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Community Preparedness for Acute Malnutrition in Amhara (CPAMA), 
Ethiopia—Phase II
Grant Number: 720FDA19GR00033
Final Evaluation Report
Oda Development Consultant 
(Final)
March 2021
Addis Ababa
Disclaimer: The project; Community Preparedness for Acute Malnutrition in Amhara (CPAMA), Ethiopia—
Phase II was implemented by CWW from March 2019 to December 2020 with the financial and technical
support from USAID/OFDA. The overall goal of the project was to contribute to the reduction and prevention 
of acute malnutrition in children under five years of age in Amhara through disaster risk reduction and systems 
strengthening. 
The implementation of the project ended on December 31, 2020 and the final evaluation was conducted by 
independent consultant. Hence, opinions expressed in this report are the shared views of the consultants
and do not necessarily represent the views of CWW and USAID/OFDA unless specified otherwise. Needless 
to mention, the consultant is responsible for any errors, omissions, and misstatement of facts in this report.
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Table of Contents
List of tables and figures.......................................................................................................... 2
Acronyms ................................................................................................................................ 2
Executive summary.................................................................................................................. 4
1. Introduction....................................................................................................................... 8
2. Goal, objective and results of the project .......................................................................... 8
3. Purpose of the final evaluation .......................................................................................... 9
4. Methodology employed. .................................................................................................... 9
4.1. Data collection methods ................................................................................................ 9
4.2. Data analysis and report writing method...................................................................... 10
5. Limitation of the final evaluation...................................................................................... 11
6. Discussion and findings.................................................................................................. 11
6.1. Relevance.................................................................................................................... 11
6.2. Effectiveness ............................................................................................................... 12
6.2.1. Project design/planning and targeting...................................................................... 13
6.2.2. Implementation arrangement ................................................................................... 14
6.2.3. Progress toward the stated outputs ......................................................................... 15
6.2.4. Adherence to program participants protection policy .............................................. 25
6.2.5. Monitoring and evaluation........................................................................................ 25
6.3. Efficiency..................................................................................................................... 26
6.4. impacts........................................................................................................................ 27
6.4.1. Health ...................................................................................................................... 28
6.4.2. Nutrition................................................................................................................... 28
6.4.3. Water Sanitation and Hygiene (WaSh)...................................................................... 33
6.4.4. Agriculture and food security................................................................................... 39
6.5. Sustainability............................................................................................................... 42
6.6. Lessons learnt. ............................................................................................................ 43
7. Conclusion and recommendation.................................................................................... 45
7.1. Conclusion .................................................................................................................. 45
7.2. Recommendation......................................................................................................... 45
Annex .................................................................................................................................... 48
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List of tables and figures 
Table 1 FGD participants by sector and Woreda …………………………………………………… 9
Table 2 Physical performance of the project -Health Sector .. …………………………………… 16
Table3 Physical performance- Nutrition Sector ……………………………………………………… 18
Table 4 Physical performance -WaSH………………………………………………………………… 20
Table 5 Physical performance – DRR………………………………………………………………… 24
Table 6 Financial performance of the project in USD………………………………………………… 26
Table 7 Fund utilization by sector in USD……………………………………………………………… 27 
Table 8 Proportion of children aged 6-23 months by food groups they had and Woreda ………… 33
Table 9 Number of months households faced food shortage in the last 12 months of survey date. 41
Figure 1 Water Distribution Sites-Closed before operating time. ………………………………… 22
Figure 2 Better quality Latrine Constructed. ………………………………………………………… 23
Figure 3 % of children with breast feeding. …………………………………………………………… 29
Figure 4 % of children with exclusive breast feeding. ………………………………………………… 29
Figure 5 Percentage of children with exclusive breast feeding in the last 24 hours of the survey date 29
Figure 6. Percentage of children who fed additional food to breast milk in the last day or night 30
Figure7 Proportion of children 6-23 months of age who receive food from 4 or more food groups… 31
Figure 8 Percentage of children who consumed the food groups by type………………………… 32
Figure 9 Primary water sources…………………………………………………………………………… 34
Figure 10 % of respondents with hand washing practice at critical time……………………………… 36
Figure 11 Cleanliness of Container based on Enumerators Observation in percentage ………… 38
Figure 12 Hotspot classification of Dessie Zuria 2015-2020………………………………………… 40 
Figure 13 Hotspot classification of Delanta 2015-2020……………………………………………… 40
Figure 14 Household Diet Diversity Score by Woreda……………………………………………… 41
Acronyms 
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CHW: Community Health Worker
CLTSH Community Led Total Sanitation and Hygiene
CPAMA: Community Preparedness for Acute Malnutrition in Amhara
CWW: Concern Worldwide 
DHS: Demographic and Health Survey
DRR; Disaster Risk Reduction
EBF: Exclusive Breast Feeding 
F to F: Fathers to Fathers 
FGD: Focus Group Discussion
GO-NGO: Government- Non-Government Organization 
GTP: Growth and Transformation Plan
HC: Health Center
HDDS: Household Diet Diversity Score
HEW: Health Extension Worker
HP: Health Post 
IEC: Information Education Communication
IMAM: Integrated Management of Acute Malnutrition
ICYF: Integrated Child and Youth Feeding
KAP: Knowledge, Attitude and Practice 
KII: Key Informants Interview
M to M: Mothers to Mothers
M&E: Monitoring and Evaluation
MAD: Minimum Acceptable Diet 
MDS: Minimum Diversity Score
MERL: Monitoring, Evaluation, Reporting and Learning 
MHIS: Health Management Information System
NFI: Non-Food Items
OECD DAC: Organization for Economic Cooperation and Development -Development Assistance Committee
PDM Product Data Management 
PHEM: Public Health Emergency Management 
SDG: Sustainable Development Goal
SPSS: Statistical Package for Social Science 
USD: United Sates Dollar
WaSH: Water, Sanitation and Hygiene
WHO: World Health Organization?
WUA: Water Users Association
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Executive summary 
CWW implemented the project called “Community Preparedness for Acute Malnutrition in Amhara (CPAMA), 
Ethiopia – Phase II from March 11, 2019 to December 31, 2020. The overall goal of the project was to contribute 
to the reduction and prevention of acute malnutrition in children under five years of age in Amhara through disaster 
risk reduction and systems strengthening. The project consists of five sectors namely health, nutrition, WaSH, 
agriculture and food security and risk management policy and practice where each sector has own objective. 
The final evaluation was conducted from January -March 2021 with the field work from February 14-25,2021 
followed by validation workshops at North Coordination and Addis Ababa Offices. The major input for this final 
evaluation report is the project end line survey report and hence we strongly recommend readers to refer CPAMA 
II End Line Survey Report Which has been submitted separately.
. 
A combination of qualitative and quantitative methods of data collection and analysis namely household survey, 
document review, FGD, KII, observation and triangulation were employed. Moreover, validation workshops were 
conducted at North Coordination and Addis Ababa offices and comments from the workshops were incorporated 
to the report. The evaluation came up with findings and recommendations which are summarized below.
Project relevance 
The evaluation determined that the project supports the SDGs namely ensure healthy lives and promote well￾being for all at all ages (goal 3), achieve gender equality and empower all women and girls (goal 5), ensure 
availability and sustainable management of water and sanitation for all (goal 6), end poverty in all its forms
everywhere (goal 1) and end hunger, achieve food security and improved nutrition and promote sustainable 
agriculture(goal2). Moreover, the project addressed key elements supported key elements of the GTPII strategy, 
Amhara National Regional State Policy of the health, water, sanitation, and disaster risk reduction, CWW, 
USAID/OFDA mission and strategies. Moreover, communities expressed the relevance of the project to their 
needs and priorities. Hence, the final evaluation concluded that the project was in line with the global, national, 
regional, and organizational (implementing and funding agencies) development polices and strategies and 
relevant for implementation.
Project effectiveness
The finding of the evaluation showed that the project was designed within the context of multi-sectoral
development model to reduce child malnutrition and illness. The project was a continuation of CPAMA I and 
findings from the implementation of phase I were considered as input for the project design. The planning process 
of the project was participatory as it involved target beneficiaries’ and other stakeholders during the need 
assessment, project design and annual planning. Subsequent consultations were held with the target community 
and their needs and priorities were considered.
Target Woreda selection was done by local government and CWW based on the food security situation reports 
(hot spot classification) of the government. According to the Ethiopia hot spot woreda’s classification (using six 
criteria) of January 2019 ( https://data.humdata.org/dataset/hotspot-priority-woredas), Delanta and Dessie Zuria 
were in the list of hotspot Woredas which needed emergency and rehabilitation assistances. Target Kebeles were 
selected by Woreda DRR committee and CWW. Priority was given to the villages that have major water problems 
in case of water supply projects, the case load of non-communicable diseases namely pneumonia and diarrhea 
and nutritional status of children to select health facilities. Kebeles covered by phase I of the project were 
considered for CLTSH intervention to scale up the practice. Availability of plot land for vegetable was considered 
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as a criterion for agriculture and food security beneficiary selection. Moreover, wealth ranking done by CWW and 
community at the onset was used as reference for beneficiary’s selection where the poorest of the poor and poor 
as defined during the wealth ranking were targeted. In nutshell, beneficiary’s selection was made by DRR 
committee with the participation of community as per the set criteria for each intervention like the presence of 
preplant or locating mothers in the household for nutrition program, existence of plots for vegetables for agriculture 
and food security, case load of non-communicable diseases at the health facilities, and others as stated under 
targeting part of this report. Hence, neither inclusion nor exclusion error was noted. 
There was an integration of efforts among the project implementing body and government sector offices. Smooth 
working relationships built by Concern with zone, Woreda and kebele level sector offices, health facilities and 
community level committees like DRR and water users committee resulted in performance beyond the set 
milestone in most cases. 
The set targets under health sectors have been attained. All targeted health facilities supported, staff trained, child 
identification, screening and consultations conducted and none of the health facility in the project area was out of 
stock and the medical commodity supply chain run smoothly as envisaged.
Three-fold of the targeted beneficiaries received behavioral change interventions on improved IYCF, 
malnourished children supported and the recovery rate for admitted children maintained above the SPHERE 
standard; 97% and performance of nearby health facilities in the region. 
The project constructed the 4 pipeline extensions, 3 rural pipe system, 3 new spring and 1 hand dug well. As a 
result, a total of 144,598 people 174% of the target was reached through WaSH related intervention. Water User’s 
Associations (WUAs) were established and trained for schemes developed. Water fee collection was introduced, 
water schemes are fenced, locked, have guards and the observed surroundings are clean. However, it was noted 
that the construction of water schemes was toward the end of the project life frame and hence the full benefits of 
improved water was not realized within the period of the project. The time for site identification and design was 
not appropriate, most of WUA members are male (mostly one female), tool kits handed over to Woreda office not 
yet distributed to care takers of the schemes, some schemes not yet handed over to community and Woreda and 
the fee introduced in most case is not sufficient to cover operation and maintenance costs. Delay in construction 
of water schemes was due to lengthy procurement process from CWW side and approval of schemes design 
work at Dublin that took time.
Project participants constructed toilets. In some cases, the materials used resulted in durable construction but in 
most cases the local materials used means the durability is shorter due to the low quality of construction materials.
The project distributed WASH NFIs (soap and jerry-can) to strengthen the water and sanitation interventions. Both 
the household survey and discussion with the community confirmed community satisfaction with the service in 
terms of the distribution modality, quality, and quantity. 
Under agriculture and food security interventions 11,377 households which was 190% of the target addressed 
and 80.85 ha which was 168% of the target brought under improved agricultural practices which includes crop 
pest management and cultural mitigation methods, compost preparation, mulching and animal dung application.
Awareness creation developed farmers interest for the program and supply of inputs contributed for the better 
performances. All (22) communities in risk-prone areas developed mitigation plans which meet minimum 
standards. Moreover, DRR and contingency plans containing soil and water conservation, mitigation of human 
livestock disease outbreak and the like activities developed and implemented as part of the DRR activities. 
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The project adhered to the program participants protection policy and all sampled households (100%) confirmed 
that they are aware of the complaint and response mechanism. Project beneficiaries expressed their satisfaction 
with the service. Moreover, the M&E activities were accomplished as envisaged. 
Project efficiency 
The project utilized 97% of the budget allocated. Of the total fund utilized, 92% and 6% was utilized for direct/sub 
award cost and sub awardee (Concern Ireland) Indirect Costs, respectively. The rest 2% was for 
approved/applicable NICRA. The average cost per beneficiary was 7.50 USD with the maximum of 20 
USD/beneficiary in agriculture and food security.
Cost saving approaches were implemented which include streamlining the project with the existing CWW
organizational set up, integration with other programs like REGRADE, leave no girls behind, Bakalar water supply 
and KOICA livelihood projects and mainstreaming with the government structure (sector offices). Such an 
arrangement is welcomed for its cost saving on top of paving ways for project sustainability. 
Project impacts 
The project brought positive impact measured using the identified indicators as listed below.
 The result showed that 95.4%(n=83) of a child under 6 months breastfed yesterday during the night or day 
prior to the survey date. According to the 2019 Min Demographic and Health Survey (DHS), 94% did breast 
feeding and the status is comparable.
 The percentage of child under 6 months who participated exclusive breastfeeding yesterday during the night 
or day prior of the survey date was 79.3 % which was 77.5% during the base year. According to the 2019 
Mini DHS result, 59% of infants under 6 months did exclusively breastfed in Ethiopia. Though the changes 
are marginal and statistically not significant, the status is higher than the national data. 
 The use of plain water in addition to breast feeding (17% of children) contributed to reducing the percentage 
of exclusive breast feeding among 6-23 months aged children in the target area. 
 The proportion of children aged 6-23 months who received food from 4 or more food groups in the last 24 
