHighCommissionerforHumanRights(OHCHR)hasexplainedthat:birthregistrationisfundamentaltothepreventionofstatelessnessandessentialtoensuretherightofeverychildtoacquirenationality.UnderSyrianandJordanianlaw,nationalityispassedthroughthefather;ifaSyrianwomangivesbirthinJordanbutthecouplecannotprovethattheyarelawfullymarriedandsocannotobtainabirthcertificate,thechildmay,ineffect,becomestateless.

Ifparentscannotprovetheir

child’sidentity,nationality,orrelationshiptothefamily,achild’slackofdocumentationcouldalsoaffectarefugeefamily’sabilitytotraveltogether,imperilingfamilyunity–arightprotectedunder

internationallawandanimportantprincipleofrefugeeprotection77”

Asmentionedin5.A.1,in2016(whenitwasmostneededandapreviousevaluationshowedthedireneed to either complement with assistance or to secure referrals to other organisations78), theformulationdidnotincludeanyreferralactivity79,thathasbeenfoundasamajorfactorhinderingtheoveralleffectivenessandefficiencyoftheintervention:• In lightoftheseriousdeteriorationof theSyrianrefugees’situation,theappropriatenessofthe

CBHFAapproachwasinsufficientlyfocusedinsecuringreferrals,whenReferralcareisconsideredas an essential part of access to comprehensive health services and differentUNHCR and otheractors (includingdonorsasECHO) issueddifferent related recommendations80andadapted theirstrategiestotheevolvingneedsofindividualswithspecificneedsandvulnerabilities,enhancingaswellthepossibilitiestocoverbasicneeds.

• The 2016 intervention focused in raising awareness (non-tangible focus) and increasing thenumber of CBHFA volunteers (by 100 percent), with the consequent effort and investment intraining,divertingattentionawayfromthepriorityneedsofthemostvulnerablepopulations.

• Theneed toprioritise the refugees’access tocomplementaryand“tangible”assistancewasalsowidely documented in the evaluation report of the IFRC-JNRCS CBHFA project carried out inDecember2015,areportthatevenlackingastandardevaluationstructure,couldhavebeenusefultoidentifymainchallengesandopportunitiesoftheapproachandbetterdefinethelastyearoftheintervention.

76Refoulementmeanstheexpulsionofpersonswhohavetherighttoberecognisedasrefugees.77 Source: “Securing Status” Syrian refugees and the documentation of legal status, identity, and family relationships inJordan,InternationalHumanRightsClinic-HarvardLawSchool(IHRC)andNRC.7811outof the15Beneficiaries’priorities identified in thatEvaluation reportaredirectly related to the refugees’needofobtaining complementary support (beyond awareness sessions), Literally: “Material help-house rental fees, Medical aid(Medication),Cooperationbetweendifferentprogrammes,Moresupportforchildrenandmothers,Firstaidbags,Aidingtoolsfor disabled people, Clothes-blankets-babymilk, Health centres for Syrians, Legal services, Freemedical days and CoveringdeliveriesinJNRCS”.Throughoutthatdocument,therearenumerousreferencestotheneedofassistanceandsupport.79Thatdecisionseemstohavebeentakenbyasimplefeasibilityandactivityorientedanalysis,thatwillbefurtherdevelopedunderEffectiveness.80Recommendationswerealreadyincludedinthe2015HealthAccessandUtilisationSurvey(HAUS):“PilotprovisionofcashtorefugeestooffsetthecostofaccessinghealthservicesatMinistryofHealth facilitiesandstrengthen linkswithagenciesprovidingcashassistancetosupporttransportcoststoaccesshealthservicesforvulnerablerefugeeswouldhelptoaddressfinancialbarriersforaccessingthehealthsystem”.


Thepotentialfor theuseofsocialmedia forcommunicatingwiththeaffectedpopulationandevenwith volunteers could have been considered, when according to the “Findings from ConsultationswithinSyriaandAmongSyrianRefugeesinJordan”81:“MostSyrianrefugeesinJordanhaveaccesstocellphones—half(53%)haveaccesstosmart-phonesandonethird(37%)haveaccesstofeaturephones.Aftertelevision(92%),socialmediaormessaging(51%)wasthemostcommonwaystolearnaboutreceivingaidandassistance.Particularlyoutsideofrefugeecamps,morethanonethird(39%)ofSyrianrefugeesusesocialmediaormessagingtofindout

aboutsupportandassistance,eithercitingJordaniansourcesofinformation(29%),Syriansources(48%),orsourcesfromothercountries(31%)asthemostuseful.

Facebookwasthemostcommonlyusedformofsocialmediaormessaging(85%),withalmosttwothirds(60%)ofrespondentsloggingonafewtimesaweekormore.

WhatsAppseemstobethepredominantmessagingserviceusedbySyrianrefugeesinJordan:two-thirds(64%)useWhatsAppeveryday,andone-fifth(20%)useitafewtimesaweek.WhatsAppusage

ingeneralismorecommoninurbanlocations(88%)thanrural(79%),andslightlymorecommonamongmen(89%)thanwomen(82%).WhatsAppisconsideredtobealowcostcommunication

channelthatiseffectiveandwidespread82”.Other key strategicelements, suchas the trainingapproach, IFRCmanagement,partnerships, JNRCSbranches’ role and participation and CBHFA volunteers’ selection are analysed under Effectiveness(section5.Cofthisreport).The benchmarking of some CBHFA components with other similar interventions in Jordan83 areanalysedundersections5.B.(TargetingandCoverage),5.C(Effectiveness)and5.D(Efficiency)andalsoinrelationtotheGRC-JNRCSCBHFAapproach(implementedsince2015inIrbid).

81“CommunityConsultationsonHumanitarianAid,FindingsfromConsultationswithinSyrianandamongSyrianrefugees inJordan”,WorldHumanitarianSummitIstambul,May2016.82 Virtually no other platforms— Twitter, YouTube, Instagram, Skype—were reported to be used by Syrian refugees inJordan.83 Although the benchmarking exercise was initially planed as well with the CBHFA approaches in theMENA region, theinformationcollecteddidnotallowtocarryoutthatexercise.


5.BTARGETINGANDCOVERAGE5.B.1IstheProjectreachingtherightareasandtherightpeople?5.B.1.a)Geographictargeting

Thedeliberatechoicetothetargetout-ofcamppopulationis,fromaprotectionandassistancegaps’perspective fully justified. At the time of starting the CBHFA intervention, it was a populationunderservedifcomparedtotheassistanceprovidedtotheexistingUNHCRcamps.

Thesecondstep,thegovernorates’geographictargetingwasalsojustified).According to thedifferent interviewsheld, the rationale for thechoiceof thegovernorateswas (#1)the ratio of Syrian refugees out of Jordanian hosts, combinedwith (#2) the lowest ratio of CHW /registeredrefugees’population(benchmarkingwiththeSphereminimumstandard,whichis1CHW/1,000,1:1000).• Athoughithasnotbeenpossibletoobtaintheinformationfor2014,theavailabledatafor2015

(the4Ws84matrixoftheCHTF),helpstoconfirmthattheadditionofonenewgovernorate(Balqa85)inthe2016proposal,wasclearlyguidedbytheCHWratioperregisteredSyrianrefugees).

• There are references, aswell in the2015proposal, that the new inclusionofMadabawas alsoguidedbythenonpresenceofcommunityhealthactors.

• If analysing the current (2017) available information on registered Syrian refugees / Jordaniansratiopergovernorate:

" Thecurrentgovernorates’choiceisadequate." Mafraq (included in the CBHFA intervention) is the governorate that would deserve,

accordingtoitsratio(53.7%)furtherinvestment86:

Figure3:Syrian–JordaniansPopulationRatioperGovernorate

Source:UNHCR.February2017screenshotfromthewebpage

http://data.unhcr.org/jordan/situation-map/

84WhoisWorkingWhere.85ThreeGovernorateshadthelowestratio:Zaqa,BalqaandTafilah.86SeeaswellTable9:CBHFAVolunteersdistributionperGovernorate(2016-2017comparison)forfurtherdetails.


To have an element of comparisonwith the registered refugees’ case loads per governorate, thefollowing figure shows the 201487-2017 comparison of out-of camp Syrian refugees’ registrationtrend88.ThecurrenttotalnumberofregisteredSyrianrefugeesintheGovernorateswheretheCBHFAintervenesishighlightedinthelabeltobettervisualisethecurrent(January2017)figures89.

Figure4:UNHCRRegistrationofOutofCampSyrianRefugeesbyGovernorate90(Evolution2014–2017)


Four out of the Six governorates of the CBHFA registered an increase in the number of registeredSyrian refugees for the period of intervention, what clearly backups the geographic choice madealongsidetheimplementationperiod.TheonlytwogovernoratesoftheCBHFAthatregisteradecreaseintheSyrianrefugeesfiguresareJerash(1,452)andAjloun(2,359):

Figure5:RegisteredVariations–Increase(2014-2017)ofRegisteredOutofCampSyrianrefugees


87TheinitialfigureisApril2014(theclosestdatefoundtothestartoftheintervention).88Administratively,Jordan’s12governoratesaredividedinto52districts,whichvaryinsizeandpopulation.89Forthecountry(UNHCRregisteredSyrianrefugeesat31January2017)TotalUrban:514,669.TotalCamps:141,063.90 It is alsoworthmentioning that In Amman,UNHCR figures by 31st January 2017, there are also: 54,374 Iraqi refugees(88,5%oftotalregisteredcaseload).

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

Amman

Gov.

Mafraq

Gov.

Irbid

Gov.

Zarqa

Gov.

Balqa

Gov.

Madaba

Gov.

Jerash

Gov.

Dispers

ed

Karak

Gov.

Ajloun

Gov.

Maan

Gov.

Aqaba

Gov.

Tafilah

Gov.

5-April-2014 154021 68978 136784 48869 17773 8884 11048 3745 9266 10119 6539 2417 2393

02-may-15 174972 75810 143031 51248 20702 11172 10738 1796 9398 9387 7278 3121 2047

31-March-2016 177992 77558 133460 49273 20247 11097 10176 1426 8962 8590 7358 3303 1515

31-January-2017 176419 79053 135542 47218 18991 10858 9596 9003 8425 7760 7401 3354 1487

176419

79053

135542

47218

1899110858 9596 7760

UNHCRRegistraUontrendbyGovernorate-OutofcampSyrianrefugeesinJordan

April2014-January2017

5-April-2014 02-may-15 31-March-2016 31-January-2017

22398

10075

1218 1974

0

5000

10000

15000

20000

25000

Amman Mafraq Balqa Madaba

Registered<<variations<<(Increase)<in< the<number<of<UNHCR<Syrian<registered<refugees<<(nonKcamp)<in<the<Governorates<of<the<CBHFA<

interventions<


5.B.2.b)RefugeesvshostpopulationandequitytargetingThepurposeoftargetingistomeettheneedsofthemostvulnerable.Whenatargetingsystemfailstoreach all of the vulnerable people in need, individuals or groups can quickly develop critical needs.TargetingcriteriamustbethenbasedonathoroughanalysisofVulnerabilityandBeneficiariesshouldbeclearlyidentified(geographiclocation,Household,Individualprofile,etc.).“Whentheysettleinacity,urbanrefugeesareusuallyconfrontedwiththesamepovertyproblemsasthelocalurbanpoor.Yettheyalsofaceadditionalchallengesduetotheirrefugeestatus:inmostcases,theylivewiththeconstantfearofbeingarrested,detainedandreturnedforciblytotheirhomecountry.Theyaredeniedaccesstobasicservicessuchaseducationorhealthandareexposedtoharassment,

intimidationanddiscrimination.Becauseurbanrefugeestendtokeepalowprofileandaredispersedinthecity,theyoftenpassunderthehumanitarianradar.

Supportingandprotectingrefugeesincitiesisanewchallengetohumanitarianorganizationswhoareusedtoassistrefugeesincamps91”.

AccordingtotheinformationcomparisonontheeconomicsituationofvulnerableJordanianandSyrianrefugees,theApril2016CAREresearch92isthemostupdatedandmethodologicallyreliablereportthatthe evaluator could find. The main finding for Syrian refugees was that “sources of income havedrastically changedsince2015,withworkandhumanitarianassistancecitedequallyas respondents’primary sourcesof income.Monthly incomehasdecreasedonaverage from209 JOD in2015 to185JODin2016.Accordingly,monthlyexpenditureshavefollowedadownwardtrendsince2014,asSyrianrefugeeshavelesscashtocovertheirbasicneeds”.Ifcomparingthemonthlyaverage income andexpendituresof thesampleofvulnerableJordanians,the situation shows a highermonthly average income and expenditure for Jordanians: themonthlyaverageincomeis356JOD93withahighermonthlyexpenditureof411JOD.Although Jordanian host communities do not face the same challenges as refugees would (i.e.documentation status, access toemployment, access to servicesetc.), they canexperiencedifferentchallenges instead, or a variation in scale in terms of need (around one quarter of the Jordanianpopulationdoesnothaveaccesstouniversalhealthinsurancecoverage94).VulnerableJordaniansbenefitfromvariousgovernment-runsocialprotectionschemesdependingonthetypeandextentoftheirvulnerability,buttheseprogrammesdonotsupportrefugeesinneed.• TheMinistryofSocialDevelopmentalsooffersseveralprotectionprogrammesandhasamandate

tosupportpoorJordanians.• Refugees,however,arenoteligibleforanyoftheprogrammesitprovides.

Another social protection programme is run by the Zakat Fund, administered by the Ministry ofAwaqaf,IslamicAffairsandHolyPlaces.TheZakatFunddeliverscashandin-kindassistanceonlytoHHs

91Source:http://urban-refugees.org.92 Riyada Consulting and Training was contracted to carry out CARE Jordan’s 2016 assessment, collecting qualitative andquantitativedataon theneeds, coping strategies, andperceptionsof Syrianurban refugeesandvulnerable Jordanianhostcommunities residing in Amman, Irbid, Mafraq, and Zarqa. A stratified random sample of 2,079 persons was targeted,including1,608Syrianrefugeesand471 Jordaniancitizens.Theconfidence levelwasmaintainedat95%andthemarginoferroris2.4%fortheSyrianrefugeesample,and4.5%fortheJordaniansample.Ofthosesurveyed,97.6%ofSyrianrefugeerespondentswereregisteredwithCAREandhadreceivedassistancefromtheorganisation(emergencycashassistanceandpsychosocialsupport).93Almostdoublethemonthlymínimumsalaryof190JODin2016,whichrecentlyincreased(February2017communication)to220JODsinceMarch2017.ThemínimumwageinJordanissetbyexecutivedecree.94 Cited in the “Comprehensive Vulnerability Assessment”, Hashemite Kingdom of Jordan, Ministry of Planning andInternationalCooperation,publishedin2016with2015data.


whodonotreceiveanyothereligiblebenefitsIBothJordaniansandforeignersareentitledtoregularcash assistance – but a recent study foundno evidence of refugees accessing transfers under thisscheme95.

On thecontrary, the supportof refugeescomes from internationalorganisations, but thissupporthastobealsodirectedtoJordanianresidentsdueto(asmentionedintheContextsection),aspecificrequirementoftheJordanianGovernmentthatprogrammingsupportsvulnerableJordaniansaswellasrefugees;itstipulatesthateither30%or50%ofbeneficiariesareJordanian,dependingonthetypeofsupport96.

Even when it is good practice to include both populations (refugees and host) to enhance socialcohesionand coexistence, themandatory inclusionof Jordanians (government requirement) in allrefugees’ assistance projects conflicts with the basic humanitarian principle of Impartiality andtargetingbyvulnerabilityandnotbystatus,nationality,etc.Inthatsense,itwouldbecoherent,tobeincoherent(notaligned)withtheGovernmentofJordan’spolicies.IFRC(duetoitsdifferentstatusandnon-mandatoryreportingtotheMoPIC),isinanuniqueposition(ifcomparedwiththerestofiNGOs)toimplementaprincipledhumanitariantargeting.

