REPORT OF THE
CRS/HAITI DEVELOPMENT ASSISTANCE PROGRAM
(DAP 2002-2007)
MID-TERM EVALUATION
SEPTEMBER 2004 – MAY 2005
January 2006
USG Grant: # FFP-A-02-00053-00-00
SO2: Increased effectiveness of FFP’s PVO and Mission partners in carrying out Title II
development activities with measurable results related to food security, with a primary focus on
household nutrition and agricultural productivity.
Disclaimer: The viewpoints and perspectives expressed in this document are solely those of CRS and FANTA
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Acknowledgements
The CRS/Haiti DAP Mid term evaluation and the preparation of this report would not have been possible
without the significant support of several people, both at CRS/Haiti and FANTA/Washington, who teamed
up to pilot test a Mid-term evaluation methodology.
CRS/Haiti wishes to acknowledge the FANTA staff for their technical support in all steps of the evaluation
process, from the design to the preliminary draft of this report, including the sampling, instrument
development and data analysis. Specifically we wish to thank the invaluable support of Gilles Bergeron
who coordinated the FANTA team as part of their technical assistance to the Haiti Title II Cooperating
Sponsors. A special thank to Megan Dietchler and Henry Lu for their excellent work in carrying out the
data analysis process. The CRS/Haiti team is deeply thankful to Mette Karlsen, Mickey Leland
International Hunger Fellow, who accompanied us during the whole process as part of her internship with
FANTA. Mette played an essential role in all steps of the survey, especially in the compilation of the first
draft of this report. Mette’s untiring support and easy communication style largely contributed to the
success of this complex undertaking.
This challenging study was largely facilitated by the invaluable contribution of the team leader, Elisabeth
Metellus. In addition to playing an essential role in the instrument development, the training and selection
of the data collectors and the supervision of the fieldwork, Elisabeth effectively designed and conducted
all the crucial steps of the Phase II qualitative study.
The mid term evaluation team is also grateful for Pierre Hugues Henry and his team contribution to the
process by providing quality data entry services.
Our most sincere gratitude goes to all the data collectors and supervisors for their patience and
dedication. The data collection team quickly understood the critical elements of this new methodology that
often required walking long distances to reach the selected participants in the survey communities. The
field team overcame those challenges with resolve and determination.
Through this highly participative process, several CRS/Haiti staff shared their knowledge and experience
to all the steps of the survey: survey design, indicator selection, questionnaires development,
interpretation of the results and report writing. Specifically we wish to acknowledge the assistance of
Florence Jean Louis, Jude-Marie Banatte, Magalie Personna and Steeve Laguerre of the Health and
HIV/AIDS sectors; Josette Josué and Lucker Registre of the Water an Sanitation sector; Stéphane
Calvin, Wildenes Etienne, Nélie Jeantillon, Emmanuel Pierre of the Education sector; Jamie Ciesla and
Natacha Rivière of the Safety Net sector, Hugues Charles of the micro-credit sector; Hervé Vaval, Harold
Paul of the agricultural sector and Agr. Joseph Dutreuil of Caritas Cayes; Gérard Fontain and Luc
Dominiqueof the Civic Education sector; Wesley Nelson of the Commodity Management aspects; and
Gary Jérôme, Ramon’s Jean-Philippe, Hernely Gédéon, Wilner Joachim and Alex Célicourt from the
Monitoring and Evaluation Units. A special thank to Dumé Dupuis who coordinated most aspects of the
fieldwork and represented CRS on the joint supervision team.
The team recognizes the leadership skills of the CRS/Haiti Country Representative, Ms Dula James, as a
determinant factor in the success of this endeavor.
And last, CRS/Haiti and FANTA are particularly grateful to the Haiti USAID Mission for having supported
the initiative of testing this evaluation methodology as part of the CRS/Haiti DAP mid term evaluation
process. The lessons learned from this challenging and complex effort should contribute to the progress
of the evaluation process not only for the USAID supported DAPs but also, for all future development
programs.
Agathe Pellerin
CRS/Haiti
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ACRONYMS
BCC: Behavioral Change Communication
BL: Baseline
CHW: Community Health Worker
CRS: Catholic Relief Services
CS: Cooperating Sponsor
DAP: Development Assistance Program
FANTA: Food and Nutrition Technical Assistance project
HH: Household
IMCI: Integrated Management of Childhood Illnesses
IPTT: Indicator Performance Tracking Table
IPBT: Indicator and Performance Benchmark Table
LOA: Life of Activity
LQAS: Lot Quality Assurance Sampling
MCHN: Maternal Child Health Nutrition
M&E: Monitoring and Evaluation
MTE: Mid-term evaluation
MCHN: Maternal and Child Health and Nutrition
MOH: Ministry of Health
PLWA
PTA: Parents Teachers Association
SA: Supervision Area
SES: Socio Economic Status
SO: Strategic Objective
SSNI: Social Safety Net Institutions
UCS: Unité Communale de Santé
UD: Unable to determine
USAID: United States Agency for International Development
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TABLE OF CONTENTS
EXECUTIVE SUMMARY ……………………………………………………………………….………... ix
CHAPTER 1 – INTRODUCTION ……………………………………………………………………….. 1
1. Introduction ………………………………………………………………………………………. 1
2. Summary of Steps of MTE …………………………………………………………….……….. 2
CHAPTER 2 – CONTEXT OF MTE …………………………………………………………………….. 2
1. CRS/Haiti Program Overview ………………………………………………………………….. 2
2. Expected Results by LOA and Mid-Term ……………………………………………..……… 3
CHAPTER 3 – METHODOLOGY ………………………………………………………………........... 13
1. Conceptual Model for M&E ……………………………………………………………............ 13
2. Design of the Survey – Phase I ……………………………………………………….…….… 15
a. Instrument Development ………………………………………………………......... 15
i. Indicator Selection and Formulation …………………………………..……….. 15
ii. Setting Performance Benchmarks ……………………………………………… 15
iii. Data Collection Questionnaires …………………………………………………. 15
b. Sampling ……………………………………………………………………………….. 16
i. Supervision Areas ………………………………………………………………… 17
ii. Sampling Lists …………………………………………………………………….. 18
c. Training ……………………………………………………………………………….… 19
d. Field Work ……………………………………………………………………………... 20
e. Data Analysis ………………………………………………………………………….. 20
3. Lessons Learned – Phase I ………………………………………………………………….… 22
a. Instrument Development ………………………………………………………….….. 22
i. Indicator and Performance Benchmark Table …………………………………. 22
ii. Setting Performance Benchmarks ………………………………………………. 22
iii. Data Collection Questionnaires ………………………………………………..… 23
b. Sampling ………………………………………………………………………………... 24
i. Supervision Areas …………………………………………………………….….. 24
ii. Sampling Lists ………………………………………………………………….…. 24
c. Training ……………………………………………………………………………….… 25
d. Field Work …………………………………………………………………………….... 25
e. Data Analysis …………………………………………………………………………… 25
4. Qualitative Assessment – Phase II ……………………………………………………………. 26
a. Identification of Problem Areas ………………………………………………………. 26
b. Selection of Methodology for Constraints Analysis …………………………..……. 26
c. Field Work …………………………………………………………………………..…. 26
d. Results Analysis ……………………………………………………………………….. 27
5. Lessons Learned – Phase II …………………………………………………………………… 27
a. Identification of Problem Areas ………………………………………………………. 27
b. Selection of Methodology for Constraints Analysis ………………………………… 27
c. Field Work ……………………………………………………………………………… 27
d. Results Analysis ………………………………………………………………………. 27
CHAPTER 4 – MTE RESULTS BY SECTOR – PHASE I ……………………………………….….. 28
1. Agriculture ……………………………………………………………………………………..… 28
a. Analysis of Results ………………………………………………………………….… 28
i. Land Characteristics ………………………………………………………... 28
ii. Gender within farmers’ associations …………………………………….… 29
iii. Conclusions and Recommendations ……………………………………... 30
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2. Micro-credit ……………………………………………………………………………………… 30
a. Analysis of Results - Community Credit Program ………………………………… 31
i. Credit Recipient Participation in Rally Posts …………………………….. 32
ii. Selection Process …………………………………………………….………. 33
iii. Management of loans ………………………………………………………... 33
iv. Group Management and Solidarity …………………………………………. 33
v. Literacy / Numeracy / Understanding Bank Books ……………………..… 34
vi. Changes in Household wealth …………………………………………..…. 34
b. Conclusions and Recommendations – Community Credit Program …………..… 35
c. Analysis of Results - Community Health Worker (Colvol) Credit Program ……… 36
i. Management of loans …………………………………………………….…… 36
ii. Group Solidarity ………………………………………………………………. 37
iii. Changes in Household wealth…………………………………………….... 37
iv. Credit Program as an Incentive to Work as CHW ………………………... 38
d. Conclusions and Recommendations - Community Health Worker (Colvol) ……. 38
 Credit Program ………………………………………………………………………... 38
3. Water and Sanitation …………………………………………………………………………... 38
a. Analysis of Results – Water and Sanitation ………………………………………... 39
i. School Cisterns …………………………………………………………….… 39
ii. School Latrines ………………………………………………………………. 40
iii. Trash Disposal ……………………………………………………………….. 41
iv. Capped Springs ……………………………………………………………… 41
v. Distance to Water Source and Type of Source ………………………...… 42
b. Conclusions and Recommendations – Water and Sanitation ……………………. 43
i. School Cisterns ………………………………………………………………. 43
ii. School Latrines ………………………………………………………………. 43
iii. Capped Springs …………………………………………………………..…. 44
4. Education…………………………………………………………………………………………. 44
a. Analysis of Results ………………………………………………………………….… 44
i. PTA Committee Members ………………………………………………..… 44
ii. School Directors …………………………………………………………...... 45
iii. School Teachers …………………………………………………………….. 45
iv. Female Students …………………………………………………………….. 46
v. Male Students ……………………………………………………………….. 46
b. Conclusions and Recommendations – Education ………………………………… 46
5. Maternal and Child Health and Nutrition ……………………………………………………… 47
a. Analysis of Results- Breastfeeding and Infant Feeding Practices by Age Group. 47
i. Mothers of Children 0-6 months …………………………………………… 48
ii. Mothers of 6-12 months ……………………………………………………. 49
iii. Mothers of 12-24 months …………………………………………………… 50
b. Conclusions and Recommendations – Breastfeeding and Infant Feeding
Practices………………………………………………………………………………… 51
c. Analysis of Results - Diarrhea and Diarrhea Management ………………………. 51
i. Diarrhea Prevalence ……………………………………………………….... 51
ii. Diarrhea Management …………………………………………………….... 52
d. Conclusions and Recommendations – Diarrhea and Diarrhea Management ….. 53
e. Analysis of Results – Health Cards, Child Immunizations and Vitamin A
Supplementation ………………………………………………………………………. 53
i. Health Cards for Children 0-6 months……………………………………… 54
ii. Health Cards and Child Immunizations in Children 6-12 months ………. 54
iii. Health Cards and Child Immunizations, and Vitamin A Supplementation
 in Children 12-24 months …………………………………………………… 55
f. Conclusions and Recommendations - Health Cards, Child Immunizations and
 Vitamin A Supplementation……………………………………..…………………….. 55
g. Analysis of Results - Pre-Natal and Post-Natal Care ……………………………… 56
i. Pre-Natal and Post-Natal Care for Mothers of Children 0-6 months…… 57
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ii. Pre-Natal and Post-Natal Care for Mothers of Children 6-12 months …. 58
iii. Pre-Natal and Post-Natal Care for Mothers of Children 12-24 months .. 60
h. Conclusions and Recommendations - Pre-Natal and Post-Natal Care……….….. 61
i. Analysis of Results - Participation in Program Activities – Rally Posts and
 Health Clinics …………………………………………………………………………… 62
i. Rally Posts and Mothers Clubs …………………………………………….. 63
ii. Mother’s Perceptions of CHW Knowledge and Skills ……………………. 64
iii. Participation of Mothers in Food Supplementation Program during
Pregnancy……………………………………………………………………… 66
iv. Regularity of Food Supplementation during Pregnancy (Pre-natal Clinic) 67
v. Regularity of Food Supplementation after Childbirth(Post-natal Clinic)… 67
vi. Correct Rationing at Health Center ………………………………………… 68
j. Conclusions and Recommendations - Participation in Program Activities –
 Rally Posts and Health Clinics ………………………………………………………… 68
k. Analysis of Results – Knowledge, skills, and Participation of CHWs …………….. 69
i. Perceptions of Knowledge …………………………………………………… 69
ii. Technical Knowledge ………………………………………………………… 70
iii. Availability of Necessary Materials and Supplies for Monthly Rally Posts 71
iv. Participation in Monthly Meeting Activities…………………………………. 72
l. Conclusions and Recommendations - Knowledge, skills, and Participation
 of CHWs ………………………………………………………………………………… 72
m. Analysis of Results - Hand Washing Knowledge and Techniques –
 Cross-Sectoral Results…………………………………………………………………. 73
i. Hand Washing Knowledge ………………………………………………….. 74
ii. Hand Washing Techniques …………………………………………………. 77
n. Conclusions and Recommendations - Hand Washing Knowledge and
 Techniques – Cross-Sectoral ………………………………………………………… 77
6. HIV/AIDS …………………………………………………………………………………………. 78
a. Analysis of Results – SSNIs ………………………………………………………….. 78
i. Means of Transmission – SSNI Management and Staff …………………. 79
ii. Means of Transmission – SSNI Children ………………………………….. 80
iii. General Knowledge - SSNI Management and Staff ……………………… 81
iv. General Knowledge - SSNI Children ………………………………………. 82
v. Perceptions of Personal Risk - SSNI Management and Staff ………….. 82
vi. Perceptions of Personal Risk - SSNI Children …………………………… 83
vii. Stigma and Discrimination - SSNI Management and Staff ……………… 84
viii. Stigma and Discrimination - SSNI Children ………………………………. 84
b. Conclusions and Recommendations – SSNIs …………………………………….. 85
c. Analysis of Results – Schools ……………………………………………………….. 85
i. Means of Transmission – School Staff and PTA Committee Members... 85
ii. Means of Transmission – School Children……………………………….. 87
iii. General Knowledge - School Staff and PTA Committee Members……. 87
iv. General Knowledge – School Children…………………………………….. 88
v. Perceptions of Personal Risk – School Staff and PTA Committee
Members ………………………………………………………………………. 88
vi. Perceptions of Personal Risk – School Children …………………………. 89
vii. Stigma and Discrimination - School Staff and PTA Committee
Members…………………………………………………………………….… 89
viii. Stigma and Discrimination - School Children……………………………... 90
d. Conclusions and Recommendations – School Staff, PTA Committee Members
 and School Children………………………………………………………………….… 91
7. Safety Net Institutions ………………………………………………………………………….. 91
a. Analysis of Results………………………………………………………..…………… 91
i. SSNI management…………………………………………………………… 92
ii. Females 8-13 years………………………………………………………….. 93
iii. Females 13 years and up…………………………………………………… 93
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b. Conclusions and Recommendations……………………………………………….. 94
8. Civic Education………………………………………………………………………………….. 94
a. Analysis of Results …………………………………………………………………… 95
i. PTA, School Staff and CHWs……………………………………………….. 95
ii. Mothers, Credit Program participants, Farmer Association members….. 96
b. Conclusions and Recommendations – Civic Education…………………………… 97
CHAPTER 5 – RESULTS BY SECTOR – PHASE II…………………………………………………. 98
1. Micro-credit ………………………………………………………………………………………. 98
a. Community credit program …………………………………………………………… 98
b. Community Health Workers program....……………………………………………... 103
2. Water and Sanitation ……………………………………………………………………………. 106
3. Education …………………………………………………………………………………………. 107
4. MCHN …………………………………………………………………………………………….. 110
CHAPTER 6 – MTE CONCLUSIONS ………………………………………………………………….. 115
1. Recommendations for Program Operations ………………………………………………….. 115
a. Agriculture ……………………………………………………………………………….. 115
b. Micro-credit………………………………………………………………………………. 115
i. Community Credit Program…………………………………………………… 115
ii. Community Health Workers Program……………………………………….. 117
c. Water and sanitation…………………………………………………………………….. 117
d. Education…………………………………………………………………………………. 118
e. MCHN…………………………………………………………………………………….. 119
f. HIV/AIDS…………………………………………………………………………………. 121
g. Safety Net………………………………………………………………………………… 121
h. Civic Education………………………………………………………………………….. 121
2. Conclusion for Methodology Development…………………………………………………….. 122
APPENDIX 1: CRS/Haiti DAP Program Objectives
APPENDIX 2: Final set of Indicators and Mid-term benchmarks
APPENDIX 3: Sample of Mid-term evaluation questionnaires (MCHN)
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List of Tables
Table 1: Indicators, baseline values, LOA and MTE targets by sectors…………………………..… 4
Table 2: Summary of sampling by sector ……………………………………………………………… 17
Table 3: Agriculture – Land Characteristics …………………………………………………………… 29
Table 4: Agriculture- Gender within farmers’ associations …………………………………………… 30
Table 5: Credit recipient participation in rally posts ………………………………………………….. 32
Table 6: Credit recipient selection process ……………………………………………………………. 33
Table 7: Credit recipient management of loans ………………………………………………………. 33
Table 8: Group management and solidarity among credit recipients ………………………………. 34
Table 9: Credit recipient literacy-numeracy-understanding of bank books …………………………. 34
Table 10: Changes in household wealth of credit recipients …………………………………………. 35
Table 11: CHWs - Management of loans ……………………………………………………………… 37
Table 12: CHWs - Group solidarity …………………………………………………………………….. 37
Table 13: CHWs - Changes in household wealth …………………………………………………….. 38
Table 14: CHWs - Credit program as incentive ………………………………………………………. 38
Table 15: Condition and maintenance of water cisterns ……………………………………………. 40
Table 16: Condition and maintenance of school latrines ……………………………………………. 40
Table 17: Trash disposal …………………………………………………………………………………. 41
Table 18: Capped springs - condition and maintenance ……………………………………………… 42
Table 19: Distance to water source …………………………………………………………………….. 43
Table 20: PTA committee members - Education program ……………………………………………. 44
Table 21: School directors - Education program ……………………………………………………… 45
Table 22: School teachers - Education program ……………………………………………………… 45
Table 23: Female students - Education program …………………………………………………….. 46
Table 24: Male students - Education program ………………………………………………………… 46
Table 25: Breast feeding and infant feeding practices among mothers ……………………………. 49
Table 26: Diarrhea and diarrhea management ……………………………………………………….. 52
Table 27: Health cards and child immunizations in children 6-12 months of age …………………. 54
Table 28: Pre- and post natal care: mothers of children 0-6 months old ……………………………. 58
Table 29: Pre- and post natal care: mothers of children 6-12 months old ………………………….. 59
Table 30: Pre- and post natal care: mothers of children 12-24 months old ………………………… 61
Table 31: Participation in program activities: rally posts and mothers’ clubs ………………………. 64
Table 32: Participation in program activities: perceptions of mothers on CHW’s knowledge on
 Health issues and communication skills…………………………………………………….. 65
Table 33: Participation in program activities: health facility- food supplementation ……………….. 66
Table 34: CHWs’ perceptions of knowledge and skills ……………………………………………….. 70
Table 35: CHWs’ technical knowledge ………………………………………………………………….. 71
Table 36: CHWs – availability of materials and supplies ……………………………………………… 72
Table 37: CHWs’ participation in monthly activities ……………………………………………………. 72
Table 38: CRS baseline results (2002)- relationship between water, sanitation, hygiene and
 Diarrhea ………………………………………………………………………………………… 74
Table 39: Hand washing knowledge and techniques results across sectors ………………………. 75
Table 40: Hand washing knowledge and techniques – cross sectoral sectors ……………………… 76
Table 41: HIV/AIDS sampling groups ……………………………………………………………………. 78
Table 42: Knowledge on means of HIV/AIDS transmission – SSNI management and staff ………. 79
Table 43: Knowledge on means of HIV/AIDS transmission- SSNI children- centers with previous
 HIV/AIDS training interventions ……………………………………………………………….. 80
Table 44: General knowledge on HIV/AIDS – SSNI management and staff ………………………… 81
Table 45: General knowledge on HIV/AIDS – SSNI children- centers with previous HIV/AIDS
 Training interventions ………………………………………………………………………….. 82
Table 46: Perception of personal risk- SSNI management and staff …………………………………. 82
Table 47: Perception of personal risk – SSNI children- centers with previous HIV/AIDS training
 Interventions …………………………………………………………………………………… 83
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Table 48: Stigma and discrimination – SSNI management and staff ………………………………. 84
Table 49: Stigma and discrimination – SSNI children – centers with previous HIV/AIDS training
 Interventions ……………………………………………………………………………………. 84
Table 50: Knowledge of HIV/AIDS transmission – school staff and PTA committee members ….. 86
Table 51: Knowledge of means of HIV/AIDS transmission – school children ……………………… 87
Table 52: General knowledge of HIV/AIDS – school staff and PTA committee members ………… 87
Table 53: General knowledge of HIV/AIDS – school children ……………………………………….. 88
Table 54: Perceptions of personal risk – school staff and PTA committee members …………….. 88
Table 55: Perceptions of personal risk – school children …………………………………………….. 89
Table 56: Stigma and discrimination – school staff and PTA committee members ……………….. 89
Table 57: Stigma and discrimination – school children ……………………………………………….. 90
Table 58: Safety Net institutions sampling ……………………………………………………………… 91
Table 59: SSNI management and staff …………………………………………………………………. 92
Table 60: SSNI Hygiene conditions and canteen management ……………………………………… 92
Table 61: SSNI female children 8-13 years old ……………………………………………………….. 93
Table 62: SSNI female children 13 years of age and up ……………………………………………... 94
Table 63: Civic education knowledge: school staff, PTA committee members, and CHWs ……… 96
Table 64: Civic education knowledge: mothers, credit program participants and farmers ……….. 97
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EXECUTIVE SUMMARY
INTRODUCTION
According to USAID/DCHA/FFP guidance, Title II Cooperating Sponsors are expected to conduct a series
of evaluation exercises during the life of their Development Activity Programs (DAPs): a Baseline survey
should be done before implementing the program, to know the conditions at the outset in intervention
areas; a final evaluation is also expected at the end of the Life of Activity (LOA) to document the extent to
which the program achieved its objectives; and a Mid Term Evaluation is recommended, about halfway
through the life of the DAP, to help program managers assess progress made, whether or not the
program is on the way to achieve its stated objectives, and make recommendations on ways to improve
performance if need be. Although relatively good experience exists on the conduct of Baseline and Final
Evaluations, little guidance exists on how to do Mid Term Evaluations—even though this may be one of
the most important steps in the LOA to guarantee its final success. To address this gap, the Food and
Nutrition Technical Assistance (FANTA) project teamed up with CRS/Haiti to pilot test a Mid Term
Evaluation (MTE) methodology that would: 1) examine progress made in reaching DAP goals; and 2)
formulate recommendations to help correct imbalances in areas found to be under performing. This report
looks at the entire activity, from methodology development to results analysis and final recommendations.
SUMMARY OF STEPS OF THE MID-TERM EVALUATION (MTE)
The MTE results presented in this report are based upon data collected in CRS/Haiti’s areas of
intervention, namely in the Southern and Grande Anse Departments. The MTE was divided into two
phases:
PHASE I: The first step in Phase I was to identify performance indicators for each sector evaluated in
the MTE. A mid-term performance benchmark was set for each selected indicator taking into account
its baseline value and LOA target. Samples targeted for data collection in each sector were also
identified at this time, activity zones being subdivided whenever possible into Supervision Areas
(SAs). On the basis of this preliminary work, the Team developed LQAS-friendly data collection
instruments in which all questions were phrased to elicit a dichotomous (yes/no) answer. Data
collection began December 9, 2004 and was completed by December 23, 2004. Completed
questionnaires were analyzed early January 2005, allowing to separate activities that had
successfully met their mid term targets from those that did not.
PHASE II: Focusing on indicators that seemed to be lagging in performance, the Team identified
activities that merited further investigation. An analysis of constraints using qualitative methods was
performed, including mainly focus group and key informant interviews. The qualitative, follow-up
investigation of Phase II took place March 14-24, 2005. The report from the qualitative research,
submitted April 2005, was used to elaborate a series of recommendations to improve project
performance.
CRS/HAITI PROGRAM
The goal of CRS’ proposed DAP is to sustainably reduce the level of food insecurity in vulnerable
communities of the Southern Peninsula with a focus on the South and Grande-Anse departments and
one area of the South East Department (Cotes de Fer). CRS will achieve this goal through integrated
activities in four sectors: Health and Nutrition (Maternal and Child Health, Water and Sanitation,
HIV/AIDS, Micro-finance), Agriculture, Food-Assisted Education and Humanitarian Assistance. To
achieve this goal, CRS will secure private funds and other sources of funding to complement DAP
resources.
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METHODOLOGY
Conceptual Model
In an operational context, the role of the M&E system is to track and mirror the flow of actions that take
place as project inputs are transformed into population-level impacts, and to verify that those impacts are
indeed taking place. A good system will also inform project managers about the action to take if impacts
are not occurring. To design the M&E, it is thus important to understand how the flow of activities is
linked: conceptually, a project uses a set of inputs, and submits those to processes in order to generate
outputs. Outputs in turn translate into effects at the target population level—effects which, in turn, are
necessary to the materialization of the project’s final impact. For instance: assume that a project wants to
increase agricultural yields by offering farmers training in a new set of techniques1
. To achieve this, the
project lines up funds and technical specialists (inputs) and organizes a training course (process) in which
it teaches farmers the selected techniques. The number of farmers trained constitutes the output of that
activity. The number of farmers that effectively adopted the technique (a subset of those who were
trained) are the effect of that activity. To the extent that adoption of the technique is essential to yield
increase, then that effect must occur if the project is to achieve its desired impact. The M&E must reflect
this process using objectively verifiable indicators.
Not all indicators to be used are of the same kind, however. Data relating to inputs, processes and
outputs can be generated easily from routine project information and for those indicators, there is no need
to do a survey. When it comes to effects and impacts, however, the project must go to the population in
order to measure how many of the trained farmers actually adopted the technique. Being a decision that
is highly personal to each farmer, this cannot be inferred from the project’s book keeping records. A
population-based data collection exercise is necessary to assess how many of the trained farmers
adopted the technique or whether yields have increased or not.
From a logistical point of view, this distinction between sources of data (project-based versus population￾based) is what distinguishes monitoring from evaluation: monitoring uses data from project records;
evaluation uses data from the population (through a random survey, a census, etc). Population-based
assessments being costlier than simple bookkeeping, project evaluations are occasional, rather than
annual. Limiting the number of population-based queries, however, presents the project with the danger
of not knowing whether the effects and impacts it is meant to achieve are indeed taking place: looking
only at monitoring data, a project manager may fail entirely to detect that there is a problem with the
adoption of the technique until it is too late to react. Unless a population-based evaluation is done during
the life of the activity, the project will not know until its final evaluation that adoption rates are not as
expected, thus jeopardizing its capacity to increase yields. Following that logic a central role of the mid
term evaluation is to verify that the desired effects are indeed taking place. This is a central premise of
this MTE model.
Because effects are manifested at the level of the population, however, the need for a survey remains. To
reduce its cost, Lot Quality Assurance Sampling is used. LQAS uses binomial distributions properties,
which are more efficient than normal distributions at assessing population-level probabilities of
dichotomous outcomes. The great advantage of LQAS is that it requires much smaller samples than
traditional population-based surveys. For instance, assuming an unstratified, homogenous universe of
infinite size, and accepting α and β errors each set at 10%, a simple random sample of n=19 is sufficient
to judge whether performance has reached or not a predetermined performance benchmark on a given
indicator (Valadez, 1996). One additional feature that makes LQAS attractive is the possibility to go
beyond the simple “pass/fail” judgment to compute population-level point estimates for indicators of
interest (e.g. vaccination coverage, disease prevalence, etc). This is done by dividing the entire project
 
1 We take for granted that the conceptual framework underlying the approach is sound; i.e. there is a cause-effect relationship
between the technique promoted and eventual productivity increases. We do not discuss this here; but the issue was covered in
the Baseline Survey Report where ample details are provided on the conceptual models used to guide intervention design in the
CRS program.
xi
area into several “supervision areas” and by combining the data across those to compute the proportion
of “pass/fail” responses over the entire project area. (Note that there must be at least four SAs to make
this statistically valid. This increases the total sample by a factor of similar magnitude; yet the potential
advantages of the method in terms of cost will likely remain positive, as the new n will remain small
compared to a traditional 30x30 cluster survey).
Design of the survey – Phase I
Indicator Selection and Formulation: An initial list was provided by CRS’ DAP Indicator Performance
Tracking Table (IPTT). A particular emphasis was given to effect-level indicators. This initial list was then
augmented with data CRS staff needed to improve the management of their activities. To comply with
LQAS’ dichotomous requirement, all indicators in the resulting list were then worded to yield a pass/fail
response.
Setting Performance Benchmarks: The second step was to set a performance benchmark for each
indicator evaluated. We generally assumed that a project should see half of its effects materialized by the
time it reaches its mid point. Obviously, linear rates are not always expected: certain effects take longer to
manifest themselves, in which case the growth rate in adoption may show a curvilinear pattern. Also,
particular activities may have started later, changing thus the expected growth curve. For those reasons,
CRS staff and FANTA carefully considered each indicator before setting its benchmark. Lastly,
benchmarks were established at 5% cutoff intervals (15%, 20%, etc). The final set of indicators and
benchmarks is listed in Appendix 2.
Data Collection Questionnaires: The MTE Indicator and Performance Benchmark Table (IPBT) served
as the starting point for the development of the Phase I questionnaires. While most of the indicators
included in the IPBT translated into single questions, there were several indicators that required a series
of questions in order to satisfy their informational requirements. Within each sector there were several
questionnaires. The quantity of questionnaires depended upon the number of sampling groups; their
composition reflected the characteristics of the target group to be sampled. Particular initiatives within the
DAP program – such as civic education, HIV/AIDS education, and the promotion of proper hand washing
techniques – were determined to have cross-sectoral relevance, and as such, questions relating to these
initiatives were included in the other DAP sector questionnaires. The first draft of the questionnaires was
developed by FANTA and presented to CRS for their input and feedback. After substantial consideration,
revision, and expansion by the CRS DAP staff, the MTE Team Leader and FANTA, a second draft was
completed and translated into French and Creole. These drafts were used in the training of the
enumerators and field-tested. The questionnaires used in the data collection reflected the experiences of
the MTE data collection team during field-testing.
Sampling: The greatest benefit of LQAS is its low sample size requirements. Compared to usual
sampling technique (such as cluster sampling which usually requires around 900 interviews) LQAS can
content itself with a sample of size n=19 (provided certain conditions are met). It is thus very economical.
However, the leanness of LQAS is also its weakness: the size of the sample is so small that it prohibits
disaggregating the data into subsets, making the simplest analytical techniques (cross-tabulations, means
comparison) impossible—unless stratifying, i.e. deriving an independent sample for each group or region
of interest. When stratifying in LQAS, it is useful to distinguish between two types of strata: those based
on geography (“supervision areas”) and those based on target groups. Subdividing by Supervision Areas
(SAs) involves dividing the entire catchment area into smaller management units. Say that a project
operates in four provinces. The catchment is the entire country program, but if activities in each province
are programmed independently, it makes sense to obtain a LQAS sample in each province to examine
how the project performs in each province. Obviously, the collection of four samples will make the study
costlier, as it will raise the total number of data points to 76 (assuming four samples of size n=19) but this
will convey two major benefits to the study: first, it will be possible to see where (and where not)
objectives are being met, pinpointing areas where improvements are needed. Second, it makes it
possible to derive coverage estimates for the indicators under review—i.e. not only will we able to say
that the sample “passed” or “failed” on a given test; we will also be able to use the percentage of units
across the four samples that passed on that test as a basis to compute a coverage estimate. This adds
xii
an important analytical dimension to the survey, as will be shown later in the results section. Subdividing
by Target Groups involves dividing the client population of an intervention into sets of individuals for
whom expectations may differ; thus it makes sense to have different benchmarks for different age groups.
As in supervision areas, dividing by target groups involves drawing a new sample for each group of
interest. The advantage here is also twofold: first it allows setting different benchmarks for the same
activity but for different groups. Second, it allows to pinpoint accurately in which group the project fails to
reach its objectives, and thus to focus attention on that particular set of people. A final note on sampling:
the method used to derive the desired sample size differs on the basis of the size of the universe. In
situations where the universe size is infinite (i.e. >500 units) the binomial probability distribution can be
used to derive sample sizes and decision rules. Where population sizes contain fewer than 500 units,
however, the hyper-geometric distribution for cumulative probabilities must be used. 
Supervision Areas: Before the sampling process could begin, CRS sector teams were tasked with
organizing their program interventions into supervision areas. In the LQAS model, the minimum number
of supervision areas necessary for aggregating the data to calculate weighted coverage estimates for
program indicators is four. Each supervision area has its own participant list and thus the sampling was
carried out based on that particular participant pool2
. Where possible, the sector teams were encouraged
to divide their supervision areas into universes of 500 units or more as this would allow sample sizes of
19, which according to the LQAS model, is sufficient to provide statistically representative data with
acceptable confidence intervals. For those sectors with supervision areas with less than 500 units, it was
necessary to undertake complex hyper-geometric calculations in order to determine appropriate sample
sizes and corresponding benchmark decision rules. Sectors that were divided into four or more
supervision areas included: Credit–Women and MCHN (with 500 or more units) and Education (required
hyper- geometric calculations because there were less than 500 units). Sectors that had less than four
supervision areas included: Agriculture and Credit–Colvol (with 500 units or more) and SSNI and Water
and Sanitation (with less than 500 units thus requiring hyper-geometric calculations).
Sampling Lists: The generation of sampling lists proved more time consuming than was originally
anticipated. The varying benchmark levels for each universe size under 500 required quite a few
complex calculations and fundamentally necessitated the creation of a whole new LQAS table for hyper￾geometric distribution. For the purpose of this exercise, a “participant” could be an individual (such as a
member of a farmer groupement), an institution (such as a school), or a locality (from which a resident
mother would be selected). Each type of “participant” group required separate sampling methodologies.
The universe and the number of participants being known for each area, the sampling was done by
starting with a random number using the sampling interval required to obtain the total number of
participants for that particular area. For those sectors with individual participants, as was the case with
Agriculture and Credit, the selection process was centralized and undertaken by CRS and FANTA, using
a random number table, before the data collectors left for the field. Armed with the names of specific
people, the data collectors visited the locality of residence of the individual, located her/him with the help
of the community and/or local CRS volunteers, and carried out the interview. Participant lists that were
comprised of institutions that receive support form CRS, such as Education, SSNI, and Water and
Sanitation, the selection process was two-fold. The selection of the institutions was centralized and
undertaken by CRS and FANTA, using a random number table, before the data collectors left for the field.
The selection of the actual respondents, however, was carried out by the data collectors in the field - on
the day of her/his visit to the institution. Data collectors used random number tables and numbered cards
to identify respondents with the desired profile for interviewing.
Sampling by sector: Six major sectors (MCHN, Credit- women and Credit CHWs, Agriculture, Education,
Safety Net and Water and Sanitation) and two cross-sectoral sectors (HIV/AIDS and Civic Education)
were evaluated. A total of 1,110 interviews were conducted with 19 different groups.
Training: Training of data collectors for Phase I was done between November 29 and December 5,
2004. During the first three-day training, questionnaires were reviewed question by question to ensure
 