hours prior to the survey date increased from 16.4% to 34.8%. The change is statistically significant. 
 Of the sampled 6-23 months aged children 25% met the Minimum Acceptable Diet in contract to 14.2% during 
the base year. Though it was not possible to get recent data, the 2016 mini-DHS report, showed that the 
percentage of children who met minimum acceptable diet in Ethiopia was only 7%.
 Of the food items included to menu, vegetable, and fruits accounts for the higher portion. The survey showed 
that 45% of the sampled children took fruits and vegetables 24 hours prior to survey date. The improvement 
in supply of vegetable for families as the result of cultivating back yard vegetable noted as major contributing 
factor for higher proportion of children who consumed vegetable and fruits in the last 24 hours of the survey 
date.
 A total of 16,868 people accessed improved water sources and the percentage of people with access to 
potable water source increased from 90.4% during the base year to 96.8% by the end of the project. However, 
the per capita water consumption was 8.8 liter per day per person which is lower compared to the set 
standard; 25 liter per day per person and the SPHERE standard, 15 liter per day per person.
 The condition of latrines was observed by enumerators and 75% of the latrines were fully 
constructed/completed and clean which was 49.1 % during the base year.
 The percentage of respondent who knows 3 out of 5 main critical moments for hand washing increased from 
83.5%(baseline) to 86.8% by the end of the project period and the change is statistically significant. Moreover, 
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66.2% of respondents store water safely which represents a major improvement from 33.6% during the base 
year but slightly below the set target 70%. Similarly, that 76.5% of households’ latrine hole were free of feces 
which was above the baseline (58.3%) and exceeded the set target (70%). 
 According to the PDM-PHA survey result, 97.2% of beneficiaries are satisfied with assistance modality, clarity 
of information received, and distribution process of nonfood items. Moreover, 91.9% and 98.2% of 
respondents were satisfied with the quantity and quality of NFI distributed by the project. 
 The number of months households faced food shortage in the last 12 months reduced from 2.7 months (base 
year) to 1.96 months (end line) which was equivalent to the target (2 months). The average months female 
respondents face food shortage was higher for both Woredas compared with their male counterparts.
 The workability of applying multisectoral approach to improve food security situation of the community was 
checked. The result showed that the food security situation of the project areas showed improvement from
2015 to the end of 2019 as they moved from hotspot 1 to 3. However, both Woredas are still in the list of 
hotspot classification through there was improvement. It is noted that the project areas are vulnerable due to 
several factors including degraded land, occurrence of frost which damages crops, erratic rainfall and other. 
Hence, though the approach supporting in pushing the Woreda toward better food security situation, the 
possibility of falling back after some progress is noted.
 The HDDS for the project area was 5.22(Dessie Zuria 4.63 and Delanta 5.96) which showed improvement 
over the project period as compared to the baseline result, 4.53. The project supplied vegetable seed and 
tools for 5750 beneficiaries to run vegetable gardens and all gardens are rated as functional.
Sustainability 
The evaluation result showed that health, nutrition, food security related interventions can likely serve the 
target community beyond the project life period and are likely sustainable. Moreover, water projects and 
associated changes shall be sustainable if at all support from the local government offices continues. 
Conclusion and recommendation
The final evaluation concluded that, the project was successful and met its objective. However, there are still 
persistency of gap in nutrition, water, sanitation and hygiene, and agriculture and food security which needs 
further intervention. Similarly, the fund utilization of the project was higher/97% and cost per beneficiary as 
stated in this document was minimal. Considering the changes brought as the result of interventions, the 
evaluation concluded that the impacts justify the cost.
The implementation of the project came up with lessons that can be an input for future projects and specific 
conclusion and recommendation as discussed in this report. 
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1. Introduction
Concern is a non-government, international humanitarian organization which envision a world where no one 
lives in poverty, in fear of oppression, where all access to a decent standard of living and have opportunities 
and choice essential to a long, health and creative life.
Concern implemented the project called “Community Preparedness for Acute Malnutrition in Amhara 
(CPAMA), Ethiopia – Phase II from March 11 ,2019 to December 31, 2020. The project was aimed to prevent 
and reduce recurrent increases in acute malnutrition in the Ethiopian highlands through the implementation 
of a multi-sectoral approach focusing on the identification of multiple hazards and Disaster Risk Reduction 
(DRR) in Dessie Zuria and Delanta Woredas of South Wollo zone, Amhara region. 
The project consists of five sectors namely health, nutrition, WaSH, agriculture and food security and risk 
management policy and practice. Each sector has sub sectors accompanied by set of interventions and 
indicators. The project had been built on the interventions and results that were implemented/achieved during 
Phase I of the CPAMA project. The first phase was involved in strengthening community risk analysis, 
healthcare delivery and preventative services and improved water, sanitation, and hygiene.
The project had been ended on December 31,2020 and the final evaluation was conducted from January -
March 2021 with the field work from February 14-25,2021 and validation workshop at North Coordination and 
Addis Ababa Offices and this evaluation report has been produced. 
The report contains introduction which gives snapshot about the project, objective of the project, purposes of 
the final evaluation, methodology employed, limitation of the evaluation, findings which consist of the project 
relevance, effectiveness, efficiency, impact, sustainability, and lessons learn and conclusion and 
recommendations. The report also contains additional information as annex for further reading. 
The major input for this report came from the project end line survey report. Though maximum efforts have 
been done to include information’s generated through the end line survey, there are still information left with 
in the end line survey report and there are cases where additional information included to this final evaluation 
report to align it to the DAC evaluation criteria. In most case details of the information are available in the end 
line survey report as we left some to avoid redundancy and make this report short and readable. Hence, we 
strongly recommend readers to refer CPAMA II End Line Survey Report Which has been submitted along 
with this report. 
2. Goal, objective, and results of the project 
The overall goal of the project was to contribute to the reduction and prevention of acute malnutrition in 
children under five years of age in Amhara through disaster risk reduction and systems strengthening. The 
objectives are: 
 To improve the health and nutrition status of children under five years of age and reduce child 
morbidity and mortality related to communicable diseases (diarrhea, pneumonia, malaria) through a 
disaster risk reduction and systems strengthening approach at the community and health facility level. 
 To contribute to the reduction of mortality and morbidity associated with malnutrition through 
improving sustainable access to safe water, sanitation, and hygiene.
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 To strengthen the agricultural crop diversification practice to improve dietary diversity of households 
with children under five years, and pregnant and lactating women.
3. Purpose of the final evaluation
-
The purpose of the final evaluation was to assess the effectiveness, efficiency, impact, relevance, and
sustainability of the project and generate lessons for learning and future programing.
4. Methodology employed.
A combination of qualitative and quantitative methods of data collection and analysis methods were employed 
to generate information from their sources. The following methods were employed.
4.1. Data collection methods 
a) Document review 
Documents related to the project and the assignment were reviewed from the outset to have insight about 
the project. Project proposal, baseline survey report, progress reports, baseline and end line row and 
summary data, Household Dietary Diversity Score (HDDS) guideline for Measurement of Household Food 
Access:2006; FANTA II, Ethiopian 2019 Mini Demography and Health Survey (HDS) report, Ethiopian Health 
Transformation Plan 2015-2020, Design and Construction Manual for Water Supply and Sanitation Facilities 
in Schools; GTP II and other related documents were reviewed. 
Based on the result of the document review, qualitative and secondary data collection tools were developed. 
Moreover, the proposed methodology under the technical proposal was modified and an inception report
which consists revised methodology, data collection tools and a matrix consisting of data sources along with 
the collection methods was produced and submitted. 
b) Focus Group Discussion (FGD) 
A total of 10 FGDs was conducted with the project beneficiaries. Groups were formed as per the sectors and 
thematic areas as follows. 
Table 1 FGD participants by sector and Woreda 
Sector Participants Dessie 
Zuria 
Delanta Total 
Health Beneficiaries participated in Health intervention 1 1 2
Nutrition Mothers with children below 5 years old 1 1 2
Mothers and fathers working as Mother to Mother 
and Father to Father Support Group 
1 1 2
WaSH Water users and WaSH committee 1 1 2
Agriculture and 
food security
DRR/food security intervention participants 1 1 2
Total 5 5 10
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The size of the FGD participants range from 8-12 for easy interaction and thematic areas listed under the 
purpose of the evaluation was discussed. Maximum care was taken to the COVID 19 during the discussion 
and the setting was as per the recommendation of the ministry of health which includes social distance.
c) Key informants’ interview 
Key informants representing CWW at different level, Delanta and Dessie Zuria sector offices, South Wollo 
Zone Sector offices and administration, health centers and health post, schools and kebele level staff were 
interviewed. The checklist developed for KII, was used toa guide the interview. 
d) Observation 
Personal observation of the facilities constructed by the project which includes health centers and posts, 
water supply schemes, vegetable garden, sanitation facilities and situation of beneficiaries were observed to 
have an insight about changes brought as the result of the intervention. Facilities representing the four sectors 
were observed. The observation checklist was used, as guideline during the visit. 
e) Case studies 
Case study was conducted to have an insight about the situation/changes and included to this report. 
f) Triangulation 
Information generated from different sources was triangulated based on the findings for their consistency and 
validity. The findings from the end line structured survey, progress reports and qualitative data generated 
from different sources were triangulated. Moreover, the findings from the qualitative and quantitative survey 
were triangulated for their consistency and validity. 
g) Validation workshop 
Validation workshop was conducted, and preliminary findings were shared with the project stakeholders
notably south Wollo Zone and Dessie Zuria and Delanta Woredas sector offices, CWW North Coordination 
Office staff and community representatives. Moreover, validation workshop was conducted at CWW head 
office and concerned staff were participated in the workshop and validated the preliminary findings. Moreover, 
comments and suggestion from the validation workshops were considered and included to the reports. 
h) Other PLA methods
The consultant brought other PLA methods notably trend analysis, ranking, mapping, before and after history 
telling and others to play while facilitating discussions. 
4.2. Data analysis and report writing method.
As stated above, four set of structured surveys; household, exclusive breast feeding, Minimum Diversity
Score, CDMI hunger gap indicator was conducted by CWW. The role of the consultant was data analysis, 
produce narrative end line survey report, augment the structured survey with the qualitative data through filed 
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work and produce end line and final evaluation reports. In view of this, row and summary data obtained from 
CWW was exported to SPSS by developing appropriate templates. 
Quantitative data were analyzed electrotonically using SPSS and organized as per the indicators. A simple 
descriptive statistic was used to explain and where required cross tabulation of variables was conducted to 
understand the relationship of different factors. Regression analysis notably binary logic and compare means 
were used to check the statistical significancy of the changes brought as the result of the intervention. 
Qualitative data was analyzed using content method of data analysis. Information generated from different 
sources were summarized as per their thematic areas and indicators and analyzed. Moreover, the findings 
of the qualitative and quantitative data were triangulated for their consistency and validity. Finally, this report 
has been produced based on the findings of the qualitative and quantitative surveys. 
5. Limitation of the final evaluation 
The final evaluation was conducted at the project kebeles in Delanta and Dessie Zuria Woredas using the 
sampling method. Hence, the findings of this evaluation cannot reliably be generalized beyond the study 
population. Moreover, though we have tried to ensure reliability and validity of responses by project 
participants and key informants, under or over reporting cannot be entirely ruled out which might bias the 
result of this evaluation.
During the validation workshop, participants from Delanta Woreda declined that some of the findings from 
the household survey notably sanitation cannot properly represent their situation and indicated that the 
problem might arose from error in household survey data collection from the enumerators side. We 
acknowledged their concerns and cleaned some outlier data but still there might be some errors which can 
bias the result of this evaluation. 
6. Discussion and findings
This section of the report presents the major findings of the evaluation as per the Organization for Economic 
Co-operation and Development’s (OECD) Development Assistance Committee (DAC) Evaluation Criteria 
namely relevance, effectiveness, efficiency, impact, and sustainability. Moreover, the adherence of the 
project to CWW protection and participation policy was also discussed and findings of the final evaluation are 
as discussed below. 
6.1. Relevance 
The relevance of the project to the global, national, regional, and organizational policies and priorities and 
target communities’ needs and priorities was assessed. Ensure healthy lives and promote well-being for all 
at all ages (goal 3), achieve gender equality and empower all women and girls (goal 5), ensure availability 
and sustainable management of water and sanitation for all (goal 6), end poverty in all its forms everywhere 
(goal 1) and end hunger, achieve food security and improved nutrition and promote sustainable 
agriculture(goal2) are amongst the 17 Sustainable Development Goals (SDG) which are under 
implementation at the globe level. Reducing global maternal mortality ratio, end preventable death of new 
born and children under five years old, end all forms of discrimination and violence against all women and 
girls everywhere, achieve universal and equitable access to safe and affordable drinking water for all, 
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eradicate extreme poverty for all people everywhere, end hunger and ensure access to safe, nutritious and 
sufficient food all year round and end all forms of malnutrition are among the targets set under the stated 
SDGs. 
The project was implemented during the GTP II (2014/15-2019/20) and the relevance of the project to this
national plan was reviewed. As per GTP II, there was an intention to reduce under five mortality rate per 
1,000 live births from 64 to 30, reduce infant mortality rate per 1,000 live births from 44 to 20, reduce maternal 
mortality rate per 100,000 live births from 420 to 199 by the end of GTPII. Similarly, there was an intention to 
increase potable water coverage from 58% to 83%, access to improved toilet service facility from 28% to 
82% and increase major crop production from 270.3 to 406 million ton from the base to the end year.
The development plan of Amhara National Regional State for the ended 5 years was aligned to GTPII and 
the development priorities stated above holds true for the regional state. Similarly, promotion of investments 
that save lives, reduce poverty, strengthen democratic governance, and help people emerge from 
humanitarian crises and progress beyond assistance is part of the mission statement of OFDA. Agriculture 
and food security, gender equality and woman empowerment, health, water, and sanitation are amongst 
priority areas for investment by USAID/OFDA. 
The goal of Concern Worldwide Ethiopia is ending extreme poverty, whatever it takes. CWW believe that no￾one should have to live in fear that they will not have a home to sleep in or enough food to feed their children.
Project beneficiaries anonymously reported that health, nutrition, access to potable water supply and food 
security are their development priorities. They confirmed their participation in problem identification and the 
translation of their priorities to the proposal and implementation. The baseline report and project proposal 
showed that the status of the target community measured using the listed indictors was lower which calls for 