Accordingtoreliablesources,thegovernmentalsoinstructedhumanitarianorganisations(throughtheMoPIC97)toserveonlyrefugeeswithcompletedocumentation,thatmakesitevenmorejustifiedtotryto reachandassist those categories, presumably that aremoredeprivedandat ahigherprotectionrisk.It is also important to highlight that the standard approval letter that NGOs receive for Refugeeassistanceprojects’approvalfromtheMinistryofPlanningandInternationalCooperation(MoPIC)98forwhich the process was already long and not always clear99, stated that the NGO in question ispermittedtoassistonlyrefugeeswithnewMoIcards.Giventheacutenessof themostvulnerable refugees’needs,diverting humanitarianresources fromrefugees in dire need to target Jordanian hosts affected by poverty/structural needs that havededicated social programmes,wouldonlymakepartial sense froma cohesionperspective and for alimited number of activities. In any case, the main focus of any humanitarian intervention in thecurrentcontext,shouldbe,fromaprincipledhumanitarianactionperspective,onrefugees.5.b.1.c)Vulnerabilitytargeting–prioritieswithintherefugees’caseloadThe targeting of refugees and especially thosewithout valid refugee documentation, as themain95AmappingofsocialprotectionandhumanitarianassitanceprogrammesinJordan.Whatsupportarerefugeeseligiblefor?.ODI–MaastrichtUniversity,Workingpaper501.January2017.96Accordingtodifferentreports(DanishRefugeecouncil,NRC)andeventheHIP2016fromECHO,theconditionforapprovalofany refugeeprojectwas in2014, thatat least30%of thecaseloadhad tobe Jordanian, and itwaschanged to40%oraccordingtoothersources,50%.NodirectiveorinstructiononthisrequestcouldbefoundinanyofthepublicallyavailableMoPICdocuments.97 The processwas “used by theMinistry to redirect the type of interventions according to the Government of Jordan'spriorities,oftenincontrastwiththoseoftheHumanitarianCommunityandofthedonors.Forinstance“hardwareprojects”areprioritisedoverprotection/psycho-socialassistance”.Source:“StrategicProgrammeDocument”,DanishRefugeeCouncil,2014.98 Already before 2015, Refugee assistance projects need to receive the authorisation of the Ministry of Planning andInternationalCooperation(MoPIC)whichwasentitledtorequestmodificationstotheprojectdesign.99 The processwas “used by theMinistry to redirect the type of interventions according to the Government of Jordan'spriorities,oftenincontrastwiththoseoftheHumanitarianCommunityandofthedonors.Forinstance“hardwareprojects”areprioritisedoverprotection/psycho-socialassistance”.Source:“StrategicProgrammeDocument”,DanishRefugeeCouncil,2014.


focus of any intervention is, in 2017,more relevant than in 2014. This ismainly due to: (#1) thewidely documenteddeterioration in the Syrian refugees’ capacity to copewith themonthly survivalexpenses,(#2)theshortfallsinhumanitarianassistancethatmeantthatmanySyrianrefugeesinurbanareas have reduced access to public services and assistance, combined with (#3) the restrictionsimposedbytheGovernmentandthehurdlesofgettinghealthandotherpriorityassistance),and(#4)theincreaseinprotectionrelatedrisksandresortingtoseverelynegativecopyingmechanisms.Whilstthelargestgroupsofconcern100arerefugeeswhoareineligibletoreceivenewMoIcardsandrefugeeswhoareeligible,buthavenotyetobtainednewMoIcardsbecausetheylackthedocumentsnecessary to receive a card through the normal issuance process, all IFRC interventions (not onlyCBHFA)inJordanareaddressedtoregisteredSyrianrefugees.TheCBHFAhasbeenaddressedtoboth:SyrianrefugeesandJordanians.

At the same time, theneed to intervene as well with other non-Syrian refugees clearly emerges.Someofthosenon-Syrianrefugees,duetotheirreducedlevelsofassistanceandaccesstosubsidisedservicesandevenmorebureaucratichurdlesencounteredthanSyrians, couldbeexposedtosimilarorevenworstconditionsthansomeoftheSyrianrefugees.Asanexampleofthedifferenthurdles,thisisthecomparisonbetweentheSyrian,IraqiandNon-Iraqi/non-Syrianrefugeeshealthfees:• Syrianrefugees,withvalidUNHCRregistrationandMoIcard,canusegovernmenthealthservices

atalllevelsatthenon-insuredJordanianrate.• ThePublicHealthCareServicesareavailabletoIraqirefugeesatMinistryofHealth(MoH)facilities

atthenon-insuredJordanianratewhiletheymustpaytheforeigners’ratetoaccesssecondaryandtertiarylevelservices.

• Non-Iraqi/non-Syrianrefugeesarechargedtheforeigners’ ratewhenutilisingMoHservicesatalllevels.

5.b.1.d)CoverageoftheCBHFAinterventionCBHFAvolunteersThe 2015 and 2016 volunteers’ figure is neither proportionate to the refugees’ case loads in thegovernoratesnortotheSyrian/Jordaniansratio.Thisisthedistributionofvolunteersasperthe2015and2016proposals:

Table10:CBHFAVolunteersdistributionperGovernorate(2016-2017comparison)

Governorate CBHFAvolunteers(2015) CBHFAvolunteers(2016)Amman 40 90Jerash 6 10Ajloun 4 10Mafraq 10 10Madaba 10 10Balqa - 20

Source:Evaluationcompilationbased

The2016structurewasdevisedfor150CBHFAvolunteers.AsperJanuary2017,thereare132activevolunteers:• 79Syrian,52JordanianandoneIraqi(37M/95F).

100RefugeeswithoutnewMoIcardsliveinsituationsoflegaluncertainty,withoutaccesstoessentialservicesandatriskofarrest,detention,forcedrelocationtorefugeecamps,andpossible“refoulement(forcedreturntoacountrywheretheymaybesubjectedtopersecution).


• The2015figuresreached50%M/Fsplitwhentheincentivesfortransportationwerethesameasin2014:doublethatofin2016).

Comparative coverage with other organisations participating and reporting to the CHTF shows thatIFRC-JNRCS-GRCaccountformorethan50%ofthetotalnumberofreportedCHVs:

Table11:ReportedNationaldistributionofCommunityHealthVolunteersperGovernorate(non-campmapping)–January2017figures

Governorates

UNHCRRegistered

Refugees(31-January-2017)

RatioRegisteredrefugees/CHVsasper

figuresconfirmedthroughtheCHTF(January2017)

TotalofreportedCHVs

JNRCS(IFRC)

JNRCS(GRC)

OtherOrganizations

Amman 176419 1649 107 67 40Mafraq 79053 1719 46 11 35Irbid 135542 1936 70 25 45Zarqa 47218 7870 6 18Balqa 18991 826 23 18 5Madaba 10858 679 16 10 6Jerash 9596 600 16 10 6Dispersed 9003 0 0 Karak 8425 2106 4 4Ajloun 7760 485 16 10 6Maan 7401 1234 6 6Aqaba 3354 1118 3 3Tafilah 1487 0 0 0 313 126 25 174

Source:CHTFJanuary2017data

The available breakdown per governorate shows a certain degree of overlapping with otherorganisations(mainlyinAmman),thatwoulddeservefurtherclarification.District/Subdistrict/CommunitiescoveredWhatisnotclearisthepreciseinterventionlocationwithineachoftheGovernoratespereachoftheyearsofintervention,thedecisionmakingbehindthechoicesmade,aswellasthetotalpopulationpercommunity, different population categories (registered refugees, non-registered refugees, hostpopulation),etc.ineachoftheareas/communitiesthatwereincludedinthedifferentproposals.Theneedforgettingthatinformationisnotonlybasedonaccountabilitypurposes,butaprioritywhenconsidering the evolution of the situation (negative) for many Syrian refugees, who have lost theirsavingsandareindebted,andhavebeenforcedtomovetowardsmoreprecariousshelters(unfinishedhouses,substandardbuildings,InformalTentedSettlements(ITSs)and/orovercrowdedshelters).• According to thedifferent interviewsheldwith theCBHFAvolunteers,manyof themmentioned

that some of the most vulnerable groups are located in more precarious and peripheral


neighbourhoods – including ITSs and many of them without valid refugee documentation arefacingsignificantbarriersinaccessingbasicservices.

Boththehistoricalandthecurrentinformationoncommunities/areascoveredandtheiridentificationonamapismissinganddespiteofseveralrequestsbytheevaluator,thatbasicinformationcouldnotbeprovidedbytheproject.ThiscontrastswiththeclearidentificationandlocationoftheGRC-JNRCSareaofinterventioninIrbid(trackingoldandnewprojectareas),thatis identifiedasagoodpracticeandshouldbereplicatedbytheIFRC-JNRCSproject:

Figure6:GRChistoricalGeographicCoveragewithintheIrbid’sGovernorate(February2017)

Source:ScreenshotfromtheGRCofficemap

NumberofdirectBeneficiariescoveredwiththeinterventionThe above mentioned limitations do not allow us to validate the estimations of the number ofbeneficiariesreachedbytheproject(whichisamaximumcumulativefigureof78,500)–seeTable12bellow.• Thenumeric figuresshowan important levelofactivities,but theprecisegeographiccoverage

(district, sub-district, communities) isnot trackedonregularbasisand theestimatedpopulationforthoseareaswasnotcollected.Sothesimpleadditionofthepopulationtobetargetedineachof theproposals toobtainacumulative figureofbeneficiaries reachedcouldcreateadoubleorevenatriplecountingduetoapartialortotaloverlappingovertheyears.ThatisthereasonwhythereportedIFRC-JNRCSfigureofbeneficiariescannotbevalidatedinthisevaluation.

• Theavailablebreakdownspercategoriesarequitegenericanditisnotpossibletofurtherrefinethem.What isavailable isanumeric countingofactivities (verywell structuredand followed insomeareaswithanewtoolthathasnotyetbeenusedasastandardinallthegovernorates).

Table12:Cumulativefigureoftargetedpopulation/directbeneficiariesoftheCBHFAintervention

(2014–2016)

15February2014–15November

2014

01March2015–December2015


31stMarch–December2016(withno-costextensionuntiltheendofMarch

2017)

March–December2016(withno-costextensionuntiltheendofMarch

2017)

CumulativeFiguresreportedfortheperiodFebruary2014–November2016

6,000beneficiaries

(CBHFA&PS)–initiallySyrian

refugees

33,000Syrianrefugeesandhost

community

7,500beneficiaries–Syrianrefugees

andhostcommunity

JNRCSvolunteers(complementary

training)

32,000beneficiaries

(CBHFA&PS)–Syrianrefugees

andhostcommunities

Unknown:uptoamaximumof78,500(both

categories:Syrianrefugeesandhost

population)Volunteers:1,107


5.CEFFECTIVENESS5.C.1Towhatextenthavetheprogramobjectivesbeenachievedandwhatwerethemajorfactorsinfluencing the achievement or non-achievement of these objectives and what other alternativescouldbetried?OutcomeandOutputlevel(effectsinthetargetpopulation)Theavailableinformationhasnotpermittedustohaveaclearpictureontheintervention,aswellasofthequality-outputsofthedifferentcomponents.• Noneofthedifferentformulations/proposalsusedtheLogicalFrameworkApproachmethodology

orformat(IFRCprogramme–projectplanningguidance)andonlythe2016formulationincludedOutput indicators101, that hasmade the project, toomuch Activity versus Output oriented. Thesame applies to theM&E System (not standardised for all CHVs-areas and full activity countingoriented)

• Just as an example, for the Outcome and its corresponding indicator: “Improved wellbeing,resilienceandpeaceful co-existenceamong32,000 (CBHFA:22,000andPSP:10,000) vulnerableSyrian refugeeandhostcommunities in Jordan”, the indicatordefinedwas:% increase inhealthknowledge among Syrian refugees and host communitymembers. That indicator shows a risingawarenessor informationvisits’ immediateeffect,andcanbeafirststep(knowledge)towardsachangeinhealthseekingbehaviour,etc.butbynomeans,measuresthedefinedOutput.

Whatcanbeconfirmedfromdifferent focusgroupscarriedoutduringthe2014and2015base linesandevaluationisthatbeneficiariesacknowledged,withsomevariation,thattheyhavebeenexposedtousefullearningsessionsconcerningmedicaldiseasesandhealthmatters,becomingmoreawareofanumberofpreventivemeasuresthatwerepromotedthroughhomevisits. Reportingmechanismsarebasedonageneralnarrativereport,purelyactivitybased(thatcollectstheinformation inhardware/paper102copies)andit isnotput inrelationtovulnerablegroups’targeting,coverageandpositivechangesinthetargetedgroups.AsalreadymentionedintheLimitationssectionofthisreport(4.C):“theCBHFAprojecthasdifferentbase linesand intermediatemeasurementsbutwith importantmethodological limitations, thatdoesnotallowtheirresults’validation”.Thedifficultiesassociatedwithshort-termfundingcycles(9-10months),compoundedwiththedelaysinimplementationandtheinsufficienttechnicalpreparationoftheimplementers,havecontributedtothenon-validityoftheinformationobtainedforthepurposesinitiallyverified.• For short-term / emergency type activities, other type of techniques (like regular FGDs with

representativegroups,followingapurposivesamplingapproach)couldhavebeenused.DesignfactorsaffectingeffectivenessAsmentionedinprevioussections,designandformulationchoicesandweaknesseshaveenormouslyconditionedtheinterventions’possibilityofbeingeffective.

101Theindicatorsincludedinthatproposal,either(#1)don’tmeasuretheircorrespondentOutcomeorOutputor(#2)areofprocess-type(notresultsoriented),astheyshouldbetomeasureOutcome/Outputlevel.102Nouseofportabledevicesandsoftwarehasbeenmadeforreportingpurposes(partiallyduetotheIFRCdifficultytohaveapermanentInformationTechnology(IT)referent.50tabletsarekeptfortheCBHFAprojectandonlyusedonceforabaselinemeasurementthatwasnotsuccessful.


All the stakeholders interviewed that were involved in the first phases of the design andimplementationoftheCBHFAprojectrespondedthatthe2014focuswasonSyrianrefugees.Someofthemalsoclarified that themain ideabehind the firstproposalwas thatSyrianswere new in theircommunities, theyhadrecentlysettledandtheydidnotknowabout theservices, theydidnot findtheirwayaroundthepublichealthsystem,etc. Inthatcontext,service informationtofacilitatetheiraccesstotheMoHandotherorganisationsandfeelintegratedwerethemainreasonsbehindthefirstdesign.Butwhencheckingthatrationalewiththewrittenproposal,thespecificfocusonSyrianrefugeesisnottherenor insuccessiveproposals.This isbecause theactivitiesareaddressedtobothcommunities(SyrianandJordanian).• Equityamongstdifferentvulnerabilities/situationsisnotsufficientlyconsidered.Itseemsthatthe

mainreasonbehindtheintervention(humanitarianpurpose)isnotsufficientlyclearoratleastnotclearlyverbalised.

• Alltargetpopulation’scategoriesreceivesimilarorthesametypeofactivities,butthedifferencesinprofilesandsituationsaretooimportant,aswellastheneedsofdeliveringspecificsupporttothoseidentifiedasmostvulnerable(includingpersonslivingwithdisabilities,ahighnumberwithinthe Syrian refugees’ caseload), from that has seriously affected the effectiveness of theinterventionanditsalignmentwithakeyhumanitarianprinciple:“Impartiality”.

