MIDTERM EVALUATION OF THE REPROSALUD PROJECT
EXECUTIVE SUMMARY OF RESULTS
By:
Bonnie Shepard
Delicia Ferrando
Arlette Beltran
Submitted by:
LTG Associates, Inc.
and
TvT Associates, Inc.
Submitted to:
The United States Agency for International Development
in Peru
Under Contract No. HRN-I-00-99-00002-00, Task Order Number 812
March 2002
Midterm Evaluation of the Reprosalud Project, was prepared under the auspices of the U.S. Agency for 
International Development (USAID)/Peru under the terms of the Monitoring, Evaluation and Design 
Support (MEDS) project, Contract No. HRN-I-00-99-00002-00, Task Order No. 812. The opinions
expressed herein are those of the authors and do not necessarily reflect the views of LTG Associates, TvT 
Associates, or USAID.
Information about this and other MEDS publications may be obtained from:
Monitoring, Evaluation and Design Support (MEDS) Project
1101 Vermont Avenue, N.W., Suite 900
Washington, DC 20005
Phone: (202) 898-0980
Fax: (202) 898-9397
cbillingsley@medsproject.com
www.medsproject.com
ACRONYMS AND FOREIGN TERMS
CBO Community-based organization
MOH Ministry of Health
NGO Nongovernmental organizations
RTI Reproductive tract infection
STI Sexually-transmitted infection
USAID United States Agency for International Development 

CONTENTS
ACRONYMS AND FOREIGN TERMS
EXECUTIVE SUMMARY .................................................................................................1
 
A. Background Information....................................................................................1
B. Summary of Main Conclusions..........................................................................3
Conclusions on Impact.................................................................................3
Organizational Performance and Costs........................................................4
Barriers and Facilitating Factors in the Advocacy Program........................5
C. Recommendations ..............................................................................................6
Replication of Phase One .............................................................................6
Strengthening the Advocacy Program.........................................................7
Maximizing and Sustaining Impact in Current Districts .............................7
Evaluation and Monitoring ..........................................................................7
D. Final Comments.................................................................................................8
ANNEXES
A: Objectives and Methodology of the Midterm Evaluation............................................11
B: Results Framework and Impact Study Tables.............................................................15
C: Impact Study Graphs....................................................................................................25
D: Detailed Summary of Impact Findings and Recommendations ..................................31
E: Process Evaluation Tables ...........................................................................................41
F: Cost Analysis Data.......................................................................................................49
TABLES
Table 1: Overview of Results and Indicators..................................................................16
Table 2: Summary of Impact of Interventions.................................................................19
Table 3: Comparison of Baseline and Midterm Evaluation 
Results Framework Indicators: 
Intervention Communities and Control Communities ......................................21
Table 4: Reproductive Health Indicators.........................................................................26
Table 5: Gender Issues Indicators....................................................................................27
Table 6: Reproductive Health and Gender Issues Indicators...........................................28
Table 7: Synopsis of General Recommendations to Reprosalud.....................................44
Table 8: MOH Limitations and Financial Issues.............................................................45
Table 9: Impact on Women.............................................................................................46
Table 10: Impact on Men...................................................................................................46
Table 11: Did Reprosalud Have an Impact on Use of Services?.......................................47
Table 12: Changes Implemented in Services to Improve Quality.....................................47
Table 13: Combined Effectiveness Indicators Constructed for the Cost Analysis............50
Table 14: RH Effectiveness Ratios at National Level.......................................................53
Table 15: Cost per Beneficiary for the Main Activities of the Reprosalud Program........53
FIGURES
Figure 1: Four Prenatal Visits in Health Services Last Pregnancy.................................26
Figure 2: Health Professional Assisted Last Childbirth..................................................26
Figure 3: Percent of Women Who Decide What the Money
They Earn Will Be Spent on............................................................................27
Figure 4: Percent of Women Who State Their Unwillingness to
Be Forced or Convinced to Have Sex..............................................................27
Figure 5: Percent of Women Who Have Attended a 
Health Service for Reproductive Health or Family Planning Services............28
Figure 6: Percent of All Women Who Would Go to a Healthcare Facility
in the Event of Symptoms that Are Warning Signs of Risk ............................28
Figure 7: Percent of Women and Men Who Believe that Housework
Is As Important As the Husband’s Work.........................................................29
Figure 8: Shared and Unshared Priorities........................................................................42
Figure 9: Essential Communications Flows in Advocacy Program, Phase Two ............43
1
EXECUTIVE SUMMARY
A. BACKGROUND INFORMATION
The Reprosalud program is a unique example of a reproductive health and gender equity
program whose beneficiaries are in hard-to-reach communities. The program is a 10-year 
cooperative agreement1
 (1995–2005) between the United States Agency for International
Development (USAID) and Movimiento Manuela Ramos, a Peruvian feminist
organization, the purpose of which is to improve the reproductive health of low-income 
women in rural and peri-urban zones in Peru.
The principal expected result of Reprosalud is that women will increase their use of
specific interventions that could protect their reproductive health, including a range from
individual health-protective behaviors to increased use of formal health services. 
Reprosalud also aims to have a positive impact on socio-cultural factors that affect
women’s health, especially gender issues.
Reprosalud represents a unique learning opportunity for the reproductive health field. 
There are very few examples worldwide of participatory community-based reproductive
health/gender equity programs that have been implemented on such a massive scale in
hard-to-reach communities of linguistic or ethnic minorities. Phase One of the project
(1996–2000) involved subgrants to more than 2,500 women’s community-based 
organizations (CBOs) in low-income communities in 8 departments,2
 including many in
which the main language is Quechua or Aymara. Seventy percent of the communities
involved in Phase One were rural. As of December 2001, 231 subgrantee CBOs have 
completed 2 subprojects and conducted participatory educational interventions on 2–3 
reproductive health problems identified by the community.3
 Over 190,000 individuals
 
1
 The agreement was signed in August 1995 and the project began in 1996. It has had two 5-year 
authorizations, with a current end date of September 30, 2005.
2
 The department is the main geo-political division in Peru. In the Ministry of Health, the next level of 
authority below the national is departmental. 
3
 One hundred and sixty two subgrantees have completed 3 themes, and 69 have completed 2. Each 
subproject involves several neighboring “associated” CBOs as well, so that the total number of women’s 
organizations involved was 2,568.
Basic Principles of the Reprosalud Program
· Commitment to gender equity and women’s empowerment,
· Commitment to participatory processes that put community members
in charge, 
· Promotion of sexual and reproductive health and rights, and
· Respect for indigenous cultures, integrating modern health knowledge
with traditional knowledge and practices that are not harmful to health.
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
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(65 percent women, 35 percent men) participated in the Phase One subprojects, and up to 
one million family members have benefited indirectly.4
The Reprosalud workshops use a participatory methodology that encourages participants
to reflect on both the physiological and social causes of health problems, as well as
possible solutions. The basic module addresses anatomy, physiology of reproduction,
and gender roles. Based on the priorities of the great majority of CBOs, Reprosalud
developed four modules: family planning, pregnancy and childbirth, reproductive tract
infections (RTIs), and violence, with separate editions for men and women, and for the
populations in the highlands and jungle areas. 
Phase One included an additional component to empower women also supported income￾generation through microcredit (“community banks”) and product development—
producing and marketing handicraft items for purchasers with bulk orders. However, this 
component is no longer part of the Reprosalud Program, since the microcredit program
became self-sufficient in 1999 and product development received funding from another
source in 2000.5
In Phase Two, which started in 2001, the planned focus for Reprosalud’s subgrant
program was “Promotion and Defense,” i.e., advocacy conducted by the CBOs with the 
health sector. The objective of the advocacy program is to establish a mutually beneficial 
and sustainable relationship between the health referral center6
 for each area and the
elected presidents and trained promoters of local CBOs in 78 defined catchment areas. 
Negotiated agreements form the basis of subgrants, and are expected to result in greater 
numbers of women using the public health services, and services that are more acceptable 
to community women and responsive to their needs.
In Phase Two subprojects, the CBO promoters will run community educational
workshops, refer women to the health services, and collect and provide feedback on the 
quality of services. In turn, the health professionals are expected to agree to do whatever 
they can to make the services more acceptable and responsive to the women from the 
communities in the catchment area. To determine the content of subprojects, the CBO
promoters carry out a new diagnosis of reproductive health needs and users’ views of
service quality. Thus, subprojects might include increased education on a particular
topic, training of CBO promoters by Ministry of Health (MOH) staff on key topics,
training of service providers in quality, and provide adequate funds to better equip a
health post or center. 
 
4
 Database reports, Reprosalud, December 2001. Project data indicate that each CBO member has an 
average of 5.3 family members. The districts in which Reprosalud is active represent 10% of the
population of Peru. 
5
 This evaluation concentrates on the reproductive health component of the program. The cost analysis 
analyzes the cost per beneficiary of the income-generation component. The product development program 
is now called “MERCOMUJER,” and receives support from the Small Enterprise Department Unit of 
USAID/Washington. 
6
 Health centers are secondary-level facilities that serve as referral centers for a catchment area, with basic 
surgical, obstetrical, and hospital facilities. While hospitals are tertiary-level facilities, often they serve as 
the basic referral center, especially in urban areas. 
EXECUTIVE SUMMARY
3
B. SUMMARY OF MAIN CONCLUSIONS 
Conclusions on Impact 
The data from the three components of the evaluation7
 support the findings presented
below. 
ß In the impact study, Reprosalud communities showed significant gains in all
but 3 of the 39 indicators in the results framework.8
 The comparison
communities showed significant gains in all but nine indicators. However, in
17 of the 39 indicators, the relative level of the gains in Reprosalud
communities ranged from 10 percent to 92 percent higher than the gains in the 
comparison communities.9
Significant Increases in the Strategic Objective of Women’s Use of Reproductive Health 
Interventions Are Attributable to Reprosalud
ß Compared to women in the comparison communities, women in Reprosalud
communities were 27 percent more likely to have their last childbirth attended 
by a health professional, 15 percent more likely to have had 4 prenatal visits 
in health services, and 18 percent more likely to seek treatment for RTIs from 
both community and formal sector sources.
ß Women in Reprosalud communities were 15 percent more likely to use a
family planning method, and 18 percent less likely to have unmet need for
family planning.10 Using composite indicators, the cost effectiveness study
showed greater impact in Reprosalud communities on use of childbirth and
prenatal services than on family planning use.
ß More than 75 percent of health professionals interviewed attributed increases
in service use wholly or partially to Reprosalud’s efforts.
The Gains Attributable to the Project in the Intermediate Results Are Mixed
ß Reprosalud has significantly increased womens’ knowledge of modern
contraceptive methods, RTIs, and the fertile days of the menstrual cycle.
 