2 In the case of the MCHN sector, the sampling was done on the whole population. The data base used for the baseline study
(number of households per locality for each commune covered by the project) was also used for the MTE.
xiii
greater consistency in administration. The CRS manager responsible for each program first made a short
presentation to explain the context of the study to the data collectors. Then, each question was discussed
including the methodology on how to note the answer. After having reviewed the questions for each
sector, the group was divided into small groups to practice the questions. The field-testing of the
questionnaires was done in the rural area of Palmiste-à-Vin. Except for the Safety Net sector, all
questionnaires were tested in the field by small groups of data collectors coordinated by a supervisor. The
whole group went to a school, an MCH center, a spring capping, a school latrine, and a farmer’s plot of
land. With regards to the Safety Net questionnaires, two enumerators and two supervisors participated in
the field-testing that was done in two orphanages in the area of Port au Prince. Based upon the number
of interviews that needed to be carried out during Phase I, it was determined to divide the data collection
team into seven teams--six composed of a team supervisor and three or four data collectors and one
made of two data collectors for the Safety Net Institutions. Phase I data were collected by 23
enumerators and 6 supervisors.
Field Work: The Phase I fieldwork took place between December 9 and December 23, 2004. The
number of interviews to be done in one day (5 to 6), the time estimated to reach each interviewee and the
number of sectors to be covered were the criteria used to determine the areas to be assigned to each
team which varied between two to seven communes. Each team of the six teams was made up of one
supervisor and three or four enumerators. Before going to the field, each team received the complete list
of people to be interviewed and sites to be visited for each locality in each commune. However, it was up
to the Team Supervisor to determine the scheduling and assignment of interviews for the team. With
regards to Safety Net questionnaires, two enumerators in the area of Port au Prince completed most of
them. The remaining interviews were conducted by a team supervisor in the areas of Jérémie and Les
Cayes. As explained in a previous section, the selection of some respondents was done in the field by
the survey team. With the LQAS sampling methodology where the name of the locality (for MCHN sector)
and/or the name of the participants (credit mothers) were pre-selected, the enumerators had to walk long
distances to reach most of the respondents. The MTE Supervision Team comprised of the MTE Team
Leader, a CRS staff person, and a FANTA staff person departed one day after the data collection team
was dispatched to the field. The idea was that we would visit all of the different teams unannounced to
check on their progress and assess their performance in the field. The supervisory visits were very useful
for the entire team in that it provided the teams to raise questions or draw our attention to issues that
were confronting them in the field. In a five-day span, the supervision team visited all of the field teams
and was able to solve the administrative or logistical problems that the teams were facing.
Data Analysis: Analyzing LQAS data is straightforward, as it only requires assessing whether the
number of defective units exceeds or not the decision rule implied by the desired benchmark. This is the
most basic analysis done with LQAS data, and it was done here for all the indicators observed in the
survey. More analysis was done however (where feasible) by dividing the population into four or more
supervision areas, which made it possible to establish an overall prevalence point for an indicator by
computing its ratio of “passes” to total sample (i.e. summing up the number of items that met the test
across SAs and divide this by the total number of items sampled). This makes it possible to state not only
which SA passed or failed the test, but whether the program as a whole, and across all its SAs also
passes the test; and to identify which SA performed best against the benchmark. Where possible, such
an analysis by SA was done here. This allowed orienting the effort of corrective action to where it was
truly needed. In the end, such detail should be a powerful help to the project in its attempt to reach its stated
objectives in all covered areas.
LESSONS LEARNED – PHASE I
Indicator and Performance Benchmark Table (IPBT): The IPBT, which was initially assembled to
serve as the backbone for the questionnaires, later needed revision in order to reflect the complexities of
the questionnaires it inspired in the first place. This situation did necessitate a further investment of time
and energy on the part of CRS in the creation of new benchmarks and LOA values. Perhaps greater
attention to the development of more complete lists of program indicators at the beginning could have
avoided such a procedural step backwards later. More focused questionnaire development could also
have minimized the time necessary for the revision of the original IPBT.
xiv
Setting Performance Benchmarks: MTE performance benchmarks were set by CRS program staff and
FANTA. For most indicators with LOA targets already set, it was assumed that the project had reached
half of its effects by the time of the mid term evaluation. However, for the questions added during the
planning of the MTE, mid-term performance benchmarks were included for all new indicators. The
strategy for setting up mid–term benchmarks differed from one sector to another. Even though mid- term
targets were set based on past and current program experiences, the team realized afterwards that for
some indicators, results were either far below or far above the expected targets. With the pass/fail LQAS
methodology, the level of the benchmark is a key determinant and requires an in-depth reflection at the
planning stage; especially in case no baseline value is available. For sectors where the MTE result would
be used as a baseline value, the subdivision of the catchment area into four supervision areas allowed for
an extrapolation of the program coverage; a useful approach for calculating the baseline value. However,
in the case of a single catchment area, the evaluation team was only able to discern whether the sample
“passed” of “failed” the mid-term benchmark, an approach that is not as informative as one using program
coverage as the baseline value.
Data Collection Questionnaires: This MTE collected an enormous amount of information on the overall
performance of the DAP. For some sectors, the questions did not cover some important issues that could
have been covered by the MTE. This is the case for the agriculture and the safety net sectors where
numerous opportunities to measure project progress were missed. In a related issue, a system should
have been put in place to monitor the inclusion of certain questions relating to such cross-sectoral topics
as HIV/AIDS. Greater consistency in the inclusion of HIV/AIDS questions would have provided increased
utility in terms of the manipulation of the data for comparison purposes across sectors and samples. The
LQAS method is based on dichotomous outcomes (yes/no, pass/fail), and every effort was made to
simplify the questionnaires in order to elicit such responses. Many of the issues investigated in Phase I,
however, were quite complex and as such, necessitated more than one question in order to get at the
desired data. In such situations, a single question may not have had specific relevance to a particular
indicator, but when it was included in a larger data set, it gained its relevance and indeed, critical
inclusion. The creation of data sub-sets was also an issue in the development of the questionnaires. As
LQAS is based on sample sizes of 19, any decrease in the sampling numbers creates sub-sets. Sub-sets
undermine the statistical attractiveness of the LQAS methodology because they change the sample size
and thus, the benchmark decision rules; and depending upon the actual responses, hyper-geometric
calculations may be necessary.
Sampling/Supervision Areas: Ideally, most sectors would have preferred to divide their catchment area
into four supervision areas. However, the evaluation team had to estimate the cost/benefit of multiplying
the sample by four. In some cases, the number of units was too small to be divided by four (for example,
21 school cisterns). In other cases, such as agriculture, the program had been working with only two
associations, the association being the unit of analysis for the programmatic component. For both MCH
and Education programs, the supervision areas corresponded to the programmatic areas. This strategy
became very useful for programming purposes since it allowed the analysis of program performance to
be done by programmatic area and for recommendations to be specific to each geographic area. Taking
into account the benefits conveyed by sampling four supervision areas, the evaluation team would
strongly recommend using this methodology as often as the number of units and the cost of the study
would permit. Ensuring, whenever possible, that the programmatic area corresponds with the supervision
area is also highly recommended.
Sampling/Sampling Lists: The most problematic issue that arose in the drawing up of sampling lists had
to do with the selection of Alternates. Not enough Alternates were identified previous to the fieldwork for
the sectors where lists had been drawn with the names of the participants (women credit and colvol
credit). This resulted in valuable time being spent by the field staff communicating by telephone with CRS
in Port-au-Prince and the redrawing of the lists for the selection of more Alternates. The need for
Alternates was one that had been recognized early on in the process; what was not anticipated was many
would be needed. In a survey that is under such tight time constraints as this one, the data collector does
not usually have the luxury of returning to a site another day in order to interview a specific person. A
greater amount of time should have been spent in assembling the participant lists for the micro-credit
xv
sectors in order to ensure their relevance to the data requirements. For the HIV/AIDS sampling, SSNIs
were divided into two supervision areas – SA1 was comprised of SSNIs that had received HIV/AIDS
trainings, while SA2 had not received such training. For each SSNI, the data collector was tasked with
interviewing six people, including two girls and two boys. Shortly after beginning the data collection, it
became quite clear why certain of the SSNIs in SA2 had never received HIV/AIDS trainings; namely
because they were centers for “special populations” like physically or mentally handicapped children,
orphaned infants, etc. There were also single-sex centers and centers for young adult males. The
populations in these centers thus precluded the satisfaction of the required number of completed
samples. As a matter of fact, less than 75% of the necessary interviews of males took place at the
centers of SA2, rendering the obtained data ineffectual. Identification of “alternates” sites would have
solved some of the problems encountered with the SSNI sector. However, the comparison between SA1
and SA2 with regards to HIV/AIDS training would not have been appropriate since the two groups were
different.
Training: The time allocated for the training was too short. Even though all enumerators had previous
experience in surveys and questionnaires, this methodology was new to all of them. Many showed
difficulties in filling the double negative questions that were found to be confusing. Changes were made
during the field test questionnaires later on before the teams left for the actual fieldwork. Enumerators
should have had more time for field testing to uncover problems related to phrasing sentences and
inconsistencies with instructions provided to them. Since supervisors were responsible for reviewing the
questionnaires in the field, additional training would have been important to help them identify the
potential inconsistencies that had to be corrected later on by the CRS/FANTA team supervisors. The
period for the field test was also too short. In her report covering the data collection period, the team
leader reported a series of notes relative to the questionnaires. Those inconsistencies were corrected
either in the field or before the data entry. In case the same questionnaires are used for a similar survey
in the future, it would be important to include all such comments in a revised version of the survey.
Field Work: No major problems were encountered for sectors where the sampling list was made up of
the names of localities or sites. The selection of alternates was one of the most problematic issues that
arose in the field. This was largely a problem with Credit-Women and SSNI sectors. Three alternates per
supervision area had been selected for the Credit-women sector but it became readily apparent that this
was insufficient. Urgent decisions had to be made very rapidly since the change in the sampling interval
directly affected the identification of all the alternates. Without effective means of communications such
as the telephone, this change would not have been done in a timely manner and this would have caused
a significant delay in the field work implementation for that sector.
Data Analysis: The primary analysis of LQAS data is notoriously simple, as it involves essentially
measuring whether the number of “passes” equals or exceeds the number needed to meet the
benchmark; and from that comparison, apply a pass/fail judgment at the program level. Some complexity
is added when doing a secondary analysis of the data by SA to derive point estimates, confidence
intervals etc; as was done here. Yet this pilot showed that, once the key principles are understood, this
secondary analysis is also straightforward: CRS staff could easily and correctly perform the primary and
secondary analyses by sector, once basic training had been done by FANTA. This augurs well for the
replicability of the methodology, and is a good lesson learned that confirms the ease of use of LQAS in
general.
QUALITATIVE ASSESSMENT – PHASE II
Identification of Problem Areas: After Phase I results had been analyzed, each CRS program sector
team met with the FANTA team and the team leader to review and discuss results for all indicators
measured during Phase I. The team focused on indicators that seemed to be lagging in performance and
discussed if they merited further investigation. Problem areas were identified in four major sectors: MCH,
Women credit, Colvol credit and School latrines. In addition to those four sectors, the CRS education
team proposed to investigate during Phase II some key issues pertaining to education that were not
addressed during Phase I. After having identified the areas to be investigated in each sector, the team
proposed the potential source of information for each area. The team leader who was the main person
xvi
responsible for conducting the Phase II of the MTE compiled those comments and proposed a Phase II
plan to the CRS/FANTA team including objectives, areas of investigations, methodology, locations and
sources where to look for each information. Since most of the sectors identified for Phase II had covered
four different supervision areas during Phase I, the team was able to propose specific supervision areas
for Phase II, more specifically areas where the results had been less performing: Port a Piment and
Aquin.
Selection of Methodology for Constraints Analysis: Qualitative methods used for Phase II of the MTE
included focus group and key informant interviews. Focus groups were conducted with groups of mothers
in the credit program, mothers with children 12-24 months old and not participating in the credit program,
colvols, school directors, teachers and members of Parents Teachers associations. Key informants
interviews were performed with field based CRS and partner staff, persons responsible for health centers
and other key leaders in the communities.
Field Work: A total of 13 focus groups (7 in Port a Piment and 6 in Aquin) and 9 key informant interviews
(4 in Port a Piment, 4 in Aquin and one CRS staff) were conducted during Phase II. All these interviews
and meetings took place during a two-week period and were conducted by the team leader who has a
long experience in qualitative survey methodology.
Results Analysis: The team leader compiled the results from all meetings and interviews for each sector.
Since Phase II evaluation was implemented as a follow up investigation for Phase I, findings specific to
Phase II and recommendations to improve project performance are combined with those of Phase I to
ensure a comprehensive and integrated report for each sector.
Lessons Learned – Phase II
Identification of Problem Areas: Similar to the Phase I, some program staff wanted to investigate
numerous issues. Time and cost constraints were important factors taken into consideration while
planning Phase II. With the assistance of FANTA staff and the team leader, the CRS team was able to
finalize a list of important issues to be investigated during Phase II. Some sectors did not identify any
issues to be examined during Phase II. However, the education team proposed to investigate new issues
pertaining to education that were not addressed during Phase I. This change in Phase II planning affected
the timing for the fieldwork. It is recommended that the complete set of performance indicators for each
sector be identified at the beginning of the study.
Selection of Methodology for Constraints Analysis: With regards to the credit mothers program, the
original plan for Phase II included the areas where problems had been identified. Field experience
showed that conducting additional interviews with key informants in areas where the credit program has
been successful revealed to be a highly informative process. While providing valuable explanations why
the program has been successful in some areas and not in others, this information also contributed to a
better understanding of the difficulties encountered in problematic areas.
Field Work: Since the composition of the group will influence the dynamic of the focus group, the
selection of the participants is a very important issue. The process must be supervised by an external
person who should follow the rules and criteria set by the team leader. It is also important to take the
time to understand the mentality of the people living in the area targeted by the study before conducting
qualitative research in a that area.
Results Analysis: The variety of program sectors and the wide range of groups and participants who
were interviewed were identified as strong points during Phase II. This methodology facilitated the results
analysis process because it provided a wide range of information from which the most significant
elements were withdrawn.
xvii
MAJOR RESULTS AND RECOMMENDATIONS FOR PROGRAM OPERATIONS 
Agriculture
Results Recommendations for Program Operations
• All 11 indicators measuring the adoption of improved
agricultural techniques by farmers and perceptions of
farmers on women participation in farmers’ associations
met the MTE target (*)
• Continue project activities as currently structured and
implemented by Caritas and CRS and extend in new
zones using the same program strategy
(*) Note: Had the performance benchmarks been set higher, thus making it more challenging for the farmers to pass on the
 indicators, weaknesses in the project may have been revealed and hence, reinforced.
Community Credit Program
Results Recommendations for Program Operations
Phase I:
• Targets met for issues related to group management,
solidarity amongst members, selection process, literacy
and numeracy levels
• Even though no additional money spent on food for
children, less food is used from the household production
and food diversity is increased because of increased
access to markets
• Participants in Port-à-Piment area have more difficulty to
reimburse their loans
Phase II:
• All people interviewed agree that the credit conditions
offered by the Caritas-CRS credit program are more
advantageous that the other credit programs. However,
they believe that the interest is still too high since they
have to use a large part of their profit to be able to pay
the interest.
• In Port a Piment where participants have difficulty
reimbursing their loans:
- Participants acknowledged the impact of the credit
program on social capital, they learn how to work as a
group, the credit allowed them to meet emergency
without having to borrow from loan sharks. But the
credit did not help them in improving their economic
situation.
- Problems encountered: extreme poverty, obligation to
use part of the loan to satisfy family obligations, lack of
past business experience, no other sources of income
to cover part of the monthly interest payments, Port a
Piment is not active trade area.
- Many women had to abandon the credit program since
their profits are not sufficient to make interest payment.
Some women are still paying interest on a principle
they are gradually reimbursing.
- Selection criteria: participants not selected from rally￾posts, selection criteria not correctly applied. Too much
disparity among group members (less solidarity).
• CRS micro-finance staff together with its partner
should immediately address the findings specific to
credit groups in Port-à-Piment, formulate concrete
recommendations for the continuation of the
program in that area, specially for participants who
experience difficulties, and ensure the
recommendations are rapidly applied
• CRS micro-finance field staff together with their
partner field staff should conduct a rapid analysis of
all other micro-finance women groups (a sample in
each programmatic area) to verify if no other groups
are experiencing situations similar to Port a Piment
• With regards to on-going groups, CRS should work
closely with its partner to:
- Provide in-service training to their field staff (credit
officer) on a regular basis
- Ensure list of participants is always up to date
- Examine current conditions of payments: interest
rate and loan capital
- Reinforce training programs for all participants
(including how bankbooks work)
- Enhance the involvement of group members in the
decision making process
- Ensure group committees share loan
management information with all group members
- Involve all group members in the selection of new
participants to replace those who decide to quit
the group and ensure new members fulfill group
criteria
- Enhance the involvement of the colvol in the
selection of the new members and in the overall
group management
- Review program strategies to ensure autonomous
groups continue to receive support from the credit
officer
xviii
Results Recommendations for Program Operations
• In Aquin where many groups are “autonomous” (they
have reimbursed the loan principle) :
- All beneficiaries acknowledged the significant
improvements in their living conditions since they
joined the credit program
- They learn how to work as a group and to better
organize themselves, can meet emergency without
having to borrow from loan sharks
- Payment of monthly interest is not a problem; many
women are “true” business women and Aquin is an
active trade area.
- Reimbursement of loan principle every six months
(cycle) is the most difficult issue. To be able to
reimburse the loan principle, they sell part of their
products or an animal (if they have other small
business) or borrow from friends. If all group members
bring back their money on the same day, it is returned
to them on the same day. If any participant does not
return part of the loan, no one in the group receives
their new loan. This strategy unduly penalizes those
who have made sacrifices to bring back their money.
- Selection criteria: No problem at the beginning, most
participants selected from rally-posts using
participation and credibility criteria. Problems arose
when members started to quit the program and the
replacement process was not well defined (not
necessarily from same community and the group is not
consulted). Reimbursement problems often with those
new members.
• More food for young children:
- Aquin: even though, no additional money is spent on
food for children, less food is used from the household
production and food diversity is increased because of
increased access to markets
- Port a Piment: credit did not directly contribute to
better child feeding but women report dipping in their
business inventory to feed their children.
• Recommendations made by participants/key informants:
- Review and apply participant selection criteria
(credibility, authentic business women, same
background)
- All credit program participants should receive training
on marketing issues to better identify their type of
business
- Decrease the interest rates
- No requirement to reimburse the principle at the end of
each cycle
- More training and support from the credit officer
- The whole group and the community colvol should be
consulted when a member must be replaced
- Management issues: bank book should be in the
hands of the group and not the credit officer,
information on bank transactions should be shared
with the whole group (not only the committee), credit
officer should continue to support “autonomous”
groups, review the role of the committee (the group is
kept out of the decision-making process)
- In Port a Piment (not a commercial area), micro-credit
loan could be used for small food processing projects
• With regards to new groups, CRS should work
closely with its partner to:
- Limit micro-credit programs to areas with active
trade activities
- Ensure guidelines for receiving credit are being
correctly applied; types of investment, and past
business experience are essential criteria
- Ensure credit participants attend training on
business development and training before
receiving the loan
- Apply all recommendations made for the on-going
groups (listed above)
• Partner’s capacity building:
- CRS staff should pursue and reinforce partner’s
capacity building on management of micro-finance
programs
- CRS micro-finance staff should increase
supervision visits at the field level
• Overall program strategies:
- Based on the overall MTE findings and the above
recommendations, CRS micro-finance staff,
together with regional micro-finance advisors,
local micro-finance partners and other micro￾finance institutions should examine the current
loan management conditions in the CRS micro￾finance program (interest rates, reimbursement of
the loan principle, types of business, length of the
cycle) and make recommendations for potential
changes that would allow better loan conditions
for program participants leading to increased
profit, thus contributing to the improvement of the
overall socio-economic conditions in the DAP
targeted areas.
xix
 Colvol (Community Health Workers) Credit Program
Results Recommendations for Program Operations
Phase I:
• Targets met in issues related to loan management, group
solidarity and credit program being an incentive for their
work as a CHW
• CHWs have more money to spend on things such as
clothing, medical care and school fees but do not spend
more money on food than before they received their loan
Phase II:
• Credit program management: colvols express concerns
with CRS’ decision to change the management from CRS
to its partner, Caritas. Change will be at their
disadvantage since interests will be returned to Caritas
and they would have to reimburse the loan principle at
the end of each cycle. For many years, Colvols have
been managing their credit fund themselves under CRS
supervision; the interest was reinvested in their loan. With
the change of management, many colvols started paying
the existing loans and plan on discontinuing their
participation in the credit program.
• Advantages of the credit program for the colvol: the credit
program helped significantly improve colvols’ living
conditions, quality of life and self-esteem.
• Impact of the credit program as an incentive for Colvol
participation in MCHN activities: the credit program
encourages the colvols to do their best in participating in
the very demanding work expected of them in the MCHN
program. The credit represents a small compensation for
the volunteer services they provide to their communities.
The colvol is the link between the hospital and the
community and the most important worker in the health
system. Key informants report that the health center’s
success is directly related to the colvols’ presence.
• Other elements to motivate the colvols: more training,
learn how to give vaccines, have access to first aid kit,
stretcher to transport urgent cases. Other benefits such
as special rate for health services, identification badge,
participate in large meetings of colvols from different
centers to exchange ideas and share experiences.
• CRS programming team should immediately reconsider
the decision of transferring the colvol micro-credit
program to Caritas. CRS should first meet with the
colvols (not only the committees), evaluate the success
and weaknesses of their credit program and propose
strategies that will benefit the colvols without negatively
affecting their important volunteer work in their
community. The micro-credit loan is an incentive for the
colvols who are the core strength of the MCHN
program. All important decisions and/or significant
changes in the micro-credit program should be
analyzed by the micro-finance team together with the
MCH team. Meetings with colvols should be done for
many groups at the same time to give them the
opportunity to share ideas and experiences.
• The MCH team should promote and organize (annual)
regional meetings of colvols from different health
centers to discuss issues that affect them, exchange
ideas and share experiences.
• The MCH team, in collaboration with the MOH staff,
should continue to train more colvols in the
administration of vaccines and analyze other strategies
suggested by the colvols to increase their motivation.
Small project proposals and diversification of health
sector funding sources could support some of those
special requests suggested by the colvols.
Water and Sanitation
Results Recommendations for Program Operations
Phase I:
• School cisterns met all targets for condition and
maintenance
• Mixed results for school latrines: met targets for cleanliness
but failed for some maintenance issues (doors closed, seat
covers)
• Capped springs: target met in 16 out the 20 indicators
measuring the quality and maintenance of water points and
fountain areas; positive efforts made for the reforestation of
spring surroundings and behavior change associated with
the capped spring
School latrines
• Ensure all latrines follow construction standards set by
CRS water and sanitation team, with special attention
to functional locks on the doors, cover on the latrine
seat and locks from the inside
• Reinforce those aspects during training of PTAs and
other local partners implementing water and sanitation
projects
• Reinforce school structure responsible for
maintenance of school latrines
xx
Results Recommendations for Program Operations
Phase II:
• Maintenance problems observed in school latrines not
related to misunderstanding between PTA and school
management staff but to lack of information and slight
negligence
Capped springs:
• Reinforce the importance of maintaining the spring
area clean and keeping the drainage canals clear.
Include those topics in the training targeting water
committees, CHWs and rally post participants – for
new spring cappings and for previously built systems.
Education
Results Recommendations for Program Operations
Phase I:
• PTA committee member: All four indicators measuring
participation in school activities met the targets in four SAs
• School director: Two indicators related to participation in
managerial training met the benchmarks. Participation in
Health, Hygiene and Nutrition training did not pass in one
new SA where directors might not have yet received such
training
• School teacher: Two indicators related to participation in
pedagogical training met the benchmarks. Participation in
Health, Hygiene and Nutrition training did not pass in one
new SA where directors might not have yet received such
training
• Female and male students: All indicators related to school
canteen were met
Phase II:
• Causes of school dropout: primary cause associated with
lack of financial means (increase in school fees and cost of
living)– student returned home because of non-payment of
school fees and periodic suspensions/ absences often
leads to complete school drop out.
• Use and assessment of training materials provided by
CRS: high level of satisfaction with CRS work expressed
by teachers, directors and PTA members. Number of
pedagogical boards per school is insufficient. High rates of
resignation of teachers after they received training sessions
(transfer to other schools for salary issue).
• PTA contribution to school development: through CRS
training sessions, PTA and school directors gradually came
to understanding with one another. PTA member
implement numerous activities that contribute to the
development of their school.
• Share Phase II results with field staff and partners:
issues of school dropout because of non-payment of
school fees and transfer of teachers who have received
CRS training to non-CRS supported schools.
• Include those issues for discussions in community
meetings with PTAs, and federation of PTAs to propose
concrete plans to address those issues at the school
and community levels.
• Emphasize advocacy training for PTAs and federation
of PTAs and assist them in their fundraising efforts for
community education activities.
xxi
MCHN
Results Recommendations for Program Operations
Phase I:
Breast feeding and Infant feeding practices:
• Targets met for: giving only breast milk on day of birth and
breastfeeding their infant within one hour of birth
• Targets not met for: giving colostrum to infants, providing
the adequate number of daily complementary feeds to
children between 6 and 24 months; and providing children
6-24 months with the appropriate dietary diversity
Diarrhea and diarrhea management:
• Three aged groups failed the target on % without diarrhea
in last two weeks
• Most of the SAs passed the benchmark and the weighted
average on diarrhea management but unequal performance
levels across the SAs (37% children given ORS during
diarrhea at the time of baseline and 60% at MTE)
Health cards, Child Immunization and Vitamin A
supplementation:
• Thanks to joint action between CRS and the Ministry of
Health, all targets met for all age groups for all indicators
Pre-natal and Post natal Care:
• Targets met for indicators dealing with immunization during
pregnancy, the number of prenatal visits, the prenatal visit
with trained provider before the third trimester of pregnancy
and the postnatal visit within 45 days of delivery
• Fewer mothers attend postnatal visits in the area of Aquin
compared to other areas. Results of Phase II show that
women in Aquin did not attend postnatal clinic because
there was a disruption in food supplements for many
months. Colvols report that youngest women attend the
postnatal clinic more than the older women.
• Results more successful for mothers of younger children:
recent exposure might be associated with better
performance (95.6% of mothers of children 0-6 months of
age who received prenatal visit with trained provider before
third trimester of pregnancy)
• Target (35%) not met for mothers who gave birth in a
health facility. Reasons reported not to deliver in a health
institution (Phase II): distance too long between home and
health center, not in agreement with some conditions for
delivery at hospital (such as fear of delivery table, fees too
high, nice clothes not available, no respect of local
customs….)
Participation in program activities:
• Participation in rally-posts: participation of children and
mothers met the benchmark in three SAs except in the area
of Aquin and Grande Anse
Factors that motivate mothers to take their children to the
rally-posts (Phase II): vaccination, weighing, education
Infant feeding practices:
• The adoption of these practices (giving colostrum to
infants, provide adequate number of daily
complementary feeds to children between 6 and 24
months, and providing children 6-24 months with the
appropriate dietary diversity) is crucial to reducing
malnutrition rates and CRS should strive to better
understand the constraints that may impede mothers
from adopting those important practices and emphasize
those practices in training of CHWs and health staff and
in education sessions to caregivers
Diarrhea and diarrhea management:
• Should continue to emphasize the BCC messages on
the importance of applying simultaneously all three
components of appropriate treatment of diarrhea: ORS,
increased liquids and same or more food
Postnatal visits in Aquin: The MCHN team should ensure
that the management staff in Aquin hospital implement
program activities according to the norms and procedures.
Delivery in health institution: share results of Phase II with
hospital health staff, include those topics in health staff
training and discuss concrete changes to improve the
environment when women give birth in a health facility.
Participation in program activities:
• Vaccination being the most important motivating factor
for mothers to participate in the rally-post, CRS MCHN
team should continue to support MCHN centers with
strategies to increase vaccination activities in the rally￾posts
xxii
Results Recommendations for Program Operations
session, Vitamin A, deworming medicines, reminder by the
colvol, colvol’s “way of doing”, popularity of the colvol,
distance between post and household. Lack of motivation of
mothers of children 12-24 months directly linked with the
perception that children who have completed their
vaccinations are at less risk.
• Participation in mothers’ clubs: All SAs passed the
benchmark of 25% (40.2% among the youngest group)
• Perceptions of mothers about CHWs’ knowledge and skills:
for mothers of children 0-6 and 6-12 months old, all of the
SAs met the targets on five indicators; the area of Port a
Piment, Roche a Bateau and Coteaux did not pass the
target for 12-24 months old for the communication on the
child’s weight
Food Supplementation Program during Pregnancy and after
childbirth:
• 82.5%, 100% and 72.5% of mothers (children 0-16, 6-12
and 12-24) received food supplements during their last
pregnancy (note that the sampling was done at the
population level)
• Results on the “regularity” of food supplementation during
pregnancy and after childbirth did not meet the expected
targets
• Food rations (Phase II): mothers report receiving the
correct amount of commodities. Irregularity due to
disruptions in the stock is the major problem.
Knowledge, skills and participation of Community Health
Workers:
• All CHWs passed the benchmarks on five indicators
measuring their perceptions of knowledge except for their
ability to provide immunization
• Results on their technical knowledge were mixed: passed
on immunization and diarrhea management and ORT but
did not pass on some infant feeding issues such as the
number of times a on-year-old child should be fed each day
and the criteria reference for malnourished children (note
that the benchmark had been set at 95%)
• CHWs in both SAs cleared the 75% benchmark for
completion and submission of rally posts reports and 85%
for participating in the monthly continuing education session
Hand washing knowledge and techniques:
• Safety Net program participants most knowledgeable on
hand washing techniques, followed by the Education
program and mothers participating in the MCHN program.
CHWs met the targets for three indicators and failed on
three.
• “After using the toilet” and before eating” messages met the
target but the indicator “before feeding children” failed in all
groups
• Correct hand washing techniques: all four groups in Safety
Net program passed, some Education groups passed
(school children did not pass), and all three groups of
mothers failed to pass for the international method of hand
washing techniques
• CRS staff and CHWs should emphasize the issue that
children older than 12 months are still at risk and
mothers should continue to take them to the rally posts
• Recommendations from mothers in Aquin (Phase II￾qualitative) to improve the rally-posts: reorganize and
improve the logistics in rally posts to avoid mothers
waiting too long; conduct education sessions for smaller
groups to facilitate better participation
Food supplementation during Pregnancy and after
childbirth:
• CRS MCHN staff and Commodity Management Office
should analyze issues of regularity of food deliveries
and propose solutions to improve the situation
Knowledge, skills and participation of Community Health
Workers:
• Address critical gaps in CHWs knowledge via monthly
continuing education sessions and formal refresher
training courses
• Use LQAS to monitor CHW’s levels of knowledge in
various SAs on a regular basis and after refresher
training courses
• Ensure CHWs have materials they need to carry out
their responsibilities properly
Hand washing knowledge and techniques
• Messages on hand washing should be reinforced in all
programs, but specially so in the MCHN program for
CHWs and mothers (improvements in hygiene behavior
may present an opportunity for better child nutrition and
health outcomes)
• A standardization of messages across programs could
be instrumental in improving hand washing knowledge
and techniques
xxiii
HIV/AIDS
Results Recommendations for Program Operations
Safety Net Institutions with HI/AIDS training and with no
HIV/AIDS training (management staff and children):
• Both groups passed and failed same benchmarks on
knowledge on “means of transmission”
• Both groups have fairly good perception of “personal
risk”
• Both groups met the targets on “stigma and
discrimination”
Schools (PTA member, School director, Teacher,
Female and Male children):
• All three groups met targets on commonly known ways
of avoiding HIV/AIDS transmission, on general
knowledge of HIV/AIDS and notions of Personal risks
and stigma and discrimination
• Transmission messages should be reinforced and expand
upon the public health messages that are currently being
spread by the media
• Discrimination and stigmatization issues must be addressed
with the youngest program participants in order to contribute
to improved conditions for PLWA on the societal level
• Reinforce the technical capacity of the local partner that are
providing training to enable them to provide better quality
training to the communities
Safety Net
Results Recommendations for Program Operations
Indicators used as “baseline”
• Management and staff can name 2 or more universal
rights of children
• Some centers failed to meet the benchmarks for
cleanliness (kitchen area, toilets/latrines) (*)
• Centers did not pass the 70% benchmark for % of
centers without food shortages in the center canteen in
the last months
• Center staff met the target on maintenance of financial
ledger
• Both groups of female children met the targets on”
going to school, having a birth certificate, having eaten
a CRS supplied food and something other than a CRS
supplied food in the last 24 hours
• Strengthen Health, Hygiene and Nutrition training in Safety
Net institutions to underscore the critical links between
cleanliness and good health
• Create a checklist of regular cleaning tasks for centers’ staff
• Include cleanliness indicators in the supervision visits of
CRS Safety net staff
* Note: indicators relating to centers’ cleanliness should have been set higher (the MTE benchmark was 50%)
Civic Education
Results Recommendations for Program Operations
13 indicators measured on 11 groups (from above
programs) as baseline information:
• Expected performance benchmarks were different for
all groups and depended upon the perceived or verified
levels of community and civic involvement, education
levels and past CRS interventions with specific target
groups
• School directors passed all 13 questions
• Design civic education training programs that speak to
the needs and constraints of each target group;
particularly mothers, CHWs, PTA members and school
teachers
xxiv
CONCLUSION FOR METHODOLOGY DEVELOPMENT
The FANTA team was very satisfied with the overall undertaking. As a pilot study, it confirmed LQAS’s
potential for the conduct of mid term evaluations; and highlighted the usefulness of the qualitative
research in Phase II. However, several lessons were learned that should be applied in future such
applications.
Phase I (LQAS Surveys)
- The entire exercise consists in evaluating whether progress made corresponds to that expected. To
do so, one must assume that LOA objectives are reasonable to start with. That, however, can be
problematic: for many indicators we simply don’t know how much improvement can be achieved in a
given time frame; and a program’s objectives (mid term and LOA) can easily be set too high, or too
low. When interpreting results, the analyst should be wary of this and always ask whether initial
objectives were too ambitious, or too modest. If need be, targets can be adjusted in light of the
findings from the mid-term.
- Unlike final evaluations, the MTE focuses on beneficiaries, not on the population at large (unless they
are one and the same). Because of this, MTE results may be far higher than LOA results, especially
where a program is effective in changing outcomes among beneficiaries. The benchmarks might
therefore be different, arguably, at those two time points. The interpretation of results should also be
clear about whom inferences are made.
- A tension exists between the amount of detail to be provided by the evaluation, and the cost of
collecting and analyzing the data. Two factors in particular play in this: (i) what questions should be
asked; and (ii) who should answer them. On the first point, the M&E Officer must guard against
overloading a survey with questions that do not lead to implementation recommendations. The
preference is to concentrate on effect indicators. On the second point, the multiplication of strata (e.g.
teachers by grade; or mothers by age group of their child) rapidly leads to sample inflation, denying
the benefits of LQAS. Principles to apply here are: (a) define a new sample group only if this group is
a particular target for the program; (b) consider parallel sampling if this is possible; (c) recall that SAs
are themselves a stratifying device.
Phase II (Qualitative research)
- Phase II is as important as Phase I and should not be given less attention.
- The experience and quality of the qualitative study field staff is critical to its success. A specialist
should be hired to do this piece of the work.
- Selecting the site for carrying out the qualitative research is critical to the findings. The selection of
respondents for Phase II is purposive and should focus on sites and population groups that were
found to display the problem.
1
CHAPTER 1 - INTRODUCTION
1.1. INTRODUCTION
According to USAID/DCHA/FFP guidance, Title II Cooperating Sponsors are expected to conduct a series
of evaluation exercises during the life of their Development Activity Programs (DAPs): a Baseline survey
should be done before implementing the program, to know the conditions at the outset in intervention
areas; a final evaluation is also expected at the end of the Life of Activity (LOA) to document the extent to
which the program achieved its objectives; and a Mid Term Evaluation is recommended, about halfway
through the life of the DAP, to help program managers assess progress made, whether or not the
program is on the way to achieve its stated objectives, and make recommendations on ways to improve
performance if need be. Although relatively good experience exists on the conduct of Baseline and Final
Evaluations, little guidance exists on how to do Mid Term Evaluations—even though this may be one of
the most important steps in the LOA to guarantee its final success. To address this gap, the Food and
Nutrition Technical Assistance (FANTA) project teamed up with CRS/Haiti to pilot test a Mid Term
Evaluation (MTE) methodology that would: 1) examine progress made in reaching DAP goals; and 2)
formulate recommendations to help correct imbalances in areas found to be under performing. This report
looks at the entire activity, from methodology development to results analysis and final recommendations.
1.2. SUMMARY OF STEPS OF THE MID-TERM EVALUATION (MTE)
The MTE results presented in this report are based upon data collected in CRS/Haiti’s areas of
intervention, namely in the Southern and Grande Anse Departments. The MTE was divided into two
phases: Phase I encompassed the development of the survey instruments, the collection of survey data,
and its analysis; Phase II examined the bottlenecks identified in Phase I, using qualitative research
methods. The quantitative data collection of Phase I took place from December 7 to December 23, 2004.
The qualitative, follow-up investigation of Phase II took place March 14-24, 2005. The steps involved in
each Phase are listed in continuation, and developed in later sections.
PHASE I: The first step in Phase I was to identify performance indicators for each sector
evaluated in the MTE. A mid-term performance benchmark was set for each selected indicator
taking into account its baseline value and LOA target. Samples targeted for data collection in
each sector were also identified at this time, activity zones being subdivided whenever possible
into Supervision Areas (SAs). On the basis of this preliminary work, the Team developed LQAS￾friendly data collection instruments in which all questions were phrased to elicit a dichotomous
(yes/no) answer. Data collection began December 9, 2004 and was completed by December 23,
2004. Completed questionnaires were analyzed early January 2005, allowing to separate
activities that had successfully met their mid term targets from those that did not.
PHASE II: Focusing on indicators that seemed to be lagging in performance, the Team identified
activities that merited further investigation. An analysis of constraints using qualitative methods
was performed, including mainly focus group and key informant interviews. The report from the
qualitative research, submitted April 2005, was used to elaborate a series of recommendations to
improve project performance.
2
CHAPTER 2 – CONTEXT OF MID-TERM EVALUATION
2.1. CRS/HAITI PROGRAM OVERVIEW
The goal of CRS’ proposed DAP is to sustainably reduce the level of food insecurity in vulnerable
communities of the Southern Peninsula with a focus on the South and Grande-Anse departments and
one area of the South East Department (Cotes de Fer). CRS will achieve this goal through integrated
activities in four sectors: Health and Nutrition (Maternal and Child Health, Water and Sanitation,
HIV/AIDS, Micro-finance), Agriculture, Food-Assisted Education and Humanitarian Assistance. To
achieve this goal, CRS will secure private funds and other sources of funding to complement DAP
resources.
CRS has implemented Title II food activities in Haiti for over four decades, targeting the most vulnerable
groups: children 0-5 years of age, pregnant and lactating mothers, primary school students, and
institutionalized persons (orphans, hospital patients, tuberculosis and HIV/AIDS out patients and the
elderly and displaced), through schools, health centers, and safety net institutions. FY 02-07 DAP
improves upon the previous program by more effectively targeting needy communities, providing more
efficient and effective service delivery and applying lessons learned from previous Title II funded and
complementary food security programs. This DAP employs an integrated approach to its programming,
implementing multiple sectoral interventions in the same communities, in order to increase the impact,
sustainability, and efficiency of each.
The Maternal and Child Health Component of the Health and Nutrition Program will improve the quality of
health services in health institutions located in the DAP targeted areas working through the Health
Communal Unit (UCS: Ministry of Health structure grouping health institutions by region). New activities
include support to immunization, IMCI and `ti-foyer`(Home-based Nutritional Demonstration using the
positive deviant approach). In addition to MCH activities targeted at health facilities, a Water and
Sanitation program is integrated into Education and Social Assistance programming. CRS private funds
support HIV/AIDS activities while pursuing the current food supplementation of HIV/AIDS beneficiaries.
Interventions in micro-credit continue to support health activities targeting Volunteer Community Health
Workers and a limited number of female participants.
In addition to integrating and focusing on geographical areas, CRS included Agriculture as a new DAP
sector, based on CRS/Haiti’s long-term experience in that area. While reinforcing current partners,
program activities in agriculture are implemented on the Southern coast through support to local peasant
associations.
CRS phased-out school-feeding as a stand-alone activity after one year in all four current DAP
departments, while strengthening community structures in schools that have received a package of
interventions to accompany food during the phase out period. A complete Food Assisted Education
package is implemented in 150 schools in the South and Grande-Anse departments for which CRS
private funds complement the food-assisted activities.
In the Humanitarian Assistance Program, food distribution continues to serve the most vulnerable such as
orphans, abandoned and street children, the physically and mentally disabled, and chronically ill and
aged persons. Levels of beneficiaries will be maintained due to limited DAP resources. This sector fosters
linkages between Social Safety Net Institutions and broader civil society, facilitating channels for
advocacy and community empowerment, and empowering the former to diversify their sources of funding.
To consolidate efforts, share experiences and develop collective projects, the children’s shelters were
grouped by geographic locations in FY03. Nine federations known as ruches were formed. At the
beginning of FY03, HIV-AIDS training of Safety Net institutions staff and children was introduced thanks
to additional funding from the USAID local Mission.
Beginning FY05, all DAP sectors will be reinforced by a Civil Society/Human Rights component (CRS
privately funded) through training programs in civic education, citizen rights and responsibilities and
3
advocacy. These efforts will contribute to the sustainability of proposed interventions and reach the
CRS/Haiti DAP goal of reducing the food insecurity level in targeted communities.
The purposes of the Title II commodities are the following: 1) nutritional and caloric supplementation for
pregnant/lactating women, nutritional recuperation of undernourished children under five and nutritional
supplements for immediate family members, 2) daily feeding of school aged children, 3) food for
humanitarian assistance/safety net activities, 4) incentive for beneficiaries to participate in all programs,
5) monetization to cover the costs of these activities. Monetization supports the costs of interventions that
will improve the accessibility and quality of health services, increase the food security support given to
persons living with HIV/AIDS, provide access to micro-credit for MCH groups, increase the availability and
utilization of potable water and sanitation facilities in targeted communities and partnering institutions, and
increase access to food through improvement of agricultural productivity while implementing a phase-out
plan for stand-alone school feeding activities.
The US Local Mission funds complements the Monetization funds for specific costs such as program
materials, salaries, warehousing and other administrative expenses.
The number of beneficiaries to be reached by each program during the five-year period is presented in
the following table:
Program Component
Number of
Beneficia￾ries During
FY 02
Number of
Beneficia￾ries During
FY 03
Number of
Beneficia￾ries During
FY 04
Number of
Beneficia￾ries During
FY 05
Number of
Beneficia￾ries During
FY 06
Number of
Beneficia￾ries Over
LOA (**)
Health and Nutrition (including
HIV/AIDS) (food distribution
beneficiaries + caretakers)
92,000 59,900 74,250 80,150 80,150 226,400
Water/Sanitation (new every year) 30,200 35,000 40,000 40,000 43,000 188,200
Credit (on-going and new clients:
women and CHWs)
4,885 6,074 6,373 6,573 6,520 7,823
Agriculture & Infrastructure (new
farmers only)
500 400 450 350 300 2,000
Education (school children only) 78,350 60,000 48,000 50,000 50,000 148,350
Social Safety Net (food
distribution beneficiaries only)
16,200 18,000 18,000 22,000 22,000 56,200
TOTAL 222,135 179,374 187,073 199,073 201,970 628,973
(*) Includes those covered by direct distribution as well as those participating solely in monetization-funded activities
(**) Total LOA beneficiaries does not equal the sum of beneficiaries in each FY since the same beneficiary could stay in the program
 for more than one year
Monitoring and Evaluation Units already integrated in each major sector of interventions continue to
monitor a series of progress indicators and focus on data quality control and feedback to partners. An
Early Warning System is in place in project areas. CRS conducted an integrated baseline study to
determine the initial values and carry out subsequent monitoring activities to determine progress of the
program at specific intervals. Program evaluations will be conducted at mid-term and final points.
Details on program objectives and activities are presented in Appendix 1. Additional information is
available in FY02, FY03 and FY04 Annual Results Reports. The joint baseline report is also an important
reference document.
2.2. EXPECTED RESULTS BY LIFE OF ACTIVITY (LOA) AND MID-TERM
Table I shows the baseline value, the expected LOA and mid term targets for all indicators to be
measured during the mid term evaluation. No baseline value is available for the indicators which were
not investigated at the beginning of the program. The program team had to set LOA and mid term targets
for those additional indicators. Moreover, some LOA targets were intentionally left blank for some
4
indicators that did not have baseline values. In such cases, the weighted coverage levels revealed in the
MTE would serve as baseline values for these indicators.
Table 1: Indicators, Baseline Values, LOA and MTE targets by sectors
AGRICULTURE
INDICATORS BL
Value
LOA
target
MTE
target
Land Characteristics
Percent of farm association members that have a dry and cool place for seed storage n/a 90% 80%
Percent of farm association member plots that use either green fertilizer or compost n/a 80% 70%
Percent of plots visited that use Level A/courbe de niveau techniques n/a 90% 75%
Percent of farm association members that planted beans in the plot of land used for
CRS activities n/a 95% 90%
Percent of farm association member plots that use/used the promoted planting
density for beans n/a 80% 60%
Percent of farm association member plots that use the promoted planting density for
plantains n/a 80% 60%
Percent of farm association member plots with one or more recommended anti￾erosion systems (“ramp pay”, “clayonnage”, or live barrier) n/a 90% 80%
Percent of farm association member plots visited with one or more anti-erosion
systems in place (“ramp pay”, “clayonnage”, or live barrier) n/a 90% 75%
Percent of farm association member plots that have at least 50 trees planted on them n/a 60% 40%
Gender issues within farmers’ associations
Percent farm association members that report the inclusion of women was a guiding
principle in the formation of their association n/a 95% 90%
Percent of farm association members that think that women should be allowed
membership in the groupement n/a 90% 80%
Percent farm association members that can state one concrete benefit for the active
involvement and membership of women n/a 90% 80%
MICRO-CREDIT – Community (women)
INDICATORS BL
Value
LOA
target
MTE
target
Participation in rally-posts
Percent of credit participants who participated in a rally post before they joined the
credit program n/a 70%
Percent of credit participants who have participated in a Rally Post since they joined
the credit program n/a 50%
Percent of credit participants who have children less than 5 years old n/a 70%
Selection process
Percent of credit participants who feel the selection process for receiving micro-credit
loans is fair and democratic n/a 75%
Percent of credit participants who feel that the Steering Committee was selected in a
fair and democratic manner n/a 80%
Management of loans
Percent of credit participants who would like to continue in the micro-credit program n/a 85%
Percent of credit participants who think they are capable of managing their loan well n/a 70%
Percent of credit participants who think they are capable of managing their business
efficiently n/a 60%
Percent of credit participants who made a profit from their business activities last
month n/a 80%
Percent of credit participants who have never had a problem paying any of the
monthly loan payments n/a 80%
Group Solidarity
Percent of credit participants whose group has assisted a fellow group member when
s/he had a problem paying back her/his loan n/a 35%
Percent of credit participants who think that their group's Steering Committee does a
good job managing the micro-credit program n/a 80%
5
Literacy/Numeracy/Understanding Bank Books
Percent of credit participants who know how to sign their name n/a 30%
Percent of credit participants who feel confident in their addition and subtraction skills n/a 30%
Percent of credit participants who report not having any difficulty in understanding
how their bank book works n/a 85%
Percent of credit participants who have read the financial agreement that they signed
with the steering committee of the group in order to get their loan n/a 20%
Changes in household wealth
Percent of credit participants who never had to borrow money from another source
since they received their loan n/a 65%
Percent of credit participants who spend more money on food than before they
received their loan n/a 75%
Percent of credit participants who feel they have more money now to spend on things
such as clothing, medical care and school fees than before they received their loan n/a 70%
Percent of credit participants who think that the amount of their loan was enough to
improve their business activities as they would have liked n/a 50%
Percent of credit participants whose school aged children all go to school n/a 60%
Percent of credit participants whose school aged children were all going to school
before they joined the credit program n/a 40%
MICRO-CREDIT (Community Health Workers – colvols)
INDICATORS BL
Value
LOA
target
MTE
target
Management of their loan
Percent of Colvols who think they are capable of managing their loan well n/a 90% 75%
Percent of colvols who think they are capable of managing their business activities
efficiently n/a 85% 75%
Percent of Colvols who made a profit from their business activities last month n/a 70% 60%
Percent of Colvols who have never had a problem paying any monthly loan payments n/a 70%
Group solidarity
Percent of Colvols whose group assisted a fellow group member when s/he had a
problem paying back their loan n/a 50% 40%
Changes in household wealth
Percent of Colvols who have never borrowed money from another source since their
received their loan n/a 60%
Percent of Colvols who state that they spend more money on food than they did
before they received their loan n/a 85% 80%
Percent of Colvols who feel they have more money now to spend on such things as
clothing, medical care, and school fees/costs than before they received their loan n/a 65% 60%
Percent of colvols who think that the amount of their loan was enough to improve their
business activities as they would have liked n/a 60% 50%
Percent of Colvols whose school-aged children all go to school n/a 85% 80%
Percent of Colvols whose school aged children all went to school before they received
their loan n/a 65%
Credit program as an incentive to work as CHWs
Percent of Colvols who think that the micro credit loan program is an incentive for
them to work as a Colvol n/a 50%
Percent of Colvols who report that they would continue to work as a Colvol even
without the micro-credit program n/a 60%
WATER AND SANITATION - CISTERNS
Indicators BL
value
LOA
target
MTE
target
Percent of cisterns with walls intact n/a 90% 70%
Percent of cisterns without standing water n/a 90% 80%
Percent of cistern faucets equipped with a handle n/a 95% 90%
Percent of cisterns without a leak/drip n/a 90% 70%
Percent of cisterns with water flowing from the faucet n/a 90% 70%
Percent of wash basins without garbage or debris n/a 85% 65%
Percent of wash basins without animal feces within 10 meters n/a 85% 65%
6
WATER AND SANITATION - LATRINES
Indicators BL
Value
LOA
target
MTE
target
Percent of latrines found to be clean (no trash lying on the floor, no feces visible) n/a 75% 60%
Per cent of latrines free of visible soiled toilet paper or other used paper n/a 75% 60%
Percent of latrines visited where all latrine doors were closed upon arrival n/a 75% 60%
Percent of latrines with functioning doors n/a 95% 80%
Percent of latrines with doors equipped with working inside locks n/a 85% 65%
Percent of latrines with seat covers in all stalls n/a 75% 60%
Percent of latrines with all latrine covers down n/a 75% 50%
Percent of latrines that had at least one broom available n/a 75% 40%
Percent of latrines located at an appropriate distance from water source n/a 90% 70%
Percent of latrines located at an appropriate distance from the school n/a 95% 70%
Percent of schools with very little garbage lying around n/a 80% 70%
Percent of schools where the garbage disposal is used n/a 90% 80%
WATER AND SANITATION – TRASH DISPOSAL
Indicators BL
Value
LOA
target
MTE
target
Percent of sites with trash can easily accessible to school children n/a 95% 80%
Percent of schools without garbage lying around n/a 85% 70%
Percent of trash disposal areas with acceptable levels of garbage in them *where the
level of trash in the garbage pit was below the level of the ground or surrounding wall) n/a 85% 70%
WATER AND SANITATION – SPRING CAPPING
Indicators BL
Value
LOA
target
MTE
target
Spring capping area
Percent of spring capping free of garbage or debris n/a 75% 65%
Percent of spring capping will walls intact n/a 85% 70%
Percent of spring capping covered by lid n/a 85% 70%
Percent of spring capping with lid firmly in place n/a 85% 70%
Percent of spring capping surrounded by a canal on three sides n/a 85% 70%
Percent of spring capping canals that are at least 20cm deep n/a 85% 70%
Percent of spring capping with front area free of standing water n/a 95% 80%
Percent of spring capping surroundings protected by vegetation n/a 80% 50%
Water point/fountain area
Percent of water point/fountain free of garbage or debris n/a 75% 65%
Percent of water point/fountain surroundings free of standing water n/a 90% 80%
Percent of water point faucet or fountain pipe with water flowing n/a 85% 75%
Percent of water point/fountain where there are no animals within 5 meters n/a 90% 80%
Percent of water point/fountain where there are no animals feces within 5 meters n/a 90% 80%
Percent of communities with a spring capping that have a committee to manage the
system n/a 80% 65%
Percent of respondents who state knowing at least one member of the spring capping
committee n/a 80% 65%
Percent of respondents who state they have never seen the system dry n/a 75% 60%
Percent of respondents who state they have never seen the system broken or
damaged n/a 75% 60%
Percent of respondents who state they have never seen people doing their laundry at
the water point/fountain n/a 75% 60%
Percent of respondents who state they have never seen people watering their animals
at the water point/fountain n/a 80% 65%
Percent of respondents who state they have never seen people bathing at the water
point/fountain n/a 80% 60%
Behavior change
Percent of respondents who state that their family treats the water with bleach before
drinking it n/a 30% 20%
Percent of respondents who state that their family has less diarrhea since the n/a 75% 65%
7
construction of the spring capping
Percent of respondents who state using more water since the construction of the
spring capping n/a 80% 70%
EDUCATION
Indicators BL
Value
LOA
target
MTE
target
PTA committee members
Percent of PTA members who attended at least one PTA meeting in the last 4
months. 50%
Percent of PTA members who state that they participated in a health-related activity at
school in the past six months 95% 60%
Percent of PTA members who state that they personally participated in a PTA small
project in the past 12 months 50% 30%
Percent of PTA members who have participated in a training event given by CRS for
PTA members 80%
School directors
Percent of School Directors who have ever received managerial or administrative
training from CRS while an employee of their school 80%
Percent of School Directors who feel that the training they received improved the
overall quality of their management or administrative performance 40%
Percent of School Directors who received any Health, Hygiene, and Nutrition training
from CRS while the director at their school. 80%
Teachers
Percent of Teachers who have ever received pedagogical or teacher training from
CRS while an employee of their school 75%
Percent of Teachers who feel that the training they received improved the overall
quality of their teaching performance 40%
Percent of Teachers who received any Health, Hygiene, and Nutrition training from
CRS while teaching at their school. 75%
Students
Percent of students who state that they received a meal the last day they were at
school 95% 80%
Percent of students who state that the quality of the meal as good 70% 50%
Percent of students who state generally eating all the food given to them at school. 80%
HEALTH AND NUTRITION
Indicators BL
Value
LOA
target
MTE
target
Breast Feeding and Infant Feeding Practices
Percent of children (0-11.99 months) given breast milk only on day of birth 32.5% 50% 40%
Percent of infants (0-11.99 months) breast fed within 1 hour of birth 6.2% 16.2% 20%
Percent infants having received colostrum 53.0% 95% 80%
Percent of children (0-5.99 months) currently being breastfed 95.8% 95% 95%
Percent of children (6-11.99 months) currently being breastfed 98.5% 98.5% 95%
Percent of children (12-23.99 months) currently breastfed 60.0% 70.0% 65%
Percent of infants (0-5.99 months) who are exclusively breastfed 16.8% 26.8% 20%
Percent of children (6-11.99 months) who were fed the appropriate number of
complementary feedings in the last 24 hours 55% 60% 60%
Percent of children (12-23.99 months) who were fed the appropriate number of
complementary feeds in the last 24 hours 41.1% 46.1% 45%
Percent of children (12-23.99 months) who received the 3 food groups (“constructeur,
“energetique”, “protecteur”) in the last 24 hours n/a n/a 80%
Diarrhea Prevalence
Percent of children (0-5.99 months) without diarrhea in the last two weeks 80.1% 85.1% 80%
Percent of children (6-11.99 months) without diarrhea in the last two weeks 60.1% 65.1% 65%
Percent of children (12-23.99 months) without diarrhea in the last two weeks 61.2% 66.2% 65$
Percent of children (6-23.99 months) with diarrhea who were given ORS 37.4% 60.0% 50%
8
Percent of children (6-23.99 months) with diarrhea who were given increased liquids
during diarrhea 44.6% n/a 50%
Percent of children (6-23.99 months) with diarrhea who were given the same or more
food 27.4% n/a 40%
Percent of children (6-23.99 months) with diarrhea receiving continued feeding during
diarrhea 15.2% 25.2% 20.0%
Percent of children (6-23.99 months) with diarrhea receiving additional food after
diarrhea episode 36.4% 46.4% 40%
Percent of children (0-23.99 months) with health card or birth certificate with date
recorded n/a n/a 90%
Percent children (6-23.99 months) receiving Vitamin A capsule in last six months 45.7% 80% 60.0%
Percent of children (12-23.99 months) fully immunized (3 doses polio) 26.7% 36.7% 35%
Percent mothers (children 0-23.99 months) who have a health card 58.7% n/a 80%
Percent mothers (children 0-23.99 months) who received at least 1 tetanus shot 83.8% n/a 70%
Percent mothers (children 0-23.99 months) fully vaccinated against tetanus during last
pregnancy (received 2 shots or was already fully vaccinated) 63.8% 73.8% 70%
Percent mothers (children 0-23.99 months) with at least 3 prenatal visits with a trained
provider 79.6% 84.6% 80%
Percent of mothers (children 0-5.99 months) who received pre-natal visit with trained
provider before third trimester of pregnancy (7 months) 81.4% n/a 80%
Percent of mothers (children 0-23.99 months) who had a trained health provider assist
the delivery 32.3% 37.3% 70%
Percent of mothers (children 0-23.99 months) who gave birth in a health facility 9.7% n/a 35%
Percent of mothers (children 0-23.99 months) who made at least one postnatal visit
with a trained health provider within 45 days of delivery 19.1% 24.1% 25%
Participation in program activities (rally-posts and mothers’ club)
Percent of children who have participated in a Rally Post in the last month n/a 90% 80.0%
Percent of mothers who have participated in a Rally Post in the last month n/a 80% 70.0%
Percent of mothers who participated in an educational session at a Rally Post in the
last month n/a 80% 70.0%
Percent of mothers who are members of a Mothers Club n/a 50% 25%
Participation in program activities (Perceptions of Mothers on CHW’s knowledge on Health Issues and
Communication Skills)
Percent mothers who think educational sessions provide practical information n/a n/a 70%
Percent mothers who think immunization provided by the health facility is valuable n/a n/a 95%
Percent mothers who think growth monitoring services that Colvol provides are useful n/a n/a 95%
Percent mothers who know if child's weigh increased or decreased in the last month n/a n/a 70%
Percent mothers who think information provided by Colvol is easy to understand n/a n/a 75%
Percent mothers who think Colvols are knowledgeable about nutrition information n/a n/a 80%
Participation in program activities (health facility-food supplementation)
Percent of mothers (0-11.99) who received food supplementation during last
pregnancy
n/a 80% 80%
Percent of mothers (12-23.99) who received food supplementation during last
pregnancy
n/a 80% 70%
Percent mothers who report receiving rations regularly each month during pregnancy n/a n/a 80%
Percent of mothers who received food supplementation regularly since birth of child n/a n/a 80%
Percent mothers reporting receiving the correct ration from the health center n/a n/a 95%
Distance to water source and source of water
Percent mothers reporting water collection taking 30 minutes or less 74.2% n/a 75%
Percent mothers that fetch their water from a protected water source 56.2% 66.2% 55%
MCHN- CHWs (colvols) (knowledge, skills and participation)
Indicators BL
Value
LOA
target
MTE
target
Perceptions of knowledge and skills
Percent of Colvols who feel totally confident in their skills to provide quality health
services to their communities n/a 90%
Percent of Colvols who feel confident in their ability to provide nutritional messages to
their communities n/a 90%
Percent of Colvols who feel confident in their ability to provide maternal health
messages to their communities n/a 90%
9
Percent of Colvols who feel confident in their ability to measure a child's weight n/a 90%
Percent of Colvols who feel confident in their ability to record a child's weight on the
Road to Health cards n/a 90%
Percent of Colvols who feel confident in their ability to provide immunizations n/a 60%
Technical knowledge
Percent of Colvols who can identify the vitamin deficiency which causes bad vision
(Vitamin A) n/a 90%
Percent of Colvols who know how many times a day a one-year old child should be
given something to eat n/a 60%
Percent of Colvols who state that it is okay for a mother to breastfeed when she has a
fever n/a 70%
Percent of Colvols who can recognize the symptoms of scabies when given a
description of the condition n/a 75%
Percent of Colvols who know that a child with a weight for age below -3 standard
deviations should be referred to a health center immediately n/a 95%
Percent of Colvols who mention using at least one Adult Participatory Learning
technique during their educational work n/a 95%
Percent of Colvols who feel that the trainings they received in the social marketing of
ORT has been useful to their work with mothers in their communities n/a 90%
Availability of materials and supplies
Percent of Colvols who, in the last 30 days, have not had a shortage of any of the
supplies or materials they needed to do their job correctly n/a 60%
Percent of Colvols who, in the last six months, have not had any difficulties providing
the expected services to their communities due to inadequate supplies or materials n/a 60%
Participation in monthly activities
Percent of Colvols who brought their report to the last Colvol meeting they attended n/a 75%
Percent of Colvols who attended the Continuing Education session at the last Colvol
meeting they attended n/a 80%
Percent of Colvols who discussed the micro-credit program at the last Colvol meeting
they attended n/a 75%
Percent of Colvols who correctly state it is not okay to give a 5 month old child ORT n/a 80%
Percent of Colvols who correctly state that when a child has diarrhea the mother
should give the child more food than usual n/a 80%
HAND WASHING KNOWLEDGE & TECHNIQUES–Cross sectoral (MTE target for each group)
KNOWLEDGE: % who know when to wash their hands
Health-Nutrition Credit Food Assisted Education Safety Net % who wash their
hands …. CHWs Mothers Women PTA
Members
School Directors,
Teachers, Students
Directors
& Staff Children
a. after using the toilet 80% 70% 70% 80% 80% 70% 70%
b. after changing babies’
diapers 20% 20% 20% 20% 20% 20% 20%
c. before preparing food 80% 70% 70% 20% 20% 70% 20%
d. before eating 80% 70% 70% 80% 80% 70% 70%
e. before feeding child 80% 70% 70% 20% 20% 70% 20%
f. working in the
garden/coming home
from school or market
20% 20% 20% 20% 20% 70% 20%
g. after playing NA NA NA NA 20% NA 70%
All key messages
combined
a, c,
d, e
a, c,
d, e
a, c,
d, e a, d a, d a, c, d,
e, f a, d, g
Benchmark for all key
messages combined 70% 50% 50% 70% 70% 60% 60%
TECHNIQUES – washing hands
% who used correct
hand washing technique
(baseline method)
70% 60% 70% 70% 70% 70% 70%
% who used correct
hand washing technique
(international method)
70% 60% 70% 70% 70% 60% 60%
10
HIV/AIDS – Cross sectoral
Indicators LOA target
MTE
target
(adults)
MTE target
(children
13& up)
Means of HIV/AIDS Transmission
Percent of respondents that can state one can avoid acquiring HIV/AIDS 75% 60%
Percent of respondents that state one can avoid HIV/AIDS by abstaining
from sex 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by using
condoms 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by limiting
sex to one partner 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with prostitutes 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with persons who have many sex partners 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by remaining
faithful to one partner 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with persons who inject drugs intravenously 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by avoiding
infected blood 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by avoiding
the use of syringes, razors, straight edges 40% 50%
Percent of respondents that state one can avoid HIV/AIDS by avoiding
contact with blood 40% 50%
Percent of respondents that state that a pregnant woman can give the
HIV virus to her child during pregnancy 60% 50%
Percent of respondents that state that a mother can give the HIV virus to
her child during child birth 60% 50%
Percent of respondents that state that a mother can give the HIV virus to
her child via breast feeding 60% 50%
General knowledge on HIV/AIDS
Percent of adult respondents that have been tested for HIV 20% N/a
Percent of respondents that state that the HIV virus can take up to six
months to show up as positive on a blood test. 60% 60%
Percent of respondents that state that there are no cure for people who
have HIV 60% 60%
Percent of PTA respondents that state that HIV/AIDS has been
discussed at their PTA meetings 55% M/a
Perception of Personal Risk
Percent of respondents that state that you do not get HIV by shaking
hands with someone who has HIV/AIDS 60% 60%
Percent of respondents that state that you do not get the HIV virus by
sharing a bathroom/toilet with someone who has HIV/AIDS 60% 60%
Percent of respondents that state that you do not get the HIV virus by
hugging someone who has HIV/AIDS 60% 60%
Percent of respondents that state that a woman can refuse to have sex
with her husband if he has a sexually transmitted infection 70% N/a
Percent of respondents that state that it is not OKAY if he
husband/boyfriend has sex with his wife/girlfriend even if she said “no” to
his sexual advances
70% N/a
Percent of respondents that state that a man can refuse to have sex with
his wife if she has a sexually transmitted infection 70% N/a
Percent of respondents that think it is not okay for a man to have sexual
relations outside of his marriage 70% 70%
11
Percent of respondents that think it is not okay for a woman to have
sexual relations outside of her marriage 70% 70%
Percent of respondents that think it is not acceptable for a man/woman
to have sexual relations in exchange for the payment of household bills
or school fees, for example
70% 70%
Percent of children that state one can avoid HIV/AIDS by remaining
faithful to one partner N/a 50%
Stigma and discrimination
Percent of respondents that state knowing someone with the HIV virus 40% 20%
Percent of respondents that state they are friends with someone infected
with HIV, or suffering from AIDS 40% 20%
Percent of respondents that state that if a friend of theirs was diagnosed
as HIV positive, they would continue your friendship with that person 70% 60%
Percent of respondents that state they would be willing to take care of a
family member that is infected with the HIV virus in their own home 70% 60%
Percent of SSNI adult respondents that state that they would accept a
child into the center that they know to be HIV positive 70% N/a
Percent of adult respondents that state they do not believe that people
who have the HIV virus deserved getting the disease because of their
past behavior
70% 60%
Percent of adult respondents that state they do not believe that people
who have the HIV virus deserved getting the disease because they are
bad religious people
70% 60%
SAFETY NET
Indicators BL
Value
LOA
target
MTE
target
Management
Percent of staff that can state two or more universal children’s rights 90% 85%
Percent of center management staff that have attended a meeting in the last 6
months with their Ruche - independently from CRS 80% 20%
Hygiene conditions
Percent of centers that were found to be clean and relatively free of trash 80% 50%
Percent of center kitchens that were found to be clean and free of trash 80% 50%
Percent of center kitchens without uncovered food out on the counters 90% 75%
Percent of kitchen food preparation areas found to be smooth/free of sticky
substances 80% 50%
Percent of kitchen food preparation stations found to have no evidence of
pests or rodents 85% 70%
Percent of kitchens with soap available at the closest water point to the kitchen 80% 50%
Percent of centers in which latrine/toilet areas found to be clean 80% 50%
Percent centers with doors on all of the latrines/toilets 80% 60%
Percent of centers in which all latrine/toilet doors close completely 80% 50%
Percent of centers in which latrines/toilets provide adequate superstructure 50% 30%
Canteen management
Percent of centers with no food shortages in the center canteen in the last
month 90% 70%
Percent of centers with financial withdrawal or deposit that is dated within the
last 30 days in the bookkeeping ledger 80% 50%
School attendance, birth certificate and meals
Percent of children that state they are currently going to primary school 95% 80%
Percent of children that state they are currently going to school o receiving any
training 95% 80%
Percent of children with birth certificates (or equivalent) 95% 80%
Percent of children that state they ate SFB, cornmeal or lentils (put local
preparation names) in the last 24 hours 95% 90%
Percent of children that state they ate something other than SFB, cornmeal or
lentils (put local preparation names) in the last 24 hours 60% 30%
12
CIVIC EDUCATION – cross sectoral
Indicators LOA
target
MTE
benchmark
% who know that the state is founded on 3 principles – property, government, citizenry 50% 20%
% who know that "Deputes” are elected for two-year terms 50% 20%
% who know the name of the tribunal in their commune 80% 50%
% who know that political parties gain political office by winning elections 80% 50%
% who know they have the right to form an association or social group 80% 50%
% who know they have the right to form a political party 80% 50%
% who know that Senators can propose laws 80% 50%
% who believe that the state and the population are both responsible for taking care of the
environment 80% 50%
% who know that a "majistra komenal" (Mayor) obtains his/her position by winning
elections 80% 50%
% who know that KASECS obtain their position by winning elections 80% 50%
% who know that ASECS obtain their position by winning elections 80% 50%
% who know that another name "maman lwa peyi a" (the constitution) is “La Loi Mere” 50% 20%
% who know that there are three branches of government – Executive, Legislative and
Judiciary 50% 20%
13
CHAPTER 3 – METHODOLOGY
3.1. A Conceptual Model for Monitoring and Evaluation (M&E)
In an operational context, the role of the M&E system is to track and mirror the flow of actions that take
place as project inputs are transformed into population-level impacts, and to verify that those impacts are
indeed taking place. A good system will also inform project managers about the action to take if impacts
are not occurring. To design the M&E, it is thus important to understand how the flow of activities is
linked: conceptually, a project uses a set of inputs, and submits those to processes in order to generate
outputs. Outputs in turn translate into effects at the target population level—effects which, in turn, are
necessary to the materialization of the project’s final impact. For instance: assume that a project wants to
increase agricultural yields by offering farmers training in a new set of techniques3
. To achieve this, the
project lines up funds and technical specialists (inputs) and organizes a training course (process) in which
it teaches farmers the selected techniques. The number of farmers trained constitutes the output of that
activity. The number of farmers that effectively adopted the technique (a subset of those who were
trained) are the effect of that activity. To the extent that adoption of the technique is essential to yield
increase, then that effect must occur if the project is to achieve its desired impact (see Figure 1). The
M&E must reflect this process, thus the logic of program design also underlies the logic of the M&E
design, by reflecting all key project steps (inputs, processes, outputs, effects, impacts) in the M&E
system, using objectively verifiable indicators.
Not all indicators to be used are of the same kind, however. Data relating to inputs, processes and
outputs can be generated easily from routine project information (inputs such as the amount of money
spent can be traced using ledger accounts; outputs such as the number of farmers trained can be
obtained from attendance lists to the course; etc) and for those indicators, there is no need to do a
survey. When it comes to effects and impacts, however, the project must go to the population in order to
measure how many of the trained farmers actually adopted the technique. Being a decision that is highly
personal to each farmer, this cannot be inferred from the project’s book keeping records. A population￾based data collection exercise is necessary to assess how many of the trained farmers adopted the
technique or whether yields have increased or not.
From a logistical point of view, this distinction between sources of data (project-based versus population￾based) is what distinguishes monitoring from evaluation: monitoring uses data from project records;
evaluation uses data from the population (through a random survey, a census, etc). Population-based
assessments being costlier than simple bookkeeping, project evaluations are occasional, rather than
annual. Limiting the number of population-based queries, however, presents the project with the danger
of not knowing whether the effects and impacts it is meant to achieve are indeed taking place: looking
only at monitoring data, a project manager may fail entirely to detect that there is a problem with the
adoption of the technique until it is too late to react. Say that our agricultural extension project is doing all
it said it would, but that the unavailability of a crucial factor (e.g. labor, or capital) impedes farmers from
adopting it. Unless a population-based evaluation is done during the life of the activity, the project will not
know until its final evaluation that adoption rates are not as expected, thus jeopardizing its capacity to
increase yields. Following that logic a central role of the mid term evaluation is to verify that the desired
effects are indeed taking place. This is a central premise of this MTE model.
 
3 We take for granted that the conceptual framework underlying the approach is sound; i.e. there is a cause-effect relationship
between the technique promoted and eventual productivity increases. We do not discuss this here; but the issue was covered in
the Baseline Survey Report where ample details are provided on the conceptual models used to guide intervention design in the
CRS program.
14
M&E system framework: 
EXTERNAL PROCESSES
INPUTS PROCESSES OUTPUTS EFFECTS
Human resources
Financial resources 
Physical facilities 
Equipment, etc
Counterpart training 
Supervision of components
Hiring of staff
Institution building
N of staff trained 
N of people fed
Quantity of seeds 
distributed
IMPACTS
Practices adopted Food consumption 
Crop yields 
Incomes
Nutritional status
Monitoring indicators
(yearly measurements)
Evaluation indicators
(BL, MTE, Final Eval)
Rainfaill, prices, policies, etc.
Program-level info Beneficiary-level info
Because effects are manifested at the level of the population, however, the need for a survey remains. To
reduce its cost, Lot Quality Assurance Sampling is used. LQAS uses binomial distributions properties,
which are more efficient than normal distributions at assessing population-level probabilities of
dichotomous outcomes. The great advantage of LQAS is that it requires much smaller samples than
traditional population-based surveys. For instance, assuming an unstratified, homogenous universe of
infinite size, and accepting α and β errors each set at 10%, a simple random sample of n=19 is sufficient
to judge whether performance has reached or not a predetermined performance benchmark on a given
indicator (Valadez, 1996). One additional feature that makes LQAS attractive is the possibility to go
beyond the simple “pass/fail” judgment to compute population-level point estimates for indicators of
interest (e.g. vaccination coverage, disease prevalence, etc). This is done by dividing the entire project
area into several “supervision areas” and by combining the data across those to compute the
proportion of “pass/fail” responses over the entire project area. (Note that there must be at least four SAs
to make this statistically valid. This increases the total sample by a factor of similar magnitude4
; yet the
potential advantages of the method in terms of cost will likely remain positive, as the new n will remain
small compared to a traditional 30x30 cluster survey).
 
4 For instance, if each SA has n=19, then the sample across four SAs will be four times that size, 76. The number of “passes” (say,
45) can then be simply divided by the total sample size (76) to yield a point estimate of 59.2% (45/76=.5921). Weighting the result
from each SA by the size of its population increases the accuracy of that estimate. As always, confidence intervals should be
placed around the point estimate to ensure that the sample means truly clears the benchmark.
15
3.2. DESIGN OF THE SURVEY (PHASE I)
3.2.a. Instrument Development
With the above M&E principles in mind, the team set out to develop the instruments used in this MTE.
This included: selecting indicators; formulating the wording; setting benchmarks and identifying the
samples. Those various steps are described in continuation.
i) Indicator Selection and Formulation
The starting point for this MTE was to identify the indicators to be tested. An initial list was provided by
CRS’ DAP Indicator Performance Tracking Table (IPTT). Following from what was said above, a
particular emphasis was given to effect-level indicators. This initial list was then augmented by eliciting
from CRS staff the data they needed to improve the management of their activities. To comply with
LQAS’ dichotomous requirement, all indicators in the resulting list were then worded to yield a pass/fail
response. They were also worded to have the “desirable” outcome point as the “pass” answer (for
example, answering “yes” to the question “Did the child have diarrhea in the last two weeks?” would point
at a negative outcome. This is difficult to analyze in LQAS so the indicator associated with that question
was re-cast as “Percent of children that did NOT have diarrhea in the last two weeks”).
ii) Setting Performance Benchmarks
The second step was to set a performance benchmark for each indicator evaluated. We generally
assumed that a project should see half of its effects materialized by the time it reaches its mid point.
Suppose for instance that 30% of mothers in the project area knew how to prepare Oral Rehydration
Salts (ORS) at the time of the Baseline. Through training, the project intends to augment that rate by 30%
and bring it to 60%. Assuming a linear adoption rate, half of this effect (15%) should have occurred by the
project’s mid-point—45% thus becoming the benchmark against which the activity is assessed.
Obviously, linear rates are not always expected: certain effects take longer to manifest themselves, in
which case the growth rate in adoption may show a curvilinear pattern.
Also, particular activities may have started later, changing thus the expected growth curve. For those
reasons, CRS staff and FANTA carefully considered each indicator before setting its benchmark5
. Lastly,
benchmarks were established at 5% cutoff intervals (15%, 20%, etc)6
. The final set of indicators and
benchmarks is listed in Appendix 2.
iii) Data Collection Questionnaires
As previously stated, the MTE IPBT served as the starting point for the development of the Phase I
questionnaires7
. While most of the indicators included in the IPBT translated into single questions, there
were several indicators that required a series of questions in order to satisfy their informational
requirements; this situation mostly took place within the MCHN sector on more complex issues such as
exclusive breastfeeding.
 
5 Questions that were added to the original questionnaires did not have a baseline value. Therefore, the program team had to set
benchmark values expected at the mid term evaluation for these new indicators. On the other hand, some mid-term benchmarks
were intentionally left blank for those indicators that did not have baseline values. In such cases, the weighted coverage levels
revealed in the MTE will serve as baseline values for these indicators. 6
 Decision rules for those intervals are readily available from the literature, but not for finer increments. To illustrate: say a baseline
reveals a point estimate of 22.3%. The project hopes to change this by 40 percentage points and bring it at 62.3% during LOA.
However, the mid point (42.3%) cannot be tested as there are no decision rules for that estimate–instead the project must chose
whether to test against either 40% or 45%. This is a minor issue when numbers are large, but it can be inconvenient when
desired changes are small (e.g. going from 10% to 15% over the LOA—what is the benchmark in such a case?). Fortunately, no
such situations were confronted in this MTE. 7
 Many of the questions that were included in the MCHN questionnaires were taken from the Haiti and Madagascar Joint Baseline
Surveys. This strategy allowed for the retention of the original formulation of the question (for comparison purposes), while
providing the opportunity to upgrade the data collection instrument, so that the data can be collected for all indicators according to
international standards (e.g. breast feeding).
16
Within each sector there were several questionnaires. The quantity of questionnaires depended upon the
number of sampling groups; their composition reflected the characteristics of the target group to be
sampled. For example, Directors of Social Safety Net Intuitions (SSNI) were asked questions regarding
the administration of the centers and included questions for the data collector on the sanitary conditions
of these centers. Young children, aged 8-13 years, which lived at the SSNIs, were posed questions
about the food they were served there and their participation in educational activities.
Particular initiatives within the DAP program – such as civic education, HIV/AIDS education, and the
promotion of proper hand washing techniques – were determined to have cross-sectoral relevance, and
as such, questions relating to these initiatives were included in the other DAP sector questionnaires.
The first draft of the questionnaires was developed by FANTA and presented to CRS for their input and
feedback. After substantial consideration, revision, and expansion by the CRS DAP staff, the MTE Team
Leader and FANTA, a second draft was completed and translated into French and Creole8
. These drafts
were used in the training of the enumerators and field-tested. The final drafts of the questionnaires –
which were ultimately used in the data collection – reflected the experiences of the MTE data collection
team during field-testing.
3.2.b. Sampling
The greatest benefit of LQAS is its low sample size requirements. Compared to usual sampling technique
(such as cluster sampling which usually requires around 900 interviews) LQAS can content itself with a
sample of size n=19 (provided certain conditions are met). It is thus very economical. However, the
leanness of LQAS is also its weakness: the size of the sample is so small that it prohibits disaggregating
the data into subsets, making the simplest analytical techniques (cross-tabulations, means comparison)
impossible—unless stratifying, i.e. deriving an independent sample for each group or region of interest.
Although this creates serious potential for “sample inflation” (multiplication of samples to accommodate
subsets of interests), it is likely that the final number of interviews across all samples will still be lower
than what it would be if we used a simple random survey based on assumptions of normally distributed
data.
When stratifying in LQAS, it is useful to distinguish between two types of strata: those based on
geography (“supervision areas”) and those based on target groups. Subdividing by Supervision Areas
(SAs) involves dividing the entire catchment area into smaller management units. Say that a project
operates in four provinces. The catchment is the entire country program, but if activities in each province
are programmed independently, it makes sense to obtain a LQAS sample in each province to examine
how the project performs in each province. Obviously, the collection of four samples will make the study
costlier, as it will raise the total number of data points to 76 (assuming four samples of size n=19) but this
will convey two major benefits to the study: first, it will be possible to see where (and where not)
objectives are being met, pinpointing areas where improvements are needed. Second, it makes it
possible to derive coverage estimates for the indicators under review—i.e. not only will we able to say
that the sample “passed” or “failed” on a given test; we will also be able to use the percentage of units
across the four samples that passed on that test as a basis to compute a coverage estimate. This adds
an important analytical dimension to the survey, as will be shown later in the results section. Subdividing
by Target Groups involves dividing the client population of an intervention into sets of individuals for
whom expectations may differ. For instance, all school students are targeted to receive HIV/AIDS
education, but their capacity to retain information may vary by age group (e.g., younger children may
have lower understanding of “high risk sexual behaviors” than older ones); thus it makes sense to have
different benchmarks for different age groups. As in supervision areas, dividing by target groups involves
drawing a new sample for each group of interest. The advantage here is also twofold: first it allows setting
different benchmarks for the same activity but for different groups. Second, it allows to pinpoint accurately
 
8 The instructions to the data collectors on questionnaire administration were in French, while the actual questions to be posed to
the interviewee were translated into Creole.
17
in which group the project fails to reach its objectives, and thus to focus attention on that particular set of
people.
A final note on sampling: the method used to derive the desired sample size differs on the basis of the
size of the universe. In situations where the universe size is infinite (i.e. >500 units) the binomial
probability distribution can be used to derive sample sizes and decision rules. Where population sizes
contain fewer than 500 units, however, the hyper-geometric distribution for cumulative probabilities must
be used. We do not explain here why this is so, as this relates to the statistical properties of each
distribution; but must inform that all our sample calculations took this rule of thumb into account.
i) Supervision Areas
The above section provided the rationale for the design of this Mid Term Evaluation. In the remainder of
this chapter, we examine how those principles were concretely applied as we selected indicators,
samples and supervision areas.
Before the sampling process could begin, CRS sector teams were tasked with organizing their program
interventions into supervision areas. In the LQAS model, the minimum number of supervision areas
necessary for aggregating the data to calculate weighted coverage estimates for program indicators is
four. Each supervision area has its own participant list and thus the sampling was carried out based on
that particular participant pool.
Where possible, the sector teams were encouraged to divide their supervision areas into universes of 500
units or more as this would allow sample sizes of 19, which according to the LQAS model, is sufficient to
provide statistically representative data with acceptable confidence intervals. For those sectors with
supervision areas with less than 500 units, it was necessary to undertake complex hyper-geometric
calculations in order to determine appropriate sample sizes and corresponding benchmark decision rules.
• Sectors that were divided into four or more supervision areas, with 500 or more units each,
included: Credit–Women and MCHN. The Education sector was also divided into four
supervision areas but required hyper-geometric calculations to determine the sample size since it
did not have 500 units.
• Sectors that had less than four supervision areas included: Agriculture, Credit–Colvol, SSNI, and
Water and Sanitation. While Agriculture and Credit-Colvol each contained 500 units or more in
their supervision areas, the SSNI and Water and Sanitation sectors did not and thus required
hyper-geometric calculations to determine sampling size.
Table 2 presents a summary of the sampling for each sector investigated during the mid-term evaluation.
Table 2: Summary of sampling by sector
Sector Supervision areas
(SA)
Universe Sample # Groups/site # Inter￾views/SA
# Total
interviews/
sector
SA1: Tiburon, Les
Anglais,
Chardonnieres
9,007 19
3 (mothers of
children 0-6, 6-12
and 12-24 months)
57
SA2: Port a Piment,
Roche a Bateau,
Coteaux
5,233 19 3 57
MCHN 9
SA3: Aquin (+ La
Colline and Vieux
Bourg)
8,599 19 3 57
285
 
