nrsp wise programme
TRANSCRIPT
NRSP WISE Programme(Water, Immunization,
Sanitation and Education)
Evaluation sponsored and financed byWorld Health Organization (WHO) Geneva
March 2020
Evaluation Report
Copyright © National Rural Support Programme - March 2020
Contributors: Professor Shamsa Rizwan PhD, FCPS, DLSHTM (Epidemiology) Child Advocacy International
Dr Siham Sikander PhD, FCPS Health Services Academy, Islamabad
Dr Assad Hafeez PhD, MRCP, FCPS, MPH Health Services Academy, Islamabad
Dr Zaeem Ul Haq PhD, Child Advocacy International, Islamabad
Dr Shahid Iqbal MSc Public Health Consultant, Child Advocacy International, Islamabad
The design of the end-line evaluation of WISE program was developed by Dr Shamsa Rizwan, Assad Hafeez, Siham Sikander and Zaeem Ul Haq. While the execution was done by Dr Shahid Iqbal. The oversight of conduct of the evaluation, analysis, interpretation and write up of the report was done by all the contributors.
Support: This work would have not been possible without the financial support of the Alliance for Health policy and Systems Research, World Health Organization (WHO) Geneva. We are deeply indebted to Dr Abdul Ghaffar Executive Director Alliance for Health Policy and Systems Research WHO for his guidance.
Acknowledgments
We would like to express our deep gratitude to the management of the National Rural Support Programme (NRSP) and the WISE Project Team who provided us with all the support needed to successfully conduct this evaluation.
Special thanks to all the evaluation team members for their painstaking efforts in design, data collection and analysis, which enabled the completion of this important study.
Design & Layout: Mansoor Abid
Printed by: National Rural Support Programme (NRSP)
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
iTable of Contents
1. Executive Summary 1 1.1. Objectives of WISE Evaluation 1 1.2. Methodology 1 1.3. Key Findings 2 1.4. Conclusion 32. NRSP Introduction 4 2.1. Brief background of NRSP 4 2.2. NRSP Objectives 4 2.3. NRSP Vision 4 2.4. NRSP Strategy 4 2.5. WISE Programme 5 2.6. Objectives of WISE Programme 5 2.7. Objectives of the WISE Evaluation 63. Research Methodology 7 3.1. Study Design 7 3.2. Qualitative Methods 74. Quantitative Methods 9 4.1. Household Survey 9 4.2. Sampling method and study area 9 4.3. Data Collection 10 4.4. Data Management: 115. Results 12 5.1. Water 12 5.2. Immunization 13 5.3. Sanitation 14 5.4. Education 156. Findings pertaining to the implementation of WISE Project 177. Conclusions 208. Recommendations 21
Annexures Annex 1: Questionnaire for IDI with DHO Preventive & DDHO, TSV for Evaluation of WISE Project 23 Annex 2: Questionnaire for IDI with DEO/ DDEO Elementary/ AEO Primary Schools/ Teachers (M/F) for Evaluation of WISE Project 25 Annex 3: Questionnaire for IDI with NRSP WISE Project Staff 27 Annex 4: Questionnaire for Focus Group Discussion with Community Representatives LSO/VO/CO 29 Annex 5: Household questionnaire (Urdu) 31 Annex 6: Household questionnaire (Sindhi) 33
ii |
W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
List of Acronyms
CO Community OrganizationCAI Child Advocacy InternationalCBK Community BookkeeperCRP Community Resource PersonCNIC Computerized National Identity CardDPO District Programme OfficerDIP Detailed Implementation PlanDDHO Deputy District Health OfficerDDEO Deputy District Education OfficerEPI Expanded Programme on ImmunizationFGD Focus Group DiscussionIDI In Depth InterviewLHW Lady Health WorkerLSO Local Support OrganizationMPR Monthly Progress ReportNRSP National Rural Support ProgrammePCRWR Pakistan Council of Research in Water ResourcesRGM Regional General ManagerSO Social OrganizerSUCCESS Sindh Union Council & Community Economic Strengthening SupportSDGs Sustainable Development GoalsTMK Tando Muhammad KhanTEO Taulka Education OfficerTSV Tehsil Superintendent VaccinationUC Union CouncilVO Village OrganizationWASH Water Sanitation and HygieneWISE Water Immunization Sanitation Education
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
11. Executive Summary
This is an end line evaluation report of the project entitled “Water, Immunization, Sanitation and Education” (WISE) developed and implemented by the National Rural Support Programme (NRSP) during the past two years. The WISE project was developed, piloted and then implemented in one tehsil (sub-district) of Sindh and one of Punjab by the NRSP from 2017-2019. The focus of the intervention was on 4 broad areas ie water, immunization, sanitation and education, while it specifically addressed:
» Access to safe drinking water » Increase in immunization coverage of Penta-3 vaccine » Access of households to sanitation » Increase in school enrolment of 4-12-year-old children.