7
 This midterm evaluation has three components: a quantitative impact study, a process evaluation, and a 
cost analysis. This summary draws on the main findings and conclusions of the three studies. The 
quantitative impact study uses a quasi-experimental design that compares results between 25 sub-grantee 
communities and 25 comparison communities. The objectives and methodology are detailed in annex A. 
8
 Refer to Results Framework in annex B. See also graphs in annex C.
9
 The gains attributable to the program were calculated through use of the odds ratio. See annex B for 
Tables from the Impact Study.
10 This indicator includes users of rhythm method who do not correctly identify the fertile period.
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
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ß Reprosalud has had a positive, but less significant effect on achieving more 
equitable gender relations between women and their spouses and families,
with more impact on women than on men. 
· There is strong support among all stakeholders for continuing to work on
gender issues and with men, especially at the community level, with
respondents stating that violence and other negative attitudes continue in
their communities. 
ß For many intermediate indicators for both reproductive health and gender,
both intervention and comparison communities increased significantly
between baseline and midterm, but there is no significant gain attributable to
the project. The Reprosalud project period coincided with a time of heavy
investments by MOH, donor agencies11 and nongovernmental organizations
(NGOs) in improving access and quality of care in reproductive health
services and in increasing gender equity.
ß The process evaluation gave evidence of increased communication within the
family and with providers, of women becoming more capable end users of
health services, of increased civic participation by women, and of lives saved 
through actions by the CBO promoters.
Organizational Performance and Costs
ß Movimiento Manuela Ramos has met Reprosalud’s multiple organizational
and programmatic challenges with competence and flexibility. This Peruvian 
women’s NGO has implemented a large-scale program that surpassed its
original objectives for coverage, using a highly participatory methodology that
defies standardization, in hard-to-reach communities that posed numerous
logistical and cultural barriers. Reprosalud directors demonstrated flexibility
by acceding to community women’s requests to work with men. The ensuing
men’s educational program took place simultaneously with the women’s
program, and incurred a major unplanned investment in staff hiring, training,
and materials development. 
· Most external stakeholders recognize that Reprosalud’s methodology and
guiding principles have gained them a uniquely high level of acceptance
in the communities with a long history of mistrust of outsiders. They 
highlight Reprosalud’s impact on increases in knowledge and use of
services.
ß The cost per beneficiary for the 5-year span of Phase One (1996–2000) was 
US$48.51, which is roughly comparable to the cost to the MOH in Peru of
US$47.22 of attending one pregnant woman through prenatal care and
 
11 See a complete listing in footnote 30 in the Impact Study.
EXECUTIVE SUMMARY
5
childbirth. Given this comparison, the intensive nature of the educational
intervention and the cost of working in rural areas, Reprosalud’s costs seem
reasonable. However, the evaluators lacked appropriate comparisons. Cost 
analyses from comparable community-based, health education programs were
not available to the evaluation team. 
ß A cost-benefit analysis should take into account that the program is expected 
to generate benefits for years to come, both within the districts where it
intervened, and through replications by other agencies using the Reprosalud
educational materials and methodology. The estimated cost per beneficiary
of replication—after subtracting certain startup and research costs and the cost 
of developing the educational materials—was 92 percent of the actual cost.12
 
ß Program managers have showed concern for cost effectiveness in their
decisions. Due to concerns for cost in Ucayali, and potential impact in San
Martín and Lima,13 in 2000 the project withdrew from these three
departments. They also amalgamated the two Puno offices. 
Barriers and Facilitating Factors in the Advocacy Program
ß The opinions of both internal and external stakeholders who will be important 
to the success of Phase Two are mainly favorable, laying a sound foundation
for the next four years of the program. These findings from the process
evaluation related to health authorities and health providers, CBO promoters
and women, local authorities, and other NGOs.
ß The MOH’s perennial emphasis on increasing service use, their investment in
improving quality of care as key to achieving this goal, and their increasing
use of user feedback as the key criteria to evaluate quality, are all facilitating
factors for the advocacy program. 
ß Most of the demands of the CBOs coincide well with MOH priorities, which
focus on all interventions that reduce maternal mortality, including family
planning. MOH and CBO priorities do not coincide in the following areas:
low-cost treatment of RTIs and sexually transmitted infections (STIs),
professional attendance at home births, and some aspects of culturally
appropriate childbirth practices.14
ß The MOH’s budgetary limitations will pose a barrier to some of the CBO
demands for reduced waiting time, provision of low-cost medicines for curing
 
12 For cost of replication, we assumed that the replicating agency was already operating in the area, with the 
offices and vehicles needed to reach rural communities, and that they would only need to reprint the 
existing educational materials.
13 Jungle communities in Ucayali that fit the profile for program intervention were mainly accessible by 
boat. In San Martin and Lima, the1997-98 baseline studies showed much higher rates of reproductive 
health knowledge and service use than in the remaining five departments in the highlands. 
14 See graph on shared and unshared priorities in annex E.
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
6
RTIs and STIs, and capacity to resolve other health problems at the local
(health post) level.15
C. RECOMMENDATIONS
Following are recommendations for replication and extension of coverage of the
educational model, the Advocacy Program, and the evaluation design. These
recommendations are described more fully in annex D and in the Process Evaluation
Report (see pages 49–54).
Replication of Phase One
To maximize the benefits from the investment in Reprosalud, it is recommended that
program managers give high priority to encouraging replication through other NGOs,
educational programs, and international agencies during the next four years. Therefore, 
staff should do active outreach to other institutions, and develop and provide a full kit of 
all the tools, manuals, and materials developed for Phase One.
Replication by the MOH or by the current CBO promoters is included in the plans for a 
few Phase Two subprojects, but these are not the main focus of Phase Two, and there are 
no funds earmarked in the budget for this purpose. We recommend that Reprosalud
involve male promoters in any replications in new communities that express interest in
workshops for men.
An important challenge in replication efforts is to assist other organizations to incorporate 
the guiding principles of the program in the replication. Additional intervention and
training may be necessary to ensure that these principles are uniformly applied (see box
on page 1).
Suggested modifications in the Phase One model for replication efforts by other agencies 
include the following:
ß Experiment with introducing male and female educational components
simultaneously by working with both male and female CBOs.
ß Strengthen the focus on gender issues through use of radio programs and
videos. These educational materials will be developed by Reprosalud in the
communications program in Phase Two.
ß Train health providers to be responsive to community feedback and to monitor 
quality of care where no complementary systems exist.
 
15 A key demand in many rural and periurban areas is to increase the capacity of MOH facilities to resolve 
problems at the local, primary-level, so that women do not have to travel to the health center in order to 
resolve their health problem. In some cases, the health center cannot resolve it either.
EXECUTIVE SUMMARY
7
Strengthening the Advocacy Program
The process evaluation provided data from which several suggestions for improving the
advocacy program were developed, including close monitoring of the communications to
and from the community level, and of the level of effort of both CBO promoters and
presidents.
Maximizing and Sustaining Impact in Current Districts
Reprosalud’s educational activities should continue in current communities and expand to
new ones in the same district. These activities should focus on areas of weakness
identified in the evaluation. As the main vehicle to maximize impact in current districts,
Reprosalud should implement a communications program to extend coverage of the
program’s educational messages, to reinforce knowledge, attitude and behavior changes,
and to reach youth and men with messages tailored to them.
Reprosalud should involve trained male and youth promoters to facilitate outreach to
their peers—male and youth involvement is important to achieve the goal of creating a 
sustainable change in the culture of the community regarding reproductive health and
gender issues. Furthermore, data from the process evaluation suggests that the support
from local authorities is stronger when they are involved in educational activities for
men. Reprosalud can involve male and youth promoters by
ß enlisting their assistance for the development of products and messages for the 
communications program,
ß inviting them to education and training activities for promoters taking place in
Phase Two, and
ß negotiating recognition for the male promoters as MOH community agents.
Evaluation and Monitoring
To strengthen the evaluation and monitoring component of the program, see all of
Section G in the process evaluation report for a full discussion. 
ß Reprosalud needs to improve oversight by hiring an evaluation and
monitoring director.
ß Reprosalud should increase the resources devoted to collection and analysis of
qualitative process and impact data, to answer important questions about
Phase Two. Additional secondary analysis of the quantitative data already
collected would also enable the program to compare performance by
department, and by other variables such as the presence of a male, youth or 
income-generation component. 
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
8
D. FINAL COMMENTS
The data indeed suggest that the program has had an important positive impact on its
beneficiaries and has brought to them significant benefits over and above those realized
in most communities in these departments, where other MOH and NGO programs have 
been operating with similar goals. Reprosalud is distinct because of its investment in
community-level, participatory educational strategies in hard-to-reach communities, and
its guiding principles. 
The most interesting aspect of the results on Reprosalud’s impact is that its gains as
compared to nonintervention communities are so significant in indicators of use of
reproductive health interventions, while mixed in many intermediate indicators that
supposedly lead to these health-protective behaviors. These results suggest that such
intensive community-based strategies may not be necessary to attain some desired
increases in knowledge, opinions, and attitudes. However, in these communities that
have historically been hard to reach, the Reprosalud model gave the complementary input 
needed to achieve significant gains in behavior—in use of reproductive health
interventions. 
Some recommendations in this report arise from a systems approach to the dynamics of
cultural change, whether in communities, in family, or in health services. This approach
assumes that change happens faster and with less resistance when working with two or
more parts of a system than when working in just one. For example, in efforts to achieve 
gender equity, it is probably more efficient to work with both men and women than to 
work with women only. 
In the same vein, the findings from this evaluation suggest that when aiming to improve
the use of services among members of these hard-to-reach communities, “supply-side” 
changes in the quality of care and in access often are not enough to achieve coverage
goals. In these communities, high levels of mistrust and lack of knowledge inhibit
change until culturally affirming and community-run educational efforts help to
overcome these obstacles.
ANNEXES
A: Objectives and Methodology of the Midterm Evaluation............................................11
B: Results Framework and Impact Study Tables.............................................................15
C: Impact Study Graphs....................................................................................................25
D: Detailed Summary of Impact Findings and Recommendations ..................................31
E: Process Evaluation Tables ...........................................................................................41
F: Cost Analysis Data.......................................................................................................49

