From unintended to undesirable effects of health intervention : the case of user fees abolition in Niger, West Africa; case 16

A case study of an evaluation carried out in Niger describes the situation in which evaluators uncovered effects the client had not anticipated in the evaluation design, but which ultimately helped the client improve the intervention. The intervention consisted of abolishing user fees for deliveries and prenatal consultations in order to increase financial accessibility to health care. The changes provoked unexpected reactions from health care workers and the population, such as users developing strategies for hoarding medicines, and nurses selling (free) healthcare booklets due to an increased workload. Uncovering of these unanticipated, and sometimes illicit effects was not envisioned by the client

More Than Brides Alliance (MTBA): Mariage n’est pas un jeu d’enfat, Rapport de référence Niger

L’Alliance « Plus qu’une épouse » vise à améliorer la vie des adolescentes et propose des interventions dans plusieurs domaines (la santé reproductive, l’éducation, les normes de genre et les moyens de subsistance, entre autres). Dans le cadre d’une évaluation des interventions visant à retarder l’âge du mariage, le Population Council a mené des enquêtes de référence sur les adolescentes dans des zones sélectionnées dans deux régions au Niger (Tillabéry et Maradi). Les objectifs de l’étude de référence étaient les suivants : 1) fournir un point de référence permettant de mesurer les changements découlant de l’intervention à mi-parcours et à la fin de l’étude ; 2) fournir des renseignements sur la situation et le contexte actuels des adolescentes dans des zones sélectionnées au Niger afin de documenter l’intervention ; et 3) identifier les thèmes nécessitant un examen approfondi à l’aide de la recherche qualitative. Les résultats suggèrent que les filles vivant dans les communautés de Tillabéry et Maradi ont besoin de ces interventions pour faire face à ces vulnérabilités. Les résultats seront utilisés pour évaluer les changements qui seraient attribuables aux interventions de l’Alliance et pour informer les équipes de programme qui cherchent à mieux comprendre les populations qu’elles servent. --- The More Than Brides Alliance (MTBA) seeks to improve the lives of adolescent girls and includes activities across multiple domains (reproductive health, education, gender norms, and livelihoods, to name a few). The Population Council conducted baseline surveys of adolescents in select areas of two regions in Niger (Tillaberi and Maradi) as part of an evaluation of MTBA interventions to delay marriage. The goals of the baseline study were to: 1) provide a benchmark against which changes resulting from the intervention may be measured at the midline and endline periods; 2) provide information about the current situation and context for adolescent girls in select areas in Niger in order to inform the intervention; and 3) identify themes in need of further exploration through qualitative research. The findings suggest that girls in these communities in Tillaberi and Maradi have a demonstrated need for interventions to address these vulnerabilities. These findings will be used both to evaluate changes over time that may be attributable to the MTBA intervention and to inform programmatic staff seeking to understand the populations they are serving

More Than Brides Alliance: Baseline report, Niger

The More Than Brides Alliance (MTBA) seeks to improve the lives of adolescent girls and includes activities across multiple domains (reproductive health, education, gender norms, and livelihoods, to name a few). The Population Council conducted baseline surveys of adolescents in select areas of two regions in Niger (Tillaberi and Maradi) as part of an evaluation of MTBA interventions to delay marriage. The goals of the baseline study were to: 1) provide a benchmark against which changes resulting from the intervention may be measured at the midline and endline periods; 2) provide information about the current situation and context for adolescent girls in select areas in Niger in order to inform the intervention; and 3) identify themes in need of further exploration through qualitative research. The findings suggest that girls in these communities in Tillaberi and Maradi have a demonstrated need for interventions to address these vulnerabilities. These findings will be used both to evaluate changes over time that may be attributable to the MTBA intervention and to inform programmatic staff seeking to understand the populations they are serving

More Than Brides Alliance: Midline evaluation report

The More than Brides Alliance (MTBA) was formed to bringing together the strengths of a diverse team skilled in adolescent program implementation and research. The goal of the research presented in this report is to promote an evidence-based programmatic approach to delaying marriage in India, Malawi, Mali, Niger, and Pakistan by gathering detailed quantitative and qualitative information from the program areas over time to examine the impact of the present intervention and inform future strategies. This report highlights data from the midline survey on a set of outcomes approximately midway through the MTBA intervention and compares them with the same indicators that were collected before the interventions began (at baseline). The goal is to assess the successes of the program to date, to contextualize findings in light of larger social trends that may explain changes on some indicators (such as increased political pressure to end child marriage), and to consider programmatic strategies that may be suitable for adaptation based on midline findings. The data provide insights into possible programmatic adaptations that could help MTBA achieve desired outcomes by endline in 2020