9 The baseline study was conducted in SA1 to SA4.The Grande Anse department was added as a separate SA since no baseline
data had been collected in that department. Baseline results will be compared to aggregated results for the first four SAs.
18
Sector Supervision areas
(SA)
Universe Sample # Groups/site # Inter￾views/SA
# Total
interviews/
sector
SA4: Cotes de Fer,
Fond des Blancs 12,172 19 3 57
SA5: Baradères,
Nippes, Grande Anse 30,665 19 3 57
SA1: South Coast,
Aquin, Cotes de Fer CREDIT and 508 19 1 19
MCHN
(CHWs) SA2: Grande Anse
and Nippes 265 29 1 29 48
SA1: Tiburon, Les
Anglais,
Chandonnieres
555 19 1 19
SA2: Port a Piment 528 19 1 19
SA3: Roche a
Bateau, Coteaux 752 19 1 19
CREDIT
(women)
SA4: Aquin, Cotes de
Fer 489 19 1 19
76
SA1: Coteaux >500 19 1 19 Agriculture SA2: Roche a Bateau >500 19 1 19 38
SA1: La Colline,
Vieux Bourg, Aquin,
Ile a Vache 27 19
5 (PTA member,
School director,
teacher, female
school child and
male school child)
95
SA2: Baraderes,
Beaumont, Jeremie,
Les Abricots
27 15 5 (idem) 75
SA3: Tiburon, Les
Anglais,
Chardonnieres, Port a
Piment, Port Salut
49 26 5 (idem) 130
Education
SA4: Fond des
Blancs , Cotes de Fer 27 15 5 (idem) 75
375
SA1: with HIV/AIDS
training
71 29
6 (management,
staff, female child 8-
13, male child 8-13,
female child >13,
male child >13)
174
Safety Net
SA2: without
HIV/AIDS training 34 20 6 (idem) 120
294
SA1: School latrines 30 16 1 16
SA2: School cisterns 21 13 1 13 Water and
Sanitation SA3: Spring cappings 45 25 1 25
54
TOTAL INTERVIEWS 1,110
ii) Sampling Lists
The generation of sampling lists proved more time consuming than was originally anticipated. The
varying benchmark levels for each universe size under 500 required quite a few complex calculations and
fundamentally necessitated the creation of a whole new LQAS table for hyper-geometric distribution.
As the questionnaires were being refined, participant lists were being drawn up by CRS for use in the
sampling. For the purpose of this exercise, a “participant” could be an individual (such as a member of a
farmer groupement), an institution (such as a school), or a locality (from which a resident mother would be
selected). Each type of “participant” group required separate sampling methodologies.
19
The universe and the number of participants being known for each area, the sampling was done by
starting with a random number using the sampling interval required to obtain the total number of
participants for that particular area.
The MCHN sector was evaluated at the population level and the sampling was drawn from the list of
localities – and number of households by locality – using the maps produced by the Haitian Institute of
Statistics.
For those sectors with individual participants, as was the case with Agriculture and Credit, the selection
process was centralized and undertaken by CRS and FANTA, using a random number table, before the
data collectors left for the field. Armed with the names of specific people, the data collectors visited the
locality of residence of the individual, located her/him with the help of the community and/or local CRS
volunteers, and carried out the interview.
Participant lists that were comprised of institutions that receive support form CRS, such as Education,
SSNI, and Water and Sanitation, the selection process was two-fold. The selection of the institutions was
centralized and undertaken by CRS and FANTA, using a random number table, before the data collectors
left for the field. The selection of the actual respondents, however, was carried out by the data collectors
in the field - on the day of her/his visit to the institution. Data collectors used random number tables and
numbered cards to identify respondents with the desired profile for interviewing.
3.2.c. Training
Training of data collectors for Phase I was done between November 29 and December 5, 2004.
Selection of enumerators and supervisors was done in three steps: before the training, after the
theoretical training and after the field test.
During the first three-day training, questionnaires were reviewed question by question to ensure greater
consistency in administration. Since each questionnaire was made up of different sections and because
some sections were repeated in more than one questionnaire, the training was done by section: MCHN
(health), hand-washing, colvols knowledge, water and sanitation, HIV/AIDS, micro-credit mothers, micro￾credit colvols, education, agriculture, social assistance, civic education. The CRS manager responsible
for each program first made a short presentation to explain the context of the study to the data collectors.
Then, each question was discussed including the methodology on how to note the answer. Additional
explanation was provided as needed. After having reviewed the questions for each sector, the group was
divided into small groups to practice the questions. After each simulation, data collectors and supervisors
shared the difficulties encountered with the whole group and clarification was provided whenever
necessary. All enumerators were trained in all questionnaires except for the Safety Net sector for which
only two data collectors and two supervisors were trained. At the end of the theoretical training three less
qualified enumerators were eliminated for not having been fully successful in the aptitude test.
The field-testing of the questionnaires was done in the rural area of Palmiste-à-Vin. Except for the Safety
Net sector, all questionnaires were tested in the field by small groups of data collectors coordinated by a
supervisor. The whole group went to a school, an MCH center, a spring capping, a school latrine, and a
farmer’s plot of land. The MCH, credit mothers and credit colvols questionnaires were tested by small
groups of two to three data collectors. For the other questionnaires, each participant had the opportunity
to conduct an individual interview or individual observation. The composition of each group changed for
each type of interview to allow the supervisors to know and assess each data collector. At the end of the
each day, difficulties encountered during the field test were discussed and appropriate changes were
included in the questionnaires accordingly. Two additional enumerators were eliminated at the end of the
field test. With regards to the Safety Net questionnaires, two enumerators and two supervisors
participated in the field-testing that was done in two orphanages in the area of Port au Prince once the
whole group came back from Palmiste- à-Vin.
Based upon the number of interviews that needed to be carried out during Phase I, it was determined to
divide the data collection team into seven teams--six composed of a team supervisor and three or four
20
data collectors and one made of two data collectors for the Safety Net Institutions. Phase I data were
collected by 23 enumerators and 6 supervisors.
3.2.d. Field Work
The Phase I fieldwork took place between December 9 and December 23, 2004. The number of
interviews to be done in one day, the time estimated to reach each interviewee and the number of sectors
to be covered were the criteria used to determine the areas to be assigned to each team which varied
between two to seven communes. Six teams were dispatched to the field along with a vehicle and a
driver per team. Each team was made up of one supervisor and three or four enumerators. Before going
to the field, each team received the complete list of people to be interviewed and sites to be visited for
each locality in each commune. However, it was up to the Team Supervisor to determine the scheduling
and assignment of interviews for the team. It was originally estimated that each enumerator could make
5 to 6 interviews per day if the work distribution by geographical areas was effectively done. This estimate
was confirmed during the fieldwork. The Supervisor was also responsible for reviewing the questionnaires
before their submission to the MTE Team Leader to make sure that they were filled out completely and
correctly..
With regards to Safety Net questionnaires, two enumerators in the area of Port au Prince completed most
of them. The remaining interviews were conducted by a team supervisor in the areas of Jérémie and Les
Cayes.
As explained in the section 2.b.ii above, the selection of some respondents was done in the field by the
survey team. With the LQAS sampling methodology where the name of the locality (for MCHN sector)
and/or the name of the participants (credit mothers) were pre-selected, the enumerators had to walk long
distances to reach most of the respondents. If a person was absent, the enumerator had to return a
second time and sometimes a third time to be able to complete the questionnaire.
Special forms were provided to team supervisors to collect information on special cases or incoherencies
encountered during the data collection and fieldwork. This detailed information was reported in the
Phase I Team Leader’s report and were taken into account in the data analysis.
The MTE Supervision Team comprised of the MTE Team Leader, a CRS staff person, and a FANTA staff
person departed one day after the data collection team was dispatched to the field. The idea was that we
would visit all of the different teams unannounced to check on their progress and assess their
performance in the field. The supervisory visits were very useful for the entire team in that it provided the
teams to raise questions or draw our attention to issues that were confronting them in the field. The
supervision team would meet with one team at a time to answer questions and solve problems and share
the exchanges and issues raised during visits with the previous team. In a five-day span, the supervision
team visited all of the field teams and was able to solve the administrative or logistical problems that the
teams were facing. The supervisory visits also allowed the Team leader to gain a more informed
perspective on the data collection results in that she was able to investigate issues more deeply with the
teams, ask questions, go out on interviews, etc. This ultimately allowed the Team Leader to provide
feedback to CRS and FANTA.
3.2.e. Data Analysis
A local firm was contracted to enter the data using the double entry methodology. All data were sent to
FANTA at the beginning of January 2005 for analysis.
Analyzing LQAS data is straightforward, as it only requires assessing whether the number of defective
units exceeds or not the decision rule implied by the desired benchmark. For instance, say that a diarrhea
prevention-BCC program wishes to test whether 50% of interviewed women have learned at least three
methods of preventing diarrhea. Assuming a sample of 19 and alpha and beta errors set at 10%, no more
than 12 of the 19 sampled mothers should fail in naming at least three correct ways of preventing
diarrhea for the program to get a “pass” on this indicator. If more than 12 women fail the test, then the
21
entire program is also judged to “fail”. The judgment of whether the program meets the test is thus made
simply by counting the number of women who failed to answer the question. This is the most basic
analysis done with LQAS data, and it was done here for all the indicators observed in the survey.
Dividing the population into four or more supervision areas, however, makes it possible to go beyond the
simple LQAS analysis of pass/fail, and establish an overall prevalence point for an indicator by computing
its ratio of “passes” to total sample (i.e. summing up the number of items that met the test across SAs and
divide this by the total number of items sampled). For instance, say that 10 women met the test in SA1,
17 in SA2, 12 in SA3, and 9 in SA4; resulting in 48 “passes” overall. Given 19 women interviewed per SA,
a total of 76 were interviewed in total. The prevalence point can be computed by taking the proportion of
“passes” to the total, i.e. 63% (48/76)10. Second, since this prevalence point is a means, the confidence
intervals (CI) around that mean can be derived; making it possible to state with confidence whether the
means estimate (and its associated CIs) effectively “clears” the benchmark or not. Thus, not only do we
know now which SA passed or failed the test, but we can state whether the program as a whole, and
across all its SAs also passes the test. Third, a new benchmark can be devised using this new estimate,
allowing to state which SA performed best against the newly estimated coverage. Whenever possible,
such a breakdown by SA was done in this survey. An example of the resulting analyses is given in the
following table:
Results:
Actual performance per SA11 Indicator BL
Value
LOA
target
MTE
Targe
t
Weight
edAver
age
(CI)
LQAS
judgme
nt
(overall
)
SA 1 SA 2 SA 3 SA 4
% children given breastmilk
only on day of birth
32.5
%
50% 40% 63.6%
(11.0ppt
)
Pass Y
Y
Y
Y
Y
Y
Y
Y
% infants having received
colostrums
53.0
%
95% 80% 72.5%
(9.9ppt)
UD B
W
Y
Y
Y
Y
Y
Y
The baseline value on the first indicator (% children given only breastmilk on day of birth) is 32.5%. The
program expects to bring that proportion to at least 50% by the end of the DAP. The target mid-point
chosen for the MTE is 40%12. The last four columns show that all four SAs “passed” on this 40% MTE
benchmark (denoted by the top Y in each cell). Further, the overall coverage estimate reveals that the
prevalence point across all SAs is 63.6% (with confidence intervals of +/-11.0 percentage points), i.e. it is
well above the expected 40% so the program as a whole also gets a “pass”. Finally, each SA is tested
against the new benchmark set by the actual coverage estimate of 63.6% (rounded up again at the next
5% increment, i.e. 65%), with results denoted in the lower Y in each Results cell demonstrating that all
SAs met that test for the first indicator.
Findings are different for the second indicator (% infants having received colostrums). From a baseline
value of 53%, the project expects to bring this indicator to the 95% level by the end of the project. The
chosen target benchmark for the MTE is 80%. Results by SA show that all but the first SA met the test for
that indicator. However, the estimated coverage for the entire program is 72.5%, with a CI of 9.9 ppt. This
means that the coverage estimate, even though below the benchmark, cannot be said with statistical
confidence to be below the 80% benchmark, as the CI of 9.9 implies the means could be as high 82.4
(72.5+9.9). Whenever it cannot be said with certainty, as is the case here, that the coverage “clears” the
benchmark one way or another, the analyst has to refrain from making a final judgment for the full
program and classify its judgment as UD (undetermined). Lastly, all SAs are tested against the new
 
10 Note that for further precision, each SA sample is weighted by the population size in its SA. 11 “Y”= Yes, met the benchmark; “B”= Failed to reach the decision rule for the benchmark; “W”= Failed to reach the decision rule for
the weighted average (rounded up at the nearest 5 percentage point increment); “UD” Unable to Determine = given the
confidence intervals, we cannot state with certainty that the weighted average clears the benchmark. In such cases, judgments
are made only at individual SA levels, not for the overall sample. 12 For convenience, benchmarks for all indicators in this MTE were rounded at 5% increments. 40% is the rounded value that comes
closest to this mid point between 32.5% and 50%.
22
benchmark provided by the 72.5% coverage estimate and it is found again that all of them pass the test,
except SA1.
In sum, what the program manager can infer from those findings is that:
1) Things appear to be going as planned with regards to the first indicator: no corrective action is
needed here at this point13.
2) Things are also going relatively well with regards to the second indicator, except for SA1, where
additional efforts will definitely have to be devoted to improve the perception of mothers
concerning the offering of colostrums on the day of birth.
Such detailed and specific analyses can thus point out, not only whether the program overall is in the
process of meeting its objectives, but also where objectives are being met and where not. This allows to
orient the effort of corrective action to where it is truly needed which, in the end, should help the project
reach its stated objectives in all covered areas.
3.3. LESSONS LEARNED – PHASE I
3.3.1 Lessons Learned – Phase I
3.3.a. Instrument Development
i) Indicator and Performance Benchmark Table (IPBT)
A certain amount of momentum was created in the formation of the questionnaires. This momentum led
to the inclusion of questions that did not correspond to a specific indicator in the original IPBT; but were
nonetheless necessary in order to link the different sections of the questionnaires. These questions
translated into the creation of new indicators that were ultimately incorporated into a revised version of
the IPBT. In other words, the IPBT, which was initially assembled to serve as the backbone for the
questionnaires, later needed revision in order to reflect the complexities of the questionnaires it inspired in
the first place. While this situation in itself is not problematic in a methodological sense, it did necessitate
a further investment of time and energy on the part of CRS in the creation of new benchmarks and LOA
values.
Perhaps greater attention to the development of more complete lists of program indicators at the
beginning could have avoided such a procedural step backwards later. More focused questionnaire
development could also have minimized the time necessary for the revision of the original IPBT as well; in
other words, paying less attention to the maintenance of questionnaire “flow” and more attention to
addressing the specific informational requirements of the indicators identified in the original IPBT.
ii) Setting Performance Benchmarks
MTE performance benchmarks were set by CRS program staff and FANTA. For most indicators with
LOA targets already set, it was assumed that the project had reached half of its effects by the time of the
mid term evaluation. However, for the questions added during the planning of the MTE, mid-term
performance benchmarks were included for all new indicators. The strategy for setting up mid–term
benchmarks differed from one sector to another.
Agriculture: both the LOA and the MTE targets were set before the MTE; however, since indicators were
measuring the adoption of agricultural practices on project participants, the team realized afterwards that
the benchmarks had been set too low,
 
13 Unless program managers want to revise their goals upwards, as the initial objective on this indicator
may have been too modest, in light of the fact that LOA objectives had already been reached by mid
point.
23
MCHN: Respondents for the MCHN sector were divided into three groups according to the age of the
child (0-6 months, 6-12 months and 12-24 months). No baseline data had been collected on mothers of
children less than six months old and overall baseline values were used as reference to set the mid-term
benchmarks for that age group. For the 6-12 and 12-24 groups, some additional analyses had to be done
with the baseline data to be able to compare the results by age group and measure the progress done
since the baseline.
For most of the other sectors (HIV/AIDS, micro-credit, education, safety net, water/sanitation, civic
education), no baseline values were available. Even though mid- term targets were set based on past and
current program experiences, the team realized afterwards that for some indicators, results were either far
below or far above the expected targets. With the pass/fail LQAS methodology, the level of the
benchmark is a key determinant and requires an in-depth reflection at the planning stage; especially in
case no baseline value is available.
For sectors where the MTE result would be used as a baseline value, the subdivision of the catchment
area into four supervision areas allowed for an extrapolation of the program coverage; a useful approach
for calculating the baseline value. However, in the case of a single catchment area, the evaluation team
was only able to discern whether the sample “passed” of “failed” the mid-term benchmark, an approach
that is not as informative as one using program coverage as the baseline value.
Even though the CRS sector teams understood the process of setting the mid-term benchmarks during
the planning process, they became more aware of their significance at the time of the analysis. Since the
whole mid-term process was a pilot exercise, the whole team was “learning by doing”. However,
examples of results analysis at the planning stage would have contributed to a better understanding of
the whole methodology including the decisions made regarding performance benchmarks.
iii) Data Collection Questionnaires
This MTE collected an enormous amount of information on the overall performance of the DAP. There
were, nonetheless, a few unfortunate cases where the data collected were not useful, or needed to be
disregarded entirely, due to poor question formulation or unclear instructions to the data collector. It is felt
that the ambitious deadlines were largely to blame for these situations. The time frame provided for the
development of a second draft of the questionnaires, their translation into both French and Creole, field￾testing, further refinement and ultimate finalization was less than three weeks. Such a short space of
time did not allow for the adequate review of all of the questionnaires by parties less closely involved in
the process, or for their translation into English – the only common language of the MTE supervisory
team.
For some sectors, the questions did not cover some important issues that could have been covered by
the MTE. This is the case for the agriculture and the safety net sectors where numerous opportunities to
measure project progress were missed.
In a related issue, a system should have been put in place to monitor the inclusion of certain questions
relating to such cross-sectoral topics as HIV/AIDS. Questions on HIV/AIDS knowledge, practice, and
attitudes were included in virtually all of the MTE questionnaires for all sectors and sampling groups;
however, not all of the relevant questions found their way into the questionnaires. Greater consistency in
the inclusion of HIV/AIDS questions would have provided increased utility in terms of the manipulation of
the data for comparison purposes across sectors and samples.
The LQAS method is based on dichotomous outcomes (yes/no, pass/fail), and every effort was made to
simplify the questionnaires in order to elicit such responses. Many of the issues investigated in Phase I,
however, were quite complex and as such, necessitated more than one question in order to get at the
desired data. In such situations, a single question may not have had specific relevance to a particular
indicator, but when it was included in a larger data set, it gained its relevance and indeed, critical
inclusion.
24
The creation of data sub-sets was also an issue in the development of the questionnaires. As LQAS is
based on sample sizes of 19, any decrease in the sampling numbers creates sub-sets. Sub-sets
undermine the statistical attractiveness of the LQAS methodology because they change the sample size
and thus, the benchmark decision rules; and depending upon the actual responses, hyper-geometric
calculations may be necessary.
3.3.b. Sampling
i) Supervision Areas
Ideally, most sectors would have preferred to divide their catchment area into four supervision areas.
However, the evaluation team had to estimate the cost/benefit of multiplying the sample by four. In some
cases, the number of units was too small to be divided by four (for example, 21 school cisterns). In other
cases, such as agriculture, the program had been working with only two associations, the association
being the unit of analysis for the programmatic component.
For both MCH and Education programs, the supervision areas corresponded the programmatic areas.
This strategy became very useful for programming purposes since it allowed the analysis of program
performance to be done by programmatic area and for recommendations to be specific to each
geographic area.
With more than two thousand participants in the mothers’ credit program, the subdivision into four
supervision areas was not entirely done according to programmatic areas. The subdivision was done to
reach at least 500 units in each area. Therefore, the conclusions drawn for each supervision area are
sometimes difficult to interpret since a single area might include more than one programmatic area. If a
problem exists in a specific area, it could go unnoticed if the area was associated with other areas where
the problem does not exist.
Taking into account the benefits conveyed by sampling four supervision areas, the evaluation team would
strongly recommend using this methodology as often as the number of units and the cost of the study
would permit. Ensuring, whenever possible, that the programmatic area corresponds with the supervision
area is also highly recommended.
ii) Sampling Lists
Perhaps the most problematic issue that arose in the drawing up of sampling lists had to do with the
selection of Alternates. Not enough Alternates were identified previous to the fieldwork for the sectors
where lists had been drawn with the names of the participants (women credit and colvol credit) . This
resulted in valuable time being spent by the field staff communicating by telephone with CRS in Port-au￾Prince and the redrawing of the lists for the selection of more Alternates. The need for Alternates was
one that had been recognized early on in the process; what was not anticipated was many would be
needed.
In a survey that is under such tight time constraints as this one, the data collector does not usually have
the luxury of returning to a site another day in order to interview a specific person. Though the data
collectors put forth an honest effort to locate the pre-selected respondents on the day of their arrival, it
was not always possible to find them, thus requiring the substitution of that person with an Alternate.
There were instances where the data collector could return at another time to interview the pre-selected
respondent, but usually it was not possible.
A greater amount of time should have been spent in assembling the participant lists for the micro-credit
sectors in order to ensure their relevance to the data requirements. All micro-credit sampling lists had to
be redrawn because the participant lists were outdated, incomplete, or otherwise inaccurate.
The most obvious example of the inappropriate participant lists was the SSNI sector. For the HIV/AIDS
sampling, SSNIs were divided into two supervision areas – SA1 was comprised of SSNIs that had
25
received HIV/AIDS trainings, while SA2 had not received such training. For each SSNI, the data collector
was tasked with interviewing six people, including two girls and two boys (aged 8-13 years old and 13
years and up). Shortly after beginning the data collection, it became quite clear why certain of the SSNIs
in SA2 had never received HIV/AIDS trainings; namely because they were centers for “special
populations” like physically or mentally handicapped children, orphaned infants, etc. There were also
single-sex centers and centers for young adult males. The populations in these centers thus precluded
the satisfaction of the required number of completed samples. As a matter of fact, less than 75% of the
necessary interviews of males took place at the centers of SA2, rendering the obtained data ineffectual.
Identification of “alternates” sites would have solved some of the problems encountered with the SSNI
sector. However, the comparison between SA1 and SA2 with regards to HIV/AIDS training would not
have been appropriate since the two groups were different.
3.3.c. Training
The time allocated for the training was too short. Even though all enumerators had previous experience in
surveys and questionnaires, this methodology was new to all of them. Many showed difficulties in filling
the double negative questions that were found to be confusing. Changes were made during the field test
questionnaires later on before the teams left for the actual fieldwork. Enumerators should have had more
time for field testing to uncover problems related to phrasing sentences and inconsistencies with
instructions provided to them. Since supervisors were responsible for reviewing the questionnaires in the
field, additional training would have been important to help them identify the potential inconsistencies that
had to be corrected later on by the CRS/FANTA team supervisors.
The period for the field test was also too short. Some interviews were done in small groups and each
enumerator did not have the opportunity to complete some of the questionnaires by himself/herself.
In her report covering the data collection period, the team leader reported a series of notes relative to the
questionnaires. Those inconsistencies were corrected either in the field or before the data entry. In case
the same questionnaires are used for a similar survey in the future, it would be important to include all
such comments in a revised version of the survey.
3.3.d. Field Work
The selection of alternates was one of the most problematic issues that arose in the field. This was
largely a problem with Credit-Women and SSNIs. Three alternates per Supervision Area had been
selected for the Credit-women sector. But, it became readily apparent that Caritas, the institution that
manages the credit program for CRS, had not provided updated list of participants. It was also revealed
that men had received loans and that there were some people that had taken out multiple loans in other
people’s names. Some of these multiple loan recipients were leaders within the community.
No major problems were encountered for sectors where the sampling list was made up of the names of
localities or sites. However, with names of participants, enumerators had to visit some households more
than once if the person was absent, The difficulties were greater for the Credit women sector where the
sampling list provided by the partner was no updated and some participants, who had been identified for
the survey, had ended up quitting the credit program. Supervisors had to contact the evaluation point
person at the CRS central office who rapidly did the sampling of the alternates again. Urgent decisions
had to be made very rapidly since the change in the sampling interval directly affected the identification of
all the alternates. Without effective means of communications such as the telephone, this change would
not have been done in a timely manner and this would have caused a significant delay in the field work
implementation for that sector.
3.3.e. Data Analysis
The primary analysis of LQAS data is notoriously simple, as it involves essentially measuring whether the
number of “passes” equals or exceeds the number needed to meet the benchmark; and from that
26
comparison, apply a pass/fail judgment at the program level. Some complexity is added when doing a
secondary analysis of the data by SA to derive point estimates, confidence intervals etc; as was done
here. Yet this pilot showed that, once the key principles are understood, this secondary analysis is
likewise a straightforward process: CRS staff could easily and correctly perform the primary and
secondary analyses by sector, once basic training had been done by FANTA. This augurs well for the
replicability of the methodology, and is a good lesson learned that confirms the ease of use of LQAS in
general.
3.4 Qualitative Assessment – Phase II
As described in section 1.2 above, Phase II investigated the bottlenecks identified during Phase I using
qualitative methodology.
3.4.a. Identification of Problem Areas
After Phase I results had been analyzed, each CRS program sector team met with the FANTA team and
the team leader to review and discuss results for all indicators measured during Phase I. During that
process, the team focused on indicators that seemed to be lagging in performance and discussed if they
merited further investigation.
Problem areas were identified in four major sectors: MCH, Women credit, Colvol credit and School
latrines. In addition to those four sectors, the CRS education team proposed to investigate during Phase
II some key issues pertaining to education that were not addressed during Phase I.
After having identified the areas to be investigated in each sector, the team proposed the potential source
of information for each area. The team leader who was the main person responsible for conducting the
Phase II of the MTE compiled those comments and proposed a Phase II plan to the CRS/FANTA team
including objectives, areas of investigations, methodology, locations and sources where to look for each
information.
Since most of the sectors identified for Phase II had covered four different supervision areas during
Phase I, the team was able to propose specific supervision areas for Phase II, more specifically areas
where the results had been less performing. After having summarized all the issues, it was decided to
conduct most of the Phase II in Port a Piment and Aquin areas.
3.4.b. Selection of Methodology for Constraints Analysis
Qualitative methods used for Phase II of the MTE included focus group and key informant interviews.
Focus groups were conducted with groups of mothers in the credit program, mothers with children 12-24
months old and not participating in the credit program, colvols, school directors, teachers and members of
Parents Teachers associations. Key informants interviews were performed with field based CRS and
partner staff, persons responsible for health centers and other key leaders in the communities.
The team leader prepared a detailed logistical plan with number of meetings, number and types of
participants for each meeting and methodology for selecting participants in each of the two areas
identified for Phase II. Since the MCH and the credit programs were targeting the same participants,
many focus groups and key informant interviews covered both sectors.
3.4.c. Field Work
The CRS field coordinator left for the field a few days before the team leader to schedule all the
interviews and focus groups according to the plan prepared by the team leader. A total of 13 focus
groups (7 in Port a Piment and 6 in Aquin) and 9 key informant interviews (4 in Port a Piment, 4 in Aquin
and one CRS staff) were conducted during Phase II. All these interviews and meetings took place during
a two-week period and were conducted by the team leader who has a long experience in qualitative
27
survey methodology. Notes from the meetings were taken by a CRS staff and compiled on a daily basis
by the team leader.
3.4.d. Results Analysis
The team leader compiled the results from all meetings and interviews for each sector. The report was
prepared according to the list of objectives originally identified by the CRS/FANTA team during the Phase
II planning stage. Results of Phase II findings are presented in Chapter 5.
Since Phase II evaluation was implemented as a follow up investigation for Phase I, findings specific to
Phase II and recommendations to improve project performance are combined with those of Phase I to
ensure a comprehensive and integrated report for each sector.
3.5 Lessons Learned – Phase II
3.5.a Identification of Problem Areas
Since this evaluation methodology was new to most of the team, the CRS staff did not rapidly understand
the process for identification of problem areas for Phase II. Similar to the Phase I, some program staff
wanted to investigate numerous issues. Time and cost constraints were important factors taken into
consideration while planning Phase II. With the assistance of FANTA staff and the team leader, the CRS
team was able to finalize a list of important issues to be investigated during Phase II.
Some sectors did not identify any issues to be examined during Phase II. However, the education team
proposed to investigate new issues pertaining to education that were not addressed during Phase I.
Issues such as causes of students’ school dropout and use and assessment of training materials
provided by CRS. This change in Phase II planning affected the timing for the fieldwork. It is
recommended that the complete set of performance indicators for each sector be identified at the
beginning of the study.
3.5.b Selection of Methodology for Constraints Analysis
With regards to the credit mothers program, the original plan for Phase II included the areas where
problems had been identified. Field experience showed that conducting additional interviews with key
informants in areas where the credit program has been successful revealed to be a highly informative
process. While providing valuable explanations why the program has been successful in some areas and
not in others, this information also contributed to a better understanding of the difficulties encountered in
problematic areas.
3.5.c Field Work
Since the composition of the group will influence the dynamic of the focus group, the selection of the
participants is a very important issue. The selection should not be done by local people involved in
program activities. The process must be supervised by an external person who should follow the rules
and criteria set by the team leader.
It is also important to take the time to understand the mentality of the people living in the area targeted by
the study before conducting qualitative research in a that area. This can be done through informal
interviews with local leaders or other people living in that community.
3.5.d Results Analysis
One positive result that came out of the Phase II results analysis is the variety of program sectors that
were covered within a same group. The wide range of groups and participants who were interviewed was
28
also identified as a strong point. This methodology facilitated the results analysis process because it
provided a wide range of information from which the most significant elements were withdrawn.
29
CHAPTER 4 – MTE RESULTS BY SECTOR – PHASE I
4.1. Agriculture
The main goal of most of CRS’ agricultural interventions is to increase farming output. What is achieved,
vis-à-vis this goal, depends on the program’s objectives. If farming efficiency is pursued, such as
increasing the volume of production per area planted, then an indicator relating to crop yields is
appropriate. If the objective is to improve household food security, the success of the intervention can be
measured as an increase in total farm production that, once converted into a common yardstick such as
monetary value or kilocalories, links the nutritional and economic needs of a farming household to its
agricultural output.
Programs that aim at improving agricultural performance typically target the factors that influence farm
output. As there was no “off the shelf” conceptual model which lay out the factors accounting for the
performance of farming in developing countries, the DAP Baseline survey team, with the technical
assistance of FANTA, designed its own model by making agricultural performance a function of three
broad categories of factors, namely: 1) land characteristics; 2) farm characteristics; and 3) institutional
and economic context.
1. Land characteristics were defined as a function of the quality and quantity of the land available
to the producer, the productive investments made and farming practices used on that land, and
exogenous factors related to the agroecology.
2. Farm characteristics included household wealth and access to family labor, farm size, technical
knowledge and education of the farmer, and gender of the household head.
3. The institutional/economic context, finally, referred to the input and output markets, access to
inputs, output prices, access to credit, means of transport, and access to information.
The CRS/DAP agriculture project is implemented by a branch of Caritas Cayes, a long-term CRS partner.
The goal of this project is to increase access to food for 1,500 smallholders farming families in the
targeted food insecure areas by 2006. The specific objectives are to:
• Increase the availability of beans and plantains for 1,500 families on 375 hectares of hillside land
through biological soil conservation/fertility recovery methods, and provision of improved seeds.
• Improve revenues and the availability of animal protein for 1,500 families through chicken and
pig-raising.
• Increase revenues via the DAP-assisted commercialization of two agricultural products of 1,500
participating families.
4.1.a Analysis of Results - Agriculture
The MTE focused on land characteristics, one of the broad factors that influence farm production. Other
indicators focused on the perception related to gender within the small farmers’ associations.
Since the beginning of the DAP, the agriculture project targeted two farmer association groups consisting
of approximately 500 farmers each. One association was in Roche a Bateau (SA1) and the other in
Coteaux (SA2). The MTE surveyed 19 farmers from each Association, or, supervision area as they were
designated.
i) Land Characteristics
In an effort to address poor soil quality, the agriculture project has been relying on small farmer
productive associations to replicate the trainings they have received in natural resource management in
their own communities. Members applied the techniques they learned in biological soil conservation, soil
preparation and fertility recovery to the production of beans and plantains (on .25 hectares of their land),
30
and expanded their production potential through the grafting of 15-25 fruit trees. In addition, each
participating farmer received grass and plantain cuttings, beans seeds, as well as further training and
technical assistance support from Caritas staff and CRS agriculture extension agents..
Both SAs (Roche a Bateau and Coteaux) successfully met the benchmark targets for all indicators
associated with land characteristics, including: the 80% benchmark which was set for “the percent of
beneficiaries who apply the techniques aiming at improving land characteristics”; the 60% benchmark for
“the percent of beneficiaries who apply appropriate planting techniques standards”; and the 40%
benchmark for “the percent of beneficiaries who have at least 50 trees planted.” Those results, in
particular, are excellent in that by their continuous application, the quality of the soil in farmer plots should
significantly improve throughout the life of the DAP and beyond.
Table 3 indicates the results of the MTE on the indicators related to “land characteristics.”
Table 3: Agriculture - Land Characteristics
Indicator MTE
Target SA114 SA2
Land Characteristics
Percent of farm association member plots that use Level
A/courbe de niveau techniques 75% Pass Pass
Percent of farm association members that have a dry and
cool place for seed storage
80% Pass Pass
Percent of farm association member plots that use either
green fertilizer or compost 70% Pass Pass
Percent of farm association member plots that use the
promoted planting density standards for beans 60% Pass Pass
Percent of farm association member plots that use the
promoted planting density standards for plantains 60% Pass Pass
Percent of farm association member plots with one or more
recommended anti-erosion system 80% Pass Pass
Percent of plots visited with one or more anti-erosion
systems in place (“ramp pay”, “clayonnage”, or live barrier).
75% Pass Pass
Percent of farm association member plots that have at least
50 trees planted on them 40% Pass Pass
ii) Gender within farmers’ associations
The second set of indicators investigated focused on the perceptions related to gender within the small
farmer associations. Three indicators were measured in this regard, namely: 1) Percent of farm
association members that report the inclusion of women was a guiding principle in the formation of their
association; 2) Percent of farm association members that think that women should be allowed
membership in the group, and 3) Percent of farm association members that can state at least one
concrete benefit of the active involvement and membership of women. SA1 and SA2 both met the
benchmark for these three indicators (80-90%), suggesting that women have achieved equal status within
the association structure and that their participation in the association is viewed positively. The results for
these indicators relating to gender are highlighted in table 4.
 
14 Pass = Met the benchmark Fail = failed to meet the benchmark
31
Table 4: Agriculture – Gender within farmers’ associations
Indicator MTE
Target SA1 SA2
Percent of farm association members that report the
inclusion of women was a guiding principle in the
formation of their association
90% Pass Pass
Percent of farm association members that think that
women should be allowed membership in the group 80% Pass Pass
Percent of farm association members that can state one
concrete benefits for the active involvement and
membership of women
80% Pass Pass
4.1. b. Conclusions and Recommendations – Agriculture
As all of the farmers surveyed in the MTE have participated in the agricultural initiatives implemented by
Caritas and supported by CRS, project staff has since realized that the MTE targets were probably set at
too low a level. Had the performance benchmarks been set higher, thus making it more challenging for
the farmers to pass on the indicators, weaknesses in the project may have been revealed and hence,
reinforced.
The adoption of the techniques promoted by both institutions is seen as critical to the reduction of food
insecurity within the participating association member families and indeed, their communities. Even
though the objectives that were targeted by the MTE (land characteristics and perceptions relating to
gender) were satisfactorily met, the adoption of those factors remains crucial to reducing food insecurity.
As such, the project should not wait until the end of the DAP to start measuring such impact-level
indicators as: the percent of in crop yield increase per hectare among targeted farmers (beans and
plantains); the average number of months of household food reserve stocks; and increases in livestock
holdings among farmer households (pigs and chickens). In areas where the project started in 2002, these
indicators could start being measured in 2006, through their steady integration into regular project
monitoring activities. Other issues, related to changes in the economic situations of the farmers, could
also be integrated into the regular monitoring systems. .
In short, the agriculture project seems to be performing according to the standards set in the MTE, which
lends support to the continuation of project activities as currently structured and implemented by Caritas
and CRS support staff.
4.2. MICRO-CREDIT
The 2002 Baseline evaluation identified a strong link between household wealth and the nutritional status
of children. The height for age (stunting) and weight for age (underweight) indicators showed the most
substantial difference in nutritional status by SES (Socio-economic status) level. As stated in the 2002
Baseline report:
“The relationship suggests that households with more domestic assets have better nourished
children. Taken as a proxy for wealth, the benefits of having more domestic assets can be
hypothesized. Greater wealth may mean increased access to food resources and improved
ability to provide diverse high quality foods, such as the more expensive nutrient-rich animal
products. Given those preliminary associations, it seems that well-targeted interventions to
increase household wealth, such as improved access to credit for women, or, income￾generating activities to the worst-off households, when coupled with effective information,
education and behavior changes messages, could ultimately improve the nutritional status of
children”. 15
 
15 Report of the 2002 Joint Baseline Survey in the Targeted Areas of the PL-480, Title II Programs in Haiti, by Gilles
Bergeron and Megan Deitchler, FANTA Project, Washington, October 2003
32
Based upon these critical findings, CRS introduced a micro-credit component into its MCHN program in
an effort to increase household resource levels. The credit component has been implemented on two
levels - at the level of CHWs and Rally Post participants - and contributes to the overall strategic
objectives of the MCHN program, namely:
• SO1 - to improve the health and nutritional status of children, pregnant and lactating women; and
• SO2 - to increase the availability and accessibility to quality health and nutrition services.
The “village banking” approach is used for both groups of credit recipients, but the organizational
structure is somewhat different. CRS partner institutions Caritas Cayes and Caritas Jacmel implement
the community micro-credit program. The CHW micro-credit program, however, is currently under the
direct supervision of CRS – but responsibility for it is gradually being transferred to the two Caritas offices.
Though the 2002 Baseline survey did not include a specific evaluation of the micro-credit program, the
CHW program has been reviewed in other previous DAP evaluation exercises: namely the final
evaluation of the VACS (Voluntary Agencies Child Survival) in 1996, and in the mid-term and final
evaluations of the 1996-2001 DAP. All of these evaluation exercises have revealed positive findings, with
the micro-credit program proving to be an incentive for the CHWs, while at the same time, contributing to
the sustainability of the MCHN program.
No formal evaluation has ever been undertaken of the rally post credit program, however. Regular
performance reviews have been performed (analyzing reimbursal and arrears rates, for example), but this
has never been done on a formal and comprehensive level.
With the objective of testing Baseline finding, that there is a link between household asset and nutrition
levels, the MTE targeted direct beneficiaries of the micro-credit at the community level. Issues such as
loan management, the levels of solidarity within the banking groups, and changes in their household
wealth, were investigated for both groups of credit recipients - CHWs, and village bank participants.
Additional issues were also tested with the groups at the community levels, such as their participation in
rally posts, the recipient selection process and their literacy/numeracy status.
No specific impact indicators have been set for the micro-credit component since the purpose of this
program is to contribute to the overall impact indicators set for the MCHN program. Therefore, the results
of this MTE will provide valuable information on the effects of the program on the credit recipients and will
assist in identifying necessary steps towards achieving the strategic objectives of the overall health
program by the end of the DAP.
4.2.a Analysis of Results - Community Credit Program
The micro-credit program targeting community participants reaches an estimated 2,000 people and is
being implemented in the south coast areas of Cotes de Fer and Aquin. At the community level,
participants are grouped around the rally-post activities. The credit program requires that at least 70% of
the credit recipients be rally post participants. Previous experience in small business is also a
requirement since the purpose of the loan is to strengthen an existing business. The group elects a
Steering Committee of three to five people who attend a training provided by the program’s implementing
partners, Caritas les Cayes and Caritas Jacmel. The Steering Committee is responsible for the
management of the overall loan portfolio, as well as the disbursal of loans to the members of the village
banks. Even though women are prioritized participants, other members, including men, from the same
community (especially those with many years of experience in small business) are also eligible. The
principle of group solidarity in the repayment and management of the loans is fundamental to the success
of this village banking structure.
For the purposes of the MTE, the credit program area was divided into four supervision areas, with
approximately 500 clients each. Such a division allowed for four sampling groups of 19 and the ability to
aggregate the results in order to derive coverage estimates for the tested indicators. Results for the
33
participants in the credit program presented in the table below are separated under six main headings: 1)
Participation in rally posts, 2) Participant selection process, 3) Loan management, 4) Group solidarity, 5)
Literacy/Numeracy skills, and 6) Changes in household wealth.
i) Credit Recipient Participation in Rally Posts
One of the main criteria of this credit program is that at least 70% of loan recipients be participants in the
monthly rally posts that are conducted by the CHWs. While the SAs performances on this benchmark are
encouraging--all of the supervision areas passed both the 70% benchmark and weighted coverage
estimate of 76% (Table 5) --we are unable to definitely state whether or not the benchmark was met, due
to the fact that there are such wide confidence intervals around the means of this indicator (+/- 9ppt16).
Nevertheless, these results seem to indicate that Caritas Les Cayes and Caritas Jacmel are implementing
the credit recipient selection process appropriately and consistently across their coverage areas.
Similar results were found for the second indicator - percent of credit participants who have participated in
a rally-post since they joined the credit program–all of the supervision areas passed the 50% benchmark.
In this instance, however, it seems that SA2 (Port a Piment) is not performing at the same level as the
other supervision areas, as it failed to meet the weighted aggregate for that indicator.
Even though having a child less than five years old is not a requirement for participation in the credit
program, all of the SAs, with the exception of SA2, met the 70% MTE benchmark that was set for this
indicator.
Table 5: Credit Recipient Participation in Rally Posts
Actual
performance
per SA18 Indicator BL
Value
LOA
target
MTE
Target
WA
(CI)
LQAS17
judgme
nt
(overall
) 1 2 3 4
Participation in rally-posts
% of credit participants who participated in a
rally-post before they joined the credit
program
NA NA 70% 76.0%
(9.5ppt UD Y
Y
Y
Y
Y
Y
Y
Y
% of credit participants who have
participated in a rally-post since they joined
the credit program
NA NA 50%
51.5%
(11.1ppt
)
UD Y
Y
Y
W
Y
Y
Y
Y
% of credit participants who have children
less than 5 years old NA NA 70%
56.6%
(11.2ppt
)
Fail Y
Y
B
Y
Y
Y
Y
Y
ii) Selection Process
Participants were asked if they felt that the selection processes for receiving a loan and selecting a
steering committee were carried out in a fair and democratic way. Judging from their answers presented
in Table 6, it appears that credit recipients believe this to be so, as benchmarks were satisfactorily met in
all four of the SAs for both indicators: 96.5% for the indicator on loan recipient selection and 93.2% for
Steering Committee selection. Only SA4 failed to meet the weighted aggregate for these indicators,
though the difference in the performance levels in this SA as compared to the others is small.
 
16 ppt= percent point
17 “Pass”: the Weighted average is greater than the MTE target; “Fail”: the Weighted average is less than the MTE target; “Unable to
determine”: the Weighted average is different from the MTE target but because the range of the confidence interval overlaps with
the MTE target, we are unable to definitively state it the MTE target was met or not. 18 SA1: Tiburon, Chardonnieres / Rendel and Les Anglais; SA2: Port a Piment; SA3: Roche a Bateau and Coteaux; SA4: Aquin
and Cotes de Fer
34
Table 6: Credit Recipient Selection Process
Actual
performance
Indicator per SA BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4
Selection process
% of credit participants who feel the selection
process for receiving micro-credit loans is fair
and democratic
NA NA 75% 96.5%
(3.8ppt) Pass Y
-
Y
-
Y
-
Y
-
% of credit participants who feel that the
Steering Committee was selected in a fair and
democratic manner
NA NA 80% 93.2%
(4.9ppt) Pass Y
Y
Y
Y
Y
Y
Y
W
iii) Management of Loans
Five questions were asked to credit recipients to get a sense of how they were doing with the
management of their loan. Three of them met the mid-term expectations in all SAs, indicating that the
participants feel they are able to manage their loan and their business efficiently (Table 7). However,
whereas three SAs met the benchmark and the weighted aggregate performance level for the percentage
of credit participants who made a profit from their business activities last month, SA2 (Port a Piment)
failed to meet both the benchmark and the WA for that indicator, which suggests that the loans may not
be being managed as well in this supervision area as compared to the others.
The results for the last indicator in this sub-heading (percent of credit participants who never had a
problem paying back any of the monthly loan payments) differ from one SA to the other. The overall
benchmark was not met (weighted aggregate – 67.2 %, +/- 9.4%), yet two SAs (SA1 and SA3) met the
benchmark.
Table 7: Credit Recipient Management of Loans
Actual
performance
Indicator per SA BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4
Management of Loans
% of credit participants who would like to
continue in the credit program NA NA 85% 89.2%
(6.4ppt) UD Y
Y
Y
Y
Y
Y
Y
Y
% of credit participants who think they are
capable of managing their loan well NA NA 70% 96.3%
(4.0ppt) Pass Y
Y
Y
Y
Y
Y
Y
Y
% of credit participants who think they are
capable of managing their business efficiently NA NA 60% 95.1%
(4.8ppt) Pass Y
-
Y
-
Y
-
Y
-
% of credit participants who made a profit from
their business activities last month NA NA 80% 74.5%
(8.8ppt) UD Y
Y
B
W
Y
Y
Y
Y
% of credit participants who have never had a
problem paying back any of the monthly loan
payments
NA NA 80% 67.2%
(9.4ppt) Fail Y
Y
B
W
Y
W
B
Y
iv) Group Management and Solidarity
Two indicators measured the level of solidarity among their credit groups, in terms of the groups’ history
of financial assistance to potential defaulters within their group, and their perceptions of the management
capacity of the Steering Committees. As all four of the SAs met the benchmark for these two indicators, it
appears that group solidarity levels are at the level that was expected by Mid-Term. It should be noted,
35
however, that SA2 (Port a Piment), once again, does not meet the weighted aggregate performance
levels for all SAs, indicating that performance is less obvious there than elsewhere.
Table 8: Group Management and Solidarity among Credit Recipients
Actual
performance
Indicator per SA BL
Value
LOA
target
MTE
Targ
et
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4
Group Solidarity
% of credit participants whose groups has
assisted a fellow group member when she/he
had a problem paying back her/his loan
NA NA 35%
46.4%
(10.9ppt
)
Pass Y
Y
Y
W
Y
Y
Y
Y
% of credit participants who think their group’s
steering committee does a good job managing
the micro-credit program
NA NA 80% 91.4%
(5.9ppt) Pass Y
Y
Y
W
Y
Y
Y
Y
v) Literacy / Numeracy / Understanding Bank Books
Three indicators were included to measure the literacy and numeracy levels of group members (Steering
Committee members were not included). Benchmarks for these three indicators were set low (30% and
20%) since it was expected that the members who are not part of the Steering Committee are less
literate. All four SAs met the benchmark set for them (Table 9): 55.4% know how to sign their names,
65.5% feel confident in their addition and subtraction skills and 41% of credit participants have read the
financial agreement with the steering committee. However, SA2 does not meet the WA for the indicator
on addition and subtraction skills.
In order to understand their loan transactions, all participants should be able to understand how their
bank book works. Unfortunately, all four SAs failed to meet that indicator benchmark. Therefore, the
project should reinforce the training programs on the understanding of the bank books and make sure
that the messages get to all group members and not only the Steering Committees members.
Table 9: Credit Recipient Literacy / Numeracy / Understanding of Bank Books
Actual
performance
Indicator per SA BL
Value
LOA
target
MTE
Targ
et
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4
Literacy / numeracy / understanding their bank book
% of credit participants who know how to sign
their name NA NA 30%
55.4%
(11.2ppt
)
Pass Y
Y
Y
Y
Y
Y
Y
Y
% of credit participants who feel confident in
their addition and subtraction skills NA NA 30%
65.5%
(10.6ppt
)
Pass Y
Y
Y
W
Y
Y
Y
Y
% of credit participants who report not having
any difficulty in understanding how their bank
book works
NA NA 85%
43.3%
(11.1ppt
)
Fail B
Y
B
Y
B
W
B
W
% of credit participants who have read the
financial agreement with the steering
committee of the group in order to get their
loan
NA NA 20%
41.0%
(11.0ppt
)
Pass Y
Y
Y
Y
Y
Y
Y
Y
vi) Changes in Household Wealth
36
With the objective of testing the Baseline findings, indicators were included in the MTE to test whether
credit loans contribute to the increased wealth and health of the household. Unfortunately, findings on
these specific issues were inconclusive (Table 10). Most of these issues will have to be addressed in the
Phase II.
First, the percent of credit participants whose school aged children all went to school remained
unchanged before and after joining the credit program (75.6% and 76.9%). Second, with the hypothesis
that the credit program would contribute to better child nutrition, benchmarks for the other two indicators -
percent of credit participants who spend more money on food than before they received their loan and the
percent of credit participants who feel they have more money to spend on things such as clothing,
medical care and school fees/costs than before they received their loan, - were both set very high (75%
and 70%). All four SAs failed to meet the benchmark for both of these indicators. The hypothesis that
access to credit contributes to increased food expenditures, clothing, medical care, transportation, and
school fees, thus failed to be confirmed. This issue will have to be addressed through a qualitative study
during Phase II.
It is also difficult to understand the findings for the indicator; namely that 88.8% reported never having to
borrow money from other sources in order to pay back their loan, and the indicators dealing with
expenditures - 35% stated that they did not spend more money on food than before, and 55.7% who do
not spend more money on things such as clothing, medical care, school fees.
Similarly, in SA4, results showed that the respondents did not reach the weighted average for never
having to borrow money from another source; nor did they meet the benchmark for not having had any
difficulty paying back their loans. What these results suggest is that participants in this supervision area,
when compared to the other SAs, are having some trouble paying back their loans and are resorting to
borrowing money from other people in order to do so. Further investigation as to the reasons for these
results will be necessary.
Moreover, 22.5% of participants think that the amount of their loan was enough to improve their business
activities as they would have liked. The incoherence between these two findings and the first indicator
(88.8% who never had to borrow money from other sources) should also be looked at during Phase II of
the evaluation.
Table 10: Changes in Household Wealth of Credit Recipients
Actual
performance
Indicator per SA BL
Value
LOA
target
MTE
Targ
et
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4
Changes in Household Wealth
% of credit participants who never had to
borrow money from another source since they
received their loan
NA NA 65% 88.8%
(6.8ppt) Pass Y
Y
Y
Y
Y
Y
Y
W
% of credit participants who spend more
money on food than before they received their
loan
NA NA 75%
35.3%
(10.7ppt
)
Fail B
W
B
Y
B
Y
B
Y
% of credit participants who feel they have
more money to spend on things such as
clothing, medical care and school fees/costs
than before they received their loan
NA NA 70%
55.7%
(10.0ppt
)
Fail B
W
B
W
Y
Y
Y
Y
% of credit participants who think the amount
of their loan was enough to improve their
business activities as they would have liked
NA NA 50% 22.5%
(9.4ppt) Fail B
Y
B
Y
B
Y
B
Y
% of credit participants whose school aged
children all go to school NA NA 60% 75.6%
(9.5ppt) Pass Y
Y
Y
W
Y
Y
Y
Y
37
% of credit participants whose school ages
children were all going to school before they
joined the credit program
NA NA 40% 76.9%
(9.4ppt) Pass Y
Y
Y
Y
Y
Y
Y
Y
4.2.b. Conclusions and Recommendations – Community Credit Program
Even though some targets set for the credit program were met (group management, solidarity amongst
members, selection processes, literacy and numeracy levels, etc.), some issues need to be reinforced by
the project staff while others need to be explored in more depth through a qualitative study.
In addition to the results of the survey, other issues were reported during the implementation of the MTE
survey (see section on survey implementation). For example, in SA1 and SA2 particularly, there were
issues related to the lists of credit program participants provided by the managing partner, Caritas. Once
the survey had begun, it was revealed that not all of the people on these lists were, in fact, credit
recipients; suggesting that there had been some improprieties somewhere in the selection processes in
these SAs. This revelation required the drawing up of the sampling lists for these SAs, once again, in
order to identify eight substitute participants that were needed to complete the 19 interviews required.
CRS will need to work more closely with its partner, Caritas Cayes, in order to ensure that the participant
lists are up-to-date and that the selection guidelines for receiving credit are being adhered to correctly.
Compared to the other three SAs, the area of Port a Piment is of most interest since this supervision area
performed at a lower level than the other three SAs. Together with its partners and field staff, CRS should
plan to undertake a careful analysis of its programs in that area. Phase II results should guide CRS in
planning this analysis.
With regards to the micro-credit program, CRS should recommend to Caritas that it reinforce the training
programs for recipients on how their bankbooks work. Caritas should also improve its strategies for
disseminating its programmatic messages, so that all of the group members get them – not just the
Steering Committee members.
CRS needs to better understand why participants in the credit program have not been spending more
money on food since they received their loans. It would be best to undertake the qualitative study in SA2
(Port a Piment) where the project failed to reach the targets set for the MTE.
4.2.c. Analysis of Results - Community Health Worker (Colvol) Credit Program
All CHWs attached to the same health center are regrouped into one or two groups according to the
number of CHWs and their geographical distribution. Previous experience in small business is not a
requirement since their primary responsibility is the organization of the monthly community rally post.
Their loan is managed as a group and the solidarity principle is again fundamental. According to the
program rules, for a CHW to participate in the credit program, he/she should have a regularly functioning
rally post. The credit component was added to the MCHN program in 1989, at the time that CHWs were
introduced into the program structure. CHWs do not receive remuneration for their activities and the
credit program is seen as a means of providing these individuals with an incentive to continue their
important work.
For the purpose of the MTE, CHWs were divided in only two groups: the first group covering all of the
CHWs of the South Coast and Cotes de Fer / Aquin, where the Baseline had been done; and the second
group covering the CHWs from the Grande-Anse / Nippes, areas where the Baseline had not been done.
i) Management of Loan
38
Four different questions were asked to get an indication of how the CHWs have been managing their
loan. Results presented in Table 11 show that all of the indicators met their mid-term expectations (75%)
in both SAs, indicating that the participants felt that they are able to manage their loan and their
businesses efficiently.
Table 11: CHWs - Management of Loans
Actual
performance per
SA19 Indicator BL
Value
LOA
target
MTE
Targe
t SA120 SA221
Management of their loan
% of colvols who think they are capable of managing their loan
well NA NA 75% Pass Pass
% of colvols who think they are capable of managing their
business efficiently NA NA 75% Pass Pass
% of colvols who made a profit from their business activities last
month NA NA 60% Pass Pass
% of colvols who have never had a problem paying back any of
the monthly loan payments NA NA 70% Pass Pass
ii) Group Solidarity
CHWs were asked if their groups had ever assisted a fellow group member when she/he had a problem
paying back her/his loan. Both SAs met the benchmark of 40% (Table 12), indicating that there is a strong
sense of group solidarity among the CHWs.
Table 12: CHWs Group Solidarity
Actual
performance per Indicator SA
BL
Value
LOA
target
MTE
Targe
t SA1 SA2
Group solidarity
% of colvols whose groups has assisted a fellow group
member when she/he had a problem paying back her/his loan NA NA 40% Y Y
iii) Changes in Household Wealth
With regards to the indicators chosen to measure the changes in household wealth, results for CHWs are
similar to those observed with the credit participants at the community level. Both SAs met the MTE
benchmark set at 80% for CHWs whose school aged children all go to school and 65% for CHWs whose
school aged children were all going to school before they joined the credit program (Table 13). The 60%
benchmark was also met for the percent of colvols who never had to borrow money from another source
since joining the credit program.
 