Somekeystrategicandpracticalproject’saspectswerenotsufficientlyconsideredordevelopedinthefirstproposalandwereleft“open”toimplementationandinterpretation,thathasnegativelyaffectedtheimplementationandconsequently,theoverallEffectiveness’intervention.Someofthosewereasimportantas:• How the selection process of the CBHFA volunteers was going to be carried out: through a

communityparticipationandvalidationprocess (thatwouldallowto identifyoneSyrianandoneJordanian),throughafullydecentralisedJNRCSbranch’process?,projectorientedorwithalong-termrecruitmentvision?withorwithoutvalidationfromtheCBHFAprogramme?,etc.

• Wouldthevolunteersbemobileorwouldtheybeattachedtotheircommunities103?• Considering the complexity of targeting in urban and peri urban settings, how the Project was

goingtobetargetingpriorityareasofintervention(geographictargetingatdistrict,sub-districtandcommunitylevel)withintheprioritisedgovernorates.

• HowtheProjectwouldbemonitoredandoutputs/outcomesmeasured.TherewasanabsenceofIndicatorsandexternalhypothesis/Assumptionsfortheintervention(nologicalframeworkmatrixwasavailabletoguidetheProject).

• Howperformance’s targets forCBHFAvolunteerswere going tobedefined:purelyquantitative-activity based?, in relation to target population per community or more linked to specificvulnerable/refugees’groups?,

• Whichactivitiesweregoingtobereinforcedforcommunitycohesion(JordanhostpopulationandSyrianrefugees)andwhichonesspecificallyaddressedtotheSyrianrefugees?

• What type of needs andwhat could be done by CBHFA teams if non-registered Syrian refugeeswerefoundinthesamecommunitiesofintervention?.

• Howandwho shouldbedoing themappingof services and its update if considering that thetraditional“communitymapping”oftheCBHFAruralapproacheswasnotadaptedtothesituationin theareasof the intervention,where sub-district,district, governorateandevennational levelmappingofserviceswouldbeneeded?

103Since2014,the CBHFAprojecthasbeen implementedfollowingthesamecommunityapproachthaninruralareasandareaswith fixedpopulation, where itmakes sense to concentrateonhavingapermanentVolunteer that canact as focalpointpercommunity.


• HowtheFirstAidcomponentoftheCBHFAapproachwasgoingtobedeliveredtocommunities,taking into consideration that CBHFA volunteers in Jordan could not act as first aid referralspoints104andthattheICRCwasalreadyhavingaFirstAidtrainingprogrammeincollaborationwithJNRCSfocusingonJordaniannationalsandnotrefugees105?.

Factorshinderingimplementation-effectivenessManagementrelatedfactorsTheJNRCS’internalmanagementstructureandorganisationalcultureandtheinsufficientlydetailedIFRC-JNRCS partnership framework seriously affected (and still affects), the CBHFA projectimplementation.• JNRCShasout-of-datepractices,thatcaused:(#1)seriousdelaysindecisionmakingandapprovals

for activities to take place (despite them being in the proposal and letter of agreement), (#2)delayedpaymentstoCBHFAvolunteersandstaff(leadingthemtobefrustratedanddemotivated),(#3)delayedfinancialreporting,thusnewtransfersoffundsandconsequentlyresultedindelaysintheimplementationofactivities.

• HRlimitations.ThelimitedJNRCSavailabilitytodiscussandresolveissuesandtoconductsufficientmonitoring of the activities continues, restricting the institution’s ability to be able to provideadequatesupporttotheCBHFAprojectofficers(dependentfromJNRCS):" Inpractice,onlyonefocalpersonat theJNRCSholdsCBHFA,FirstAid,DisasterManagement

and Cash programmes with the IFRC, PNSs and ICRC, that makes impossible (althoughattempted), the requested time allocation to properly follow CBHFA, which is implementedwith2differentapproaches(GRC–IFRC).

" AHealthCoordinatorwasrecruitedbyJNRCSbutleftwithoutachievingtheexpectedresults.TheworkingframeworkagreementbetweenIFRCandJNRCSismoreagenericpartnershipdocument(IFRC–NationalSocieties106)thana layoutofdetailedobligationsandrelationshipswiththeAmmanofficeandthedifferentbranches(includingsupervision)aroundaproject implementationplan.ThatresultsintwospeedsofownershipandimplementationoftheCBHFAproject. IFRCinfluenceisalsodifficulttoguaranteewiththecurrentpartnershipagreement.

ThelackofJNRCSexperiencedstaffinhealthand/orhumanitarianprogrammesmeantthattheIFRCsupporthadtofocusdisproportionallyoncapacitybuildinganddirectinvolvementinbureaucraticandadministrativeprocesseswiththeJNRCStofollowthecommitmentswithdonors.Thatrequiredalotoftimeandenergyand,takingawaytimefromtheCBHFAprojectdevelopment.Accountability–TransparencyrelatedfactorsThe IFRC had a very timid role in terms of establishing responsibilitieswhen serious allegations ofJNRCSabusive/coercivepowerwerereported.• IFRC insufficient enforcement of the “Fraud and corruption prevention and control policy”with

regards to serious allegations of (as the minimum) systematic abuse of power by the JNRCStowardsdifferentHRassignedtotheproject.Thiswouldhavedeservedandstilldeserves,anIFRC

104TheJordanlegalframeworkallowsFirstAidpracticetodoctors,nursesandparamedical,butnottovolunteers(exceptinaccidents,whentheywouldbeactingasindividuals).105TheFirstAidapproach isnot reallydeliveredat community level. Due to legal limitations, the volunteerscannotbeacommunityfirstreferralorhaveafirstaidkitforthecommunity.TheIFRC-JNRCSstrategydidnotconsidertodirectlytraincommunitymembers in first aid, thatwouldbemoreappropriateandwouldalsohelp toperceive theaddedvalueof theCBHFAvolunteersatcommunity level.This issomethingthatGRC-JNRCSisonthecontrary implementing,andaccordingtothem,withalotofsuccessatboth(communitylevelandiNGOs/NGOsinIrbid).106WithintheRedCrossandRedCrescentMovement,thehostNationalSocietyisnotusuallyconsideredasanimplementingpartner(althoughabackdonormaylookatitthatway).Relationshipisnotbetweenadonorandrecipientbutequalpartners(atleast,thatistheexpectedspirit).


Genevainvolvementandthefollowupoftheactionsdetailedinthementionedpolicy.• Atagivenmoment,thislackofIFRCactionseemstohavedemotivatedstaffandcreatedalackof

trust in the IFRC’s ability or willingness to investigate the reported wrongdoings and grant thecomprehensiveanonymityandprotectionforthosereportingtheallegations(toavoidallpossibleretaliatoryactions).

5.C.2 Has there been any unforeseen or indirect effects, either positive or negative (on thecommunities,volunteers,NationalSociety(JNRCS))?What can be extracted from the different project documents and also from the CBHFA volunteers’groupdiscussionsasunforeseenorindirecteffectsare:Positiveeffects• ThemostpositiveeffectofthedecisiontohavebothJordanianandSyriannationals inthesame

pairsand teams, showscohesionandapositivemodelof coexistence, that in certainareaswithhightensions,couldhavehadfurtherimpact.Thispairingofdifferentnationalsinthecommunitywork seems to be quite unique for the project (if comparedwith the other CHTF organisations’reportedworkingmodel:withlessJordaniannationals’participation).

• A contribution to “normalise” and reduce the gender gap when the CBHFA home visits andactivities are done inMale / Female pairs107. In some cases, itwasmentioned that it helped tochangeperceptionsincertainareasthatwereveryconservativeandinothersitwassaidthatitputpressureontheCBHFAfemalevolunteers,but inthemajorityofthecases, itwasperceivedasapositiveelement.

• Insomecommunities,populationfeelingofbeingconsideredandnotneglected.• Increase in the technical capacity of the trained staff that could contribute in the future to the

improvementof communityworkandhealthcare in thecountry (even those thatwere trainedandthatarenolongercollaboratingwiththeintervention).

• IncreaseinthepopulationawarenessofkeyhealthandpsychosocialtopicsandsomekeysuccessstoriesinsomeGovernartesweresharedduringtheevaluator’svisit.

• Someof theVolunteers alsopointedout that they gained trust, self esteem and social abilitiesthatarealreadyusefulintheirpersonal/familyandprofessionallife.

Negativeeffects• ThemostregularlypointedoutnegativepartoftheCBHFAworkwasconsistentlyreportedinall

theCBHFAgroupdiscussionscarriedoutduringtheevaluation,anditisreferredtotheincreasingdifficulties to confront dire and acute needs of the refugees and not being able to do anythingabout it (no possibility to give assistance or support). That has created, in some cases, animpossibilitytocarryouthomevisitsandanoverallreductioninitstotalnumberthroughouttheyearsandanegativecommunityperceptionthatwillpossiblyreduceinstitutionalacceptance.

• Some sentences extracted from the discussions (volunteers explainingwhat some families toldthem)illustratethechallengingsituation:“Ifyoucannotgivemeanyassistance,goaway”,“StopinformingmeabouttheNCDs;Ineedmedication”.“Ineedsupportandyoucomeheretotalk”…

107Evenif intheHHtherewerewomenaloneandthemalewasnotallowedtoenter, itwasstillconsideredpositiveasa“model”ofchange.


5.C.3 Does the Project have an effective coordination linking with other interventions, includingJNRCSprogrammessuchasCTP,PSP,YouthandLivelihoods.Howcanintegrationbeimprovedinthefuture?The project has participated in different coordination forums (external and internal) and createdspaces for bilateral and multilateral exchanges that have not been always fruitful. The missedopportunitiesaremoreevidentinthePSPcomponent,thatcouldhavebeenmoreoptimised;areferralpathwayandprotocolwascreatedandagreedbetweenIFRC-JNRCSandDRCbutitseemsnottohavebeenputinplace.OtherinitiativeswithintheRCmovementarenotlinked.ExternalparticipationTheIFRCisregularlyattendingtheinter-sectorialcoordinationmechanismestablishedthroughouttheCountryastheHumanitarianCountryTeam(HCT),CASHWorkingGroup,CountryHealthSector.JNRCShasrecently(2017)startedtoattendtheCountryHealthSectormonthlymeetings.TheIFRC/JNRCSwasleading(until2016),theInter–agencyCommunityHealthTaskGroup(CHTG)atCountry level in Jordanand still participating in themonthlymeetings. Theobjectives for this groupare:• Increase health service accessibility and coverage by raising refugee and host community

awarenessoftheavailablehealthservicesandbystrengtheningthereferralmechanismsinplace.• Promotea senseofownershipandcontrolofaffectedcommunitiesof theirownhealth through

communitycapacitybuildingandincreasingcommunityparticipation.• Somekeytasksarethedevelopmentofastandardjobdescriptionamongsthumanitarianagencies

ontheroleandresponsibilitiesofacommunityhealthworker/volunteersandabankofresourcesoftrainingandIEC(InformationEducationandCommunication)materials.

InternalRCRC health partners meeting In addition to the CHTG, theMovement coordinated untill 2016, ahealth partners monthly meeting. The objective was to share who is doing what where, reduceduplication,shareresources,shareexperiences/knowledgeandpromoteaoneRCRCapproach.With the German RC (the other country CBHFA implementer), a close working relationship wasdevelopedand it is still maintained throughout.This led tosharingof toolsandresourcesandevenjointtrainingattimes.


5.DEFFICIENCY5.D.1InthecurrentJordancontext,aretherealternativemodelsthatcouldimproveCBHFAplanningorreducecosts?Theoverall Efficiencyof this intervention is considered low,mostlydue to thenon-appropriatenessandthenon-adaptationofthechosenstrategytocopewiththemainhealthpopulationneeds.An improvement in theabovementionedpoints,witha rationalisationof the trainingapproachandCHBFAvolunteers’timeallocationandabettermanagementandpartnership’sdefinition(seesection5.D.2),wouldcontributetoaclear improvement intheoverallCBHFAplanningand efficiencyoftheintervention.MoredetailedsuggestionsaregivenintheRecommendations’sectionofthisreport.Here,thefocusisintraining(whichhasbeenoneofthemainprojects’activities).TrainingapproachThetrainingapproachwasfullycentralisedbyJNRCSinAmman:• 1 Training of Trainers CBHFA Master facilitator training was carried out in early 2014 by the

Egyptian Red Crescent, but only two participants were ultimately linked to the project. NodocumentedinformationontheJNRCSrationalefortheparticipants’choicecouldbefoundandnootherToTweredelivered.

• Therestofthetraining(modulestotheCBHFAvolunteers),havebeendelivered,initsmajoritybyonlyoneJNRCStrainerinAmman,losingtheopportunityto:(#1)createapermanentnetworkoftrainers that could facilitate replication at Governorate level (for other volunteers andorganisations),(#2)toimprovetheeffectivenessofthetrainingdeliveredifcountingthereducednumber of participants108 that would allow more interaction or (#2) directed to the targetpopulation(astheGRC-JNRCSisdoinginIrbidwithtwoFirstAidtrainers).

• Therearedoubtsaboutthequalityandstandardisationofsomeofthetrainingdelivered.Thefactthatmanyofthedocuments,trainingcontents,etc.arenotsystematicallytranslatedintoEnglish,compoundedwith:(#1)theJNRCSadaptationandproductionofmaterialsontopicsandmoduleswhereboth: ICRCand IFRChavea vast standardisation andmanuals alreadyavailable, (#2)Nosystematicpreandpost test resultsareavailableor translated intoEnglish, (#3) thenon-Arabicabilities of the IFRC delegates to monitor and supervise the overall content and delivery ofmodules,contributetoraisethesedoubts.

Thenumberof trainings thatCBHFAvolunteers have gone through is totally disproportionate (toomany topics tobeeffective),andmoreappropriate foraparamedicalvolunteer thanfor theHealthandServiceinformationpurposeinitiallyenvisagedforthatnetwork.• Traininghasaccountedforahighpercentageofthetotalactivitiesandresourcescarriedoutsince

thestartoftheintervention.

• A demanding calendar for volunteers to be able to follow the whole yearly plan: in 2016, 20training days in total for each of the CBHFA volunteers, that can hinder participation andcommitmentamongstvolunteers.Asanexample:132CHVsweretrainedin2016(37M/95F)butonly35%-46CHVs(14Maleand32Female)assistedatalltraining(9)deliveredthroughouttheyear.

108Asthetrainingwascentralised,manytimesparticipantsfromdifferentgovernoratesgatheredtogetherandwerehigherinnumberthan40,thatalsoconditionedthevenueplace,thecostoftransportation,etc.


• Capacitybuildingefforts to thevolunteershavebeenmadealmostexclusively through training,whencapacitybuildinggoesbeyondtraining.WithoutacorrectplanningatGovernoratelevelandcontinuouspresenceofqualifiedstaffforsupervision,eveninthebestcasescenarioofasuccessfulandsustainedtraining,pressuresintheJNRCSbranchesandothertypesofdifficultieswouldneedtobemonitoredtoobtainpositiveresultsatcommunitylevel.

Thenumberoftrainingsdeliveredisnotproportionatewiththeregularityandtypeofactivitiestodeliveronamonthlybasis(lackingacomparativeEffectiveness-CoverageandEfficiencyanalysis).• Ifcarryingoutabasicefficiencyanalysis,consideringthe2016trainingbudget109 (37,500JOD) in

comparisonwith themaximumnumber of hours permonth that the current number ofCBHFAvolunteers(132)canworkduetotheincentivesreductionpolicy(amaximumof8hours/activitiesa month), the result is a maximum of 1,056 h. per month, that could be done by 26 CBHFAsvolunteersiftheyworked40hoursamonth(asitwasdonein2015).

• Ifcomparingthe2016annualtrainingbudgetwiththenumberoftrainingdaysdeliveredduringtheyear2016(37,500JOD-20days110),anincreaseintheCBHFAvolunteers’incentivesbudget(33,525 JOD) to a minimum ethical standard, it could be immediately feasible to reduce thenumberoftrainingdaysto8-9daysayearandallocateaproperbudgetlinethatwouldmaketheinterventioneffective.

