Measurement Matters: Lessons from M&E in a Post-Conflict State

For more than fifty years, the Canadian Hunger Foundation (CHF) has been providing assistance to thousands of poor, rural communities in some of the most remote areas around the world. We’ve been on the ground in South Sudan since 2000, and over those last 13 years, we’ve witnessed first hand the positive changes that can take place when well-governed and functioning systems are in place.

South Sudan is a difficult environment to work in, and Jonglei and Upper Nile States are among the most dangerous places in the world for a mother and her child. Here, the odds are about one in fifty that a mother or her infant will die during childbirth.

In an effort to assist the Government of South Sudan in building its capacity to deliver health services, we’re working with a local partner, Christian Mission Aid, to make health systems safer through an integrated livelihood and health project called the Maternal and Child Health Enhancement Program (MCHEP). Together we’re improving the health of mothers and children through improved access to nutritious food and nutritional supplements – efforts that will ultimately benefit more than 118,000 men, women and children. We’re also increasing access to reproductive health services, and scaling up prevention and treatment efforts that target the five major diseases and infections threatening mothers and children.

At the outset we established a Monitoring and Evaluation system in order to track and monitor progress on food security, food diversity, nutrition and maternal and child health indicators. Through household level interviews, focus groups, clinic registries and patient information forms, we’ve been collecting data to track the impact of our project interventions.

However, working in this context we’ve faced challenges:

• Limited access to communities due to seasonal issues and conflict
• Lack of trust and social capital because it is a post-war zone
• Ongoing internal and external insecurity and widespread refugee flows
• Limited infrastructure and physical and human resource constraints
• Low capacity and limited education levels of local staff

In light of these realities, we’ve had to shift the way we program and monitor project progress:

• Building buy-in and trust are essential: We’ve spent more time building relationships with community leaders, women’s groups and local government up front.
• Peace-building is mainstreamed: Ensuring conflict resolution and peace-building skills are an integral component of the work we’re doing, whether the activity focuses on agricultural support or building skills in women’s small business entrepreneurship.
• Generating momentum by focusing on existing and new institutional structures: Significant efforts were made to link into and improve existing data collection procedures – for example by working closely with front line nursing staff in local clinics. Designing the appropriate indicators and questionnaire formats stemmed from building buy-in and ownership at the local level for data collection and management. Moreover, 63 Women’s Nutrition and Reproductive Health Groups (WN&RHGs) have been formed to facilitate the expansion of health care delivery.
• Triangulation became more important: In a context where data sources were limited and sample sizes restricted, we had to rely more on triangulating data—verifying data sets through alternate sources—in order to see the big picture and validate findings.
• Implementing a thorough baseline across diverse communities was essential for programing and monitoring: A team of 32 people collected information from the communities where we work. This ‘baseline’ helped us to gauge how communities were doing when we started, where we needed to make adjustments, and the results we will have achieved when the project ends.
• Working through Women’s Nutrition and Reproductive Health Groups: Sixty-three of these groups will be further strengthened and mobilized as platforms to address healthcare needs and support collective action towards improved maternal healthcare services. Group members act as advocates and trainers for improved maternal, newborn and child health, thereby complementing that of other health practitioners.

The adjustments have paid off, and we’re seeing impressive results. Households are now producing twice as much sorghum and maize as they were a year ago, and they’re integrating new foods into their diets like leafy vegetables and fish. Health is also improving, as more than 15,000 women and 25,000 children under the age of five have been treated at our clinics, and the prevalence of diarrhea and other intestinal infections has dropped from 84% to 70%. Through integrated health and nutrition interventions, the prevalence of malnutrition, iron deficiencies and anemia among women and children has similarly dropped. More households now have access to clean water and mothers are able to deliver their babies more safely with the help of trained medical staff in new wards that have been equipped for that purpose.

These are just some of the promising results we’re already seeing in South Sudan. But as we move forward, we know we will be working from a solid foundation.