Impact Evaluation of Sexual Health in Nicaragua
KIT Royal Tropical Institute led the impact evaluation of the cervical cancer screening and treatment programme of the Nicaraguan Ixchen Centre for Women. Results indicate that the aid was effective: over 40,000 women, who otherwise would not have accessed services, now were screened for cervical cancer and more than 1,200 of these received necessary treatment, contributing to lowering the high mortality rate.
There are almost 900 cases of cervical cancer in Nicaragua every year, a rate (40 cases/100,000 women) that is twice as high as in the rest of Central America (22 cases/100,000). With over 400 deaths annually, cervical cancer is the number one cause of mortality among women 15-49 years.
While there were Nicaraguan Ministry of Health efforts for cervical cancer services in Nicaragua, these often did not reach disadvantaged women. The Ixchen Women’s Centre programme was set up to bring cancer screening and treatment to the doorstep of poor women in remote areas. Between 2005 and 2009, the Dutch government supported the programme with €2.4 million. Six mobile health teams toured 75 municipalities, in collaboration with government clinics, organising education sessions and offering cervical cancer screening services and referral for treatment, free of charge.
KIT and partners (ETC Crystal, ECORYS, CDR, CIES) were contracted by the Ministry of Foreign Affairs to undertake an impact evaluation study – which served as one of the case studies for its review of Dutch development aid policy in the field of sexual and reproductive health and rights (SRHR).
The study questions focused on key issues including the net effect of the intervention and the explanatory factors; the effect on clients’ knowledge of and attitudes; the net effect of the intervention in terms of the number of people correctly treated and explanatory factors; the results of the programme in terms of public-private partnership; and cost-effectiveness of the intervention. The study design was an impact evaluation with a counterfactual analysis, combining both quantitative and qualitative research methods.
Results indicate that the programme was effective: over 40,000 women, who otherwise would not have accessed services, now were screened for cervical cancer and more than 1,200 of these received necessary treatment, contributing to lowering the high mortality rate.
Also, the final report was published by the Dutch Ministry of Foreign Affairs. The Ministry submitted it to Dutch Parliament where subsequently it was part of the documentation reviewed by the Parliament’s Commission on Foreign Trade and Development Cooperation in February 2014, who then discussed the effectiveness Sexual and Reproductive Health and Rights aid programme.
Evaluations that make a difference
The study in May 2014 was selected by Eval Partners as one of the ‘Evaluations that Make a Difference: Stories from around the World’. It will thus be part of a collection that will help evaluation users (e.g. governments and international organizations, NGOs and advocates) better understand how evaluation can truly be a force for positive change. It will also help evaluators gain insight into evaluation approaches that can influence use and impact.