19 Y”: Yes, met the benchmark; “B”: Failed to reach the decision rule for the benchmark 20 SA1 included all of the areas covered by the project since 2002 (South Coast, Aquin and Cotes de Fer) 21 SA2 included the areas that were not covered by the Baseline and where activities have continued since 2002, but with limited
support from CRS (Grande Anse and Nippes).
39
Based upon the link that was proposed by the Baseline survey, that increased income would translate
into higher nutrition levels for children, the MTE sought to test the following indicators: 1) Percent of
credit participants who spent more money on food than before they received their loan; and 2) Percent of
credit participants who felt that they had more money to spend on things such as clothing, medical care
and school fees/costs than before they received their loan. The benchmarks for these indicators were set
at high levels - 80% and 60% respectively. MTE results revealed that both SAs failed to meet the
benchmark for the first indicator (more food), but passed the benchmark for the second one (use money
for other things). Therefore, the hypothesis that the credit program contributes to increased food
expenditures was not confirmed in this survey. This issue will have to be addressed through a qualitative
study in Phase II of the MTE.
Table 13: CHWs Changes in Household Wealth
Actual
performance per Indicator SA
BL
Value
LOA
target
MTE
Targe
t SA1 SA2
Changes in household wealth
% of colvols who never had to borrow money from another
source since they received their loan NA NA 60% Pass Pass
% of colvols who spend more money on food than before
they received their loan NA NA 80% Fail Fail
% of colvols who feel they have more money to spend on
things such as clothing, medical care and school fees/costs
than before they received their loan
NA NA 60% Pass Pass
% of colvols who think the amount of their loan was enough
to improve their business activities as they would have liked NA NA 50% Fail Fail
% of colvols whose school aged children all go to school NA NA 80% Pass Pass
% of colvols whose school aged children were all going to
school before they joined the credit program NA NA 65% Pass Pass
iv) Credit Program as an Incentive to work as CHW
An interesting finding was revealed regarding the perception of the CHWs on their dual roles as volunteer
health promoters and credit recipients. Whereas at least 50% of CHWs stated that the credit program is
an incentive for them to work as volunteers, at least 60% stated that they would continue their work as
CHWs even if the credit program were discontinued (Table 14). This seem to indicate that, in general,
CHWs appreciate the benefits that they experience within their communities as a result of being a CHW,
but that the credit program is not so much an incentive to continue working as a CHW, but rather an
added bonus or reward of sorts.
Table 14: CHWs – Credit Program as Incentive
Actual performance
per SA Indicator BL
Value
LOA
target
MTE
Target SA1 SA2
Credit program as an incentive to work as CHWs
% of colvols who think the micro credit loan program is an incentive
to work as a colvols NA NA 50% Y Y
% of colvols who would continue to work as a colvol even without
the micro credit program NA NA 60% Y Y
4.2.d. Conclusions and Recommendations – Community Health Worker (Colvol) Credit Program 
40
Most of the targets related to loan management, group solidarity and credit program being an incentive
for their work as a CHW were met. However, even though CHWs have more money to spend on things
such as clothing, medical care and school fees, target for one of the most critical of the benchmarks was
not met – the indicator that tested whether CHWs spent more money on food now, as compared to before
receiving the loans. This issue surfaced for credit recipients at the community level as well, and will need
further investigation in order to validate or invalidate the positive link between increased income and
nutritional status, set forth in the Baseline report.
4.3. Water and Sanitation Program
Water and Sanitation services are key to the development process and to the improvement of the quality
of people‘s lives. Safe water and good sanitation are essential to the protection of community health, by
limiting the transmission of infectious diseases, especially among children and other vulnerable groups,
by ensuring the maintenance of a sanitary home environment and improving the nutritional status of its
inhabitants. Such services also contribute to the enhancement of human dignity and economic
opportunity.
The CRS Water and Sanitation project is committed to addressing the myriad of issues that surround the
evolution and adoption of appropriate technologies and behaviors and does so within the framework
established by CRS’ strategic plan and the regional Health and Water Sanitation strategy. This approach
has enabled CRS and its partners to strengthen community structures such as: Parent Teachers
Associations (PTA) and Community Water committees, health center representatives, and Community
Health Workers (CHW). By utilizing local resources for construction work and community-based project
management, the project builds the capacities of the target communities to identify, develop, implement
and maintain their own future water and sanitation projects, thereby contributing to the long-term
sustainability of such initiatives. Actively involving the target communities in all aspects of project
development fosters a sense of community ownership and confidence in their abilities to transform their
own lives.
While improved water supply and sanitation facilities are important, they will not necessarily have a health
impact in and of themselves, unless proper hygiene practices in food preparation, basic sanitation, and
correct hand washing techniques, are also adopted. The information given to community members should
be locally relevant, realistic and complete and should also take into account local circumstances. The
communication process needs to be open and evolving in order to promote positive behavioral changes.
Children being agents of change, the school is an excellent channel to pass important messages related
to health, water and sanitation; as a means of keeping children healthy, improving the quality of the
learning environment, and influencing the pupil’s family members’ behaviors, as well as those within their
communities.
In Haiti, one of the biggest challenges to sustainable development goals is the growing number of families
without access to adequate waste disposal and water provision in both poor urban and rural areas.
Important water and sanitation-related findings were reported in the 2002 DAP Baseline survey: the
prevalence of diarrhea was found to be statistically lower in households with a latrine/toilet, with a
protected water source and where the distance to water source was less than half an hour away.
Knowledge about how to prevent diarrhea and correct hand washing techniques were also associated
with lower diarrhea prevalence.
4.3.a. Analysis of Results
In the MTE, the focus was on the water and sanitation infrastructures themselves (which were built in the
south coast of Haiti, from Tiburon to Port Salut), as well as their use and maintenance. The survey
covered four components of the CRS Water and Sanitation project, namely:
• Capped springs in communities where rally posts are implementing MCHN activities
• Latrines in schools participating in the Education program
41
• Water cisterns in schools participating in the Education program
• Garbage disposal in schools participating in the Education program
Information on the distance to the water source and the type of water was also collected by the MCHN
questionnaires and is presented in that section.
i) School Cisterns
Seven indicators related to the condition and maintenance of water cisterns were assessed. Results
presented in Table 15 show that MTE targets were met on all those indicators, suggesting that the school
cisterns are generally properly cared for and protected.
Table 15: Condition and maintenance of water cisterns
Indicator MTE
Target
LQAS judgment
(overall)
Percent of cisterns with walls intact 70% Pass
Percent of cisterns without standing water 80% Pass
Percent of cistern faucets equipped with a handle 90% Pass
Percent of cisterns without a leak/drip 70% Pass
Percent of cisterns with water flowing from the faucet 70% Pass
Percent of wash basins without garbage or debris 65% Pass
Percent of wash basins without animal feces within 10 meters 65% Pass
ii) School Latrines
Another set of indicators investigated in the MTE related to the condition of the school latrines at the time
of the survey, their usage and maintenance. Of the 10 indicators that were tested, only five met the MTE
performance benchmarks (Table 16), namely:
• Percent of latrines that were found to be clean
• Percent of latrines free of visibly soiled paper
• Percent of latrines with functioning doors,
• Percent of latrines located at an appropriate distance from a water source, and
• Percent of latrines located at an appropriate distance from the school.
The remaining failed to meet their performance benchmarks. Those included:
• Percent of latrines where all latrine doors were closed upon arrival
• Percent of latrines with doors equipped with working inside locks,
• Percent of latrines with seat covers in all stalls,
• Percent of latrines with all latrine covers down, and
• Percent of latrines that had at least one broom available.
These results show that the project had mixed results in both its behavioral and technical goals for the
latrines. Hygiene practices are deemed as critical as the condition and maintenance of the latrine. Also, a
latrine has to be well maintained in order to be in good condition. Results suggest that maintenance is a
major issue. It should be addressed in Phase II of the MTE, and in the second half of the DAP.
Table 16: Condition and maintenance of school latrines
42
Indicator MTE
Target
LQAS judgment
(overall)
Percent of latrines found to be clean (no trash lying on the floor, no feces
visible) 60% Pass
Percent of latrines free of visible soiled toilet paper or other used paper 60% Pass
Percent of latrine sites visited where all latrine doors were closed upon arrival 60% Fail
Percent of latrines with functioning doors 80% Pass
Percent of latrines with doors equipped with working inside locks 65% Fail
Percent of latrines with seat covers in all stalls 60% Fail
Percent of latrines with all latrine covers down 50% Fail
Percent of latrines that had at least one broom available 40% Fail
Percent of latrines located at an appropriate distance from water source 70% Pass
Percent of latrines located at an appropriate distance from the school 70% Pass
iii) Trash disposal
When the project builds a school latrine, it also provides garbage cans to the school, and teaches proper
garbage disposal methods. The survey data indicates that trash cans were easily accessible to school
children in at least 80% of the cases, but that the schools failed to use the trash disposal system properly
(Table 17). Both the Water and Sanitation and the Education projects will need to emphasize the
importance of proper garbage disposal practices in the future if schools are going to improve their overall
performance on basic sanitation indicators by the end of the DAP.
Table 17: Trash disposal
Indicator MTE
Target
LQAS judgment
(overall)
Percent of sites with trash can easily accessible to school children 80% Pass
Percent of schools without garbage lying around 70% Fail
Percent of trash disposal areas with acceptable levels of garbage in them
(where the level of trash in the garbage pit was below the level of the ground
or surrounding wall)
70% Fail
iv) Capped Springs
Twenty-five capped springs were visited during the MTE. The indicators that were measured focused on
evaluating the quality and maintenance of both the capped spring and water point fountain areas. Three
indicators were also included to measure behavior changes associated with the capped spring, those
being obtained by interviewing a community member who happened to be in the capped spring area at
the time of the data collector’s visit.
Among the eight infrastructure indicators set for the capped spring area, five met the MTE performance
targets whereas three did not (Table 18). An encouraging finding relates to the efforts made for the
reforestation of the spring surroundings. On the other hand, the survey documented unacceptable levels
of garbage lying around capped spring areas, and a recurrent absence of drainage canals surrounding
three sides of the spring structure. The project should emphasize to users the importance of maintaining
the area clean, and keeping the drainage canals clear and free. Perhaps the community water committee
should be retrained.
Twelve indicators were tested with regards to the water point area, only one of which did not meet the
MTE target, namely the presence of debris around the water point. All other indicators met their targets.
Such results are encouraging, and show that the Water Committees are maintaining the capped spring
43
structures and are disseminating effectively important key hygiene and health messages. That most
interviewed community members stated knowing someone on the local Water Committee demonstrates a
visible presence and level of activity on the part of the Committees. Overall, these results show strong
community involvement in water and sanitation issues. The positive results associated with the technical
aspects of the spring cappings also point at the quality of their construction, done by the local masons.
Finally, all three of the behavior change indicators met their MTE performance targets: at least 20% of
the individuals surveyed stated that their household members regularly purify the water they obtain from
the capped spring; 60% or more responded that their household has experienced less diarrhea since the
construction of the spring; and at least 70% state that they use more water now that the capped spring is
in place. These encouraging results are presented in the table below.
Table 18: Capped springs- condition and maintenance
Indicator MTE
Target
LQAS judgment
(overall)
Spring capping area
Percent of spring capping free of garbage or debris 65% Fail
Percent of spring capping with walls intact 70% Pass
Percent of spring capping covered by lid 70% Pass
Percent of spring capping with lid firmly in place 70% Pass
Percent of spring capping surrounded by a canal on three sides 70% Fail
Percent of spring capping canals that are at least 20cm deep 70% Fail
Percent of spring capping with front area free of standing water 80% Pass
Percent of spring capping surroundings protected by vegetation 50% Pass
Water point/fountain area
Percent of water point/fountain areas free of garbage or debris 65% Fail
Percent of water point/fountain surroundings free of standing water 80% Pass
Percent of water point faucet or fountain pipe with water flowing 75% Pass
Percent of water point/fountain where there are no animals within 5 meters 80% Pass
Percent of water point/fountain where there are no animals feces within 5 meters 80% Pass
Percent of communities with a spring capping that have a committee to manage
the system 65% Pass
Percent of respondents who state knowing at least one member of the spring
capping committee 65% Pass
Percent of respondents who state they have never seen the system run dry 60% Pass
Percent of respondents who state they have never seen the system broken or
damaged 60% Pass
Percent of respondents who state they have never seen people doing their laundry
at the water point/fountain 60% Pass
Percent of respondents who state they have never seen people watering their
animals at the water point/fountain 65% Pass
Percent of respondents who state they have never seen people bathing at the
water point/fountain (DN) 60% Pass
Behavior changes
Percent of respondents who state that their family treats the water with bleach
before drinking it 20% Pass
Percent of respondents who state that their family has less diarrhea since the
construction of the spring capping 65% Pass
44
Indicator MTE
Target
LQAS judgment
(overall)
Percent of respondents who state using more water since the construction of the
spring capping 70% Pass
v) Distance to Water Source and Type of Source (mothers of the MCHN program)
Indicators related to the distance to water source and the type of water source (protected versus not
protected) were tested by collecting information from the 285 mothers selected for the MCHN program
(19 mothers in each SA for each child’s age group: 0-6, 6-12, 12-24 months). Two of these indicators had
been collected in the Baseline survey, and could thus be compared to the MTE results.
It appears that households had to travel farther for water at the time of the MTE than they did in 2002
when the Baseline was carried out (Table 19). In 2002, 74.2% of mothers reported that their water
collection took 30 minutes or less. In 2004, that number had lowered to 48.5% across the supervision
areas. As a matter of fact, only SA2 (Port a Piment, Roche a Bateau, Coteaux) met the 75% benchmark
for this indicator; while SA1, SA3 and SA4 all failed to do so.
With regards to the quality of the water source, 50% of households fetch their water from a protected
water source at Mid-Term, as compared to the 56.2% that did so at the time of the Baseline. SA2, SA3
and SA4 all met the benchmark for this indicator. SA1 is the only supervision area that did not meet the
55% benchmark nor the weighted average for this indicator indicating that the coverage of the capped
springs were lower in this SA than in the others.
Since the beginning of the DAP in 2002, 45 springs have been capped on the south coast (SA1 and
SA2). Of these, 29 were built in SA1 (12 in Tiburon, two in Les Anglais, seven in Chardonnieres and eight
in Rendel). Why this SA failed on the coverage indicator when it received the majority of the project’s
resources is perhaps that the area is more scarcely populated than SA2. Perhaps the water projects
implemented in SA1 do not reach as many households as in the other SAs for this reason. This should
be confirmed by the project monitoring data. .
Important water and sanitation related findings were reported in the 2002 DAP baseline: the prevalence of
diarrhea was found to be statistically lower in households using a protected water source (34.3%)
compared to an unprotected source of water (24.1%). The same study did not show the same significant
difference with the distance to water.
Therefore, these findings do not necessarily show that the sanitation program should intensify spring
capping projects in SA1, but rather that cost effectiveness studies should be undertaken, taking into
account the affected populations, before such spring capping projects are undertaken.
Table 19: Distance to water source
Actual performance
per SA Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4
Distance to water source, all age groups (aggregates)
Percent mothers reporting water collection
taking 30 minutes or less
74.2
% NA 75%
48.5
%
(6.4%
)
Fail B
Y
Y
Y
B
Y
B
W
Percent of mothers that fetch their water
from a protected water source
56.2
% NA 55%
50.0
%
(6.7%
)
Unable
to
determi
ne
B
W
Y
Y
Y
Y
Y
Y
45
4.3.b. Conclusions and Recommendations – Water and Sanitation
i) School Cisterns
The hardware seems to be intact and functioning well with regard to the availability of water and the
maintenance of school cisterns. Knowledge on maintenance of those thus seems appropriate.
In order to ensure the sustainability of the school cisterns, the CRS/Education field-based staff should
continue to ensure that the cisterns are always well maintained by encouraging the target communities
and PTAs to continue their good work and to make sure that the school children continue their correct
behavior with regard to the cistern.
ii) School Latrines
Targets measuring the cleanliness of the school latrines were met. However, targets set for maintenance
issues were not met for some indicators. In order to get the project on the right track, in terms of its
achieving its LOA targets, the CRS/WS project will collaborate closely with CRS/Education project with
respect to the maintenance of the school latrines, and to keep them clean. Minimum standards should be
imposed for the purchase of materials for the construction of these facilities (such as locks, seat covers,
etc). The CRS/Education staff should also reinforce school sanitation efforts by encouraging PTAs to
establish appropriate organizational structures, cleanliness committees, and guidelines concerning
proper, safe, and sanitary waste disposal procedures, as well as outlining the proper usage and
maintenance of school sanitation facilities.
A qualitative study will be undertaken to understand why school latrines maintenance is a problem. As
improper hygiene practices and the lack of proper sanitation practices have negative consequences on
the health of students and school staff alike, further study is needed to understand: why school latrines
are not being well maintained; who is responsible for the cleaning the latrines; why these responsibilities
are not being carried out; and why there is no system to keep latrines in good condition.
iii) Capped Springs
CRS/WS must continue to support the Water Committees in the construction and maintenance of the
capped spring structures and environs. It must also work through these committees to better educate the
local communities in how to better care for the capped spring and water points. Such small-scale public
health campaigns can also be integrated into MCHN activities and the messages promoted by the CHWs,
which may assist in further disseminating proper hygiene information. The Water and Sanitation project
will also undertake cost effectiveness surveys in order to select the most appropriate sites for construction
of the capped springs in the future. This will facilitate the establishment of more efficient program
monitoring and evaluation systems that will, in turn, ensure greater coverage of water services.
4.4. EDUCATION
The Food Assisted Education (FAE) component of the DAP operates in the South, South East, and
Grande Anse Departments. All FAE schools benefit from and participate in: a) a School Canteen; b)
Health Hygiene and Nutrition interventions (trainings, activities, de-worming); c) Quality of Education
activities, to improve school management and teaching; and d) Community Participation activities, mainly
via the strengthening of Parent-Teacher Associations (PTAs). The program targets 156 primary schools
(of which 145 are FAE schools), and reaches an estimated 48,000 school children.
The sampling methodology covered four supervision areas, and five categories of respondents: PTA
Members; School Directors; School Teachers; female pupils; male pupils.
4.4.a. Analysis of Results
i) PTA Committee Members
46
Results presented in Table 20 indicate that PTA members regularly organize and attend their quarterly
meetings, and participate in the school health activities and in the small projects that support their school.
Data also indicate that in all SAs, PTA members do attend the trainings organized by CRS. Program staff
should continue emphasizing the importance of PTA Members’ involvement in school activities in order to
build upon and strengthen these positive behaviors.
Table 20: PTA Committee Members- Education Program
SA122 SA2 SA3 SA4 Indicator MTE
Benchmark BMK WC BMK WC BMK WC BMK WC
Per cent of PTA members that attended at
least one PTA meeting in the last 4 months. 50% Pass Pass Pass Pass Pass Pass Pass Pass
Per cent of PTA members stating
participation in a school health-related activity
in the past 6 months
60% Pass Pass Pass Pass Pass Pass Pass Pass
Per cent of PTA members stating
participation in a PTA small project in the past
12 months
30% Pass Pass Pass Pass Pass Pass Pass Pass
Per cent of PTA members stating
participation in a training event given by CRS
for PTA members
80% Pass Pass Pass Pass Pass Pass Pass Pass
ii) School Directors
Data indicates that the majority of directors is satisfied with the training and support that they have
received from CRS (Table 21). Some emphasis should be given by program staff to sensitize schools
directors on the importance of health, hygiene, and nutrition education, to enlist their support and
leadership for this activity. SA2 Directors might not have yet received such trainings, as this supervision
area is relatively new in the program; which could explain why this supervision area failed on this
particular indicator.
Table 21: School Directors – Education Program
SA1 SA2 SA3 SA4 Indicator MTE
Benchmark BMK WC BMK WC BMK WC BMK WC
Per cent of School Directors that have ever
received managerial or administrative training
from CRS while an employee of their school
80% Pass Pass Pass Fail Pass Pass Pass Pass
Per cent of School Directors that feel that the
training they received improved the overall
quality of their management or administration
40% Pass Pass Pass Pass Pass Pass Pass Pass
Per cent of School Directors that received
Health, Hygiene, and Nutrition training from
CRS since being director at their school.
80% Pass Pass Fail Fail Pass Pass Pass Pass
iii) School Teachers
Results indicate that teachers participate in and are satisfied with trainings provided by CRS. Similarly,
teachers in all supervision areas felt that the trainings they received helped improve the overall quality of
their teaching (Table 22). However, Teachers in SA2 (as School Directors in this zone) failed to pass the
benchmark for Health, Hygiene and Nutrition training. This may be due to the training calendar for such
training interventions, and the fact that SA2 is relatively new to the program.
 
22 SA1 : La Colline d’Aquin, Aquin, Vieux Bourg d’Aquin, Ile a Vache, SA2: Baraderes, Beaumont, Jeremie, Les
Abricots, SA3: Tiburon, Port a Piment, SA4: Fond des Blancs et Cotes de Fer
47
Table 22: School teachers – Education Program
SA1 SA2 SA3 SA4 Indicator MTE
Benchmark BMK WC BMK WC BMK WC BMK WC
Percent of Teachers that ever received
pedagogical or teacher training from CRS while an
employee of their school
75% Pass Pass Pass Pass Pass Pass Pass Pass
Percent of Teachers that feel the training they
received improved the overall quality of their
teaching
40% Pass Pass Pass Pass Pass Pass Pass Pass
Percent of Teachers that received any Health,
Hygiene, and Nutrition training from CRS while
teaching at their school.
75% Pass Pass Fail Fail Pass Pass Pass Pass
iv) Female Students
Benchmarks were met on all indicators related to the School Canteen: both male and female students
stated having received a meal the last day that they were at school (Tables 23 and 24). They also state
appreciating the quality of these meals and mention they eat all the food given to them at school. Only in
a few cases are weighted coverages not met (by female students in SA1 who are less emphatic in having
meals regularly served; and by male students in SA3 who seem less appreciative of the quality of the
meals). In order to address the latter issue, greater emphasis could be placed in this SA at the level of the
School Canteen staff on providing children with a greater variety of meals.
Table 23: Female Students – Education Program
SA1 SA2 SA3 SA4 Indicator MTE
Benchmark BMK WC BMK WC BMK WC BMK WC
Percent of female students who received a meal
the last day they were at school 80% Pass Fail Pass Pass Pass Pass Pass Pass
Percent of female students who state that the
quality of that meal was good 50% Pass Pass Pass Pass Pass Pass Pass Pass
Percent of female students who state generally
eating all the food given to them at school. 80% Pass Pass Pass Pass Pass Pass Pass Pass
v) Male Students
Table 24: Male students- Education Program
SA1 SA2 SA3 SA4 Indicator MTE
Benchmark BMK WC BMK WC BMK WC BMK WC
Percent of male students who received a meal
the last day they were at school 80% Pass Pass Pass Pass Pass Pass Pass Pass
Percent of male students who state that the
quality of that meal was good 50% Pass Pass Pass Pass Pass Fail Pass Fail
Percent of male students who state generally
eating all the food given to them at school. 80% Pass Pass Pass Pass Pass Pass Pass Pass
Benchmarks were met on all indicators related to the School Canteen: both male and female students
stated having received a meal the last day that they were at school. They also state appreciating the
quality of these meals and mention they eat all the food given to them at school. Only in a few cases are
weighted coverages not met (by female students in SA1 who are less emphatic in having meals regularly
served; and by male students in SA3 who seem less appreciative of the quality of the meals). In order to
48
address the latter issue, greater emphasis could be placed in this SA at the level of the School Canteen
staff on providing children with a greater variety of meals.
4.4.b. Conclusions and Recommendations - Education
Overall, results for this sector are positive, with the sampling groups passing most of the benchmarks that
were set for their corresponding indicators. School Directors, PTA members and Teachers all seem to be
participating in the training events that have been offered to them by CRS, as well as in other activities
aimed at improving the staff performance and staff-parent relations. The only instance where the
benchmark was not met for these sampling groups took place in SA2 and related to Health, Hygiene and
Nutrition training. As SA2 is new to the program and those trainings, CRS will need to provide greater
support for such events in the future if LOA goals for this indicator are to be met in that area.
This MTE exercise did not examine school retention rates for children even though this is one of the most
important goals of the Education project. The reason for this is that this information already exists within
CRS monitoring documentation for this sector. While survival rates can be calculated relatively easily, the
reasons why students drop out of school are not as readily apparent from school attendance records.
Therefore, CRS will need to further investigate why children leave school early in order to develop
appropriate strategies for combating this trend.
4.5. Maternal Child Health and Nutrition (MCHN)
The overall objective of the DAP’s Maternal and Child Health and Nutrition (MCHN) program is to improve
the health and nutritional status of children under-five, pregnant and lactating women by 2007. Refer to
Chapter 2 and Appendix 1for a more detailed presentation of the program.
The CRS/MCHN program is implemented in different departments of the Southern Peninsula: South
Coast, Aquin and Cotes de Fer (South East), Grande Anse and Nippes. The original DAP proposed by
CRS did not include the Grande Anse/Nippes department and no Baseline data had been collected for
this department; although additional resources provided on a yearly basis by USAID had allowed CRS to
continue interventions in that department. Consequently, CRS decided to include the Grande Anse
department in the Mid-Term Evaluation (MTE); but not to include the results in the aggregated results.
The departments where the Baseline was conducted were divided into 4 supervision areas for the MCHN
sector; the aggregated results of which were compared with those of the Baseline survey, when this was
possible.
Indicators used in the Baseline study were included in the MTE as appropriate and applicable; using the
same formulation. It is important to note that cluster sampling was used in the Baseline study whereas
the Mid-Term evaluation used LQAS. It is not ideal to mix methods, but both surveys are meant to be
representative of the overall population. Thus we have good ground to claim for the comparability of
results between those two points in time.
The MTE results for the MCHN sector are presented in seven general sections:
• Breastfeeding and infant feeding practices
• Diarrhea and diarrhea management
• Child immunization and vitamin A
• Prenatal and postnatal care
• Participation in program activities: rally posts and health clinics
• Health knowledge of the Community Health Workers
• Hand washing knowledge and practices
4.5.a. Analysis of Results – Breast Feeding and Infant Feeding Practices by Age Group
Appropriate infant and child feeding practices are essential to the health and nutritional status of children.
Current international guidelines for infant and child feeding recommend that children be exclusively
49
breastfed from birth up until six months of age. Breastfeeding should be initiated within one hour of
delivery and nutrient-rich colostrum should be fed to the infant. Beyond six months of age and through
two years or older, the infant should continue to be breastfed frequently, and on-demand. Good hygiene
and proper food handling techniques, including avoiding the use of feeding bottles, should be practiced.
Starting at six months, complementary foods, in addition to breast milk, should be provided. In general,
the number of daily complementary feeds and quantity of food provided at each feed should increase with
the age of the child. For the average healthy breastfed infant, meals of complementary foods should be
provided two to three times per day for children 6-9 months of age and three to four times per day for
children 9-12 months and 12-24 months. In addition, nutritious snacks should be offered to children 6-24
months one to two times per day, as desired. Once complementary feeding is initiated, adequate food
group variety is important to ensure that the child’s minimum nutrient requirements are met. The nutrient
content of complementary foods should be high for all age groups. Meat, poultry, fish or eggs should be
eaten daily, or as often as possible. Vitamin A rich fruit and vegetables should be eaten daily, and
adequate lipid content should be included in the child's diet23. Data on those various aspects of infant and
child feeding practices were collected in the Baseline survey, and then again in the Mid-Term evaluation.
For the purpose of this analysis, we compare the results from both sets of data, as well as the
benchmarks that were established for the project’s mid-point.
i) Breastfeeding and Infant Feeding Practices among Mothers of Children 0-6 Months of Age
As stated earlier, children should be exclusively breastfed from birth up until six months of age.
Breastfeeding should be initiated within one hour of delivery and nutrient-rich colostrum should be fed to
the infant. Beyond six months of age and through two years or older, the infant should continue to be
breastfed frequently, and on-demand; and diet diversity should be increased. CRS’ behavior change
interventions were designed to increase the number of mothers that adopt those practices. The data in
Table 25 examines how the program has performed in its nutrition-related BCC interventions to date.
At the time of the Baseline, thirty percent of all infants 0-6 months old received only breastmilk on the day
of birth. Project managers expected that the BCC activities promoting this practice would succeed in
increasing the percent of mothers who give only milk on the day of birth to forty percent by the Mid-Term,
and to fifty percent by the end of the project (LOA). As the MTE data shows, the project has already
exceeded its LOA expectations since 63% of mothers gave only breastmilk to their infants on the day of
birth. This rate of progress is excellent. Similarly, the percent of mothers that breastfed their infant within
one hour of birth was, at Baseline, 6.2%; to be increased to 20% percent by Mid-Term, and 50% percent
by LOA. The Mid-Term target was satisfactorily met (34.2%), placing CRS in a good position to fulfill its
LOA goal on this indicator.
Looking at the performance of the various SAs, the benchmarks were met in all five SAs for both
indicators; likewise the target set by the weighted average was also met everywhere. As CRS’
performance on these two indicators may be characterized as “successful”, no changes to its BCC
program operations in those areas is warranted at this time, as they appear to be having the desired
effect in all SAs.
The weighted average for the indicator on giving colostrum to newborns is 72.5% +/- 9.9 ppt at Mid-Term.
As the confidence interval range overlapped with the MTE target of 80%, we are unable to definitively
state whether or not the MTE target was actually met for this indicator. We can, however, highlight that
three of the four SAs cleared the MTE benchmark, which suggests that the program is making adequate
progress in promoting this practice in the majority of its impact areas. The only exception to this trend is
SA1, where CRS failed to meet its target. This signals to project managers that the field staff in this SA
will need to pay special attention to colostrum-related messages henceforth if they are to reach their LOA
targets. Otherwise, the project should continue implementing its activities in the three other SAs as
before, since the results there seem to be in line with program expectations.
 
23 This text is borrowed from Bergeron and Deitchler, 2002.
50
The other two indicators, namely, the percent of infants currently breastfed and the percent of infants
exclusively breastfed were measured according to two methods: the Baseline method and the
international method. The difference between these two methods in calculating rates of exclusive
breastfeeding lies largely in the period of reference. In the Baseline method, mothers were asked when
particular foods were introduced into the child’s diet; any food other than breastmilk that is given to the
child before the child reaches 6 months disqualified that child from being considered “exclusively
breastfed from 0 to 6 months”. In contrast, the international method focuses only about what the child ate
within the last twenty four hours: if the child was given anything besides breastmilk in the preceding day,
then that child was not considered exclusively breastfed and disqualified from passing on that indicator.
The MTE results for the two methods were found to be nearly identical, with 51.3% according to the
Baseline method, and 51.4% by international method). Mid-Term expectations were met in all SAs;
though SA3 failed to meet the performance level set by the weighted average. When looking at the
“Percent of infants exclusively breastfed, using the international method”, the project also achieved its
MTE objectives.
ii) Breastfeeding Practices among Mothers of Children 6-12 Months of Age
Except for exclusive breastfeeding rates (which do not apply to children older than 6 months) the same
indicators used for infants aged 0-6 months were also used for infants 6-12 months of age. CRS’
interventions seem to have had the desired effects with regards to offering newborns only breastmilk on
the day of birth. The overall results for the practices of giving breastmilk within the first hour of birth,
providing colostrum, and maintaining breastfeeding cannot be determined as the confidence intervals for
these indicators lay around 10%. The results did, however, highlight weakly performing supervision
areas. For the practice of early initiation of breastfeeding (i.e. breastmilk within 1 hour of birth), for
example, SA2 was shown to be the weakest performing area. For receiving colostrum, we saw that SA1
(which failed to reach the benchmark for 0-6 months) now satisfied the benchmark; while SA2, SA3 and
SA5 all failed to reach it. These results suggest that this practice is a bit shaky in its adoption rate;
therefore, the messages should be reinforced in all sites on this behavior.
Table 25: Breast Feeding and Infant feeding Practices among Mothers
Actual performance per SA25
Areas covered by
Baseline26 GA
Indicator BL
Value
LOA
target
MTE
Targe
t
WA24
(CI)
LQAS
judgme
nt
(overall
)
1 2 3 4 5
Breast feeding and Infant feeding practices 0-6 months of age
Percent of children given
breastmilk only on day of birth
32.5
%
50% 40% 63.6%
(11.0ppt
)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent of infants breastfed
within 1 hour of birth
6.2% 16.2
%
20% 34.2%
(10.6ppt
)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent of infants having
received colostrums
53.0
%
95% 80% 72.5%
(9.9ppt)
UD B
W
Y
Y
Y
Y
Y
Y
Y
-
Percent of infants currently
breastfed
95.8
%
95% 95% 100.0%
(--)
Pass Y
-
Y
-
Y
-
Y
-
Y
-
Percent of infants exclusively
breastfed (BL method)
16.8
%
26.8
%
20% 51.3%
(10.3ppt
Pass Y
Y
Y
Y
Y
W
Y
Y
Y
-
 
24 The weighted average was computed using only data from SAs 1 through 4, i.e. from the areas where the Baseline study had
been carried out. Data from SA5 was not included into the weighted average as this area (Grande Anse department), was not
originally included in the DAP and the Baseline study, as was already explained. . 25 “Y”= Yes, met the benchmark; “B”= Failed to reach the decision rule for the benchmark; “W”= Failed to reach the decision rule for
the weighted average (rounded up at the nearest 5 percentage point increment); “UD” (Unable to Determine) = given the
confidence intervals, we cannot state with certainty that the weighted average clears the benchmark. In such cases, we do not
make a judgment for the overall sample. We look instead only at individual SA performance. “-“: not applicable 26 SA1= Tiburon, Les Anglais et Chardonnières, SA2 = Port a Piment, Roche a Bateau et Coteaux, SA3 = Aquin (La Colline, Aquin,
Vieux Bourg d’Aquin), SA4 = Fond des Blancs et Cotes de Fer, SA5 = Nippes et Grande Anse
51
Actual performance per SA25
Areas covered by
Baseline26 GA
Indicator BL
Value
LOA
target
MTE
Targe
t
WA24
(CI)
LQAS
judgme
nt
(overall
)
1 2 3 4 5
)
Percent of infants exclusively
breastfed (Int’l method)
NA 26.8
%
20% 51.4%
(10.3ppt
)
Pass Y
Y
Y
Y
Y
W
Y
Y
Y
-
Breast feeding and Infant feeding practices, 6-12 months of age
Percent of children given
breastmilk only on day of birth
NA NA 40% 70.6%
(9.6ppt)
Pass Y
Y
Y
Y
Y
W
Y
Y
Y
-
Percent of infants breastfed
within 1 hour of birth
NA NA 20% 21.4%
(9.6ppt)
UD Y
Y
Y
W
Y
Y
Y
Y
Y
-
Percent of infants having
received colostrums
NA NA 80% 71.5%
(10.0ppt
)
UD Y
Y
B
W
B
W
Y
Y
B
-
Per cent of infants 6-12
months currently breastfed
98.5
%
98.5
%
95% 95.3%
(4.3ppt)
UD Y
-
Y
-
Y
-
Y
-
Y
-
Percent of infants 6-12 months
fed the appropriate # of
Complementary Feedings (CF)
in last 24 hrs
55.6
%
60.6
%
60% 20.6%
(9.3ppt)
Fail B
-
B
-
B
-
B
-
B
-
Percent of infants 6-12
months given all 3 food groups
(as described by CRS
messages) in last 24 hours
--
80% 60.0%
(11.4ppt
)
Fail B
Y
Y
Y
B
Y
B
Y
Y
-
Breast feeding and Child feeding practices, 12-24 months of age
Percent of infants 12-24
months currently breastfed 60.0
%
70.0
%
65% 73.0%
(10.1ppt
)
UD Y
Y
Y
Y
Y
W
Y
Y
B
-
Per cent of infants 12-24
months fed the appropriate #
of CF in last 24 hrs
41.1
%
46.1
%
45% 23.3%
(11.6ppt
)
Fail B
Y
B
Y
B
W
Y
Y
B
-
Per cent of infants 12-24
months given all 3 food groups
(as described by CRS
messages) in last 24 hours
--
80% 66.8%
(10.1ppt
)
Fail B
W
Y
Y
Y
Y
Y
Y
B
-
Since complementary foods are to be introduced at 6 months of age, two new indicators were added to
this age group, namely (1) the frequency of feeding, and (2) the diversity of foods offered to the child.
Unfortunately, the project failed to meet its objectives on both counts. With regards to feeding the
appropriate number of complementary foods to the child, the data suggests that mothers in the CRS area
not only failed to reach the benchmark in all SAs, they regressed from the situation at Baseline: the
proportion of mothers offering the appropriate number of daily complementary feeding to their 6-12 month
old children fell from 55 percent at Baseline, to 20.6 percentage points at the Mid Term. Therefore the
messages about the appropriate frequency of complementary feedings should be reinforced in all of the
SAs. Further investigation into the causes of this steep regression will need to be investigated more
closely, in order to develop a programmatic strategy for addressing this serious drop in performance.27.
CRS’ educational messages also focus on the importance of giving all three food groups to children 6-12
months of age; the three food groups including body builders/protein, body protectors/fruits and
vegetables, and energy providers/sugar, oil, starch, cereals. Since no information had been collected on
this at Baseline, the MTE target was arbitrarily set at 80%. Results showed that only 60% of the 6-12
month old children received those three food groups the day before the survey was carried out; and that
 
27 For instance, do the economic and political difficulties that have affected Haiti in the last 15 months explain this apparent
degradation of the capacity of mothers to offer food with the appropriate frequency?
52
the problem was mostly in SAs 1, 2 and 4, who all failed to reach the 80% MTE benchmark for this
indicator.
iii) Breastfeeding Practices among Mothers of Children 12-24 Months of Age
The situation described above for the 6-12 month olds is replicated in the 12-24 months age group: at the
aggregate level (weighted average), the program failed to reach its targets, both in terms of the frequency
and the diversity of the diet. It should be noted, however, that the dietary diversity indicator failed only in
SA1 and SA5; it met both the benchmark and the target set by the weighted average in all of the other
groups. For that age group, therefore, it appears that messages about dietary diversity should be
reinforced in SA1 and SA5; while messages about feeding frequency should be reinforced in all SAs. It is
important to note that SA5 is the Grande Anse area where program activities have not been implemented
as intensively as in the other four supervision areas. At the same time, however, SA1 includes the area of
Port a Piment, where low program coverage, participation and effectiveness have been observed in most
of CRS supported programs over the last two years.
4.5.b. Conclusions and Recommendations – Breastfeeding and Infant Feeding Practices
The rate of progress for two important breast feeding indicators - giving breast milk only on day of birth
and infants breastfed within one hour of birth- is excellent and CRS should continue its same BCC
strategies, as they appear to be having the desired effect in all SAs.
However, the following three key practices have not been adopted as widely as expected by mothers in
the CRS intervention areas: (1) giving colostrum to infants; (2) providing the adequate number of daily
complementary feeds to children between 6 and 24 months; and (3) providing children 6-24 months with
the appropriate dietary diversity. According to the conceptual framework used by CRS, the adoption of
these practices is crucial to reducing malnutrition rates and therefore, CRS should strive to better
understand the constraints that may impede mothers from adopting these important practices in the
future.
SA1 and SA5 are areas where the program was shown most often to fail to meet the targets for the infant
and child feeding indicators of focus for this study. The program should reinforce its training program in
the Grande Anse area (SA5) in order to reach the same results as in the other areas. SA1 is a complex
issue and the overall situation of low program participation will be addressed as a whole - in coordination
with the other program sectors.
4.5.c. Analysis of Results - Diarrhea and Diarrhea Management
“Appropriate prevention and treatment of infection and disease are essential to protect a child’s nutritional
status. As described in the applied conceptual framework, children’s health and nutritional status are
closely related. In the presence of infection and disease, appetite as well as the absorption and utilization
of nutrients may diminish. Similarly, children who are malnourished are not as resistant to illness, disease
and infection. Children’s health status is therefore both an underlying causal factor, and a related
outcome of malnutrition.”28
i) Diarrhea Prevalence
Results on the prevalence of diarrhea as well as information on the types of treatment and practices
provided by the caretakers during childhood diarrhea are presented in Table 26.
 
28 This text is from Bergeron and Deitchler, Report on the DAP Baseline study, 2002
53
The weighted average for children without diarrhea was 66.5% for children less than 6 months old, 61.7%
for children 6-12 months old and 52.4% for children 12 to 24 months old. The overall result for the 6 to 24
month olds was 57.0%.
Even though most of the SAs passed the benchmark and the weighted average for this indicator, the data
revealed unequal performance levels across the SAs. For example, SA3 failed to meet the benchmark
and weighted average for 0-6 month olds, SA2 failed for 6-12 month olds, while SA1 failed for 12-24
month olds. When combining the last two age groups (namely, the 6-24 month olds), SA1, SA2 and SA5
all failed to pass the benchmark. However it seems that diarrhea prevention messages have made
progress in SA4 (Cotes de Fer and Fond des Blancs), as this supervision area passed the benchmark for
diarrhea prevention for all age groups.
Table 26: Diarrhea and Diarrhea Management
Actual performance per SA
Areas covered by
Baseline GA Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4 5
Diarrhea and diarrhea management, 0-6 months of age
% infants without diarrhea in
last two weeks 80.1 85.1 80%
66.5%
(10.2ppt
)
Fail Y
Y
Y
Y
B
W
Y
Y
Y
-
Diarrhea and diarrhea management, 6-12 months of age
Percent infants without
diarrhea in last 2 weeks
60.1 65.1 65%
61.7%
(11.0ppt
)
UD Y
Y
B
W
Y
Y
Y
Y
B
-
Diarrhea and diarrhea management, 12-24 months of age
Percent infants without
diarrhea in last 2 weeks 61.2 66.2 65%
52.4%
(11.1ppt
)
Fail B
W
Y
Y
Y
Y
Y
Y
Y
-
Diarrhea and diarrhea management (for children who had had
diarrhea during the last two weeks), 6-24 months of age
Percent children without
diarrhea in last two weeks
64.5
%
(6-
35.9
month
s)
69.5
% 65% 57.0%
(7.9ppt) Fail B
W
B
Y
Y
Y
Y
Y
B
-
Percent children who were
given ORS for diarrhea
37.4
% 60% 50%
53.0%
(12.9ppt
)
UD Y
W
Y
Y
-
-
Y
Y
Y
-
Percent children with diarrhea
who were given increased
liquids during diarrhea
44.6
% NA 50%
43.1%
(12.0ppt
)
UD Y
Y
Y
W
-
-
Y
Y
Y
-
Percent children with diarrhea
who were given the same or
more food
27.4
% NA 40%
40.4%
(12.8ppt
)
UD Y
Y
Y
Y
-
-
Y
W
Y
-
Percent children receiving
continued feeding during
diarrhea
15.2
%
25.2
% 20%
16.8%
(10.0ppt
)
UD Y
Y
Y
Y
-
-
Y
Y
Y
-
54
Actual performance per SA
Areas covered by
Baseline GA Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4 5
Percent children with diarrhea
receiving additional food after
diarrhea episode
36.4
%
46.4
% 40%
38.1%
(12.5ppt
)
UD Y
Y
Y
Y
-
-
Y
Y
Y
-
ii) Diarrhea management
Questions on diarrhea management were tabulated only for children who had had diarrhea during the last
two weeks. Therefore, in order for the number to be sufficient for the analysis, the results on diarrhea
management were aggregated using the data collected on the last two age groups, namely for children 6-
24 months, for SA1, SA2 and SA4. Too few children had diarrhea in SA3 to be included in this tabulation.
The recommended treatment for diarrhea involves three components: 1) Providing ORS for the child
during diarrhea 2) Providing increased fluids to the child during diarrhea and 3) Providing the same or
more quantity of food to the child during diarrhea. In addition, children should receive additional food after
the diarrhea episode has passed.
Only 37.4% of children were given ORS during diarrhea at the time of the Baseline. LOA expectations for
that indicator are 60% and the benchmark at the MTE was 50%. At Mid-Term, the data showed that 53%
of children who had had diarrhea during the last two weeks were given ORS during diarrhea. This rate of
progress is excellent and places CRS in a good position to fulfill its LOA goal for that indicator. It also
supports the continuation of its BBC program on the use of ORS, as it appears to be having the desired
effect.
With regards to the four indicators measuring increased intake of fluids and food during diarrhea, the
range of the confidence interval overlapped with the MTE targets so it is not possible to state definitively
whether or not MTE targets were met. It can, however, be concluded that the program has made
adequate progress in promoting appropriate diarrhea management in that all of the SAs cleared the
benchmark for these indicators.
Judging from the overall results, it seems that significant progress has been made in terms of the
percentage of children who were given the same or more food during diarrhea: 27.4% at the time of the
Baseline and 40.4% at Mid-Term. With regards to the percent of children with diarrhea who were given
increased liquids during diarrhea, the progress was not as significant, however.
Another important indicator, namely increased feeding during diarrhea, was computed by combining the
proportion of children who were given both increased liquids and same or more food during diarrhea.
Even though all SAs passed the benchmark, only 16.8% of children with diarrhea were given both
increased liquids and same or more food during diarrhea at the time of the Mid-Term.
“During episodes of diarrhea, the growth of a child may falter, due to the child’s impaired ability to absorb
and utilize nutrients. The period following recovery from diarrhea represents an important opportunity
during convalescence, or “catch-up growth” can occur. Once diarrhea has ceased, increased feeding is
therefore recommended, and may enable a child to return to his/her prior health and nutrition status,
rather than to remain at a deteriorated level”.29 At the time of the Mid-Term, all SAs passed the
benchmark of 40% set for that indicator.
4.5.d. Conclusions and Recommendations - Diarrhea and Diarrhea Management
 
29 This text is from Bergeron and Deitchler, Report on the DAP Baseline study, 2002
55
Diarrhea prevalence among children 6-24 months old failed to pass the benchmark in SA1 and SA2. For
programmatic purposes, project managers should instruct the staff working in those two areas to pay
special attention to diarrhea prevention messages.
Among the three components recommended for the treatment of diarrhea, the use of ORS has increased
significantly since the time the Baseline was conducted: 53% of the children 6-24 months old who had
had diarrhea during the last two weeks were given ORS during diarrhea at the time of the Mid-Term
evaluation compared to 37.4% at the time of the Baseline. The increased use of ORS can possibly be
explained by the increased access to ORS through a social marketing program set up by all of the CHWs
in collaboration with PSI (Programme de Sante et Information).
With regards to the other two components of the recommended treatment for diarrhea (same or more
food and increased liquids) all SAs passed the benchmark with more than 40% of the children with
diarrhea receiving additional liquids and the same or more food. This result places CRS in a good position
to reach the LOA targets for those indicators.
When comparing the results of the Mid-Term with those from the Baseline, the progress was more
significant for the indicator measuring the amount of food given to the child during diarrhea than the
indicator on increased liquids. Even though all SAs passed the benchmark of 20% set for the indicator
combining both components of the treatment (continued feeding: increased liquids and same or more
food), CRS staff and CHWs should continue to emphasize the BCC messages on the importance of
applying simultaneously all three components of appropriate treatment of diarrhea: ORS, increased
liquids and same or more food.
Finally, results also showed that messages related to the giving of additional food to the child after the
diarrhea episodes have been successful in CRS targeted areas.
4.5.e. Analysis of Results – Health Cards, Child Immunizations and Vitamin A Supplementation
The CRS program encourages mothers to have a health card and birth certificate for their children.
Information on the possession of health cards and birth certificates was collected for all age groups, while
data on vitamin A supplementation was collected for only two age groups: 6-12 and 12-24 months old.
Current guidelines for Vitamin A capsule supplementation in developing countries recommend that
children aged twelve months to five years of age receive 200,000 IU, as a single dose, every four to six
months. The information on Vitamin A supplementation was collected by recall.
Immunization status was collected on children 12-24 months of age, using the standards developed by
the Demographic Health Survey. For the purposes of this MTE, being fully immunized required that each
of the following vaccinations were received: BCG, Measles, three DPT and three doses of polio, not
including polio at birth (Haiti DHS 2000). Children receiving these vaccinations (according to the
recommended immunization schedule) are able to achieve full immunization by one year of age.
i) Health Cards for Children 0-6 months
Results on health cards and immunization for the age groups are presented in Table 27.
The Mid-Term target for the percent of children having a health card or a birth certificate was set at 90%
for all three age groups. For the 0-6 month old children, the weighted average for that indicator was
85.8% (+/- 7.8ppt) at Mid-Term. Because the range of the confidence interval overlapped with the MTE
target for this indicator, we are unable to definitively state if the MTE target was met or not. We can,
however, conclude that three SAs (SA1, SA3 and SA4) cleared the benchmark, suggesting that the
program has made progress in those SAs in promoting the importance of the health card. Project and
partner staff working in SA2 (including Port a Piment) should pay special attention to this message, as the
90% performance target was not reached in this area. The low performance in SA2 for the younger
children can be explained by the decreased participation at rally posts, which has been observed in the
area of Port a Piment over the last few months. As fewer mothers have been taking advantage of the
56
growth monitoring services offered at the rally post level, fewer mothers have been obtaining health cards
for their children.
ii) Health Cards and Child Immunizations in Children 6-12 Months of Age
The MTE results for the number of children aged 6-12 months with health cards or birth certificates
indicated that the program has been performing well in all of the SAs – as all SAs cleared the benchmark
with an overall average of 96.6%. Similar improvements were seen with Vitamin A supplementation. At
the time of the Baseline, 45.7% of all children 6-12 received a Vitamin A capsule within last six months.
Program staff and partners expected that this indicator would increase to 60% by the Mid-Term, and 80%
by the end of the project. As the data showed, the LOA expectations have already been met by Mid￾Term, as 82.8% of children have received a Vitamin A capsule in the last six months. This rate of
progress is excellent.
Table 27: Health cards, Child Immunizations and Vitamin A Supplementation
Actual performance per SA
Areas covered by
Baseline GA Indicator BL
Value
LO
A
targ
et
MTE
Target
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4 5
Child Immunization and Vitamin A, 0-6 months of age
Percent children with health
card or birth certificate with
date recorded
NA 90% 85.8%
(7.8ppt)
Unable
to
determi
ne
Y
Y
B
W
Y
Y
Y
Y
B
-
Child Immunization and Vitamin A Supplementation, 6-12 months of age
Percent children 6-12 months
with health card or birth
certificate with date recorded
NA 90% 96.6%
(4.1ppt) Pass Y
-
Y
-
Y
-
Y
-
Y
-
Percent children receiving
Vitamin A capsule in last six
months
45.7
% 80% 60% 82.8%
(7.8ppt) Pass Y
Y
Y
Y Y
W
Y
Y Y
-
Child Immunization and Vitamin A Supplementation , 12-24 months of age
Percent children 12-24 months
with health card or birth
certificate with date recorded
NA 90% 84.4%
(7.9ppt) UD B
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent children receiving
Vitamin A capsule in last six
months
46.4
% 80% 60% 90.9
(5.7ppt) Pass Y
W
Y
Y Y
Y
Y
Y Y
-
Percent children fully
immunized
(3 doses polio)
26.7
% 36.7
% 35%
63.5%
(11.1ppt
)
Pass Y
W
Y
Y Y
Y
Y
Y Y
-
iv) Health Cards, Child Immunizations, and Vitamin A Supplementation in Children 12-24 Months
 of Age
On average, 84.4% of 12-24 month olds have a health card or birth certificate with their date of birth
recorded. Except for SA1, all SAs met the benchmark, set at 90%. Program staff based in SA1 (Tiburon,
Les Anglais, Chardonnieres) should therefore examine the possible reasons for their lower performance,
and emphasize to mothers the importance of the health cards for children of this age group.
Data on Vitamin A supplementation was also collected for children 12-24 months. At the time of the
Baseline, 46.4% of all children aged 12-24 months had received a Vitamin A capsule in last six months.
Program staff and partners expected that this indicator would increase to 60% by the Mid-Term and to
80% by the end of the project. As the data showed, LOA expectations were largely met by Mid-Term, as
57
90.9% of children had received a Vitamin A capsule during the last six months. This rate of progress is
excellent.
Information on the immunization status of children aged 12-24 months old was collected and revealed
that 63.5% of children in this age group were fully immunized at the time of the MTE. This rate of
progress is excellent, as the LOA target for this indicator was 36.7%. This success can largely be
contributed to three national immunization campaigns that have been undertaken by the Ministry of
Health (with WHO support) during the last two years.
4.5.f. Conclusions and Recommendations – Health Cards, Child Immunizations, and Vitamin A
 Supplementation
We believe that joint action between CRS and the Ministry of Health has been instrumental in increasing
the level of Vitamin A supplementation and full immunization of children over the last three years. Since
the beginning of the DAP, CRS has been providing support to the Ministry of Health by transporting
vaccines from their main warehouse in Port au Prince to CRS’ regional warehouse in Les Cayes. CRS
has also contributed to the improvement of the cold chain by supplying new refrigerators to five health
centers located in the project area. Because of the shortage of staff at the health center level, and the
limited number of CHWs who can provide immunization services, CRS staff provides assistance in
immunization services whenever they are doing supervision visits. The positive results highlighted above
can also be explained by an increased awareness on the part of parents on the importance of child
immunization. Project staff reported that in many areas, parents are now asking for those services.
For programmatic purposes, project staff should pay special attention to the possession of health cards
for children 0-6 months of age in SA 2 (Port a Piment, Roche a Bateau and Coteaux) and for 12-24 month
olds in SA1 (Tiburon, Les Anglais and Chardonnieres).
4.5.g. Analysis of Results – Pre-natal and Post-natal Care
“During pregnancy, the health of the developing fetus is directly linked to the health and nutrition status of
the mother. Women’s dietary intake, for example, influences the availability of certain nutrients to the
developing fetus. Women deficient in vitamins or minerals are unable to provide the required quantity of
nutrients to the infant, resulting in negative outcomes for the growth and development of her child. Poor
maternal health acts in a similar way to cause negative consequences for the infant. Any infection or
disease that puts the health of the mother at risk also puts the health of the unborn infant at risk. In
developing countries, maternal death during pregnancy or in childbirth usually means death for the infant
also.
Several practices can contribute to reducing maternal, peri-natal, and neo-natal deaths, and poor
pregnancy outcomes in developing countries. Interventions related to access and use of pre- and post￾natal care and improvement of women’s nutritional status are all recognized as important to protecting
maternal and infant health and nutrition”30.
“Quality pre-natal care offers important preventative health benefits to the mother and infant. Pre-natal
care provides health workers an opportunity to identify and treat illness, communicates health messages,
and allows for early detection of potential pregnancy complications. In addition, interventions for
protection against iron deficiency anemia and neonatal tetanus can be provided to women during pre￾natal visits. The availability and use of these services were collected during the Baseline study. The same
information was collected during the Mid-Term, therefore, measuring the progress done on the issues on
pre and post natal care”31.
 
30 This section is borrowed from Bergeron and Deitchler, Joint Baseline report, 2002
31 Ibid.
58
“Almost all births in Haiti take place at the home of the mother and less than 10% of births take place at a
health institution. More important than delivery location may be the presence of a trained birth attendant
at the time of delivery. The presence of a trained health worker during delivery increase the likelihood that
neonatal and post-partum infection will be prevented, and that referral to emergency health care will be
made, when appropriate. Further, health messages are shared when a trained health worker is present at
birth; the relationship between the health worker and the mother can be established and important infant
feeding and care guidance can be impressed”32
“The post-natal care visit is an important opportunity to initiate follow up with the mother and her newborn.
The visit allows the health worker to monitor the health of the mother and her infant, as well as to provide
additional guidance to the mother on proper feeding and care of the child”33.
The MTE collected data on the timing and location of the post-natal visit and if there was a consultation
with a trained health worker. Results are presented for the three age groups of children. One can
assume that mothers of children aged 0-6 months are those who are still receiving some post-natal care.
On the other hand, mothers of children aged 12-24 months old at the end of 2004 received their pre- and
post- natal care during 2002 and 2003.
At the time of the Baseline, information on pre- and post-natal care was not collected for mothers of
children less than six months old. Therefore, Mid-Term results for the 0-6 months old are compared with
Baseline results for mothers of all children 6-59.9 months. For the other two age groups, Baseline results
are available by age group. On the other hand, LOA program targets have been set for all age groups
combined and the table below presents the same targets for all three age groups.
i) Pre- and Post-Natal care for Mothers of Children 0-6 Months of Age
Results presented in Table 28 show that 91.6% of mothers of 0-6 months old children had a health card.
For the indicator concerning mothers’ complete immunization status during last pregnancy (two maternal
tetanus toxoid vaccinations), the confidence interval overlapped with the MTE target of 70%; therefore,
we are unable to definitively state if the MTE target was met or not. We can, however, conclude that all of
the SAs cleared the benchmark, suggesting that the program has been making adequate progress in all
of the SAs with regards to immunization of pregnant women.
Similar results were reported for the utilization of prenatal services. In all of the SAs, at least 80% of
mothers had 3 or more prenatal visits with a trained provider. Therefore, the result of 78.2% for the CRS
coverage area is excellent. During the Baseline survey, the overall result for mothers of children of all age
groups combined (6 to 59.9 months) was 79.6%. This high value observed at the time of the Baseline can
explain why the progress done at mid-point was not significant.
Significant progress was also noted in the percent of mothers who received pre-natal care from a trained
provider before the third trimester of their pregnancy. At the time of the Baseline, 81.4 % of mothers (for
all age groups) visited their trained provider before their third trimester; by Mid-Term, this percentage
increased to 95.6%.
The percent of mothers who had a trained health provider assist in their delivery has nearly doubled since
the Baseline survey was carried out (from 32.3% in 2002 to 68.0% in 2004). The MTE benchmark for that
indicator was set at 70%, and all of the SAs cleared the MTE benchmark. Among the mothers who gave
birth at home, 60.2% gave birth with a trained health provider present. This result showed significant
progress since the Baseline in 2002 when only 23.8% of all mothers who had given birth at home had a
 
32 Ibid. 33 Ibid.
59
trained health provider present. Note, however, that SA1 seems to be performing at a lower level than
the other three SAs with regards to this indicator.
At the time of the MTE, the percent of mothers who gave birth in a health facility was still very low (6.5%).
As explained above, where the mother delivers is not as important as having a trained birth attendant
present at the time of delivery It is interesting to note that only SA3 (Aquin) met the benchmark of 35% set
for the MTE. This is likely due to the fact that all four health facilities located in this supervision area are
health centers and/or hospitals, and provide these types of maternity services. Access may therefore
explain the low proportion of facility-based deliveries.
The Baseline results revealed that postnatal care was not much of a priority for women, in that only 19.1
% of mothers surveyed made at least one postnatal visit with a trained health provider within 45 days of
delivery. This priority has obviously changed, however, in that 56.2% of mothers had made at least one
post-natal visit at the time of the MTE. This rate of progress is excellent when compared to the MTE
performance benchmark, which was at 25%. There was one exception to this general trend, namely that
SA3 (Aquin), which has not performed as well as the other SAs in regards to post-natal care.
Interestingly enough, data from SA5 revealed a similar increase in post-natal care. This trend can be
explained by the fact that CRS has continued its support of pre- and post-natal services in this area,
including food supplementation for pregnant and lactating women as a major activity.
Table 28: Pre- and Post-Natal Care: Mothers of Children 0-6 months old
Actual performance per
SA
Areas covered by
Baseline
Indicator GA
BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4 5
Pre-Natal and Post-Natal Care, 0-6 months of age
Percent mothers who have a
health card 58.7%34 NA 80% 91.6%
(6.5ppt) Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent mothers who received
at least 1 tetanus shot
83.8%
(all age
groups)
NA 70% 92.4%
(6.4ppt) Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent women fully
vaccinated against tetanus
during last pregnancy
(received 2 shots or was
already fully vaccinated)
63.8%
(all age
groups)
73.8%
(all age
groups) 35
70% 77.1%
(9.8ppt) UD Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent mothers with at least 3
prenatal visits with a trained
79.6%
(all age
84.6%
(all age 80% 78.2%
(9.5ppt) UD Y
Y
Y
Y
Y
Y
Y
Y
Y
-
 