All the four key areas in turn, addressed a number of targets in the Sustainable Development Goals (SDG)1 especially goals 3, 4 and 6.
1.1. Objectives of WISE Evaluation
The objectives of this evaluation carried out in the two tehsils namely Tando Muhammad Khan (TMK) and Hasilpur were to:
i. Assess the acceptability, feasibility, adoption, fidelity and sustainability of WISE project strategies.
ii. Assess the impact of WISE interventions at the community level across the two tehsils; and iii. Explore the policy level impacts across sectors collaborating with WISE project.
1.2. Methodology
A mixed methods approach, was adopted to allow a holistic understanding2. To assess the first and third objective, an extensive desk review of WISE project documents was undertaken to understand the processes and procedures of WISE implementation; this also helped in designing the topic guides and survey questionnaires. Tool development was followed by in-depth interviews and focus group discussions across a range of respondents including WISE project staff, including LSOs, VOs, COs, CRPs and officials of health/education departments at the tehsil level. In all, 58 in-depth interviews (38 in Hasilpur+20 in TMK) and 6 focus group discussions (3 in each tehsil) were conducted. Written notes were taken for all qualitative contacts. To assess the second objective, impact of WISE interventions at the community level, six Union
1 SDG3: Good Health & Wellbeing, SDG 4: Quality Education SDG6: Clean water & Sanitation2 Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Creswell, J.W. 2014
2 |
W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
Councils (UCs) out of the total 18 UCs were randomly selected; four from Tehsil Hasilpur and two from Tando Muhammad Khan (TMK). Three localities within each UC, and then 30 households (HHs) within each locality were selected randomly, with 90 households spread across each UC. In all, 540 HHs were surveyed (360 in Hasilpur and 180 in TMK); the sample size took into account a design effect to address the clustering in the selection process. Data from the 540-household based survey was entered into MS Excel file- the descriptive analysis and infographic development was done using the same software. For qualitative data analyses, the data was read, reread to identify emerging themes within each area of inquiry. These themes along with their respective substantiating verbatim quotes were coded/labelled. The final emergent themes and quotes were translated into English for inclusion into this report.
1.3. Key Findings:
i. Access to safe drinking water: Overall 99.7% of sampled HHs in both districts have access to safe drinking water. Water testing done by WISE indicates that out of 456 communal sources of water 79.5% have been found safe (and painted Green) for drinking purposes. While 95.5% HHs had the knowledge of treating water to make it safe for drinking, 96.5% acknowledged NRSP’s contribution to making safe drinking water accessible for the communities. LSOs find it feasible to treat water at the HH level and feel it is acceptable for the community. All of them think this component of WISE is sustainable. Similarly, the project staff at WISE also finds this feasible and sustainable.
ii. Immunization: Overall, 98.5% of the children (under 23 months of age) were vaccinated with Penta-3, as reported by their mothers in both districts. Out of these vaccinated children, 88% also had EPI cards with them at the time of survey. About 99.8% HHs considered it feasible to get their children vaccinated, while 97.8% HHs valued NRSP’s contribution in increasing coverage of immunization. Tehsil level health managers and vaccinators also reported NRSP’s contribution in increasing vaccination coverage. Moreover, it was seen as sustainable, even without the support of NRSP. Similarly, LSO, VO, members indicated NRSP’s substantial role in increasing immunization coverage; though being feasible and culturally acceptable, they raised a concern that the quality of work might get compromised once NRSP’s WISE project concludes.