More Than Brides Alliance: Endline evaluation report

This endline report presents findings from the More Than Brides Alliance’s (MTBA) project “Marriage: No Child’s Play” (MNCP) carried out in four countries: India, Malawi, Mali, and Niger. The MTBA project sought to empower girls, raise awareness about the risks of child marriage, improve girls’ access to sexual and reproductive health services, and support social norms favorable to girls’ education, economic engagement, and agency in marital decision-making. Results are presented from the MNCP evaluation, including over the final year, which was characterized by significant adaptations in programming and research due to Covid-19. This report explores behavioral outcomes related to child marriage, schooling, work, and pregnancy, as well as indicators related to knowledge and attitudes, based on cross-sectional surveys in intervention and comparison villages conducted with adolescent girls ages 12–19 at three time points (2016/7, 2018, 2020) and with parents of adolescent girls or other adults living in households with adolescent girls at endline (2020). Impact is presented—measured by results from difference-in-differences analysis—using baseline and endline surveys, comparing change in intervention areas to change in comparison areas

A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa)

<p>Abstract</p> <p>Background</p> <p>African policy-makers are increasingly considering abolishing user fees as a solution to improve access to health care systems. There is little evidence on this subject in West Africa, and particularly in countries that have organized their healthcare system on the basis of the Bamako Initiative. This article presents a process evaluation of an NGO intervention to abolish user fees in Niger for children under five years and pregnant women.</p> <p>Methods</p> <p>The intervention was launched in 2006 in two health districts and 43 health centres. The intervention consisted of abolishing user fees and improving the quality of services (drugs, ambulance, etc.). We carried out a process evaluation in April 2007 using qualitative and quantitative data. Three data collection methods were used: i) individual in-depth interviews (n = 85) and focus groups (n = 8); ii) participant observation in 12 health centres; and iii) self-administered structured questionnaires (n = 51 health staff).</p> <p>Results</p> <p>The population favoured abolition; health officials and local decision-makers were in favour, but they worried about its sustainability. Among health workers, opposition to providing free services was more widespread. The strengths of the process were: a top-down phase of information and raising community awareness; appropriate incentive measures; a good drug supply system; and the organization of a medical evacuation system. The major weaknesses of the process were: the perverse effects of incentive bonuses; the lack of community-based management committees' involvement in the management; the creation of a system running in parallel with the BI system; the lack of action to support the service offer; and the poor coordination of the availability of free services at different levels of the health pyramid. Some unintended outcomes are also documented.</p> <p>Conclusion</p> <p>The linkages between systems in which some patients pay (Bamako Initiative) and some do not should be carefully considered and organized in accordance with the local reality. For the poorest patients to really benefit, it is essential that, at the same time, the quality of services be improved and mechanisms be put in place to prevent abuses. Much remains to be done to generate knowledge on the processes for abolishing fees in West Africa.</p

Explorer les possibilités et les défis de la mise en oeuvre de stratégies de recherche en libre accès dans les institutions de développement

En mars 2016, le LASDEL a participé à l’atelier de préparation au projet pilote initié et financé par le CRDI, portant sur les données ouvertes en vue d’élaborer et de mettre en oeuvre un plan de gestion de données (PGD) pour les données produites dans le cadre du projet no 108131. L’objectif principal de ce projet est « l’élaboration d’une politique type relative aux données de recherche ouverte ainsi que de lignes directrices sur la mise en oeuvre à l’intention des organismes subventionnaires de la recherche sur le développement, afin de favoriser un meilleur accès aux données sur le développement » (cf. Proposition de recherche pour le projet n° 108131du CRDI). Le LASDEL s’est engagé dans ce projet à travers son programme n° 106949 (« Problèmes négligés du système de santé ») appuyé financièrement par le CRDI, qui a servi de cadre d’application du projet pilote. Le projet pilote s’inscrit dans la politique d’ouverture du LASDEL sur le plan international par la diffusion des résultats de ses travaux de recherche. En effet, le partage des données était déjà une préoccupation depuis les premières années de fonctionnement du Labo (qualité des transcriptions, qualité et disponibilité des rapports, archivage, partage entre les chercheurs, diffusion des résultats). La création de « Études et travaux » en accès libre en ligne sur le site du LASDEL répondait notamment à ce souci. Toutefois, la première réunion du projet pilote (8 et 9 mars 2016) s’est terminée sur une perception assez sceptique quant à ses implications. En effet, les chercheurs ont manifesté de la réticence quant au partage de certaines données primaires qualitatives, en particulier les entretiens transcrits. Cependant l’expérience menée a permis de comprendre que les craintes peuvent être surmontées et nous avons pu ainsi appréhender les bénéfices qu’apportent les « données ouvertes » : une plus grande clarté dans la production des données; le potentiel de recherche optimisé; source d’inspiration pour améliorer le fonctionnement du Laboratoire. Par ailleurs, nous relevons que le partage des données (de qualité) nécessite au moins le développement des capacités techniques, institutionnelles, et d’excellence de la recherche et certainement bien d’autres bénéfices que nous n’imaginons pas encore et que nous découvrirons si l’opportunité nous est donné au LASDEL de continuer l’aventure avec les « Données ouvertes »