interventions.
FGD participants at Asgedie Kebele of Dessie Zuria explained the relevance of the project to their setting as follows. 
“ We were consulted on the activities for implementation from the outset. We listed our priority as nutrition, health, 
water, improving sanitation and agriculyure. Some of us(leaders) participated in the project launch meting and 
confirmed that our needs and priorities were included to the proposed activities. Hence, we can confirm that the 
project was to our needs and priorities”
Generally, the objectives and interventions of the project fits to sustainable development goals, national and 
regional development plan, implementing and funding agencies development and target communities felt 
needs and priorities. Hence, it is safe to conclude that the project was in line with the global, national, regional,
and organizational (implementing and funding agencies) development polices and strategies. Hence, the 
project was relevant, and its implementation was rational. 
6.2. Effectiveness
The effectiveness of the project was assessed in terms of attaining the set milestones, quality of the service 
and results obtained, success of the implementation strategy, government involvement and value adds from 
their participation, and expected and unexpected results brought as the result of the project implementation. 
The findings related to the effectiveness of the project is as discussed below. 
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6.2.1.Project design/planning and targeting.
Project design/Planning
Reviewed documents show that the determinates of malnutrition are multifaced which require multisectoral 
approach. Considering this fact, the project was designed within the context of integrated development model 
to reduce child malnutrition and illness. The multisectoral approach (WaSH, Health, Agriculture and Food 
Security and DRR as component) was in line with the 2014-2025 Global Multi Sectoral Nutrition Strategy 
which recommends the implementation of multisector including agriculture, health, livelihood, education, and 
humanitarian assistance. https://www.fantaproject.org/sites/default/files/Multi-Sectoral-Nutrition-Strategy￾2014-2025.pdf)
The result of the project document review and discussion with the community and key informants confirmed
that the planning process of the project was participatory as it involved target beneficiaries’ and other 
stakeholders during the need assessment, project design and annual planning. 
The project was a continuation of CPAMA I and findings from the implementation of phase I was considered 
as input for the project design. The project was focused on strengthening community risk analysis, healthcare 
delivery and preventative services and improved water, sanitation, and hygiene as part of strengthening the 
efforts made under phase I. 
Discussion made with the community and key informants confirmed that subsequent consultations were 
made with the target community and their needs and priorities were considered. Moreover, project launch 
workshop was conducted, and the project was validated by the stakeholders (government sector offices and 
community) from the outset to make sure that their recommendations were translated to project proposal. 
Moreover, annual plan was developed and shared with all concerned offices and their comments were 
included. It is also noted that the interest of the funding agency was kept in radar as there was 
commutation/discussion on the project throughout the project period. 
Targeting 
The result of the evaluation confirmed that target Woreda selection was informed by their food and nutrition 
security situation and agreement of concerned offices. According to the Ethiopia hot spot woreda’s 
classification ( using six criteria) of January 2019 ( https://data.humdata.org/dataset/hotspot-priority￾woredas), Delanta and Dessie Zuria were in the list of hotspot Woredas which needs emergency and 
rehabilitation assistances. According to the report, Delanta was under hotspot area 1 for agriculture and 2 for 
health, nutrition, water, and sanitation. Similarly, Dessie Zuria was under hot spot 2 classification for water 
and 3 for other sectors. Interviewed key informants from Zone and Woreda confirmed that the selection of 
Woredas was done by themselves based on their priorities for intervention.
Mohamed Seid is a team leader for Early Warning in Disaster Risk Management Commission of South Wollo Zone. 
He confirmed that the selection of the Woredas was done by them as follows. “I know that it was we who select 
Delanta and Dessie Zuria Woredas for project implementation. Both Woredas were identified as hot spot areas 
which needs timely intervention. These Woredas were food insecure and under safety net program, degraded, 
confronting frost problem and nutritional status of children was deteriorated. As the DRR team member and leading 
agency for such projects, it was we who recommend, both Woredas from the outset.”
14
Demis Refisa, is planning office of Dessie Zuria Woreda Health Office. He explained the project design and planning 
process as follows. “I participated in the assessment, formulation and monitoring and evaluation of the project. As 
per the findings of the assessment priority was accorded to the targeted kebeles and the identified interventions 
namely nutrition, health, water and sanitation and agriculture. As per the project design, training and material 
supports, regular supervision and review meetings were conducted (accorded acknowledgement) which has greatly 
contributed to the improvement in service delivery at HC and HP level”. He remarked that the relationship of 
/integration of intervention components and the approach followed (M to M, and F to F) has pleased him and gave 
his acknowledgement, among others, to the wider acceptance and success of the Project.
Discussion made with the key informants, community and document review also confirmed that target 
kebeles and beneficiary’s selection was participatory and as per the needs and priorities of the community. 
Priority was given to the villages that have major water problems in case of water supply projects. The case 
of Gosh Meda health center, schools, and villages which are critically in need of potable water can be 
mentioned as an example. Health facilities were selected based on the case load of non-communicable 
diseases namely pneumonia and diarrhea and nutritional status of children. Those kebeles under phase I 
was considered for CLTSH intervention since the intention of CPAMA II was to strengthen efforts commenced 
under the first phase. Beneficiaries’ selection was made by DRR committee as per the set criteria for each 
intervention. For instance, the availability of plot land for vegetable was considered as a criterion for 
agriculture and food security interventions. It was noted that CWW did wealth ranking from the outset and 
target communities have been categorized to the poorest of the poor, poor, medium, and better off. It is 
confirmed that the list was used as reference for beneficiary’s selection by DRR committee. Moreover, the 
DRR contains elected representative of the committee and the list of selected beneficiaries were posted at 
the community gathering or where all have access, and everyone has the chance to validate and complain 
on the selection including the process. 
CWW puts complaint reporting and handling mechanism in place at different level (national to project kebeles) 
to avoid inclusion and exclusion errors. Interviewed beneficiaries and FGD participants confirmed the 
transparency in beneficiary selection. The result of the PDM survey was in line with this opinion as all reported 
to know the mechanism and 97.3% not ever placed complaint with CWW. Those who placed the complaint 
reported that it took less than a week to resolve the complaint. Moreover, the nutritional status of children as 
per the growth monitoring results were used as criteria. Hence, we confirmed that neither inclusion nor 
exclusion error was committed on beneficiaries targeting and the target Woredas are food insecure and 
needs timely intervention. 
6.2.2.Implementation arrangement 
The project was implemented by CWW with active participation of sector offices and beneficiary communities. 
It is noted that the organization structure of CWW is stretched from the head offices in Addis to target kebeles. 
The head office of CWW is staffed with technical expertise in health, nutrition, water and MERL areas. 
Moreover, the North Area Coordination Office located at Kombolcha is staffed with technical experts including 
the Coordinator, Program Manager in charge of managing the project, M&E and other staffs. At Woreda level, 
there were Project Managers (one for each Woreda) and project officers and there were outreach workers 
per target kebeles. It is noted that the project was streamlined with the ongoing CWW development 
activities/programs.
The result of discussion with sector offices at different level confirmed the integration of efforts among the 
implementing and sector offices. The smooth work relationship with zone, Woreda and kebele level sector 
15
offices, health facilities and community level committees like DRR and water users committee was confirmed. 
Surprisingly, none of the interviewed key informant from sector office and discussion participants complained 
on the implementation arrangement of the project. All acknowledged CWW for its transparency, involving 
them on every activities and healthy work relationship. 
Validation workshop participants from Delanta expressed the implementation arrangement of the project as follows. 
“We have been involved in the implementation of the project actively. There was subsequent consultation during 
planning, implementation, and monitoring. The culture of coordination among different sectors in our Woreda has 
been cultivated even for other development activities and we consider such coordination among our sector offices 
as unintended benefit we got from the project. The culture of consultation, collaboration, and sense of ownership for 
the project has been developed compared to the before situation. We have no complin on the implementation 
arrangement of the Woreda since we were part of the project implementors and equally responsible for the success 
and failure of the project.”. They finally mentioned staff and management turnover from their side as a problem which 
had its own impact on the implementation of the project. 
6.2.3.Progress toward the stated outputs
The performance of the project in terms of attaining the stated milestone/output was assessed using the 
output indicators stated in the project document. It is noted that most of the indicators under the health, 
nutrition, WaSH, agriculture and food security and disaster risk reduction falls under output indicators and 
this part of the report portrays the project performances using these output level indicators as shown below.
a) Health sector 
A set of interventions were categorized under four sub sectors namely health system and clinical support, 
communicable diseases, community health and pharmaceuticals and other medical commodities support 
were implemented. The project implemented interventions geared toward strengthening of health delivery 
and preventive services which include capacity building supports to health facilities operating in both the 
project woredas. This includes training/ refresher training to health officers at the woreda offices and Health 
Extension Workers (HEWs) such as HMIS, ICMNCI, Public Health Emergency Management (PHEM) and 
supply chain management (pharmaceuticals and tracer products) working at the respective kebeles.
Refresher training was given to communities aimed at reducing the spread of communicable disease. In the 
same way, as part of capacity building/ improve service delivery, the project, among others, has provided 
sterilizer, waste collection buckets (plastic containers); and other COVID-19 prevention and protective 
equipment as the details of the performance is summarized below. 
16
Table 2 Physical performance of the project -Health Sector 
Objective 1: Health Baseline 
Value 
Target Actual Justification
Sub-sector 1: Health Systems and Clinical Support
Number of Health Facilities Supported 0 77 77
Percentage of total weekly surveillance reports submitted 
on time by health facilities
0% 100% 100%
Number of outpatient consultations 0 2,327 12,954 Increased community 
health seeking behavior, 
collaboration of outreach 
Workers and HEW. 
Number of health care staff trained Total: Total: 192 Total: 135 The outbreak of COVID 
Male: 0 Male: 120 Male: 93 19 affected the training. 
Female: 0 Female: 72 Female: 42
Sub-sector 2: Communicable Diseases
Number of communicable disease consultations 9,867 26,417 25,437 Linkage of HEW and 
outreach workers enabled
to reach the targeted 
number 
Sub-sector 3: Community Health
Number of Community Health Workers (CHW) supported 
(total within project area and per 10,000 population)
0 128 134 Additional 6 CHW
included at the end 
Number and percentage of CHWs conducting public health 
surveillance 
126 
(100%)
126 (100%) 128(100%)
Number of children under five years of age who received 
community-based treatment for common childhood 
illnesses
0 7,843 16,280 Linkage of HEW and HW
and community behavior 
enabled to reach the 
targeted number
Sub-sector 4: Pharmaceuticals and other medical 
commodities
Number of people trained in medical commodity supply 
chain management
0 Total: 92 Total: 31 Outbreak of COVID-19 
Male: 60 Male: 22
Female: 32 Female: 9
Number of health facilities out of stock of any medical 
commodity tracer products, for longer than one week, 7 
consecutive days
14 0 0 This was as the result of 
technical and logistic 
support from the project. 
As shown above, the project experienced a mixed picture in terms of attaining the set targets. Activities 
related to surveillance which involves identification, screening, and treatment of children for common 
childhood illness performed above the target. The major reason for such higher performances were the 
capacity building for health staff and health institutions, the integration of CWW employee, community 
outreach workers with HEW and the cultivated community health service seeking behavior. Moreover, the 
selection of entry points like community assembly sites (churches, health post and centers) to educate 
community on public health at large and supplementing the effort with home-to-home visit were noted as 
17
success factors for the project. Interview and discussion result showed that the commitment of outreach 
workers and HEWs are acknowledged as other success factor and reaching larger number of children. 
Getnet Berehanu is a staff of South Wollo Zone Health Department working at the capacity of Nutritionist. He argues 
that the project enhanced the capacity of health offices and staff at Delanta and Dessie Zuria which has been 
translated to better performance. He explained the situation as follow. “The project supported health facilities and 
personnel in different forms. The training to health workers motivated them and the integration of front-line workers 
namely CWW employed outreach and health extension workers was so smooth and collaborative. They did good 
work and their overall performance in terms of quality and outreach was increased significantly”. He continued 
explaining the result by citing example as follow.” There are 21 Woredas under South Wollo Zone of which Dessie 
Zuria is the first Woreda in terms the percentage of children screed. Dessie Zuria identified and screened more that 
80% of eligible children while the average data for our zone was 40% in last year. Moreover, the quality of the work 
which include regularly updating their data base was better as compared to other Woredas”. He finally, concluded 
that the project has share on the better performance of the Woreda and his office recognizes and acknowledge the 
contribution of the project for the betterment of child health. 
The HEWs, in their part explained the practical skill they shared/ built (supported with regular supervision 
and cluster level review meetings) and the resulting improvement in the areas of child treatment- childcare 
and in general service delivery. The consequences of regular supervision also explained in terms of 
improvement in record keeping, use of assessment chart booklet, classification, treatment of childhood 
illness, and maintaining reporting timelines (weekly surveillance report).
The evaluation result showed that pharmaceuticals and other medical commodities supply, and support was 
smooth and none of the health facilities were out of stock during the project period. Zone and Woreda Health 
Offices confirmed that medicine supply particularly essential drugs were better at the Zone and Woredas 
level due to the health sector financing (revolving fund at each health center) and better supply from the 
government side. However, it was noted that the supply system can be interrupted due to logistic problem
though it not happened in the target Woredas due to logistic support by the project. South Wollo Zone Health 
Department A/Head explained the pharmaceuticals supply system as follows.
“Medicine supply is better in our zone and health facilities usually not run out of stock due to the malfunctioning of 
the health office or lack of revolving fund. But there are times when the supply system does not function well due to 
manmade problem like logistic”. He confirmed that “ Delanta and Dessie Zuria were not out of stock during the 
project period while there were cases where some woredas got out of stock like Sayint due to logistic problem”. He 
continued explain the role of the project in filling the gap as follow. “CWW did logistic support in transporting 
pharmaceutical commodities from Zone to woredas and to health facilities. We acknowledge CWW for their support 
and maintaining none of the health facility out of stock and beneficiating several community members” 
Interviewed HC and HP staff also confirmed that the supply of medical commodity/ medicines was smooth 
and the length of time/weeks in which their stock was empty of the necessary medicines was nil. They 
explained that HCs have the mandate to purchase the necessary medicines quarterly using their own 
financial resources/ revolving budget. Respectively, the visited health facilities did not report a shortage or 
being an out of stock on their priority drugs.
 