34 Information of mothers of children less than 6 months old were not collected at the Baseline; those Baseline results are those of
mothers of children 6-59.9 months old all combined 35 LOA results for pre and post natal care are only available for three indicators and were originally set for mothers of children of all
age groups combined (6-59.9 months old)
60
Actual performance per
SA
Areas covered by
Baseline
Indicator GA
BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
) 1 2 3 4 5
provider groups) groups)
Percent of mothers who
received pre-natal visit with
trained provider before third
trimester of pregnancy (7
months)
81.4%
(all age
groups)
NA 80% 95.6%
(5.0ppt) UD Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Percent of mothers who had a
trained health provider assist
the delivery
32.3 %
(all age
groups)
37.3%
(all age
groups)
70%
68.0%
(10.7ppt
)
UD Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent mothers who gave
birth at home with a trained
provider present
23.8%
(all age
groups)
NA 60%
60.2%
(11.0ppt
)
UD Y
W
Y
Y
Y
Y
Y
Y
Y
-
Percent of mothers who gave
birth in a health facility
9.7%
(all age
groups)
NA 35% 6.5%
(5.2ppt) Fail B
-
B
-
Y
-
B
-
B
-
Percent of mothers who made
at least one postnatal visit with
a trained provider within 45
days of delivery
19.1 %
(all age
groups)
24.1%
(all age
groups)
25%
56.2%
(11.4ppt
)
Pass Y
Y
Y
Y
Y
W
Y
Y
Y
-
ii) Pre- and Post-Natal care for Mothers of Children 6-12 Months of Age
For mothers of children aged 6-12 months, Mid-Term results were compared with those of the Baseline
for that specific group (Table 29). Results were similar to those of mothers of younger children presented
in the previous section. Results presented in the table below show that 85.8% of mothers of 6-12 months
old children had a health card and that all SAs cleared the benchmark.
For the indicator on complete immunization status during last pregnancy (two maternal tetanus toxoid
vaccinations), the range of the confidence interval overlapped with the MTE target; therefore, we are
unable to definitively state if the MTE target was met or not. We can, however, conclude that all SAs
cleared the benchmark, except SA5, suggesting that the program has been making adequate progress in
the first four SAs with regards to immunization of pregnant women. At the time of the Baseline study,
only 49.1% of mothers of children 6-12 months old were fully vaccinated against tetanus during their last
pregnancy.
Similar results were reported for the utilization of prenatal services. The first four SAs cleared the
benchmark for the percent of mothers who had at least three prenatal visits with a trained provider. SA5
did not meet the benchmark for this age group, however. During the Baseline survey, the overall result for
the joint evaluation (the four Cooperating Sponsors) was 65%. With a survey done at the population level
in the CRS intervention area, the result of 78.5% of mothers with at least three prenatal visits with a
trained provider for CRS area is excellent. The high value of 83.8% observed at the time of the Baseline
could explain the lack of further progress achieved by Mid-Term
More substantial progress was noted for the percent of mothers who had pre-natal visit with a trained
provider before the third trimester of pregnancy. At the time of the Baseline, the result was 78.5 %
whereas by Mid-Term, this percentage increased to 88.6% for mothers of children aged 6-12 months old.
All SAs cleared the benchmark for this indicator - except the Grande Anse.
The percent of mothers who had a trained health provider assist in the delivery has doubled since the
time the Baseline study was carried out (from 31.0% in 2002 to 63.7% in 2004). All SAs cleared the
61
benchmark for that age group. However, SA1 and SA2 did not meet the weighted average suggesting
that these two areas have been performing at a lower level than the other two SAs with regards to the
assistance of a trained health provider at delivery. Among the mothers who gave birth at home, 65.2%
gave birth with a trained health provider present. This is excellent progress, as the Baseline value was
only 18.4%. All of the SAs cleared the benchmark set for this indicator, but both SA1 and SA2 seem to be
performing less well when compared to the other two SAs in that they did not meet the weighted average.
At the time of the MTE, the percentage of mothers of children 6-12 months old who gave birth in a health
facility was still very low (13.0%) but the rate is still higher than that for mothers of younger children
(6.5%). It is interesting to note that SA3 (Aquin) and SA4 (Cotes de Fer) met the benchmark of 35% set
for the MTE.
Results of the Baseline study showed that post-natal care was not an area of concern for mothers of
children 6-12 months old in that only 18.7 % of them made at least one post-natal visit with a trained
health provider within 45 days of delivery. As the MTE target for this indicator was set at 25%, the data
suggests that CRS has been performing very well in that the Mid-Term result was 47.7%. As with the
previous age group, SA3 (Aquin) has not been performing as well the other SAs.
For mothers of children aged 6-12 months old, results observed in SA5 were not as positive as those
observed in the younger age group for the same indicators. SA5 failed on three important indicators:
complete vaccination during pregnancy, three prenatal visits with a trained health provider and a pre-natal
visit with a trained provider before the third trimester of pregnancy. We can assume that mothers who
recently gave birth have better pre- and post-natal care practices than those who gave birth one year ago.
Table 29: Pre- and Post-Natal Care: Mothers of Children 6-12 months old
Actual performance per SA
Areas covered by
Baseline Indicator BL GA
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgmen
t
(overall) 1 2 3 4 5
Pre-Natal and Post-Natal Care , Mothers of Children 6-12 months of age
Percent of mothers who
have a health card
59.5
% NA 80% 85.8%
(8.3ppt) UD Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent of mothers who
received at least 1 tetanus
shot
71.4
% NA 70% 92.7%
(5.7ppt) Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent of women fully
vaccinated against tetanus
during last pregnancy
(received 2 shots or was
already dully vaccinated)
49.1
%
73.8%
(all age
groups)
70%
74.5%
(10.2ppt
)
UD Y
Y
Y
Y
Y
Y
Y
Y
B
-
Percent of mothers with at
least 3 prenatal visits with a
trained provider
83.8
%
84.6%
(all age
groups)
80% 78.5%
(9.4ppt) UD Y
Y
Y
Y
Y
Y
Y
Y
B
-
Percent of mothers who
received pre-natal visit with
trained provider before third
trimester of pregnancy (7
months)
78.5
% NA 80% 88.6%
(7.4ppt) Pass Y
Y
Y
Y
Y
Y
Y
Y
B
-
Percent of mothers who had
a trained health provider
assist the delivery
31.0
%
37.3%
(all age
groups)
40%
63.7%
(10.7ppt
)
Pass Y
W
Y
W
Y
Y
Y
Y
Y
-
Percent mothers who gave
birth at home with a trained
provider present
18.4
% NA 60%
65.2%
(11.4ppt
)
Unable to
determin
e
Y
W
Y
W
Y
Y
Y
Y
Y
-
Percent of mothers who
gave birth in a health facility
14.5
% NA 35% 13.0%
(7.3ppt) Fail B
-
B
-
Y
-
Y
- B
-
62
Actual performance per SA
Areas covered by
Baseline Indicator BL GA
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgmen
t
(overall) 1 2 3 4 5
Percent of mothers who
made at least one postnatal
visit with a trained provider
within 45 days of delivery
18.7
%
24.1%
(all age
groups)
25%
47.7%
(11.5ppt
)
Pass Y
Y
Y
Y
Y
W
Y
Y
Y
-
iii) Pre- and Post-Natal Care for Mothers of Children 12-24 Months of Age
Results presented in Table 30 show that only 68.6% of mothers of children 12-24 months had a health
card. SA1 and SA2 did not meet the benchmark; nor did SA5. For the indicator on complete immunization
status during last pregnancy (two maternal tetanus toxoid vaccinations), the range of the confidence
interval overlapped (65.0% +/-11.0ppt) with the MTE target of 70%; therefore, we are unable to
definitively state if the MTE target was met or not. We can definitively state, however, that all SAs except
SA1 cleared the benchmark for the indicator.
Similar results were reported for the utilization of prenatal services. All SAs, except SA1 and SA5, cleared
the benchmark for the percent of mothers who had at least three pre-natal visits with a trained provider.
During the Baseline survey, the result for that age group was 78.5% and the overall result for the joint
evaluation (the four Cooperating Sponsors) was 65%. Therefore, the result of 83.2% at the MTE for CRS
area showed excellent progress. This high value observed by CRS at the time of the Baseline (78.5%)
can explain why the progress achieved by Mid-Point, 83.2%, has only been a slight improvement.
As with the other two previous groups, more substantial progress was noted for the percentage of
mothers who had a pre-natal visit with trained provider before the third trimester of their pregnancy. At the
time of the Baseline, the result was 78.5 % and this percentage increased to 87.8% at the time of the Mid￾Term evaluation.
The percent of mothers who had a trained health provider assist in their delivery significantly increased
from 32.1% at Baseline to 54.8% at mid term. All SAs cleared the MTE benchmark (set at 40%), although
SA1 revealed a weaker performance in comparison to the other SAs. Among the mothers who gave birth
at home, 60.9% had gave birth with a trained health provider present. This is excellent progress
compared to the Baseline result, which was 24.3% for that same indicator.
At the time of the MTE, the percent of mothers who gave birth in a health facility was 12.2%. Here again,
SA3 (Aquin) met the benchmark of 35% set for the MTE, but not the other SAs. Likely, the fact that all
four health facilities located in Aquin are health centers and/or hospitals that provide delivery services
helps explain the good performance of this SA, as compared to the others.
Results of the Baseline study had indicated that post-natal care was an area of concern, as only 18.1% of
mothers of children 12-24 months had made at least one post-natal visit to a trained health provider within
45 days of delivery. The MTE target was set at 25%. The rate of progress for that indicator is excellent
since the percent increased from 18.1% to 52.0% at the time of the Mid-Term evaluation, clearing the
benchmark with a comfortable margin in all areas. We note however that SA3 (Aquin) performed at a
lower level than the other SAs on this indicator.
In SA1, SA2 and SA5, mothers of children aged 12-24 months failed to clear the benchmark for health
cards and both SA1 and SA5 also failed to clear the benchmark for the recommended number of pre￾natal visits (three) with a trained provider.
Table 30: Pre- and Post-Natal Care: Mothers of Children 12-24 months old
Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
)
Actual performance per SA
63
Areas covered by
Baseline GA
1 2 3 4 5
Pre-Natal and Post-Natal Care , 12-24 months of age
Percent of mothers who have a
health card 60.6
% NA
80% 68.6%
(10.5ppt
)
Fail B
Y
B
Y
Y
Y
Y
Y
B
-
Percent of mothers who received
at least 1 tetanus shot
80.3
%
NA 70% 81.7%
(8.8ppt)
Pass Y
W
Y
Y
Y
Y
Y
Y
Y
-
Percent of women fully
vaccinated against tetanus
during last pregnancy (received 2
shots or was already dully
vaccinated)
57.9
%
73.8%
 (all age
groups)
70% 65.1%
(11.0ppt
)
UD B
W
Y
Y
Y
Y
Y
Y
Y
-
Percent of mothers with at least
3 prenatal visits with a trained
provider
78.5
%
84.6%
(all age
groups)
80% 83.2%
(8.0ppt)
UD B
W
Y
Y
Y
Y
Y
Y
B
-
Percent of mothers who received
pre-natal visit with trained
provider before third trimester of
pregnancy (7 months)
78.5
% NA
80% 87.8%
(6.8ppt)
Pass Y
W
Y
Y
Y
Y
Y
Y
Y
-
Percent of mothers who had a
trained health provider assist the
delivery
35.3
%
37.3 %
(all age
groups)
40% 65.6%
(10.3ppt
)
Pass Y
W
Y
Y
Y
Y
Y
Y
Y
-
Percent mothers who gave birth
at home with a trained provider
present
24.3
%
NA 40% 60.9%
(11.4ppt
)
Pass Y
W
Y
Y
Y
W
Y
Y
Y
-
Percent of mothers who gave
birth in a health facility
11.3
%
NA 35% 12.2%
(7.2ppt)
Fail B
-
B
-
Y
_
B
-
B
-
Percent of mothers who made at
least one postnatal visit with a
trained provider within 45 days of
delivery
18.1
%
24.1%
(all age
groups)
25% 52.0%
(11.0ppt
)
Pass Y
Y
Y
Y
Y
W
Y
Y
Y
-
4.5.h. Conclusions and Recommendations - Pre- and Post-Natal Care for Mothers of Children 0-
24 months
Generally speaking, CRS has met most of its pre- and post – natal care Mid-Term targets; and has
performed particularly well on indicators dealing with immunization during pregnancy, the number of
prenatal visits, and the pre-natal visit with trained provider before the third trimester of pregnancy. This
indicates that the majority of the mothers in the project intervention area have adopted the promoted
health practices with regards to pre- and post-natal care.
The improved performance in the percentage of mothers delivering their baby with a trained health
provider present (even at their homes) can be explained by the recent intensification of training programs
for Trained Birth Attendants by the project. However, even though all SAs met the benchmark for this
indicator, SA1 and SA2 showed lower performance levels than the other SAs. Project staff based in
those areas should increase these types of training programs and encourage mothers to use the services
of well-trained TBAs.
Results are more successful for mothers of younger children (0-6 months old) than for those of older
children (6-12 and 12-24 months). This suggests that more recent exposure to program activities may be
associated with better performance levels. This link may be further supported by the fact that most of the
mothers of older children (12-24 months old), who have had less exposure to the program as their child
grows, failed to pass the benchmark for the possession of a health card.
64
Better performance on the percentage of mothers who gave birth in a health facility in SA3 (Aquin) can be
explained by the greater number of health facilities offering such services in that area. On the other hand,
although the Aquin area met the benchmarks for the percent of women who made at least one post-natal
visit to a trained health provider within 45 days of delivery for all three age groups, it performed at a lower
level than the other SAs with respect to the post-natal care indicators. This may be explained by the fact
that supplementary feeding programs (at pre- and post-natal clinics) were suspended for more than one
year in the most important health facility located in that area (Hospital of Aquin). This suspension was due
to poor “food monitoring” which was associated with personnel changes within institution’s management.
With regards to SA5, mothers of the youngest group of children met all the benchmarks set for the other
SAs (with the exception of the benchmark set for the indicator: “Percent of mothers giving birth at a health
facility”). These positive results can be explained by the fact that support to pre- and post-natal services
(food supplements for pregnant and lactating women) in the Grande Anse was never interrupted since the
beginning of the DAP, thanks to supplemental resources made available by USAID during FY03 and
FY04.
4.5.i. Analysis of Results - Participation in Program Activities - Rally Posts and Health Clinics
This section looks at the participation of mothers in different program activities, both at the community
and the health facility levels. Since the Mid-Term evaluation was done at the population level, results for
these indicators provided critical information on program coverage for specific interventions and activities.
One of the most important program activities evaluated in the MTE was the rally post, an activity carried
out at the community level by Community Health Workers to provide such preventative services as:
nutritional surveillance, health education, and the distribution of vitamin A and deworming medicine.
Immunization services are also offered at the rally post level, although their provision depends on the
presence of trained CHWs, qualified to provide such services.
As part of the MTE, data were collected on the level of participation in rally post activities, including
Mother’s Clubs, as well as the perceptions of mothers on the levels of knowledge and expertise of their
local CHW. Mother’s participation in the food supplementation programs was also explored, as this plays
an important role in maintaining/improving the nutritional status of beneficiaries (rations are used as a
nutritional treatment in the recuperation of malnourished children and as a nutritional supplement for
pregnant and lactating women participating in the pre- and post-natal clinics). All CRS MCH food
supplementation programs are carried out at the health facility level. The program starts at the second
trimester of the pregnancy and ends when the child is 12 months old. Food supplementation programs
are integrated into the pre- and post-natal clinics not only for nutritional purposes but also as a means of
encouraging beneficiaries to take advantage of the available health services.
As food is delivered on a monthly basis, every mother should complete a series of 17 visits to the health
facility where she receives quality health services for both her baby and herself. This distribution program
is identified as a “preventive model”. Food supplementation is also used in the “curative model” which
focuses on managing moderate and severe malnutrition cases that are referred at the community level by
the CHWs through the reference/counter reference system. Since the Mid-Term evaluation was carried
out at the population level and the LQAS methodology required that all questions be applicable to all
interviewees, information on the recuperation program was not included in this particular survey; thus, all
questions related to food supplementation were related to the pregnancy and lactation periods. Mothers
of children 0-12 months should have received food supplements beginning in the second trimester of their
pregnancy and should still be participating in the food supplementation program for lactating women.
i) Rally Posts and Mothers’ Clubs
The results presented in Table 31 indicate that 75.5% of children 0-6 months old had participated in a
rally post in the month preceding the survey. However, as the confidence interval was so large (+/-
9.7ppt) it is not possible to definitively state whether the MTE target of 80% was met or not. We can,
however, conclude that SA1, SA2 and SA4 cleared the 80% benchmark, while SA3 and SA5 did not;
65
suggesting that the program coverage for community rally posts has been adequate in the first three SAs
but not so in SA3 (Aquin) and SA5 (Grande Anse) for children of that age group. Similar results were
observed for the participation of the mother herself at the rally post: SA3 and SA 5 failed to meet the
benchmark whereas the other three supervision areas met the 70% MTE target.
With regards to the participation of the mothers in educational sessions held at the rally post, mothers of
0-6 month old children failed to meet the benchmark set at 70%. The weighted average for this group was
52.2%. SA1, SA3 and SA5 did not meet the 70% benchmark. Results for SA5 (Grande Anse) can be
explained by the fact that project activities at the community level did not receive the same level of
institutional support as in the other supervision areas since the beginning of the DAP. However, the
results for SA3 (Aquin) were particularly alarming in that their performance on this indicator was
significantly lower than in the other SAs; thus the program needs to better understand the constraints that
have impeded eligible mothers from participating in the educational session s at the rally posts.
For mothers of children 6-12 months of age, the rally post participation rates were similar to those of
mothers of younger children, in that:
• 75.6% of children aged 6-12 months participated in a rally post the month preceding the survey.
With the exception of SA3, all SAs cleared the benchmark suggesting that the program’s
coverage for the community rally post has been adequate in all but SA3 (Aquin).
• Similar results were observed for the participation of the mother herself in the rally post: SA3
failed to meet the benchmark whereas the other four SAs met the 70% MTE target for
participation.
• Mothers of 6-12 months old children also failed to meet the benchmark set at 70% for their
participation in the educational sessions held at the rally post. Though SA1, SA2, SA4 and SA5
all cleared the benchmark, SA3 (Aquin) did not. SA3’s performance was so poor that it brought
the program’s overall coverage estimates down to 57.4%; SA3 failed to meet both the MTE target
and the overall weighted average for this indicator. Once again, efforts need to be made to better
understand why participation rates in the rally posts are so low in the area of Aquin.
Attendance rates at rally posts were less positive for the mothers of children 12-24 months old. Overall,
only 68.1 % of children and 62.5% of mothers participated in a rally post in the month before the survey
was undertaken. With the exception of SA4, no SA met the established benchmarks for all three of the
participation indicators. These results can be explained by the fact that mothers often stop attending post￾natal clinics once their child has received all the necessary immunizations or once the child has reached
approximately one year of age. There were some successful results - in SA4 (Cotes de Fer), for
example, where the refresher course scheduled for all CHWs in all areas before the end of the DAP had
recently been complete. That area shows an increased mother’s attendance rates in the rally posts there.
Surprisingly, some positively deviant results were found in SA3 (Aquin) where two indicators also met the
established benchmarks. This issue will also be looked at during the Phase II of the MTE.
The results on the participation in Mothers’ Club activities were much better than expected as 40.2% of
the mothers of children 0-6 months of age were reportedly members of a local Mothers’ Club. All SAs
passed the 25% benchmark, including SA5 where other projects such Haitian Health Foundation
implement similar activities. For the mothers of 6-12 and 12-24 month olds, all of the SAs passed the
benchmark even though the confidence interval of the overall averages (29.9% +/- 10.0ppt and 29.0 +/-
10.4 ppt) overlapped with the 25% target.
Table 31: Participation in Program Activities: Rally Posts and Mothers’ Clubs
Indicator BL Actual performance per SA
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
)
Areas covered by
Baseline GA
66
1 2 3 4 5
Participation at program activities: rally post and mothers’ club/0-6 months of age
Percent of children who have
participated in a Rally Post in the
last month
NA 90% 80% 75.5%
(9.7ppt) UD Y
Y
Y
Y
B
W
Y
Y
B
-
Percent of mothers who have
participated in a Rally Post in the
last month
NA 80% 70% 65.0%
(10.5ppt UD Y
Y
Y
Y
B
W
Y
Y
B
-
Percent of mothers who
participated in an educational
session at a Rally Post in the last
month
NA 80% 70%
52.2%
(11.1ppt
)
Fail B
Y
Y
Y B
W
Y
Y
B
-
Percent of mothers who are
members of a Mothers Club NA 50% 25%
40.2%
(11.1ppt
)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Participation at program activities: rally post and mothers’ club/6-12 months of age
Percent of children who have
participated in a Rally Post in the
last month
NA 90% 80% 75.6%
(9.6ppt) UD Y
Y
Y
Y
B
W
Y
Y
Y
-
Percent of mothers who have
participated in a Rally Post in the
last month
NA 80% 70%
70.0%
(10.1ppt
) UD Y
Y
Y
Y
B
W
Y
Y
Y
-
Percent of mothers who
participated in an educational
session at a Rally Post in the last
month
NA 80% 70% 57.4%
(11.4pp) Fail Y
Y
Y
Y
B
W
Y
Y
Y
-
Percent of mothers who are
members of a Mothers Club NA 50% 25%
29.9%
(10.0ppt
)
UD Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Participation at program activities: rally post and mothers’ club/12-24 months of age
Percent of children who have
participated in a Rally Post in the
last month
NA 90% 80% 68.1%
(9.8ppt) Fail B
Y
B
W
B
Y
Y
Y
B
-
Percent of mothers who have
participated in a Rally Post in the
last month
NA 80% 70% 62.5%
(10.3ppt
)
UD B
Y
B
W
Y
Y
Y
Y
B
-
Percent of mothers who
participated in an educational
session at a Rally Post in the last
month
NA 80% 70% 54.4%
(11.4ppt
)
Fail B
Y
B
W
Y
Y
Y
Y
B
-
Percent of mothers who are
members of a Mothers Club
NA 50% 25% 29.0%
(10.4ppt
)
UD Y
Y
Y
Y
Y
Y
Y
Y
Y
-
ii) Perceptions of Mothers about Community Health Workers’ Knowledge and Skills
Five questions were asked of the mothers to measure their perceptions of the Community Health
Workers’ knowledge of health issues, ability to perform his/her tasks and communicate specific health
messages.
For mothers of children 0-6 and 6-12 months old, all of the SAs met the performance benchmarks for
these perception-related indicators (Table 32). This was a very positive result since it reflects mothers’
respect and recognition of the CHW as a valuable health resource at the community level.
Among mothers of 12-24 month old children, data results showed that CHWs in SA2 (Port a Piment,
Roche a Bateau and Coteaux) need to improve their communication with mothers particularly with
67
regards to their child’s weight. This SA failed to meet both the target and the performance benchmark for
this indicator.
Table 32: Participation in Program Activities: Perceptions of Mothers
on CHW’s Knowledge on Health Issues and Communication Skills
Actual performance per SA
Areas covered by
Baseline
GA
Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
)
1 2 3 4 5
Participation at program activities:
Rally-post: perception of mothers on CHW’s knowledge on health issues /0-6 months of age
Percent mothers who think
educational sessions provide
practical information
NA NA 70% 85.6%
(7.4ppt)
Pass Y
Y
Y
W
Y
Y
Y
Y
Y
-
Percent mothers who think
immunization provided by the
Health facility is valuable NA NA
95% 96.7%
(2.5ppt)
Unable
to
determi
ne
Y
-
Y
-
Y
-
Y
-
Y
-
Percent mothers who think
growth monitoring services
that Colvol provides are useful
NA NA
95% 98.7%
(2.5ppt)
Unable
to
determi
ne
Y
-
Y
-
Y
-
Y
-
Y
-
Percent mothers who know if
child's weigh increased or
decreased in the last month
NA NA
70% 65.2%
(11.1ppt
)
Unable
to
determi
ne
Y
Y
Y
Y
Y
Y
Y
Y
B
-
Percent mothers who think
information provided by Colvol
is easy to understand
NA NA
75% 84.9%
(7.9ppt)
Pass Y
Y
Y
Y
Y
W
Y
Y
Y
-
Per cent mothers who think
colvols are knowledgeable
about nutrition information
NA NA
80% 90.0%
(6.9ppt)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Participation at program activities:
Rally-post: perception of mothers on CHW’s knowledge on health issues /6-12 months of age
Percent mothers who think
educational sessions provide
practical information
NA NA 70% 85.5%
(7.2ppt)
Pass Y
Y
Y
W
Y
Y
Y
Y
Y
-
Percent mothers who think
immunization provided by the
Health facility is valuable
NA NA
95% 98.2%
(3.5ppt)
UD Y
-
Y
-
Y
-
Y
-
Y
-
Percent mothers who think
growth monitoring services
that Colvol provides are useful
NA NA
95% 98.6%
(2.6ppt)
Pass Y
-
Y
-
Y
-
Y
-
Y
-
Percent mothers who know if
child's weigh increased or
decreased in the last month
NA NA
70% 79.9%
(9.2ppt)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Percent mothers who think
information provided by Colvol
is easy to understand
NA NA
75% 90.3%
(7.0ppt)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Per cent mothers who think
colvol are knowledgeable
about nutrition information
NA NA
80% 93.4%
(5.7ppt)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
Participation at program activities:
Rally-post: perception of mothers on CHW’s knowledge on health issues /12-24 months of age
Percent mothers who think
educational sessions provide
practical information
NA NA 70% 80.7%
(8.3ppt)
Pass Y
Y
Y
W
Y
Y
Y
Y
Y
-
68
Actual performance per SA
Areas covered by
Baseline
GA
Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
)
1 2 3 4 5
Percent mothers who think
immunization provided by the
Health facility is valuable
NA NA
95% 95.9%
(4.2ppt)
UD Y
-
Y
-
Y
-
Y
-
Y
-
Percent mothers who think
growth monitoring services
that Colvol provides are useful
NA NA
95% 97.3%
(3.6ppt)
UD Y
-
Y
-
Y
-
Y
-
Y
-
Percent mothers who know if
child's weigh increased or
decreased in the last month
NA NA
70% 74.1%
(9.6ppt)
UD Y
Y
B
W
Y
Y
Y
Y
Y
-
Percent mothers who think
information provided by Colvol
is easy to understand
NA NA
75% 90.4%
(6.4ppt)
Pass Y
W
Y
Y
Y
Y
Y
Y
Y
-
Per cent mothers who think
colvol are knowledgeable
about nutrition information
NA NA
80% 89.9%
(6.8ppt)
Pass Y
Y
Y
Y
Y
Y
Y
Y
Y
-
iii) Participation of Mothers in Food Supplementation Program during Pregnancy
Results in Table 33 show that 82.5% of mothers of children 0-6 months received food supplementation
during their pregnancy. Whereas SA1, SA2 and SA4 all passed the 80% benchmark for this indicator,
both SA3 (Aquin) and SA5 (Grande Anse) did not.
In contrast to the previous group, 100% of mothers of children 6-12 months in all SAs received food
supplements during their last pregnancy. This is an excellent result, considering that sampling for the Mid￾Term evaluation was done at the overall population level. It indicates a high program coverage and an
effective referral/counter referral system.
Among mothers of children 12-24 months, finally, 72.5% received food supplementation during their last
pregnancy. We note that all of the first four SAs met the benchmarks set for the food supplementation
indicators, but SA5 did not do so. As said earlier, SA5 (Grand Anse) was initially scheduled for gradual
phased out. Practically, this meant that food deliveries should have continued in that area even though
activities were not fully supervised by CRS during 2002-2003. Analysis of the Commodity Office
monitoring data may provide insights into the irregularity of the deliveries in the Grande Anse during that
period.
Table 33: Participation in program activities: health facility- food supplementation
Actual performance per SA
Areas covered by
Baseline
GA
Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
)
1 2 3 4 5
Participation at program activities: health facility- food supplementation/0-6 months of age
Percent of mothers who received
food supplementation during last
pregnancy
NA 80%
(MTE
was
70)
80% 82.5%
(8.5ppt)
UD Y
Y
Y
Y
B
W
Y
Y
B
-
Percent mothers how report
receiving rations regularly each
month during pregnancy
NA NA 80% 41.0%
(11.0ppt
)
Fail B
Y
B
Y
B
W
B
Y
B
-
Percent of mothers who received
food supplementation regularly
since birth of child
NA NA 80% 29.3%
(10.0
ppt)
Fail B
Y
Y
Y
B
Y
B
Y
B
-
69
Actual performance per SA
Areas covered by
Baseline
GA
Indicator BL
Value
LOA
target
MTE
Targe
t
WA
(CI)
LQAS
judgme
nt
(overall
)
1 2 3 4 5
Percent mothers reporting
receiving the correct ration from the
health center
NA NA 95% 55.9%
(11.3ppt
)
Fail B
Y
B
Y
B
W
B
Y
B
-
Participation at program activities: health facility-food supplementation/6-12 months of age
Percent of mothers who received
food supplementation during last
pregnancy
NA 80% 80% 100.0%
(0.0ppt)
Pass Y
-
Y
-
Y
-
Y
-
Y
-
Percent mothers how report
receiving rations regularly each
month during pregnancy
NA NA 80% 34.7%
(10.1ppt
)
Fail B
Y
B
Y
B
W
B
Y
B
-
Percent of mothers who received
food supplementation regularly
since birth of child
NA NA 80% 19.8%
(7.9ppt)
Fail B
Y
B
Y
B
Y
B
Y
B
-
Percent mothers reporting
receiving the correct ration from the
health center
NA NA 95% 54.3%
(11.0ppt
)
Fail B
Y
B
Y
B
W
B
Y
B
-
Participation at program activities: health facility-food supplementation/12-24 months of age
Percent of mothers who received
food supplementation during last
pregnancy
NA 80% 70% 72.5%
(9.6ppt)
UD Y
W
Y
Y
Y
Y
Y
Y
B
-
Percent mothers how report
receiving rations regularly each
month during pregnancy
NA NA 80% 30.3%
(10.3ppt
)
Fail B
Y
B
Y
B
Y
B
Y
B
-
Percent mothers reporting
receiving the correct ration from the
health center
NA NA 95% 49.4%
(11.4ppt
)
Fail B
Y
B
Y
B
Y
B
Y
B
-
iv) Regularity of Food Supplementation during Pregnancy (Pre-Natal Clinic)
Three related indicators measured the regularity of the food supplementation program in the MCHN
program. The data indicated that only in SA2 did the program clear the expected 80% benchmark for
regularity of food rations during post-natal visits. In all other SAs, mothers of children 0-6 months of age
reported not receiving their food rations in a consistent manner during their last pregnancy: overall, only
41% of mothers received rations on a regular basis during their pregnancy. A similar picture emerges with
regards to the second and third groups (mothers of children 6-12 months, and mothers of children 12-24
months): as reported earlier, 100% of mothers of 6-12 months participated in the food supplementation
program during their pregnancy; yet, only 34.7% mentioned receiving their rations on a regular basis. All
of the SAs failed to meet the 80% benchmark for this indicator in that group. Likewise, the indicator for
women of 12-24 months old children failed to meet the associated benchmark in all SAs as well, as only
30.3% of women overall received a food supplement during their last pregnancy (the mother of a child
aged 12-24 months in December 2004 was pregnant during the period April 2002 and April 2003). For
the three age groups, therefore, and except for SA2 among mothers of children 0-6 months, no SA
passed the established MTE benchmarks for the regularity of food supplementation during their last
pregnancy.
v) Regularity of Food Supplementation after Childbirth (Post-Natal Clinic)
Mothers of children less than 12 months old are expected to participate in the post-natal clinic and receive
food supplementation regularly. Results, however, showed that only 29.3% of mothers of children 0-6
months and 19.8% of mothers of children 6-12 months received regular food rations during their post-
70
natal visits.
vi) Correct Rationing at Health Center
On average, only half of the mothers reported having received the correct ration and ration size during
their visits at the health center: 55.9% for mothers of 0-6 month old age group; 54.3% for mothers of 6-12
month olds; and 49.4% for mothers of 12-24 month olds. However, it is difficult to accurately interpret
these results on the correct ration size as some mothers included the lack of a ration (no food available at
the time of the visit) as one way to report an “incorrect” ration. It is recommended that this issue be
looked at through a qualitative study during the Phase II of the Mid-Term evaluation regardless, as the
performance levels were low enough to merit further investigation.
4.5.j. Conclusions and Recommendations - Participation in Program Activities - Rally Posts and
Health Clinics
Mother’s Clubs seem to be popular in the CRS program area, as attested by the MTE survey results. The
project should therefore continue its support of these clubs and encourage the creation of new clubs as
well.
Rally post participation is an important performance indicator for the program as this is where mothers
receive education on health, nutrition, childcare, and pre- and post -natal care practices. Low
participation rates in the area of Aquin are of concern, however, and will be investigated in detail in Phase
II of the MTE. Since the hospital of Aquin experienced leadership problems in the last few years, focus
groups with mothers will be held in that area of SA3 separately. Similar focus groups with mothers
(preferably those of children older than 12 months) will also be held in another center also located in
Aquin (La Colline d’Aquin for example) for comparison purposes. In addition, focus groups will be
conducted with CHWs to explore the factors influencing mothers’ low participation in rally posts; and key
informant interviews will be completed with the person responsible for the health facility, as well as with
the person coordinating the CHWs activity at the center level. Groups in Aquin and La Colline d’Aquin will
be met separately.
Since a similar issue was observed in SA2 (Port a Piment), focus groups will be conducted with the same
focus topics of enquiry as in the SA3 area of Aquin. This strategy is being followed in order to more fully
investigate the reasons for the low participation of mothers of children older than 12 months in the rally
posts.
On mothers’ perceptions of the CHWs knowledge and performance, the overall results were encouraging.
However, project staff in SA2 should look into the reasons why fewer mothers in this SA feel that the
educational sessions provide practical information, as compared to the other SAs. This finding is
consistent across all mother’s groups in that SA.
Issues related to the regularity of food supplementation in MCHN program can be explained by the
insecurity and unstable political situation (difficulties in transporting food from Port au Prince to the CRS
regional office in Les Cayes and from the warehouses to the distribution centers, scarcity of spare parts
for truck maintenance, etc.) that has prevailed throughout Haiti over the last two years. However, the CRS
Commodity Management Staff will be notified of our findings and will be encouraged to increase their
efforts to improve the regularity of the deliveries to MCH centers, to ensure that these centers do not
experience interruptions in their pre- and post-natal clinic operations or disruptions in food
supplementations to clinic participants, who rely on the food.
The results for the food component of the MCHN program were considered unsatisfactory by program
staff in that food supplementation is a key contributing factor to increasing the usage of quality health care
services by pregnant and lactating women and their children. Food supplementation is among the crucial
project activities that directly contribute to the achievement of the DAP objective, which is to improve the
health and nutritional status of children under-five, pregnant and lactating women by 2007.
71
Conclusions and recommendations on the issue of the correct ration size received by the participants will
be presented in the Phase II section of this report.
4.5.k. Knowledge, Skills, and Participation of Community Health Workers
A network of about 1,000 Community Health Workers (CHW) carries out most health outreach activities of
the MCHN program. These individuals are in charge of holding monthly meetings at rally posts, where
community health education sessions are offered to caregivers and such services as growth monitoring,
immunization, provision of vitamin A and deworming medicines are provided to children less than 5 years
of age. To be able to undertake these responsibilities, CHWs are trained by project staff at the beginning
of the DAP and participate in monthly continuing education sessions, provided by the staff at the area
health facility.
The knowledge of CHWs was not assessed in the Baseline survey and no impact indicators were
established for this aspect of CRS’ program. However, given the key role played by CHWs in transmitting
knowledge at the community level, it is clear that the success of CRS’ BCC strategy relies to a great
extent on the knowledge of the CHWs and their capacity to transmit that knowledge. To assess those
issues, the MTE tested both the CHW’s perception of their own capacity and their real capacity through a
set of questions. Furthermore, the capacity of CHWs to deliver services is also associated with the
existence and availability of materials and supplies.
The indicators developed for CHWs therefore focused on four main areas: a) Perception of own
Knowledge, b) Actual Tests of Technical Knowledge, c) Availability of Supplies and Material Needed for
the Monthly Rally Posts, and d) Participation in Monthly Meetings. For the purpose of those questions the
CHWs were divided in two groups: the first group consisted of areas covered during the Baseline survey;
while the second group encompassed those in the Grand Anse – the department that was not included in
the Baseline.
i) Perceptions of Knowledge - CHWs
A set of six indicators were used to measure the CHWs perception of their own level of knowledge and
skills related to their work in the rally posts, namely:
• Ability to provide quality health services
• Ability to provide nutritional messages
• Ability to provide maternal health messages
• Ability to correctly measure a child’s weight
• Ability to record that child’s weight on the growth card
• Ability to provide immunizations.
The benchmark was set at 90% for the first five of these indicators and it was met for all five of them in
both SAs (Table 34). However, CHW do not feel they have the ability to provide vaccination services,
even though the benchmark had been set at a lower level (60%) for this indicator. This is an interesting
but unsurprising finding since CHWs have not received any training from CRS in this area. CRS may
decide to train CHWs to provide vaccines in the future, but this will depend largely on the local Ministry of
Health officials’ point of view.
Table 34: CHWs’ Perceptions of Knowledge and Skills
72
Actual performance per SA36 Indicator MTE
Target SA137 SA238
Percent of Colvols who feel totally confident in their skills to
provide quality health services to their communities 90% Pass Pass
Percent of Colvols who feel confident in their ability to provide
nutritional messages to their communities 90% Pass Pass
Percent of Colvols who feel confident in their ability to provide
maternal health messages to their communities 90% Pass Pass
Percent of Colvols who feel confident in their ability to measure a
child's weight 90% Pass Pass
Percent of Colvols who feel confident in their ability to record a
child's weight on the Road to Health cards 90% Pass Pass
Percent of Colvols who feel confident in their ability to provide
immunizations 60% Fail Fail
ii) Technical Knowledge - CHWs
Results on indicators testing the technical knowledge of CHWs were mixed (Table 35). While knowledge
appears to be strong in some technical areas, it seems to be weak in others. For example:
• Vitamin A
One question asked about the symptoms related to Vitamin A deficiency, and CHWs in both
supervision areas met the 90% benchmark on this indicator, thus demonstrating that they
possess this knowledge.
• Diarrhea management & ORT
A benchmark of 80% was set, and reached in both SAs, for indicators related to CHWs’ technical
knowledge of diarrhea management. These results showed that CHWs have good knowledge on
the use of ORT and the correct feeding practices during episodes of diarrhea. In addition, a 90%
benchmark was met by CHWs in both SAs for the supporting indicator: “CHWs who feel the
trainings they received in social marketing of ORT was useful in their work with the mothers in the
community (see part C of the Table below).”
• Knowledge on breastfeeding and infant feeding
As previously stated, CHWs are the key actors in the transmission of messages to program
participant. Consequently, they must be aware of certain critical topics such as appropriate
breastfeeding and infant and child feeding practices.
When tested on specific indicators, the MTE results showed that at least 70% of CHWs in both
SAs knew that fever should not prevent mothers from breastfeeding their children. However,
when tested on the number of times a one-year-old child should be fed each day, CHWs failed to
clear the benchmark of 60% in both supervision areas. This is a very important indicator and
critical to the success of the program with regard to the BCC strategy, so failure to meet the
benchmark for this knowledge is unsatisfactory.
Table 35: CHWs’ Technical Knowledge
 
36 Y”: Yes, met the benchmark; “B”: Failed to reach the decision rule for the benchmark. No prevalence estimates were derived
since we had only two groups, or SAs; which provides an insufficient number of cases to calculate robust estimates. 37 SA1 included all areas covered by the project since 2002 (South Coast, Aquin and Cotes de Fer) 38 SA2 included areas that were not covered by the Baseline and where activities continued since 2002 with a minimum CRS
support (Grande Anse and Nippes)
73
Indicator MTE Actual performance per SA
Target SA1 SA2
Percent of Colvols who can identify the vitamin deficiency which
causes bad vision (Vitamin A) 90% Pass Pass
Percent of Colvols who know how many times a day a one-year old
child should be given something to eat 60% Fail Fail
Percent of Colvols who state that it is okay for a mother to breastfeed
when she has a fever 70% Pass Pass
Percent of Colvols who can recognize the symptoms of scabies when
given a description of the condition 75% Fail Fail
Percent of Colvols who know that a child with a weight for age below
-3 standard deviations should be referred to a health center
immediately
95% Fail Fail
Percent of Colvols who mention using at least one Adult Participatory
Learning technique during their educational work 95% Pass Fail
Percent of Colvols who feel that the trainings they received in the
social marketing of ORT has been useful to their work with mothers in
their communities
90% Pass Pass
• Use of participatory learning methods during education session
Participatory learning is one of the best adult learning techniques, so CHWs are encouraged to
use them in their educational sessions at the rally post. Though CHWs in both SAs have been
trained in these techniques during this DAP cycle, CHWs in SA2 did not perform as well as their
colleagues in SA1. A 95% benchmark was set for the percent of CHWs that use at least one
participatory training technique – SA1 met this benchmark whereas SA2 did not.
• Criteria of reference for malnourished children
The growth chart is the main tool that helps CHWs make referral decisions in cases of marasm.
In the case of kwashiorkor, the presence of edema should guide the decision. Basically, all
children diagnosed <3 SD deviations should be referred to the health facility. All of the CHWs
have been instructed and trained in identifying the criteria for the referral of a child to the health
facility for better management of malnutrition. As the referral system was set up to quickly
address acute malnutrition cases, it is critical that CHWs recognize the warning signs of these
conditions.
The benchmark for CHWs ability to identify the criteria for immediate referral to health centers
was set at the highest level permitted by the LQAS methodology, namely 95%. The benchmark
was set so high because CHWs need to be well aware of the criteria. In order to properly test the
CHWs knowledge of the referral protocol, the question that was posed to them on this issue was
phrased in a somewhat complicated, yet realistic manner. The survey results revealed, however,
that the CHWs in both SAs were unable to answer the question appropriately, as to the
immediate need for referral of any <-3SD malnourished child, and thus did not pass the 95%
benchmark for this indicator.
iii) Availability of Necessary Materials and Supplies for Monthly Rally Posts
There are certain materials and supplies that are necessary in order for a CHW to perform his/her job
effectively. Not only do these materials and supplies ensure a higher quality of service provision, but also
serve to encourage caregiver attendance at the rally posts. Two indicators were used related to this issue
(Table 36). It seemed that CHWs regarded certain materials/supplies as necessary, even though, from a
service provision standpoint, they are not – such as backpacks, raincoats, registers, etc. CHWs in SA1
reported that they did not have all of the materials/supplies that they needed, thereby not meeting the
60% benchmark that was set; whereas CHWs in SA2 stated that they did – thus meeting this benchmark.
What is interesting about these varying performance levels is that CHWs in SA1 are regularly supervised
by CRS project staff and thus have regular access to materials/supplies; yet those in SA2 have not had
such access because CRS staff have not had a presence in the Grand Anse. The results for these
74
indicators must therefore be based upon the CHWs definitions of what is indeed “necessary”; perhaps
CHWs in SA1 are more aware of what is available and more demanding regarding the supplies and
materials they feel that they need in order to hold the rally post.
Table 36: CHWs - Availability of Materials and Supplies
Indicator MTE Actual performance per SA
Target 1 2
Percent of Colvols who, in the last 30 days, have not had a
shortage of any of the supplies or materials they needed to do their
job correctly
60% Fail Pass
Percent of Colvols who, in the last six months, have not had any
difficulties providing the expected services to their communities
due to inadequate supplies or materials
60% Fail Pass
iv) CHW Participation in Monthly Meeting Activities
CHWs monthly responsibilities include the following activities:
• Completion and Submission of the Rally Post Report
• Participation in the monthly continuing education session
• Discussion of the micro-credit program.
CHWs in both supervision areas cleared the 75% benchmark in terms of their completion and submission
of Rally Post Reports, and 80% benchmark for participating in the monthly continuing education session
(Table 37). CHWs in SA1 did not, however, clear the benchmark for having discussed the micro-credit
program in the last monthly meeting, whereas their counterparts in SA2 did meet this 75% benchmark.
This particular performance discrepancy may be related to the fact that credit activities were just started in
SA2, so perhaps the enthusiasm and motivation levels for CHWs in this area are very high at the
moment.
Table 37: CHWs’ Participation in Monthly Activities
Actual performance per SA Indicator MTE
Target SA1 SA2
Percent of Colvols who brought their report to the last Colvol
meeting they attended 75% Pass Pass
Percent of Colvols who attended the Continuing Education session
at the last Colvol meeting they attended 80% Pass Pass
Percent of Colvols who discussed the micro-credit program at the
last Colvol meeting they attended 75% Fail Pass
Percent of Colvols who correctly state it is not okay to give a 5
month old child ORT 80% Pass Pass
Percent of Colvols who correctly state that when a child has
diarrhea the mother should give the child more food than usual 80% Pass Pass
4.5.l. Conclusions and Recommendations – Knowledge, Skills, and Participation of Community
Health Workers
CRS’ MTE results indicate that Community Health Workers have a positive perception of their knowledge
and skill level related to their work at the rally post. The CHWs feel that they have the necessary
knowledge to conduct a rally post, which basically has 2 components: an education session for
participants on certain key messages and the provision of specific services. Based upon the positive
results of many of the MCHN indicators, it appears that the CHWs are doing an effective job at
75
communicating the key messages to mothers/caregivers during education sessions at the rally posts.
Therefore, one could propose a credible link between the high knowledge/skill level demonstrated by the
CHWs at Mid-Term and the improved practices demonstrated at the household level by mothers and
caregivers since the Baseline survey was undertaken.
It is important to note here, however, that the MTE did expose critical gaps in CHWs knowledge – gaps
that will need to be addressed via formal refresher training courses over the remainder of the DAP.
While it is true that CHWs do participate in monthly continuing education sessions at the health facilities,
it is clear from the data that more formalized technical trainings will also need to be undertaken in order to
bring CHW knowledge levels up to programmatic expectations and necessity. CRS plans to undertake
such refresher courses in 2005, but, in the meantime, health centers should reinforce the critical BCC
messages, along with adult participatory training techniques, at their monthly continuing education
sessions. Addressing CHW knowledge issues now, at all levels, will only serve to improve the adoption
rate of these behaviors at the household level; thus driving the achievement of project impact in all
supervision areas.
The participatory learning methods must be implemented not only at the CHW level but also during
education sessions at the rally post where key message and expected behavior must be reinforced. BCC
strategy should also use other channels such as mother’s clubs, father’s clubs and youth clubs to ensure
that key messages are being widely diffused and adopted among the community members. Some
incentive strategies, such as contests among clubs, should also be taken into considered. In order to
keep track of the performance level of the BCC strategies, CRS should monitor CHWs’ levels of
knowledge by using LQAS in its various SAs on a regular basis throughout the remainder of the program.
In addition, the project staff plans to apply these same indicators to different groups of CHWs next year,
after all of them have participated in the refresher training courses, in order to measure if the expected
improvements were achieved. The results of this end-of-training evaluation will be compared to the MTE
results and appropriate action will be taken if necessary.
As the availability of materials to conduct rally posts determines the quality of service provision, and
therefore the attendance rates, CRS will need to ensure that CHWs and health facility staff have the
materials they need in order to carry out their responsibilities properly. Assessing the supply chain can
also be done on a regular basis henceforth, in the different SAs, using LQAS.
4.5.m. Analysis of Results - Hand Washing Knowledge and Techniques – Cross Sectoral Results
“To some extent, childhood illness and disease can be reduced with the undertaking of certain
preventative health practices. These include appropriate infant and child feeding practices, and
adequate health service delivery, such as childhood immunization against vaccine preventable
diseases. Behaviors related to hygiene, safe water, and sanitation are also important for the
prevention of illness and disease.”39
CRS’ Baseline results (Table 38) showed that hand washing knowledge and hand washing techniques
were significantly associated with diarrhea prevalence at the time of the survey (difference statistically
significant at p=0.001). Children of caregivers who knew of three or more occasions when they should
wash their hands had a significantly lower prevalence of diarrhea (20.0%) than those children of
caregivers who did not know of at least three occasions (30.9%).
 
39 This section is borrowed from Bergeron and Deitchler, Joint Baseline report, 2002
76
In addition, the children of caregivers who demonstrated correct hand washing technique showed, for
example, a lower prevalence of diarrhea (26.4%) than the children of caregivers who demonstrated
incorrect hand washing technique (53.4%).
Table 38: CRS Baseline Results (2002) –
Relationship between Water, Sanitation, Hygiene & Diarrhea
Household Characteristic/ Caregiver Knowledge Prevalence Diarrhea (%)
Knowledge about when to wash hands
1. Respondent knows 3 or more times when hands should be washed 20.0
2. Respondent knows less than 3 times when hands should be washed 30.9
P value P=0.001
Hand washing technique
1. Respondent demonstrates correct hand washing technique 26.4
2. Respondent demonstrates incorrect hand washing technique 53.4
P value P=0.001
In light of the importance of this issue on the health of the children and program impact in general, the
CRS MTE included several indicators aimed at measuring hand washing knowledge and techniques
among mothers and participants in different CRS programs. These groups were:
• Health and Nutrition: CHWs and three groups of mothers (children of three age groups)
• Micro-credit: participants of the micro-credit program
• Food Assisted Education: PTA members, school directors, teachers, female students, and
male students
• Safety Net: SSNI managers, SSNI staff, females 8-13 and females 13&up (see methodology
section for more details)
Even though results were analyzed by sector, a final summary table for all sectors was prepared to allow
for easier comparison and facilitated the formulation of more generalized conclusions and
recommendations across sectors.
i) Hand Washing Knowledge
When asked, “When should you wash your hands?”, respondents were given the opportunity to provide
more than one answer. All of the answers that were provided by the respondent were marked as “YES”
by the data collector, and those answers that were not provided were marked as “NO.”
Benchmarks for each answer were determined by each sector. In addition to individual answers, a
separate analysis was done of a composite of the answers. This composite was made up of the key
messages that were promoted by each sector program; and the messages promoted differ for each target
group. Therefore, the success of the hygiene education project was measured via “pass/fail” results for
specific groups of “key messages”.
Table 39 shows the key messages promoted by each program sector, as well as the benchmarks set for
each message:
77
Table 39: Hand Washing Knowledge and Techniques Results across Sectors
Health and Nutrition Credit Food Assisted Education Safety Net
When should you
wash your hands? CHWs
Mothers
(0-6, 6-12
and 12-24
mo.)
Com’ty
Members PTA
Members
School Directors,
Teachers, Female
& Male Students
Directors
&
Staff
Females
and
Males
<12 and
>12
a. after using the
toilet 80% 70% 70% 80% 80% 70% 70%
b. after changing
babies’ diapers 20% 20% 20% 20% 20% 20% 20%
c. before preparing
food 80% 70% 70% 20% 20% 70% 20%
d. before eating 80% 70% 70% 80% 80% 70% 70%
e. before feeding
children 80% 70% 70% 20% 20% 70% 20%
f. working in the
garden/coming home
from school or market
20% 20% 20% 20% 20% 70% 20%
g. after playing NA NA NA NA 20% NA 70%
All key messages
(promoted by each
program) combined
a, c, d,
e a, c, d, e a, c, d, e a, d a, d a, c, d,
e, f a, d, g
Benchmark for all key
messages combined 70% 50% 50% 70% 70% 60% 60%
The cross-sectoral results are presented in Table 40 for comparison purposes.
When looking at the individual messages by program, participants of the Safety Net program were the
most knowledgeable on hand washing techniques, followed by the Education program and lastly, the
mothers participating in the MCHN program. Community Health workers, who are responsible for
promoting the correct messages, met the benchmark for three indicators and failed on three others.
The message that met the benchmark in almost all groups was “after using the toilet”, followed by “before
eating”. Surprisingly, all groups failed on the indicator “before feeding children”.
Results showed that the youngest female participants from the Safety Net program were the most
knowledgeable on hand washing techniques with five “pass” out of seven indicators. Disturbingly,
mothers of children 0-6 months old failed to meet the established benchmarks for five of the six
indicators.
For the messages and the corresponding behaviors to be successful, program participants should know
and adopt as many correct practices as possible. Therefore, the combination of messages was also
tested as another indication of program success. Almost all categories of participants of the Education
Program passed the benchmark for the “combined key messages”. For the Safety Net program, only the
females older than 13 years of age passed the benchmarks. Among all of the MCHN participants,
including the CHWs, none of the groups surveyed passed the benchmarks for all of the key messages
combined.
These results indicate that messages on hand washing should be reinforced in all programs, but
especially so in the MCHN program. Moreover, a standardization of messages across programs could be
instrumental in improving hand washing knowledge and techniques, as participants would receive more
complete and uniform messages even though the messages would be transmitted via different channels
within the same community.
78
Table 40: Handwashing Knowledge and techniques - Cross Sectoral Results
When should you wash
your hands? Colvol Mothers 0-6 Mothers 6-12 Mothers 12-24 Women - Credit PTA School Director Teacher Female Student Male Student SSNI Mgr - both SA SSNI Staff Female 8-13 Female 13&up
a. after using toilet Pass Pass – UD40 Pass - UD Pass - UD Fail - UD Pass - UD Pass Pass - UD Pass - UDPass - UD Pass Pass Pass Pass
b. changing babies'
diapers Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Pass Pass Fail Fail
c. before preparing food Fail Fail Fail Fail Fail Fail Fail - UD Fail - UD Fail-UD Fail Fail Fail Pass Fail
d. before eating Pass Fail Fail Fail Fail Pass Pass-UD Pass Pass - UD Fail - UD Pass Pass Pass Pass
e. before feeding children Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail
f. working in the
garden/coming home from
school or market
Pass Fail Pass - UD Pass - UD Pass Pass Pass Pass Pass - UD Pass Fail Fail Pass Pass
g. after playing NA NA NA NA NA NA NA Fail Pass - UD Fail-UD NA NA Pass Pass
All key messages? (#
differs for each group)41 Fail Fail Fail Fail Fail Pass - UD Pass Pass - UD Pass - UD Fail-UD Fail Fail Fail Pass
Correct handwashing
technique (baseline
method)42
Pass Pass - UD Fail-UD Fail-UD Fail Fail-UD Pass-UD Pass-UD Fail Fail Pass Pass Pass Pass
40 UD: Unable to determine- the confidence interval overlaps with the MTE target 41 see narrative for the combination of messages for each group 42 see table in narrative for description of both methods
79
Correct handwashing
technique (international
method)
Pass Fail Fail Fail Fail Fail Fail-UD Fail Fail Fail Pass Pass Fail Pass
80
ii) Hand Washing Techniques
As previously discussed, most people interviewed during the Mid-Term were already aware of when hand
washing is critical (e.g. before feeding, after toilet use). As in the Baseline study, respondents were also
asked to demonstrate the techniques of hand washing. The correct had washing technique has been
defined as involving four components:
Correct hand washing technique
Baseline method International method
The use of water 99
The use of soap 99
The washing of both hands 99
Scrubbing a minimum of three times 99
Drying (towel or shake hands) 9
With the highly significant association between the correct hand washing technique and diarrhea
prevalence, this positive behavior becomes an important means of diarrhea prevention.
MTE results on hand washing techniques are presented in Table 40. All four groups interviewed in the
Safety Net centers passed the benchmarks for the Baseline method and three passed for the
international method.
Results of the Education sector were less successful since the students did not pass the benchmarks for
either the Baseline or international hand washing methods. Even though the directors and the teachers
passed the benchmark for the Baseline method, we were unable to definitively state if the MTE target was
met or not for this indicator because the range of the confidence interval overlapped the MTE target level.
With regards to the three groups of mothers (of children 0-24 months old), all failed to pass the
benchmark set for the international method of hand washing technique. We cannot definitively state if the
MTE target was met for the Baseline method because the range of the confidence intervals overlapped
with the MTE target.
4.5.n. Conclusions and Recommendations - Hand Washing Knowledge and Techniques – Cross
Sectoral
Even though most groups passed the benchmark on some of the most critical messages on hand
washing knowledge (e.g. after using the toilet and before eating), the overall results on hand washing
knowledge were not at the level we had expected by mid-term. When looking at the three major
programs, the Safety Net one was the most successful at transmitting hygiene messages.
With respect to the Education program, the results showed that the students have acquired the
knowledge but that their hand washing technique behavior has not yet changed in accordance.
Hygiene issues are critical to the child’s health and the MCH program should reinforce its hygiene
messages -especially with the CHWs, who are the primary health educators for the thousands of mothers
who participate in the rally posts and mothers’ club.
In view of the significant association reported in the Baseline study between diarrhea prevalence on the
one hand, and hand washing knowledge and the correct hand washing techniques on the other hand, it is
recommended that all CRS programs reinforce these important hygiene messages. Behavior change
messages emphasizing the importance of hand washing for disease prevention is a recommended area
for attention.
Moreover, a standardization of messages across programs would be important so we provide participants
with more coherent, complete and focused messages about proper behaviors and practices across
81
program activities and educational initiatives. Improvements in hygiene behavior may present an
opportunity for better child nutrition and health outcomes in the whole of CRS’ program area.
4.6. HIV/AIDS
CRS/Haiti has incorporated HIV/AIDS into the DAP by providing food to PLWHA43 and to Social Safety
Net Institutions (SSNI) that care for HIV/AIDS-affected children. CRS has provided HIV/AIDS education
and training to SSNI managers, staff, and residents in an effort to:
• Educate SSNI residents, aged 8 years and older, about the health and social issues
associated with HIV/AIDS;
• Educate SSNI staff on HIV/AIDS and on how to care for children afflicted with the disease,
and
• Raise awareness and solidarity levels in the communities where the SSNIs are located.
In addition to the SSNI sector, indicators on HIV/AIDS were also measured for all respondents targeted
by the Education program: PTA members, school directors, teachers, female students and male students.
This information was collected to provide “baseline” data for the training program on HIV/AIDS which will
be implemented by the Education program in the second half of the DAP.
The MTE collected data on four HIV/AIDS-related topics:
1. Means of transmission
2. Knowledge of HIV/AIDS
3. Perception of Personal Risk, and
4. Stigma and Discrimination.
Table 41 shows the sampling groups on which MTE results on HIV/AIDS indicators were collected.
Table 41: HIV/AIDS Sampling Groups
Safety Net Institutions Schools
Received HIV/AIDS
training
No HIV/AIDS training
as yet
SA1 SA2
No HIV/AIDS
training as yet
Management Staff Management Staff PTA members
Support Staff School Directors
Female children
(8-13 years)
Support Staff
Teachers
Female students Female children
(>13 years) Male students
4.6.a. Analysis of Results – Safety Net Institutions
With the objective of using the same sample for both the SSNI program and the HIV/AIDS program, the
sampling methodology for this sector originally included a group of institutions where HIV/AIDS training
had been carried out during the last two years (SA1) and another group where no HIV/AIDS training has
been done to date (SA2).
 