Voice without choice? Investigating adolescent girls’ agency in marital decision-making in Niger

This article uses qualitative data from Niger to examine adolescent girls’ perceptions of their own agency in marriage decisions and contextual factors influencing these perceptions. We find that girls make marital decisions within a context that stresses parental consent and community approval, places a high value on obedience, and is constrained by limited opportunities, gendered distribution of labor, and dominant social norms promoting an early and narrow ‘window of opportunity’ for marriage. Findings demonstrate that interventions aiming to delay marriage in Niger must work to influence both community norms supporting child marriage and girls’ own motivations in martial decision-making

« More than Brides Alliance (MTBA) » : Rapport d’évaluation à mi-parcours au Mali et au Niger

L’Alliance « Plus qu’une épouse » (More Than Brides Alliance—MTBA) a été formée, rassemblant les forces d’une équipe diversifiée, compétente pour la mise en œuvre et la recherche de programmes destinés aux adolescents. Le volet recherche de l’Alliance MTBA vise à fournir des preuves et des connaissances sur ce qui fonctionne pour retarder le mariage des enfants en Inde, au Malawi, au Mali, au Niger et au Pakistan en évaluant le programme d’intervention de l’Alliance MTBA et en examinant les facteurs spécifiques du mariage des enfants dans chaque contexte. Dans ce rapport, nous visons à évaluer les succès du programme au Mali et au Niger à ce jour, à contextualiser les résultats à la lumière des tendances sociales plus larges qui peuvent expliquer les changements sur certains indicateurs (comme la pression politique accrue pour mettre fin au mariage des enfants) et à envisager des stratégies programmatiques susceptibles de convenir à l’adaptation sur la base des résultats intermédiaires. Alors que nous faisons le bilan du programme à mi-parcours, nous nous tournons vers les données pour donner un aperçu des adaptations programmatiques possibles qui pourraient aider le programme MTBA à atteindre les résultats souhaités d’ici à la fin de 2020. --- The More than Brides Alliance (MTBA) was formed to bringing together the strengths of a diverse team skilled in adolescent program implementation and research. The goal of the research presented in this report is to promote an evidence-based programmatic approach to delaying marriage in India, Malawi, Mali, Niger, and Pakistan by gathering detailed quantitative and qualitative information from the program areas over time to examine the impact of the present intervention and inform future strategies. This report highlights data from the midline survey on a set of outcomes approximately midway through the MTBA intervention and compares them with the same indicators that were collected before the interventions began (at baseline). The goal is to assess the successes of the program to date in Mali and Niger, to contextualize findings in light of larger social trends that may explain changes on some indicators (such as increased political pressure to end child marriage), and to consider programmatic strategies that may be suitable for adaptation based on midline findings. The data provide insights into possible programmatic adaptations that could help MTBA achieve desired outcomes by endline in 2020

A conceptual framework for understanding child marriage, marriage markets, and marriageability

The term ‘marriageability’ is used frequently in child marriage literature but is rarely defined. We propose a conceptual framework to define marriageability and use qualitative case studies to illustrate how ideas about marriageability contribute to child marriage. Pressure to capitalize on a girl’s marriageability before it declines in order to secure the ‘best’ partner may explain why child marriage persists. We find that marriageability involves both eligibility—or perceived readiness for marriage—as well as desirability or ‘value’ on the marriage market. We propose that understanding marriageability in context, particularly in countries with limited evidence on interventions to address child marriage, is essential for suggesting ways interventions may critically examine notions of marriageability and disrupt pathways to child marriage