b) Nutrition
The project implemented a set of interventions related to Infant and Young Child Feeding and management 
of acute malnutrition with the intent of improving the health and nutrition status of children under five years 
18
of age and reduce child morbidity and mortality rate. It reached 58,036 beneficiaries through nutrition sector 
which was 319% of the target as the summary of output is depicted below.
Table3 Physical performance- Nutrition Sector 
Sub-sector 1: Infant and Young Child Feeding in 
Emergencies Baseline Target Total 
Number of people receiving behavior changing 
interventions to improve infant and young child 
feeding practices
Total: 0
Total 17,891 Total 53,462 Selection of 
appropriate entry 
points for awareness 
creation and 
integration of efforts 
among outreach 
workers and HEW 
resulted in higher 
performance. 
Male:8,445 Male: 23,263
Female:9,446 Female: 30,199
Sub-sector 2: Management of Acute Malnutrition
Number of health care staff trained in the prevention 
and management of acute malnutrition
Total: 0 Total: 206 Total: 204
Male: 0 Male:47 Male:11
Female: 0 Female:159 Female: 193
Number of supported sites managing acute 
malnutrition 77 77 77
Number of admitted rates of recovery, default, 
death, relapse, and average length of stay for 
people admitted to Management of Acute 
Malnutrition sites
Recovery: 
99.3% Recovery: >75% Recovery: 97.2%
Default: 0.5% Default: <15% Default: 1.1%
Death: 0% Death: <10% Death: 0.5%
Relapse: Relapse: Relapse:
Length of stay: 
<60d
Length of stay: 
<60 days
Length of stay: 
72 days
The performance of the project as shown above was above the set target in case of educating target 
community on IYCF and as per the plan in case of training health care staff on the prevention and 
management of acute malnutrition. All public health facilities in the project area; 77 supported and participated 
in the implementation of the planned interventions. In this regard, the following points have been noted.
 The nutrition team leaders of both woredas confirmed that the training was provided to health workers 
on the SAM guideline (revised) that focused on improving case management system, Integrated 
Management of Acute Malnutrition (IMAM). 
 The IYCF team members at both Woredas confirmed that the training and material support, Mother 
to Mother (M to M) and Father to Father (F to F) support group and IEC materials were used as an 
approach to convey / transfer IYCF messages to the wider community. The approaches, as has been 
explained, has applied home to home visit, group meetings at HPs and selected sites/Gots/villages 
and media composed of solar-powered radios and recorded messaging (USB stick). As per the KIIs 
and FGDs, the focus areas of the messages/topics mentioned were dieting during pregnancy, 
breastfeeding, complementary feeding (dietary diversity and meal frequency) and hygiene and 
sanitary practices promotion.
 The use solar powered radio is appreciated as it gives chance to hear the message repeatedly and 
convey the right message. 
19
 As discussed above, the project applied multisectoral approach and the linkage created with nutrition 
sensitive agriculture contributed to improved nutritional status of children.
 The introduction of mothers to mothers and fathers to fathers’ support group is appreciated by local 
government and the beneficiary community. The support groups served as platform for discussion 
and enhanced husbands’ participation in child management affairs. 
“I am impressed with the approach of the project. We are exercising similar approach using the women 
health development army for the promotion of health within the target community. The project thought us 
the other side of the equation- fathers to fathers’ health development army approach. The approach can 
strengthen our women to women development army approach and is one of our home take assignment for
further testing and replication.”
W/ro Astatek Gizaw- South Wollo Zone Women and Children Affair Office 
 The recovery rate is within the SPHERE standard. Reviewed document/progress report and 
discussion with health facility staff confirmed that the recovery rate, default, and death rate of children 
admitted due to acute malnutrition was kept within the international SPHERE cutoff points; above 
75% recovery rate. According to the research work of Hanna Demelash, Abel Fekadu and Haile 
Wolde which was published in February 2017, the recovery rate at Felegwhiwot hospital of Bahirdar 
was 58%. Similarly, the journal listed that the recovery rate at Woldia hospital and Jimma University 
Specialized Hospital as 85% and 77.8% respectively. Hence, the recovery rate recorded by the 
project compared to the nearby areas is encouraging. 
 The length of stay was longer because of the COVID-19 occurrence that hindered health personnel 
and patient free treating. 
c) WaSH
The supply of potable water, sanitation, hygiene promotion and the provision of nonfood items were some of 
the interventions under the WaSH sector. A total of 144,598 people which was 174% of the plan was reached 
through WaSH related intervention. The performance of the project in this regard was as summarized below.
20
Table 4 Physical performance -WaSH
Sub-sector 1: Water Supply Baseli
ne 
Target Total Justifications 
Number of people directly utilizing 
improved water services provided with 
OFDA funding
0 Total: 10,860 Total: 16,868 Late start due to rainy season, 
COVID 19 outbreak and 
lengthy procurement process 
and design approval from 
CWW side contributed for late 
start. The sites are populated 
resulted in higher number of 
beneficiaries. 
M: 5,539 Male: 8,450
F: 5,321 F:8,064
Percent of water user committees 
created and/or trained by the WASH 
program that are active at least three (3) 
months after training
0% 100% 100%
Percent of water points developed, 
repaired, or rehabilitated that are clean 
and protected from contamination
0% 100% 86%
Percentage of households that collect 
25 liters per person per day for drinking, 
cooking and personal hygiene from and 
improved water source
10.80% 25% 3.7% The number of people with 
access to potable water supply 
is 97% but when the amount(25
liter per day is considered, the 
data is 3.7%
Number of primary schools with access 
to water supply facility
0 9 schools 8
Number of health facilities with 
functioning water supply
0 3 health 
centers 
3
Sub-sector 2: Sanitation 
Number of people directly utilizing 
improved sanitation services provided 
with OFDA funding
Total: 0 Total: 73,346 Total: 53,891 COVID 19 contributed for 
under performance.
M:0 Male: 35,940 Male:26,148
F=0 F: 37,406 F:27,743
Average number of users per 
functioning toilet
0 60 50
Percent of households targeted by 
latrine construction/promotion program 
whose latrines are completed and clean
49.1% 70% 82% Quality of latrines was poor 
Sub-sector 3: Hygiene Promotion
Number of people receiving direct 
hygiene promotion (excluding mass 
media campaigns and without double 
counting)
Total: 
37,647
Total: 82,896 Total: 101,648 Hygiene promotion works done 
by organizing public show, 
musicians, songs, drama, by 
celebrating global hand 
washing days. Key messages 
were transmitted to the public. 
Male: 40,619 Male: 50,770
Female: 
42,277
Female: 50,878
Number of school WASH clubs 
established and trained 
0 9 clubs 22
21
Sub-sector 4: WASH Non-Food Items
Total number of people receiving WASH 
NFIs assistance through all modalities 
(without double counting)
0 Total: 1,976 Total: 1,976 Soap and Jeri can distributed
Male: 1,522 Male: 
Female: 454 Female: 
Percent of households reporting 
satisfaction with the contents of WASH 
NFIs received through direct distribution 
(i.e. kits), vouchers, or cash
0% 70% 97.20% Beneficiary interviews and a 
PDM survey
Percent of households reporting 
satisfaction with the quantity of WASH 
NFIs received through direct distribution 
(i.e. kits), vouchers, or cash
0% 70% 93.60%
The project has constructed the 4 pipeline extensions, 3 rural pipe system, 3 new spring and 1 hand dug 
well. On top of that the project has created potable water access to 3 health centers and 7 primary schools. 
The team visited water schemes, sanitation facilities and nonfood items distributed at the field level. In this 
regard, water line extension in Ambaye Kebele of Delata with its 50,000-liter capacity reservoir, springs like 
that of Kola Mote in Desse Zuria including its distribution points, collection chambers were observed. 
Moreover, discussion was made with water user committee and beneficiary community. The findings are as 
discussed below. 
Potable water supply 
The planned water schemes have been constructed and are serving the target community. The findings 
related to water supply are as follow.
 The number of beneficiaries reached is higher than the targeted number. It is noted that the sites are 
populated, and water was distributed for those villages where the line is crossing. Though reaching 
more number and address benefit sharing issue is fine, it was important to consider the population 
number during the design as population size is an important variable that affects the quantity of water 
for supply and life span of the scheme. 
 The construction of water scheme was late and done in the second and third quarter of 2020. The 
lengthy procurement process from CWW side and the rainy season which came after
commencement of the project contributed for the delay. Moreover, it was noted that the approval of 
design of water scheme was done at CWW head quarter/Dublin that took prolonged time and 
resulted in delay of construction works. Zone Water and Energy Department explained their concern 
and the availability of skilled personnel who can manage the design works and bill of quantity at their
level and shorten the time. They mentioned the possibility of seeking support from Regional Bureau 
in case higher technical support is required. 
 Study and design of the proposed water schemes were conducted from April to September which is
mainly rainy season. Under such case the timing, particularly June to September is not the right time 
to identify schemes and design due to the false water discharge in rainy season that can mislead the 
result. 
 All visited water distribution points have established Water User Committee (WUC) and have 7
members, of which at least one member is a female. Moreover, 2 members of the committee were 
trained in operation and maintenance of water schemes. The project handed over hand tools to 
22
Woreda Water Office though the trained committee members on operation and maintenance did not 
yet receive tool kits that is supposed to help them in undertaking simple operation and maintenance.
 All water schemes have established water users’ fee ranging from Br 3 to 15. Most of them started 
fee collection in the last few months though cash is in hands of individuals. The amount of water 
users fee in some cases is low and might not cover the running cost. Example- Yediha which was 
found to be less than the system’s requirement to cover expenses (guarding and O&M)
 FGD participants responded that the time for water fetching due to travel and queening reduced. On 
the average they require 10-20 minutes’ walk which was more than half an hour before the project. 
Moreover, they responded that the quantity of water they are collecting increased as compared with 
the before project situation. However, it was observed that water points are open twice in a day that 
affected the amount of water collected per day. 
 The surrounding of water schemes is clean, schemes are fenced, locked, and the workmanship of 
the structures noted as very good.
Figure 1 Water Distribution Sites-Closed before operating time
Sanitation and hygiene 
The project promoted sanitation and hygiene practice through awareness creation and encourage 
community to construct latrine. The project met the target as shown below while the following points are 
noted.
 Project participants constructed toilets using masonry/stone or wood wall, corrugated iron roof and 
door and wood floor. Though the use of durable materials was observed, most are constructed from 
local materials and their durability is noted as shorter due to the quality of construction materials.
 Discussion made with the community uncovered that community practice hand washing practices
and the outbreak of COVID-19 accelerated the sanitation practices within the community. However, 
it has been understood that a delay in construction of water schemes, and shortage of water at some 
community scaled down the practices. 
23
Figure 2 Better quality latrine Constructed.
WASH Non-Food Items
The project distributed WASH NFIs (soap and jerry-can) to strengthen the water and sanitation interventions. 
Both the household survey and discussion with the community confirmed community satisfaction with the 
service in terms of the distribution modality, quality, and quantity. Details of this is discussed under the impact 
part of this report.
d) Agriculture and food Security 
As part of agriculture and food security sector, improving agricultural production and/or food security activities 
and the promotion of improved agricultural practices were implemented. Accordingly, 11,377 households 
which was 190% of the target addressed and 80.85 ha which was 168% of the target brought under improved 
agricultural practices. Awareness creation developed farmers interest for the program and supply of inputs 
like vegetable seed contributed for the better performances. 
e) Disaster Risk Reduction 
A total of 412 beneficiaries which was 80% of the target reached through DRR activities as detailed 
activities status shown below.
24
Table 5 Physical performance – DRR
Objective 5: Risk Management Policy and Practice Baseline Target Total 
Sub-sector 1: Policy and Planning
Number of hazard risk reduction plans, strategies, policies, disaster preparedness, 
and contingency plans developed and in place 7 63 94
Number of people participating in discussions regarding national risk reduction 
strategies because of the program 0
Total: 33 Total: 38
Male:24 Male: 34
Female: 9 Female: 4
National and local risk assessment, hazards data and vulnerability information is 
available within targeted areas (Y/N) No Yes Yes
% of communities in risk-prone areas with mitigation plans meeting minimum 
standards 55% 60% 100%(n=22)
Sub-sector 2: Building Community Awareness/Mobilization
Number of people participating in trainings 0
Total: 481 Total: 412
Male: 350 Male: 315
Female: 131 Female: 97
Percentage of attendees at joint planning meetings who are from the local community 0% 25% 25%
As shown above, activities under this sector were accomplished as per the plan; hazard risk reduction plans, 
strategies, policies, disaster preparedness, and contingency plans developed and put in place, trainings 
conducted, and community members participated in planning meeting. All (22) communities in risk-prone 
areas developed mitigation plans that meets minimum standards. Consequently, activities contained in the 
plans were implemented which was an additional value for the project. A total of 1490 km of hill sides, 2115 
km of farming trace, 25 km of flood diversion cannel were constructed, 50,000 seedlings were planted, and 
57,846 livestock vaccinated as the result of developing hazard risk reduction and implementation which was 
not part of the planned interventions. The deputy kebele Administrator in Ambaye, Memihir Merayaw Ayele 
(and FGD participants) in Delanta explained the purpose of establishing DRR and its contribution/ benefit as 
follows.
“We have DRR committee at kebele level consisting of kebele chairperson, representative of agriculture, health, 
youth, school, Women Affairs and religious leaders. They responded the DRR purpose in such a way that instituting 
DRR in their kebele has helped them in the initiation of planning (beforehand) and taking the responsibility to 
communicate early warning information to residents and sectoral offices. He explained that the plan foresees natural 
hazards expected to prevail, preliminary preparation to be made and deal with the situation (resource mobilization, 
making responses). The Committee then initiated a structure/ system that mobilizes resources (savings in terms of 
money as well as agricultural produces) and responds in cases of household’s livelihoods disruption. Accordingly, 
participants as well explained the mini groups organized aimed at mobilizing resources-savings (one group saves 
Br 20 per month, other group Br 12 per 15 days, etc.). On the other hand, the kebele manager has mentioned the 
support the kebele has provided (Br 500 per year) to 44 and 24 children/ teenagers (2012 and 2013 EC respectively) 
who lost their families.
Similarly, the DRR committee Chairperson, Seid Muhiye in Atint Mesberia (Dessie Zuria) explained their role in 
such a way that “community members identified risk areas, organized community groups and continued to 
implement conservation activities in areas identified as risk prone”. They continued their explanation by saying/ 
showing “soil and water conservation activities implemented at individual farms and community managed areas that 
overall reduced soil erosion and thereby the risks associated with it.”.
25
DRR initiated/ supported soil and water practice
6.2.4.Adherence to program participants protection policy 
CWW has different protection and participation policies including the code of conduct (March 2018), 
Complaint and Response Mechanism Guideline, Associated policies to Concern’s Code of Conduct and Child 
protection policy. Interviewed staff confirmed that they know the polices and signed up on their engagement 
with CWW. Process owners within the coordination office confirmed that their staff has signed and adhered 
to the participants protection policy. 
The result of structured survey on sampled project participants confirmed same result. All sampled 
households (100%) confirmed that they are aware of the complaint and response mechanism and knows 
how to use it. Project beneficiaries expressed their satisfaction with the service.
6.2.5.Monitoring and evaluation
Discussion made with the sector offices, health facilities and community confirmed that CWW and partners 
conducted regular and joint monitoring. Project staff at respective Woreda(officers) monitor the day-to-day 
activities of the project while the outreach workers made home to home visits and monitor the progress. The 
north coordination office staff, program manager with the support of other staff monitor the performance of 
the project. 
Sector offices acknowledged for receiving quarter reports on regular base and timely. Moreover, there were
review of programs by GO-NGO forms for which CWW is the chair organization. Zone Finance and Economic 
Development Office also confirmed that the project submit reports on time and CWW is one of the top best 
performing NGO in their zone. Woreda sector offices also acknowledged the timely monitoring activities of 
CWW. 
26
6.3. Efficiency 
The efficiency of the project in terms of cost effectiveness, the extent to which management of the project or 
cooperation with the stakeholders contributed toward the efficacy of the project, realistic of the timeline of the 
project. In this regard, the project utilized 97% of the budget allocated as summarized below. 
Table 6 Financial performance of the project in USD
Line item 
Revised 
budget Utilized %
1 Sub-awardee Salaries
1.1 National Staff
1.1.1 Woreda Based 
 