ANNEX A
OBJECTIVES AND METHODOLOGY
OF THE MIDTERM EVALUATION
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
12
Planning for this midterm evaluation began in June 2001 and data collection took place in
October and November 2001, at a point in the life of the project when the educational
activities for Phase One had concluded, and the Advocacy Program for the second five￾year phase was just gearing up. All plans to extend coverage and increase impact were 
on hold, awaiting the results of this evaluation. 
The general objectives of the evaluation are:
1. To determine the impact of the educational program in the first 5 years (Phase One) 
of the Reprosalud project on the participating women and their communities, 
according to the results framework.
2. To collect lessons learned on Phase One for purposes of replication, and 
3. For Phase Two, 2001-2005:
a. To recommend improvements and an evaluation design for the Advocacy
Program, and 
b. To recommend next steps that would extend the coverage and maximize the
impact of the Phase One educational program.
The evaluation has three components: a quantitative impact study, a process evaluation,
and a cost analysis. This executive summary summarizes the main conclusions of the
three components with regard to the general objectives.
The quantitative impact study uses a quasi-experimental design that compares results
between 25 subgrantee communities and 25 comparison communities.1
 Separate
questionnaires for both women and men have close-ended questions based on the Results 
Framework and indicators of the project. Reprosalud’s Monitoring and Evaluation Unit
collected the baseline and midterm data. Fifty percent of the households in the study
were CBO members, and 50% community members; in larger communities. For a
variety of reasons related to the logistics of data collection, the unit of analysis is the
social network of the CBO members, and not the individuals surveyed. Because there
were significant differences on many indicators between the baseline values of the
intervention and comparison communities, the evaluation measures differences in the
amount of increase or decrease, using the Odds Ratio to compare the relative change
from the baseline in Reprosalud and comparison communities. The Odds Ratio allows 
the evaluator to attribute changes to Reprosalud with more certainty. 
The two main sources of information for the midterm process evaluation were a round of
primary data collection in five departments and at headquarters through semi-structured 
interviews by B. Shepard and D. Ferrando, and review of project documents. The
 
1
The quantitative data was problematic, because the program has suffered from under-investment in 
evaluation since its inception. See a full explanation of the problems with the data in section I.B of the 
Cost Benefit Analysis.
ANNEXES
13
evaluation team collected information from health authorities and providers, local
authorities, CBO promoters and members, other NGOs involved in reproductive health,
Reprosalud staff, and USAID staff. The evaluation team conducted 168 semi-structured 
individual interviews and 5 group interviews with the informants in 2-3 districts in five
departments and in Lima.2
 Based on field notes, the results were loaded into a database, 
and analyzed by subject codes attached to the questions. 
The objectives of the cost analysis were:
1) to determine the cost per beneficiary at the national and departmental levels for
each of the components of the program: reproductive health, micro-credit, and
product development;
2) to analyze the cost-efficiency of each program nationally and by department3
; and
3) to determine the cost of replicating the reproductive health component of the
program.
To determine the cost per beneficiary, the evaluator assigned headquarters and non￾program costs to the departments and to a program. She divided the total departmental
and national costs by their corresponding number of beneficiaries. To analyze cost￾efficiency, she used the same 25 comparison and intervention communities as the impact 
study, and compared the levels of change on four composite indicators of reproductive
health and gender equity. To determine cost per beneficiary of replication, she subtracted 
some costs related to research and materials development, and other startup costs that
would not apply to an existing program in similar areas. 
 
