Between 2013 and 2016 UNICEF worked to strengthen investment in Child Health Days (CHD) in 13 countries in sub-Saharan Africa by enhancing national ownership, scaling-up, and coverage through the “Scaling up Nutrition and Immunization” project – funded by Global Affairs Canada.

KIT Royal Tropical Institute was contracted by UNICEF headquarters in New York to conduct an external evaluation of the CHD activities under this project covering the period 2013 – 2016. The purpose of the evaluation was to: 1) inform program and policy decisions, including through a UNICEF management response, and 2) ensure accountability against the expected results.

Improving child survival and development

One of UNICEF’s core objectives is to improve the health and nutrition of children in order to enhance child survival and development. This is done through activities such as immunization; nutrition-specific high impact interventions; water, sanitation and hygiene interventions (WASH); distribution of insecticide-treated bed nets (ITNs) etc. Where communities and their children are difficult to reach due to geographic conditions and/or weak health systems, child health days (CHDs) are organized usually twice a year. The range of possible interventions delivered through CHDs includes VAS, deworming, immunization, but also WASH, nutritional screening for acute malnutrition (MUAC) and referral to therapeutic feeding centres. The aim of CHDs is to complement the delivery of regular primary health care services when access to these services is impaired by local conditions. The ultimate aim of CHDs is to reduce child morbidity and mortality.

Objectives and goals of the evaluation

The external evaluation conducted by KIT had two objectives:

1. Determine to what extent the project contributed to increased coverage and effectiveness of the CHDs, and how this was realised
2. Gather evidence on what worked well and through which mechanisms, to facilitate evidence-informed policy decision making

The goal of the evaluation was therefore not only to appreciate if the intervention worked, but also how it worked: why, where, and for whom. For this, a mixed-methods research approach was used combining quantitative (to look amongst others at increased coverage and effectiveness) and qualitative methods (to provide insights into what worked and why). The framework guiding evaluation was based on the five well established OECD/DAC evaluation criteria (relevance, effectiveness, efficiency, impact and sustainability). The evaluation team ensured regular involvement of UNICEF New York, UNICEF ESARO and WCARO, several UNICEF country offices, different stakeholders and target group representatives throughout the evaluation process.

Results:

KIT produced an in-depth evaluation report. It brought together the data from country case studies, secondary analyses of existing data (routine administrative health data and data from nationally representative household surveys), and document and literature reviews, in line with the evaluation framework. The report included a re-constructed Theory of Change, validated with a number of key stakeholders at UNICEF headquarters and regional offices.

The quantitative data provided insights into levels of coverage reached and highlighted countries that experienced difficulties in reaching their targets (effectiveness). The cases studies provided insights into the relevance, efficiency, sustainability and lessons learned. Promising practices were extracted from the case study countries as well as peer reviewed academic literature.

The report also included key recommendations, developed in a participatory manner with the Evaluation Core Group members (with representatives from UNICEF New York and GAC). These were developed to help strengthen the Enhanced Child Health Days supported by a follow on grant from Canada covering 15 countries in Sub Saharan Africa.