317,345 
 
298,624 94%
1.1.2 Coordination Office Staff
 
84,080 
 
78,251 93%
SUBTOTAL: Field Staff 
401,425 
 
376,875 94%
1.1.3
Head quarter staff 
66,410 
 
65,606 99%
1.2
International Staff 
39,015 
 
36,228 93%
Total salary 
506,850 
 
478,708 94%
2
Sub-awardee Fringe Benefits 
210,229 
 
208,714 99%
3
Sub-awardee Travel and Transport 
266,934 
 
268,406 101%
4
Sub-awardee Program Supplies 
504,243 
 
492,045 98%
5
Sub-awardee Other Direct Costs 
187,823 
 
216,615 115%
6
Sub-awardee Beneficiary Training 
99,492 
 
109,445 110%
7
Sub-awardee OMB Circular A-133 (or RCA) 
Audits if not recovered under approved NICRA
 
2,495 
 
4,132 166%
TOTAL DIRECT/SUB-AWARDEE COSTS
 1,778,065 
 
1,778,065 100%
8
Sub-awardee (Concern Ireland) Indirect Costs - 10% on 
Total Modified Indirect Costs
 
123,430 
 
118,635 96%
TOTAL SUB-AWARDEE COSTS 
1,901,495 
 
1,896,700 100%
9
Approved/Applicable NICRA (5.54% on Total Direct 
Costs)
 
98,505 
 
38,116 39%
Total program cost 
2,000,000 
 
1,934,816 97%
The utilization of budget as shown above was as per the allocated budget except for minor under performance 
under salary and cost over running under sub award OMB Circular. Of the total fund utilized, 92% and 6% 
was utilized for direct/sub award cost and sub awardee (Concern Ireland) Indirect Costs respectively. The 
rest 2% as approved/Applicable NICRA. 
27
Closely observing the fund utilization, 36% allocated for salary and benefit (25% and 11% for salary and 
benefits respectively). A quarter of the fund (25%) was utilized for program supplies which includes 
construction of water supplies, materials, survey, water quality test, gender mainstreaming and the like. 
Similarly, 6% of the budget was utilized for beneficiaries training. Viewed from the perspective of utilizing the 
allocated budget in line with the approved budget line item, the performance of the project was appreciable. 
Of the utilized fund, 41% was for WaSH followed by health (16%) and Agriculture. The average cost per 
beneficiary was 7.50 USD with the maximum of 20 USD/beneficiary in agriculture and food security. Cost per 
beneficiary was lowest for nutrition as summarize below.
Table 7 Fund utilization by sector in USD 
Sector 1: 
Health
Sector 2: 
Nutrition
Sector 3: 
WASH 
Sector 4: 
Agriculture 
and Food 
Security
Sector 5: 
RRMP
Total 
Budget 
318,868 
 
440,910 
 
808,585 
 
231,957 
 
199,680 
 
2,000,000 
Utilized 
309,243 
 
412,363 
 
793,784 
 
227,524 
 
191,902 
 
1,934,816 
% utilized 97% 94% 98% 98% 96% 97%
% share 16% 21% 41% 12% 10% 100%
# of beneficiaries 
43,624 
 
58,036 
 
144,598 
 
11,377 
 
414 
 
258,049 
Cost/beneficiary 7.09 7.11 5.49 20.00 463.53 7.50
The cost effectiveness of the implementation arrangement was also assessed in lens of cost effectiveness 
and the major findings are listed below.
 The project was streamlined with the existing CWW organizational set up which is stretched from the 
head office to Woreda. It was implemented in coordination with other programs like REGRADE, No 
Girls Left Behind, Bakalar water supply and KOICA Livelihood projects under the north coordination 
office. Such arrangement allowed cost saving, sharing experience among projects and logistics. 
Such integration is also vital for increasing the resolution of the project impacts.
 The project was streamlined with the existing government structure. Government staff like sector 
staff (health, water, agriculture) were mobilized and they actively engaged in the implementation of 
the project. The arrangement is acknowledged for its cost saving on top of paving ways for project 
sustainability. 
6.4. impacts 
This section of the report presents the changes brought as the result of the project intervention using 
indicators selected under the five sectors and sub sectors. Some of the indicators stated under the sectors 
are output level and discussed under the effectiveness of this report and hence this section will focus only on 
the higher level (outcome/impact) level as discussed below. 
28
6.4.1.Health 
The objective of the health sector was to improve health and nutrition status of children under five years of 
age and reduce child morbidity and mortality related to communicable diseases (diarrhea, pneumonia, 
malaria) through a disaster risk reduction and systems strengthening approach at the community and health 
facility level. Indicators listed under this sector are out put level and discussed under the effectiveness part 
of this report. 
6.4.2.Nutrition 
The objective of the nutrition sub sector was to improve the health and nutrition status of children under five 
years of age and reduce child morbidity and mortality related to communicable diseases (diarrhea, 
pneumonia, malaria) through a disaster risk reduction and systems strengthening approach at community 
and health facility level. The sector has got two sub sectors namely Infant and Young Child Feeding in 
Emergencies (IYCF) and Management of Acute Malnutrition and the performance toward the stated outcome 
indicators are as discussed below.
A) Infant and Young Child Feeding in Emergencies (IYCF) sub sector.
Indicator 1. Proportion of infants 0-5 months of age who are fed exclusively with breast milk.
According to the World Health Organization (WHO), breastfeeding has many health benefits for both the 
mother and infant. Breast milk contains all the nutrients an infant need in the first six months of life. 
Breastfeeding protects against diarrhea and common childhood illnesses such as pneumonia and may also 
have longer-term health benefits for the mother and child, such as reducing the risk of overweight and obesity 
in childhood and adolescence.
Exclusive breastfeeding is when the infant receives only breast milk; no other liquids or solids are given – not 
even water – except for oral rehydration solution, or drops/syrups of vitamins, minerals, or medicines. 
Considering this definition, the result showed that 95.4%(n=83) of a child under 6 months breastfed yesterday 
during the night or day prior to the survey date. The finding showed that 4.6% not breastfed at all in the last 
24 hours of the survey date. According to the 2019 Min Demographic and Health Survey (DHS), 94% did
breast feeding while the rest 6% of infants under age 6 months not breastfed at all 24 hours prior to the 
survey date. Hence, the performance of the project was slightly higher than the national average. 
The percentage of child under 6 months who did exclusive breastfed yesterday during the night or day prior 
of the survey date was 79.3 % which was 77.5% during the base year. According to the 2019 Mini DHS result, 
59% of infants under 6 months did exclusively breastfed in Ethiopia and the status of the project area was 
higher as compared to the national average data. 
The performance was below the set target (90%) and the change as compared to the baseline is marginal 
and statistically not significant. Mothers explained that they run after their family affairs in addition to caring
for their children. Consequently, it was unlikely for them to stay with children throughout the day and there 
are times when their elders or others take care of the children. Under such case, they said that it is 
unavoidable to give available supplementary feed at least water though they know that a child should fed 
29
exclusively on breast. This was raised as major reason which diminished the proportion of children with 
exclusive breast feedings. The summary of the finding is as shown below. 
Figure 3 % of children with breast feeding Figure 4 % of children with exclusive breast feeding.
The performances of the woreda by the end of the project was comparable as 79.3% of the children 
under 6 months did exclusive breast feeding in the last 24 hours of the survey date. In terms of 
changes from the base line situation, it was relatively better for Delanta than Dessie Zuria. However, 
as explained above the change from the base line status was marginal as shown below. 
Figure 5 Percentage of children with exclusive breast feeding in the last 24 hours of the survey date. 
The practice of exclusive breast-feeding was cross- tabulated with the age of respondents and the 
result showed that respondents at younger age practice exclusive breast feeding slightly higher than 
their elders. As stated above, the average age of respondents administered for EBF is 28 and taking 
this average age as cutoff point, 80.3% of the respondents under the age of 28 practiced exclusive 
breast feeding while the status for above 28 years old respondents was 73.1%. Similarly,78.2% and 
70% of respondents within the age range of 20-30 and 30-40 practiced exclusive breast feeding 
which shows reduction in breast feeding practice as age increase.
The correlation of family size with exclusive breast-feeding was tested using the average family size 
of respondents (4.41) as cutoff point. The result showed that exclusive breast-feeding practice 
reduce with an increase in family size. The proportion of mothers who did exclusive breast-feeding 
among respondents with less than 4.41 family size was 80.4% while the practice was 74.2% among 
respondents with above 4.41 family size.
4.6%
95.4%
% child with breastfed yesterday 
during the day or night- End line 
No Yes
79.30% 77.50%
% child with exclusive breastfed 
yesterday during the day or night
Baseline
End line
78.30%
76.90%
77.50%
79.30%
79.30% 79.30%
75.50%
76.00%
76.50%
77.00%
77.50%
78.00%
78.50%
79.00%
79.50%
Desie Zuria Delata Project
Base line End line
30
The finding showed that the use of additional feed particularly plain water was common for the reason 
stated above. Closely observing the feeding practices, children under 6 months took additional foods 
to breast milk which lowered the proportion of children who practices exclusive breast feedings. Plain 
water was taken by 17.2% of the children under 6 months followed by porridge (4.6%) and milk other 
than breast milk (3.4%). It is noted that some of the sampled children took more than one food items
in addition to breast milk as shown below. 
Figure 6. Percentage of children who fed additional food to breast milk in the last day or night.
The result of discussion with mothers’ groups is in line with the household survey result. Under all FGD 
setting, mothers confirmed that all of them fed breast milk to their child. They confirmed that the awareness 
they got from the project supported them to have in-depth understand about breast feeding not only its 
importance but also the techniques of exclusive breast feeding.
“we know that breast feeding is important for newborn children. Accordingly, we are feeding our children as much 
as possible. The health extension workers and women health development army are educating us on breast feeding 
but the project educated us in detail on the breast feeding”. Among M-to-M participants W/ro Fetenu Adimas 
(Tsehay Mewucha) explained the benefit in the following way: “Though we know about breast- feeding earlier, our 
understanding about the benefits and techniques was limited. Now we start breast-feeding as early as possible 
after birth and give due consideration for the frequency, positioning, and the like. We are giving supplementary feed
after 6 months. Though we understand the need for exclusive breast feeding, there is workload in the household 
and sometimes we leave children with their elder siblings to take care at our absence. When a child cry in between, 
they feel that a child is in hunger and give at least water or milk when available”.
FGD participants in Tsehay Mewucha kebele of Delanta Woreda 
Indicator 2. Proportion of children 6-23 months of age who receive food from 4 or more food groups.
(Child Minimum Dietary Diversity)
According to World Health Organization, children older than 6 months are recommended to consumption of 
at least four food groups among the identified seven food groups. Considering this, the intention of the project, 
was diversifying dietary among children 6-23 months.
The finding shows that the percentage of children aged 6-23 months who received food from 4 or more food 
groups increased from 16.4% to 34.8% by the end of the project and the change is statistically significant. 
17.20%
2.30%
3.40%
1.10%
4.60%
2.30%
0.00%2.00%4.00%6.00%8.00%10.00%12.00%14.00%16.00%18.00%20.00%
Plain water
Infant formula((such as Lactogen, Cerelac)
Milk other than breast milk
Juice or juice drinks
Porridge
other liquids, including sugar water, clear…
31
According to the Health Sector Transformation Plan of Ethiopia, October 2015, only 4.3% of children under 
6 months consumed the recommended four food groups. 
According to the result of the survey, 25% of sampled children aged 6-23 months met the MAD standard 
which was 14.2% during the base year. Similarly, the 2016 mini-DHS report, showed that the percentage of 
children who met minimum acceptable diet in Ethiopia was only 7%. Though there is time difference to some 
extent, still the performance of the project was remarkable. 
W/ro Hawa Mohammed is the resident of Asgede kebelee of Dessie Zuria. She explained the benefit she 
got from the project as follows. “my knowledge on child feed diversification was limited and I used to focus 
on major foods mainly cereals. After attending a training/ demonstration which was facilitated by CWW
staff and HEW, I started to think out of box and include all available food items in my home to the child 
food menu. I am growing vegetable and included it to the diet which was not the case before. I am now 
appreciating that every food item in the house has value and add to the diet. The challenge from my side 
is that I am poor, and availability of food items at home is limited, which forced me to feed my child limited 
varieties”. She continued explaining the benefit and in between remained cautious thinking of how to 
sustain the practice without having the project’s support of diversification and improving crop production 
and productivity, vegetable, and livestock for the future.
The finding showed that dietary diversification at Dessie Zuria showed significant improvement while the 
performance at Delanta showed decline from the effect of frost. Key informants from Delenta explained that 
diversifying diet is one of the recent developments achieved not only for children but also adults and cited 
the inclusion of vegetables grown on their garden. Similarly, project final evaluation validation workshop 
participants explained that the finding from the household survey does not represent the reality on their 
ground. The summary is as shown below. 
Figure7 Proportion of children 6-23 months of age who receive food from 4 or more food groups
Data on diet diversity was further analyzed to understand the intra food groups consumption patterns. The 
result showed that most children 6-23 months took grains, roots and tuber as supplementary feeding followed 
by fruits and vegetables. Compared with the baseline situation, there is increment in proportion of children 6-
23 months who fed on fruits and vitamin A rich vegetables.
18.60%
47.40%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
Base line End line
Dessie Zuria 
14.20
%
12.90
%
12.00%
12.50%
13.00%
13.50%
14.00%
14.50%
Base line End line
Delanta 
16.40
%
34.80
%
0.00%
10.00%
20.00%
30.00%
40.00%
Base line End line
Average 
32
Discussion made with the beneficiaries uncovered that there is higher proportion of children who consumed 
vegetable and fruits in the last 24 hours due to the awareness raised on the importance of vegetables and 
fruits for child health and the improvement in supply of vegetable for families as the result of cultivating back 
yard vegetable. Th result of survey data shown below confirms this fact. 
Figure 8 Percentage of children who consumed the food groups by type.
The dietary diversity situation of children within the two target Woredas were compared. The result of the 
survey shows that the proportion of children 6-23 months consumed the listed food groups is better at Dessie 
Zuria as compared to Delanta. The proportion of children who had all food groups is higher for Dessie Zuria 
where the difference is higher for eggs, fruits, and vegetables as shown below.
Table 8 Proportion of children aged 6-23 months by food groups they had and Woreda 
Food Groups 
Woreda
Dessie Zuria Delanta Total
Number % Number % Number %
Food group 1 Grains, roots and tubers Yes 159 90.9% 67 66.3% 226 81.9%
Food group 2 Legumes and nuts Yes 39 22.3% 19 18.8% 58 21.0%
Food group 3 Dairy products (milk, yogurt, cheese) Yes 71 40.6% 39 38.6% 110 39.9%
Food group 4 Flesh foods (meat, fish, poultry and liver/organ 
meats) 
Yes 3 1.7% 0 .0% 3 1.1%
Food group 5 Eggs Yes 84 48.0% 13 12.9% 97 35.1%
Food group 6 Vitamin-A rich fruits and vegetables Yes 95 54.3% 18 17.8% 113 40.9%
Food group 7 Other fruits and vegetables Yes 107 61.1% 18 17.8% 125 45.3%
81.9%
21.0%
39.9%
1.1%
35.1%
41%
45%
81.4%
32.9%
34.9%
7.7%
32.2%
13.3%
20.6%
Food group 1 Grains, roots and tubers
Food group 2 Legumes and nuts
Food group 3 Dairy products (milk, yogurt, cheese)
 Food group 4 Flesh foods (meat, fish, poultry and…
 Food group 5 Eggs
Food group 6 Vitamin-A rich fruits and vegetables
Food group 7 Other fruits and vegetables
Base line End line
33
M to M Club Member without Own Land but Practice Gardening
W/ro Hager, within 20’s years of age, married and has 3 children. She withdrew from school from grade 8 due to limited economic 
capacity of her parents to support her. Then she married at early age to a person chosen by her parents. Hager, having no 
farmland of her own, in 2018 was selected by DRR Committee to be a beneficiary of IYCF. Consequently, she, being literate, 
became an active participant of Mothers-to-Mother’s support group. 
During the first phase she received vegetable seed from CWW and tried on a plot of land rented from her neighbor with the aim 
of providing basic feed ingredients /diversify child’s food. The production she obtained was more than expected and resulted an 
alternative income without which she could not sustain as a landless. She without any hesitation purchased cabbage seed and 
planted on a rented plot near her resident (about 150 m2
) the production of which became beyond satisfactory. She said that “I
included vegetables to my family food menu which was not common in the past. I understood the importance of vegetable on my 
child health and feeding practices”. She continued explaining that vegetable was available to some extent in the local market, but 
I could not afford purchasing. Moreover, market days are limited, and the quality of vegetable was not as good as I am harvesting 
from my farm since it is coming from distant areas. I also sale part and I earned Br 3000, from sale of cabbage produce.”
During the discussion, Hagere expressed her acknowledgment to the Project’s contribution not only grasping basic knowledge 
on exclusive breast feeding but also on the management of children greater than six months old. On top of that she also gave 
credit to the Project for supporting her to realize an alternative income without which it was impossible
to lead the present conservative lifestyle. However, she in between of the conversation thought of the challenge she may 
face/encounter on sustaining the gardening practice because owners looking into the benefit may resort to use their land by their 
own. 
6.4.3.Water Sanitation and Hygiene (WaSh)
Water, sanitation, and hygiene was one of the four sectors implemented by the project with the objective of 
contributing to the reduction of mortality and morbidity associated with malnutrition through improving 
sustainable access to safe water, sanitation, and hygiene. The sector consists of four sub sectors namely 
water supply, sanitation, hygiene promotion and WASH Non-Food Items. A total of 144, 598 people against 
the planned 82896 was served under this sector. A total of 26 kebeles, three health centers from Dessie 
Zuria Woreda were targeted under the WASH component.
34
A set of objectively verifiable indicators under each sub sectors were assigned to gauge the performance of 
the project. Most of the indicators are output level indicators and discussed under the effectiveness part of 
this report. However, those higher-level indicators for which their data was captured through KAP survey are 
discussed under this part as follows. 
a) Water supply
Indicator 1. Percentage of households that collect 25 liters per person per day for drinking, 
cooking, and personal hygiene from and improved water source.
According to the national water supply standard, a person at the rural area is supposed to get 25 liter per day 
for drinking, cooking, and personal hygiene from improved water sources. In this regard, the project created 
access to potable water sources through developing water points and extension of pipe system to the 
community and institutions. The overall performance is as summarized below.
 Pipeline system and water points were constructed as disused under the effectiveness part of this report. 
Accordingly, the percentage of people with access to potable water source increased from 90.4% at the 
base year of the project to 96.8% by the end of the project. A total of 16,868 people got an access to 
improved water sources and the increment in access to potable water source was statistically significant. 
The status of the project area in terms of access to potable water source is better compared to Woreda 
and South Wollo zone. For instance, access to potable water at Delanta Woreda in 2020/21 is 76.74% 
which is lower than the project kebeles. 
 Pipeline and extension work were the major intervention of the project. Consequently, public tap to 
yard/plot became the major sources of potable water that accounts for 74.5% followed by piped water in 
to the dwelling and protected springs. As compared to the base year, there was major shift from 
depending on springs and wells (both protected and unprotected) to public tap as displayed below. 
Figure 9 Primary water sources 
11.7%
1.3%
74.5%
2.4%
1.9%
7.4%
.8%
.0% .0%
.0%
9.4%
47.0%
22.0%
.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Primary water source for human
End line Baseline
35
 Though an access to potable water sources has been increased, still there are barriers in use of water 
which include waiting time (38.8%), their busyness to go and collect water (20.9%) and distance to the 
source (16.3%).
 The average frequency to collect water per day is 1.72 which is about twice per day mainly in the morning 
and afternoon. Majority of the households (93%) are using 20-liter collapsible jerrican for collecting water. 
 The finding of the end line survey showed that an average of 41.35 liter per day (38.12 liter and 45.33 
liter for Dessie Zuria and Delanta respectively) was collected by a household during the survey date. 
Considering the average household size of the WASH KAP survey (4.70), the per capita water 
consumption was 8.8 liter per day per person with higher consumption at Delanta(9.9 liter per day per 
person). 
 The survey uncovered that 3.7% (Dessie Zuria 3.8% and Delanta 3.6%) of households collect an 
adequate daily amount of water (as per the standard) from an improved reliable water source. The 
performance is below the set target (25%) and the base line data (10.8%). The following points/opinions
have been noted under this case.
o The fact that water schemes are open twice in a day limited the volume of water collected and 
consumed by beneficiaries. Of the respondents 38.8% raised waiting time as barrier on collection 
and use of water
o Discussion made with the community confirmed that there is no complain on the discharge/yield
amount from water schemes and their concern was on limited time when water points are open. 
We also noted the practice of optimal water utilization like regular bathing is limited due to low 
practice level and weather condition.
o The project area is high land with limited demand for drinking water, as explained by discussion 
participants, contributed for low consumption. 
o The construction of facilities like washing basin along with the water schemes enabled 
households to use the water at the distribution points that can limit the amount of water collected. 
o We triangulated the result of the household survey with the qualitative information obtained 
through discussion and observation. We confirmed that the schemes are open twice in a day 
and there was queening for water collection. Moreover, we observed that people mainly use 20-
liter jerrycan which is in line with the result of the end line survey. 
 