2
 See Methodology Annex I in the process evaluation report for a table describing the numbers and types of 
interviews in the evaluation. Three ex-staff of USAID and Reprosalud who were closely involved in 
designing and implementing Reprosalud were interviewed as well. 
3
 Unfortunately, the size and representativity of the sample in each region does not allow valid comparisons 
between departments. 
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
14
ANNEX B
RESULTS FRAMEWORK AND IMPACT STUDY TABLES
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
16
Table 1: Overview of Results and Indicators
Results Indicators
SO: Increased use by women of 
interventions in reproductive 
health
1. % of women who had at least 4 prenatal visits to a healthcare
professional during a pregnancy occurring within the last two years (since 
the last study)
2. % of women whose last delivery, occurring within the last two years, 
was performed by a healthcare professional
3. % of women who use some method of birth control
4. % of women with an unmet need for family planning (including those 
who use the rhythm method and are unsure of their own fertile days) 
* % of women with an unmet fertile-period need (ENDES 96 rhythm￾method users who do not know when their own fertile days are have 
been added to this group)
24. % of women who have gone to a healthcare facility for consultation 
regarding reproductive health or family planning 
30a. % of women who have gone to a healthcare professional due to 
discomfort related to RTIs (or vaginal discharge)
RI 1: More equitable gender 
relations between women and 
their partners/families
5. % of women whose partner helps care for the children if they become ill
6. % of women who decide how to spend the money they earn
7. % of women who make joint decisions with their partner about sexual 
relations, birth control methods, and number of children
9. % of women who share one or more household chore with their partner
11. % of women who make a joint decision with their partner about the 
educational level their children should reach
11ª. % Of women who have spoken with their partner about the number of 
children they want to have.
RI 1.1: Strengthened ability of 
women to achieve equality in 
gender relations
12 % of women who agree that a woman should be able to decide to use 
family planning even if her partner objects (This is also an indicator for 
RI2)
12.1 % of women who state their unwillingness to be forced or convinced 
to have sex
13. % of women who have spoken with their partner about family
planning more than two times in the last 12 months
% of women who have spoken with their partner about STD’s more than 
two times in the last 12 months
14. % of women who would go to the police/authorities if their partner 
abused them
15. % of women who have spoken with their partner about the risks of 
pregnancy and postpartum in the last 12 months
16. % of women who have spoken with their children age 12 years and 
older about male-female relationships and family planning more than two 
times in the last 12 months
16a. % of women who know where to go for help or advice if they are 
abused
RI 1.2: Increase in positive 
attitudes of men towards 
equitable relationships with 
women and family
17. % of men who believe that it is never right to hit a woman
18. % of men who believe that a man does not have the right to force an 
unwilling women to have sex
18.1 % of men who believe that both parents should take care of the 
children when they become ill
ANNEXES
17
Results Indicators
RI 1.3: Increase in women's 
knowledge about gender 
equality
19. % of women who believe that the work they do outside the home is as 
important as the work done outside the home by their partner
19.1 % of men who believe that the work they do outside the home is as 
important as the work done outside the home by their partner 
20. % of women who believe that housework is as important as the work 
done outside the home by their partner 
20.1 % of men who believe that the housework done by their partner is as 
important as his own work done outside the home 
21. % of women who believe that their sons and daughters should reach 
the same level of education
21.1 % of men who believe that their sons and daughters should reach the 
same level of education
23. % of women who got a higher score on the final (comprehension 
level) exam for the gender chapter
RI 2: Increased capacity of women 
in use of reproductive health 
services 
12. % of women who agree that a woman should be able to decide use 
family planning even if her partner objects (This is also an indicator for 
RI 1.1)
33. % of women who have incurred a health expense in the last 12 
months
33.a. % of women who use health services even though they cannot pay 
the fees.
RI 2.1: Increased capacity of 
women as end users of formal 
health services
% of women who sought help from any source for discomfort related to 
RTIs. 
32. % of women who take care of their health in order to feel well
RI 2.2: Increase in women's health 
as a priority within the home 
and community
29. % of women who would go to a healthcare facility in the event of 
symptoms that are warning signs of risk.
% of providers who believe that communication with women users has 
improved
% of providers who note that users are more assertive, i.e. more apt to give 
feedback or to make demands. 
RI 2.21: Women have greater 
willingness to use health 
services
29. % of women who would go to a healthcare facility in the event of 
symptoms that are warning signs of risk. (also RI2.2)
31. % of women who would advise someone with RTIs to go to a 
healthcare facility
RI 2.3: Women have increased 
access to income-generating 
sources, credit, and markets
34.
35.
36.
37.
RI 2.4: CBO’s increase their 
abilities to organize 
reproductive health services in 
communities
35.
36.
37.
38.
Service sub-projects
Microcredits and product 
development
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
18
Results Indicators
RI 2.5: Women participate more in 
identifying and performing 
activities according to their 
priorities
34.
35.
36.
37.
RI 2.6: Increase in women's 
knowledge about their 
reproductive health needs 
38. % of women who know how at least one modern contraceptive method 
works
39. % of women using the rhythm method who know the fertile days of 
their cycle
40. % of women who can recognize some symptom of pregnancy or
postpartum warning signs that indicate risk
43. % of women who know how RTIs are spread
43a. % of women who have heard about Pap and breast exams 
% of women who know to use a condom to protect against AIDS/STD’s
% of women who got a higher score on the final (comprehension level) 
exam for the basic and specific module
RI 3: Women in CBO’s actively 
participate in the proposal 
formulation, adaptation, and 
supervision process for 
reproductive health programs
RI 3.1: Authorities are sensitized 
and prepared to make changes 
that include sexual and 
reproductive rights from a 
woman’s perspective
RI 3.2: Women in CBO’s have an 
increased ability to represent, 
defend, and negotiate the 
interests and sexual and 
reproductive rights of women
Reproductive Health sub￾projects and others
ANNEXES
19
Table 2: Summary of Impact of Interventions
Net increase, in 
percentage points, 
between the baseline 
and the midterm 
evaluation
Indicators
InterventionControl
Odds 
Ratio
Odds Ratio from 1.199 to 1.999 VERY SIGNIFICANT
38. % of women who know how at least one modern contraceptive method 
works 42.0 17.0 1.920
43. % of women who know how RTIs are spread 14.1 6.7 1.599
32. % of women who take care of their health in order to feel well 8.3 -8.8 1.325
2. % of women whose last delivery, occurring within the last two years, 
was performed by a healthcare professional 11.9 1.8 1.274
39. % of women using the rhythm method who know the fertile days of
 their cycle 5.8 0.1 1.253
6. % of women who decide how to spend the money they earn 4.5 -2.0 1.225
4.1 % of women with an unmet need for family planning -9.2 -5.0 0.817
4. % of women with an unmet need for family planning (including those 
who use the rhythm method and are unsure of their own fertile days) -11.2 -3.2 0.823
Odds Ratio from 1.100 to 1.198 SOMEWHAT HIGH
12.1 % of women who state their unwillingness to be forced or convinced 
to have sex 13.4 3.3 1.194
30. % of women who have sought treatment for symptoms of RTIs (or 
vaginal discharge) 10.2 -1.0 1.178
3. % of women who use some method of birth control 13.4 4.0 1.153
1.a % of women who had at least 4 prenatal visits to a healthcare
professional during a pregnancy occurring within the last two years 27.5 18.8 1.148
14. % of women would go to the police/authorities if their partner abused 
them 24.1 21.5 1.133
7. % of women who make joint decisions with their partner about sexual 
relations, birth control methods, and number of children 9.2 5.2 1.129
21. % of women who believe that their sons and daughters should reach the 
same level of education 5.2 -4.9 1.118
11. % of women who make a joint decision with their partner about the 
educational level their children should reach 6.6 0.2 1.111
Odds Ratio from 1.050 to 1.099 MODERATE
19.1 % of men who believe that the work they do outside the home is as 
important as the work their partner does outside the home 17.7 12.4 1.097
43.b % of women who believe that while a women is breastfeeding it is 
dificult for her to become pregnant 22.3 16.0 1.091
16.a % of women who know where to go for help or advice if they are 
abused 20.0 14.7 1.083
27. % of women who have gone to a healthcare facility for prenatal and 
postnatal care, and who believe that the services provided by the nearest 
facility are good (or very good)
5.8 1.5 1.081
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
20
Net increase, in 
percentage points, 
between the baseline 
and the midterm 
evaluation
Indicators
InterventionControl
Odds
Ratio
13. % of women who have spoken with their partner about family
planning more than 2 times in the last 12 months 5.1 2.7 1.080
43.a % of women who have heard about Pap and breast exams 18.2 12.2 1.069
30.a % of women who have gone to a healthcare professional due to 
discomfort related to RTIs (or vaginal discharge) 10.8 7.0 1.068
Odds Ratio from 1 to 1.049 LOW
18. % of men who believe that a man does not have the right to force an 
unwilling woman to have sex 6.9 3.0 1.046
17. % of men who believe that it is never right to hit a woman 6.6 4.2 1.041
21.1 % of men who believe that their sons and daughters should reach the 
same level of education 2.3 -0.7 1.034
33. % of women who incurred a health expense in the last 12 months 0.5 -0.5 1.021
12. % of women who agree that a woman should be able to decide to take 
care of herself even if her partner objects -4.5 -4.6 1.006
11.a % of women who have spoken with their partner about the number of 
children they want to have 4.8 4.7 1.003
Odds Ratio less than 1 PROGRAM HAD NO EFFECT
29. % of women who would go to a healthcare facility in the event of 
symptoms that are warning signs of risk 29.0 25.4 0.994
9. % of women who share one or more household chore with their partner 23.5 19.3 0.988
19. % of women who believe that the work they do outside the home is as 
important as the work done outside the home by their partner 6.4 6.8 0.986
5. % of women whose partner helps care for the children if they become ill 6.0 5.3 0.982
26. % of women who believe that the services provided by the nearest 
healthcare facility are good (or very good) 10.7 16.9 0.936
20. % of women who believe that housework is as important as the work 
done outside the home by their partner 10.4 12.5 0.926
20.1 % of men who believe that the housework done by their partner is as 
important as his own work done outside the home 11.2 14.6 0.910
24. % of women who have gone to a healthcare facility for consultation 
regarding reproductive health or family planning 15.9 17.2 0.909
16. % of women who have spoken with their children age 12 years and 
older about male-female relationships and family planning more than 
two times in the last 12 months
8.9 6.5 0.845
40. % of women who can recognize some symptom of pregnancy or 
postpartum warning signs that indicate risk 26.6 26.8 0.782
ANNEXES
21
Table 3 COMPARISON OF THE BASELINE (BL) AND THE MIDTERM EVALUATION (IE) RESULTS FRAMEWORK INDICATORS:
INTERVENTION COMMUNITIES AND CONTROL COMMUNITIES
Intervention Community Control Community
Indicators
BL IE Dif. n BL n IE z Signif BL IE Dif. n BL n IE z Signif
Odds 
Ratio
OR
SO: Increased use by women of interventions in reproductive health
1.a % of women who had at least 4 prenatal visits to a healthcare professional 
during a pregnancy occuring within the last two years 55.6 83.1 27.5 372 261 -7.240 Sig (0.05) 62.2 81.0 18.8 312.0 294.0 -5.114 Sig (0.05) 1.148
2. % of women whose last delivery, occurring within the last two years, was 
performed by a healthcare professional 36.1 48.0 11.9 465 279 -3.200 Sig (0.05) 40.9 42.7 1.8 425 321 -0.494 1.274
3. % of women who use some method of birth control 58.4 71.8 13.4 1046 855 -6.071 Sig (0.05) 60.6 64.6 4.0 1076 823 -1.783 Sig (0.05) 1.153
4. % of women with an unmet need for family planning (including those who 
use the rhythm method and are unsure of their own fertile days)
48.4 37.3 -11.1 1034 848 4.834 Sig (0.05) 50.1 46.9 -3.2 1071 818 1.379 Sig (0.10) 0.823
4.1 % of women with an unmet need for family planning 27.1 17.9 -9.2 1042 855 4.741 Sig (0.05) 26.1 21.1 -5.0 1069 821 2.525 Sig (0.05) 0.817
RI 1: More equitable gender relations between women and their partners/families
5. % of women whose partner helps care for the children if they become ill 38.7 44.7 6.0 955 783 -2.527 Sig (0.05) 30.0 35.3 5.3 979 753 -2.338 Sig (0.05) 0.982
6. % of women who decide how to spend the money they earn 31.6 36.1 4.5 1599 1389 -2.596 Sig (0.05) 29.8 27.8 -2.0 1540 1246 1.158 1.225
7. % of women who make joint decisions with their partner about sexual 
relations, birth control methods, and number of children 23.7 32.9 9.2 1035 848 -4.431 Sig (0.05) 22.6 27.8 5.2 1067 817 -2.588 Sig (0.05) 1.129
9. % of women who share one or more household chore with their partner 23.2 46.7 23.5 1045 855 -10.77 Sig (0.05) 18.6 37.9 19.3 1075 824 -9.392 Sig (0.05) 0.998
11. % of women who make a joint decision with their partner about the 
educational level their children should reach 57.4 64.0 6.6 965 776 -2.798 Sig (0.05) 57.8 58.0 0.2 971 767 -0.084 1.111
11.a % of women who have spoken with their partner about the number of 
children they want to have 67.8 72.6 4.8 1054 853 -2.273 Sig (0.05) 69.3 74.0 4.7 1074.0 820.0 -2.241 Sig (0.05) 1.003
RI 1.1: Strengthened ability of women to achieve equality in gender relations
12. % of women who agree that a woman should be able to decide use family 
planning even if her partner objects 68.9 64.4 -4.5 1039 855 2.071 Sig (0.05) 65.0 60.4 -4.6 1073 823 2.056 Sig (0.05) 1.006
12.1 % of women who state their unwillingness to be forced or convinced to 
have sex 50.6 64.0 13.4 1040 852 -5.852 Sig (0.05) 55.4 58.7 3.3 1067 820 -1.435 Sig (0.10) 1.194
13. % of women who have spoken with their partner about family planning 
more than 2 times in the last 12 months 15.2 20.3 5.1 1044 852 -2.908 Sig (0.05) 11.4 14.1 2.7 1074 822 -1.757 Sig (0.05) 1.080
14. % of women would go to the police/authorities if their partner abused 
them 14.3 38.4 24.1 1037 854 -12.01 Sig (0.05) 15.7 37.2 21.5 1067 822 -10.691 Sig (0.05) 1.133
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
22
Intervention Control
Indicators
BL IE Dif. n BL n IE z Signif Bl IE Dif. n BL n IE z Signif
Odds 
Ratio
OR
16. % of women who have spoken with their children age 12 years and 
older about male-female relationships and family planning more than 
two times in the last 12 months
7.1 16.0 8.9 396 381 -3.893 Sig (0.05) 3.9 10.4 6.5 388 289 -3.352 Sig (0.05) 0.845
16.a % of women who know where to go for help or advice if they are 
abused 45.6 65.6 20.0 1607 1395 -10.98 Sig (0.05) 44.8 59.5 14.7 1549.0 1251.0 -7.737 Sig (0.05) 1.083
RI 1.2: Increase in positive attitudes of men towards equitable relationships with women and family
17. % of men who believe that it is never right to hit a woman 57.4 64.0 6.6 707 697 -2.531 Sig (0.05) 58.8 63.0 4.2 679 633 -1.557 Sig (0.10) 1.041
18. % of men who believe that a man does not have the right to force an 
unwilling woman to have sex 84.6 91.5 6.9 706 697 -3.981 Sig (0.05) 88.8 91.8 3.0 681 633 -1.831 Sig (0.05) 1.046
RI 1.3: Increase in women's knowledge about gender equality
19. % of women who believe that the work they do outside the home is as 
important as the work done outside the home by their partner 51.4 57.8 6.4 730 813 -2.522 Sig (0.05) 48.4 55.2 6.8 997 786 -2.852 Sig (0.05) 0.986
19.1 % of men who believe that the work they do outside the home is as 
important as the work done outside the home by their partner 52.1 69.8 17.7 476 620 -5.987 Sig (0.05) 55.9 68.3 12.4 612 571 -4.388 Sig (0.05) 1.097
20. % of women who believe that housework is as important as the work 
done outside the home by their partner 33.7 44.1 10.4 804 855 -4.339 Sig (0.05) 30.2 42.7 12.5 1073 822 -5.631 Sig (0.05) 0.926
20.1 % of men who believe that the housework done by their partner is as 
important as his own work done outside the home 36.2 47.4 11.2 561 698 -3.997 Sig (0.05) 33.3 47.9 14.6 682 633 -5.393 Sig (0.05) 0.910
21. % of women who believe that their sons and daughters should reach the 
same level of education 86.7 91.9 5.2 610 492 -2.745 Sig (0.05) 94.5 89.6 -4.9 602 442 2.957 Sig (0.05) 1.118
21.1 % of males who believe that their sons and daughters should reach the 
same level of education 89.1 91.4 2.3 385 386 -1.077 91.6 90.9 -0.7 370 320 0.325 1.034
RI 2: Increased capacity of women in use of reproductive health services
24. % of women who have gone to a healthcare facility for consultation 
regarding reproductive health or family planning 26.3 42.2 15.9 1606 1392 -9.187 Sig (0.05) 22.5 39.7 17.2 1549 1248 -9.851 Sig (0.05) 0.909
RI 2.1: Improved capacity of women as end users of formal health services
26. % of women who believe that the services provided by the nearest 
healthcare facility are good (or very good) 45.5 56.2 10.7 1260 1039 -5.107 Sig (0.05) 52.8 69.7 16.9 1550 968 -8.397 Sig (0.05) 0.936
27. % of women who have gone to a healthcare facility for prenatal and 
postnatal care, and who believe that the services provided by the nearest 
facilityt are good (or very good)
55.4 61.2 5.8 271 344 -1.450 Sig (0.10) 67.8 69.3 1.5 314 271 -0.389 1.081
RI 2.2: Increase in women's health as a priority within the home and community
29. % of women who would go to a healthcare facility in the event of 
symptoms that are warning signs of risk 42.6 71.6 29.0 655 783 -11.11 Sig (0.05) 36.8 62.2 25.4 1005 786 -10.678 Sig (0.05) 0.994
30. % of women who have sought treatment for symptoms of RTIs (or 
vaginal discharge) 63.2 73.4 10.2 392 247 -2.673 Sig (0.05) 71.5 70.5 -1.0 358 219 0.257 1.178
ANNEXES
23
Intervention Control
Indicators
BL IE Dif. n BL n IE z Signif BL IE Dif. n BL n IE z Signif
Odds
Ratio
OR
30a. % of women who have gone to a healthcare professional due to 
discomfort related to RTIs 50.6 61.4 10.8 393 246 -2.669 Sig (0.05) 51.4 58.4 7.0 358 219 -1.637 Sig (0.10) 1.068
32. % of women who take care of their health in order to feel well 56.8 65.1 8.3 1246 1393 -4.368 Sig (0.05) 65.2 56.4 -8.8 1535 1250 4.741 Sig (0.05) 1.325
33. % of women who have incurred a health expense in the last 12 months 49.5 50.0 0.5 1608 1395 -0.273 45.7 45.2 -0.5 1549 921 0.241 1.021
RI 2.6: Increase in women's knowledge about their reproductive health needs
38. % of women who know how at least one modern contraceptive method 
works 13.5 55.5 42.0 1608 1395 -24.41 Sig (0.05) 14.9 31.9 17.0 1550 1251 -10.713 Sig (0.05) 1.920
39. % of women using the rhythm method who know the fertile days of 
their cycle 22.5 28.3 5.8 239 214 -1.419 Sig (0.10) 24.0 24.1 0.1 306 233 -0.027 0.782
40. % of women who can recognize some symptom of pregnancy or 
postpartum warning signs that indicate risk 19.4 46.0 26.6 1044 855 -12.43 Sig (0.05) 13.2 40.0 26.8 1076 823 -13.399 Sig (0.05) 0.782
43. % of women who know how RTIs are spread 4.9 19.0 14.1 1193 1150 -10.57 Sig (0.05) 4.7 11.4 6.7 1007 921 -5.448 Sig (0.05) 1.599
43.a % of women who have heard about Pap and breast exams 63.2 81.4 18.2 1608 1395 -11.04 Sig (0.05) 59.6 71.8 12.2 1550.0 1251.0 -6.732 Sig (0.05) 1.069
43.b % of women who believe that while a women is breastfeeding it is 
dificult for her to become pregnant 34.0 56.3 22.3 1193 1001 -10.48 Sig (0.05) 30.9 46.9 16.0 1200.0 951.0 -7.594 Sig (0.05) 1.091
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
24
ANNEX C
IMPACT STUDY GRAPHS
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
26
Table 4: Reproductive Health Indicators
Net increase, in percentage 
points, between the 
baseline and the midterm 
evaluation 
Reproductive Health Indicators
Invervention Control
Odds 
Ratio
1.a % of women who had at least 4 prenatal visits to a healthcare 
professional during a pregnancy occuring within the last two
years
27.5 18.8 1.148
2. % of women whose last delivery, occurring within the last two 
years, was performed by a healthcare professional 11.9 1.8 1.274
Figure 1: Four Prenatal Visits in Health Services During Last 
Pregnancy
50
55
60
65
70
75
80
85
Baseline Midterm evaluation
Percentage
Intervention
Control
Net Increase
27.5
18.8
Intervention Control
Figure 2: Health Professional Assisted Last Childbirth
25
30
35
40
45
50
55
60
Baseline Midterm Evaluation
Percentage
Intervention
Control
Net Increase
11.9
1.8
Intervention Control
ANNEXES
27
Table 5: Gender Issues Indicators
Net increase, in percentage 
points, between the baseline 
and the midterm evaluation Indicators on Gender Issues
Invervention Control
Odds 
Ratio
6. % of women who decide how to spend the money they earn 4.5 -2.0 1.225
12.1 % of women who state their unwillingness to be forced or 
convinced to have sex 13.4 3.3 1.194
Figure 3: Percent of Women Who Decide How to 
Spend the Money They Earn
25
27.5
30
32.5
35
37.5
40
Baseline Midterm Evaluation
Percentage
e
Intervention
Control
Net Increase
4.5
-2.0
Intervention Control
Figure 4: Percent of Women Who State Their 
Unwillingness to Be Forced or Convinced to Have Sex
45
50
55
60
65
Baseline Midterm Evaluation
Percentage
Intervention
Control
Net Increase
13.4
3.3
Intervention Control
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
28
Table 6: Reproductive Health and Gender Issues Indicators
Net increase, in percentage 
points, between the baseline 
and the midterm evaluation
Indicators on Reproductive Health and Gender Issues that showed 
significant increases in both intervention and control 
commmunities, but no gains attributable solely to Reprosalud Invervention Control
Odds 
Ratio
29. % of women who would go to a healthcare facility in the event of 
symptoms that are warning signs of risk
 24. % of women who have gone to a healthcare facility for
consultation regarding reproductive health or family planning
20 & 20.1 % of women and men who believe that housework is just as 
important as the husband’s work outside the home
Figure 5: Percent of Women Who Have Gone to a Healthcare Facility 
for Reproductive Health or Family Planning Services
20
25
30
35
40
45
Baseline Midterm Evaluation
Percentage
Intervention
Control
Net Increase
15.9 17.2
Intervention Control
Figure 6: Percent of All Women Who Would Go to a Healthcare 
Facility in the Event of Symptoms That Are Warning Signs of Risk.
30
40
50
60
70
80
Baseline Midterm Evaluation
Percentage
Intervention
Control
Net Increase
25.4 29.0
Intervention Control
ANNEXES
29
Figure 7: Percent of Women and Men Who Believe that Housework Is 
As Important As the Husband’s Work Outside the Home
25
30
35
40
45
50
Baseline Midterm Evaluation
Percentage
Women
Intervention
Women
Control
Men
Intervention
Men
Control
Men
Women
Net Increase
10.4
12.5
11.2
14.6
Intervention Control Intervention Control
 Women Men
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
30
ANNEX D
DETAILED FINDINGS OF IMPACT STUDY AND RECOMMENDATIONS
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
32
In comparison to similar communities where Reprosalud did not intervene, the
program has shown substantially greater increases on key reproductive health
indicators related to knowledge and to the Strategic Objective of use of reproductive 
health intervention.4
:
· Knowledge: 92% more likely to know how at least one modern contraceptive 
method functions, 60% more likely to know how RTIs are contracted, and
rhythm users are 25% more likely to know the fertile days in the menstrual
cycle. 
· 27% more likely to have their last childbirth attended by a health professional, 
15% more likely to have had four pre-natal visits in health services, and 18% 
more likely to seek treatment for RTIs from both community and formal
sector sources (see graphs from impact study in annex C).
· 15% more likely to use a family planning method, and 18% less likely to have 
unmet need for family planning.5
 Using composite indicators, the cost
effectiveness study showed greater impact on use of childbirth and prenatal
services than on family planning use. 
· In the process evaluation, more than 75% of health professionals interviewed
attributed increases in service use wholly or partially to Reprosalud’s efforts.
The process evaluation yielded instances of dramatic positive effects on health,
including lives saved. See the “Achievements” annex in the Process Evaluation. While 
the indicator “Number of lives saved” falls outside of the results framework, the CBO
promoters in some instances clearly were the deciding factor in saving a woman’s life. 
Examples include persistence in helping a woman to detect and then treat an advanced
case of cervical cancer, and many instances of overcoming many obstacles in order to get 
a woman in childbirth with danger signs to a health facility. 
The process evaluation gave evidence of women’s increased communication 
within the family and with providers, of women becoming more capable end users of 
health services, of increased civic participation by women, and of unplanned effects (at 
this stage) on quality of care in services. 
· Sixty percent of health professionals said that Reprosalud has played a
significant role in increases in quality of services, mainly through its effect on
the provider-user relationship in which the women became more capable end
users. Both they and the CBO promoters and members made the following
two points: 
o Users are more apt to give feedback and make demands, thus
contributing to efforts to improve quality
o Users are more educated and communicative, making the providers’
job easier and more efficient. 
 