• Otherorganisationsdon’tbase their calculationsonhourspermonth. Theydefinemore refinedtargetspermonthpervolunteer.IRDforinstance,inoneofthegovernoratesstipulates34homevisitsamonthand53referrals+Followupforthe53referralspervolunteer(donethroughmobiledeviceswithODKsoftwareandReferralforms),withamonthlyincentiveof260–280JOD.

OutofthedifferenttopicsinwhichtheCBHFAvolunteersweretrained,volunteersappreciatealotforitscontent(usefulness)andpracticalapproach,theFirstAidtraining(deliveredin2days).• There is an overwhelming preference for that module. 97% of all the CBHFA volunteers that

participated in the different evaluation’s group discussionsmanifested their preference for thistraining,identifyingitastheirfavourite.

• Itwasfrequentlysuggestedtocreateanadvancedmodule.• After consulting the available trainingmaterial, thatmodule is thebest structuredand couldbe

consideredasthemostdistinctivetopicoftheRedCrossandRedCrescentmovementthatcoulddefinitelybemoreexploitedatthecommunitylevel.

ViolencePrevention(new2016topicdeliveredinoneday)hadaswellagreatacceptanceamongstthevolunteers.According to them, violence iswidespreadand thebasic skills acquired to identify casesandhaveabasicinterventionand/orreferralwasfoundveryusefulfortheiractivities.Outof the20 trainingdaysdelivered in2016,onlyonedaywasallocated to theactivity thatwouldhavebeenkey:ReferralsandCoordination.Othertopicsthat someoftheCBHFACHVssuggestedtoreinforcewereBehaviorChangeandCommunicationskills. 5.D.2Weretheresufficientandappropriateresourcesandsupportfromboth(IFRCandtheNationalSociety)toimplementtheproject?Differentmodels of supervision –managementwere tried for CBHFA management at Branch level,thatincludedafulltimeHRallocationin2014-2015(onepergovernorate)thatwasreplacedin2016

109Trainingbudgetlinesdonotincludeanyrunningcost,orHRpermanentstaffsalaries,thatifcalculated,wouldincreasethereflectedfigure.110TrainingcentralisedinAmmanduringtheyear2016.


by volunteers’ focal points (a decision that was not based in a cost-effectiveness and efficiencyanalysis).• Thefactthatsomeoftheinitiallyappointedhumanresourcesatbranches’level111wereeithernot

therightmatchtothepositionorwerenotgivenspacetoworkbythebranchmanagers,wouldhave deserved IFRC and JNRCS to apply problem-solving alternatives (including considering theGRC-JRCSmodel inIrbid,requestareplacementandnewrecruitmentofHR,requestachangeofattitude in some branch managers, etc.), instead of replacing the structure by volunteers withmuchlessdedicationandresponsibilityobligations112.

AsimilardynamichappenedwiththedrasticJNRCSunilateraldecisiontocut,fromthe2016project,volunteers incentives (that were entitled to cover transportation expenses) by half113, without anyfurtheranalysisordiscussion.• TheJNRCSYouth-VolunteerpolicyandtheYouth-Volunteerspecificdepartmentinterestsseemto

have guided the decision-making behind that JNRCS instruction to drastically reduce the CHVsincentives’ scheme that had been in place in 2014 and 2015114. According to the differentstakeholdersinterviewed,monthlyincentiveswerecutbyhalf“becauseyouthincentivesare5JOD/day115andthatdepartmentwantstostandardisethepolicy”.

• This had, according to all actors interviewed (including CBHFA volunteers), serious and verynegative consequencesonboth: the implementationofactivities (thathad todefinea ceilingofonly8 activitiespermonthper volunteer116) andan important loss of volunteers (mostlymales)thatobligedtoenteragainintoafullcycleofnewtraining(insteadofrefreshments).

• The decision to review the incentives should have been based on ethical, effectiveness andefficiencyconsiderationsandtheoverallalignmentwithotherorganisationsdoingthesametypeof activities (CHTF). It is also surprising to see that whilst IFRC-JNRCS volunteers are paid amaximumof5JODperdaywithamaximumof40JODpermonth,GRC-JRNCSarepaiddoubleperdayandthenumberofdayspermonthisdefinedaccordingtotheactivities’needs.

• TheamountdefinedundertheunilateralJNRCSdecisionissimplyunethicalifconsidering:" theminimumsalaryinJordan(recentlyincreasedto220JOD/month)," whatotherorganisations fromCHTFpay to their volunteers (in some cases, higher than the

minimum salary, and most of all, if comparing the monthly incentives with the MinimumExpenditureBasket(MEB)117andtheSurvivalMinimumExpenditureBasket(SMEB)118inJordanand the fact that many of the CBHFA volunteers are Syrian nationals, confronted to a direeconomicsituationwhohavehardlyanyotherincome:

• In 2016 (November figures) only 132 active volunteers out of the 1,107 trained since 2014(cumulative figure) remain.There isalwaysahigh turnover,which is linked to thenatureofanyvolunteerwork,butaccordingtotheinterviewedCBHFAstaffandvolunteers,thedrasticand“out

111Fieldofficerassistants(Oneperbranch).112Moredetailsaboutthe initialstructureareprovidedinAnnexV:OrganisationChartfortheCBHFARollouut(13-March-2014),thatalsoincludedtheHealthCoordinatorposition.113Thatweredefinedatamaximumof10JOD/dayandwerereducedto5JOD/day.114 And that was also aligned with the GRC, the CHTF working group and the IFRC Cash Transfer Programme (CTP)volunteers.115Inthe2014GoJproposal,volunteerswerepaid10JOD/day,theVolunteers’supervisors(15JOD/day)andtheFieldOfficerAsisstants(350JOD/month).116Thatminimisesthepossibilitytooptimisethetrainingeffortsandactivitiesatcommunitylevel.117TheMinimumExpenditureBasket(MEB) isawayofestablishingpovertylinesforrefugeepopulations.It isemergingasthe primary tool to develop a cost andmarket based expression of minimum needs of refugees in any given country. Itbroadly followsthenotionofa“costofbasicneedsapproach”.TheMEB is theexpressionof themonthlycostpercapita,whichallowsaSyrianrefugeetoliveadignifiedlifeoutsidethecampsinJordan.Thisimpliesthefullaccesstoallrightsandrepresentstheminimumneededtoleadadignifiedlifeoutsidethecamps.118TheSMEBistheexpressionofthemonthlycostpercapitawhichistheminimumneededforphysicalsurvivalandimpliesthedeprivationofaseriesofrights.


ofthemarket”cutinthesupportfortransportation-incentiveshashadamajorimpactintheverylowvolunteers’retentionrate:whichisonly12%.

Themonthlyincentivewas100JODin2015,anditcanbeconsideredcorrectfromapure“volunteer”perspective.ItwasalittlebitabovetheJordanianSMEBforoneindividualaloneandtheequivalenttotheaverageMEBforanindividualinaHHof3members:

Figure7:MinimumExpenditureBasketandSurvivalMinimumExpenditureBasketinJordan(June2015)

Source:EvaluationcompilationbasedonMEBandSMEBdataforJordan

Themonthlyincentivewas40JODin2016andstillthesamein2017andit issimplyunethical. It isequivalentto30%oftheJordanianSMEBforoneindividualalone(132JOD)andtheequivalentof38%oftheaverageMEBforanindividualinaHHof3members(106):

Figure8:MinimumExpenditureBasketandSurvivalMinimumExpenditureBasketinJordan(October2016119)

Source:EvaluationcompilationbasedonMEBandSMEBdataforJordan

EfficiencygainsthroughanewCBHFAVolunteers’selectionandvalidationprocedureThe2016newvolunteers’recruitmentwas,forthefirsttime,alsoopenedoutsidethepreviousJNRCSentourage120(throughFacebook)tomoreapplicants.

119ItwasnotpossibletofindtheMEBandSMEBdataforJune2016.TheOctober2016dataistheonlyinformationexternallyaccessiblefor2016.

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The newly created selection and validation procedures defined by the CBHFA project officers, haveundoubtedlybeendecisiveinthesuccessfulprofilesthatwereeitherrecruitedorvalidatedin2016.• Thisshiftwasput inplaceto(#1)counteractpreviousweaknesses identified insomevolunteers

thathadbeendirectlyrecruitedbyJNRCSbranches(werepossiblyandduetoconflictinginterests– family ties, theirprofilesdidnotmatch theminimum requirements toperform the tasks thatwereincludedforCBHFAvolunteersintheyears2014and2015),and(#2)toimprovethetraining’levelandeffectiveness,aswellastheactivities’reporting121.

• The current network of trained CBHFA volunteers have a huge potential and their level ofcommitment,willingnesstodomoreandhumanitarianvisionmeantheyareamajorassetfortheinstitutionandforthefutureproject’sreorientation.

The2016newvolunteers’selectionandvalidationprocessthatwassetupbytheJNRCSCBHFAstaffteam(representedinthefollowingfigue)isgoodpracticethatcouldbereplicatednotonlyinotherJNRCSprogrammeswithvolunteersbutalsofortheselectionofCBHFAproject’sstaff.

Figure9:2016CBHFAvolunteers’recruitmentandselectionprocess

Source:CBHFAFieldOfficerpresentation

120BeforetheJNRCSYouthdepartmenthadvolunteersintheirdatabase.Withthenewvolunteers’selectionprocesssetupin2016,thepotentialcandidatesgothroughaseparateprocess(notwithYouthdepartment).Facebookhasbeenkey,havinganaverageof10volunteersperdayandcollectingatotalof700applicationwhilsttherecruitmentwasopen.121 That (according to the interviewed)was very challengingdue to thedifferent levels of education and capacities of theinitial networkof volunteers, thathadmadedifficult the standard followupof somepartsof themodules, aswell as thecorrectimplementationofsomemonitoringandreportingmechanisms.

1.FillingAnapplica-on

2.Firstinterview

3.ShortassessmentforApplica-on&Approval

4.Secondinterview

5.FinalInterviewtomakesurethatwecaninvestintheVolunteer


5.ECONNECTEDNESS5.C.1Do lessons from the implementationof this project indicateany changes to its design in thefuturetoensureanexitstrategyestablishesacommunitybasisfortheNationalSociety,thusbetterenhancingconnectedness/sustainability?Concerningthechoiceofpartnershipconnectedness,theIFRCdecisiontouselocalcapacities(JNRCS),and using the existing JNRCS branches’ infrastructure can have, in theory, a better contribution toconnectednessthaninthecasewhereforeigncapacitiesandresourceshadbeenutilisedinaparallel-verticalsetup,butthisneedstobeputintoperspective.TheIFRC-JNRCSpartnership,duetothelongJNRCSpresenceinthecountry,couldalsocontributetoConnectednessbyitsinfluentialroleifJNRCSisconsideredareliablepartnerbytheGovernmentandinternationalactors,thusaffordingastrongrelationshipandaninfluentialvoicewithAuthorities.Thatinfluential role couldhavebeenuseful for theprojectpurposebut at least in the relationswith theMoH,theaddedvaluehasnotbeenfound122.• TheJNRCSpartnershipwiththeMoH123forthesettingupofanintegratedhealthapproach,linking

communities with primary/secondary health has been acknowledged by different actorsinterviewedasquite a controversial issue inside JNRCS. The fact that there is a cleardeficit anddifficulties in theexchange-coordinationbetween the JNRCSand theMoH and that JNRCSdoesnothaveahealthdepartment,evenwhentheIFRCandsomePNSsvisioncontributedto itssetup124,isaseriousobstacletoconnectednessandminimizesthepotentiallobbyandadvocacyroleoftheNationalSociety.

• JNRCS Interest in Institutional Capacity Building and the development of long-term Youthdepartment/volunteers is, inthecurrenthumanitariansituationnotcompatiblewiththeneedtomaintain a project orientation of the CBHFA volunteers that would have to focus on beingeffectiveandefficientintheshortterm(projectorientation).

Whatisalsoafactisthattherehasbeenlimitedintegrationofthepreviousevaluation’sFindingsthathadalreadyidentified,asapriority,theneedforsecuringkeyreferralsandlookingforcomplementaryassistance.Thealignmentwithcountrystrategiesandpriorities is, inthecurrentsituation,thebestapproachtoConnectedness.Itisconfirmedthatthecommunityhealthandinformationapproachandbysimilaritythe CBHFA approach, is (as reflected in the “Health Sector Humanitarian Response Strategy Jordan2017-2018”),fullyalignedwiththecurrentnationalpriorities.CHVsthemselves,inthatstrategy,areentitledtobefocalpointsforInformation-Referrals,thatopensaswellthepathwayforfurtherinvestmentinthatarea.

122 Different IFRC attempts to engage MoH with JNRCS at branch level were not successful, apparently due to JNRCSreluctancytotheinvolvement.123Thefactthatthereisacleardeficitanddifficultiesintheexchange-coordinationbetweentheJNRCSandtheMoHhasbeenacknowledgedbydifferentactorsinterviewedasquiteacontroversial issue,alsoaffectingthepossibilityofcreatingamoreformalframeworkatnationallevel.124PNSsandtheIFRCcontributedformorethanoneyeartoaJNRCShealthcoordinatorpositionbuttheyrefusedtocontinuegiventhenon-decisionmakingcapacityandweakpositionoftheselectedJNRCSprofile.


6.CONCLUSIONSRelevance-AppropriatenessOverall, the rationale in early 2014 (when it was designed) to launch the CBHFA and the IFRCprioritisationofan intervention to respond to thecommunityhealthand informationneedsof theSyrian refugees living out of campswas, from a needs-based perspective, highly relevant and fullyjustifiedby:• the possibility to reduce Syrian refugees’ pressure and financial burden on the Jordan public

health system (that when the project was formulated, was granting free access to Syrianrefugees),byreinforcingkeybehaviourchangetopics(preventiveapproach);

• thepossibilityofreducing, throughimprovedaccesstoinformation,enhancedcoordinationandreferralmechanisms, themainbarriers limiting refugees’ access tohealth care thathadbeenatthattimeidentified(morerelatedtobureaucratic-administrativehurdles andlackofknowledgeabouttheJordanianhealthsystemandreferralprocesses).

Inspiteofitsinitialrelevance,theCBHFAfirstdesign/formulation:• did not sufficiently consider equity amongst different vulnerabilities/situations. All target

population’scategorieswouldreceivesimilarorthesametypeofactivities,butthedifferencesinprofiles and situations are too important, as well as the needs of delivering specific support tothose identified as most vulnerable, that has seriously affected the effectiveness of theinterventionanditsalignmentwithakeyhumanitarianprinciple:“Impartiality”;

• andwasnotsufficientlyadaptedto:(#1)thetargetingchallengesinurbanandperi-urbansettings,considering the relatively small size of country with high population density and easytransportation that would facilitate refugees’ movements in search of livelihood opportunitiesand/orbetteraccesstoservices;(#2)theforeseeabledeteriorationoftheprotectionenvironmentassociatedwithprotracteddisplacementsituationsandmorespecificallytothespecificprotectionchallengesandneedsofanon-camprefugeecaseloadinacountrythatisnotapartytothe1951ConventiononRefugeesorits1967Protocol;

Therelevanceofrespondingtothemostvulnerablerefugees’healthrelatedneeds, improvingaccessto informationatcommunity levelandeffectivereferralshas increasedovertime.This ismostlydueto: (#1) deteriorating access to the health system and worsening key health indicators (highlyinfluenced by the November 2014 policy change from free public healthcare to requiring Syrianrefugeestopayforhealthservices inthepublicsector), (#2)the acutedrop intheSyrianrefugees’economic situation in Jordan and their resorting to negative coping mechanisms, (#3) the risingprotectionvulnerabilitiesin2015and2016(highlyinfluencedbylegalandpolicychangeshappeninginthoseyears)and(#4)decliningfundsandchangingpriorities, fromaddressinghumanitarianneeds inbenefitoftheresilienceanddevelopmentagenda.ThelimitationsofwhattheCBHFAimplementercanachievewithastandaloneintervention(intangible)in terms of connecting populations in high distress with other levels of assistance (tangible) to bedeliveredbyserviceproviders/organisationswasnotsufficientlytakenintoconsiderationinsuccessiveformulations(2015and2016),especiallywhen:(#1)thereisaninsufficientofferandcoverage(especiallyinthehealthsectorandcash-basedassistance)and(#2)thereareexternalfactorssuchasthelegalstatusissuesthatlimitswhatcanbehandleddirectlybytheimplementer.