43 PLWA: People Living with AIDS
82
Six groups were targeted for the survey: 1) SSNI Management staff; 2) SSNI Staff; 3) Female children
aged 8-13 years old; 4) Male children aged 8-13 years old; 5) Female children aged 13 years and up and
6) Male children aged 13 years and up. Unfortunately, the targeted number of sampling groups could not
be reached in both SAs, however, because there were not enough male children in residence that could
respond to the questionnaires. This meant that the MTE was not able to present findings for this
sampling group (see section on field work results and section on MTE results for SSNI).
i) Means of Transmission – SSNI Management and Staff
The CRS HIV/AIDS training focuses on educating its participants in the means of transmission and
prevention of the disease; more specifically on the three most common modes of prevention: 1)
abstinence; 2) fidelity; and 3) use of condoms. Other means ways of transmission such as contaminated
blood and vertical transmission (mother to child transmission) were also included in the training.
Table 42 presents the knowledge levels of the adults employed at the selected SSNIs - Management
Staff persons (Directors) and support staff - on the different ways to transmit the HIV virus.
Table 42: Knowledge on Means of HIV/AIDS Transmission –
SSNI Management and Staff
Actual performance per SA44
Director Staff
Indicator MTE
Target SA1
* SA2* SA1 SA2
Percent of respondents that state one can avoid acquiring HIV/AIDS 75% Pass Pass Pas
s
Fail
Percent of respondents that state one can avoid
HIV/AIDS by abstaining from sex 40% Pass Pass Pas
s
Pass
Percent of respondents that state one can avoid
HIV/AIDS by using condoms 40% Pass Pass Pas
s
Pass
Percent of respondents that state one can avoid
HIV/AIDS by limiting sex to one partner 40% Pass Pass Pas
s
Pass
Percent of respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with prostitutes 40% Fail Fail Fail Fail
Percent of respondents that state one can avoid
HIV/AIDS by avoiding unprotected sex with persons
who have many sex partners
40% Fail Fail Fail Fail
Percent of respondents that state one can avoid HIV/AIDS by remaining
faithful to one partner 40% Fail Pass Pas
s
Pass
Percent of respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with persons who inject drugs intravenously 40% Fail Fail Fail Fail
Percent of respondents that state one can avoid HIV/AIDS by avoiding
infected blood 40% Fail Fail Fail Fail
Percent of respondents that state one can avoid HIV/AIDS by avoiding
the use of syringes, razors, straight edges 40% Pass Fail Pas
s
Pass
Percent of respondents that state one can avoid HIV/AIDS by avoiding
contact with blood 40% Fail Pass Pas
s
Pass
Percent of respondents that state that a pregnant woman can give the
HIV virus to her child during pregnancy 60% Pass Pass Pas
s
Pass
Percent of respondents that state that a mother can give he
HIV virus to her child during child birth 60% Pass Pass Pas
s
Pass
Percent of respondents that state that a mother can give the
HIV virus to her child via breast feeding 60% Fail Pass Pas
s
Pass
 
44“Pass” = met the benchmark; “Fail” =: Failed to reach the decision rule for the benchmark;
83
* SA1 received HIV/AIDS training. SA2 did not receive HIV/AIDS training.
It is interesting to note that there were no significant differences between the SSNI staff that have
received training from CRS and those that have not; for example, both groups passed and failed many of
the same benchmarks. Both groups were able to correctly identifying three ways by which to avoid the
HIV/AIDS virus but failed to reach the benchmark on some of the less mainstream avoidance messages
(such as refusing to have unprotected sex with prostitutes, persons who inject drugs intravenously, and
persons who have may sexual partners.)
It may therefore be possible that the CRS trainings have not been adding any value to its participants, in
that it appears that the mass media may already be doing an adequate job in spreading the most
conventional messages regarding HIV/AIDS transmission, namely ABC (Abstinence, Be faithful, and
Condom usage) -type messages.
Nevertheless, the results from the survey do provide a certain level programmatic guidance to its future
training design activities. For example, transmission messages should be reinforced at all levels in the
training and revision of the training materials should be undertaken in an effort to better complement and
expand upon the public health messages that are currently being spread by the media.
ii) Means of Transmission – SSNI Children
Children in the SSNIs also participated in the HIV/AIDS training sessions. Children were divided into age
groups: children from 8 to 13 years old and children older than 13 years. Unfortunately, the institutions
randomly selected for the mid-term evaluation did not have enough male children to take part in the
study. Therefore, results are only available for female children.
Table 43 presents the levels of knowledge of both groups of children on HIV/AIDS transmission. This
information was only collected in SA1 where the training on HIV-AIDS had taken place. The MTE targets
were different for the age groups because it was assumed that the older children would retain more
information than the younger group.
Table 43: Knowledge on Means of HIV/AIDS Transmission – SSNI Children –
Centers with Previous HIV/AIDS Training Interventions
Actual performance
Indicator
MTE target Female
8-13 years
Females 13
& up MTE target
Percent of respondents that state one can avoid
acquiring HIV/AIDS 30% Pass Pass 60%
Percent of respondents that state one can avoid
HIV/AIDS by abstaining from sex 30% Pass Pass 50%
Percent of respondents that state one can avoid
HIV/AIDS by using condoms 30% Fail Fail 50%
Percent of respondents that state one can avoid
HIV/AIDS by limiting sex to one partner 30% Fail Fail 50%
Percent of respondents that state one can avoid
HIV/AIDS by avoiding unprotected sex with
prostitutes
30% Fail Fail 50%
Percent of respondents that state one can avoid
HIV/AIDS by avoiding unprotected sex with
persons who have many sex partners
30% Fail Fail 50%
Percent of respondents that state one can avoid
HIV/AIDS by remaining faithful to one partner
30% Fail Fail 50%
Percent of respondents that state one can avoid
HIV/AIDS by avoiding unprotected sex with
persons who inject drugs intravenously
30% Fail Fail 50%
Percent of respondents that state one can avoid
HIV/AIDS by avoiding infected blood 30% Pass Fail 50%
84
Actual performance
Indicator
MTE target Female
8-13 years
Females 13
& up MTE target
Percent of respondents that state one can avoid
HIV/AIDS by avoiding the use of syringes, razors,
straight edges
30% Pass Pass 50%
Percent of respondents that state one can avoid
HIV/AIDS by avoiding contact with blood 30% Pass Pass 50%
Percent of respondents that state that a pregnant
woman can give the HIV virus to her child during
pregnancy
50% Pass Pass 50%
Percent of respondents that state that a mother can
give the HIV virus to her child during child birth 50% Pass Pass 50%
Percent of respondents that state that a mother can
give the HIV virus to her child via breast feeding 50% Pass Pass 50%
As Table 43 presents, there was not much difference between the two age groups in their level of
knowledge regarding HIV transmission. The results also revealed that the younger age group passed the
benchmark for the “infected blood” as a way of transmission while the older group did not.
Interestingly enough, both groups of children were only able to report “abstinence” as a means of
preventing HIV/AIDS transmission – even after they had received the CRS training; both groups failed to
pass the MTE benchmarks for all of the other ways of avoiding HIV/AIDS. Moreover, they did not indicate
any knowledge related to the transmission of the virus during sex, while they passed the benchmarks for
the indicators related to vertical transmission and contact with straight edges tools.
The type of knowledge that the children in the SSNIs have as compared to staff persons from the same
institutions is informative. Results revealed that children were more informed on non-sexual ways of
transmission or prevention while the adults knew more about ways of transmitting the virus sexually.
This finding may be related to the content that is being presented to both groups in the training events.
iii) General Knowledge on HIV/AIDS – SSNI Management and Staff
The general knowledge on HIV/AIDS was measured on two indicators: 1) Percent of respondents that
state that the virus can take up to six months to be detected; and 2) Percent of respondents that state that
there is no cure for people with HIV.
In SA1, both groups of adults passed the 60% benchmark for these two indicators (Table 44). The only
benchmark that was not met in SA2, which has not received the training, was the “Percent of respondents
that state that the HIV virus can take up to six months to show up as positive on a blood test” – which was
not passed by the SSNI support staff.
Knowing one’s negative sero-status is the best motivation to protect one self against possible future
contamination, it is interesting and encouraging to note that both sampling groups in both SAs passed the
20% benchmark for being tested for HIV..
Table 44: General knowledge on HIV/AIDS- SSNI Management and Staff
85
* SA1: received HIV/AIDS training. SA2 did not receive HIV/AIDS training.
iv) General Knowledge on HIV/AIDS – SSNI Children
The only group of SSNI children for which HIV/AIDS knowledge results were obtained, was for females
aged 13 years and above who have received training. This group of children passed the 60%
benchmark for both indicators related to general HIV/AIDS knowledge (Table 45).
Table 45: General Knowledge on HIV/AIDS – SSNI Children –
Centers with Previous HIV/AIDS Training Interventions (SA1)
Actual performance Indicator MTE target Female >13
Percent of respondents that state the HIV virus can take up to
six months to show up as positive in a blood test 60% Pass
Percent of respondents that state there are no cure for people
who have HIV 60% Pass
v) Perceptions of Personal Risk – SSNI Management and Staff
Notions of personal risk were assessed using several indicators:
• Indicators that measured false information – such as the possibility of infection through
hugging, sharing toilets/bathrooms, and by shaking someone’s hand;
• Indicators that measured respondent’s attitudes regarding sexual decision-making – such as
if it was acceptable for a man or woman to refuse to have sex with his/her wife/husband if
he/she has a sexually transmitted infection; and,
• An indicator that measured the acceptance levels of the respondents regarding exchanging
sex for material things – such as clothing.
Table 46 shows that the technical and administrative staffs of both categories of safety net centers (those
who had access to training and those who did not) have a fairly good perception of personal risk. Both
groups passed the 60% benchmarks for the indicators measuring the perception that one cannot be
contaminated by superficial physical contact with an infected person (shaking hands, hugging, sharing
toilets/bathrooms); and both groups passed the 70% benchmark on the indicators related to gender
discrimination in sexual practice. However, the SSNI Directors in SA2 (which have not had HIV/AIDS
training) did not pass the 70% benchmark for the indicator that measured their belief that women have the
right to refuse sex with their boyfriends or husbands.
Table 46: Perception of Personal risk – SSNI Management and Staff
Actual performance
Indicator Director Staff MTE
Target SA1 * SA2 SA1 SA2
Percent of respondents that state that you do not get HIV
by shaking hands with someone who has HIV/AIDS 60% Pass Pass Pass Pass
Actual performance
Indicator Director Staff MTE
Target SA1 * SA2 SA1 SA2
Percent of respondents that have been tested for HIV 20% Pass Pass Pass Pass
Percent of respondents that state that the HIV virus can
take up to six months to show up as positive on a blood
test.
60% Pass Pass Pass Fail
Percent of respondents that state that there are no cure
for people who have HIV 60% Pass Pass Pass Pass
86
Actual performance
Indicator Director Staff MTE
Target SA1 * SA2 SA1 SA2
Percent of respondents that state that you do not get the
HIV virus by sharing a bathroom/toilet with someone who
has HIV/AIDS
60% Pass Pass Pass Pass
Percent of respondents that state that you do not get the
HIV virus by hugging someone who has HIV/AIDS 60% Pass Pass Pass Pass
Percent of respondents that state that a woman has the
right to say “no” to having sex with her husband/boyfriend 70% Pass Pass Pass Pass
Percent of respondents that state that it is not okay if the
husband/boyfriend has sex with his wife/girlfriend even if
she said “no” to his sexual advances
70% Pass Pass Pass Pass
Percent of respondents that state that a woman can
refuse to have sex with her husband if he has a sexually
transmitted infection
70% Pass Pass Pass Pass
Percent of respondents that state that a man can refuse to
have sex with his wife if she has a sexually transmitted
infection
70% Pass Pass Pass Pass
Percent of respondents that think it is not okay for a man
to have sexual relations outside of his marriage 70% Pass Pass Pass Pass
Percent of respondents that think it is not okay for a
woman to have sexual relations outside of her marriage 70% Pass Pass Pass Pass
Percent of respondents that think it is not acceptable for a
n/woman to have sexual relations in exchange for the
payment of household bills or school fees, for example
70% Pass Pass Pass Pass
* SA1: with HIV/AIDS training. SA2: without HIV/AIDS training
vi) Perceptions of Personal Risks – SSNI Children
Some of the questions that were asked of the adult SSNI staff were not asked of the children because
many of these questions were related more to life experience than actual knowledge per se. As a result,
the children were asked fewer questions – with the performance benchmarks set slightly differently,
depending upon the age of the child.
Table 47: Perception of Personal Risk – SSNI Children
Centers with Previous HIV/AIDS Training Interventions (SA1)
Actual performance
Indicator MTE
target
Female
8-13
Female +
13
MTE
target
Percent of respondents that state that you do not get
HIV by shaking hands with someone who has
HIV/AIDS
50% Pass 60% Pass
Percent of respondents that state that you do not get
the HIV virus by sharing a bathroom/toilet with
someone who has HIV/AIDS
50% Pass 60% Pass
Percent of respondents that state that you do not get
the HIV virus by hugging someone who has
HIV/AIDS
50% Pass 60% Pass
Percent of respondents that think it is not okay for a
man to have sexual relations outside of his marriage 50% Pass 70% Pass
Percent of respondents that think it is not okay for a
woman to have sexual relations outside of her
marriage
50% Pass 70% Pass
Percent of respondents that think it is not acceptable
for a man/woman to have sexual relations in
exchange for the payment of household bills or
Not
Asked
Not
Asked 70% Pass
87
Actual performance
Indicator MTE
target
Female
8-13
Female +
13
MTE
target
school fees, for example
Percent of respondents that state one can avoid
HIV/AIDS by remaining faithful to one partner 30% Fail 50% Fail
Both groups of children in the centers passed their respective benchmarks on their perceptions of their
personal risks with regard to HIV/AIDS transmission via shaking hands, sharing bathrooms or hugging
(Table 47). They also passed their benchmarks for their opinions that faithfulness is important for both
men and women and that it is unacceptable to have sex for material gain.
These positive results suggest that the training sessions that are being offered are well understood by the
children.
vii) Stigma and Discrimination – SSNI Management and Staff
In an effort to investigate issues of stigma and discrimination, the indicators chosen related to the
negative beliefs on the moral or religious causes of infection for PLWHA and how these beliefs impact
relationships with PLWHAs.
Table 48 shows the results on stigma and discrimination among the groups of management and support
staff of the SSNIs surveyed.
Table 48: Stigma and Discrimination – SSNI Management and Staff
Actual performance
Indicator MTE Director Staff
Target SA1* SA2* SA1 SA2
Percent of respondents that state knowing someone
with the HIV virus 40% Pass Pass Pass Pass
Percent of respondents that state they are friends
with someone infected with HIV, or suffering from
AIDS
40% Pass Pass Fail Fail
Percent of respondents that state that if a friend of
theirs was diagnosed as HIV positive, they would
continue your friendship with that person
70% Pass Pass Pass Pass
Percent of respondents that state they would be
willing to take care of a family member that is
infected with the HIV virus in their own home
70% Pass Pass Pass Pass
Percent of SSNI respondents that state that they
would accept a child into the center that they know
to be HIV positive
70% Pass Pass Pass Pass
Percent of respondents that state they do not
believe that people who have the HIV virus
deserved getting the disease because of their past
behavior
70% Pass Pass Pass Pass
Percent of respondents that state they do not
believe that people who have the HIV virus
deserved getting the disease because they are bad
religious people
70% Pass Pass Pass Pass
At least 40% of the adult respondents knew someone infected with the HIV virus, and at least 40% of the
staff considers themselves as friends of a PLWHA. With this experience of friendship, it is positive to see
that at least 70% of the respondents, in both SAs and sampling groups, reported good will and
acceptance toward PLWHAs and did not seem to have significant, if any, moral or religious judgment
against them.
88
viii) Stigma and Discrimination – SSNI Children
In terms of stigma and discrimination levels for children, the MTE targets were set at 50% for 8-13 year
olds and 60% for children older than 13 years old (Table 49).
Table 49: Stigma and Discrimination – SSNI Children -
Centers with Previous HIV/AIDS Training Interventions (SA1)
Actual performance
Indicator MTE
target
Females
8-13
Females
+ 13
MTE
target
Percent of respondents that state knowing someone
with the HIV virus 20% Pass 20% Fail
Percent of respondents that state they are friends
with someone infected with HIV, or suffering from
AIDS
50% Pass 20% Fail
Percent of respondents that state that if a friend of
theirs was diagnosed as HIV positive, they would
continue your friendship with that person
50% Pass 60% Pass
Percent of respondents that state they would be
willing to take care of a family member that is
infected with the HIV virus in their own home
NA NA 60% Pass
Percent of respondents that state they do not
believe that people who have the HIV virus deserved
getting the disease because of their past behavior
50% Pass 60% Pass
Percent of respondents that state they do not
believe that people who have the HIV virus deserved
getting the disease because they are bad religious
people
50% Pass 60% Pass
Both groups of children passed the benchmark set for their expected levels of stigma and discrimination
against PLWHA. The younger age group passed the benchmark of 50% and the older age group passed
the benchmark of 60% on two specific indicators relating to these issues: 1) their willingness to remain
friends with someone who is found HIV positive; and 2) they do not have any moral or religious prejudice
against PLWHAs. Moreover, for the older age group, the 60% target was met for the indicator “Percent
that state they would be willing to take care of a family member that is infected with the HIV virus in their
own home.” These results were very encouraging and show a positive impact of the HIV/AIDS training in
the SSNIs.
4.6.b. Conclusions and recommendations – SSNIs
The overall results for the HIV/AIDS surveys show that there is not a lack of knowledge on the part of
program participants. All of the respondent groups - adults and children, males and females, students and
SSNI residents - all showed acceptable levels of general knowledge on the topic. However, the results
also showed that providing information is not enough. Programs have to identify strategies for addressing
the negative attitudes and practices that continue to stigmatize and be used to discriminate against
PLWHAs. Behavior Change and Communications (BCC) Strategies need to be reinforced in the schools
in order to change prevailing attitudes and practices – as performance levels on related issues were
higher in SSNIs where the HIV/AIDS program has been incorporating BCC activities.
The main programmatic recommendation that is supported by these results is that the HIV/AIDS program
should upgrade the level of information provided through the program and that the training should go
beyond the conventional information that is already provided by mainstream media outlets.
4.6.c. Schools
89
Data on HIV/AIDS knowledge and attitudes was collected in schools where CRS has been supporting
educational programs but not HIV/AIDS training, as yet. The questions that were asked of the adults and
children in the SSNIs were also asked of the adults and children in the schools. The following section
presents the HIV/AIDS results in the schools.
i) Means of Transmission – School Staff and PTA Committee Members
Table 50 presents the respondent’s knowledge on HIV/AIDS transmission of three groups of adults in the
CRS supported school system: 1) Members of the Parent-Teacher Associations (PTA) Committee; 2)
School Directors; and 3) Teachers. The same MTE targets that were set for SSNIs were also set for the
Education groups – even though the HIV/AIDS education and training has yet to take place within the
education sector. The school data were collected in four supervision areas45 allowing the decision rule for
pass/fail to be taken for each zone.
Table 50: Knowledge of HIV/AIDS Transmission –
School Staff and PTA Committee Members
 
45 SA1 : La Colline d’Aqui, Aquin, Vieux Bourg d’Aquin, Ile a Vache, SA2: Baraderes, Beaumont, Jeremie, Les Abricots, SA3:
Tiburon, Port a Piment, SA4: Fond des Blancs et Cotes de Fer
90
The results indicated that, in general, all three groups passed the 40% benchmark on the commonly
known ways of avoiding HIV/AIDS transmission, namely abstinence, faithfulness, and condoms (Table
50). An area of demonstrated weakness, however, dealt with the issue of unprotected sex with persons
belonging to higher risk groups – such a prostitutes, intravenous drug users, and persons with many sex
partners. Several of the sampling groups failed to meet the 40% benchmarks set for these indicators.
All three sampling groups in the four supervision areas passed the benchmark of 60% for the indicators
related to Mother-to-Child transmission during pregnancy and breastfeeding.
When analyzing the results by category of respondent, it is noted that the teachers are better informed
than the directors on the ways of transmission of the HIV virus whereas the PTA members are the least
knowledgeable on the ways of transmission.
Reviewing the data by SA, it is observed that SA4 performed the best with regards to knowledge on the
ways of HIV/AIDS transmission; whereas SA3 was the poorest performer.
Actual performance
PTA member School director Teacher
Indicator
MTE
Target S
A
1
S
A
2
S
A
3
S
A
4
SA
1
SA
2
SA
3
SA
4
SA
1
SA
2
SA
3
SA
4
Percent of respondents that state one can avoid
acquiring HIV/AIDS 75% P P P P P PPPPPPP
Percent of respondents that state one can avoid
HIV/AIDS by abstaining from sex 40% P P P P P P P P P P P P
Percent of respondents that state one can avoid
HIV/AIDS by using condoms 40% P P P P P P P P P P P P
Percent of respondents that state one can avoid
HIV/AIDS by limiting sex to one partner 40% F P F P P P P P P P F P
Percent of respondents that state one can avoid
HIV/AIDS by avoiding unprotected sex with
prostitutes
40% F F F F F F F F F F F F
Percent of respondents that state one can avoid
HIV/AIDS by avoiding unprotected sex with
persons who have many sex partners
40% F F F F F F F F F F F P
Percent of respondents that state one can avoid
HIV/AIDS by remaining faithful to one partner 40% P P P P P P P P P P P P
Percent of respondents that state one can avoid
HIV/AIDS by avoiding unprotected sex with
persons who inject drugs intravenously
40% F F F F F F F F F F F F
Percent of respondents that state one can avoid
HIV/AIDS by avoiding infected blood 40% F F F F F F F P P P F F
Percent of respondents that state one can avoid
HIV/AIDS by avoiding the use of syringes,
razors, straight edges
40% P P P P P P P P P P P P
Percent of respondents that state one can avoid
HIV/AIDS by avoiding contact with blood 40% F F P P P F F P P P F P
Percent of respondents that state that a
pregnant woman can give the HIV virus to her
child during pregnancy
60% P P P P P P P P P P P P
Percent of respondents that state that a mother
can give he
HIV virus to her child during child birth
60% P P P P P P P P P P P P
Percent of respondents that state that a mother
can give the
HIV virus to her child via breast feeding
60% P P P P P P P P P P P P
91
ii) Means of Transmission – School Children
The school students were segregated by gender. The team wanted to assess potential inequities in their
levels of knowledge on HIV/AIDS-related issues. With respect to their knowledge on ways of
transmission, the students were only asked about Mother to Child transmission, since sexual education is
not part of their curriculum. Both groups of children in all of the SAs passed the 60% benchmark set for
their knowledge on HIV/AIDS and its potential transmission during pregnancy, childbirth or via
breastfeeding (Table 51).
Table 51-: Knowledge of Means of HIV/AIDS Transmission – School Children
iii) General knowledge of HIV/AIDS – School Staff and PTA Committee Members
General levels of knowledge on HIV/AIDS was measured via two indicators: 1) Percent that state that the
virus can take up to six months to be detected; and 2) Percent that state that there is no cure for people
with HIV/AIDS. Moreover, to find out if HIV/AIDS is a priority topic in the schools, it was asked to the PTA
member if this topic has ever been discussed in any of their PTA meetings in the past.
Table 52 shows that all three groups passed the 60% benchmarks set for the two indicators measuring
the respondent’s general knowledge of HIV/AIDS. With regards to the PTA meeting, three SAs passed
the benchmark of 55% for the “Percent that state that HIV/AIDS has been discussed at their PTA
meetings” – which is encouraging.
Table 52: General Knowledge of HIV/AIDS- School Staff and PTA Committee Members
iv) General Knowledge of HIV/AIDS – School Children
The general knowledge of children was assessed using the same indicators and benchmarks as for the
adults. Table 53 shows the level of general knowledge of the students by gender and supervision area. It
indicates that students in SA1, SA2 and SA3 passed the benchmark of 60% set for the indicator
Actual performance
Female student Male student
Indicator
MTE
Target SA1 SA
2 SA3 SA
4 SA1 SA2 SA3 SA4
Percent of respondents that state that a
pregnant woman can give the HIV virus to
her child during pregnancy
60% Pass Pas
s
Pass Pa
ss
Pass Pass Pass Pass
Percent of respondents that state that a
mother can give he
HIV virus to her child during child birth
60% Pass Pas
s
Pass Pa
ss
Pass Pass Pass Pass
Percent of respondents that state that a
mother can give the
HIV virus to her child via breast feeding
60% Pass Pas
s
Pass Pa
ss
Pass Pass Pass Pass
Actual performance
PTA member School Director Teacher
Indicator
MTE
target S
A
1
S
A
2
S
A
3
S
A
4
SA
1
SA
2
SA
3
SA
4
SA
1
SA
2
SA
3
SA
4
Percent of respondents that state that the HIV
virus can take up to six months to show up as
positive on a blood test.
60% P P P P P P P P P P P P
Percent of respondents that state that there are
no cure for people who have HIV 60% P P P P P P P P P P P P
Percent of respondents that state that HIV/AIDS
has been discussed at their PTA meetings 55% P F P P N
A
N
A
N
A
N
A
N
A
N
A
N
A
N
a
92
measuring if the HIV virus can remain undetected in the bloodstream for up to 6 months. SA4 did not
pass the benchmark for that indicator. On the other hand, students in all of the SAs knew that there is no
cure for HIV/AIDS. This result differed from those revealed in the SSNIs - where all of the girls older than
13 years of age passed the benchmark set at 60%.
Table 53: General Knowledge of HIV/AIDS- School Children
Actual performance
Female student Male student
Indicator
MTE
targe
t
SA
1
SA
2
SA
3
SA
4 SA1 SA2 SA3 SA4
Percent of respondents that state that the HIV
virus can take up to six months to show up as
positive on a blood test.
60% P P P F P P P F
Percent of respondents that state that there are
no cure for people who have HIV 60% P P P P P P P P
v) Perceptions of Personal Risks – School Staff and PTA Committee Members
Notions of personal risk were assessed by several indicators relating to misinformation regarding
HIV/AIDS – such as that it is possible to get infected by hugging, sharing toilets, and/or shaking
someone’s hand. Benchmarks were also set for indicators that measured discrimination against PLWHA
and on issues related to sexual decision making among men and women.
All adult groups passed the 60% benchmark that was set for the indicator that one cannot get the HIV
virus by shaking hands, sharing bathrooms or hugging someone that is infected with the disease (Table
54).
Table 54: Perceptions of Personal Risk – School Staff and PTA Committee Members
Schools
PTA member School Director Teacher
Indicator
MTE
Targ
et
SA
1 SA2 SA3 SA4 SA1 SA2 SA3 SA4 SA1 SA2 SA3 SA4
Percent of respondents that state
that you do not get HIV by shaking
hands with someone who has
HIV/AIDS
60% PPPPPPPPPP P P
Percent of respondents that state
that you do not get the HIV virus by
sharing a bathroom/toilet with
someone who has HIV/AIDS
60% PPPPPPPPPP P P
Percent of respondents that state
that you do not get the HIV virus by
hugging someone who has
HIV/AIDS
60% PPPPPPPPPP P P
Percent of respondents that think it
is not okay for a man to have
sexual relations outside of his
marriage
70% PPPPPPPPPP P P
Percent of respondents that think it
is not okay for a woman to have
sexual relations outside of her
marriage
70% PPPPPPPPPP P P
Percent of respondents that think it
is not acceptable for a man/woman
to have sexual relations in
exchange for the payment of
household bills or school fees
70% PPPPPPPPPP P P
93
Similar results were found for the other indicators as well: “Percent of respondents who think that is not
correct for a husband or a wife to have sexual relations outside of their marriage”; and “Percent of
respondents who think it is not acceptable to have sexual relations in exchange of any kind of favor like
payments of bills, school fees, or others”. These results show that the adults interviewed are well aware
of their personal risks of being exposed to the HIV virus.
vi) Perceptions of Personal Risks – School Children
Students in schools were asked the same questions as the adults were, except for the indicator
concerning the exchange of sex for material benefits.
The results show that the students passed the benchmark of 60% for the indicators that measured
common misbeliefs about risk of HIV infection (Table 55). They also passed the benchmark of 70%
regarding extramarital relations as a risk to be infected by the HIV virus. Results are similar for male and
female children through the four SAs.
Table 55: Perceptions of Personal Risks – School Children
vii) Stigma and Discrimination - School Staff and PTA Committee Members
To assess problems of stigma and discrimination in the schools, respondents were asked questions
about their personal relations with and attitudes toward PLWHAs. Results are presented in Table 56.
Five of the 12 groups sampled did not pass the benchmarks set for the “percent of respondents that know
someone with HIV virus”; nor did they pass the same benchmarks that were set for the ”percent of
respondents that state they are friends with someone infected with HIV or suffering from AIDS.”
However, all of the groups did pass the 70% benchmarks for the indicators measuring stigmatization and
discrimination issues - such as taking care of infected family members in their own homes.
Table 56: Stigma and discrimination – School Staff and PTA Committee Members
Actual performance
PTA member School Director Teacher
Actual performance
Female student Male student
Indicator
MTE
target SA1 SA2 SA3
S
A
4
SA1 SA2 SA3 SA4
Percent of respondents that state that you do
not get HIV by shaking hands with someone
who has HIV/AIDS
60% P P P P P P P P
Percent of respondents that state that you do
not get the HIV virus by sharing a
bathroom/toilet with someone who has
HIV/AIDS
60% P P P P P P P P
Percent of respondents that state that you do
not get the HIV virus by hugging someone who
has HIV/AIDS
60% P P P P P P P P
Percent of respondents that think it is not okay
for a man to have sexual relations outside of his
marriage
70% P P P P P P P P
Percent of respondents that think it is not okay
for a woman to have sexual relations outside of
her marriage
70% P P P P P P P P
94
SA
1
SA
2
SA
3
SA
4 SA1 SA2 SA3 SA4 SA1 SA2 SA3 SA4
Percent of respondents that state
knowing someone with the HIV
virus
40% F P F P P P F P F P F P
Percent of respondents that state
they are friends with someone
infected with HIV, or suffering from
AIDS
40% F F F F F F F P F F F F
Percent of respondents that state
that if a friend of theirs was
diagnosed as HIV positive, they
would continue your friendship with
that person
70% P P P P P P P P P P P P
Percent of respondents that state
they would be willing to take care of
a family member that is infected
with the HIV virus in their own home
70% P P P P P P P P P P P P
Percent of respondents that state
they do not believe that people who
have the HIV virus deserved getting
the disease because of their past
behavior
70% P P P P P P P P P P P P
Percent of respondents that state
they do not believe that people who
have the HIV virus deserved getting
the disease because they are bad
religious people
70% P P P P P P P P P P P P
viii) Stigma and Discrimination – School Children
The same questions were also asked of male and female students in the four supervision areas. Table 57
shows the results for students.
Table 57: Stigma and Discrimination – School Children
Actual performance
Female student Male student
Indicator
MTE
target S
A
1
S
A2
S
A3
SA
4 SA1 SA2 SA3 SA4
Percent of respondents that state knowing
someone with the HIV virus 20% F P P P P P P P
Percent of respondents that state they are friends
with someone infected with HIV, or suffering from
AIDS
20% F F F F P P F F
Percent of respondents that state that if a friend
of theirs was diagnosed as HIV positive, they
would continue your friendship with that person
60% F F F F F F F F
Percent of respondents that state they would be
willing to take care of a family member that is
infected with the HIV virus in their own home
60% P P P F P F P F
Percent of respondents that state they do not
believe that people who have the HIV virus
deserved getting the disease because of their
past behavior
60% P P P P P P P P
Percent of respondents that state they do not
believe that people who have the HIV virus
deserved getting the disease because they are
bad religious people
60% P P P P P P P P
95
Surprisingly, among all categories of respondents evaluated during the MTE, the students are the only
ones who met the target of 20% for knowing someone with HIV/AIDS. They also passed the 60%
benchmark for stating that people who have the HIV virus did not deserve getting the disease. In spite of
this relative openness, these children still discriminate against PLWHAs in that they: 1) would not stay
friends with someone whom they learned to be infected and 2) would not be willing to take care of a
family member infected with HIV in their own home.
This finding is the most significant of all these MTE results for HIV-AIDS in that it calls for the necessity of
an HIV/AIDS education program that reaches its participants on an intellectual level, but also on
attitudinal levels as well.
4.6.d Conclusions and Recommendations – School Staff, PTA Committee Members, and School
Children
The overall results for the HIV/AIDS surveys show that there is not a lack of knowledge on the part of
program participants. All of the respondent groups - adults and children, males and females, students and
SSNI residents - all showed acceptable levels of general knowledge on the topic. However, the results
also showed that providing information is not enough. Programs have to identify strategies for addressing
the negative attitudes and practices that continue to stigmatize and be used to discriminate against
PLWHAs. Behavior Change and Communications (BCC) Strategies need to be reinforced in the schools
in order to change prevailing attitudes and practices – as performance levels on related issues were
higher in SSNIs where the HIV/AIDS program has been incorporating BCC activities.
The main programmatic recommendation that is supported by these results is that the HIV/AIDS program
should upgrade the level of information provided through the program and that the training should go
beyond the conventional information that is already provided by mainstream media outlets.
Another recommendation that emerges from these results is that children in the education program
should have access to HIV/AIDS programs that are aiming at behavioral change. Discrimination and
stigmatization issues must be addressed in the youngest of the program’s participants in order to
contribute to improved conditions for PLWHA on the societal level.
4.7. Social Safety Net Institutions - SSNIs
CRS-supported Social Safety Net Institutions (SSNI) care for more than one hundred housed orphans
and abandoned children. The SSNI sector was not covered by the 2002 Baseline study; therefore,
indicators measured during the MTE will be used as baseline, and guide CRS staff in setting targets for
the final evaluation. For the purposes of the MTE, SSNIs were divided into two supervision areas: those
that had participated in CRS-sponsored HIV/AIDS education activities in the last two years, and those
that had not. Five groups within each SSNI were targeted for the survey. Unfortunately, the targeted
numbers could not be reached for all five groups in both SAs (see Table 58 and section on field work
results).
Table 58: Safety Net Institutions Sampling
Sectors covered by MTE Intended Number of
Samples
Number of
Samples
Target groups Realized
Safety Net HIV/AIDS SA1 SA2 SA1 SA2
SSNI Management Staff person 33 29 19 27 17
SSNI Support Staff person 3 29 19 27 17
Female Child (8-12 years old) 33 29 19 25 (*)
Male Child (8-12 years old) 33 29 19 (*) (*)
Female Child (>13 years old) 33 29 19 24 (*)
Male Child (>13 years old) 33 29 19 (*) (*)
96
(*) The number of respondents for these age groups was too small to allow for the statistical analysis of the results (see the section
on the MTE Field Work)
As the table above indicates MTE SSNI results could not be calculated for any of the male children
groups; neither from the 8-12 year old group, nor those that were 13 years old and up – in either SA. This
unfortunate situation largely arose out of the fact that many of the SSNIs that were selected during the
sampling process served female children only, and so there were not enough male children in the overall
sample to make definite performance determinations.
The same can be said for the situation in SA2. The SSNIs in SA2 had never received HIV/AIDS
education from CRS over the past two years, essentially because most of the populations served by
these SSNIs are “special needs” groups, such as mentally and/or physically handicapped children,
orphaned infants, etc. – groups that are not able to participate in such initiatives in any meaningful way.
Results in SA2 were thus only obtained for the staff people.
4.7.a. Analysis of Results
i) SSNI Management and Staff
A part of CRS’ SSNI program consists in providing training to center management and support staff on
universal children’s rights. The MTE results showed that at least 85% of SSNI Management in both
supervision areas could name at least two of these rights, thus passing the performance benchmark set
for this indicator (Table 59). This sampling group also passed the 20% benchmark for the percent SSNI
Managers that attended a Ruche (or, SSNI federation) in the last six months.
Table 59: SSNI Management and Staff
SA1 SA2
Indicator MTE
Target MTE Benchmark
Met? (Pass/Fail)
MTE Benchmark
Met? (Pass/Fail)
Percent SSNI Management who can name 2 or more universal rights
of children 85% Pass Pass
Percent SSNI Management who have attended a Ruche meeting in
the last six months 20% Pass Pass
Meeting the MTE benchmarks for cleanliness proved more difficult for some of the SSNIs. While centers
in both SAs met most benchmarks, they did not maintain levels of cleanliness defined as adequate by
CRS (Table 60). For example, centers in SA1 failed to meet three benchmarks that were set at 50%:
being acceptably clean and relatively free of trash, having soap available at the closest water point to the
kitchen, and having toilets/latrines found to be clean upon inspection. SSNIs in SA2 failed to meet the
50% benchmark for having a food preparation area found to be smooth/free of sticky substances.
Overall, it appeared that the SSNIs in SA2 were found to be cleaner and better maintained than those in
SA1. The following table presents results on the hygiene conditions observed at the selected centers
along with two indicators dealing with canteen management.
Table 60: SSNI Hygiene Conditions and Canteen Management
SA1 SA2
Indicator MTE
Target MTE Benchmark
Met? (Pass/Fail)
MTE Benchmark
Met? (Pass/Fail)
Hygiene conditions
% centers found to be clean and relatively free of trash 50% Fail Pass
% kitchens found to be acceptably clean and free of trash 50% Pass Pass
97
% kitchens without uncovered food out on the counters 75% Pass Pass
 % kitchens food preparation areas found to be smooth/free of sticky
substances 50% Pass Fail
% kitchen food preparation stations found to be free of evidence of
pests or rodents 70% Pass Pass
% kitchens with soap available at the closest water point to the
kitchen 50% Fail Pass
% centers in which latrine/toilet areas found to be clean 50% Fail Pass
% centers with doors on all of the latrines/toilets 60% Pass Pass
% centers in which all latrine/toilets doors close completely 50% Pass Pass
% centers in which latrine/toilets provide adequate superstructure 30% Pass Pass
Canteen management
% centers without food shortages in the center canteen in the last
month 70% Fail Fail
% centers with at least one entry for a financial withdrawal or deposit
that is dated within the last 30 days in the bookkeeping ledger 50% Pass Pass
Another important area investigated in the MTE related to the management of the SSNI canteens. Center
management and staff were asked if the center had experienced any food shortages in the last month.
Results showed that at least 30% of canteens had experienced food shortages in that period. Thus the
program did not pass the 70% benchmark for the indicator “Percent of centers without ford shortages in
the center canteen in the last month.” As nutritional supplementation is an important factor in CRS’
support of SSNIs, the reasons behind this level of shortages will need to be more closely examined.
Since the beginning of the DAP, most center staff have received training on center management
strategies, including bookkeeping. In an effort to measure the application of the new skills that have been
learned as a result of these trainings, the MTE examined the financial ledgers for all of the SSNIs that
were visited. Results indicated that at least 50% of the centers have been maintaining their ledgers in the
last 30 days, as evidenced by at least one entry for a financial withdrawal or deposit.
ii) SSNI Female Children 8-13 Years of Age
Female children 8-13 years of age at selected SSNIs were interviewed to determine if DAP indicators for
primary school attendance, possession of a birth certificate, consumption of CRS supplied food (SFB,
cornmeal and lentils), and consumption of other food types met mid-term project benchmarks. In the
case of these four indicators, CRS/Haiti met or exceeded the expected benchmark results (Table 61).
Table 61: SSNI Female Children 8-13 years old
Indicator MTE
Benchmark
Numerator
SA1
MTE Benchmark
Met? (Pass/Fail)
Percent of female children 8-13 who report going to primary school 80% 25 Pass
Percent female children 8-13 yrs reporting having a birth certificate 80% 22 Pass
Percent female children 8-13 yrs having eaten SFB, cornmeal or lentils in
the last 24 hours 90% 23 Pass
Percent female children 8-13 yrs having eaten something other than SFB,
cornmeal or lentils in the last 24 hours 30% 24 Pass
iii) SSNI Female Children 13 Years of Age and Up
Interview responses obtained from older female children, those aged 13 years and above, were
compared against expected DAP mid-term benchmarks (Table 62). These girls were asked if they
attended school or received other training, possessed a birth certificate, ate CRS supplied food (SFB,
cornmeal and lentils), and ate other food types in the last 24 hours. CRS/Haiti met or exceeded all the
expected benchmarks on these indicators.
98
Table 62: SSNI Female Children 13 Years of Age and Up
Indicator MTE
Benchmark
Numerator
SA1
MTE
Benchmark
Met?
(Pass/Fail)
Percent Female children 13 yrs & up currently going to school or
receiving any training 80% 24 Pass
Percent Female children 13 yrs & up reporting having a birth certificate 80% 23 Pass
Percent Female children 13 yrs & up having eaten SFB, cornmeal or
lentils in the last 24 hours 90% 23 Pass
Percent Female children 13 yrs & up having eaten something other than
SFB, cornmeal or lentils in the last 24 hours 30% 22 Pass
4.7.b. Conclusions and Recommendations - SSNIs
In regards to the indicators relating to SSNI cleanliness, it is clear that the benchmarks should have been
set higher. More specifically, the benchmark for the indicator concerning evidence of pests was only set
at 30%, meaning that only 4 out of 27 selected centers had to be free of such evidence in order to pass
the benchmark. Analyzing a bit further, what this meant was that only 9 centers were “free” from pests
while 18 were not. In retrospect, the benchmark should have been higher in order to reflect the
cleanliness standards that should already be in place in the CRS-supported centers. While CRS/Haiti
met its mid-term target of 30% for this indicator it seem is clear that more needs to be done to improve the
cleanliness of SSNIs.
To encourage higher sanitation levels, CRS/Haiti will work with SSNI center staff to create a checklist of
regular cleaning tasks. Responsibilities for completing the tasks will be assigned to specific center staff
persons, while center managers will be responsible for verifying that these daily tasks are completed
every day. Additionally, CRS/Haiti will also strengthen its Health, Hygiene and Nutrition (HHN) training
materials in an effort to underscore the critical links between cleanliness at the SSNI and good health.
The fact that CRS-supported SSNIs are experiencing food shortages may be attributed to the volatile
political situation in Haiti over the last months, which have made the timely delivery of food items difficult if
not impossible at times. Nonetheless, further investigation will need to be undertaken to pinpoint why the
centers are not receiving their entitled food supplementation supplies. 
4.8. Civic Education
Catholic social teaching recognizes that the dignity of the human person involves the right to political
freedom and participation. In an effort to increase people’s realization of these inherent rights, the DAP
has begun integrating civic education and training into its activities, via the Civil Society, Human Rights
and Peace building Program (CSHRPB). It is believed that people’s improved understanding of their
political rights and system of governance, will encourage a more active and constructive role in local and
national politics, which will in turn focus greater attention and resources on the fight against poverty and
hunger in Haiti. Improved governance, especially the ability of communities to influence factors and
decisions that affect their food security, is an important contributor to achieving CRS program impact46. 
CRS took advantage of the opportunity provided by the DAP Mid-Term Evaluation to develop thirteen
indicators based upon the four main components of this educational initiative, namely: civic education,
 
46 Concept Paper for its Strategic Plan for 2004-2008, Fifth Draft », Bureau for Democracy, Conflict and Humanitarian Assistance,
March 17, 2003, p18.
99
community advocacy, governance, and conflict resolution. Since those indicators are new, they were not
collected at baseline thus the MTE results are used as baseline values for this sector. Program activities
planned for FY05 and FY06 will be assessed once again at the end of the DAP, as the program will have
trained CRS staff and partners in these basic concepts; who will have, in turn, trained community
members and leaders as part of this “tickle down” effort to engage citizens at all levels of society.
A total of 11 groups were targeted by the MTE for this program. Table 1 below presents results of the
MTE on questions assessing the levels of civic knowledge of PTA members, School Teachers, and
School Directors in four supervision areas, and Community Health Workers (CHW) in two supervision
areas; Table 2 presents the results on the same questions for mothers and credit program participants in
four supervision areas, and for members of Farmer Associations in two supervision areas. Expected
performance benchmarks were different for all of the surveyed groups and depended upon the perceived
or verified levels of community and civic involvement, education levels, and past CRS interventions with
specific target groups.
4.7.a. Analysis of Results
i) School Staff, PTA Committee Members, and CHWs
Looking at the MTE results presented in the tables below, several observations can be noted about these
groups. All of the target populations knew that:
• They have the right to form an association or social group
• They have the right to form a political party
• That “Kazèk” and “Azèk” obtain their positions by winning elections
None of the groups (with the exception of the School Directors) knew that:
• The state is founded upon three principles: property, government and citizenry
• Both the state and the general population are responsible for taking care of the environment
• That another name for the Constitution is “Maman lwa peyi-a”
The most successful results came from School Directors, who answered all thirteen questions correctly.
This comes as no real surprise, given that School Directors tend to be the most educated of all of the
surveyed groups, and that many have participated in CRS-initiated civic education training in the past
(Table 63).
Interestingly, School Teachers and PTA Committee Members passed and failed on the very same
questions; both groups passed the benchmarks for questions 1-8, 12 and 13 and failed on questions 2-6
and 9-11. Looking more closely at these results, the questions on which these groups passed relate to
issues which impact them at the community level; whereas those on which they failed dealt more with
larger democratic concepts and facts, like the names of the three branches of the national government.
As School Teachers are responsible for communicating basic civic education to children, special attention
will need to be placed on emphasizing the importance and relevance of such key knowledge to Teachers.
Similar trends were revealed in the performances of CHWs as well; CHWs passed and failed on the same
indicators across both supervision areas.
Table 63: Civic Education Knowledge: School Staff, PTA Committee Members, and CHWs
100
ii) Analysis of Results - Mothers, Credit Program Participants, and Farmer Association Members
Of all of the targeted groups, mothers of children less than 2 years old failed most to meet performance
benchmarks on civic knowledge: all three groups of mothers (mothers of children 0-6, 6-12 and 12-24
months) failed to meet the benchmarks for five to six of the 13 indicators. Though they did pass on one
indicator, we are unable to state with certainty if weighted coverage estimates on the others actually
cleared the benchmarks since the confidence intervals overlapped with the benchmark. Perhaps the
tremendous burden put on women at the household level limits their exposure to politics and civic
education, explaining their poor knowledge of those issues. Further investigation of those results should
be undertaken to better understand why their knowledge is so limited, and how the CSHRPB program
can encourage and facilitate their future inclusion in those educational activities. The knowledge of
participants in the micro-credit program is slightly better, perhaps because they have already begun to
receive training in topics such as participatory decision making and association formation (including the
establishment of member rights and responsibilities). As to farmer association members, they generally
faired better, which may suggest that associative structures are perhaps more conducive to the transfer of
key CSHRPB concepts and the replication and reinforcement of civic principles.
 