4
 The percent of greater likelihood refers to women in Reprosalud communities, and the percent of change 
corresponds to the “odds ratio” in Tables 24 and 25 of the Impact Study annexed to this summary. 
5
 This indicator includes users of rhythm method who do not correctly identify the fertile period. 
ANNEXES
33
· There was much evidence of increased civic participation in the process
evaluation, including election of CBO promoters as local authorities.6
Reprosalud has had a positive but less significant effect on the Intermediate Result of 
achieving more equitable gender relations between women and their spouses and 
families. There are several possible explanations for these uneven results: the program’s 
greater emphasis on health issues than on gender issues, more cultural resistance to
changes in gender roles than to increasing usage of health services, a lower investment in
working with men than with women, and the fledgling state of the art in constructing
indicators and survey instruments on gender issues.7
 The following indicators show
increases for women that are attributable to the program. See illustrative graphs from the 
impact study, Annex 4.
· 22.5% more likely to decide how they will spend money they earn, 
· 19% more likely to report not submitting to forced or pressured sex, 
· 13% more likely to go to the authorities if their spouses beat them
· 13% more likely to decide jointly with their spouses on matters related to
children’s education, sexual relations, contraception and number of children.
· 12% of women (but only 3.4% of men) more likely to agree that boy and girl 
children should have the same educational level.
There is strong support among all stakeholders for continuing to work on gender 
issues and with men, especially at the community level, with respondents stating that 
violence and other negative attitudes continue in their communities. This finding is 
understandable given that not all CBOs worked with men, and that the work with them
received less emphasis. 
· Among all respondents, when asked how the project might expand, more
work with men and on violence was in the top three most frequent responses, 
and in the top five when respondents were asked a general question about
their recommendations to Reprosalud for the next period.
Reprosalud’s educational activities and communications program in Phase Two should 
emphasize the following indicators for which Reprosalud communities enjoyed
significant gains, but the actual percentage is still much less than ideal. 
· Women whose last childbirth was attended by a health professional rose from
36.1% to 48%. Women who know the danger signs for childbirth and post￾natal rose from 19.4% to 46%.
· Users of rhythm who know their fertile days rose from 22.5% to 28.3%
 