b) Sanitation
Indicator 1. Percent of households targeted by latrine construction/promotion program whose 
latrines are completed and clean.
Enumerators observed the condition of latrines and 75% of the latrines were fully constructed/completed and 
clean. The baseline survey report showed that 49.1 % of latrines were fully constructed and clean. Discussion 
participants attributed the change to awareness creation works of the project. Field observation made also 
confirmed that significant number of latrines were completed and clean though the materials for construction 
for most was local and their durability is the concern area. 
36
c) Hygiene promotion 
Indicator 1. Percent of people targeted by the hygiene promotion program who know at least three 
(3) of the five (5) critical times to wash hands.
Discussion made with the project participants and other key informants showed that hand washing practice 
has been promoted during the project period. The outbreak of COVID-19 was also an opportunity for the 
promotion of hand washing as there was education through different medias. On the other hand, the result 
of the household survey showed marginal improvement, and the validation workshop participants explained
their reservation on the validity of the household survey in sanitation and hygiene in addition to food 
diversification. As per the recommendation of workshop participants outlier data for Delanta was cleaned and 
still the performance is lower though it is above the base value. 
Ato Zeleke Assefa, 45, is the resident of Ambaye kebele, Beg Amba Village/got of Delanta Woreda. He explained 
the sanitation practice as follows. “we have been educated on sanitation and hygiene which includes hand washing, 
how to store water and keeping our compound clean. As per the education we received from CWW staff and kebele 
health extension worker, we are washing our hands and water containers, among others. The project also provided 
us soap and plastic water container. We understood that several people are dying due to the recent outbreak 
diseases and it is must for my family members to wash our hands to be safe. My neighbors and all people I know 
wash their hands at least after visiting toilet and before eating”
The result of survey showed that the percentage of respondent who knows 3 out of 5 main critical moments 
for hand washing increased from 83.5%(baseline) to 86.8% by the end of the project period. The change is 
statistically significant, marginally as p value is 0.498 where 0.5 is a cutoff point. The proportion of 
respondents who knows 3 critical times for hand washing increased from 89.6% to 91.3% at Dessie Zuria 
and 75.9% to 81.2% at Delanta.
The proportion of beneficiaries who practiced hand washing at the 5 critical times showed differs across the 
board. The percentage of beneficiaries with hand washing practice after defecation and before preparation 
of food is higher as compared to others. Hand washing after cleaning the defecation of children is the lowest 
practice as compared to other critical time as shown below. 
Figure 10 % of respondents with hand washing practice at critical time
81.0%
62.0%
83.9%
72.5%
74.6%
.0% 50.0% 100.0%
HAND WASHING AFTER DEFECATION/FAECAL …
HAND WASHING AFTER ATTENDING TO A CHILD …
HAND WASHING BEFORE PREPARING FOOD
BEFORE FEEDING A CHILD
BEFORE EATING
% of respondents with hand washing practice at critical times
37
Though it was not part of the project indicator, the household survey captured the environmental sanitation 
situation of the project participants. The result of the observation result revealed the presence of either human 
or animal feces within 37.6% of the survey respondents’ compounds (22.1% and 56.5% at Dessie Zuri and 
Delanta respectively). The base line data was 41.7% and there is slight reduction in occurrence of either 
animal or human feces. The observed feces predominantly belonging to animal (88%) while observed human 
feces was insignificant; 0.7%. There is difference in the type and intensity of feces observed at Delanta and 
Dessie Zuria. 
Indicator 2 Percent of households targeted by the hygiene promotion program who store their 
drinking water safely in clean containers.
Water storage safety is the indicator which assesses the proportion of households storing drinking water in 
a way that protects its quality and prevents contamination. Information for measuring the safety of water 
container can be generated through self-reporting or observation methods. A total of four questions are used 
to measure the water storage safety as listed below.
 Are the water containers clean?
 Is there any lid?
 Does the water store in separate jug?
 Do the water containers have narrow necks and/or presence of tap?
The possible answer for the above four questions is yes or no and water is stored safely only if at least 
three answers to the observation-based questions are “YES”. Based on these method and computation,
data collected by enumerators through observation was computed and the result show that 66.2% of 
respondents store water safely which was 33.6% during the base year. The performance is above the 
baseline but slightly below the set target 70%.
The result of the end line survey showed that 23.5% of the respondent’s store water for drinking and 
domestic consumption. Observation made by enumerators confirmed that 79.4% of the respondents’ 
water containers were clean, lids observed on containers within 95.6% of respondents, there is presence 
of tap or narrow mouth on 73.5% of containers and 67.6% of respondents store water in separate jugs. 
The cleanness of containers was compared with the before project situation and the result showed a 
mixed picture. The percentage of households who store water in separate jug and presence of tap on 
narrow mouth increased from 23% to 67.6% and 40% to 73.5% which is a positive change. Similarly, 
presence of lid increased from 73% to 95.6%. On the other hand, the cleanness of containers has been 
reduced from 84% to 79.4% during the project period. The quality of data from Delanta might be the 
reason (as challenged by validation workshop participants) for such reduction since 100% of containers 
at Dessie Zuria reported as clean while that of Delanta was 36.4%. The comparison of the base and end 
line situation is as shown below.
38
Figure 11 Cleanliness of Container based on Enumerators Observation in percentage 
Indicator 3 Percent of households targeted by the hygiene promotion program with no 
evidence of feces in the living area.
Enumerators observed the presence of fecal matter around the latrine hole and found that 76.5% of 
households’ latrine hole were free of feces which was above the baseline (58.3%) and the set target 
(70%). Community awareness creation and technical support by the project and government offices 
contributed for better performance. 
d) WaSH NFI 
The project distributed nonfood items namely jerrican and soap to strengthen the access to potable water 
supply and its proper utilization. The beneficiary selection was done in collaboration with kebele Disaster 
Risk Reduction Committee, and the distribution effected accordingly. Accordingly, beneficiaries were 
asked about their opinion on their satisfaction on the modality or content, quality, and quantity of the NFI 
distributed. Moreover, discussion was made with the beneficiaries and key informants notably kebele 
chairpersons, development agents and Woreda staff to have their view. The finding is presented as per 
the stated indicators below. 
Indicator 1 Percent of households reporting satisfaction with the contents of WASH NFIs received 
through direct distribution (i.e. kits), vouchers, or cash
According to the PDM-PHA survey result, 97.2% of beneficiaries are satisfied with assistance modality, 
clarity of information received, and distribution process and the performance was above the set target 
(70%). Interviewed community members expressed their satisfaction with the service specially at the 
time of COVID 19 occurrences where they badly need sanitary facilities. 
Indicator 2. Percent of households reporting satisfaction with the quantity of 
WASH NFIs received through direct distribution (i.e. kits), vouchers, or cash
The result of the PDM-PHA survey conducted showed that 91.9% of the respondents satisfied with the 
quantity of WaSH NFI namely soap and Jerican distribute by the project. When the level of satisfaction 
79.4%
95.6%
73.5%
67.6%
0.0%
84.0%
73.0%
40.0%
23.0%
0.0% 1.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Storage
container is
clean
Presence of a lid Presence of a
tap or narrow
mouth
Water storage in
separte Jug
None of the
above
Cleaness of water container
End line Baseline
39
is unpacked, 77.6% were satisfied very much and the rest 14.3% were mostly satisfied. On the other 
hand, 0.91% were not satisfied at all, 5.5% not very much satisfied and the reset were neutral. 
Closely observing the finding, the dissatisfaction was major on quantity of soap for which 80.7% of the 
dissatisfied beneficiaries mentioned. Of the dissatisfied beneficiaries, 10% cited jerrycan quantity as their 
major disaffection area. Community explained that the demand for soap was higher at time of distribution 
and the occurrence of the discases increased its demand while the Jerrycan serve for longer time and 
there is no problem once quality material is provided. 
Indicator 3. Percent of households reporting satisfaction with the quality of WASH NFIs 
received through direct distribution (i.e. kits), vouchers, or cash
The result of the survey showed that beneficiaries welcomed the quality of the distributed nonfood items. 
Of the respondents, 98.2% satisfied with the quality; 94.5% satisfied very much and 3.7% satisfied very 
much. 
Generally, the distribution of NFI is reported as satisfactory in terms of the quality and quantity. Moreover, 
the selection of beneficiaries was transparent as community stated and further confirmed by the 
household survey. The introduction of Complaint Reporting and Handling Mechanism reported as a 
strength of the project since it contributes to fair distribution of items and maintain the proposed 
quality/quantity of the items. 
All household survey participants reported that they were informed about the distribution date and place 
in advance. Of the respondents, 72%, 54% and 13% witnessed that they were selected for the project 
since they are the poorest of the poor, household with children under five years old and household with 
pregnant mother, respectively. During the discussion, participants anonymously mentioned that they 
were selected by the kebele Disaster Risk Reduction committee and the selection process was 
transparent. 
6.4.4.Agriculture and food security 
The objective of this sector was to strengthen the agricultural crop diversification practice with the intent 
of improving dietary diversity of households with children under five years, and pregnant and lactating 
women. This sector is related to the nutrition sector of the project as the increased agricultural production 
or improved food security contributes for the improvement in the nutritional status of families at large and 
children under five years old in particular. Two sub sectors have been identified under this sector: number 
of months with sufficient food for families and percentage of households with functional back yard garden. 
Sub-sector 1: Improving Agricultural Production/Food Security
Indicator 1. Number of months of household food self-sufficiency because of improved 
agricultural production programming
The result of the hunger scale related household data showed that the number of months households 
faced food shortage in the last 12 months reduced from 2.7 months (base year) to 1.96 months (end line) 
which was equivalent to the target (2 months). 
40
The average months female respondents face food shortage was higher for both Woredas compared 
with their male counterparts. The project supported the beneficiaries through provision of inputs and 
trainings with the intent of increasing production and productivity. Moreover, improved agricultural 
practices were promoted as 80.85 hectare of land against the planned 48 hectares was brought under 
improved agricultural practices. 
Table 9 Number of months households faced food shortage in the last 12 months of survey date 
Woreda Number of months 
Sex of the respondent
Male Female Total
Mean Mean Mean
Dessie Zuria 1.90 2.32 2.06
Delanta 1.63 2.21 1.83
Total 1.77 2.27 1.96
It is known that both target Woredas are food insecure and under productive safety net program during the 
base year and even this time. Analysis was made to what extent the project supported target Woredas to 
push out of food insecure situation by implementing integrated development activities. Accordingly, the
workability of applying holistic approach than single development approach was checked using the 
government hot spot classification reports. According to the national hot spot Woredas classification, both 
Woredas showed improvement over the last years as shown below. 
Figure 12 Hotspot classification of Dessie Zuria 2015-2020 Figure 13 Hotspot classification of Delanta 2015-2020
As shown above, the food security situation of the project areas showed improvement from 2015 to the end 
of 2019 as they moved from hotspot 1 to 3 by the end of the project period. It is acknowledged that the project 
has stake for such improvements. However, both Woredas are still in the list of hotspot classification though 
there is improvement. It is noted that the project areas are vulnerable due to several factors including
degraded land, occurrence of frost which damages crops, erratic rainfall and other and hence the possibility 
of falling back after some progress is noted. This is witnessed by the January 2021 hotspot classification 
1
2 2
3
2 2
3 3 3
HOT SOPT CLASSIFICATION LEVEL 
DESSIE ZURIA 
1 1
2
3
2 2
3 3 3
HOT SOPT CLASSIFICATION LEVEL 
DELANTA 
41
report as both Woredas fall under level 2 classification despite of their level 3 status as of 2019. In nutshell 
the finding shows that integrated approach can bring positive changes considering that the level of input 
injection is sufficient.
The development process by its very nature is not a smooth and uninterrupted process. It involves a series of 
discontinuous ‘jumps. The factors affecting economic growth, though functionally related with each other, are 
marked by several “discontinuities” and “hump.” What is needed is a “big push” to undo the initial inertia of the 
stagnant economy. It is only then that a smooth journey of the economy towards higher levels of productivity and 
income can be ensured. Unless big initial momentum is imparted to the economy, it would fail to achieve a self￾generating and cumulative growth. A certain minimum of initial speed is essential if at all the race is to be run. A big 
thrust of a certain minimum size is needed to overcome the various discontinuities and indivisibilities in the economy 
and offset the diseconomies of scale that may arise once development begins.
P.N. Rosenstein-Rodan; The theory of big push
Indicator 2 Household Diet Diversity Score (HDDS)
Household Dietary Diversity is the number of different food groups consumed by a household over a given 
reference period notably 24 hours prior to the survey date. A total 12 food groups are used to calculate the 
HDDS. 
The result of end line survey showed that the HDDS for the project area was 5.22(Dessie Zuria 4.63 and 
Delanta 5.96) which showed improvement over the project period as compared to the baseline result, 4.53. 
Similarly, the number of food group consumed by household in previous 24 hours of the survey date was 
6.27 where the data was 5.55 and 7.15 for Dessie Zuria and Delanta respectively. 
Figure 14 Household Diet Diversity Score by Woreda 
Indicator 3 Percentage of households with a (functional) backyard garden
Respondents were asked whether they grow fruits and or vegetables. In case respondents are cultivating 
crops/vegetables, enumerators observed the type of garden and plants growing and seed and any harvest 
conducted in the last 10 days of the survey date. Moreover, enumerators collected information on the barrier 
they are facing and the purpose of produce from their garden. The finding is as discussed below.
4.63
5.96
5.22
Dessie Zuria Delanta Total
42
 Of the respondents, 29%(Dessie Zuria 36.5% and Delanta 20%) cultivate a garden to grow 
vegetables or fruits in their compound or near your home. 
 Garden on the ground is the only type available at all observed back yards. During the baseline data, 
the ground garden was the most common form (90%), followed by key-hole gardens (5%) and 
sack/bag gardens (2%) and other (3%).
 All gardens were planted at time of the survey. During the base year, 82% of the garden were planted 
which was 100% during the end line survey. 
 Using the set indicator, all gardens are rated as functional. Hence, the percentage of households 
with a (functional) backyard garden is 100%.
 In relation to the use of the produce, 94% use for immediate consumption followed by sale and 
reserve for seed. The use of the produce is comparable with the base year situation as shown below. 