47 *The MTE Performance values expressed as % are weighted coverage estimates calculated by aggregating the data from SAs.
“Pass” = met the benchmark; “Fail” =: Failed to reach the decision rule for the benchmark; “UD” (Unable to Determine) = given
that the benchmark falls within the results’ confidence intervals, we cannot state with certainty that the weighted average cleared
the benchmark. In such cases, we do not make a judgment for the overall sample. We looked instead only at individual SA
performance. For ease of presentation, results by individual SA are not presented in that table. The MTE Performance values
expressed as either "Pass" or "Fail" (no %) are for sectors that did not have 4 Supervision Areas from which to aggregate the
data.
MTE Performance47
Indicator MTE
B’mark LOA PTA
Members
School
Directors
School
Teachers
CHWs
SA1
CHWs
SA2
% who know that the state is founded on 3 25.7% 32.4% 11.9%
principles – property, government, citizenry 30% 80% UD UD Fail Fail Fail
% who know that "Deputes” are elected for two- 47.6% 72.3% 56.6%
year terms 30% 80% Pass Pass Pass Pass Pass
% who know the name of the tribunal in their 84.4% 88.0% 81.8%
commune
80% 90% UD Pass UD Pass Pass
% who know that political parties gain political 83.9% 97.4% 95.9%
office by winning elections 80% 90% UD Pass Pass Pass Pass
% who know they have the right to form an 98.7% 98.7% 100.0%
association or social group 80% 90% Pass Pass Pass Pass Pass
% who know they have the right to form a 82.2% 96.0% 95.9%
political party 80% 90% UD Pass Pass Pass Pass
78.3% 83.9% 73.3% % who know that Senators can propose laws 80% 90% UD UD UD Fail Pass
% who believe that the state and the population 60.0% 87.0% 62.7%
are both responsible for taking care of the
environment
80% 90% Fail UD Fail Fail Fail
% who know that a "majistra komenal" (Mayor) 85.3% 96.2% 92.2%
obtains his/her position by winning elections 80% 90% UD Pass Pass Pass Pass
% who know that KASECS obtain their position 88.1% 96.2% 90.9%
by winning elections 80% 90% Pass Pass Pass Pass Pass
% who know that ASECS obtain their position 88.0% 94.8% 90.9%
by winning elections 80% 90% Pass Pass Pass Pass Pass
% who know that another name "maman lwa 55.87% 92.3% 56.0%
peyi a" (the constitution) is “La Loi Mere” 80% 90% Fail Pass Fail Fail Fail
% who know that there are three branches of 57.03% 90.8% 77.4%
government – Executive, Legislative and
Judiciary
80% 90% Fail Pass UD Pass Pass
101
Table 64: Civic Education Knowledge: Mothers, Credit Program Participants and Farmers
MTE Performance
Mothers Indicator MTE
B’mark LOA
0-5.99
mos
6-11.99
mos
12-23.99
mos
Credit
Parts.
Ag. Ass.
M’bers
SA1
Ag.
Ass.
M’bers
SA2
% who know that the state is founded on 3 1.3% 2.1% 0.8% 1.2%
principles – property, government, citizenry 20% 50% Fail Fail Fail Fail Fail Fail
% who know that "Deputes” are elected for 13.7% 11.2% 12.9% 30.4%
two-year terms 20% 50% UD Fail UD Pass Pass Pass
% who know the name of the tribunal in their 20.5% 28.1% 16.6% 42.2%
commune
50% 80% Fail Fail Fail UD Pass Fail
% who know that political parties gain political 47.0% 53.6% 40.7% 49.1%
office by winning elections 50% 80% UD UD UD UD Pass Pass
% who know they have the right to form an 79.2% 61.8% 73.1% 82.6%
association or social group 50% 80% Pass Pass Pass Pass Pass Pass
% who know they have the right to form a 56.0% 52.9% 47.2% 34.0%
political party 50% 80% UD UD UD Fail Pass Pass
57.4% 51.1% 46.9% 55.5% % who know that Senators can propose laws 50% 80% UD UD UD UD Pass Pass
% who believe that the state and the 6.9% 3.7% 7.9% 20.4%
population are both responsible for taking
care of the environment
50% 80% Fail Fail Fail Fail Fail Fail
% who know that a "majistra komenal" 46.3% 49.2% 48.2% 60.7%
(Mayor) obtains his/her position by winning
elections
50% 80% UD UD UD UD Pass Pass
% who know that KASECS obtain their 50.9% 53.1% 53.4% 66.6%
position by winning elections 50% 80% UD UD UD Pass Pass Pass
% who know that ASECS obtain their position 53.4% 53.1% 52.1% 65.5%
by winning elections 50% 80% UD UD UD Pass Pass Pass
% who know that another name "maman lwa 5.0% 6.5% 3.4% 5.0%
peyi a" (the constitution) is “La Loi Mere” 20% 50%
Fail Fail Fail Fail Pass Pass
% who know that there are three branches of 17.5% 15.2% 5.5% 7.3%
government – Executive, Legislative and
Judiciary
20% 50% UD UD Fail Fail Pass Pass
4.7.b. Conclusions and Recommendations – Civic Education
CRS is committed to empowering its beneficiaries to take an active role in deciding and negotiating
issues that affect their daily lives. Improving the levels of civic knowledge is one step in that direction. In
pursuing this commitment, the CSHRPB program must design training programs that speak to the needs
and constraints of all the target groups; particularly mothers, CHWs, PTA Members and School Teachers
– all of whom fared poorly on the indicators for this sector. For instance, the civic education sessions for
women’s groups should be designed to be precise and short so to not require too much of their time,
considering that, in most cases, they have to juggle several responsibilities at once.
Although all of the target groups knew that “Kazèk and Azèk” obtain their positions by winning elections, it
is important that the CRS Staff and partners who facilitate the civic trainings define clearly these officials’
roles and responsibilities, to provide the target groups with the information they need to make educated
decisions when voting—especially since this is an election year in Haiti.
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CHAPTER 5 – MTE RESULTS BY SECTOR – PHASE II
5.1 Micro-Credit
5.1.a. Community Credit Program
WOMEN CREDIT PROGRAM
Results from Phase I MTE related to women’s credit raised two main questions:
i) Why do some women report having problems reimbursing their loans, and why some are not
reimbursing at all?
ii) Why do some women report not investing more in the feeding of their children since they joined the
credit program?
i) Why is it difficult for some women to reimburse the loan?
To understand the difficulties associated with the reimbursement, many factors must be taken into
consideration:
• The economic situation of the people prior to joining the credit program
• The conditions associated with making profit, such as
- Type of investment
- Past experience in doing business
• The conditions set for the reimbursement of the interest and the principle
- Payment of the interest
- Reimbursement of the principle
- Conditions for renewing the loan in the following cycle
• The training and support received
• The participants selection process
When exploring the reasons why some women have difficulties reimbursing their loan, all of the above
elements were reported during the interviews.
The participants’ economic situation prior joining the credit program:
According to the persons interviewed, in order for the loan to generate benefits, the person should have
other sources of income such as livestock or agricultural activities or a certain amount of money already
invested in a small business. Very often those investments are used to pay the monthly interest and even
to reimburse the principle borrowed from the credit program. When a person only depends on the small
business to fulfill her/his family needs, the risk for bankruptcy is higher; since profits are rarely sufficient to
pay back the interest, the loan principle is often used to make interest payments. .
It was also noted that part of the interest is often used to pay for family emergencies such as school fees,
rent, health care, etc. Those who have an alternative source of income can recover that money much
more easily. However, those without supplemental forms of income are very likely to ever be able to pay
back the debt owed on the loan.
Observations:
According to one key informant in Port a Piment, one major problem for reimbursement in that area is the
extreme poverty of the people and not a general lack of trust as it was anticipated. People in this area
have many children, the agricultural systems are archaic, and many people only generate sufficient
income to fulfill basic family needs. Typically, men in the town of Port Piment do not farm and are often
unemployed. One of the people interviewed even reported a stigma associated with performing farm
work: “working on the farm is considered a disgrace for a man who lives in a town “. The same person
had been a victim of such stigma himself and was rejected by his friends. Even his wife was very critical
of his choice to farm in order to meet the needs of his family
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In Port a Piment, many women who were interviewed reported to have had to use a major part of their
loan to satisfy family obligations. Many women have between 2 and 9 children. Among the eight women
interviewed, only three of them live with a spouse, one is a widow, and the other four receive nearly no
assistance from the father of their children.
Conditions related to profit generation
Types of investment
According to the women with more business experience, credit participants should reinvest their profit
and even diversify their investments into activities outside of the small business such as farming and
livestock. In this way participants would be able to sell an animal or produce whenever they are in need of
emergency funds instead of dipping into the loan principle. Those who only invest in small businesses do
not have such an alternative.
Past business experience
Experience in managing business is an important contributing factor for profit generation. The person who
is running the business must pay attention to all potential opportunities. To make a profit, one must know
in which type of business to invest in order to sell products quickly (the expression in Creole used to
describe this is: “fok ou konn brase lajan an”the principle must turn around quickly in order to make a
profit.) Those who make more profit are the “madame sara” or business women who move from one large
market to another. In order to be able to do this, the person needs a larger amount of principle to cover
costs such as travel expenses. The loan alone is not sufficient to have a profitable business. Those who
sell at home or in the local market do not make much profit. Competition is also more important since
many people are in the same type of business.
According to a key informant, people who receive a loan must be “authentic business woman “ in order to
be able to make some profit. This issue was reported as a problem in Port a Piment. The preliminary work
of identifying the « true business women » was not completely done.
Remarks :
All groups unanimously reported that, currently, profits are much smaller than what they were a few years
ago. They gave the following explanations: 
• They tend to invest more for a smaller quantity of products
• Sales are very slow. Women explained that their purchasing power has decreased. Moreover,
key informants reported that there are more people in the same area doing the same type of
business. They suggest that they should have more opportunity to be able to add more variety to
their type of business and types of products that are sold. This would also facilitate the fulfillment
of customers’ various needs and preferences.
• The cost of transport and other business-related costs are very high. According to the women, in
order to reduce overall transportation costs, they should buy a greater quantity of products at a
time.
• Women must cope with unpredictable situations such as:
o Payments made with forged banknotes. Many women reported to have been the victims
of such instances of counterfeit.
o Goods stolen at the market or the warehouse.
o Robberies.
o Loss of perishable goods that cannot be sold rapidly enough during periods of bad
weather or political crisis.
o Selling on credit is also a risk. The cash value of the products sold on credit is not often
recovered. Women report that it is sometimes difficult to turn down credit to their
customers.
Faced with such problems, many women in Port a Piment, said they had to abandon the credit program
not to have to face the stress of constantly searching for money to make interest and principle payments
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In the commune of Aquin, it appears easier for women to run their small businesses in spite of the
difficulties mentioned above. These women tend to have more access to larger markets, and all women
who were interviewed are experienced business women or “madame sara”. The majority of women
participants in Aquin have left the credit program and are continuing to run their business supported by
the program..
In Port a Piment, the situation is quite different. According to a key informant, this area is not an active
trade area, as there are no major markets in the commune as in Aquin. Women in the Port-a-Piment area
said they are very poor, and many of them no longer have their small businesses supported by the credit
program.
Conditions for reimbursement of the principle and interests:
Payment of interest:
In Aquin commune, women who were interviewed report that the payment of monthly interest is not a
problem for them; they are able to pay it back with the profits generated from their small businesses.
 However, in Port a Piment women are confronting serious problems since their profits are not sufficient
to make interest payments. Many women report being many months behind on their payments and, as a
result, used one of the following strategies to make interest payments:
• Use part of remittances received from relatives living abroad
• Use part of the loan principle
• Use a combination of profits and loan principle
• Sell of an animal such as a goat or a pig
• Sell a piece of furniture such as a chair, table, or kitchen utensils
• Sell part of their harvest of corn or beans. (When such an option is not possible during drought
periods women’s economic situation becomes more desperate .
• None of the women interviewed reported borrowing additional money to make interest payments.
They preferred dealing with Caritas instead of individuals or loan sharks and they did not want
other people to be aware of their financial difficulties.
In both Aquin and Port a Piment, all categories of people interviewed (credit participants, Colvols and key
informants) unanimously agree that the credit conditions offered by FODA (the Caritas-CRS credit
program) are more advantageous than the other credit programs available. However, they believe that
interest is still too high since, in order to be able to it back , women are forced to use a larger part of their
small business profits.
Reimbursement of loan principle:
In Aquin commune, the reimbursement of loan principle seems to be the most difficult issue for credit
participants. At the end of each cycle (generally 6 months), all participants within each group have to
return the entire principle in addition to the monthly interest payments. For most women, it is extremely
difficult to come up with the full principle every six months and they have to use different strategies to be
able to do it. Those who raise animals while managing their small business will sell an animal in order to
be able to get the amount needed. Others participate in “consortium” schemes to have access to the
required amount at the time the reimbursement is due. Regular saving is not the most commonly used
method; only one woman reported doing that. Many report having to sell all their products to be able to
pay back the principle. In case the amount is insufficient or participants have not sold everything, they will
end up borrowing the difference. The credit officer and the key informants also confirmed this information
that participants provided. According to women who had participated in the credit program, they borrow
from friends or relatives without interest.
In Port a Piment, women are not obligated to return the principle at the end of each cycle; it is only done
at the end of the first cycle. The principle must be reimbursed when a participant decides to leave the
program.
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Conditions for loan renewal:
With regards to conditions to renew loans in a new cycle, women in Aquin reported two problems:
1. As mentioned above, women must return the amount of the principle at the end of each cycle.
This money is handed over to the credit officers. Documents are then filled in to renew the credit
for the group. If all group members bring back their money, the money is returned to the
beneficiaries to start a new cycle. This can be done on the same day or within the following two
days. Credit participants and key informants believe that, in light of the numerous sacrifices and
losses the participants must face to find the money, it should not be mandatory for them to bring
the money back since it ends up being given right back to them anyway.
2. Moreover, in order for each group member to receive their money back on the last day of the
cycle, all of them must returned the full amount. If any participant does not return part of the loan,
no one in the group receives their new loan. This strategy unduly penalizes those who have made
sacrifices to bring back the money.
The support and training received:
According to all categories of people interviewed in the commune of Aquin (key informants, credit
participants, colvols), the problems arise when the groups become self-sufficient, this usually happens
after two years. At that stage, they do not receive much support from the credit officer. There is nobody to
motivate, train and support the group, which creates confusion within the group.
Participant selection process:
Solidarity is the foundation of this credit program. This means that the whole group is responsible if one
member does not pay. If this happens, the entire group needs to reimburse for the delinquent member.
Therefore, the participant selection process is crucial. Everyone must answer for everyone else’s integrity
and accept to associate herself with the others. The participant selection process has a significant impact
on the regularity of reimbursements. According to the information collected during the meetings,
members who do not reimburse after having received the credit are people who are not well recognized
by the existing group.
According to the key informants, program participants and colvols in Aquin, when the program just
started, groups used to reimburse on a regular basis. Participant selection was done at the level of the
rally-posts (MCH program) using regular participation and credibility status in the community as important
selection criteria. Participants were able to choose their own associations or “makonn”. Problems arose
when “makònn” members started to quit the credit program and the replacement process was not well
defined. According to the information collected during the interviews, the on-going members are not
informed about the origin of the new members added to the group to replace those who have left. The
group committee submits the names of the new members to the credit officer without consulting with the
whole group. Selection criteria for these new members are not well defined. New members are not
necessarily rally-post participants and often live in either isolated areas or in areas unknown from the
group. According to women participants and key informants those new members are the ones who tend
to have problems with reimbursement and are often the reason groups fail and break up. .
In Port-à-Piment, credit beneficiaries are not selected from the rally posts’ participants. Right from the
beginning, selection criteria were not established and not correctly applied. The problem comes from the
fact that, at the group level, some members do not even know each other and some even live in different
localities. Moreover, according to a key informant, there is too much disparity among members of within
each group. Such differences include lifestyle, past experiences, life interests and attitudes and outlooks.
All of these elements are essential for solidarity within the group and a crucial condition for the success of
a credit program.
Recommendations made by the participants and key informants
In Aquin commune
• According to the key informants, beneficiaries who participate in the credit program should
receive a training on marketing issues to assist them in identifying the type of business to
establish while taking into account community needs
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• Key informants also propose that beneficiaries do not reimburse the principle at the end of each
cycle. They think that the interest paid on a monthly basis should be considered as a long-term
reimbursement of the loan principle.
• With regards to the participant selection process, it was suggested that, when a member quits the
group, her replacement cannot be chosen without consulting with the colvols in the community
and the other group members. The colvols should always have a waiting list of potential
candidates interested in joining the credit program in case some members decide to quit. It was
also suggested that the colvol in charge of the community rally post participate in each end-of￾credit cycle meeting, be informed of cases of abandonment, and be able to propose new
members to the group. If a new member wishes to join a group, the group must approve its
choice. Moreover, any change within a group should be the subject of a new agreement between
the group and the organization that loans the money.
• With regards to the management of the funds, the key informants proposed the following:
- The group bank book should be in the hands of the committee
- Two committee members should have the right to sign on the bank book
- Two signatures should be mandatory for any bank withdrawal: the credit officer and a
committee member
- Group members should be informed before any withdrawal is done. The amount and the
purpose should be recorded in the meeting book
- Group members should be regularly informed on the balance of the group bank account.
- If a group has completely reimbursed the principle, a member who wishes to quit the
program should have access to his/her savings
- Procedures should be simplified to allow members to have access to their savings
- Group members should have access to a share of the interest
• In the case of non-reimbursement of the principle by all group members, the program should
establish a fair procedure for sharing savings
• The credit officer should continue to support credit groups even though they have reached
“autonomous” status.
• The role of the committee should be better defined. The committee should not make decisions
without consulting with the other group members. The committee is perceived as having too
much authority on the group, which is often kept out of the decision-making process. At the same
time, the committee is often not able to assume certain responsibilities since it is under direct
control of the credit officer.
A Port à Piment
Suggestions proposed by the persons interviewed are the following:
• Revise the participant selection process
- Collect better information on their credibility
- Participants must be authentic business women
- Within each group, members must have similar socio economic backgrounds and life
styles
• Beneficiaries should receive continuous support from the credit officer
• Interest rates should be decreased
• Port a Piment, being a difficult area for commercial activities, micro-credit could be used for small
food processing projects.
ii) Do young children benefit from the credit program for mothers?
According to some interviews conducted in Port-à-Piment, the credit did not help women in improving
their economic situation. On the other hand, for some women, the money received allowed them to take
care of some emergency situations such as school fees, rent and medical treatment. At the beginning,
some women were able to make a small profit, but not sufficient to pay the interests and fulfill all
household needs. For the majority, the credit did not directly contribute to the improvement of child
feeding and nutrition. However, they report dipping into their business inventory to feed their children,
since most of them run food-related businesses.
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In Aquin commune, the situation is completely different. Even though women report not investing more in
the feeding of their children, the latter indirectly benefit from the small business program. Les bénéfices
réalisés par les femmes ne sont pas perçus de façon monétaire tout comme les femmes ne sont pas en
mesure de dire ce que représente le crédit (Elisabeth est-ce plutot “profit” ??) dans le du business.
Women do not readily report an improvement in child nutrition as a benefit of the credit program.
However, all report that going to the market on a daily basis gives them the opportunity to buy foodstuffs
for the household. This also allows them to diversify the food given to the children and to avoid using all
harvested crops for household consumption. As such, they are able to store part of the harvest and sell it
when prices are higher.
In both Aquin and Port a Piment, the people interviewed acknowledged the impact of the credit program
on reinforcing social capital and relations among group members. They learn how to work as a group and
to better organize themselves. It was also their first opportunity at saving. Some received training on how
to manage a business. All beneficiaries report that the credit allowed them to have access to loan to meet
an emergency without having to borrow from high-interest street lenders or loan sharks.
In Aquin, all beneficiaries unanimously acknowledged the changes that occurred in their lives since they
received the credit. They were able to reinforce their small business. They also used the profit to improve
their housing conditions, to launch or expand animal raising activities, or to buy seeds or fertilizers. Key
informants report that it is difficult to imagine the level of abject poverty of women participants before
joining the credit program.
5.1.b. Community Health Workers Credit Program
With regards to the colvols credit program, the objectives of Phase II were the following:
i) Examine the difficulties encountered by the colvols during loan reimbursement
ii) Examine the impact of the credit program’s incentive effect on colvols’ work
iii) Discuss alternative sources of motivation and incentives for participation other than credit
i) What are the difficulties colvols will face under the new credit program management?
Right at the beginning of the meeting, colvols in Aquin commune, expressed their concern regarding
CRS’ decision to change the management of the credit program. According to the colvols, CRS would like
the colvol credit program to begin to be managed by the partner Caritas, despite the fact the program has
been well managed by colvols themselves ever since 1991. They feel such a change is unnecessary
given that the program has produced positive results under colvols’ direction. Many participants feel that
the change in program management will be to their disadvantage, as conditions for participation will likely
change. Therefore, many colvols plan on discontinuing their participation in the credit program once they
have paid off their existing loans.
According to the colvols:
• The change represents a loss of autonomy and self-worth for colvols, since they were managing
their own credit portfolio perfectly well until the decision was made to have another partner
assume management responsibility.
• The old management system allowed colvols to create a growing and revolving line of credit
through the interest that was paid on the loans. The perception now is that the interest will not be
used to increase the revolving credit.
- Through Caritas, they are asked to reimburse the loan principle at the end of each cycle
rather than continuing a line of credit as practiced under the old management system.
This procedure will have severe implications on their business activities. In order to be
able to return the capital at the end of each cycle, they are losing profits generated by
their small business activities. In many cases, reimbursing at the end of each cycle is the
equivalent to losing their initial investment.
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- By and large, colvols report that, under these new terms, they would prefer to return their
loan principle and end their participation in the credit program altogether.
According to the colvols and key informants in Port à Piment, the credit management is already being
undertaken by Caritas. Colvols report that they also have to reimburse the principle at the end of each
cycle. As in Aquin, this is a problem for Port-a-Piment colvols since it is often difficult to find that money.
A key informant in Port-a-Piment reported additional factors that could explain the difficulties colvols have
faced regarding loan reimbursement:
• People have different ways of managing their business
• There are several constraints linked with last year’s severe drought
• From an economic point of view, problems differ from one person to another
• It is more difficult to make profits with certain types of businesses. For example, if someone sells
an agricultural product such as rice, a portion of it is often used for household consumption.
• Many colvols lack alternative sources of income.
Advantages of the credit program for the colvol:
In the commune of Aquin, even though the colvols were not pleased with the management changes,
they were, on the other hand, very enthusiastic during the discussion on the impact the credit program
has made in their lives. The credit has enabled them to do the following:
• Compile savings. “Before joining the credit program, we did not know what a savings bank book
was”, stated one participant.
• Learn how to manage small businesses.
• Avoid using loan sharks and street lenders during emergencies..
• Avoid the humiliation of borrowing through informal channels (friends, family, street lenders, etc.)
• Send children to school
• Use the profits for the feeding children, especially during the lean and dry seasons
• Provide care and treatment for severely ill children thanks to the profits generated by small
businesses.
• Make home improvements
• Obtain the satisfaction of starting a small business and watching it grow.
• Buy and store grains when prices are low and resell them at a profit.
• Invest in profitable small businesses such as the raising of small animals.
• Have access to purchase more goods in order to expand small businesses.
According to the key informants in Aquin, the credit program helped significantly improve colvols’ living
conditions and quality of life. Overall, the colvols felt that the credit program not only improved their
economic outlook but also improved their self-esteem and made them feel like productive members of
society. Most colvols felt that, in the absence of the credit program, their ability to provide for themselves
and to run profitable small businesses would substantially diminish.
In Port à Piment, key informants and colvols were reticent when asked what the credit program had done
for them or what they would do without the credit. One colvol replied, “sometimes the loan helps you a lot
and sometimes, it puts you in a bind [financially]”. According to a key informant, in the past, it was not
difficult to manage and take advantage of the credit. The drought and the high cost of living have made
activities such as animal-raising and agricultural very difficult, thus making loan reimbursement less more
challenging. The interview participants spoke more about the difficulties of loan reimbursement than
about the advantages and opportunities the credit afforded them. Colvols in the Port-a-Piment areas
experienced many of the same problems experienced by the women credit program beneficiaries.
ii) Impact of the credit program as an incentive for Colvol participation in MCHN activities
According to key informants, the credit program encourages the colvols to do their best in participating
in the very demanding work expected of them in the MCHN program. This work consists of organizing
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rally posts, preparing reports, participating in community meetings, making home visits, etc. The credit
represents a small compensation compared to the services they provide to their respective communities.
The key informants interviewed perceive the colvols in the following ways:
• The colvol is the link between the hospital and the mothers. He/she encourages and sometimes
accompanies mothers to go to the health centers. According to key informants, without the
colvols, there would not be as many people going to health centers.
• The colvol facilitates communication between the health center and the community. He/she
passes on important health messages to the community.
• According to some people responsible for health centers, their success is directly related to the
colvols’ presence.
• The colvol’s work is very important for the community and very demanding for the colvol.
Communities are very rarely critical of their work or performance.
• The colvol is the key to making community health care activities work.
• The colvol is like the “salt in the food”; he/she is the core strength of the health centers. This is
because the colvols are the ones doing the most demanding work: traveling to isolated areas to
conduct rally posts, administer vaccinations, and conduct motivation and training sessions for
mothers.
• Without the colvols, there would be a huge gap in health care provision in the targeted
communities.
• The colvol is devoted. He receives no salary.
• The colvol is the most important and often the most admired worker in the health care system
• The colvol performs wonderful work and deserves more encouragement
The mothers also show a great appreciation for the work of the colvol. Covols encourage them, give
them advice, and inspire trust from them.
From their perspective, the colvols report to be the leaders and among the most well known members in
their communities. As such, they would continue to work as colvols even if they did not benefit from the
credit program. However, they would probably not have the same level of strength to perform their duties
since the credit program allows them to eat better than before.. Moreover, had the credit program not
come along, they would probably have eventually moved somewhere else to escape their poverty; the
credit program prevented this from happening by offering colvols the possibility of developing profitable
small businesses.
The most motivating factors for a colvol are the following:
• Providing a real service to their community
• Being well recognized in their community.
• Establishing trust with the people they serve.
• Earning respect and self-esteem through their work.
• Helping save children’s lives.
Other factors that encourage them are the following: 
• Training provided by CRS
• Small per diems provided during trainings
• Some colvols report being treated with respect by CRS and the health institutions with which they
are associated.
iii) What are the other elements that could contribute to motivate the colvols in their
 work
The colvols wish they could have more possibilities to help the people in their community because, very
often, they are the first to be contacted when community members have problems. They would like the
following:
• More training to better develop the health education topics. They would like to have the same
training as that provided to conduct the mothers’ clubs.
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• Learn how to give vaccines. 
• Learn how to control blood pressure. Some people suffer from high blood pressure in their
communities and they could refer them to the health center in case of emergency.
• Have access to a first aid kit.
• Have a stretcher to transport urgent cases to the health center
The colvols wish we could offer them more benefits for participation such as:
• To be used as resources for some positions for which they have the qualifications.
• Have an access card for health care services, including a special rate for health care and
medication for themselves and their families.
• Benefit from some benefits in the health institutions, such as access to free consultation when
they are sick, a letter of reference when they need to consult another health center, exemption in
case they need to buy medications, better and more rapid access to health services in the
centers for which they work.
• Have an identification badge.
• Participate in a large meeting of all colvols on a periodic basis (yearly or every two years); this
would give them the possibility to exchange ideas and share experiences, etc
• The reopening of the household latrine program and water capping projects that used to help the
communities while providing them with some income (colvols were actively participating in the
latrine program and received stipends for the construction work they were doing)
• “Have a kind gesture” for them (small amount of money) at some specific periods of the year,
such as the beginning of the school year, Mother’s day, and the end-of-the year holidays in
December.
5.2 Water and sanitation
School Latrines
To explain the weaknesses observed in the maintenance of school latrine infrastructure (Phase I report),
interviews were conducted with CRS education program field animators, school directors, teachers and
PTA board members in two schools where latrines were not adequately maintained. The two schools
visited were in Chardonnières and Port-à-Piment.
Three elements were considered for the maintenance of the latrine building: the closing of the doors, the
cover on the latrine seat and the lock from the inside. The results of the interviews show that the incorrect
functioning of any of those elements does not result from a misunderstanding between the school office
and the PTA members. The relationships between those entities seem fine and PTA members seem well
involved in school activities by providing their contribution. The interviews showed that the problems in
the maintenance of the latrine structure were rather the results of some communication issues and slight
negligence.
The closing of the doors: according to the interviewees, all doors have functional locks. The keys are
kept in the director’s office or by the guard. However, some doors present some construction defects in
the way they are installed and the doors can be opened from the outside without using a key. This is the
case for one of the schools where the lack of fence facilitates access to the schoolyard to intruders thus
making the proper management of the latrines difficult.
For the cover on the latrine seat, interviewees from one the two schools claimed that they were not
informed that the latrines should be covered; they received this information about a month ago by a CRS
animator. The school director confirmed that the covers are currently being made and they will be
installed shortly. For the other school, the personnel in charge confirmed that the covers exist; however,
according to the assistant director, one of them came off and it seems difficult to reinstall it. PTA members
were not informed of that situation.
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For the locks from the inside, it is simply non-existent in both of the schools visited. In one case,
interviewees thought they existed, but never paid any attention during maintenance checks. CRS
animators confirmed they failed to insist on the importance of a lock from the inside of the latrine and they
will soon present the correct message.
5.3 Education
Some key issues pertaining to education that were not addressed during Phase I were examined during
Phase II. Those points were the following:
• Causes of students’ school dropout
• Use and assessment of training materials provided by CRS
• PTA members’ contribution to the development of their schools.
Causes of school dropout:
CRS decided to examine the reasons why a high rate of school dropout was observed in some schools of
Aquin commune. To address this issue, meetings were conducted with a first group composed of school
directors, teachers and PTA members from three different schools in Aquin commune, and a second
group composed of parents whom children had dropped out from those same schools.
According to the two groups, the main cause of school dropout is associated with financial difficulties.
Very often, parents cannot manage to pay the school fees of 600 to 750 gourdes per year (including
entry, school and canteen fees) payable by installments throughout the year. According to the parents
met during the survey, the lack of financial means is the primary cause of school dropout. If a parent fails
to settle his debt with the bursar office, the school director will wait for a few days and then send the
student home. This situation frequently occurs before quarterly and final exams. However, there are
cases where the action is not taken by the school director. Sometimes the decision not to return to school
is made by the student himself/herself who decides to stay home to avoid the humiliation associated with
the parents having failed to pay the school fees. In some cases, the director’s office publicly reports the
names of those who are have debts with the bursar office.
The parents stated that a student is not definitively returned home because of debts. As soon as the
parents pay their dues, the student can return to school. This kind of regular disruption results in several
days or months of missed classes and exams. Consequently, the student’s ability to learn is severely
affected. Very often, the student cannot keep up with the current class level and must repeat the same
grade the year after year. As a result, a student may remain in the same class for several years or may
simply leave the school altogether because he/she has either become too old or was not able to keep up
with their grade level. Therefore these kinds of periodic suspensions and absences often lead students to
drop out of school completely. .
With the persistent increase of school fees and of the cost of living in general, parents report that it is
becoming more and more difficult for them to pay for school fees. This situation is exacerbated when the
harvests are poorer in single parent households (for example, in the case of a widow or single mother).
According to parents, the underlying cause of dropout is due to these socio-economic factors.
In the case of a poor family with many school-aged children, parents are forced to choose between what
children will attend and those who will not. How is the selection done?
• Some parents report continuing with those children who are in the higher grades and withdraw
the younger ones from school to allow the older ones to acquire as much knowledge as possible.
• Even though the above strategy is the most common one adopted by the parents, they will only
keep the more advanced children in school until they reach a certain level. As explained by some
parents, “Until they are able to survive by themselves, to sign their name, etc”. At some point, the
older ones will be withdrawn from school to allow the younger ones to also acquire a minimum of
knowledge.
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• The choice depends on the learning abilities of the child and his/her school performance. Under
this scenario, the smarter ones remain in school.
• Sometimes the choice is made by the school director who decides to let a child attend the school
in spite of his/her debts, because he/she is particularly gifted and intelligent.
• The type of school attended by the child could also have an impact on the choice and priority.
According to a key informant, parents will prioritize fees for children attending a congregational
school, then, a secondary public school, and so on.
According to the parents, the sex of the child does not influence their choice. This was confirmed by a
rapid analysis of available data on children of both sexes attending school compared to the number of
children of both sexes in the same area. Results show that there is no sex discrimination when it comes
to decide which child should go to school.
Even though the non-payment of school fees remains the most important reason for school dropout,
questions were discussed with the two groups to look for other causes of school dropout. The results are
the following:
• According to some school directors and teachers, some children must stay home to help with
agricultural tasks and animal husbandry. This is especially common in the case of a single
mother. However, according to interviewed parents, if a child cannot attend school, the primary
reason is not because the child is needed for household tasks but because the family simply does
not have the financial means to send him/her to school. All parents all would like to see their
children go to school.
• The quality of education and the quality of teachers are also mentioned as a cause of school drop
out by all three groups: directors, teachers and parents. Sometimes parents change schools just
to have their children in the class of a specific teacher they believe is good. The opposite is also
true.
• Occasionally parents will have a child change schools because of his/her poor performance.
• The school discipline and punctuality of the teachers are other important elements for the
parents. Some parents mention having had to withdraw their child from a school because of the
teachers’ irregularity.
• Early pregnancy among adolescents: school directors and teachers indicate that cases of school
dropouts due to early pregnancy are common among adolescents. This often occurs when the
school fees are paid by a male friend. When a girl is pregnant, the school prevents her from
coming to school. She may also be subject to the mockery of other schoolmates. One of the
parents interviewed during the survey reported having to have her child dropped out the school
because she had become pregnant.
• Relationships with other students, the appearance of the school building and the uniform:
according to school directors and teachers, some students would like to be with their friends who
attend another school; others refuse to remain in a school because they are the subject of jokes
from their schoolmates because their clothing is ruined or dirty, or simply because they do not
have decent shoes.
• Parents’ incapacity to buy school materials or to fulfill some school requirements, such as the
uniform and the closed black shoes, is also another cause of school dropout mentioned by the
interviewed parents.
School dropout resulting from household financial difficulties (the most common reason) often leads to a
definitive drop out. In most of the other cases, the problem can be solved by a change of school if the
parents have the means.
According to the groups met during the interviews, children who withdraw definitively from a school are
emotionally affected. They feel inferior and become bitter. Parents loose their control more rapidly; they
hang in the streets or in the bush. They are more exposed to bad companions, alcohol and drugs.
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Impact of school canteen:
Even though they acknowledge its importance, parents do not consider the non-existence or the quality of
a school canteen as a cause of school dropout by a student. However, school directors and teachers in
the area of Aquin report that even though this does not represent a cause of school dropout, the canteen
is an incentive for children to come to school. They explain that when there is a disruption in the stock,
fewer children come to school and, for those who come late; they cannot concentrate easily and have to
be dismissed earlier than usual. According to interviews done with school directors and teachers in les
Anglais and Port-à-Piment, a similar situation prevails on the south coast.
Use and assessment of training materials provided by CRS:
In both areas covered by MTE Phase II, Aquin and the southern coast, school directors and teachers
appreciate trainings provided by CRS These trainings consist of pedagogical sessions related to the use
of attendance books, pedagogical boards and practical guides for administrative procedures.
All interviewed teachers had the opportunity to participate in a whole series of pedagogical training
sessions from September 2004 to March 2005, except for one new teacher who only attended one
session. This training allowed them to considerably improve the quality of their course work. They do not
perform lectures as they used to do, but rather encourage more student participation. They are able to
better prepare their courses and use concrete and practical examples. They can also prepare better
evaluation tests for the students. The success rates for the primary school national exams (CEP) have
increased as a result.
The school directors show more interest in the preparation of the lessons, and can provide a better
support to the teachers. They can also review and correct exams. Thanks to the training received on the
“Guide Pratique d’Administration Scolaire (GPAS), they now know how to use the detailed national
program developed by the Ministry of Education, are aware of the criteria for teachers’ recruitment and
students’ admission, and can better control students’ attendance and monitor absences. Consequently,
the success rate for the Primary School National Exams has increased. In one school of Port-à-Piment,
the success rate for the primary school exam was less than 50% three years ago, 64% in 2002-2003, and
reached 100% in 2003-2004.
The teaching materials/pedagogical posters have allowed for improved presentation skills and a better
involvement and participation of students; however, the number available is insufficient. The school
directors in Aquin report that they did not have the means to acquire more than three posters. They are
kept in the school director’s office, and are often used to the benefit of students of higher classes and not
for the youngest ones.
School directors raised the issue of high rates of resignation and quitting by teachers after they have
received training sessions from CRS. They consider that to be a major loss for their school. In Aquin,
each of the three school directors interviewed reported the loss of three trained teachers. Of these 9
teachers, four definitively left the teaching career and the remaining five work in different schools.
According to the school directors, salary is the main reason for their departure.
All interviewed parents said that they are aware of the activities realized by CRS in the schools. They
mentioned:
• School canteens
• Deworming medicines
• Health, hygiene and nutrition trainings
• Distribution of materials (desks, benches)
• Training for PTA members
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Interviewees have expressed a high level of satisfaction and appreciation for the work CRS is doing.
PTA members’ contributions to school development:
According to PTA members and school directors present in the focus group debates, PTA members
implement numerous activities that contribute to the development of their school. Among those, PTA
members
• Participate in the construction of school buildings or the rehabilitation of some rooms, by providing
water, construction materials, or by working as a daily worker.
• Participate in cleaning the school.
• Assist in re-establishing discipline inside the school.
• Make sure school canteens are properly managed ensuring the quality of the meal
• Bring their contribution to the daily operations of the school canteen, such as wood/charcoal for
cooking the food.
• Contribute financially to the acquisition of some materials or furniture for the schools.
• Conduct quarterly meetings with the parents.
• The school directors turn to the PTA members to encourage the parents to pay the school fees.
PTA members report to be interested in all aspects of student life and school-related activities.
At the moment PTA committees were created, their relations with the school director were somewhat
tense due misconceptions one another’s roles. PTA members felt they had the ultimate say and decision￾making power over all aspects of school administration. The directors, however, did not feel comfortable
with working with the PTA members who presented a challenge and threat to their authority over the
school. . A school director admitted that initially they viewed the PTA as an embarrassing organization.
Through CRS training sessions, they gradually came to an understanding with one another and the
directors began to understand the importance of the PTAs. Additionally, PTA members realized that what
was really needed was open and honest cooperation between themselves and the school director.
According to CRS animators, there is a major change in the integration of PTA members in school
activities. Some directors even recommend refresher sessions so that they can continue to deepen this
cooperation. When there is an open understanding and trust established between the community and the
school staff, it allows for an increased approval and success rate of school-related projects and ensures
that school infrastructure is maintained.
5.4 MCHN
MTE Phase II objectives for the MCH program were the following:
1.a. Identify the factors that motivate mothers to take their children to the rally-posts and eventually, the
factors that could contribute to increasing their motivation
2.b. Understand the reasons why the percentage of pregnant women who deliver in health institutions is
lower than expected in comparison with those delivering at home
3.c. Collect additional information on the food rations received by pregnant and lactating women.
4.d. Understand the reasons why women in the area of Aquin attend fewer prenatal visits than in the
other areas
a. Factors that motivate mothers to take their children to the rally posts
Results from Phase I showed that children 12-24 months old are not taken to the rally posts as regularly
as children less than 12 months old. This finding is more pronounced in the area of Aquin. During Phase
II, focus groups were conducted to better understand what motivates mothers to take their children to the
rally posts.
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All mothers who were interviewed had children more than 12 months old and continued to take them to
the rally posts. They report to be interested in all activities carried out at the rally post:
• Vaccination:
Vaccination is reported as the most motivating activity conducted at rally posts. According to
mothers, rally posts are often overcrowded with children of all age groups when vaccinations are
being administered. Even mothers who do not usually take their children to the rally posts are
present on those days. . By the time a child has received all his/her vaccines, many mothers stop
taking their children to the rally post.
• Weighing
Mothers are interested in weighing their children in order to monitor their progress. They report to
be proud when the child gains weight, and when the child does not gain weight, they receive
advise on how to help them to recover. The weighing seems to be more important for children
less than 12 months old. Mothers explain that, at that age, children are more fragile and they can
die easily from “minor” illnesses. After one year of age, there are people in the community who
believe that children are more resistant to disease and that the risk of mortality has been reduced
(The expression in Creole used to describe this is, “yo finn chape”).
• Education sessions
Mothers report to greatly appreciate the education sessions given at the rally posts because they
are taught how to take care of their children and, if they are sick, the colvols give them advice.
However, among the interviewed mothers, a majority had not attended education sessions the
last time they had taken their child to the rally post. The reasons for not attending reported by the
mothers are the following:
- They arrived late and the education session was finished by the time they arrived. In all
rally-posts, education sessions are done before all other activities take place. The colvol
waits until a certain number of mothers are present to start the session. Once done,
he/she continues with the other activities and the education session is not repeated.
- They were on time but there was no education session because too many mothers came
late. The colvol had started right away with the other activities. Some mothers said that
their child had already been weighed at the Aquin hospital where the education session is
not usually done
- They were absent. Some had their child taken to the rally post by somebody else, for the
others, their children did not go at all.
- The waiting time in the rally post is too long; this is why some mothers are not interested
in coming early. Some mothers send their children ahead of time with somebody else and
come later. This is a way for them to save time since they have many things to do at
home.
• Vitamin A
Mothers are very conscious of the importance of Vitamin A for their children. This activity
encourages them to take their children to the rally post.
• Deworming medication
More children are present at the rally post when there is a distribution of deworming medication.
According to the colvols, occasionally children who are completely vaccinated come to the rally
posts only on the days there is a distribution of deworming medication.
Key informants and colvols validated the information provided by the mothers. In addition to the services
offered, key informants and colvols reported other factors that motivate mothers to take their children to
the rally post. Those factors are:
• Many colvols remind the mothers in the locality the day before or the day of the rally post (this is
done by home visits or with a megaphone). Mothers say that this is a highly encouraging method
since they have a tendency to forget the date. Moreover, when children hear the colvol making
the announcement with the megaphone, even children who are old enough to understand
(starting at 2 years) ask to go to the rally post. This seems to be an important means of
motivation to take the oldest children to the post since mothers get pressure from them. Many
colvols explain their success with that method of communication. One mother said that she likes it
when the colvol comes around to remind the day of the rally post.
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• The colvols’ “way of doing”: Some colvols are more patient than others and speak gently with
mothers, inspiring trust. However, other colvols become angry when mothers do not understand
the messages and some colvols resort to encouraging mothers by giving candy to their children.
• The popularity of the colvols also has a positive effect; it stimulates mothers to pay more attention
to what the colvol is doing and saying. A key informant in Port a Piment reports that a colvol who
is socially isolated does not have the same level of efficacy as one who is well-known around the
community.
• The level of socialization of the people in the community. According to a key informant in Port a
Piment, the more there are social activities in the locality, the more people are interested in
participating in the rally post. This is the case of Baillet rally post.
• The distance between the post and the place where mothers live. Mothers are more encouraged
to go to the rally post when it is near their home. According to some colvols in Aquin, a few rally
posts are for mothers who live in the mountains; it is difficult for them to bring their children
(especially in Modis, Bois Jean Ba, Nan Bel Air). According to the colvols in Port a Piment, It
seems that the distance is not a problem since the longest time the mothers have to walk to go to
a rally post is 20 minutes. Mothers who do not live near the rally post will only take the youngest
one to the post if they have more than one child less than 5 years old. Distance is also an issue
for pregnant women if they have to carry a young child.
• Small gifts: Many years ago, some mothers remember being given soap or cups in the rally
posts. This was an effective motivation strategy.
• Food supplements: In Aquin, some women and colvols reported that the food supplementation
program for lactating women is one of the factor motivating mothers to take their babies (less
than 12 months old) to the post. For example, when there is a shortage of commodities in the
center, the number of participants to come to the posts significantly decrease (for example 10
instead of 30 or 60 instead of 136). When the child gets older than 12 months, the mother is less
interested in doing as much for her child especially since he has received all his vaccines and his
chances of surviving are perceived as greater.
In Port à Piment, the food supplement does not seem to be a determining factor in the motivation
of the mothers. Interviewed mothers showed a real enthusiasm for the rally posts. The colvols
report that mothers are highly motivated. Colvols report that some mothers refuse to take their
children to the center when they are referred for nutritional recuperation because of the weight
loss. Those mothers consider this as a disgrace and do not want to be seen as mothers who are
not feeding their child adequately and prefer to take care of child with their own means.
According to the key informants and the colvols, mothers of children more than 12 months old need more
incentive to take their children to the post. Although lack of motivation of this group of mothers is
somewhat related to the fact that the program no longer provides them with a food supplement, the drop
in participation is also directly linked with the perception that children who have received all their
vaccinations are at less risk.
What should be improved in the rally posts?
• Mothers report that too much time is wasted when they have to wait for the latecomers for the rally
post activities to begin. Some suggest weighing should begin as children arrive and that education
could be done when a certain number of mothers are present. Following the education sessions,
the colvol could then continue with the other activities.
• Mothers consider that the education session is done for too many people at the time. It is
sometimes difficult to hear as children cry and parents talk to each other. According to key
informants, colvols do not have the time to repeat the education session for different groups since
they are alone to do all activities in the post.
• Key informants suggest that at the level of the rally post, the education session could be organized
the same way it is organized in the mothers’ club. The colvols could be trained for that and receive
the same training material.
• Key informants consider that in some rally posts; there should be more people to carry out the
activities. At the beginning, there was supposed to be 30 children per colvol. Now, some rally posts
have more that 75. Moreover, colvols who are trained to do vaccination have additional work to do.
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• Mothers say that in some posts, there are not enough seats, especially on days when vaccinations
are conducted. They wish there could be more seats available. This was also reported by the key
informants.
• In some posts, there is not enough shade. Mothers wish they could have a “covered” site.
• Mothers would like there to be ORT packets regularly available in the rally posts. The same
suggestion was made by colvols.
• Some mothers think that children have fever after having receiving the vaccines because the
“person who gave the vaccine was not patient enough”. (This should be investigated in order to find
out if mothers are not well informed of the side effects of vaccines or if the method used by the
person who gives the vaccine should be examined).
• All groups that were interviewed would like vaccinations to be done in rally posts on a regular basis
because distances to get to the health center are too long.
• Some mothers think that more demonstrations should be done in the rally-posts such as for oral
rehydration salts and AK-1000.
• Many colvols believe that resuming household latrine building program would encourage mothers to
come to the rally posts.
b. Why are there fewer women to deliver at the hospital than expected?
The majority of women recognize the advantages of delivering the baby in a health institution, especially
for rapid care in case of an emergency. However, results of Phase I show that there are fewer women
than expected that deliver in a health institution. Reasons reported during the interviews are the following:
• The distance between the home and the health institution: some women who had taken the
decision to deliver in the health institution report not too have had the time to get there (delivery
with too rapid progress, transportation problems).
• Conditions for delivery at the hospital:
- Women are afraid of the delivery table that they call “ti bourik” (a Creole word for donkey). The
position is not comfortable, their intimacy is not respected and they are exposed to everybody
else to see. They are left without surveillance on the table and they are afraid that their baby
falls when they are pushing.
- They are scared of the episiotomies, the “scissors” as they said.
- They cannot get the support from their spouse the way they would receive it when they deliver
at home (they cannot rest their back on him)
- They cannot deliver in the position they would like to.
- They do not have the encouragement and assistance they get from the traditional birth
attendant; they say they feel alone.
- The delivery at the hospital is expensive: in addition to the fees for the bed, women must pay
the medicines. At the Aquin hospital, it costs much more than anywhere else for the bed. They
pay five times the amount requested in neighboring institutions (250 gourdes compared to 50
gourdes) and they must buy everything including the gloves for the staff. If they deliver at the
hospital, they have to pay all expenses.
- They must have nice clothes for the baby and for themselves as they would not like on-lookers
to see their socio-economic status. At home, they can wear what they have without fear of
being judged about their appearance.
- The health professional staff’s bed-side manner is not always good or welcoming in the health
institutions.
• There are some local customs/taboos they wish to continue to respect but cannot be respected if
they deliver at the hospital. These customs include:
- Leaving the doors closed after the delivery
- Plugging their ears during delivery. “Do not take wind” (The expression in Creole to describe
this is “pa pran van”),
- Keeping the head of the baby covered
- Taking hot water baths with herbal leaves
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Health card:
All women who were interviewed report to have their health card. It is the same card used for all
deliveries, except if they do not frequent the same health institution (each health institution provides its
own card).
c. Food rations received by the pregnant and lactating women
Mothers report that the rations are the same for pregnant and lactating women and the quantities are:
¾ 4 marmites of wheat
¾ 2 marmites of beans
¾ ½ gallon of oil
However, it might happen that the ration is slightly decreased if there are more women than expected.
According to women, rations are distributed in a very irregular manner and most of the time, this is due to
disruptions in the stock. However, in addition to stock disruptions, women in Aquin report other situations
where they did not receive any rations. For example, many mentioned not having received any rations
because the wait for consultations is long and by the time they come back from the consultation, the time
scheduled for the distribution is over (in Aquin, the distribution usually stops at noon).
d. In the area of Aquin, why are there fewer mothers to do post natal visits compared to the
 other areas?
During Phase I, it was noted that significantly fewer women were attending the post natal clinic than in
other zones. Reasons reported by the mothers to explain that finding are the following:
• According to the colvols and key informants, the main reason is that the Aquin hospital that
provides health services in the area did not have food supplements for many months; therefore,
lactating women do not receive food supplements the same way they do in other institutions.
Some colvols report that some lactating women go to other institutions where food supplements
are available. However, according to other colvols, it is not always easy for women to receive
food supplements in an institution other than the one located in their area since they do not have
a reference card issued by such an institution. Although the area covered by each institution is
well defined, some women confirmed having two cards from two different institutions.
• Colvols also report that some women, especially the eldest, do not attend the postnatal clinic
because it is not part of their tradition. They would go only if they would have a health problem.
Within a group of six women who were interviewed, none had done a post natal clinic visit since
the birth of their last child. Four said that they did not have to do a post natal clinic visit since they
did not have any problems, but that they continue to bring their babies for check-ups at the clinic.
Some acknowledged never having heard of post natal clinics.
The reasons listed above seem to be linked to one another. If women do not feel the need to go to a
post-natal clinic, there must be other factors that may encourage them to go. The food supplements seem
to be a motivating element.
According to key informants, the following reasons can explain why mothers do not go to the post natal
clinic in Aquin hospital:
• The increase in the cost of services: an amount of 25 gourdes is requested just to look for their
file and the medication is very expensive.
• The way patients are welcomed needs some improvement
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CHAPTER 6 – MTE CONCLUSIONS
6.1 MAJOR RESULTS AND RECOMMENDATIONS FOR PROGRAM OPERATIONS 
6.1.a Agriculture
Results Recommendations for Program Operations
• All 11 indicators measuring the adoption of improved
agricultural techniques by farmers and perceptions of
farmers on women participation in farmers’ associations
met the MTE target (*)
• Continue project activities as currently structured and
implemented by Caritas and CRS and extend in new
zones using the same program strategy
(*) Note: Had the performance benchmarks been set higher, thus making it more challenging for the farmers to pass on the
 indicators, weaknesses in the project may have been revealed and hence, reinforced.
6.1.b Micro credit
i) Community Credit Program
Results Recommendations for Program Operations
Phase I:
• Targets met for issues related to group management,
solidarity amongst members, selection process, literacy
and numeracy levels
• Even though no additional money spent on food for
children, less food is used from the household production
and food diversity is increased because of increased
access to markets
• Participants in Port-à-Piment area have more difficulty to
reimburse their loans
Phase II:
• All people interviewed agree that the credit conditions
offered by the Caritas-CRS credit program are more
advantageous that the other credit programs. However,
they believe that the interest is still too high since they
have to use a large part of their profit to be able to pay
the interest.
• In Port a Piment where participants have difficulty
reimbursing their loans:
- Participants acknowledged the impact of the credit
program on social capital, they learn how to work as a
group, the credit allowed them to meet emergency
without having to borrow from loan sharks. But the
credit did not help them in improving their economic
situation.
- Problems encountered: extreme poverty, obligation to
use part of the loan to satisfy family obligations, lack of
past business experience, no other sources of income
to cover part of the monthly interest payments, Port a
Piment is not active trade area.
- Many women had to abandon the credit program since
their profits are not sufficient to make interest payment.
Some women are still paying interest on a principle
they are gradually reimbursing.
- Selection criteria: participants not selected from rally￾posts, selection criteria not correctly applied. Too much
disparity among group members (less solidarity).
• CRS micro-finance staff together with its partner
should immediately address the findings specific to
credit groups in Port-à-Piment, formulate concrete
recommendations for the continuation of the
program in that area, specially for participants who
experience difficulties, and ensure the
recommendations are rapidly applied
• CRS micro-finance field staff together with their
partner field staff should conduct a rapid analysis of
all other micro-finance women groups (a sample in
each programmatic area) to verify if no other groups
are experiencing situations similar to Port a Piment
• With regards to on-going groups, CRS should work
closely with its partner to:
- Provide in-service training to their field staff (credit
officer) on a regular basis
- Ensure list of participants is always up to date
- Examine current conditions of payments: interest
rate and loan capital
- Reinforce training programs for all participants
(including how bankbooks work)
- Enhance the involvement of group members in the
decision making process
- Ensure group committees share loan
management information with all group members
- Involve all group members in the selection of new
participants to replace those who decide to quit
the group and ensure new members fulfill group
criteria
- Enhance the involvement of the colvol in the
selection of the new members and in the overall
group management
- Review program strategies to ensure autonomous
groups continue to receive support from the credit
officer
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Results Recommendations for Program Operations
• In Aquin where many groups are “autonomous” (they
have reimbursed the loan principle):
- All beneficiaries acknowledged the significant
improvements in their living conditions since they
joined the credit program
- They learn how to work as a group and to better
organize themselves, can meet emergency without
having to borrow from loan sharks
- Payment of monthly interest is not a problem; many
women are “true” business women and Aquin is an
active trade area.
- Reimbursement of loan principle every six months
(cycle) is the most difficult issue. To be able to
reimburse the loan principle, they sell part of their
products or an animal (if they have other small
business) or borrow from friends. If all group members
bring back their money on the same day, it is returned
to them on the same day. If any participant does not
return part of the loan, no one in the group receives
their new loan. This strategy unduly penalizes those
who have made sacrifices to bring back their money.
- Selection criteria: No problem at the beginning, most
participants selected from rally-posts using
participation/credibility criteria. Problems arose when
members started to quit the program and replacement
process was not well defined (not from same
community and group not consulted). Reimbursement
problems often with those new members.
• More food for young children:
- Aquin: even though, no additional money is spent on
food for children, less food is used from the household
production and food diversity is increased because of
increased access to markets
- Port a Piment: credit did not directly contribute to
better child feeding but women report dipping in their
business inventory to feed their children.
• Recommendations made by participants/key informants:
- Review and apply participant selection criteria
(credibility, authentic business women, same
background)
- All credit program participants should receive training
on marketing issues to better identify their type of
business
- Decrease the interest rates
- No requirement to reimburse the principle at the end of
each cycle
- More training and support from the credit officer
- The whole group and the community colvol should be
consulted when a member must be replaced
- Management issues: bank book should be in the
hands of the group and not the credit officer,
information on bank transactions should be shared
with the whole group (not only the committee), credit
officer should continue to support “autonomous”
groups, review the role of the committee (the group is
kept out of the decision-making process)
- In Port a Piment (not a commercial area), micro-credit
loan could be used for small food processing projects
• With regards to new groups, CRS should work
closely with its partner to:
- Limit micro-credit programs to areas with active
trade activities
- Ensure guidelines for receiving credit are being
correctly applied; types of investment, and past
business experience are essential criteria
- Ensure credit participants attend training on
business development and training before
receiving the loan
- Apply all recommendations made for the on-going
groups (listed above)
• Partner’s capacity building:
- CRS staff should pursue and reinforce partner’s
capacity building on management of micro-finance
programs
- CRS micro-finance staff should increase
supervision visits at the field level
• Overall program strategies:
- Based on the overall MTE findings and the above
recommendations, CRS micro-finance staff,
together with regional micro-finance advisors,
local micro-finance partners and other micro￾finance institutions should examine the current
loan management conditions in the CRS micro￾finance program (interest rates, reimbursement of
the loan principle, types of business, length of the
cycle) and make recommendations for potential
changes that would allow better loan conditions
for program participants leading to increased
profit, thus contributing to the improvement of the
overall socio-economic conditions in the DAP
targeted areas.
121
 ii) Colvol (Community Health Workers) Credit Program
Results Recommendations for Program Operations
Phase I:
• Targets met in issues related to loan management, group
solidarity and credit program being an incentive for their
work as a CHW
• CHWs have more money to spend on things such as
clothing, medical care and school fees but do not spend
more money on food than before they received their loan
Phase II:
• Credit program management: colvols express concerns
with CRS’ decision to change the management from CRS
to its partner, Caritas. Change will be at their
disadvantage since interests will be returned to Caritas
and they would have to reimburse the loan principle at
the end of each cycle. For many years, Colvols have
been managing their credit fund themselves under CRS
supervision; the interest was reinvested in their loan. With
the change of management, many colvols started paying
the existing loans and plan on discontinuing their
participation in the credit program.
• Advantages of the credit program for the colvol: the credit
program helped significantly improve colvols’ living
conditions, quality of life and self-esteem.
• Impact of the credit program as an incentive for Colvol
participation in MCHN activities: the credit program
encourages the colvols to do their best in participating in
the very demanding work expected of them in the MCHN
program. The credit represents a small compensation for
the volunteer services they provide to their communities.
The colvol is the link between the hospital and the
community and the most important worker in the health
system. Key informants report that the health center’s
success is directly related to the colvols’ presence.
• Other elements to motivate the colvols: more training,
learn how to give vaccines, have access to first aid kit,
stretcher to transport urgent cases. Other benefits such
as special rate for health services, identification badge,
participate in large meetings of colvols from different
centers to exchange ideas and share experiences.
• CRS programming team should immediately reconsider
the decision of transferring the colvol micro-credit
program to Caritas. CRS should first meet with the
colvols (not only the committees), evaluate the success
and weaknesses of their credit program and propose
strategies that will benefit the colvols without negatively
affecting their important volunteer work in their
community. The micro-credit loan is an incentive for the
colvols who are the core strength of the MCHN
program. All important decisions and/or significant
changes in the micro-credit program should be
analyzed by the micro-finance team together with the
MCH team. Meetings with colvols should be done for
many groups at the same time to give them the
opportunity to share ideas and experiences.
• The MCH team should promote and organize (annual)
regional meetings of colvols from different health
centers to discuss issues that affect them, exchange
ideas and share experiences.
• The MCH team, in collaboration with the MOH staff,
should continue to train more colvols in the
administration of vaccines and analyze other strategies
suggested by the colvols to increase their motivation.
Small project proposals and diversification of health
sector funding sources could support some of those
special requests suggested by the colvols.
6.1.c Water and Sanitation
Results Recommendations for Program Operations
Phase I:
• School cisterns met all targets for condition and
maintenance
• Mixed results for school latrines: met targets for cleanliness
but failed for some maintenance issues (doors closed, seat
covers)
• Capped springs: target met in 16 out the 20 indicators
measuring the quality and maintenance of water points and
fountain areas; positive efforts made for the reforestation of
spring surroundings and behavior change associated with
the capped spring
School latrines
• Ensure all latrines follow construction standards set by
CRS water and sanitation team, with special attention
to functional locks on the doors, cover on the latrine
seat and locks from the inside
• Reinforce those aspects during training of PTAs and
other local partners implementing water and sanitation
projects
• Reinforce school structure responsible for
maintenance of school latrines
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Results Recommendations for Program Operations
Phase II:
• Maintenance problems observed in school latrines not
related to misunderstanding between PTA and school
management staff but to lack of information and slight
negligence
Capped springs:
• Reinforce the importance of maintaining the spring
area clean and keeping the drainage canals clear.
Include those topics in the training targeting water
committees, CHWs and rally post participants – for
new spring cappings and for previously built systems.
6.1.d. Education
Results Recommendations for Program Operations
Phase I:
• PTA committee member: All four indicators measuring
participation in school activities met the targets in four SAs
• School director: Two indicators related to participation in
managerial training met the benchmarks. Participation in
Health, Hygiene and Nutrition training did not pass in one
new SA where directors might not have yet received such
training
• School teacher: Two indicators related to participation in
pedagogical training met the benchmarks. Participation in
Health, Hygiene and Nutrition training did not pass in one
new SA where directors might not have yet received such
training
• Female and male students: All indicators related to school
canteen were met
Phase II:
• Causes of school dropout: primary cause associated with
lack of financial means (increase in school fees and cost of
living)– student returned home because of non-payment of
school fees and periodic suspensions/ absences often
leads to complete school drop out.
• Use and assessment of training materials provided by
CRS: high level of satisfaction with CRS work expressed
by teachers, directors and PTA members. Number of
pedagogical boards per school is insufficient. High rates of
resignation of teachers after they received training sessions
(transfer to other schools for salary issue).
• PTA contribution to school development: through CRS
training sessions, PTA and school directors gradually came
to understanding with one another. PTA member
implement numerous activities that contribute to the
development of their school.
• Share Phase II results with field staff and partners:
issues of school dropout because of non-payment of
school fees and transfer of teachers who have received
CRS training to non-CRS supported schools.
• Include those issues for discussions in community
meetings with PTAs, and federation of PTAs to propose
concrete plans to address those issues at the school
and community levels.
• Emphasize advocacy training for PTAs and federation
of PTAs and assist them in their fundraising efforts for
community education activities.
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6.1.e. MCHN
Results Recommendations for Program Operations
Phase I:
Breast feeding and Infant feeding practices:
• Targets met for: giving only breast milk on day of birth and
breastfeeding their infant within one hour of birth
• Targets not met for: giving colostrum to infants, providing
the adequate number of daily complementary feeds to
children between 6 and 24 months; and providing children
6-24 months with the appropriate dietary diversity
Diarrhea and diarrhea management:
• Three aged groups failed the target on % without diarrhea
in last two weeks
• Most of the SAs passed the benchmark and the weighted
average on diarrhea management but unequal performance
levels across the SAs (37% children given ORS during
diarrhea at the time of baseline and 60% at MTE)
Health cards, Child Immunization and Vitamin A
supplementation:
• Thanks to joint action between CRS and the Ministry of
Health, all targets met for all age groups for all indicators
Pre-natal and Post natal Care:
• Targets met for indicators dealing with immunization during
pregnancy, the number of prenatal visits, the prenatal visit
with trained provider before the third trimester of pregnancy
and the postnatal visit within 45 days of delivery
• Fewer mothers attend postnatal visits in the area of Aquin
compared to other areas. Results of Phase II show that
women in Aquin did not attend postnatal clinic because
there was a disruption in food supplements for many
months. Colvols report that youngest women attend the
postnatal clinic more than the older women.
• Results more successful for mothers of younger children:
recent exposure might be associated with better
performance (95.6% of mothers of children 0-6 months of
age who received prenatal visit with trained provider before
third trimester of pregnancy)
• Target (35%) not met for mothers who gave birth in a
health facility. Reasons reported not to deliver in a health
institution (Phase II): distance too long between home and
health center, not in agreement with some conditions for
delivery at hospital (such as fear of delivery table, fees too
high, nice clothes not available, no respect of local
customs….)
Participation in program activities:
• Participation in rally-posts: participation of children and
mothers met the benchmark in three SAs except in the area
of Aquin and Grande Anse
Factors that motivate mothers to take their children to the
rally-posts (Phase II): vaccination, weighing, education
Infant feeding practices:
• The adoption of these practices (giving colostrum to
infants, provide adequate number of daily
complementary feeds to children between 6 and 24
months, and providing children 6-24 months with the
appropriate dietary diversity) is crucial to reducing
malnutrition rates and CRS should strive to better
understand the constraints that may impede mothers
from adopting those important practices and emphasize
those practices in training of CHWs and health staff and
in education sessions to caregivers
Diarrhea and diarrhea management:
• Should continue to emphasize the BCC messages on
the importance of applying simultaneously all three
components of appropriate treatment of diarrhea: ORS,
increased liquids and same or more food
Postnatal visits in Aquin: The MCHN team should ensure
that the management staff in Aquin hospital implement
program activities according to the norms and procedures.
Delivery in health institution: share results of Phase II with
hospital health staff, include those topics in health staff
training and discuss concrete changes to improve the
environment when women give birth in a health facility.
Participation in program activities:
• Vaccination being the most important motivating factor
for mothers to participate in the rally-post, CRS MCHN
team should continue to support MCHN centers with
strategies to increase vaccination activities in the rally￾posts
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Results Recommendations for Program Operations
session, Vitamin A, deworming medicines, reminder by the
colvol, colvol’s “way of doing”, popularity of the colvol,
distance between post and household. Lack of motivation of
mothers of children 12-24 months directly linked with the
perception that children who have completed their
vaccinations are at less risk.
• Participation in mothers’ clubs: All SAs passed the
benchmark of 25% (40.2% among the youngest group)
• Perceptions of mothers about CHWs’ knowledge and skills:
for mothers of children 0-6 and 6-12 months old, all of the
SAs met the targets on five indicators; the area of Port a
Piment, Roche a Bateau and Coteaux did not pass the
target for 12-24 months old for the communication on the
child’s weight
Food Supplementation Program during Pregnancy and after
childbirth:
• 82.5%, 100% and 72.5% of mothers (children 0-16, 6-12
and 12-24) received food supplements during their last
pregnancy (note that the sampling was done at the
population level)
• Results on the “regularity” of food supplementation during
pregnancy and after childbirth did not meet the expected
targets
• Food rations (Phase II): mothers report receiving the
correct amount of commodities. Irregularity due to
disruptions in the stock is the major problem.
Knowledge, skills and participation of Community Health
Workers:
• All CHWs passed the benchmarks on five indicators
measuring their perceptions of knowledge except for their
ability to provide immunization
• Results on their technical knowledge were mixed: passed
on immunization and diarrhea management and ORT but
did not pass on some infant feeding issues such as the
number of times a on-year-old child should be fed each day
and the criteria reference for malnourished children (note
that the benchmark had been set at 95%)
• CHWs in both SAs cleared the 75% benchmark for
completion and submission of rally posts reports and 85%
for participating in the monthly continuing education session
Hand washing knowledge and techniques:
• Safety Net program participants most knowledgeable on
hand washing techniques, followed by the Education
program and mothers participating in the MCHN program.
CHWs met the targets for three indicators and failed on
three.
• “After using the toilet” and before eating” messages met the
target but the indicator “before feeding children” failed in all
groups
• Correct hand washing techniques: all four groups in Safety
Net program passed, some Education groups passed
(school children did not pass), and all three groups of
mothers failed to pass for the international method of hand
washing techniques
• CRS staff and CHWs should emphasize the issue that
children older than 12 months are still at risk and
mothers should continue to take them to the rally posts
• Recommendations from mothers in Aquin (Phase II￾qualitative) to improve the rally-posts: reorganize and
improve the logistics in rally posts to avoid mothers
waiting too long; conduct education sessions for smaller
groups to facilitate better participation
Food supplementation during Pregnancy and after
childbirth:
• CRS MCHN staff and Commodity Management Office
should analyze issues of regularity of food deliveries
and propose solutions to improve the situation
Knowledge, skills and participation of Community Health
Workers:
• Address critical gaps in CHWs knowledge via monthly
continuing education sessions and formal refresher
training courses
• Use LQAS to monitor CHW’s levels of knowledge in
various SAs on a regular basis and after refresher
training courses
• Ensure CHWs have materials they need to carry out
their responsibilities properly
Hand washing knowledge and techniques
• Messages on hand washing should be reinforced in all
programs, but specially so in the MCHN program for
CHWs and mothers (improvements in hygiene behavior
may present an opportunity for better child nutrition and
health outcomes)
• A standardization of messages across programs could
be instrumental in improving hand washing knowledge
and techniques
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6.1.f. HIV/AIDS
Results Recommendations for Program Operations
Safety Net Institutions with HI/AIDS training and with no
HIV/AIDS training (management staff and children):
• Both groups passed and failed same benchmarks on
knowledge on “means of transmission”
• Both groups have fairly good perception of “personal
risk”
• Both groups met the targets on “stigma and
discrimination”
Schools (PTA member, School director, Teacher,
Female and Male children):
• All three groups met targets on commonly known ways
of avoiding HIV/AIDS transmission, on general
knowledge of HIV/AIDS and notions of Personal risks
and stigma and discrimination
• Transmission messages should be reinforced and expand
upon the public health messages that are currently being
spread by the media
• Discrimination and stigmatization issues must be addressed
with the youngest program participants in order to contribute
to improved conditions for PLWA on the societal level
• Reinforce the technical capacity of the local partner that are
providing training to enable them to provide better quality
training to the communities
6.1.g. Safety Net
Results Recommendations for Program Operations
Indicators used as “baseline”
• Management and staff can name 2 or more universal
rights of children
• Some centers failed to meet the benchmarks for
cleanliness (kitchen area, toilets/latrines) (*)
• Centers did not pass the 70% benchmark for % of
centers without food shortages in the center canteen in
the last months
• Center staff met the target on maintenance of financial
ledger
• Both groups of female children met the targets on”
going to school, having a birth certificate, having eaten
a CRS supplied food and something other than a CRS
supplied food in the last 24 hours
• Strengthen Health, Hygiene and Nutrition training in Safety
Net institutions to underscore the critical links between
cleanliness and good health
• Create a checklist of regular cleaning tasks for centers’ staff
• Include cleanliness indicators in the supervision visits of
CRS Safety net staff
* Note: indicators relating to centers’ cleanliness should have been set higher (the MTE benchmark was 50%)
6.1.h. Civic Education
Results Recommendations for Program Operations
13 indicators measured on 11 groups (from above
programs) as baseline information:
• Expected performance benchmarks were different for
all groups and depended upon the perceived or verified
levels of community and civic involvement, education
levels and past CRS interventions with specific target
groups
• School directors passed all 13 questions
• Design civic education training programs that speak to
the needs and constraints of each target group;
particularly mothers, CHWs, PTA members and school
teachers
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6.2. Conclusion for Methodology Development
The FANTA team was very satisfied with the overall undertaking. As a pilot study, it confirmed LQAS’s
potential for the conduct of mid term evaluations; and highlighted the usefulness of the qualitative
research in Phase II. However, several lessons were learned that should be applied in future such
applications.
Phase I (LQAS Surveys)
- The entire exercise consists in evaluating whether progress made corresponds to that expected. To
do so, one must assume that LOA objectives are reasonable to start with. That, however, can be
problematic: for many indicators we simply don’t know how much improvement can be achieved in a
given time frame; and a program’s objectives (mid term and LOA) can easily be set too high, or too
low. When interpreting results, the analyst should be wary of this and always ask whether initial
objectives were too ambitious, or too modest. If need be, targets can be adjusted in light of the
findings from the mid-term.
- Unlike final evaluations, the MTE focuses on beneficiaries, not on the population at large (unless they
are one and the same). Because of this, MTE results may be far higher than LOA results, especially
where a program is effective in changing outcomes among beneficiaries. The benchmarks might
therefore be different, arguably, at those two time points. The interpretation of results should also be
clear about whom inferences are made.
- A tension exists between the amount of detail to be provided by the evaluation, and the cost of
collecting and analyzing the data. Two factors in particular play in this: (i) what questions should be
asked; and (ii) who should answer them. On the first point, the M&E Officer must guard against
overloading a survey with questions that do not lead to implementation recommendations. The
preference is to concentrate on effect indicators. The inclusion of “lower” level indicators (outputs,
processes) should be considered only when this information is (a) not readily available from other
sources (e.g. the IPTT); and (b) considered essential to the project’s functioning. On the second
point, the multiplication of strata (e.g. teachers by grade; or mothers by age group of their child)
rapidly leads to sample inflation, denying the benefits of LQAS. Here again, the M&E officer should
exert caution so that the cost of using LQAS in the end does not exceed that of other methods (e.g. a
30x30 cluster survey). A few principles to apply here are: (a) define a new sample group only if this
group is a particular target for the program; (b) consider parallel sampling if this is possible; (c) recall
that SAs are themselves a stratifying device; if, say, 4 SAs are considered, defining any new group
will add four new samples of n=19 (or whatever the sample size is) for interviews.
Lessons learned from Phase II (Qualitative research):
- The experience and quality of the qualitative study field staff is critical to its success. Contrary to
common belief, qualitative research cannot be improvised. The person doing the data collection
needs a strong sense of the objectives of the study so he/she can orient the discussion towards key
problems and resolve those as they emerge. This person also needs to organize the materials in a
way that explores and interprets the problem with objectivity, rather than simply narrates the findings.
Such skills cannot be improvised and a specialist should be hired to do this piece of the work.
- Selecting the site for carrying out the qualitative research is critical to the findings. Unlike in Phase I
where the selection of respondents is done in a random fashion, the selection of respondents for
Phase II is purposive. It should focus on sites and population groups that were found to display the
problem. If several groups/sites are found to fail, they should be also visited, as the reasons for failing
may differ across context, and the richness of the interpretation will be enhanced by the diversity of
findings.
127
APPENDIX 1
CRS/HAITI DAP Program Objectives
Program Goal:
To sustainably reduce the level of food insecurity in vulnerable communities of the Southern Peninsula
with a focus in the South and Grande-Anse Departments.
To achieve this goal, CRS/Haiti will address four major sectors of interventions:
• Health and Nutrition comprised of three sub-sectors: Maternal and Child Health (MCH),
HIV/AIDS and Water/Sanitation with complementary micro-enterprise activities to achieve
objectives of food security
• Agriculture
• Education
• Humanitarian Assistance
Strategic Objective One (Health and Nutrition):
A. To improve the health and nutritional status of children under five, pregnant and
lactating women by 2006
Intermediate Results:
1.1 Increased nutritional status of children 0-59 months in the project zone by 5% points above
the baseline for height/age by 2006
Health activities :
ƒ Growth Monitoring
ƒ Screening at rally posts
ƒ Food supplementation to malnourished children 6-59 months
ƒ Training Community Health Workers (Colvols) in nutritional surveillance, participatory
 learning, adult education
ƒ Technical assistance and supervision of Colvols
ƒ Distribution growth chart/plastic covers to caregivers of 0-59 months.
ƒ Support UCS development in referral system.
ƒ Education/ training and support to health providers and communities for case
 management of severe malnutrition.
Micro-credit activities
ƒ Targeting 1,800 new female clients in rally post; structure them in 300 community banks
 of 30 women each.
ƒ Technical assistance in group animation/ organization and financial management of
 community banks
ƒ Literacy and numeracy training in financial management to members of savings/credit
 groups
ƒ Fund 60 community banks; Village banking: each group receives a collective loan from
 partner institutions, each client receives an individual loan from the committee for a 4-6
 months credit cycle
ƒ Financial/technical assistance to current beneficiaries of last DAP.
ƒ Train in financial management for partner institutions.
ƒ Implement of MAGI (Microfinance Alliance for Global Impact) Accreditation System for
128
 monitoring Partner Institutions.
1.2 Increased availability and accessibility to quality health and nutrition services shown by
increase in service use by 25% over the baseline
Health activities :
ƒ Support and supervise rally posts
ƒ Food supplementation to pregnant and lactating mothers in 26 heath facilities
ƒ Training health providers in quality pre, peri and postnatal services
ƒ Training Agent de Santé, Colvols in vaccination, deworming, ORT, Vitamin A distribution,
ƒ Census of project zone and maintenance of census
ƒ Support to UCS in vaccination coverage strategies
ƒ Support to UCS in quality of care supervision of PR and Primary Care health facility.
ƒ Support social marketing of ORT.
ƒ Support UCS in management of stock (ie vitamin A, Iron-Folic pills and vaccines)
ƒ Support to UCS in management of Health Information Systems
ƒ Train Colvol in participatory education techniques and community maternal/child health
ƒ Train and equip TBAs (matrons).
ƒ Forum/meetings to discuss project strategies and progress.
Micro-credit activities :
ƒ Target 2,400 CHWs attached to 58 health facilities in FY02 (900 in 18 health facilities in
 FY06).
ƒ Organize them in groups and determine with them appropriate and profitable activities in
 which they can invest their credit funds.
ƒ Train members of CHW micro-finance committees in financial management, group
 organization and animation.
ƒ Financial and technical assistance to current beneficiaries of the last DAP.
ƒ Annual forums, working meetings, and exchange visit to allow CHW groups to share
 experiences and address weaknesses.
1.3 Increased good health and nutrition knowledge, attitudes and practices of caregivers
 and communities by 25% over the baseline by 2006.
Activities
ƒ Participatory Learning and Action methodology used for community management of
 malnutrition
ƒ Adult education both at rally post and health facilities
ƒ Ti-foyer
ƒ Positive-deviant mothers peer educators.
ƒ Support Social marketing of ORT activities.
ƒ Development and/or reproduction of educational materials
ƒ Support UCS in supervision of Colvols, and health service providers
ƒ Pilot study on postitive deviant mothers and their feeding practices
ƒ Education (including food demonstrations)
1.4 Increased availability and utilization of potable water in 50 schools and 75
communities and sanitation facilities in 50 schools/orphanages
Activities
ƒ Participatory Leaning and Action methodology used to involve communities in
 community, family and personal hygiene.
ƒ Construction of 75 capping springs
ƒ Construction of 50 cisterns
ƒ Construction of 50 compartment latrines in schools
ƒ Education and maintenance follow up via latrine and water point committees.
ƒ Construction of incinerators in 24 health facilities
129
ƒ Training of staff at health facility in medical waste management
1.5 Increased food security (food availability, social network support and income
access) of persons infected with HIV and PLWA by 2006 (majority of activities are
non-DAP funded)
Activities
ƒ Research and qualitative study on implementing IGA activities with PLWA.
ƒ Income generating activities (IGA) with the caregivers of children of PLWA (including,
training in IGA, access to credit)
ƒ Community qualitative activities using PLA methodology to strengthen community
support to PLWAs and their families.
ƒ Form and train Peer Leader Groups to assist PLWA and their families and in HIV
prevention
ƒ Train # of health facility service providers in HIV and AID counseling.
ƒ Coordinate with other national and international movements in support of PLWA.
ƒ Food supplementation to PLWA and their families.
ƒ Development or reproduction of appropriate IEC materials to support education sessions
Strategic Objective Two (Agriculture):
B. To increase access to food for 1,500 small holder farming families in targeted food insecure
 areas by 2006.
Intermediate Results:
2.1 Increased availability of bean and plantain for 1,500 families on 375 hectares of hillside
land through biological soil conservation/fertility recovery methods and provision of
improved seeds
Activities
ƒ Acquisition and planting of 30,000 fruit and wood trees
ƒ Implementation of natural resource management practices (live structures, organic
fertilization, tree planting, grafting, soil preparation) on 375 hectares of hillside land
ƒ Establishment of 3 revolving funds for distribution of 1,500 loans of bean seeds and
plantain cuttings to plant on 375 hectares
ƒ Reimbursement of loans
ƒ Provision of training, management and extension services to farmers
2.2 Improved revenue and availability of animal proteins for 1,500 families through chicken
and pig raising
Activities
ƒ Order, purchase and distribution of 4,500 improved chickens to 1,500 farmers
ƒ Order, purchase and distribution of 1,500 improved mature pig breeders to 1,500 farmers
ƒ Establishment of a credit fund for supply to farmers with chicken food and pig food
ƒ Provision of health, training and extension services to farmers
2.2 Increased revenue generated by assisted commercialization of two agricultural
products by 1,500 families
 Activities
ƒ Identification of markets for crop commercialization
ƒ Implementation of an economic survey
ƒ Constitution and training of 3 pre-cooperatives
130
ƒ Facilitation of products and facilitation between pre-cooperatives and identified buyers
Strategic Objective Three (Education):
C. To improve educational progress among primary school children in targeted zones and
 ensure structures are in place to address education needs in de-targeted zones
Intermediate results:
3.1 Sustainability: By the end of the DAP, 60% of phase out communities will have been
engaged in at least two basic school support activities for two consecutive years after
CRS withdraws
Phase out strategy
Participatory learning and Action training
Civic Education training
Support in development and implementation of small projects in support to schools
3.2 Access: 10% increase in access to quality education (gross attendance rate) in 157
schools
School Feeding
ƒ Daily school-feeding
ƒ Distribution of cook stoves in selected schools
ƒ Training of kitchen staff
Health, Hygiene and Nutrition Activities (DAP funded)
ƒ Latrine building, cisterns and potable water.
ƒ Health Education for pupils, including STD and HIV/AIDS awareness (last 3 years of
 program)
ƒ PTAs training on Health/Hygiene and Nutrition
ƒ Support for Health Days
ƒ Distribution of de-worming medicine (non-DAP funded).
Support to Parents Teachers’ Associations (non-DAP funded)
ƒ Civic education training
ƒ Training in Participatory Learning Action (PLA)
ƒ Support to PTAs Forums (locality, district, department levels) and Federations for PTA
 motivation and experience sharing, contributing to their sustainability
ƒ Sensibilization to respect performance contracts clauses
ƒ Training on fundraising and small projects management for PTA in the targeted zones.
ƒ Support in development and implementation of small projects in support to schools
3.3 PROGRESS: 20% increase in educational progress (cohort survival rate at grade 5 in FAE
program Schools (from 55% MENJS/Ministry of Education data)
Quality of Education Package (non-DAP funded):
ƒ Distribution of MENJS Curriculum and training of teachers
ƒ Distribution of MENJS Guide Pratique d’Administration Scolaire and training of School
 Management staff
ƒ Teaching staff training in specific teaching tools and techniques, using Ed2004 Teaching
 Curriculum and other materials
ƒ Distribution of teaching aid material
ƒ Distribution of distance education materials
ƒ Coordination with radio station for program broad casting, and monitoring of distance
131
 learning
Strategic Objective Four (Social Assistance):
D. To increase access to food for 17,500 highly vulnerable children and adults living or
receiving care in Social Safety Net Institutions (SSNI) and hospitals by 2006.
Intermediate Results:
4.1 Increased access to food for orphans, abandoned and street children cared for by
Social Safety Net Institutions (SSNI) and for the physically and mentally disabled, and
the chronically ill and aged persons cared for in hospitals and SSNI.
Activities
ƒ Food delivery to 65 children shelters on a quarterly basis
ƒ Food delivery to 50 hospitals and nursing homes
ƒ Food monitoring by program staff and CMO staff
4.2 Increased access to formal education/vocational instruction for institutionalized
children; including AIDS education.
Activities
ƒ Non-formal and formal educational opportunities to OCF centers as main criterion for
 participation
ƒ Improvement quality environment : building cisterns and latrines
ƒ Civic education for OCF directors
4.3 Increased “children’s shelters” managerial capacity through training, to improve the
quality of services provided and to become more sustainable.
Activities
ƒ Training in small project design and implementation for centers directors
ƒ Funds for Income-generating activities(DAP and private sources)
ƒ Coordination with donors for support to institutions
4.4 Upgraded sanitary/safety conditions of “children’s shelters”.
Activities
ƒ Infrastructure projects: latrines, toilets, other sanitary improvements
EARLY WARNING SYSTEM:
During the 96-01 DAP, CRS had put in place an EWS. This system, which was temporarily closed due to
limited resources and the lack of interest at the national level, was launched again with this new FY02-06
DAP in collaboration with the four CSs supported by the DAP (CARE/CRS/Save the Children/World
Vision) and the National Council for Food Security (CNSA). The system is coordinated by the
CRS/Agriculture Program and collects information on indicators selected by all CSs. After having
conducted a pilot experiment in four localities of the South Coast during FY02 and FY03, CRS expanded
the EWS in 3 additional DAP targeted areas. The system collects information on indicators selected by all
CSs. Major indicators are rainfall and prices for charcoal and basic food stuff in local markets. Nutritional
indicators (prevalence of severe malnutrition, new cases of Kwashiorkor) are also compiled from the
health institutions located in the same agro-ecological zones selected for the EWS.
132
AREAS OF INTERVENTION (FY 02/03/04)
PROGRAM SOUTH GRANDE
ANSE
NIPPES SOUTH-EAST WEST
MCHN Côtes de Fer only
TB/HIV/AIDS (food
supplement)
Jacmel area
WATER/SANITATION Côtes de Fer area
CREDIT Through
partners
Through partners Through
partners
AGRICULTURE (new program
in DAP)
FOOD ASSISTED
EDUCATION
Côtes de Fer area
SAFETY NET Jacmel area
 Continuing FY2003 Phased out end at the end of FY2002
133
APPENDIX 2
TABLE OF INDICATORS AND SAMPLING GROUPS
CRS/FANTA DAP MID-TERM EVALUATION