6
 See Annex on Achievements in Process Evaluation Report. 
7
 The state of the art in investigating reproductive health matters in quantitative surveys is much more 
advanced in Peru and worldwide than in investigating gender issues. Therefore, we would advise caution 
in interpreting these findings on gender issues because of some methodological problems in the survey, and 
because of the other factors named which do not indicate program failure, but rather the need to adjust the 
model to intensify attention to gender issues and to men. The ethnographic study should shed more light on 
the dynamics of change in gender issues in the program. 
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
34
· Women who know how at least one modern contraceptive method works rose 
from 13.5% to 55.5%.
· Women who know how vaginal discharge is contracted rose from 4.9% to
19%
· Women in union with unmet need for family planning fell from 48.4% to
37.3% 
· Women who decide how they will spend the money they earn rose from
31.6% to 36.1% 
· Women who decide jointly with their spouses on sexual relations,
contraception, and number of children rose from 23.7% to 32.9%. The
number of women who had spoken “often” to partners about family planning
rose from 15 to 20 percent, and “often” to children over 12 about this and
relations in a couple rose from 7.1% to 16%.
· Women who would go to the authorities if beaten rose from 14.3% to 38.4%
.
For other indicators, results were disappointing and education in the next period 
needs to reinforce these issues: 
· Women who agree that women should use contraception even when her
partner is opposed fell significantly in both Reprosalud and comparison
communities. In Reprosalud communities, the decrease was from 68.9% to
64.4%.8
· Both men (36.2% to 47.4%) and women ( 33.7% to 44.1%) rose in giving
equal value to women’s work in the home, but to low levels, and with no gain 
in comparison to the non-intervention communities.
For some intermediate indicators for both reproductive health and gender, both
intervention and comparison communities increased significantly between baseline 
and midterm, but there is no significant difference between the levels of increase. For 
these indicators, the Reprosalud program did not add any significant gain in the
intervention community to what would have taken place anyway. The Reprosalud
project period coincided with a time of intense social change in Peru. The MOH and 
many donor agencies9
invested heavily in improving access and quality of care in family 
planning and maternal-child health services in order to improve health statistics and
service use. NGOs and some government agencies undertook ambitious grassroots and 
communications projects to increase gender equity. The following selection is from a
longer list of indicators where no significant additional impact from Reprosalud was
found (see illustrative graphs from the impact study in annex C).
· For the percent of women to go to a healthcare facility in the event of warning 
signs of risk, the gain was 29% for Reprosalud communities and 25.4% for
comparison communities.
 