TargetingandCoverageFour out of the Six governorates of the CBHFA registered an increase in the number of registeredSyrian refugees for the period of intervention, that clearly backups the governorates’ choice madealongsidetheimplementationperiod.• Onthecontrary,thehistoricalandthecurrentinformationoncommunities/areascoveredwithin

eachGovernorateandtheiridentificationonamapisnotavailableforsomeperiodsoftime,whilstthe totalpopulationpercommunityanddifferentpopulationcategories’breakdowns (registeredrefugees,non-registeredrefugees,hostpopulation),arenotavailable.Thismissinginformationiskey to estimate the intervention’s coverage and validate the estimations of the number ofbeneficiaries reached by theproject (which,according to IFRCreports, reachedamaximumof78,500 Syrian refugees and Jordanian hosts - cumulative figure since the start of the 2014intervention).

• In spite of the “right” Governorate targeting, the 2015 and 2016 CBHFA volunteers’ figure isneitherproportionatetotherefugees’caseloadsnortotheSyrian/JordaniansratioproportionbyGovernorate.MafraqistheGovernoratethatisclearlyunderservedbytheCBHFAcoverage.

Whilstthelargestgroupsofconcernare,since2015,refugeeswhoareineligibletoreceivenewMoIcardsandrefugeeswhoareeligible,buthavenotyetobtainednewMoIcardsbecausethey lackthedocumentsnecessarytoreceiveacardthroughthenormalissuanceprocess,allIFRCinterventions(notonlyCBHFA)inJordanareaddressedtoregisteredSyrianrefugees.• Thefactthatthegovernmentalsoinstructedhumanitarianorganisations(throughtheMoPIC)to

serve only refugeeswith complete documentation (including “only” thosewith newMoI cards),makes it even more justified to try to reach and assist those categories, presumably that arealreadymoredeprivedandatahigherprotectionriskorriskingtofallintothose.

Effectiveness

Design choices and formulation weaknesses have enormously conditioned the interventions’possibility of being effective. The available information did not permit a clear picture on theintervention,aswellasofthequality-outputsofthedifferentcomponents.Whatcanbeconfirmedisthattoomanyeffortshavebeenexertedinincreasingtheproject’sgovernoratescoverage(thatisaclearhumanitarianpriority),aswellasCBHFAvolunteers’presenceandtrainingaccordingly.However,very little has been done to improve the quality (targeting and effectiveness), that makes anunbalancedcoverage-effectivenessintervention,thus,highlyinefficient.Non intended positive project’s effects have been identified in two main areas: (#1) the projectcontribution to “normalise” and reduce the gender gap at community level (when the CBHFAvolunteers’homevisits andactivitiesaredoneinMale/Femalepairs)and(#2)thedecisiontohaveboth Jordanian and Syrian nationals in the same pairs and teams, showed cohesion and a positivemodelofcoexistence,thatincertainareaswithhightensionsbetweenbothcommunities,couldhavehadafurtherpositiveimpactasapositivemodel.Thispairingofdifferentnationalsinthecommunitywork seemsalso tobequiteunique for theproject (if comparedwith theotherCHTForganisations’reportedworkingmodel:withlessJordaniannationals’participation).Themajor identified factors negatively affecting the CBHFA implementation are related to: (#1) theJNRCS’internalmanagementstructureandorganisationalculture,(#2)theinsufficientlydetailedIFRC-JNRCS partnership and (#3) the insufficient or non-existent link with other initiatives within the RCmovement:• the JNRCS implementation structuredoesnot resteasilywitha structure internallyorganised to

steer and implement the project’s goals and a clear line of operational decision-making in


accordancewiththeneedsandvolumeoftheCBHFAprogramme;• to be successful, each partner should bring capacities and resources to an inter-dependent

relationshipandtheaddedvalueofworking togethershouldbeclearandrecognised,creatingasense of joint investment and partnership. What seems to have happened is that the IFRC ispulling (activerole) withouthavingaclearmanagementrole,and JNRCS is justdrifting(passiverole)

• the coordination missed opportunities are more evident in the DRC PSP component, where areferralpathwayandprotocolwascreatedandagreedbetweenIFRC-JNRCSandDRCbutitseemsnot tohavebeenput inplace.Other initiativeswithin theRCmovementarenot linkedwith theCBHFAintervention.

Thereisapartnership(IFRC-JNRCS)risk,thatisnotsustainableandcouldstarthavingnegativeeffectsfortheimageofIFRCinparticular,relatedwith:• thecurrentvisibilityandexternalexposureof IFRC(includingtodonors), generatedprimarilyby

thedifferencebetweentheIFRCprojection-humanitarianprofileandthereal JNRCScapacitytodeliverafullyorientedhumanitarianresponseaccordingtominimumstandards(thatreliesontheJRNCSwillingnesstochangeandfollowadifferentwayofmanagement);

• thepoorCBHFAperformanceinrespondingtotheacuteneedsofthemostvulnerablepopulationsinproportiontotheirneeds;

• theIFRCinsufficientwillingnesstofollowandenforcethe“Fraudandcorruptionpreventionandcontrolpolicy”whenseriousallegationsofJNRCSabusive/coercivepowerwerereported.

EfficiencyEfficiencyin this type of programme is not just aboutminimising or reducingcosts but in balancingrelativecostswiththeneedsofthepeople,equitytargeting,coverageandeffectiveness.TheoverallEfficiencyofthisinterventionisconsideredlow,mostlyduetothenon-appropriatenessandthenon-adaptationofthechosenstrategytocopewiththemainhealthpopulationneeds.Efficiencygainswereachieved throughanewCBHFAVolunteers’ selectionandvalidationprocedurethatwasputinplacein2016:• Volunteers’recruitmentwas,forthefirsttime,alsoopenedoutsidethepreviousJNRCSentourage

(throughFacebook)tomoreapplicantsandtheprocesswasoperatedseparatelyfromtheYouthDepartment (fully byCBHFA). Thenewly created selection and validationproceduresdefinedbythe CBHFA project officers, have undoubtedly been decisive in the successful profiles thatwereeitherrecruitedorvalidatedin2016.

On the contrary, three main issues were identified as key in lowering the overall intervention’sefficiencyandsomeofthemalsoraiseethicalissues:• Different models of supervision – management were introduced for CBHFA management at

Branchlevel,that includedafulltimeHRallocationin2014-2015(onepergovernorate)thatwasreplaced in2016byvolunteers’ focalpoints (adecision thatwasnotbaseda cost-effectivenessandefficiencyanalysis).

• The drastic JNRCS unilateral decision to cut, from the 2016 project, volunteers incentives (thatwere entitled to cover transportation expenses) by half125, without any further analysis ordiscussion. The amount defined under the unilateral JNRCS decision is simply unethical ifconsidering: (#1)theminimumsalary inJordan, (#2)whatotherorganisationsfromCHTFpaytotheir volunteers andmost of all, (#3) if comparing themonthly incentives with theMinimum

125Thatweredefinedasamaximumof10JOD/day(maximummonthlyallocationof100JODpervolunteer)andwasreducedto5JOD/day(maximummonthlyallocationof40JODpervolunteer).


ExpenditureBasket(MEB)126andtheSurvivalMinimumExpenditureBasket(SMEB) inJordanandthe fact thatmany of the CBHFA volunteers are Syrian nationals (subjected to a dire economicsituationwhohavehardlyanyotherincome).

• The 2016 intervention focused in Raising awareness (Non-tangible focus) and increasing thenumber of CBHFA volunteers (by 100 percent), with the consequent effort and investment intraining,divertingattentionawayfromthepriorityneedsofthemostvulnerablepopulations.

• Capacity building efforts to the volunteers have beenmade almost exclusively through trainingthattookadisproportionateeffortandresources,whencapacitybuildinggoesbeyondtraining.

ConnectednessThealignmentwithcountrystrategiesandpriorities is, inthecurrentsituation,thebestapproachtoConnectedness.• It is confirmed that the community health and information approach as well as the CBHFA

approach, are(as reflected in the “Health Sector Humanitarian Response Strategy Jordan 2017-2018”), fully alignedwith the current national priorities. CHVs themselves, in that strategy, areentitled to be focal points for Information-Referrals, that opens aswell the pathway for furtherinvestmentinthatarea.

Conversely:• JNRCS Interest in Institutional Capacity Building and the development of long-term Youth

department/volunteers isnotcompatiblewiththeneedtomaintaina projectorientationof theCBHFA volunteers that would have to focus on being effective and efficient in the short term(projectorientation),

• The fact that there is a clear deficit and difficulties in the exchange-coordination between theJNRCSandtheMoHandthatJNRCSdoesnothaveahealthdepartment,areseriousobstaclestoconnectedness.

126 TheMinimum Expenditure Basket (MEB) is a way of establishing poverty lines for refugee populations, following thenotionofa“costofbasicneedsapproach”.Itistheexpressionofthemonthlycostpercapita,whichallowsaSyrianrefugeetoliveadignifiedlifeoutsidethecampsinJordan,whilsttheSMEBistheexpressionofthemonthlycostpercapitawhichistheminimumneededforphysicalsurvivalandimpliesthedeprivationofaseriesofrights.


7.RECOMMENDATIONSCBHFAprioritiesandfocus(Design-based)R1 (addressed to IFRC MENA–GLOBAL). CBHFA addressed to out-of camp IPDs or refugees inhumanitariansettings,shouldconsider,initsdesignandthroughoutthewholeimplementationperiod,thefollowingdesign-guidingelements:• the possibility to vary strategies according to the context/needs changes (adaptability). The

evolvingspecificvulnerabilitiesandprotectionneedsofthemostvulnerablerefugees,intheMENAregion (at least in Lebanon and Jordan) are highly dependent on the legal framework and thecontext evolution. In this context, CBHFA interventions should ensure that the design andimplementationofactivitiesaimsatreducingandmitigatingprotectionrisks;

• that addressing out-of camp refugees or IDPs interventions (growing global trend) needs adifferent approach than the work with host-fixed population in rural environments (traditionalCBHFAscenario),whereusuallytheirneedsarestructural/linkedtopoverty;

• the need to signmore detailed IFRC-National Society partnerships’ agreements, clearly statingminimumcommitmentsandmilestonesfromtheRCNationalSocietytobeaccomplished.

R2 (addressed to IFRC-JNRCS). In the 2017 Jordancontext,a relevantCBHFAdesignrequiresahighlevelofflexibilityandsomedegreeof“outofthebox”thinking(thatotherCHTForganisationsalreadyimplemented)foradaptationto:• thespecifichealthrelatedandprotectiongapsofthemostvulnerablenon-camprefugees;• thenotoriousGovernoratesanddistrictsdifferencesinrefugees’caseloadsandfreeservicesoffer

availableforSyrianrefugees(includinghealthcare).That demands the setting up of an effective referral system, either complementary or outside theinitially available free of charge public health systemand looking beyond the traditional communitymapping,expandingthereferralstowhateverreliablepartnerwithinthedistrict,Governorateorevennationallevel.R3(addressedtoIFRC-JNRCS).Forthenextphase,themainfocusofanyhumanitarianinterventioninthecurrent Jordancontext, shouldbe, fromaprincipledhumanitarianactionperspective,onoutofcamp refugees, out of which, themost vulnerable categories should be targeted in priority. CBHFAshouldclearlyrefocusonthemostvulnerableandconsequently,tofollowthe“Onerefugeeapproach”recommendation (R4) should prioritise, for geographic intervention, the areas where the mostvulnerableareliving:• Given the acuteness of themost vulnerable refugees’ needs, diverting humanitarian resources

from refugees in dire need to target Jordanian hosts affected by poverty/structural needs (thathavededicated social programmes),wouldonlymakepartial sense froma cohesionperspectiveandfora limitednumberofactivities. Inthatsense, itwouldbecoherent, tobe incoherent (notaligned) with the Government of Jordan’s policies, that places IFRC-JNRCS, due to its differentstatus, in an unique position (if compared with the rest of iNGOs) to implement a principledhumanitariantargeting.

R4 (addressedto IFRC-JNRCS).Prioritygroupswithinthetargetpopulation for thenextphaseshouldbe:• RefugeesofanynationalityincludedintheUNHCRregisteredPopulationsofconcern:

" Having more problems for any household member’s civil-legal and/or identity-recognition(renewalofasylumcertificate,difficultiestohaveall the legaldocumentsforMoInewcard),livinginaunsafeenvironment,etc.


" Familywithamemberwithdisabilities/estimatedataminimumofeightpercentofrefugeesinJordanhavingasignificantinjuryofwhich90%wereconflict-related)127.

" Familieswithoutofschoolchildrenatprimaryschoolageand/offamilieswithyoungchildren:thatcannotbeenrolled/followsecondaryeducation.

" Femaleheadedhouseholdswithchildren," Familieswithbedriddenand/ormentalhealthdisorders’members." households with children born from teenager couples and early marriage (a crime under

Jordanlaw).• RefugeesofanynationalitynotincludedintheUNHCRregisteredPopulationofconcernand/ornot

eligible forMoI registration/renewal for different reasons (including lacking civil documentation,left the camps without Baillout, entered ilegally, etc.)128. Under this category, the need tointerveneaswellwithothernon-Syrianrefugees clearlyemerges,duetotheir reduced levelsofassistance and access to subsidised services and evenmore bureaucratic hurdles encounteredthan Syrians and that couldbeexposed to similaror evenworst conditions than someof theSyrianrefugees.

TheIFRC-JNRCSpartnershipR5(addressedtoIFRC).Consideringtheforeseenevolutionoftherefugees’crisisinJordan,thespacefor a principled humanitarian emergency-type response gains relevance but at the same time, afeasibilitycross-checkneedstobecarriedoutbythe IFRC.Notall relevant interventionsare feasible(for either external or internal factors or a combination of both) and in this case, themain limitingfeasibilityfactortobecross-checkedisthecapacityandthewillingnessoftheimplementingpartner(JNRCS) to commit to the needed institutional changes requested to be both: aligned with thehumanitarianprioritiesofthemostvulnerablerefugees’populationandeffectiveinthenewdesign’simplementation.• It isalso important toclarifywhy IFRCwants to remainpresent in Jordanandwhatneeds tobe

achieved (operational side)within a timeline, featuring clearmilestones for the continuationofthemission,itsdownsizeortermination.Otherwise,theinertiaofthedailyactivitiesandtheneedtosurmountadministrativeandbureaucraticJNRCSbarriersenablesCBHFAstafftonotprioritisethebasicinordertoperformwhat’surgent.

• TheclearestspacetomaximisethepotentialaddedvalueforaCBHFAIFRC-JNRCsinterventionisthe branches’ theoretical outreach coverage potential, but as it is not feasible to carry outOrganization Development activities and achieve minimum standards whilst delivering effectiveprojectsinahumanitariancrisis,aparallelIFRCsetup(similarastheGRC-JNRCSinIrbid)shouldbeconsideredfor implementationatboth:GovernoratesandHeadQuarters’ level (seeR8formoredetails).ThissetupcouldbeinplaceatleastuntillJNRCS’minimumconditions129tobeconsideredareliablehumanitarianpartneraremet).