6.5. Sustainability 
The possibility in the continuity of service and impact after the withdrawal of the project was assessed and 
the result is as summarized below.
Health interventions are built within the ongoing government structure and activities. It is the role and 
responsibilities of the health offices to make sure that the health system which included public health, 
pharmaceutical supply, nutritional related intervention, and prevention of non-communicable diseases run 
properly. Hence, results brought and services in the area of health and nutrition is likely sustainable. 
The project supported the construction of water schemes including extension works, water user’s association 
established, trained and tool kits for operation and maintenance handed over to Woreda Water offices. 
Moreover, the water fee system put in place and functional though it needs strengthening. Respective 
Woreda water and energy offices are in place and staffed with experts that can provide technical assistances. 
Hence, the constructed water schemes and their services are likely sustainable. However, its sustainability 
heavily depends on the technical support from the government and community continued to live their 
commitment in managing the schemes. Some of the scheme like the extension works and pipeline system 
and reservoirs are beyond the capacity of water care takers and need technical support from Woreda staff. 
Moreover, the water fee put in pace is smaller in some case and cannot cover operation and maintenance 
cost. The tool kits are at the Woreda office and not yet handed over to the community. Furthermore, some 
water points not yet handed over to the community. Hence, the sustainability of the water schemes depends 
on the efforts of the Woreda and community in terms of putting facilities in place and technical support. 
Agricultural production related activities notably back yard vegetable production and the improved agricultural 
practice promotion are likely sustainable as the agriculture offices have staff and structure at different level 
which can provide technical support. Community tested the importance of vegetable production in the lens 
of child nutrition and family health at large. They expressed to continue production and even expanding for 
its food value and additional income earning. However, the supply of required inputs like vegetable seed, 
affordability of the seeds, availability of water for gardening particularly during the dry season, etc are some 
of the factors that can affect its sustainability. Hence agriculture office is expected to provide technical 
support and linkages with the suppliers to ensure sustainability
43
Disaster Risk Reduction Committee is part of the government structure which will continue and serve the 
community. Moreover, the development of DRR plan, contingency plan and early warning activities are the 
jobs of the government and hence their sustainability is likely. 
6.6. Lessons learnt.
The implementation of the project generated lessons which can be used as input for future similar projects 
as listed below. 
 The project followed multisectoral a project implementation approach than following on a single 
intervention. Since factors affecting the nutritional status of children are multifaced, the choice of 
integrated development approach is appreciable and can be taken as lesson. 
 Active participation of stakeholders from the onset is noted as a point of departure for project success 
and sustainability. The evaluation confirmed that community and sector offices owned the project 
since they participated from the beginning. 
 Project area and beneficiary selection was transparent and based on evidence like national Woredas 
hot spot classification report, involvement of zone and Woreda sector offices and DRR committee at 
the community level. The fact that CWW did wealth ranking from the onset, inbuilt compliant handling 
mechanizes and the validation of the selected beneficiaries by posting their name at community 
gathering placed re-enforced transparency. Hence, the interplay of using local structures, sector 
offices, predefined wealth ranking result and inbuilt compliant mechanism can be taken as lesson to 
ensure transparency and effective targeting.
 The organizational structure of some organization might be disconnected at some point and might 
not land at Woreda level like the case of Disaster Risk Management Agency which is extended to 
Zone level. Under such case, the need for checking the connection of structure from region to 
Woreda and or conduiting where interrupted with the next responsible structure is taken as lesson. 
 The project proved the possibility of outreaching more children with limited resources. The integration 
of efforts particularly at the front line (outreach workers and HEW), refresher training, motivation, 
proper selection of entry points, home to home visit, and the commitment of staff and cultivating the 
health seeking behavior of the target community led the project to identify, screen and treat larger 
number of children which can be taken as lesson. 
 The project demonstrated that introduction of nutrition sensitive agriculture as one of a breakthrough
in terms of diversifying food menu and inclusion of vitamins which are vital for the health of human 
being. 
 Mothers to mothers and fathers to father’s support group contributed for better outreach and serve 
larger number of community members on top of enhancing the participation of fathers on child affairs. 
The approach is welcomed by the local government and community which can be tested and 
replicated to other areas. 
44
 The development of water schemes particularly pipe systems require the use of different variables 
and realistic demand projection. In this regard, the need for considering all required technical 
variables particularly population for projection is taken as lesson for the future similar works. 
Moreover, accounting those people residing at areas where the pipeline shall cross should be 
considered to ensure benefit sharing and sustainability.
 WaSH projects require the integrated efforts of water and health offices. Unfortunately, capacity 
building which includes training of water users committee was handled by water office and the 
capacity building was skewed toward water management and operation and maintenance. However, 
the integration of water and sanitation through joint efforts of water and health office is noted as gap 
area which needs be strengthened.
 The role of women in water collection and management is higher under the target community setting. 
Hence, they can play decisive role if they assume the position of water scheme management
committee. It is observed that the water users committee are male dominated where most committee 
consists of only a female. Increasing the number of female committee member is taken as a lesson 
for similar projects. 
 Water fee determination should consider the income and expenditure analysis so that fee collected 
can cover operation and maintenance costs. Considering this, determining workable fee rate using 
simple analysis than setting arbitrary figure is taken as lesson. Moreover, handing over schemes on 
time and accompanying water management body for sometimes can give time for learning and fixing 
problems before phasing out. 
 Water is an important ingredient of WaSH interventions. However, its construction was pushed to 
the end of the project period due to different factors as listed in this report. Hence, the need for 
introducing efficient procurement process and design and its approval at the area coordination office 
and if not at the national level is taken as lesson. 
 Awareness creation can enhance the diversification of food for children aged 6-23 months in 
particulars and the family at all. The project proved the possibility of dietary diversification with 
training beneficiaries and promoting nutrition sensitive agriculture (back yard vegetable production). 
However, it is learnt that the supply side which is food production is the key area in need of attention 
while implementing similar projects to increase the resolution of impacts and sustainability of the 
practice. Hence, diversifying intervention in addition to vegetable production is taken as lesson.
 The durability of latrines constructed from local materials noted as lower. Hence, the introduction of 
sanitation marketing where slabs cabs can be produced and distributed to beneficiaries with 
reasonable prices is taken as lesson to strengthen the effort.
 The quality of data for monitoring and evaluation is critical to make objective judgments. Hence, the 
need of due consideration for the quality of data is taken as lesson since it can mislead findings. 
45
7. Conclusion and recommendation
7.1. Conclusion
Data was collected using qualitative and quantitative data collection methods and analyzed. The finding of 
the final evaluation showed that the practice of exclusive breast feeding promoted, child and household 
dietary diversified, access to potable water increased, sanitation and personal hygiene promoted, and food 
gap reduced. Moreover, the food security of the of the target community improved as witnessed by reduced 
food gap and move from hotspot priority one to three/two. Hence, the general conclusion is that the project 
was successful and met its objective. However, there are still persistency of gap in nutrition, water, sanitation 
and hygiene, and agriculture and food security which needs further intervention. Similarly, the fund utilization 
of the project was higher/97% and cost per beneficiary as stated in this document was minimal. Considering 
the changes brought as the result of interventions, the impact justifies the cost. Specific conclusion and 
recommendations are as listed under the recommendation part below.
7.2. Recommendation 
Targeting of Woredas and beneficiaries was done with care and noted as transparent. Hence, neither 
inclusion nor exclusion error was committed. 
The choice of multisectoral approach, as stated in the 2014-25 Multi Sectoral Nutrition strategy is a step 
toward improving the nutritional status of children. The project implemented the approach and the result 
obtained is encouraging. Hence, the replication of the approach with additional of the following points is
recommended.
 The introduction of nutrition sensitive agriculture- back yard vegetable production brought positive 
change in terms of diversifying the diet. Hence, upscaling and replicating the experience for similar 
projects is recommended.
 The project area is food insecure, under productive safety net and struggling to get out of the list of hot 
spot level classified Woreda. Under such case strengthening interventions that can enhance the food 
supply side of the equation is recommended. Under such case, the need for carefully selection of 
intervention that can supply nutritious rich foods like poultry is recommended.
 The project promoted macronutrients notably protein, carbohydrate, and fat. Since micronutrients which 
includes vitamins and minerals are equally important for mothers and child health, their inclusion to the 
list of future project activities is recommended. But there is a need for detail study on the supply and 
other related issues before jumping into the intervention. 
Development needs the integration of efforts, commitment and use of different strategies and approach. In 
this regard, the project served 232,607 beneficiaries which was 173% of the target. Capacity building, 
collaboration, integration, commitment of staff, use of different approach including fathers to fathers and 
mothers to mothers’ support group, clarity of messages (IEC) materials and proper targeting attributed for 
the success. Hence, the project demonstrated the ability of serving more beneficiaries with limited resource 
if at there are integration of efforts and commitment of actors. 
Mothers to mothers and fathers to father’s support group are found instrumental to disseminate information 
to the wider community. Moreover, the approach paved ways for fathers to take part in their family/child affairs 
46
which must be replicated. Under this case, it is recommended, if CWW take ample time and figure out the 
mechanics under which the approach operates better, document and disseminate/replicate. 
The construction of water schemes/line extension is the positive step to create assess to potable water. 
However, the following has been recommended to strength the effort for the future.
 Population is one of the most important factors for design of the water systems, so it should be estimated, 
to know the increasing demand and ensure continuous supply to them. In this regard, considering the 
possible beneficiaries, actual population data and demand projection is recommended for the future 
similar projects. 
 The number of female water users committee members is lower. Considering the role women can play 
on the use and management of water scheme, increasing their representation in water users committee 
is recommended.
 Water fee is instrumental for sustainable use of water schemes. Hence, gradual increment of water fee 
by the schemes is recommended. 
 The integration of water and sanitation to the training and follow up technical service is important to 
maximize impacts. In this regard, the integration of water and health office on training WSCHCo members 
was low as the training was mainly done by water office. The integration of efforts from the two offices is 
recommended for the future. 
 Tool kits were not handed over to water users committee at time of the survey. Hence, respective Woreda 
Water Office are recommended to hand over the tools accordingly.
 Some of the structures constructed- extension works, reservoirs and facilities require technical 
assistance which might be beyond the capacity of water users committee. Hence, technical back up from 
Woreda Water and Energy Office is required to sustain the systems. 
 The finding shows that the quantity of water consumed is lower (below half of the set standard) and it is 
noted that several factors contributed for limited water consumption at household level. Hence, continued 
education and motivating community on optimal use of water should be done.
The durability of latrine is one of the important things for the sustainability of the service. In this regard, the 
use of durable materials for construction is sought, where sanitation marketing is one of the possible 
approaches to distribute quality slabs for the target community. Hence, the implementation of sanitation 
marketing as stated in the government plan can curb the problem. 
Studies show that water can be contaminated in between the distribution point and mouth. One of the possible 
areas of contamination is the use of water container. Hence, strengthening educating the community about 
this critical path is recommended for the future. 
Exclusive breast feeding can be affected by different factors like mother’s health and nutritional status, 
economic status of families, workload on mothers and others. In relation to this, mother explained that staying 
with a child and feeding throughout the day is difficult as they go for household activities to fulfil the 
requirements of their families. They leave children with their elders and under such case the possibility of 
availing supplementary feed at least water and the practice of using a bottle with a nipple, a practice that is 
discouraged because of the risk of illness to the child noted. Hence, improving the socio-economic condition 
of the households, nutritional status of mothers, reduce load on mothers and devising a means under which 
awareness on CYFP to other family members are some of the recommendations for the possible intervention 
47
to promote exclusive breast feedings. However, this might take time and can be considered as long-term
solution to the challenge.
The result of the end line showed that 96% of the target population have access to potable water. On the 
other hand, the survey result showed that only 3.7 % collected the set standard amount (25 liter per day per 
person) indicating more work on optimal utilization of the water schemes. The fact that water schemes 
particularly, pipe and extension system were constructed as per the demand projection and set standard, 
indicates the sub utilization of the constructed schemes. Hence, the finding calls for optimal utilization of the 
existing systems and construction of additional schemes based on the demand and supply gaps. 
Poverty is multifaced and maximum effort is required to push beneficiaries out of the poverty trap. Under this 
case the economic thought argue for big push which requires intensive intervention and hence, maximizing 
investment on key poverty reduction interventions can support beneficiaries to break the cycle. 
48
Annex
Annex 1. List of personnel contacted: REDACTED for sensitive nature of contact information
Annex 2 Program performance matrix
Baseline Target Actual %
Beneficiaries reached 0 134,428 232,607 173%
Objective 1: Health
# of beneficiaries reached 
 