8
 This is an idea that contravenes the culture of these communities, according to the baseline of the 
ethnographic study. 
9
 See a complete listing on page 95, footnote 30, in the Impact Study.
ANNEXES
35
· For the percent of women who attended a health service for reproductive health or 
family planning services in the last year, the gain was 16% in Reprosalud
communities and 17.2% in comparison communities.
· For the percent of women to recognize pregnancy or postpartum warning
signs indicating the presence of a risk, the gain was 26.6% in Reprosalud
communities and 26.8% in comparison communities. 
· For the percent of women to share one or more household chores with their 
partner, the gain was 23.5% in Reprosalud communities and 19.3% in
comparison communities.
· For the percent of women who believe that housework is just as important as 
their husband’s work, the gain was 10.4% in Reprosalud communities and
12.5% in comparison communities. 
A. MORE DETAILS ON RECOMMENDATIONS
Following are recommendations for replication and extension of coverage of the 
educational model, for the Advocacy Program, and for evaluation design. These 
recommendations are described more fully in the Process Evaluation Report
Replication And Extension Of Coverage
To maximize the benefits from the investment in Reprosalud, we recommend that 
program managers give high priority to encouraging replication through other NGOs, 
educational programs, and international agencies during the next four years. 
Replication by the MOH, or by the current CBO promoters, is both possible and included 
in the plans for some sub-projects, but there are many logistical and financial obstacles in 
both cases. Staff should do active outreach to other institutions. Reprosalud’s substantial 
investment in investigating key reproductive health and gender problems, and in
producing culturally appropriate training manuals and educational materials, make
replication feasible in other hard-to-reach communities in the Andean jungle and
highlands areas, both in Peru and in other Andean countries. Their methodology and
tools could be adapted for other settings. Through such replication, this investment can
continue to produce benefits for years to come.
An important challenge in replication efforts is to assist other organizations to 
incorporate the guiding principles of the program in the replication (see box page 1). 
Commitment to gender equity, respect for indigenous cultures and for low-income 
communities, true community participation, and rights-based, comprehensive approaches
to reproductive and sexual health, imply comprehensive cultural changes in some
organizations. Additional intervention and training may be necessary in some or all of
these principles.
Suggested modifications in the Phase One educational program for replication efforts
o To introduce male and female educational components simultaneously by 
working with both male and female CBOs. The resistance to the program 
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
36
in its early stages might have been lessened if both male and female CBOs 
were involved. Also, this modification might increase the program’s
impact on gender issues, and the level of support from local authorities. 
o To strengthen the focus on gender issues in replications through use of 
radio programs and videos, which Reprosalud will develop in the
communications program in Phase Two. This suggestion is in response to 
the mixed results on gender issues. 
o To train health providers in responsiveness to community feedback and 
quality of care in contexts where no complementary program exists to do 
so. Reprosalud could count on many complementary MOH-led programs 
that improved access through insurance, and quality partly by emphasizing
user feedback and provider/user relations. Programs in other contexts may 
not be able to count on this complementary and necessary input.
o To weigh opportunity costs to the community participants vs. the
sustainability of the program in setting policy on financial incentives and 
non-cash benefits for promoters. The level of commitment of Reprosalud￾trained promoters in Phase Two will demonstrate whether the financial
incentives to promoters provided by Reprosalud lead to high dropout rates 
of promoters once these incentives are withdrawn, and other non-cash 
incentives replace them. 
To facilitate replication of the Phase One educational program
o Develop and provide a full kit of all the tools, manuals, and materials
developed for Phase One.
o Respond positively to all MOH requests to replicate the program through
the sub-projects, or through agreements at the departmental level. 
o Increase outreach to other NGOs, educational institutions and international
agencies working in Peru and in the Andean region to publicize the
availability of training for replication
o Develop diagnostic procedures to determine whether agencies need
reinforcement in some or all of the underlying principles of the program. 
Identify additional tools and curricula for filling these gaps.
To strengthen the advocacy program
o Closely supervise and evaluate whether communication is flowing from 
the community level to the negotiating team, and vice-versa. Identify 
ways to build these communications into routine interactions and sub￾project events.
o Monitor level of promoter involvement in community-level educational 
activities closely, and devise low-cost motivation strategies if necessary.
o Devise a back-up plan for cases in which the CBO President is not 
participating as planned in the Defenders’ Committees. Reliance on CBO 
Presidents for the Defenders Committees is a potential weakness. They
rotate frequently and may not have sufficient commitment to the program. 
ANNEXES
37
Maximizing Impact in Current Districts
The process and impact evaluations identified the following needs for reinforcing impact
that the strategies in Phase Two must address: 
1) The need for refresher training for promoters and CBO members (see the
section on remaining needs on page 45–46 of the Process Evaluation Report).
2) The need to reach more men, and more youth of both sexes (ages 15-24). 
3) The need to strengthen educational interventions on gender issues. 
4) The importance of taking advantage of the trained male and youth promoters
in those communities that worked with them, to keep these promoters engaged 
with the program.
Discussion
All sub-projects in Phase Two include educational activities at the community level,
determined by a diagnosis of reproductive health needs conducted just before the
negotiation with the health center. Current plans only call for involvement of the female
CBO promoters. The content of these activities has been shaped by needs expressed by 
both CBO members and the health sector. They will not necessarily include more work 
with men and youth, more focus on gender issues, or even reinforcing the reproductive
health knowledge needs identified in this evaluation. The following recommendations
are designed to meet these needs. 
o To implement a communications program with the following goals: 
ß Develop messages that support efforts to expand coverage on the part 
of the CBO promoters and others replicating the program, by lessening 
resistance to the program’s educational messages and creating demand 
for the program in new communities.
ß Reinforce health-protective knowledge, attitude and behavior changes
on gender and reproductive health issues. Besides providing both
CBO promoters and women with educational inputs, this program
would also focus on youth and to men, for whom Phase One activities 
had less impact. 
ß Involve CBO promoters, and male and youth promoters, in
competitions as a mechanism to develop radio programs and
educational videos. 
o To involve male and youth promoters trained by Reprosalud as much as 
possible in Phase Two education and training activities, including the
community-level workshops, and negotiate recognition for them as MOH
community agents. 
o To continue to work with men. Community-level respondents universally 
recommended continuing work with men. Men’s involvement is key to
achieve the goal of creating a sustainable change in the culture of the
community regarding reproductive health and gender issues. Furthermore, 
data from the process evaluation suggests that the support from local
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
38
authorities is stronger when they are involved in educational activities for
men. Increasing the level of support from local authorities is extremely 
important to the advocacy program during the next four years, and a key
factor in the sustainability of the program after Reprosalud ends. 
Evaluation and monitoring
· To strengthen the evaluation and monitoring component of the program: 
See all of Section G in the process evaluation report for a full discussion. 
o Improve oversight by hiring an evaluation and monitoring director
o Analyze the whole database of 70 communities to compare results by
department. The findings on departmental differences from the cost
effectiveness study were not reliable because of the small sample size. 
o Devote increased resources to collection of qualitative process and impact 
data, adding evaluation questions pertinent to the advocacy program and
to replications. Monitor unplanned benefits from the program such as
lives saved, and women elected to local offices. 
o Improve the results and indicators framework as suggested in the attached 
annex. Develop improved Intermediate Results and indicators for the
advocacy program.
Additional Research
· To conduct studies that would advance the state of knowledge in the
reproductive health field and inform replication efforts. Reprosalud—with 
its current budget and staff—could not undertake these studies. If USAID or 
other stakeholders decide to gather the resources to carry out any of them, the 
efforts should be organized in a way as not to create added burdens on the 
staff. 
o Compare the costs of Reprosalud for each percentage gain in usage of
services above the gains of comparison communities with those of a
program that improves access and quality of care in health services.
o Carry out a cost-benefit analysis that takes into account the sustainable
effects of the program both in the intervention communities, and in
communities where replication takes place. 
o Compare the results in communities with and without autodiagnósticos.
o Evaluate the extent and quality of MOH replication of the program in
Ucayali and San Martín, where MOH was trained to replicate the program 
and supervise the CBO promoters after Reprosalud’s withdrawal. 
o Compare the results of Reprosalud with communities where the program
works with both men’s and women’s CBOs simultaneously, and
strengthens the component on gender issues. 
o The findings from the impact study on the differences between
communities with both income-generation and reproductive health
components, and communities with only reproductive health, were
ambiguous because the sample size was too small. It would be useful to 
ANNEXES
39
manipulate the larger database of 70 communities to see whether more
reliable findings could be generated. 
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
40
ANNEX E
PROCESS EVALUATION TABLES
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
42
SHARED AND UNSHARED PRIORITIES 
IN THE ADVOCACY PROGRAM
The following chart reveals the main areas of shared and unshared priorities expressed by 
health authorities, health providers, and promoters. 
Key:
____ _ _ ____ boxes on the left: MOH priorities not shared by Reprosalud. 
__ __ __ __ __ __ boxes in the middle: shared priorities. 
________ boxes on the right: Reprosalud priorities not shared by MOH. 
- - - - - - - - - - boxes: partially shared category “culturally appropriate institutional
births.”
Figure 8: Shared and Unshared Priorities
MOH 
PRIORITIES
Many other maternal￾child health and
primary health care
issues, e.g. measles
vaccination campaign
at time of study. 
REPROSALUD/CBO PRIORITIES
SHARED PRIORITIES
MATERNAL 
MORTALITY
Professionals 
attend home
births
Culturally appropriate
institutional births
Treatment 
of RTIs &
STIs * (not 
life threat￾ening)
Treatment of life￾threatening STIs (e.g.
syphilis) and cervical
cancer 
Full coverage for
pre-natal care
Access to family
planning methods Free or reduced cost
treatment and medi￾cines for cervical
cancer, STIs, & RTIs
Achieving 
80% 
coverage in
institutional 
childbirth
ANNEXES
43
Figure 9: Essential Communications Flows in Advocacy Program, Phase Two
Health Center or
Hospital Sub-project steering
committee
Steering Committee
of the Defenders’
Committee 
(directiva)
Steering Committee
of the Promoters’
Network
Defenders’ Committee Promoters’ Network
CBO Presidents (15-
20 CBOs in each sub￾project)
CBO Promoters (from 15
to 20 CBOs in each
subproject)
Local authorities
CBO Members &
spouses
Other community
women & spouses
Zonal coordinator Zonal coordinator
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
44
Table 7: Synopsis of General Recommendations to Reprosalud
i.e. response to a general, 
open-ended question
Recommendation Total Who
Expansion of Coverage
39
Promoters; Local Authorities
Continue with Phase One
39
CBO Members; Local Authorities
Coordination w/ DISA / MINSA
32
Health Authorities; Providers
More Supervision & Training of 
CBOs Promoters
30
Promoters; Health Authorities; 
Providers
More Work w/ Men, Couples, 
and Family 27
Promoters; Local Authorities
More Work w/ Youth
18
Promoters; Local Authorities; 
CBO Members
More Coordination between RS, 
Health Authorities, & Local 
Authorities 15
Promoters; Local Authorities
Sharing RS Methodology w/ 
MINSA &/or NGOs (Training 
Staff & Promoters) 14
Health Authorities; Other RH 
Programs
ANNEXES
45
Table 8: MOH Limitations and Financial Issues
Barriers Related to Under-funding (Total = 25)
Financial 
Limitations, 
Budget 
(Includes 
Infrastructure 
& Equipment)
Deficient Supply of 
Medications and 
FP Methods
Limited 
Personnel 
(General 
and 
Specialized)
Limited 
Community 
Outreach
Cultural 
Sensitivity 
(Childbirth 
Customs)
Employees' 
lack of 
interest and 
motivation
Continuity of 
Personnel in 
positions 
(Administrative 
Problems)
Service 
Problems 
and 
Management
Language 
Barriers 
(Need of 
Bilingual 
Personnel)
Ancash
Health Authorities 4 1 1
Providers
Ayacucho*
Health Authorities 3 1 1
Providers 1 1 1
Huancavelica
Health Authorities 4 1
Providers 1 1 1
La Libertad
Health Authorities 3 1
Providers 2
Puno
Health Authorities 1 1 1 1
Providers 1 1 1
TOTAL 17 4 3 1 3 2 2 2 1
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
46
Table 9: Impact on Women
More 
knowledge 
about RH
"Takes care of 
her health" 
(Includes 
Better hygiene, 
RTIs and ETS)
More use 
of 
services
Use of 
Family 
Planning
Can 
communica
te w/ 
Provider / 
makes 
Demands & 
Give 
Feedback
Better 
communi￾cation & 
relationship 
with 
spouse
More 
political 
participation
No or 
very few 
changes 
Health Authorities 10 5 6 3 3 1 1 1
Providers 8 4 7 2 1 1 1 1
Local Authorities 2 5 3 3 1 5 2 4
CBO Members 19 18 11 15 7 2 2
TOTAL 39 32 27 23 12 9 6 6
Table 10: Impact on Men
Insufficient 
Impact on 
Men
Positive 
Attitudes in 
Gender 
Relations 
(General 
Statements)
Positive 
Change in 
Family 
Planning 
Use& 
Attitudes
Increased 
RH Health 
Care 
Knowledge 
& 
Education
Decrease 
of 
Domestic 
Violence 
& Rape
Improved 
Self-care & 
Hygiene 
(prevention 
of STDs)
Increased 
Use of 
Services 
by Men & 
Women 
Men’s 
Domestic 
Help
Improved 
Dialogue & 
Communica￾tion with 
Women (& 
Family)
Health Authorities 2 6 5 5 6 3 4
Providers 7 4 3 4 2 1 3
Local Authorities 5 5 5 2 1 6 3 2 2
CBO Members 11 11 7 4 6 1 1 6 2
TOTAL 25 26 20 15 15 10 9 8 7
ANNEXES
47
Table 11: Did Reprosalud Have an Impact on Use of Services?
Table 12: Changes Implemented in Services to Improve Quality
*provider dismissed staff offenders
HEALTH AUTHORITIES & PROVIDERS
Due to 
Reprosalud
Partially Due 
to 
Reprosalud
Unclear
No/ 
Other 
Reason
Ancash 3 1 3
Ayacucho 5 3 1
Huancavelica 2 6 3
La Libertad 5 1 1
Puno 3 3
TOTAL 18 13 5 4
Provider 
attends home 
births or home 
prenatal
Provider 
adapts to 
cultural 
preferences
Free 
childbirth 
services
Better 
treatment 
(more 
"friendly", more 
responsive)
More 
Quechua 
speakers
Increase 
access 
through 
hours, more 
personnel, 
etc.
New 
services, 
RTIs, 
violence
Less waiting 
time, more 
efficiency
Ancash 1 4 3 4* 1
Ayacucho 3 2 1
Huancavelica 2 5 4 2 2 1
La Libertad 1 4 1 5 3 2
Puno 2 1 1 2 1
TOTALS 4 18 8 10 3 7 2 2
 CHILDBIRTH TOPICS
According to Health Professionals 
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
48
ANNEX F
COST ANALYSIS DATA
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
50
Table 13: Combined Effectiveness Indicators Constructed for the Cost Analysis
Nr. Results grouping Indicators Description of combined indicator
I
SO: “women make greater use 
of reproductive health services”
a) Women receive prenatal and birth 
care from trained personnel.
(Indicators 1 and 2)
b) Women in a relationship who use 
contraceptive methods when they
really need them (excluding those
who do not use contraceptive methods 
for reasons relating to values 02 to 08, 
20 and 21 in question 214); new
indicator: based on questions 211 and 
215.
"Integral" indicator, which gives a weighting 
of 50% to each of the two following
combined indicators:
a) one ranging from 1 (% of women with 
children under the age of 3 receiving one of 
the health services in a) of the preceding 
column) to 2 (% of women with children 
under the age of 3 receiving both of the
services in a) of the preceding column.
b) one ranging from 1 (% of women in a 
relationship who need to use contraceptive 
methods and replied 'no' to question 211 but 
'yes' to 215) to 2 (% of women in a
relationship who need to use contraceptive 
methods and replied 'yes' to question 211).
II
IR 1, IR 1.1 and IR 1.3 (a
combination of the three for
women): “women have more
equitable gender relationships 
with their partners and
families", "women strengthen
their capacity to bring about 
changes in their gender
relationships”; “women and
men have greater knowledge of 
gender equity”
Women who take key family
decisions with their partners
(indicators 7, 9 and 11), who have 
good communication on sexual issues 
with their partner (indicator 13) and 
who believe that daughters and sons 
should be educated to the same level 
(indicator 21).
Combined indicator ranging from 1 (% of
women in a relationship who fulfill only one 
of these assertions) to 5 (% of women in a 
relationship who meet all five)10
 