135
AGRICULTURE INDICATORS
(p. 1 of 1)
BL
Value
LOA
target
MTE
target
Farm
(Observation) Farmers
Land Characteristics
Percent of farm association members that have a dry and cool place for seed storage n/a 90% 80% √
Percent of farm association member plots that use either green fertilizer or compost n/a 80% 70% √
Percent of plots visited that use Level A/courbe de niveau techniques n/a 90% 75% √
Percent of farm association members that planted beans in the plot of land used for CRS
activities n/a 95% 90% √
Percent of farm association member plots that use/used the promoted planting density
for beans n/a 80% 60% √ (√)
Percent of farm association member plots that use the promoted planting density for
plantains n/a 80% 60% √
Percent of farm association member plots with one or more recommended anti-erosion
systems (“ramp pay”, “clayonnage”, or live barrier) n/a 90% 80% √
Percent of farm association member plots visited with one or more anti-erosion systems
in place (“ramp pay”, “clayonnage”, or live barrier) n/a 90% 75% √
Percent of farm association member plots that have at least 50 trees planted on them n/a 60% 40% √
Gender issues within farmers’ associations
Percent farm association members that report the inclusion of women was a guiding
principle in the formation of their association n/a 95% 90% √
Percent of farm association members that think that women should be allowed
membership in the groupement n/a 90% 80% √
Percent farm association members that can state one concrete benefit for the active
involvement and membership of women n/a 90% 80% √
136
CREDIT – WOMEN/PARTICIPANT
(p. 1 of 1 )
BL
Value
LOA
target
MTE
target
Credit￾Part.
Participation in rally-posts
Percent of credit participants who participated in a rally post before they joined the credit program n/a 70% √
Percent of credit participants who have participated in a Rally Post since they joined the credit program n/a 50% √
Percent of credit participants who have children less than 5 years old n/a 70% √
Selection process
Percent of credit participants who feel the selection process for receiving micro-credit loans is fair and
democratic n/a 75% √
Percent of credit participants who feel that the Steering Committee was selected in a fair and democratic
manner
n/a 80% √
Management of loans
Percent of credit participants who would like to continue in the micro-credit program n/a 85% √
Percent of credit participants who think they are capable of managing their loan well n/a 70% √
Percent of credit participants who think they are capable of managing their business efficiently n/a 60% √
Percent of credit participants who made a profit from their business activities last month n/a 80% √
Percent of credit participants who have never had a problem paying any of the monthly loan payments n/a 80% √
Group Solidarity
Percent of credit participants whose group has assisted a fellow group member when s/he had a problem
paying back her/his loan n/a 35% √
Percent of credit participants who think that their group's Steering Committee does a good job managing the
micro-credit program n/a 80% √
Literacy/Numeracy/Understanding Bank Books
Percent of credit participants who know how to sign their name n/a 30% √
Percent of credit participants who feel confident in their addition and subtraction skills n/a 30% √
Percent of credit participants who report not having any difficulty in understanding how their bank book works n/a 85% √
Percent of credit participants who have read the financial agreement that they signed with the steering
committee of the group in order to get their loan n/a 20% √
Changes in Household Wealth
Percent of credit participants who never had to borrow money from another source since they received their
loan n/a 65% √
Percent of credit participants who spend more money on food than before they received their loan n/a 75% √
Percent of credit participants who feel they have more money now to spend on things such as clothing, medical
care and school fees/costs than before they received their loan n/a 70% √
Percent of credit participants who think that the amount of their loan was enough to improve their business
activities as they would have liked n/a 50% √
Percent of credit participants whose school aged children all go to school n/a 60% √
Percent of credit participants whose school aged children were all going to school before they joined the credit n/a 40% √
137
program
CREDIT – COLVOLs
(p. 1 of 1) BL Value LOA target MTE target Colvol
Management of their loan
Percent of Colvols who think they are capable of managing their loan well n/a 90% 75% √
Percent of colvols who think they are capable of managing their business activities efficiently n/a 85% 75% √
Percent of Colvols who made a profit from their business activities last month n/a 70% 60% √
Percent of Colvols who have never had a problem paying any monthly loan payments n/a 70% √
Group solidarity
Percent of Colvols whose group assisted a fellow group member when s/he had a problem paying
back their loan n/a 50% 40% √
Changes in Household Wealth
Percent of Colvols who have never borrowed money from another source since their received their
loan n/a 60% √
Percent of Colvols who state that they spend more money on food than they did before they received
their loan n/a 85% 80% √
Percent of Colvols who feel they have more money now to spend on such things as clothing, medical
care, and school fees/costs than before they received their loan n/a 65% 60% √
Percent of colvols who think that the amount of their loan was enough to improve their business
activities as they would have liked n/a 60% 50% √
Percent of Colvols whose school-aged children all go to school n/a 85% 80% √
Percent of Colvols whose school aged children all went to school before they received their loan n/a 65% √
Credit program as an incentive to work as CHWs
Percent of Colvols who think that the micro credit loan program is an incentive for them to work as a
Colvol n/a 50% √
Percent of Colvols who report that they would continue to work as a Colvol even without the micro￾credit program n/a 60% √
138
Cisterns WATER and SANITATION – CISTERNS
(p. 1 of 2) BL Value LOA target MTE target Observation School Administrator
Percent of cisterns with walls intact n/a 90% 70% √
Percent of cisterns without standing water n/a 90% 80% √
Percent of cistern faucets equipped with a handle n/a 95% 90% √√
Percent of cisterns without a leak/drip n/a 90% 70% √√
Percent of cisterns with water flowing from the faucet n/a 90% 70% √√
Percent of wash basins without garbage or debris n/a 85% 65% √
Percent of wash basins without animal feces within 10 meters n/a 85% 65% √
Latrines
WATER and SANITATION - LATRINES BL Value LOA target MTE target Observation Student
Percent of latrines found to be clean (no trash lying on the floor, no feces visible) n/a 75% 60% √
Per cent of latrines free of visible soiled toilet paper or other used paper n/a 75% 60% √
Percent of latrines visited where all latrine doors were closed upon arrival n/a 75% 60% √
Percent of latrines with functioning doors n/a 95% 80% √
Percent of latrines with doors equipped with working inside locks n/a 85% 65% √
Percent of latrines with seat covers in all stalls n/a 75% 60% √√
Percent of latrines with all latrine covers down n/a 75% 50% √
Percent of latrines that had at least one broom available n/a 75% 40% √
Percent of latrines located at an appropriate distance from water source n/a 90% 70% √
Percent of latrines located at an appropriate distance from the school n/a 95% 70% √√
Percent of schools with very little garbage lying around n/a 80% 70% √
Percent of schools where the garbage disposal is used n/a 90% 80% √
Schools
WATER and SANITATION – TRASH DISPOSAL BL Value LOA target MTE target Observation Student
Percent of sites with trash can easily accessible to school children n/a 95% 80% √
Percent of schools without garbage lying around n/a 85% 70% √
Percent of trash disposal areas with acceptable levels of garbage in them *where the
level of trash in the garbage pit was below the level of the ground or surrounding wall) n/a 85% 70% √
139
Capped Spring WATER and SANITATION – SPRING CAPPING
(p.2 of 2) BL Value LOA target MTE target Observation Community Member
Spring capping area
Percent of spring capping free of garbage or debris n/a 75% 65% √
Percent of spring capping will walls intact n/a 85% 70% √
Percent of spring capping covered by lid n/a 85% 70% √
Percent of spring capping with lid firmly in place n/a 85% 70% √
Percent of spring capping surrounded by a canal on three sides n/a 85% 70% √
Percent of spring capping canals that are at least 20cm deep n/a 85% 70% √
Percent of spring capping with front area free of standing water n/a 95% 80% √
Percent of spring capping surroundings protected by vegetation n/a 80% 50% √
Water point/fountain area
Percent of water point/fountain free of garbage or debris n/a 75% 65% √
Percent of water point/fountain surroundings free of standing water n/a 90% 80% √
Percent of water point faucet or fountain pipe with water flowing n/a 85% 75% √
Percent of water point/fountain where there are no animals within 5 meters n/a 90% 80% √
Percent of water point/fountain where there are no animals feces within 5 meters n/a 90% 80% √
Percent of communities with a spring capping that have a committee to manage the
system n/a 80% 65% √
Percent of respondents who state knowing at least one member of the spring capping
committee n/a 80% 65% √
Percent of respondents who state they have never seen the system dry n/a 75% 60% √
Percent of respondents who state they have never seen the system broken or damaged n/a 75% 60% √
Percent of respondents who state they have never seen people doing their laundry at the
water point/fountain n/a 75% 60% √
Percent of respondents who state they have never seen people watering their animals at
the water point/fountain n/a 80% 65% √
Percent of respondents who state they have never seen people bathing at the water
point/fountain n/a 80% 60% √
Behavior change
Percent of respondents who state that their family treats the water with bleach before
drinking it n/a 30% 20% √
Percent of respondents who state that their family has less diarrhea since the
construction of the spring capping n/a 75% 65% √
Percent of respondents who state using more water since the construction of the spring
capping n/a 80% 70% √
140
Sampling Groups
EDUCATION Stud.
(p. 1 of 1)
BL
Value
LOA
target
MTE
target
F M PTA Dir./ Admin Teacher
PTA committee members
Percent of PTA members who attended at least one PTA meeting in the last
4 months. 50% √
Percent of PTA members who state that they participated in a health-related
activity at school in the past six months 95% 60% √
Percent of PTA members who state that they personally participated in a
PTA small project in the past 12 months 50% 30% √
Percent of PTA members who have participated in a training event given by
CRS for PTA members 80% √
School directors
Percent of School Directors who have ever received managerial or
administrative training from CRS while an employee of their school 80% √
Percent of School Directors who feel that the training they received improved
the overall quality of their management or administrative performance 40% √
Percent of School Directors who received any Health, Hygiene, and Nutrition
training from CRS while the director at their school. 80% √
Teachers
Percent of Teachers who have ever received pedagogical or teacher training
from CRS while an employee of their school 75% √
Percent of Teachers who feel that the training they received improved the
overall quality of their teaching performance 40% √
Percent of Teachers who received any Health, Hygiene, and Nutrition
training from CRS while teaching at their school. 75% √
Students
Percent of students who state that they received a meal the last day they
were at school 95% 80% √√
Percent of students who state that the quality of the meal as good 70% 50% √√
141
Percent of students who state generally eating all the food given to them at
school. 80% √√
142
Sampling Groups
MCHN - Mothers
(p. 1 of 3)
BL
Value
LOA
target
MTE
target Mothers of Child. 0-6 Mothers of Child. 6-12 M/CG of Child. 12-24
Breast feeding and Infant Feeding Practices
Percent of children (0-11.99 months) given breast milk only on day of birth 32.5% 50% 40% √√
Percent of infants (0-11.99 months) breast fed within 1 hour of birth 6.2% 16.2% 20% √√
Percent infants having received colostrum 53.0% 95% 80% √√
Percent of children (0-5.99 months) currently being breastfed 95.8% 95% 95% √
Percent of children (6-11.99 months) currently being breastfed 98.5% 98.5% 95% √
Percent of children (12-23.99 months) currently breastfed 60.0% 70.0% 65% √
Percent of infants (0-5.99 months) who are exclusively breastfed 16.8% 26.8% 20% √
Percent of children (6-11.99 months) who were fed the appropriate number of
complementary feedings in the last 24 hours 55% 60% 60% √
Percent of children (12-23.99 months) who were fed the appropriate number of
complementary feeds in the last 24 hours 41.1% 46.1% 45% √
Percent of children (12-23.99 months) who received the 3 food groups
(“constructeur, “energetique”, “protecteur”) in the last 24 hours n/a n/a 80% √√
Diarrhea Prevalence
Percent of children (0-5.99 months) without diarrhea in the last two weeks 80.1% 85.1% 80% √
Percent of children (6-11.99 months) without diarrhea in the last two weeks 60.1% 65.1% 65% √
Percent of children (12-23.99 months) without diarrhea in the last two weeks 61.2% 66.2% 65$ √
Percent of children (6-23.99 months) with diarrhea who were given ORS 37.4% 60.0% 50% √√
Percent of children (6-23.99 months) with diarrhea who were given increased
liquids during diarrhea 44.6% n/a 50% √√
Percent of children (6-23.99 months) with diarrhea who were given the same or
more food 27.4% n/a 40% √√
Percent of children (6-23.99 months) with diarrhea receiving continued feeding
during diarrhea 15.2% 25.2% 20.0% √√
Percent of children (6-23.99 months) with diarrhea receiving additional food after
diarrhea episode 36.4% 46.4% 40% √√
Health cards, child immunization and Vitamin A supplementation
Percent of children (0-23.99 months) with health card or birth certificate with date
recorded n/a n/a 90% √ √√
Percent children (6-23.99 months) receiving Vitamin A capsule in last six months 45.7%- 46.4% 80% 60.0% √√
Percent of children (12-23.99 months) fully immunized (3 doses polio) 26.7% 36.7% 35% √
143
Sampling Groups
MCHN
(p. 2 of 3) BL Value LOA target MTE target Mothers of Child. 0-6 Mothers of Child. 6-12 M/CG of Child. 12-24
Pre-and post-natal care
Percent mothers (children 0-5.99 months) who have a health card 58.7% (*) n/a 80% √
Percent mothers (children 6-11.99 months) who have a health card 59.5% n/a 80% √
Percent mothers (children 12-23.99 months) who have a health card 60.6% n/a 80% √
Percent mothers (children 0-5.99 months) who received at least 1 tetanus shot 83.8% (*) n/a 70% √
Percent mothers (children 6-11.99 months) who received at least 1 tetanus shot 71.4% n/a 70% √
Percent mothers (children 12-23.99 months) who received at least 1 tetanus shot 80.3% n/a 70% √
Percent mothers (children 0-5.99 months) fully vaccinated against tetanus during
last pregnancy (received 2 shots or was already fully vaccinated) 63.8% (*) 73.8% (*) 70% √
Percent mothers (children 6-11.99 months) fully vaccinated against tetanus during
last pregnancy (received 2 shots or was already fully vaccinated) 49.1% 73.8% (*) 70% √
Percent mothers (children 12-23.99 months) fully vaccinated against tetanus
during last pregnancy (received 2 shots or was already fully vaccinated) 57.9% 73.8% (*) 70% √
Percent mothers (children 0-5.99 months) with at least 3 prenatal visits with a
trained provider 79.6% (*) 84.6% (*) 80% √
Percent mothers (children 6-11.99 months) with at least 3 prenatal visits with a
trained provider 83.8% 84.6% (*) 80% √
Percent mothers (children 12-23.99 months) with at least 3 prenatal visits with a
trained provider 78.5% 84.6% (*) 80% √
Percent of mothers (children 0-5.99 months) who received pre-natal visit with
trained provider before third trimester of pregnancy (7 months) 81.4% (*) n/a 80% √
Percent of mothers (children 6-11.99 months) who received pre-natal visit with
trained provider before third trimester of pregnancy (7 months) 78.5% n/a 80% √
Percent of mothers (children 12-23.99 months) who received pre-natal visit with
trained provider before third trimester of pregnancy (7 months) 78.5% n/a 80% √
Percent of mothers (children 0-5.99 months) who had a trained health provider
assist the delivery 32.3% (*) 37.3% (*) 70% √
Percent of mothers (children 6-11.99 months) who had a trained health provider
assist the delivery 31.0% 37.3% (*) 40% √
Percent of mothers (children 12-23.99 months) who had a trained health provider
assist the delivery 35.3% 37.3% (*) 40% √
* Not all indicators were collected on the age groups at the baseline; those baseline results and LOA targets are those of mothers of children 6-59.9 months old all
combined
144
Sampling Groups
MCHN
(p. 3 of 3) BL Value LOA target MTE target Mothers of Child. 0-6 Mothers of Child. 6-12 M/CG of Child. 12-24
Pre-and post-natal care (cont’d)
Percent of mothers (children 0.5.99 months) who gave birth in a health facility 9.7% (*) n/a 35% √
Percent of mothers (children 6-11.99 months) who gave birth in a health facility 14.5% n/a 35% √
Percent of mothers (children 12-23.99 months) who gave birth in a health facility 11.3% n/a 35% √
Percent of mothers (children 0-5.99 months) who made at least one postnatal visit
with a trained health provider within 45 days of delivery 19.1% (*) 24.1% (*) 25% √
Percent of mothers (children 6-11.99 months) who made at least one postnatal visit
with a trained health provider within 45 days of delivery 18.7% 24.1% (*) 25% √
Percent of mothers (children 12-23.99 months) who made at least one postnatal visit
with a trained health provider within 45 days of delivery 18.1% 24.1 (*) 25% √
Participation in program activities (rally posts and mothers’ club)
Percent of children who have participated in a Rally Post in the last month n/a 90% 80.0% √ √√
Percent of mothers who have participated in a Rally Post in the last month n/a 80% 70.0% √ √√
Percent of mothers who participated in an educational session at a Rally Post in the
last month n/a 80% 70.0% √ √√
Percent of mothers who are members of a Mothers Club n/a 50% 25%
Participation in program activities (perceptions of mothers on CHW’’s knowledge on Health Issues and Communication skills)
Percent mothers who think educational sessions provide practical information n/a n/a 70% √ √√
Percent mothers who think immunization provided by the health facility is valuable n/a n/a 95%
Percent mothers who think growth monitoring services that Colvol provides are
useful n/a n/a 95% √ √√
Percent mothers who know if child's weigh increased or decreased in the last month n/a n/a 70% √ √√
Percent mothers who think information provided by Colvol is easy to understand n/a n/a 75% √ √√
Percent mothers who think Colvols are knowledgeable about nutrition information n/a n/a 80% √ √√
Participation in program activities (health facility- food supplementation)
Percent of mothers (0-11.99) who received food supplementation during last
pregnancy
n/a 80% 80% √√
Percent of mothers (12-23.99) who received food supplementation during last
pregnancy
n/a 80% 70% √
Percent mothers who report receiving rations regularly each month during pregnancy n/a n/a 80% √ √√
Percent of mothers who received food supplementation regularly since birth of child n/a n/a 80% √√
Percent mothers reporting receiving the correct ration from the health center n/a n/a 95% √ √√
145
Distance to water source and source of water
Percent mothers reporting water collection taking 30 minutes or less 74.2% n/a 75% √ √√
Percent mothers that fetch their water from a protected water source 56.2% (*) 66.2% 55% √ √√
* Not all indicators were collected on the age groups at the baseline; those baseline results and LOA targets are those of mothers of children 6-59.9 months old all
combined
146
MCHN– COLVOLs (Knowledge, skills and participation)
(p. 1 of 1) BL Value LOA target MTE target Colvol
Perceptions of knowledge and skills
Percent of Colvols who feel totally confident in their skills to provide quality health services to their
communities n/a 90% √
Percent of Colvols who feel confident in their ability to provide nutritional messages to their communities n/a 90% √
Percent of Colvols who feel confident in their ability to provide maternal health messages to their
communities n/a 90% √
Percent of Colvols who feel confident in their ability to measure a child's weight n/a 90% √
Percent of Colvols who feel confident in their ability to record a child's weight on the Road to Health cards n/a 90% √
Percent of Colvols who feel confident in their ability to provide immunizations n/a 60% √
Technical knowledge
Percent of Colvols who can identify the vitamin deficiency which causes bad vision (Vitamin A) n/a 90% √
Percent of Colvols who know how many times a day a one-year old child should be given something to
eat n/a 60% √
Percent of Colvols who state that it is okay for a mother to breastfeed when she has a fever n/a 70% √
Percent of Colvols who can recognize the symptoms of scabies when given a description of the condition n/a 75% √
Percent of Colvols who know that a child with a weight for age below -3 standard deviations should be
referred to a health center immediately n/a 95% √
Percent of Colvols who mention using at least one Adult Participatory Learning technique during their
educational work n/a 95% √
Percent of Colvols who feel that the trainings they received in the social marketing of ORT has been
useful to their work with mothers in their communities n/a 90% √
Availability of materials and supplies
Percent of Colvols who, in the last 30 days, have not had a shortage of any of the supplies or materials
they needed to do their job correctly n/a 60% √
Percent of Colvols who, in the last six months, have not had any difficulties providing the expected
services to their communities due to inadequate supplies or materials n/a 60% √
Participation in monthly activities
Percent of Colvols who brought their report to the last Colvol meeting they attended n/a 75% √
Percent of Colvols who attended the Continuing Education session at the last Colvol meeting they
attended n/a 80% √
Percent of Colvols who discussed the micro-credit program at the last Colvol meeting they attended n/a 75% √
Percent of Colvols who correctly state it is not okay to give a 5 month old child ORT n/a 80% √
Percent of Colvols who correctly state that when a child has diarrhea the mother should give the child
more food than usual n/a 80% √
147
HAND WASHING KNOWLEDGE AND TECHNIQUES – Cross sectoral (MTE target for each group)
KNOWLEDGE: % who know when to wash their hands
Health and Nutrition Credit Food Assisted Education Safety Net
When should you wash your hands? CHWs Mothers of children (0-6, 6-12 and 12-24
mo.)
Communit
y
Members
PTA
Members
School
Directors,
Teachers,
Female & Male
Students
Directors &
Staff
Females
and
Males
<12 and
>12
a. after using the toilet 80% 70% 70% 80% 80% 70% 70%
b. after changing babies’ diapers 20% 20% 20% 20% 20% 20% 20%
c. before preparing food 80% 70% 70% 20% 20% 70% 20%
d. before eating 80% 70% 70% 80% 80% 70% 70%
e. before feeding children 80% 70% 70% 20% 20% 70% 20%
f. working in the garden/coming home
from school or market 20% 20% 20% 20% 20% 70% 20%
g. after playing NA NA NA NA 20% NA 70%
All key messages combined a, c, d, e a, c, d, e a, c, d, e a, d a, d a, c, d, e, f a, d, g
Benchmark for all key messages
combined 70% 50% 50% 70% 70% 60% 60%
TECHNIQUES – washing hands
% who used correct hand washing
techniques (baseline method) 70% 60% 70% 70% 70% 70% 70%
% who used correct hand washing
techniques (international method) 70% 60% 70% 70% 70% 60% 60%
148
Samples
HIV/AIDS – Cross Sectoral – Adults
(page 1 of 2)
LOA
target
MTE
target ED
PTA
ED –
DIR.
ED –
TEACH.
SSNI –
DIR.
SSNI -
STAFF
Means of HIV/AIDS Transmission
Percent of adult respondents that can state one can avoid acquiring HIV/AIDS 75% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by abstaining
from sex 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by using
condoms 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by limiting sex
to one partner 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with prostitutes 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with persons who have many sex partners 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by remaining
faithful to one partner 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by avoiding
unprotected sex with persons who inject drugs intravenously 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by avoiding
infected blood 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by avoiding
the use of syringes, razors, straight edges 40% √√ √ √ √
Percent of adult respondents that state one can avoid HIV/AIDS by avoiding
contact with blood 40% √√ √ √ √
Percent of adult respondents that state that a pregnant woman can give the
HIV virus to her child during pregnancy 60% √√ √ √ √
Percent of adult respondents that state that a mother can give the HIV virus to
her child during child birth 60% √√ √ √ √
Percent of adult respondents that state that a mother can give the HIV virus to
her child via breast feeding 60% √√ √ √ √
General knowledge on HIV/AIDS
Percent of adult respondents that have been tested for HIV 20% NA NA NA √√
149
Percent of adult respondents that state that the HIV virus can take up to six
months to show up as positive on a blood test. 60% √√ √ √ √
Percent of adult respondents that state that there are no cure for people who
have HIV 60% √√ √ √ √
Percent of adult respondents that state that HIV/AIDS has been discussed at
their PTA meetings 55% √√ NA NA NA
Samples
HIV/AIDS – Cross Sectoral – Adults
(page 2 of 2)
LOA
target
MTE
target ED
PTA
ED –
DIR.
ED –
TEACH.
SSNI –
DIR.
SSNI -
STAFF
Perception of Personal Risk
Percent of adult respondents that state that you do not get HIV by shaking hands
with someone who has HIV/AIDS 60% √√ √ √ √
Percent of adult respondents that state that you do not get the HIV virus by sharing
a bathroom/toilet with someone who has HIV/AIDS 60% √√ √ √ √
Percent of adult respondents that state that you do not get the HIV virus by
hugging someone who has HIV/AIDS 60% √√ √ √ √
Percent of adult respondents that state that a woman can refuse to have sex with
her husband if he has a sexually transmitted infection 70% NA NA NA √√
Percent of adult respondents that state that it is not OKAY if he husband/boyfriend
has sex with his wife/girlfriend even if she said “no” to his sexual advances 70% NA NA NA √√
Percent of adult respondents that state that a man can refuse to have sex with his
wife if she has a sexually transmitted infection 70% NA NA NA √√
Percent of adult respondents that think it is not okay for a man to have sexual
relations outside of his marriage 70% √√ √ √ √
Percent of adult respondents that think it is not okay for a woman to have sexual
relations outside of her marriage 70% √√ √ √ √
Percent of adult respondents that think it is not acceptable for a man/woman to
have sexual relations in exchange for the payment of household bills or school
fees, for example
70% √√ √ √ √
Stigma and discrimination
Percent of adult respondents that state knowing someone with the HIV virus 40% √√ √ √ √
Percent of adult respondents that state they are friends with someone infected with
HIV, or suffering from AIDS 40% √√ √ √ √
Percent of adult respondents that state that if a friend of theirs was diagnosed as
HIV positive, they would continue your friendship with that person 70% √√ √ √ √
150
Percent of adult respondents that state they would be willing to take care of a
family member that is infected with the HIV virus in their own home 70% √√ √ √ √
Percent of SSNI adult respondents that state that they would accept a child into
the center that they know to be HIV positive 70% NA NA NA √√
Percent of adult respondents that state they do not believe that people who have
the HIV virus deserved getting the disease because of their past behavior 70% √√ √ √ √
Percent of adult respondents that state they do not believe that people who have
the HIV virus deserved getting the disease because they are bad religious people 70% √√ √ √ √
SSNI Education-schools HIV/AIDS – Cross Sectoral – Children
(page 1 of 2) MTE
target
Female
8-12
MTE
target
Female
13& up
MTE
target
Fem.
student
Male
student
Means of HIV/AIDS transmission
Percent of children that can state one can avoid acquiring HIV/AIDS 30% √ 60% √ NA
Percent of children that state one can avoid HIV/AIDS by abstaining from sex 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by using condoms 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by limiting sex to one
partner 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by avoiding unprotected
sex with prostitutes 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by avoiding unprotected
sex with persons who have many sex partners 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by remaining faithful to
one partner 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by avoiding unprotected
sex with persons who inject drugs intravenously 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by avoiding infected
blood 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by avoiding the use of
syringes, razors, straight edges 30% √ 50% √ NA
Percent of children that state one can avoid HIV/AIDS by avoiding contact with
blood 30% √ 50% √ NA
Percent of children that state that a pregnant woman can give the HIV virus to
her child during pregnancy 50% √ 50% √ 60% √√
151
Percent of children that state that a mother can give the HIV virus to her child
during child birth 50% √ 50% √ 60% √√
Percent of children that state that a mother can give the HIV virus to her child
via breast feeding 50% √ 50% √ 60% √√
General knowledge on HIV/AIDS
Percent of children that state that the HIV virus can take up to six months to
show up as positive on a blood test. NA 60% √ 60% √√
Percent of children that state that there are no cure for people who have HIV NA 60% √ 60% √√
SSNI Education-schools HIV/AIDS – Cross Sectoral – Children
(page 2 of 2) MTE
target
Female
8-12
MTE
target
Female
13& up
MTE
target
Fem.
student
Male
student
Perception of personal risk
Percent of children that state that you do not get HIV by shaking hands with
someone who has HIV/AIDS 50% √ 60% √ 60% √√
Percent of children that state that you do not get the HIV virus by sharing a
bathroom/toilet with someone who has HIV/AIDS 50% √ 60% √ 60% √√
Percent of children that state that you do not get the HIV virus by hugging
someone who has HIV/AIDS 50% √ 60% √ 60% √√
Percent of children that think it is not okay for a man to have sexual relations
outside of his marriage 50% √ 70% √ 70% √√
Percent of children that think it is not okay for a woman to have sexual
relations outside of her marriage 50% √ 70% √ 70% √√
Percent of children that think it is not acceptable for a man/woman to have
sexual relations in exchange for the payment of household bills or school fees,
for example
NA √ 70% √ NA √√
Percent of children that state one can avoid HIV/AIDS by remaining faithful to
one partner 30% √ 50% √ NA √√
Stigma and discrimination
Percent of children that state knowing someone with the HIV virus 20% √ 20% √ 20% √√
Percent of children that state they are friends with someone infected with HIV,
or suffering from AIDS 50% √ 20% √ 20% √√
152
Percent of children that state that if a friend of theirs was diagnosed as HIV
positive, they would continue your friendship with that person 50% √ 60% √ 60% √√
Percent of children that state they would be willing to take care of a family
member that is infected with the HIV virus in their own home NA √ 60% √ 60% √√
Percent of children that state they do not believe that people who have the HIV
virus deserved getting the disease because of their past behavior 50% √ 60% √ 60% √√
Percent of children that state they do not believe that people who have the HIV
virus deserved getting the disease because they are bad religious people 50% √ 60% √ 60% √√
Samples
Female
children
Male
Children
SSNIs
(p. 1 of 1)
BL
Value
LOA
target
MTE
target Mgmt Obser vation 8-13 13 &up 8-13 13 & up
Management
Percent of staff that can state two or more universal children’s rights 90% 85% √
Percent of center management staff that have attended a meeting in
the last 6 months with their Ruche - independently from CRS 80% 20% √
Hygiene conditions
Percent of centers that were found to be clean and relatively free of
trash 80% 50% √
Percent of center kitchens that were found to be clean and free of
trash 80% 50% √
Percent of center kitchens without uncovered food out on the counters 90% 75% √
Percent of kitchen food preparation areas found to be smooth/free of
sticky substances 80% 50% √
Percent of kitchen food preparation stations found to have no
evidence of pests or rodents 85% 70% √
Percent of kitchens with soap available at the closest water point to
the kitchen 80% 50% √
Percent of centers in which latrine/toilet areas found to be clean 80% 50% √
Percent centers with doors on all of the latrines/toilets 80% 60% √
Percent of centers in which all latrine/toilet doors close completely 80% 50% √
Percent of centers in which latrines/toilets provide adequate 50% 30% √
153
Samples
Female
children
Male
Children
superstructure
Canteen management
Percent of centers with no food shortages in the center canteen in the
last month 90% 70% √
Percent of centers with financial withdrawal or deposit that is dated
within the last 30 days in the bookkeeping ledger 80% 50% √
School attendance, birth certificate and meals
Percent of children that state they are currently going to primary
school 95% 80% √√
Percent of children that state they are currently going to school o
receiving any training 95% 80% √√
Percent of children with birth certificates (or equivalent) 95% 80% √
Percent of children that state they ate SFB, cornmeal or lentils (put
local preparation names) in the last 24 hours 95% 90% √√√√
Percent of children that state they ate something other than SFB,
cornmeal or lentils (put local preparation names) in the last 24 hours 60% 30% √√√√
154
SAMPLES SAMPLES
Education –schools Health Health Credit Agric. CIVIC EDUCATION – cross sectoral
(p. 1 of 1)
LOA
target
MTE
bench
mark
PTA
member
School
Director
School
teacher
Colvol
(CHW)
LOA
target
MTE
bench
mark
Mothers
(0-6/6-
12/12-24
mo)
women
Associ￾ation
member
% who know that the state is founded
on 3 principles – property,
government, citizenry
80% 30% √ √ √√ 50% 20% √√ √
% who know that "Deputes” are
elected for two-year terms 80% 30% √ √ √√ 50% 20% √√ √
% who know the name of the tribunal
in their commune 90% 80% √ √ √√ 80% 50% √√ √
% who know that political parties gain
political office by winning elections 90% 80% √ √ √√ 80% 50% √√ √
% who know they have the right to
form an association or social group 90% 80% √ √ √√ 80% 50% √√ √
% who know they have the right to
form a political party 90% 80% √ √ √√ 80% 50% √√ √
% who know that Senators can
propose laws 90% 80% √ √ √√ 80% 50% √√ √
% who believe that the state and the
population are both responsible for
taking care of the environment
90% 80% √ √ √√ 80% 50% √√ √
% who know that a "majistra
komenal" (Mayor) obtains his/her
position by winning elections
90% 80% √ √ √√ 80% 50% √√ √
% who know that KASECS obtain
their position by winning elections 90% 80% √ √ √√ 80% 50% √√ √
% who know that ASECS obtain their
position by winning elections 90% 80% √ √ √√ 80% 50% √√ √
% who know that another name
"maman lwa peyi a" (the constitution)
is “La Loi Mere”
90% 80% √ √ √√ 50% 20% √√ √
% who know that there are three
branches of government – Executive,
Legislative and Judiciary
90% 80% √ √ √√ 50% 20% √√ √
155
156
APPENDIX 3 – Sample questionnaire
MCHN – 0 - 5.99 MONTHS (M1)
(12 pages)
Necessary Materials :
• A piece of paper to map households
• Random Number Table
Commune: Supervision Area #:
Section Communale: ID # Sample:
Localite: Enumerator Code:
Date: DAY MONTH YEAR Supervisor Code:
INSTRUCTIONS FOR THE RANDOM SELECTION OF MOTHER’S OF CHILDREN :
1) When you arrive in the community, walk around in order to determine where the center of it is. Ask several community
members to assist you in doing this.
2) Once you have identified the center of the community go there and spin a bottle. Walk in the direction that the bottle
points in – walking in a straight line as much as possible. Walk until you come to the edge of the community in that
direction, mapping out and labeling - with a number - all of the houses that you find along the way. Walk back to the town
center where you began.
3) Using the Random Number Table, pick a number between 1 and the number of houses you counted. Go to that house.
4) If there is a child in the desired age range in that household, ask if the biological mother of that child is available for
interviewing.
• If the mother of that child is available and willing, conduct the interview.
• If the biological mother of that child is not available or is unwilling to be interviewed, do not conduct the interview.
Go to the next closest household.
5) If there is no child in the age range you are looking for in that neighboring household, go to the next household in the
direction determined by the bottle (moving away from the town center.)
6) Continue moving in the direction determined by the bottle – away from the center - until you find a child in the desired age
range whose biological mother is available for interviewing.
NOTE : You are only interviewing the biological mother of the child. Do not interview anyone else.
If you come to a household with more than one child in the desired age range, identify which of these children have
mothers that are available for interviewing. If there is more than one child (6-11.99 months) whose mother is available for
interviewing, randomly select one of these mothers to interview.
If there is no child in the household of the desired age, do not begin the interview. Thank the person you spoke with and
continue on to the next household – or until you find a child of in the desired age range whose biological mother is available
for interviewing.
157
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
M1-001
Are there any children aged 0 – 5.99 months living in this household?
If YES (Y), randomly select one child aged 0 – 5.99 months.
If there is more than one child 0 – 5.99 months, and the mothers of these children are available,
randomly select one of them for interviewing. Write the name of the selected mother’s child below in
M1-002.
M1-001
M1-002 Name of the selected child
0 – 5.99 months M1-002 _________________________________
You will refer to the child by name throughout the
proceeding questionnaire.
When you see “<NAME>” in the questionnaire, use
the child’s name.
M1-003
Does the child have a health card or a birth certificate with birth date recorded?
Mark YES (Y) if the mother says that the child has a health card or birth certificate (even if she does
not have them available to show them to you).
M1-003
Instructions for questions M1-004 and M1-005:
DO NOT FILL OUT BOTH M1-004 and M1-005. You are only filling in ONE of these answers. The answer you fill in depends on whether the mother :
ƒ Is able to provide you with the child’s health card or birth certificate – in which case you would use the health card or birth certificate to fill in
M1-004 ; OR
ƒ Is unable to provide you with the child’s health card or birth certificate – in which case you would ask her to merely tell you the child’s date of birth
and use that information to fill in M1-005.
M1-004
Child’s birth date
according to record
(d/m/y)
M1-004 ___________ / _____________ /___________
 day / month / year
M1-005 Child’s birth date
according to recall (d/m/y) M1-005 ___________ / ___________ / ____________
 day / month / year
The child will have to have been born
between:
June (today’s date) 2004 and
December (yesterday’s date) 2004.
Read this introduction to the following section to the respondent :
The following questions relate to the early weeks/months of your child’s life.
Most of the questions that I would like to ask you have to do with what the child was fed during that time.
a. Lòk M1-006 a
b. Tea M1-006 b
c. Sugar Water M1-006 c
d. Breast Milk M1-006 d
e. Boiled Water M1-006 e
f. Bottle M1-006 f
g. Nothing M1-006 g
h. Does not Remember M1-006 h
M1-006 What did you give < NAME > on the day of birth?
(More than one answer is possible.)
(Do not read the answers to the respondent)
Anything else?
(If lòk is not mentioned by the respondent, ask specifically
if it was given to the child on the day of birth.)
Mark all of the items mentioned by the respondent as
YES (Y) and all of those NOT mentioned as NO (N).
i. Other M1-006 i
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
158
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
M1-007 How long after birth was it until you put < NAME > to your breast for the first time?
Convert the respondent’s answer into hours.
ƒ If the respondent began breast feeding the child within the first hour of birth (0-60 minutes),
write 01 in the box to the right.
ƒ Between 1 and 2 hours (61-120 minutes), then write 02;
Between 2 and 3 hours, write 03, etc.
NOTE: You are always rounding the time up to the nearest hour.
ƒ If the respondent did not breast feed the child within the first 24 hours, then write 00 in the
box to the left.
M1-007
# hours after birth
M1-008
Did you give < NAME > the first yellow milk (colostrum)?
Mark YES (Y) if the respondent gave the colostrum to the child.
Mark NO (N) if the respondent did not give the colostrum to the child, if she discarded it or if she
doesn’t remember.
M1-008
M1-009 Is < NAME > still being breast fed? M1-009
M1-010
If < NAME > is no longer being breast fed, ask the respondent the following question:
For how many months did you breast feed < NAME >?
ƒ If the respondent breast fed the child for less than 1 month, then write 01 in the box to the
right.
ƒ If she breast fed between 1 and 2 months, then write 02;
Between 2 and 3 months write 03, etc.
NOTE: You are always rounding the amount of time up to the next month.
ƒ If the respondent has not breast fed the child at all since birth, then write 00 in the box.
: “Write 99 if the mother is still breast feeding.”
M1-010 # months breast fed
M1-011 Yesterday during the day and at night, how many times did you give < NAME > solid food, semi￾solid food or food like porridge? M1-011 # times
M1-012 Yesterday during the day and at night, how many times did you give < NAME > snacks (like fig,
mango, avocado, candy, “marinad”)? M1-012 # times
159
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
Instructions for questions M1-013 below:
1) Ask the respondent if she has started feeding the child the particular food items listed below.
2) If the respondent answers:
a. YES - that she HAS begun feeding the child that particular food item - then follow up by asking her how old the child was (in months) when she
began to feed her/him it – recording the number of months in the box to the right.
ƒ If the respondent began feeding the child a specific food item within the first month of birth, write 01 in the box to the right.
ƒ Between 1 and 2 months = 02, between 2 and 3 months = 03, etc.
NOTE: You are always rounding the amount of time up to the next month.
b. NO – that she HAS NOT begun feeding the child that particular food item - then write 00 in the box to the right and proceed to the next food item.
M1-013 Have you started giving < NAME >:
a. 
a. Liquids other than breast milk
(like tea, sweet water, etc.)? M1-013 a # months (child)
b. Milk (other than breast milk) and/or
cheese? M1-013 b # months (child)
If YES:
How many months old was < NAME > when
you started giving her/him this? c. Semi-solid foods (like porridge, soup,
etc.)? M1-013 c # months (child)
d. Starches (like rice, potatoes, maize, etc.)? M1-013 d # months (child)
e. Meat, Fish, or Herring? M1-013 e # months (child)
f. Eggs? M1-013 f # months (child)
g. Fruit and vegetables? M1-013 g # months (child)
h. Food prepared with fat, oil and/or butter? M1-013 h # months (child)
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
160
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
The section below is meant to be more conversational between you and the respondent.
You will be talking about what < NAME > ate yesterday – from when the child woke up in the morning yesterday to when s/he woke up this morning
(that means during the day yesterday and during the night last night).
Instructions for question M1-014:
1) Ask the respondent what she fed the child for all of the meals and snacks yesterday (from when the child woke up in the morning to when s/he
woke up this morning.)
2) Ask the respondent to explain what she put in the meal – for example, if she made porridge, what did she use to prepare it? Cereal? Milk? Butter?
Mark as YES (Y) all of the ingredients that the respondent mentions (given to the child to eat) in the boxes to the right.
3) At the end of the questioning for this section, return to the list and mark as NO (N) all of the food items that were NOT mentioned
(items that were not given to the child to eat) by the respondent, in the boxes to the right.
Make sure that all of the food items that ARE mentioned are marked as YES (Y)
and that all of the food items that are NOT mentioned are marked as NO (N) before proceeding to the next section. THIS IS VERY IMPORTANT!
M1-014 What did you give < NAME >: a. Breast milk? M1-014 a
ƒ When s/he first
woke up in the morning
yesterday?
b. Commercially produced infant formula? M1-014 b
ƒ For Breakfast yesterday? c. Any other milk, such as tinned, powdered, or fresh animal milk? M1-014 c
ƒ For Lunch yesterday? d. Plain water? M1-014 d
ƒ In the afternoon yesterday? e. Fruit juice? M1-014 e
ƒ For Dinner yesterday? f. Any other liquid (sugar water, carbonated drinks, soup broth,
coffee, tea, etc.) M1-014 f
ƒ As a snack anytime during
the day or evening
yesterday?
g. Cereal or food made from grains (like rice, maize, sorghum,
etc.)? M1-014 g
ƒ To drink (liquids)? h. Pumpkin or yellow/orange fleshed squash, carrots or
yellow/orange fleshed sweet potatoes? M1-014 h
i. Any starches or any food made from roots or tubers
(like potatoes, cassava, manioc, etc.)? M1-014 i
j. Legumes or any food made from beans, peas or lentils (like
cowpeas, pink beans, black beans, chick peas, lentils, peas, etc.)? M1-014 j
k. Dark green leafy vegetables (like cassava leaves, bean leaves,
kale, spinach, pepper leaves, taro leaves, amaranth leaves, etc.)? M1-014 k
l. Ripe mango or ripe papaya? M1-014 l
m. Any other fruit or vegetable? M1-014m
n. Any beef, goat, pork, lamb or rabbit meat? M1-014 n
o. Chicken, guinea hen, duck or other bird? M1-014 o
p. Fresh or dried fish or shellfish? M1-014 p
q. Any organ meats (like liver, kidney, etc.)? M1-014 q
r. Eggs? M1-014 r
s. Cheese or yoghurt? M1-014 s
t. Any food prepared with fat (like lard, butter or oil)? M1-014 t
u. Groundnuts, peanuts or any other nut? M1-014 u
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
161
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
a. Let the baby continue sleeping M1-015 a
b. Wake up the baby M1-015 b
c. The child doesn’t eat prepared “food” yet M1-015 c
If < NAME > is sleeping when her/his food is
ready, what do you do?
Mark as YES (Y) the answer given by the
respondent.
Mark as NO (N) all of the answers that were not
given by the respondent.
d. Other M1-015 d
M1-015
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
Read this introduction to the following section to the respondent :
I would like to ask you a question about diarrhea.
M1-016 Has < NAME > had diarrhea in the last two weeks?
The definition for diarrhea is three or more runny stools per day.
M1-016
Read this introduction to the following section to the respondent :
Now, I would like to ask you about your vaccination history during your pregnancy with <NAME> –
what vaccines you received, how many times, etc.
Directions for questions M1-027 to M1-030 about her vaccination history.
Ask the mother if she has a health card for herself.
ƒ If she has a health card, then use the health card to mark the boxes to the far right accordingly (TT vaccination.)
ƒ If she does not have a health card, then ask her about her immunization history directly.
M1-017 Do you (mother) have a health card? M1-017
M1-018 When you were pregnant with < NAME >, did you get any vaccinations in the arm/shoulder to avoid
the child getting tetanus – which is when the body is permanently tense?
M1-018
If the mother has a health card, ask her to see it in order to confirm her TT vaccination history.
If the mother is not able to show you the health card for whatever reason, or does not have a health card,
just ask her to recall the information and mark the box accordingly.
If she did not receive any TT vaccinations, mark NO (N) in the box to the right.
M1-019 Did you receive two vaccinations against tetanus (TT) during your pregnancy with < NAME >?
Mark as YES (Y) if the respondent received TWO TT vaccinations when she was pregnant with this child.
Mark all of the answers in M1-020 as NO (N) and continue on to question M1-021.
Mark as NO (N) if the respondent did not receive two tetanus vaccinations. Continue on to M1-020 below.
If the respondent did not receive vaccinations during her pregnancy with the child, ask her the next set of
questions:
M1-019
M1-020 a. There was a shortage of TT vaccinations at
Health Facility M1-020 Why didn’t you get TWO vaccinations for
Tetanus when you were pregnant with
< NAME > ?
Mark as YES (Y) any of the answers that ARE
mentioned by the respondent.
b. She was already fully vaccinated. M1-020
Mark as NO (N) all of the answers that are NOT
mentioned by the respondent.
c. She did not go in to the Health Facility to
get the full (2) vaccinations M1-020
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
162
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
Read this introduction to the following section to the respondent :
In the following section, I will ask you about the health care you received during your pregnancy with < NAME >
and the time immediately following the delivery of < NAME >.
M1-021 Who did you consult with during your last
pregnancy? a. Doctor M1-021 a
Mark as YES (Y) all the people that the
respondent MENTIONS that she consulted with. b. Health Agent M1-021 b
Mark as NO (N) all of the people that the
respondent DOES NOT MENTION consulting
with.
c. Nurse M1-021 c
d. Auxiliary M1-021 d
e. Colvol M1-021 e
f. Trained Birth Attendant (TBA) M1-021 f
g. Untrained Birth Attendant M1-021 g
h. Traditional Practitioner M1-021 h
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
163
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
Instructions pour questions M1-022 – M1-028
ONLY the following medical people ARE CONSIDERED TRAINED
PROVIDERS of prenatal and postnatal services :
ƒ Doctors
ƒ Health Officers
ƒ Nurses
ƒ Auxiliaries
The following people are NOT CONSIDERED TRAINED PROVIDERS of
prenatal and postnatal services :
ƒ Colvol
ƒ Trained Birth Attendant (NOTE : This person IS considered a
trained person for deliverys ONLY)
ƒ Untrained Birth Attendant
ƒ Traditional Practitioner
NOTE : The ONLY EXCEPTION to this instruction concerns assistance during delivery (M1-024) – Trained Birth Attendants are considered trained
providers of delivery services. If a Trained Birth Attendant was at least one of the people present during the delivery of < NAME >, then mark question
M1-024 as YES (Y).
How many prenatal visits did you have with a trained health provider (a doctor, nurse, health officer
and/or auxiliary) during your pregnancy?
If the respondent CONSULTED WITH AT LEAST ONE of the trained health providers mentioned above left,
M1-022 then write the number of times they were consulted.
If the respondent DID NOT CONSULT WITH AT LEAST ONE of the trained health providers mentioned
above left, then write 00 in the box to the far right.
If the respondent did not consult with anyone during her pregnancy with < NAME >, then write 00 in the box.
M1-022
# pre-natal visits to
trained health
provider
M1-023
How many months pregnant were you with < NAME > when you went for your first pre-natal visit?
If the respondent CONSULTED WITH AT LEAST ONE of the trained health providers mentioned above left,
then write the number of months pregnant she was in the box to the right.
If the respondent DID NOT CONSULT WITH any of the trained health providers mentioned above left, then
write 00 in the box to the far right.
NOTE: If the respondent gives an uneven amount of time (like 1 ½ months) then round up the amount of
time to the next month (for example, 1 ½ months will get rounded up to 2 months – and 02 gets written in
the box to the right).
M1-023
# months pregnant
– first pre-natal visit
to trained health
provider
Who delivered < NAME >?
M1-024 Mark as YES (Y) , if at least ONE OF THE TRAINED HEALTH PROVIDERS mentioned above left assisted
in the delivery of < NAME >.
NOTE: TRAINED BIRTH ATTENDANTS ARE CONSIDERED TRAINED PROVIDERS OF DELIVERY
SERVICES and should be marked as YES (Y) in the box to the right.
M1-024
M1-025 Where did you deliver < NAME >? a. At her home M1-025 a
b. In another person’s home M1-025 b
c. In a health facility (health center, a clinic,
dispensary or hospital) M1-025 c
Mark as YES (Y) the answer that is mentioned by
the respondent.
Mark as NO (N) all of the other answers that are
NOT mentioned by the respondent.
You will only mark ONE ANSWER as YES (Y). d. Other M1-025 d
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
M1-026
How many days after the birth of < NAME > was it until YOU went to a health facility (health center,
clinic, hospital, etc.) for your first post natal visit?
If the respondent has not been to a health facility AT ALL since the birth of the child, write 00 in the box to
right.
M1-026
# of days after birth
– first post-natal
visit
164
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
M1-027 a. Doctor M1-027 a
b. Health Agent M1-027 b
When you went in for your first pre-natal visit,
who were you examined by?
c. Nurse M1-027 c
Mark as YES (Y) all of the answers that ARE
mentioned by the respondent. d. Auxiliary M1-027 d
Mark as NO (N) all of the answers that are NOT e. Colvol M1-027 e
mentioned by the respondent.
f. Trained Birth Attendant (TBA) M1-027 f
If the respondent has not been for a post-natal
visit, mark all of the answers as NO (N). g. Untrained Birth Attendant M1-027 g
h. Traditional Practitioner M1-027 h
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before proceeding to the next section.
THIS IS VERY IMPORTANT!
M1-028
If the respondent was examined by a trained medical provider (mentioned above left) of post￾natal services (YES (Y) in M1-027 a-d above), ask :
How many days after the delivery of < NAME > was it until you were examined by a trained health
provider (a doctor, nurse, auxiliary or health agent) for the first time?
If the respondent was examined by one of the trained health providers mentioned above left - within 45
days of delivery – mark the number of days in the box to the right.
ƒ If the respondent was examined the first day after birth, then write 01 in the box.
If the respondent was NOT examined by one of the trained health providers mentioned above left within
45 after the birth, write 00 in the box to the right.
If the respondent DID NOT consult with a trained medical provider (see the list above to the left) of post￾natal services AT ALL, write 00 in the box to the right.
M1-028 # of days after
delivery
Read this introduction to the following section to the respondent :
In this next section, I will be asking you about the Rally Post, the services you receive from the Colvol and the food rations you received when you
were pregnant and since the delivery.
M1-029 Has < NAME > been taken to the Rally Post in the last month (30 days)? M1-029
M1-030 Have you participated in a Rally Post in the last month (30 days)? M1-030
M1-031 Have you participated in an educational session at the Rally Post in the last month (30 days)? M1-031
M1-032 The last time you participated in an educational session at the Rally Post, did you find the
information practical? M1-032
M1-033 In general, do you think that the immunization services that the Colvol provides you with are
valuable? M1-033
M1-034 In general, do you think that the growth monitoring services that the Colvol provides you with are
useful to raising a healthy child? M1-034
M1-035
Last month, did your child increase or decrease in weight?
Mark as YES (Y) if the respondent is able to answer this question.
Mark NO (N) if the respondent is unable to answer this question or does not know.
M1-035
M1-036 Do you think that the information given to you by the Colvol is said in a way that is easy to
understand? M1-036
M1-037 Do you think that the Colvol is knowledgeable about the nutrition information that s/he provides
to you? M1-037
165
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
M1-038 Are you a member of a Mother's Club? M1-038
M1-039
How many months pregnant were you with < NAME > when you received your first food ration?
If the respondent DID NOT receive food rations during her pregnancy with < NAME >, then write 00 in the
box to the right.
M1-039 # months pregnant
M1-040
After you received your first food ration, did you continue to receive them regularly each month
during your pregnancy with < NAME>?
If the respondent DID NOT RECEIVE FOOD RATIONS AT ALL during her pregnancy with < NAME >, or,
if she did not receive them regularly, then mark as NO (N).
M1-040
M1-041
Have you received food rations every month (you never missed a month) since the delivery of
< NAME >?
Mark as NO if the respondent never received food rations since the delivery of the child or if she did not
receive them regularly.
M1-041
M1-042
The last time you went to the health center to receive your food rations, did the health center give
you the correct ration amount of each product and the correct type of ration for you?
(2 “marmites” of bulgar, 1 “marmite” of beans, 4 bottles of oil)
M1-042
M1-043
How long does it take you to fetch water (round trip – R/T - including any amount of time that you
normally have to wait in order to get the water at the water point)?
Calculate this amount of time in minutes.
M1-043 # minutes R/T
M1-044
Is this water source capped?
Mark YES (Y) if the respondent mentions that there is a pipe or capped spring.
Mark NO (N) if the respondent answers that they get their water from a well or an uncapped spring.
M1-044
Read this introduction to the following section to the respondent :
CRS is going to begin civic education trainings. The following questions relate to democracy, and your understanding of it in Haiti.
Questions M1-045 – M1-057 concern the respondent’s knowledge of civic issues.
The enumerator will mark either YES (Y) or NO (N) depending on whether the answer provided by the respondent matches the one provided in italics.
M1-045
What are the three principals on which the state was founded?
Mark YES (Y) if the respondent can name ”the state,” government” and “territory”.
Mark NO (N) if the respondent cannot name all three of these principles mentioned above.
M1-045
M1-046
How long are “Depites/Depute” elected for?
Mark YES (Y) if the respondent answers “4 years.”
Mark NO (N) for all other answers or if the respondent does not know.
M1-046
M1-047
In each “Commune” there is one tribunal. What is the name of this tribunal?
Mark YES if the respondent answers “Tribunal de Paix”.
Mark NO (N) for all other answers or if the respondent does not know.
M1-047
M1-048
In a democracy, how do political parties gain political office?
Mark YES (Y) if the respondent answers that in a democracy political parties gain political office via
elections.
Mark NO (N) for any other answer or if the respondent answers that s/he doesn’t know.
M1-048
M1-049
As a Haitian, do you have the right to form an association or social group?
Mark YES (Y) if the respondent answers that s/he has the right to form an association or social group.
Mark NO (N) for any other answer or if the respondent answers that s/he doesn’t know.
M1-049
166
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
M1-050
As a Haitian, do you have you have the right to form a political party?
Mark YES (Y) if the respondent answers “Yes” s/he does have the right to form a political party.
Mark NO (N) for any other answer or if the respondent answers that s/he doesn’t know.
M1-050
M1-051
Can Senators propose laws?
Mark YES (Y) if the respondent answers “Yes”.
Mark NO (N) if the respondent answers “No.”
M1-051
M1-052
Who do you think is responsible for protecting the environment?
Mark YES (Y) if the respondent answers that it is “everybody’s responsibility” or that it is BOTH the
government's and the people's responsibility to protect the environment.
Mark NO (N) if the respondent says that it is the government’s responsibility but DOES NOT mention the
people’s responsibility or her/his own responsibility.
Also mark NO (N) if the respondent provides any other answer than those provided above.
M1-052
M1-053
In a Haitian democracy how does a “majistra kominal” obtain his/her position?
Mark YES (Y) if the respondent answers that in democracy a “majistra kominal” gains political office via
elections.
Mark NO (N) for any other answer or if the respondent answers that s/he doesn’t know.
M1-053
M1-054
In a Haitian democracy, how does a KASEC obtain his/her position?
Mark YES (Y) if the respondent answers that in a democracy a “CASEC” gains political office via
elections.
Mark NO for any other answer or if the respondent answers that s/he doesn’t know.
M1-054
M1-055
In a Haitian democracy how does an ASEC obtain his/her position?
Mark YES (Y) if the respondent answers that in a democracy a “ASEC” gains political office via elections.
Mark NO for any other answer or if the respondent answers that s/he doesn’t know.
M1-055
M1-056
What is the other name for “maman lwa peyi a”?
Mark YES (Y) if the respondent answers “constitution.”
Mark NO (N) for any other answer or if the respondent answers that s/he doesn’t know.
M1-056
M1-057
In a democracy, there are three divisions of power. What are these three divisions?
Mark YES (Y) if the respondent answers all of the following: “Executive”,” Legislative”, and “Judicial”.
Mark NO (N) if the respondent cannot name all of the three divisions listed above or if the respondent
answers that s/he doesn’t know.
M1-057
167
CRS/HAITI MID-TERM EVALUATION
QUESTIONNAIRE MCHN - MOTHERS OF CHILDREN 0 – 5.99 MONTHS (M1)
Q # QUESTIONS Q # RESPONSES
Read this introduction to the following section to the respondent :
These are the last two questions that I would like to ask you today. I thank you for your patience and willingness to speak with me.
Before we finish, I have just two more question which are about hand washing.
For this section, ask the respondent the following questions about their hand washing behaviors.
DO NOT PROMPT THE RESPONDENT AT ALL DURING THIS PART OF THE INTERVIEW.
Instructions for questions M1-058 and M1-059 :
1. Ask the respondent when s/he washes her/his hands (M1-058).
ƒ If the respondent provides any of the answers provided to the right, mark those particular answers as YES (Y).
2. Ask the respondent if s/he would please wash her/his hands while explaining to you her/his procedure (M1-059).
ƒ If the respondent demonstrates a particular technique that is listed to the right, then mark that technique as YES (Y).
3. As soon as the respondent has finished washing her/his hands and explaining the process to you, return to the answers to make sure that they are
marked correctly.
ƒ Mark YES (Y) for all of the answers given and the techniques demonstrated by the respondent.
ƒ Mark NO (N) for all of the answers NOT GIVEN or techniques NOT DEMONSTRATED by the respondent.
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before finishing the questionnaires.
THIS IS VERY IMPORTANT!
a. After using the toilet/latrine M1-058 a
b. After changing a babies’ diapers M1-058 b
c. Before preparing food M1-058 c
d. Before eating M1-058 d
e. Before feeding children M1-058 e
f. After working in the garden / coming home from
school / market M1-058 f
M1-058 When do you wash
your hands?
g. After playing M1-058 g
a. Uses clean water
If there is no water faucet, the respondent should pour
water over their hands.
They should not dip their hands in water - if they do this,
then mark this technique as NO (N) in the box to the
right.
M1-059 a
b. Uses soap/ash M1-059 b
c. Washes both hands M1-059 c
d. Rubs hands together at least
three times. M1-059 d
Could you please show me
how you wash your hands,
explaining the procedure to
me while you do it?
e. Dries hands in a hygienic manner – air drying or
uses a clean cloth. M1-059 e
M1-059
Make sure that all of the answers listed above are marked as either YES (Y) or NO (N) before finishing this questionnaire.
THIS IS VERY IMPORTANT!
THE END