ImplementationfocusR6 (addressedtoIFRC–JNRCS).ToIncreaseemphasisontargetingthemostvulnerableandeasetheiraccesstokeyservices,itwillbeneededtomapvulnerabilityzonesandgroupsandeasetheiraccesstokeycomponents,reconsideringthesizeoftheprojectandthecurrentnumberofCBHFAvolunteers.Itwill also be needed to better plan, and assignmeans to follow and track coverage (including clearpopulation’s estimates and mapping, making use of IT means) for a better M&E, follow up and

127 “Hidden victims of the Syrian crisis: disabled, injured and older refugees”, HelpAge International and HandicapInternational,2014.128ECHOestimatesaminimumfigureofaround100,000Syriansrefugeesinthissituation.129Includinguntiltheinvestigationontheabuseofpowerallegations’issatisfactorilyclosed.


georeferencing for CBHFACHVs130. It is also suggested to explore the possibilities of an agreementwithIRD,thatdevelopedanimpressivereferrals’mappingsystemandadaptedPDAtools.R7. (addressed to IFRC-JNRCS). CBHFA should be organised, having one Field Coordinator perGovernorate(sameasGRC-JNRCSinIrbid),reportingtooneanduniqueCBHFAIFRC-JNRCScoordinatorinAmman.ThoseprofilesshouldbeselectedfollowingthebestpracticesidentifiedintheEfficiencyconclusions(efficiencygainswereachievedthroughanewCBHFAVolunteers’selectionandvalidationprocedure thatwasput inplace in2016) and to theextentpossible, shouldbe refugees. Each FieldCoordinator per Governorate will be responsible for two different mobile teams for thedistrict/subdistrict to reach more vulnerable subareas131/population (rotating and moving to otherareaswhentargetsarereached).R7.I. Public health and information campaigning CBHFA teams to facilitate the entry point for thelinkingofhealthandcivildocumentationreferralswithprioritypopulation(activitytobedeliveredbymixedSyrianandJordanianCBHFAvolunteerstogether132:minimumof30hoursamonthperareaofcoverage,withincentivespaidaccordingtoMEBoratleasthalfoftheminimummonthlysalary).• Ingroupgatherings–campaigns,itissuggestedtodeliver:

" TheFirstAidGRC-JNRCSIrbid’smodelafterarevisionofthemoduleandcontent.ICRCcouldfacilitateanewTrainingofTrainers(ToT)FirstAidtrainingthatwouldallowtohaveatleast3formedtrainersatGovernorateslevel. Theobjectivesandpopulationinvitedtoassistshouldbethesubjectoffurtherresearch,benchmarkingwithcurrentGRCactivities.

" Behaviour change and raising awareness (Health and basic civil documentation messages)through interactivemethodologies such as role playing, recreational activities, small quizzesandgames…)about:- a very reduced number of health messages that should be adapted to the morbidity

profile of under 5s to achieve impact and should be delivered through interactivedemonstrations in public institutions (schools, mosques, health centres…) and also bedelivered in public places where out of school refugees’ children and youth could begathering;

- basiccivildocumentationmessages,concentratingonInformationabouttheimportanceofBirth and Marriage Certificates and direct referral for free Counselling and free legalrepresentation (if necessary). See Annex VI, Diagrams of the Birth and Marriagecertificates’process.

R7.II.OutreachdistrictreferralteamsforIdentificationofthemostvulnerablerefugees(activitytobedelivered preferably onlyby refugees133’ CBHFAvolunteers, organisedbypairs thatwould includehome visits for identification of the most vulnerable households referrals’ needs and follow up,following/adapting the IRD CHVsmodel and performance targets. Incentives should be ofminimummonthly salary or directly equivalent to those of IRD134). Prioritywill be to ensure short-term acuteneedsofrefugeesaremet:equitableaccess,uptakeandqualitycomprehensivehealthcareofprimaryandsecondaryhealthcarehealthcare.• Key referrals (health,disabilitiesassistanceand legal) shouldbesecured inbilateralpartnerships

withhealth, legal andorganisationsworkingwith refugees’ disabilities for free (regardless theirstatus): suchasMSF,NRCandHandicap International.Cash forhealth through theECHO iNGO’sconsortium.

130All theCHVs thatparticipated in theevaluationdiscussionshaveWhatsApp, themajorityFacebookandsuggestedthattheywouldratherprefertousetabletsthanpaperforreporting-M&Epurposes.131ThataccordingtotheCBHFAvolunteersinterviewed,canbesometimeslocatedintheoutskirtsortheirinitiallyassignedneighborhoods.132Tomaximizethecohesionperceptionbetweenbothcommunities.133 If the outreach targeting are the most vulnerable refugees (mostly Syrians with difficulties to cope with legalrequirements),itwillbeeasiertogetaccessandtrustthroughrefugeesofthesamenationality(commonpracticeinthistypeofapproaches).134Higherthantheminimumsalary.


R8(addressedtoIFRC-JNRCS):GoodpracticefromotherCHTForganisationscouldbeapplied,suchas:• PretestandposttestforvolunteersandToTstrainersbeforegoingtothefield(theyneedtopass

aminimuminthetests)andretestthemonregularbasis(performancegrid).• AvoidingCHVsrelatedtoeachotherinthesamegovernorate,asaruletoreducecheating.• Useofportabledeviceswithgeoreferenceforoutreachreferralteamsandfollow-upvisits.• CHVs goals defined per month for outreach referral teams on precise targets per month per

volunteer and related to the most vulnerable profiles: number of visits, number of referrals,numberoffollowupreferrals,etc.

AnnexestotheEndofProjectEvaluationforJordanNationalRed

CrescentSociety(JNRCS)CommunityBasedHealthandFirstAid(CBHFA)andPsychosocialSupport

projectinJordan

ANNEXI:TermsofReference

ANNEXI-Termsofreference

EndofProjectEvaluationforJordanRedCrescentSociety(JRCS)CommunityBasedHealthandFirstAidandPsychosocialSupportprojectinJordan

Summary

Purpose:ThepurposeofthisevaluationistoaccountforJRCSsupportprovidedtoSyrianrefugeeslivinginhostcommunitiesandtovulnerableJordanians.Thisevaluationwillbeconductedtodocumentthegoodpractices,challengesandlessonslearnedthatwillbeusefulintheimprovementoffutureprojectimplementation.

AsforCBHFAprojectinJordan,thisisthethirdyearofimplementationanditisimportanttoreviewthepastthreeyears’activities.CBHFAintheMiddleEastcontext,bothaconflictsettingandaprotractedcrisis,canbecontributingagoodshowcasefortheglobalCBHFA.

Audience:Theresultsof theevaluationwillbeusedtoreportbacktotheGovernmentof Japanontheachievementsoftheproject,theevaluationwillbeusedbyJRCS,IFRC,PartnerNationalSocieties(PNS)inJordan

Commissioners:ThiswillbeanexternalevaluationcommissionedbytheJapaneseGovernmentthroughIFRC.

Durationoftheevaluation:Thewholeevaluationprocesswilltake4weeks,including1dayforbriefing,12daysoffieldwork,1dayfordebriefingand7daysforwritingthereport.

Timeframe:February2017

Location:FieldvisitswillbecarriedoutintheGovernoratesofAmman,Jerash,Ajloun,Mafraq,BalqaandMadaba.

---------------------------------------------------------------------------------------------------------------------1.BackgroundJRCS’ CBHFAprojectwas initiated in 2014with support of the JapaneseGovernment. TheProject titled‘Enabling healthy and safe living in families affected by the Syrian crisis in Jordan’ is implemented byJordan Red Crescent Society (JRCS) with technical support from IFRC and funding support from theGovernment of Japanese. Between February and November, 2014, activities were implemented in thegovernorates of Irbid, Mafraq, Jerash, Ajloun and Amman and targeted 6,000 beneficiaries in 20communities.Since then,over300volunteershavebeen trained invarioushealth topics includingnon-communicablediseases,firstaid,commonillnessesandviolenceprevention.Throughtheiractivitiesthevolunteers,havereachedover102,000beneficiarieswithhealthinformationduringthethreeyears.

Theoverallgoaloftheprojectis“Improvedwellbeing,resilienceandpeacefulco-existenceamong(22,000)vulnerableSyrianrefugeeandhostcommunitiesinJordan.”Federation’s communityhealthpromotion approach, CommunityHealth and FirstAid in action (CBHFA)wasintroducedforthefirsttimeinJordanRedCrescent.CBHFAapproachseekstocreatehealthy,resilientcommunitiesworldwide.CBHFAcomprisesacomprehensiveapproachtoprimaryhealthcare,first-aidandhealth preparedness at community level. It mobilizes communities and volunteers to use simple tools,adaptedtolocalcontexttoaddressthepriorityhealthneedsofacommunityandtoempowerthemtobeinchargeoftheirowndevelopmentandhealthoutcomes.SpecificobjectivesoftheCBHFAprogramme:

Outcome1:RefugeesfromSyriaandhostcommunitiesaremoreself-reliantandresilienttodiseases,disastersandlocalconflicts

Outcome 2: The protective environment of themost vulnerable refugees from Syria andmembers of the host communities (women, men, boys and girls) is enhanced and theirpsychologicaldistressisminimized

Outcome3:JRCShavestrengthenedtheircapacityandenhancedtheirabilitytoreachouttomostvulnerablegroupswithintherefugeeandhostcommunities

2.Evaluationpurposeandscope

1. Review the effectiveness, efficiency, relevance, impact and sustainability of the project byreviewing the outputs achieved in relation to inputs provided, and the outcomes achieved as aresultofprojectoutputsdeliveredtodate.

2. Analysis of strengths and challenges of the CBHFA project in the context of Jordan, from theCommunity Health Volunteers (CHVs), Focal persons(FP), trainer and branch manager points ofview

3. Documentationof lessons learnedandproviderecommendations for further improvement in thedesign, delivery, quality and resourcing of the project to increase effectiveness, efficiency,relevanceorimpact.

ScopeThisevaluationwillcoverJRCSCBHFAprogrammeimplementationsupportedthroughIFRCsince2014,inthe 6Governorates of Amman, Jerash, Ajloun,Mafraq, Balqa andMadaba). In addition, this evaluationshouldexaminethelevelofgenderanddiversitymainstreamingi.e.howissuesspecifictogroupsofmenandwomen of different age and social backgrounds should be taken into account in future, to ensureproperneedsassessmentandimprovedeffectiveness.

RecommendationsaddressedtoJRCS, IFRCcountryofficeJordan,MENA,GVAshouldbealso included intheevaluationreportandassesstheinterventionfromahistoricperspectiveforthelastthreeyears.

EvaluationcriteriaandspecificevaluationquestionsThisevaluationwillfocusonsixofthesevenevaluationcriteriaaswellasoncoordination,accountabilityandlessonslearning.

1. Relevance&AppropriatenessThe extent to which the operation's activities have been suited to the priorities of the target community. Theconsultantisexpectedtoconsiderthefollowingquestionsinmeasuringrelevance/appropriateness:

• Towhatextentaretheobjectivesofthisprogrammestillvalid?• Howrelevantistheprojectregardingthebeneficiaryrequirements,localcontextandneeds,suchasreferral

system?• IstheCBHFAprogrammealignedtotheJordancountryhealthstrategy,plans?• How does the project compliment intervention of other actors, including relevant Government

departments?• Howsatisfiedwiththeprojectaretheprojectbeneficiaries?• Whatisthestakeholders’viewpointrelatedtotheperformanceoftheproject?• Whatarethemainissuesraisedregardingsatisfactionwiththeproject?• Howwellwerethetargetgroupsidentified?• HowsatisfiedisJRCS–includinglocalbranches–withtheproject?• What are the main issues raised regarding satisfaction with the project e.g. support received

communication,howtoimprove?• WasthepartnershipmodelofIFRCwithJRCSsufficientlydetailedandimplemented?2. Coverage

Theextenttowhichtheoperationwasabletoreachthepopulations/areasaffected;howthecriteriaforreachingthemwereidentified/implemented:Thustheconsultantwillbeguidedbutnotlimitedbythefollowingquestioninmeasuringcoverage:

• Towhatextentwerethemostvulnerableidentifiedandsupportedbythisoperation• Towhatextentwerethereinclusionandexclusionerrors3. Effectiveness

Towhatextentaretheinterventionslikelytoachieveitsintendedresults?Theconsultantisexpectedtoconsiderthefollowingquestionsinmeasuringeffectiveness.

• Towhatextenthavetheprogramobjectivesbeenachieved?• Whatwerethemajorfactorsinfluencingtheachievementornon-achievementoftheseobjectives?• Aretheactivitiesandoutputsoftheprogrammeconsistentwiththeoverallgoalandtheattainmentof its

objectives?• Werethesupervisionandmanagementmechanismsonalllevelssufficientinrelationtoprojectneedsand

expectations?• Werestandardsofqualitydefinedanddidtheactivitiesachievehighlevelsofqualityinimplementation?• HoweffectivehascollaborationwithMinistryofHealthandotheractorsbeen?

4. Efficiency

Theuseoftimeandresources:! Howwellweretheinputs(funds,people,materialsandtime)usedtoproduceresults?! Hasthescaleofbenefitsbeenconsistentwiththecost?Cost-efficiency:(a)Towhatextenthasthefunding

been utilized to directly assist beneficiaries (b) Have the project support and operational costs beenreasonable(%)comparedtoentirebudgetandbeneficiaryassistance?

! Howwell isCBHFA integratedwithother JRCSprogrammessuchasCTP,PSP,YouthandLivelihoods.Howcanintegrationbeimprovedinthefuture?

! Wastheprojectimplementedinthemostefficientwaycomparedtoalternatives?

5. ImpactofinterventionThese are positive and negative changes produced by the intervention, directly or indirectly, intended orunintended. This involves the main impacts and effects resulting from activities on local social, economic,environmental and other development indicators. Examination should be concerned with both intended andunintendedresultsandmustalsoincludethepositiveandnegativeimpactofexternalfactors.Theconsultantisexpectedtoconsiderthefollowingquestionsinmeasuringimpact:

• Hastherebeenanyunforeseenorindirectpositiveornegativeimpact(tothecommunities,volunteers,NS)?• Didtheprojectaddresstheneedsofallintendedbeneficiariesinaconsistentmannerasperprojectdesign?

• Didtheprojectachieveitsintendedimpact?• Whatrealdifferencehastheprogrammemadetothebeneficiaries?• Whatifanyweretheunintendedpositiveornegativechangesinthelivesoftheaffectedpopulations.• Has CBHFA interventions contributed to behaviour change in targeted communities, and/or among

individuals??

6. Sustainability• Istheresufficientcommunityownershipregardingtheproject?• Whatarethemainfactors,eitherpositivelyornegativelyaffectingthesustainabilityofprojectoutcomes?• Do lessons fromthe implementationof thisproject indicateanychanges indesign inthefuturetoensure

bettersustainability?

7. AccountabilityTheIFRCisboundbyenablingaction3ofstrategy2020tocommittoacultureoftransparentaccountabilitytoourstakeholders. Thus the consultant will be guided but not limited by the following question in measuring ouraccountability:

• Towhatextentwerebeneficiariesinvolvedintheplanning,designandimplementationoftheproject/?

8. CoordinationOneoftheimportantrolesoftheIFRCsecretariatistocoordinatetheactivitiesofRedCrossRedCrescentpartners.In order tomeasure if this rolewas fully satisfied the consultantwill be guided but not limited by the followingquestions:

• Towhatextentwasthisrolebeenfulfilledandwasitadequateandconstructive• Howadequatewasthecoordinationwithnon-RedCrossRedCrescentactors,i.e.clusters,intermsofboth

theinformationcontributedandtheinformationreceivedthroughtheavailablemechanisms?• Howadequatewas the coordinationwithin theRCRCMovement?Howwellwas the action connected to

othersimilarprogramsimplementedbyJRCSwithPNSsupport?• Whatcanwelearnfromthisexperience?