10 Initially, a combined indicator ranging from 1 to 7 was proposed, and included two additional indicators: 
(i) women who believe that their work outside or within the home is as important as the work done by their 
husband (a combination of indicators 19 and 20); and (ii) women who have frequently talked with their 
partner about STDs in the last 12 months (indicator 13.1). However, these indicators were considered for 
developing an alternative indicator, given that the number of void replies to the questions which made them 
up resulted in the number of cases dropping significantly.
ANNEXES
51
 
11 Initially, a combined indicator ranging from 1 to 5 was proposed and included two additional indicators: 
(i) men who believe that both should look after the children when they are ill (indicator 18.1); and (ii) men 
who believe that their work out of or in the home is as important or less important than that of their wives 
(a combination of indicators 19.1 and 20.1). However, these indicators were considered for developing a 
separate alternative indicator, given that the number of void replies to the questions that made them up 
resulted in a significant reduction in the number of cases.
Nr. Results grouping Indicators Description of combined indicator
I
IR 1.2 and IR 1.3: (a
combination of the two for
men): “increase in positive
attitudes and practices of men 
in their relationship with
women and with their
families", "women and men
increase their knowledge on
gender equity"
Men who believe that women should 
not be physically assaulted (indicator 
17), who believe that they cannot
demand sexual relations if the woman 
is unwilling (indicator 18); and who 
believe that daughters and sons should 
be educated to the same level
(indicator 21.1)
Combined indicator ranging from 1 (% of
men in relationships who fulfill only one of 
these assertions) to 3 (% of men in
relationships who meet all 3).11
II
IR 2, IR 2.1, IR 2.2: (a
combination of the three):
"women have a greater capacity 
to access RH services",
"women improve their capacity 
as end consumers of formal
health services", "increase in
the positive appreciation of
women's health within the
home and within the
community”.
Women who do not forego access to 
health services through lack of income 
(new indicator: question 502a, reply 
'no'), women who look after their
health for a feeling of well-being 
(indicator 32) and women who have 
invested in health in the last 12
months.
Combined indicator: ranging from 1 (% of 
women who fulfill only one of these
assertions) to 3 (% of women who fulfill all 
three).
MIDTERM EVALUATION OF THE REPROSALUD PROJECT
52
Nbr. Results grouping Indicators Description of combined indicator
III
IR 1.2 and IR 1.3: (a
combination of the two for
men): “increase in positive
attitudes and practices of men 
in their relationship with
women and with their
families", "women and men
increase their knowledge on
gender equity"
Men who believe that women should 
not be physically assaulted (indicator 
17), who believe that they cannot
demand sexual relations if the woman 
is unwilling (indicator 18); and who 
believe that daughters and sons should 
be educated to the same level
(indicator 21.1)
Combined indicator ranging from 1 (% of
men in relationships who fulfill only one of 
these assertions) to 3 (% of men in
relationships who meet all 3).
IV
IR 2, IR 2.1, IR 2.2: (a
combination of the three):
"women have a greater capacity 
to access RH services", 
"women improve their capacity 
as end consumers of formal
health services", "increase in
priority given to women's
health within the home and
within the community”.
Women who do not forego access to 
health services through lack of income 
(new indicator: question 502a, reply 
'no'), women who look after their
health for a feeling of well-being 
(indicator 32) and women who have 
invested in health in the last 12
months.
Combined indicator: ranging from 1 (% of 
women who fulfill only one of these
assertions) to 3 (% of women who fulfill all 
three).
ANNEXES
53
Table 14: RH Effectiveness Ratios at National Level
BASE LINE MIDTERM EVAL. Improvement %
Comp. S + A Comp. S + A Comp.c/ S+A c/ Difference d/
Ia (SO) 1.04 1.04 1.30 1.43 25.41% 37.75% 12.34%
Ib (SO)12 1.88 1.86 1.91 1.92 1.85% 3.21% 1.37%
I (SO) a/ 1.46 1.45 1.61 1.67 10.23% 15.58% 5.35%
II (IR 1., IR 1.1, IR 1.3) 1.50 1.57 1.63 1.97 8.84% 25.34% 16.50%
III (IR 1.2, IR 1.3) 2.09 2.06 2.08 2.20 -0.35% 6.77% 7.12%
IV (IR 2., IR 2.1, IR 2.2) 1.60 1.54 1.51 1.71 -5.46% 10.80% 16.26%
Global Indicator b/ 1.66 1.66 1.71 1.89 2.83% 14.04% 11.22%
a/ I (SO) = [ Ia (SO) + Ib (SO) ] / 2
b/ Global Indicator = [ I + II + III + IV ] / 4
c/ Improvement % = [ (BASE LINE) Indicator / (MIDTERM EVAL.) Indicator ] – 1, for each CBO group.
d/ Difference = Improvement (S + A) – Improvement (Comp.).
Table 15: Cost Per Beneficiary for the Main Activities of The Reprosalud 
Program
(Soles at January 1995 value)13
Total Cost Total 
Benef
iciarie
Cost per 
Beneficiar
y
Total 
Cost 
Total 
Benef
iciarie
Cost per
Beneficia
ries
Total 
Cost
Total 
Benef
iciarie
Cost per
Beneficiary
Ayacuc
ho
2,116,278
.46
 
1823
0
116.0
9
 
62,327.
47
 
17
8
350.1
5
 
Huar
az
2,061,320
.08
 
1535
5
134.2
4
 
82,966.
51
 
10
1
821.4
5
 
Huancavel
ica
2,071,072
.14
 
2282
9
90.7
2
 
Trujill
o
1,498,411
.20
 
1640
7
91.3
3
 
1,568,045
.41
 
316
8
494.9
6
 
48,978.
56
 
40 1,224.
46
 
Lima 
Este
667,861.
46
 
382
6
174.5
6
 
Pun
o
1,783,724
.94
 
2036
7
87.5
8
 
1,581,409
.95
 
302
4
522.9
5
 
102,789.
88
 
13
4
767.0
9
 
Juliac
a
1,735,201
.71
 
1844
2
94.0
9
 
59,783.
88
 
12
7
470.7
3
 
Tarapo
to
1,042,694
.15
 
1243
2
83.8
7
 
927,620.
01
 
253
9
365.3
5
 
142,917.
37
 
61 2,342.
91
 
Pucall
pa
1,410,905
.52
 
816
8
172.7
4
 
1,874,846
.23
 
411
2
455.9
5
 
82,162.
41
 
52 1,580.
05
 
Tota
l
14,387,469
.66
13605
6
105.7
5
 
5,951,921
.60
1284
3
463.4
4
 
581,926.
08
69
3
839.7
1
 
REPRODUCTIVE 
HEALTH
MICROCREDITS
OS
PRODUCT DEVELOPMENT
REGIO
N
 
12 Because of the way this indicator on family planning use was constructed, it gives very different results 
from the impact study, which shows a 13% rise in use of a contraceptive method in Reprosalud 
communities and a 4% rise in comparison communities, and a 15% greater likelihood, according to the 
odds ratio, that women from Reprosalud communities would use a contraceptive method. The impact study 
is more precise.
13
Exchange rate for 1995 soles is 2.18 soles.