 26,829 
 
43,624 163%
Sub-sector 1: Health Systems and Clinical 
Support
Number of Health Facilities Supported 0 77 77 100%
Percentage of total weekly surveillance reports submitted on 
time by health facilities 0% 100% 100%
100%
Number of outpatient consultations 0 2,327 12,954 557%
Number of health care staff trained
Total: Total: 192 Total: 135 Total: 70%
Male: 0 Male: 120 Male: 93 Male: 77%
Female: 0 Female: 72 Female: 42 Female: 58% 
Sub-sector 2: Communicable Diseases
Number of communicable disease consultations 
9,867 26,417 
25,437 96%
Sub-sector 3: Community Health
Number of Community Health Workers (CHW) supported (total 
within project area and per 10,000 population) 0 128 134 134
Number and percentage of CHWs conducting public health 
surveillance 126 (100%) 126 (100%) 128(100%) 128(101%)
Number of children under five years of age who received 
community-based treatment for common childhood illnesses 0 7,843 16,280 208%
Sub-sector 4: Pharmaceuticals and other medical 
commodities
Number of people trained in medical commodity supply chain 
management 0
Total: 92 Total: 31 34
Male: 60 Male: 22 37
Female: 32 Female: 9 28
Number of health facilities out of stock of any medical 
commodity tracer products, for longer than one week, 7 
consecutive days
14 0 0 0
Objective 2: Nutrition Baseline Target Actual %
Number of beneficiaries reached 
 18,189 
 
58,036 319
Sub-sector 1: Infant and Young Child Feeding in 
Emergencies
77.50% 90% 79.3%
49
Proportion of infants 0-5 months of age who are fed exclusively 
with breast milk
Dessie Zuria 
= 78.3%
Dessie Zuria = 
79.3%
Delanta 
=76.9% Delanta =79.3%
Proportion of children 6-23 months of age who receive food 
from 4 or more food groups
16.40%
25%
34.8%
Dessie Zuria 
= 18.6%
Dessie Zuria = 
47.4%
Delanta = 
14.2% Delanta =12.9%
Number of people receiving behavior changing interventions to 
improve infant and young child feeding practices Total: 0
Total 17,891 Total 53,462
Male:8,445 Male: 23,263
Female:9,446 Female: 30,199
Sub-sector 2: Management of Acute Malnutrition
Number of health care staff trained in the prevention and 
management of acute malnutrition
Total: 0 Total: 206 Total: 204 99
Male: 0 Male:47 Male:11 23
Female: 0 Female:159 Female: 193 121
Number of supported sites managing acute malnutrition 77 77 77 100
Number of admitted rates of recovery, default, death, relapse, 
and average length of stay for people admitted to Management 
of Acute Malnutrition sites
Recovery: 
99.3%
Recovery: 
>75%
Recovery: 
97.2%
Default: 0.5% Default: 
<15% Default: 1.1%
Death: 0% Death: <10% Death: 0.5%
Relapse: Relapse: Relapse:
Length of 
stay: <60d
Length of 
stay: <60 
days
Length of stay: 
72 days
Objective 3: Water, Sanitation, and Hygiene Baseline Target Total Total 
# of people reached 0 82,896 
 
144,598 174
Sub-sector 1: Water Supply
Number of people directly utilizing improved water services 
provided with OFDA funding 0
Total: 10,860 Total: 16,868 155
Male: 5,539 Male: 8,450 153
Female: 
5,321 Female:8,064 152
Percent of water user committees created and/or trained by the 
WASH program that are active at least three (3) months after 
training
0% 100% 100% 100%
Percent of water points developed, repaired, or rehabilitated 
that are clean and protected from contamination 0% 100% 86% 86%
50
Percentage of households that collect 25 liters per person per 
day for drinking, cooking and personal hygiene from and 
improved water source
10.80% 25% 3.7%
Number of primary schools with access to water supply facility 0 9 schools 7 78
Number of health facilities with functioning water supply 0
3 health 
centers 3 100
Sub-sector 2: Sanitation 
Number of people directly utilizing improved sanitation services 
provided with OFDA funding
Total: 0 Total: 73,346 Total: 53,891 73
Male: Male: 35,940 Male:26,148 73
Female: Female: 
37,406 Female:27,743 74
Average number of users per functioning toilet 0 60 50 50
Percent of households targeted by latrine 
construction/promotion program whose latrines are completed 
and clean
49.10% 70% 75.1%
Sub-sector 3: Hygiene Promotion
Number of people receiving direct hygiene promotion 
(excluding mass media campaigns and without double￾counting)
Total: 37,647
Total: 82,896 Total: 101,648 123
Male: 40,619 Male: 50,770 125
Female: 
42,277 Female: 50,878 120
Percent of people targeted by the hygiene promotion program 
who know at least three (3) of the five (5) critical times to wash 
hands
Percentage: 
83.6%
Percentage: 
90% 86.80%
Percent of households targeted by the hygiene promotion 
program who store their drinking water safely in clean 
containers
Percentage: 
33.8%
Percentage: 
70% 66.20%
Percent of households targeted by the hygiene promotion 
program with no evidence of feces in the living area. 58.30% 70% 75%
Number of school WASH clubs established and trained 0 9 clubs 22 244
Sub-sector 4: WASH Non-Food Items
Total number of people receiving WASH NFIs assistance 
through all modalities (without double-counting) 0
Total: 1,976 Total: 1,976 100
Male: 1,522 Male: 
Female: 454 Female: 
Percent of households reporting satisfaction with the contents 
of WASH NFIs received through direct distribution (i.e. kits), 
vouchers, or cash
0% 70% 97.2
Percent of households reporting satisfaction with the quantity 
of WASH NFIs received through direct distribution (i.e. kits), 
vouchers, or cash
0% 70% 91.9
Objective 4: Agriculture and Food Security Baseline Target Total %
51
Number of beneficiaries reached 
 6,000 
 
5,750 96
Sub-sector 1: Improving Agricultural Production/Food 
Security
Number of months of household food self-sufficiency as a 
result of improved agricultural production programming 2.7 Months 2 months 1.96 month 
Number of people directly benefiting from improving 
agricultural production and/or food security activities 0
Total: 6,000 Total: 11,377 190
Male: 3,500 Male: 9,335 267
Female: 
2,500 Female: 2,042 82
Number of hectares under improved agricultural methods 0 48ha 80.85
Percentage of households with a (functional) backyard garden 83% 89% 100
Objective 5: Risk Management Policy and Practice Baseline Target Total Total 
Number of beneficiaries reached 514 412 80
Sub-sector 1: Policy and Planning
Number of hazard risk reduction plans, strategies, policies, 
disaster preparedness, and contingency plans developed and 
in place 7 (35%) 63
94 149
Number of people participating in discussions regarding 
national risk reduction strategies as a result of the program 0
Total: 33 Total: 38 115
Male:24 Male: 34 142
Female: 9 Female: 4 44
National and local risk assessment, hazards data and 
vulnerability information is available within targeted areas (Y/N) No Yes Yes Yes
% of communities in risk-prone areas with mitigation plans 
meeting minimum standards
55% 60% 100% (n=22)
Number of people participating in trainings 0
Total: 481 Total: 412 86
Male: 350 Male: 315 90
Female: 131 Female: 97 74
Percentage of attendees at joint planning meetings who are 
from the local community 0% 25% 25% 25%