9. Lessonslearnt

Theconsultantshouldconsiderthefollowingareastomeasurewhethertheissueslistedwereeffectiveanddiscusswhatworkedwell,whatdidn’tworkwell,andwhatcouldbedonetoimproveinthefuture.

• Howwaseachtrainingmodule/toolsselected?Howweretoolsutilizedbythevolunteers?• Towhatextentwasthealignment/linkagesofCBHFAwithotherprojects(e.gPSP,YouthandCTP)done?• Wererecommendationsfrompreviousevaluationreportsadoptedandimplemented?• Howaccuratewasthedatacollectionfortheproject(thiswouldallowyoutoexploreissuesarounddigital

datacollection,etc)3.EvaluationMethodology1.Documentanalysis/review:

" Datasources• All project related documentation such as the project proposal / plans, budgets,financialandnarrativereports,guidancedocuments,photographyetc.)

• Pastevaluationreports• Monitoringformatsandevaluationreports• IECandBCCmaterialsdevelopedbytheproject

" Referencedocuments• CBHFAmodulesusedbyvolunteers• CBHFAPMERtoolkit

2. CommunityEvaluation

a) Baseline versus end line data to assess changes in knowledge, attitude and possibly inpractices(KAP)(randomselectionandstructuredinterviews)

b) FocusGroupsDiscussionsandquestionnaires• CBHFA: with key community groups who were met with during the project time

frame e.g. refugee groups, men/women/youth/other groups, health committees,CBOs,healthfacilities,schools(studentsandteachers)etc

• Community leaders/key persons who have been involved or linked/aware of theprojecttoseetheimpactoftheproject

• Casestudiesofcertainindividuals/households

c) Volunteer/TrainerandCBHFAStaffEvaluation• Project wrap up workshops before the evaluation starts for all branches and for

HQ/IFRCaswellifpeoplearewillingtobeinvolved

Evaluationwillbecarriedoutbyanexternalconsultantassistedbya locallycontractedconsultant.TheexternalConsultantwillbehiredfollowingIFRCstandardprocedureforrecruitmentofConsultants.

ThelocalConsultantwillbehiredthroughatransparentrecruitmentprocessandidentifiedbyprofessionalexperienceandcompetencies.TheevaluationwillbecarriedoutwithsupportfromJRCS/IFRCregional/incountry staff who will assist in the evaluation process. All findings should be evidence based andmethodologyusedexplainedinthefinalevaluationreport.

4.Deliverables

1. Evaluationoftheprojecta. Inceptionreportandinterviewguideforqualitativedatacollectionb. Draftreportandpresentationc. Afinalevaluationreport

Thefinalreportshouldfollowthefollowingstructureandaddress(butnotlimited)tothefollowing:1.Executivesummary2.Abbreviations/acronyms3.Introduction4.Reviewaimsandobjectives5.Methodology6.Impactonbeneficiaries7.Recommendations8.Overallanalysisandlessonslearnt9.Conclusion10.Appendices

5.ProposedTimelineTentatively1stofFebruarytoEndFebruaryTBC–(Maximum4weeks).Thewholeevaluationprocesswilltake4weeks,including1dayforbriefing,12daysfieldwork,1daydebriefingand7dayswritingthereport6.EvaluationQualityandEthicalStandards

The evaluation team should take all reasonable steps to ensure that the evaluation is designed andconductedtorespectandprotecttherightsandwelfareofpeopleandthecommunitiesofwhichtheyaremembers,andtoensurethattheevaluationistechnicallyaccurate,reliable,andlegitimate,conductedinatransparent and impartial manner, and contributes to organizational learning and accountability.Therefore,theevaluationteamshouldadheretotheevaluationstandardsoftheIFRC.7.ConfidentialityAll collected survey information will be strictly confidential. No names of survey respondents can bementionedinanydocument.8.DataownershipAllcollecteddataandinformationrelatedtothissurveywillbecomethepropertyofIFRC.9.TheIFRCEvaluationStandardsare:

1.Utility:Evaluationsmustbeusefulandused.2. Feasibility: Evaluations must be realistic, diplomatic, and managed in a sensible, cost effective

manner.

3.EthicsandLegality: Evaluationsmustbeconducted inanethicaland legalmanner,withparticularregardforthewelfareofthoseinvolvedinandaffectedbytheevaluation.

4. Impartiality and Independence; Evaluations should be impartial, providing a comprehensive andunbiasedassessmentthattakesintoaccounttheviewsofallstakeholders.

5.Transparency:Evaluationactivitiesshouldreflectanattitudeofopennessandtransparency.

6.Accuracy:Evaluationsshouldbetechnicalaccurate,providingsufficient informationaboutthedatacollection,analysis,andinterpretationmethodssothatitsworthormeritcanbedetermined.

7.Participation:Stakeholdersshouldbeconsultedandmeaningfullyinvolvedintheevaluationprocesswhenfeasibleandappropriate.

8.Collaboration:Collaborationbetweenkeyoperatingpartnersintheevaluationprocess

Annex1Responsibilitiesoftheprimaryevaluator

- Prepareinceptionreportandinterviewguide- Preparesurveyquestionnaire- LeadtheFGD- Draftreportandpresentation- Afinalevaluationreport

Qualificationsoftheprimaryevaluator

- ExperienceofworkinginMonitoringandEvaluation–required- ExperienceofworkingfortheRedCross/RedCrescent–preferred- Academicbackgroundandpracticalexperienceinpublichealth–preferred- FluentlyspokenofArabic–required

Annex3TheexpectedOutcome/Activities/IndicatorsoftheprojectOutcome 1: Refugees from Syria and host communities aremore self-reliant and resilient to diseases,disastersandlocalconflicts

" Activity1:CoordinationwithMinistryofHealth,localauthoritiesandhumanitarianactors" Activity2:Disseminationofhealthinformationatcommunityevents,inschools,duringhousehold

visits and with established community groups and community based organisations throughactivitiesandprintedmaterials

" Activity3:Promotionofhealthy lifestylesandgoodnutrition, including inschoolsandwithyouthgroupsadaptingIFRC’sinitiative“YouthasAgentsofBehaviouralChange(YABC)“

" Activity4:Homevisitstopre-natalandpost-partummotherstoeducateandsupportthemothersinhealthypregnancies,exclusivebreastfeedingpractices,torecognisethedangersignsinanew-bornandtopromoteimmunisations

" Activity 5: Promotion of routine immunisations for targeted children to participate in NationalImmunisationDays

" Activity 6: Building the capacity of communities to reduce the risks and impact of emergenciesthroughdisseminationofaccidentpreventionmessagesandbasicfirstaidskills

" Activity7:Raisingawarenesswithcommunitiesaboutviolencepreventionandenlistingthesupportofmenandboystopromoteacultureofnon-violenceandpeace

" Activity 8: Promotion of child protection with joint training and activities of the CBHFA teams,enforcedbytheestablishmentofreferralmechanisms

" Activity 9: Establishment of referral pathways and communications to improve beneficiaries'accesstohealthcareservices

IndicatorsforOutcome1:

• Numberofpeoplereachedbyhealthawarenessactivitiesthroughhomevisits,communitymeetingsandcampaigns,disaggregatedbynationality,sexandbyagegroup

• %ofhomevisitsconductedtopregnantandlactatingwomenwherebywomensaidtheybreastfedexclusivelyforthefirst6months

• Numberofpeoplereachedwithfirstaidinformation,disaggregatedbynationality,sexandbyagegroupwherepossible

Outcome2:TheprotectiveenvironmentofthemostvulnerablerefugeesfromSyriaandmembersofthehostcommunities(women,men,boysandgirls)isenhancedandtheirpsychologicaldistressisminimized

" Activity1:Organiserecreationalactivitiesforchildren(cornersincludinghomeworkclubs)" Activity2:Organiseguidedworkshops/resilienceworkshopsforchildren." Activity3:Organiseresilienceworkshopsforcaregiversandadults" Activity4:Conductlecturesandpsycho-educationalsessionsformaleandfemalecaregivers" Activity5:Conducthomevisitswhenrequired" Activity6:Organizefamilytrips,festivedaysandcommunityworkshops,summercamps


• Numberofpeoplewhoparticipatedinpsychosocialguidedworkshopsandresilienceactivities,disaggregatedbynationality,sex,agegroupandtypeofactivity

• %ofindividualswhoparticipatedintheprogrammewhoreportanincreasedfeelingofsafetyorabilitytohandlestressandcrisis.

• #ofwomen,men,girlsandboysfromdifferentactivitygroupswhohaveparticipatedinjointsocialcohesionandcommunityactivitiesthathavebeenidentifiedasconnectingfactorsforsocialcohesion.

• CommunitymembersincludingJRCvolunteers(disaggregatedbyage,sexandnationality)thatexpressanincreasedrespectandappreciationfordiversityandtrustindifferentcommunities

Outcome 3: JRCS have strengthened their capacity and enhanced their ability to reach out to mostvulnerablegroupswithintherefugeeandhostcommunities

" Activity1:Identificationandrecruitmentofnewvolunteers" Activity 2: Conduct induction course for all new volunteers to introduce the Red Cross and Red

Crescent(RCRC)Movementandtoenablevolunteerstoconducttheirvolunteerworkaccordingtothehumanitarianprinciplesandvalues.

" Activity3:Conduct relevantCBHFAtechnical trainings fornewstaffandvolunteersandrefreshertrainingsforexistingones.

" Activity 3: Provide the necessary tools to volunteers to enable them implement risk reductionactivitiesinthecommunity

" Activity4:Providesupportivesupervisionofcommunityhealthvolunteers" Activity5:Monitoringandevaluatingofthecommunityhealthactivities


• Number of trainings facilitated by newly trained CBHFA facilitatorswhowere trained in trainingskillsin2016

• Number of community health volunteers trained in CBHFA and relevant health topics,disaggregatedbysex,nationalityandtrainingtopic

ANNEXII: JHAS/UNHCRHospitals

ANNEXII–JHAS/UNHCRHospitalsJHAS/UNHCRsystemistheonlyreferralsystemforsecondaryhealthcarefortheSyrianrefugees in Jordan. It comprises a central referral hub and an affiliated network ofhospitals(sourceUNHCR):

UNHCRwillbeabletocoverthecostoftreatmentforpatientsthroughJHASclinicsif:

- Patient cannot afford to pay for the treatment at PHCs and governmentalhospitals(thecasehavebeenevaluatedasavulnerablecase).-Patientcannotgetasubsidizedprice for thetreatmentneededatPHCsandgovernmentalhospitals(holdinvalidUNHCRcertificateorinvalidsecuritycard).

ANNEXIII: List of Consulted

Documents-Bibliography

Annex III - List of consulted documents / bibliography InternalIFRC-JNRCS-GRCDocumentsrelatedtotheintervention∗ Different internal reports,databases, planningandmanagementdocuments for theCBHFA

projects(IFRC-JNRCS-GRC)andIFRCoperationsinJordan(2014-2017)∗ “CBHFAInternalEvaluationReportJordan”,December2014∗ “Evaluation Report of the Community Based Health and First Aid (CBHFA) project in the

Governorates of Jarash, Ajloun, Amman, Madaba and Mafraq”, Prof. Sami Khasawnih, 30December2015

∗ “Evaluation Report of the Psychosocial Support Programme (PSP)”, Dr. Dirar Assal, 30December,2015

IFRCPolicies∗ “IFRCFirstAidPolicy”,2007∗ “IFRCHealthPolicy”,2005∗ “IFRCVolunteeringPolicy”,2011∗ “PlanningMonitoringEvaluationandReporting(PMER)ToolkitforCBHFA”,2013∗ “ImplementationguideforCBHFA”,2009∗ “Maternal,newbornandchildhealthframework”,2013∗ “Strategy2020”,2010∗ “Project/programmeplanning,Guidancemanual”,2010DocumentsrelatedtothecontextHealthrelated∗ “Joint Rapid Health Facility Capacity and Utilization Assessment (JRHFCUA)”, Ministry of

Health of the Hashemite Kingdom of Jordan, with support from the World HealthOrganization, the International Advisory, Products and Systems, theMassachusettsGeneralHospital Center forGlobalHealth,HarvardUniversity and the JordanUniversity for ScienceandTechnology,January2014

∗ “Population-Based Health Access Assessment for Syrian Refugees in Non-Camp Settingsthroughout Jordan”,UNHCR, InternationalMedicalCorps,UNFPA survey.November2013–March2014.

∗ “Assessment of Mental Health and Psychosocial Support Needs of Displaced Syrians inJordan”, World Health Organization and International Medical CorpsIn collaboration withtheJordanianMinistryofHealthandEasternMediterraneanPublicHealthNetwork,2013

∗ “Access to Health Care and Tensions in Jordanian Communities Hosting Syrian Refugees,ThematicAssessmentReport”,ReachInitiative,June2014

∗ “MentalHealthPsychosocialandChildProtection forSyrianAdolescentRefugees in Jordan”,UNICEFandIMC,December2014

∗ “UrbanRefugeesinAmman:MainstreamingofHealthCare”,ISIM,2012∗ “Health SectorHumanitarianResponseStrategy: Jordan2014-2015”,Health SectorWorking

Group.UpdatedMay2015.∗ “HealthcareAccessforSyrianRefugeesLackingLegalDocumentationinJordan”,SITGraduate

Institute,2016∗ “SyrianRefugeeHealthAccessSurveyinJordan”,UNHCR,JohnsHopkinsBloombergSchoolof

PublicHealth,JordanUniversityofScience&TechnologyandWHO,December2014∗ “Health Access and Utilization survey among non-camp refugees in Jordan”, UNHCR, May

2015∗ “Health Access and Utilization survey – Access to Health Services in Jordan among Syrian

refugees”,UNHCR(byNielsen),December2016∗ “AnalysingequityinhealthutilizationandexpenditureinJordanwithfocusonMaternaland

ChildHealthServices”,UNICEFandTheHashemiteKingdomofJordanHighHealthCouncil,August2016

Non-healthrelated∗ “Hidden victims of the Syrian crisis: disabled, injured and older refugees”, HelpAge

InternationalandHandicapInternational,2014∗ “StrategicProgrammeDocument”,DanishRefugeeCouncilinJordan,2014∗ “JordanVulnerabilityAssessmentFramework,KeyFindings”,June2015∗ “JordanResponsePlanfortheSyriacrisis–ExecutiveSummary”,JRP,2015∗ “Comprehensive Vulnerability Assessment”, Hashemite Kingdom of Jordan, Ministry of

PlanningandInternationalCooperation,publishedin2016with2015data.∗ “TheJordanResponsePlanfortheSyriacrisis2017-2019(Draft)”,JRP,updatedJanuary16th

2017∗ “FiveYearsintoExile”,Care,June2015∗ “RunningonEmpty,ThesituationofSyrianchildreninhostcommunities inJordan”,UNICEF,

May2016∗ “SecuringStatus:Syrianrefugeesandthedocumentationoflegalstatus,identity,andfamily

relationshipsinJordan”,NRC,November2016.∗ “Understanding statelessness in the Syria refugee context”, Institute on Statelessness and

InclusionandNRC,2016∗ “Livingonthemargins”,AmnestyInternational,April2016∗ “HumanitarianImplementationPlan(HIPSyriaRegionalCrisis)Version2”,ECHO,March2016∗ “Community Consultations on Humanitarian Aid, Findings from Consultations within Syrian

andamongSyrianrefugeesinJordan”,WorldHumanitarianSummitIstambul,May2016∗ “Amappingof social protectionandhumanitarianassistanceprogrammes in Jordan.What

support are refugees eligible for?”, Working Paper 501 - ODI and Maastricht University,January2017

Others∗ “Cash transfers for refugees, an opportunity to bridge the gap between humanitarian

assistanceandsocialprotection”,ODIBriefing,January2017∗ “WhatPracticesareused to identifyandprioritizevulnerablepopulationsaffectedbyurban

humanitarianemergencies?”,HumanitarianEvidenceProgramme,January2017∗ “EvaluationofHumanitarianActionGuide”,OverseasDevelopment InstituteLondon,March

2013∗ “The Sphere Project, Humanitarian Charter and Minimum Standards in Humanitarian

Response”,Sphere,2011edition∗ JordanRefugeeresponse,Inter-agencycoordinationbriefingkit,ISWG,May2016∗ Jordanpopulationandhousing2015Census,UNICEF1,2015∗ Inter-agencyInformationSharingPortalSyria,RegionalRefugeeResponse∗ UNHCRStatisticsRefugeesinJordan∗ WhoisWorkingWhere(CHTF),2015and2017∗ MinimumExpenditureBasketandSurvivalMinimumExpenditureBasketinJordan,June2015

andOctober2016∗ http://urban-refugees.org∗ “Factsheet–Jordan:SyrianCrisis”,ECHO,January2017

1 https://www.unicef.org/jordan/media_10894.html

ANNEXIV: List of contacted Key

Informants

ANNEXIV–ListofcontactedKeyInformants(KIs)

DATE LOCATION TYPEOFDYNAMIC INSTITUTION PARTICIPANT'SNAME POSITION07February Amman JNRCS IbrahimAjlouni CBHFAProjectOfficer(GoJ)07February Amman JNRCS OsamaKanaan CBHFAProjectOfficer(BRC)07February Amman JNRCS NadiaKremeed CBHFAProjectOfficerAssistant(GoJ)07February Amman IFRC MikaYamai CBHFADelegate07February Amman IFRC MakiIgarashi MENA'sRegionalOfficeHealthCoordinator07February Amman IFRC RobertOndrusek MENA'sRegionalOfficeProgrammeCoordinator07February Amman IFRC ChristopherGeorge ProgramCoordinator07February Amman IFRC MuftahEtwilb HeadofCountryOffice

08February Amman Individualinterview DanishRedCross JacintaHurstDRCHeadofMissionand(formerIFRCHealthCoordinatorandInterimHeadofOperations)

08February Amman

AssistancetotheInter–agencyCommunityHealthTaskGroup(CHTG)monthlymeeting

IMC,IRD,Medair,JICA,Caritas,JPS,IOCC,UNHCR,MSFFrance,IFRC-JNRCS

08February Amman MedairElsaGroenveldHeidiGiesbrecht

Health&NutritionProjectManagerHealthAdvisor

08February Amman IRD

AseelAminOlaAlshraidehNawallNajjar

HealthCoordinatorHealthCoordinatorHealthSpecialist

08February Amman IOCC AyaAbdelqaderLafi HealthProjecteducator09February Amman IndividualInterview GermanRedCross MelaniePlöger ProgramCoordinator09February Amman IndividualInterview ICRC RaedAburabi HealthCoordinator09February Amman IndividualInterview IFRC SawsanAbuRassa CashTransferOfficer11February Ajloun IndividualInterview MoH-PrimaryHealthCareCenter AliALQudah DirectoroftheAjlunPrimaryHealthCareCentre11February AJloun IndividualInterview JNRCS NabihaSamardali HeadoftheJordanRedCrescent'sbranchinAjloun11February AJloun GroupDiscusssion JNRCS CBHFAVolunteers CBHFAVolunteersintheAjlounbranch18February AJloun IndividualInterview IRD CommunityHealthVolunteer IRDCommunityHealthVolunteerinAjloun11February AJloun IndividualInterview IRD CommunityHealthVolunteer IRDCommunityHealthVolunteerinAjloun12February Salt IndividualInterview JNRCS MohammedShomali HeadoftheJordanRedCrescent'sbranchinSalt12February Salt GroupDiscussion JNRCS CBHFAVolunteers CBHFAVolunteersintheBalqabranch12February Salt IndividualInterview Beneficiary-Homevisit Syrianrefugee SyrianrefugeefamilyinSalt

13February Amman Individualinterview JNRCS MamdouhAlhadidJRCSHeadofTheNationalCenterforFirstAidandRiskReduction

13February Amman Individualinterview JNRCS KhaledAlShoura JRCSCBHFATrainingOfficer13February Amman Individualinterview IFRC MarshalMukuvare CashbasedprogrammingDelegate13February Amman Individualinterview IFRC khaledAbuAssaf FinancesManager13February Amman GroupDiscussion IFRC CommunityHealthVolunteers CBHFAVolunteersintheAmmanbranch14February Jerash GroupDiscussion IFRC CommunityHealthVolunteers CBHFAVolunteersintheJerashbranch15February Amman Individualinterview MSF-France ErwanGrillon MSF-FHeadofMissionSyriacrisis15February Amman Individualinterview MSF-France GemaDominguez MSF-FMedicalCoordinator15February Amman Individualinterview UNHCR IbraheemAbuSiam HealthCoordinationSectorlead15February Amman Individualinterview ECHO MatteoPaoltroni TechnicalAssistant-AmmanRegionaloffice15February Amman Individualinterview EmbassyofJapan HiroshiSeto EconomicCooperation-SecondSecretary16February Mafraq Individualinterview JNRCS AliShdefat HeadoftheJordanRedCrescent'sbranchinMafraq16February Mafraq GroupDiscussion JNRCS CommunityHealthVolunteers CBHFAVolunteersintheMafraqbranch16February Mafraq GroupDiscussion EmiratiJordanianFieldHospital Said-Alnkabi HospitalMedicalDirector16February Mafraq Individualinterview NRC RanaSalem ICLAProjectCoordinator18February Amman Jointsession IFRC MikaYamai CBHFADelegate18February Amman Jointsession JNRCS OsamaKanaan CBHFAProjectOfficer(BRC)18February Amman Jointsession JNRCS NadiaKremeed CBHFAProjectOfficerAssistant(GoJ)18February Amman Jointsession JNRCS KhaledAlShoura JRCSCBHFATrainingOfficer

18February Amman Jointsession JNRCS MamdouhAlhadidJRCSHeadofTheNationalCenterforFirstAidandRiskReduction

18February Amman Jointsession JNRCS LinaQamhiya CBHFAProjectOfficerAssistant(BRC)24February Writtenresponses IFRC NicholasPrince FormerIFRCHealthCoordinator01March Writtenresponses IFRC MikiTakahara FormerIFRCCBHFADelegate

Jointsession

Briefing-JointSession

ANNEXV: OrganisationChartforthe

CBHFARollout(13-March-2014)

ANNEXV–OrganisationChartfortheCBHFARollout(13-March-2014)

ORGANOGRAMME(FOR(CBHFA,(JRCS(23RD(MARCH(2014

GRC

HQ 1450(JD/month

HQ 1200(JD/month

Amman FO(1 FO(2 FO(3 FO(4 FO(Irbid(GRC 800(JD/month

350(JD/month

Branch Ajloun Jerash Mafraq Irbid Amman

Volunteer(

Supervisor15(JD/day

Community 25(CHVs 10(JD/day

FRC

CBHFA(Project(Officer(JRCS

Japanese(Government(Proposal

125(CHVs

Field(Officer(Assistants(x(1(per(branch

100(CHVs

Volunteer(Supervisors

Health(Coordinator(JRCS

Project(Officer(FRC

CBHFA&Steering&CommitteePNS,&JRCS,&IFRC&

ANNEXVI: DiagramsoftheBirthand

Marriage certificates’process

ANNEXVI–DiagramsoftheBirthandMarriagecertificates’process1

1 Source: NRC report: “Securing Status: Syrian refugees and the documentation of legal status, identity, and family relationships in Jordan”, availableat:https://www.nrc.no/resources/securing-status-syrian-refugees-and-the-documentation-of-legal-status-identity-and-family-relationships-in-jordan/

23

If more than one year has passed since the birth, the parents cannot register the child at the Civil Status

'HSDUWPHQW�XQWLO�WKH\�ÞOH�D�ODZVXLW�LQ�WKH�0DJLVWUDWHV�FRXUWV�DQG�UHFHLYH�D�SRVLWLYH�MXGJPHQW�

7KHUH�LV�QR�OHJDO�SURFHVV�E\�ZKLFK�D�FKLOG�ERUQ�LQ�6\ULD�FDQ�UHFHLYH�D�ELUWK�FHUWLÞFDWH�IURP�-RUGDQLDQ�authorities.

In interviews in February and March 2016, birth registration for Syrian children born in Jordan was discussed

with 47 families, covering the births of 54 children.

•�7ZHQW\�HLJKW�FKLOGUHQ�KDG�ELUWK�FHUWLÞFDWHV�LVVXHG�E\�WKH�-RUGDQLDQ�&LYLO�6WDWXV�'HSDUWPHQW�

•�7KH�UHPDLQLQJ��FKLOGUHQ�ODFNHG�ELUWK�FHUWLÞFDWHV��)LIWHHQ�FKLOGUHQ�ODFNHG�ELUWK�FHUWLÞFDWHV�EHFDXVH�WKHLU�SDUHQWV�GLG�QRW�KDYH�WKH�ULJKW�GRFXPHQWV�WR�SURYH�they were legally married.

��)LYH�FKLOGUHQ�ODFNHG�ELUWK�FHUWLÞFDWHV�EHFDXVH�WKHLU�IDPLOLHV�EHOLHYHG�WKH�ELUWK�QRWLÞFDWLRQ�WR�EH�VXIÞFLHQW��,Q�ÞYH�FDVHV��WKH�SDUHQWV�GLG�QRW�UHFHLYH�D�ELUWK�QRWLÞFDWLRQ�IURP�WKH�KRVSLWDO�RU�KDG�SUREOHPV�UHODWLQJ�WR�WKH�ELUWK�QRWLÞFDWLRQ�- In one case, the Civil Status Department refused to register a child because the father did not have a new

MoI card.

•�$V�RI�0DUFK��FKLOGUHQ�ZLWKRXW�ELUWK�FHUWLÞFDWHV�ZHUH�PRUH�WKDQ�RQH�\HDU�ROG��DV�D�UHVXOW��LQ�HDFK�FDVH�WKH�FKLOGpV�SDUHQWV�ZLOO�QHHG�WR�LQLWLDWH�D�ODZVXLW�LQ�WKH�0DJLVWUDWHV�FRXUWV�WR�UHJLVWHU�WKH�ELUWK�

The numbers quoted here are not intended to suggest the statistical prevalence of birth registration issues

in the broader refugee community, but rather to illustrate the range of cases encountered in interviews and

highlight challenges to birth registration that refugees in similar situations may reasonably be expected

to encounter.

3URÞOH�RI�&DVHV

Harvard report Nov 2016.indd 23 24/10/2016 09:48:18

25

Although the Government of Jordan has made important accommodations to assist Syrian refugees to register their marriages, obstacles continue to prevent some refugees from registering marriages. Lack of awareness, lack of required documents, inconsistency in court practices, and onerous costs (including costs associated with travel DQG�WKH�ÞQH�LPSRVHG�ZKHQ�DQ�LQIRUPDO�PDUULDJH�FRQGXFWHG�LQ�-RUGDQ�LV�UHJLVWHUHG��ZHUH�LGHQWLÞHG�LQ�Registering Rights�DV�WKH�PRVW�VLJQLÞFDQW�FKDOOHQJHV�DURXQG�PDUULDJH�UHJLVWUDWLRQ�IRU�6\ULDQ�UHIXJHHV�LQ�-RUGDQ�34 These themes persisted in interviews for this report in February and March 2016.35

7KH�6KDULpD�FRXUWV�DUH�WKH�PDLQ�DFWRUV�LQYROYHG�LQ�PDUULDJH�UHJLVWUDWLRQ�DQG�RIWHQ�DUH�FRQIURQWHG�ZLWK�FKDOOHQJLQJ��complex, and tragic cases involving issues of early marriage, false and fraudulent documentation, and other GLIÞFXOW�IDPLO\�FLUFXPVWDQFHV��1RQHWKHOHVV��UHIXJHHV�KDYH�GHVFULEHG�GLIÞFXOWLHV�QDYLJDWLQJ�FRPSOLFDWHG�procedures and expressed confusion about how their cases might be treated because they have heard about different rules being applied in similar cases.

B. Challenges to Marriage Registration

2QFH�DOO�WKH�UHTXLUHPHQWV�KDYH�EHHQ�PHW��LQ�WKH�SUHVHQFH�RI�WZR�ZLWQHVVHV�DQG�WKH�EULGHpV�JXDUGLDQ��XVXDOO\�her father), who has given consent to the marriage, the couple will sign a marriage contract and the judge ZLOO�LVVXH�WKHP�ZLWK�D�PDUULDJH�FHUWLÞFDWH�36 The court fees for a marriage range from JOD 25 (USD 35) to JOD 110 (USD 155).37�7KHUH�DUH�QR�IHHV�DVVRFLDWHG�ZLWK�0R,�DSSURYDO�RU�REWDLQLQJ�D�KHDOWK�FHUWLÞFDWH�

0DUULDJH�5DWLÞFDWLRQ�&HUWLÞFDWH

&RXSOHV�ZKR�PDUULHG�RXWVLGH�WKH�SURFHVV�RXWOLQHG�DERYH�t�W\SLFDOO\��WKURXJK�D�PDUULDJH�RIÞFLDWHG�E\�D�VKHLNK�t��DQ�qLQIRUPDOr�PDUULDJH��FDQ�OHJDOLVH�DQG�UHJLVWHU�WKHLU�PDUULDJH�E\�REWDLQLQJ�D�PDUULDJH�UDWLÞFDWLRQ�FHUWLÞFDWH��$�FRXSOH�ZKRVH�6\ULDQ�PDUULDJH�FHUWLÞFDWH�RU�IDPLO\�ERRN�ZDV�ORVW��GHVWUR\HG��RU�OHIW�LQ�6\ULD�FDQ�DOVR�DSSO\�IRU�D�PDUULDJH�UDWLÞFDWLRQ�FHUWLÞFDWH�

7KH�UHTXLUHPHQWV�IRU�D�PDUULDJH�UDWLÞFDWLRQ�FHUWLÞFDWH�DUH�WKH�VDPH�DV�IRU�D�PDUULDJH�FHUWLÞFDWH��+RZHYHU��the court may impose additional conditions, at its discretion, such as requiring more than two witnesses and/RU�WKH�VKHLNK�ZKR�RIÞFLDWHG�WKH�LQIRUPDO�PDUULDJH�FHUHPRQ\�WR�FRPH�WR�WKH�FRXUW��

$GGLWLRQDOO\��D�ÞQH�RI�-2'��86'��LV�LPSRVHG�LI�WKH�LQIRUPDO�PDUULDJH�ZDV�FRQGXFWHG�LQ�-RUGDQ�39 In an important accommodation, the Jordanian cabinet has twice established time-limited exemptions (31 October to 31 December 2014; 13 May to 13 July 2015) for informal marriages penalties, allowing couples ZKR�PDUULHG�LQIRUPDOO\�LQ�-RUGDQ�WR�UHFHLYH�PDUULDJH�UDWLÞFDWLRQ�FHUWLÞFDWHV�ZLWKRXW�SD\LQJ�WKH�ÞQH�Syrian couples are not eligible to receive family books from the Jordanian state.

7R�REWDLQ�D�PDUULDJH�FHUWLÞFDWH��D�FRXSOH�PXVW�JR�WR�WKH�6KDULpD�FRXUW��XVXDOO\�RYHU�VHYHUDO�VHVVLRQV��DQG�present the following documents:

6WHSV�WR�2EWDLQLQJ�D�0DUULDJH�&HUWLÞFDWH�RU�0DUULDJH�5DWLÞFDWLRQ�&HUWLÞFDWH�LQ�-RUGDQ

0DUULDJH�&HUWLÞFDWH

Harvard report Nov 2016.indd 25 24/10/2016 09:48:20