iii. Sanitation: In the sampled households of both districts 96% had dustbins or any intermediary site in their villages and 93.5% were also using those for garbage disposal. Around 97% HHs thought that dustbins are a good idea and 94.5% found it feasible to use. Moreover, 94% valued the NRSP contribution in providing dustbins. All LSO and VO members confirmed that use of dustbins is feasible, however they voiced it to be a challenge to inculcate habits among the people to use it. However, they thought it would not be sustainable without WISE project support. The residents also recognized that the habit of solid waste disposal was difficult to adopt, however, its acceptability was increasing gradually.
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
3iv. Education: In the two districts, overall 98.5% of sampled HHs had their children (between 04-12 years of age) enrolled in schools. About 99% HHs were aware of the enrolment campaign carried out by WISE Project. Overall, 98.5% thought it to be feasible and easy to take children to schools, while 98% HHs recognized the increase in the enrolment rates as the project’s contribution. Though tehsil education management confirmed the role of NRSP in increased enrolment rates, yet raised the concern about its sustainability after WISE project is concluded. LSO and VO members, on the other hand, thought it to be feasible, culturally acceptable and sustainable without NRSP’s support.
v. Policy level Impact of WISE programme: NRSP worked closely with all the governmental sectors involved with the 4 key outcomes. National Rural Support Programme successfully inked memorandum of understanding (MoUs) in 2017/2018 with the departments of health, education and public health engineering division at the district level in Bahawalpur, Punjab and Tando Muhammad Khan, Sindh. These MoUs are a unique example where representatives from various sectors are included as signatories on a single policy document . The impacts at the community level that the WISE programme achieved have been appreciated by district commissioners in Bahawalpur and Tando Muhammad Khan. On the continuum of achieving policy impact, NRSP successfully created partnerships for health and development for the communities being served by government sector departments. Whilst any change in policies across sectors, being the end point on this policy impact continuum, is not an improbable outcome if WISE programme continues to strengthen these public-private collaborations for the communities.
1.4. Conclusion
Our evaluation confirmed that WISE project objectives were successfully achieved. The contribution made by the project was acknowledged by all the stakeholders including health, education, and sanitation sectors. This overarching theme of contribution and good implementation was also resonated by the community in both the tehsils in Punjab and Sindh province. There are some concerns about the sustainability of these initiatives once the project ends in areas of sanitation and vaccination. The WISE Project should be scaled up to other areas of the country with its multi-sectoral approach to improve water, immunization, sanitation and education.
4 |
W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
2. NRSP Introduction
2.1. Brief background of NRSP
NRSP was established in 1991 and is the largest Rural Support Programme in the country in terms of outreach, staff and development activities. It is a not for profit organization with a mandate to alleviate poverty by harnessing people’s potential and undertaking development activities in Pakistan. It has a presence in 72 Districts in all the four Provinces including Azad Jammu and Kashmir through regional offices and field Offices. NRSP is currently working with more than 3.6 million poor households organized into a network of 228,847 Community Organizations. With sustained incremental growth, it is emerging as Pakistan’s leading engine for poverty reduction and rural development.
2.2. NRSP Objectives
The main objective of NRSP is to foster a countrywide network of grassroots level organizations to enable rural communities to plan, implement and manage developmental activities and programmes for the purpose of ensuring productive employment, alleviation of poverty and improvement in the quality of life.
2.3. NRSP Vision
All rural households in the country are organized into vibrant and inclusive institutions for poverty reduction and sustainable development.
2.4. NRSP Strategy
NRSP strategy is to harness people’s potential to help themselves by:
» Organizing the households » Planning by each household » Capital formation
CO COCO
VOVO
LSO
LOCAL SUPPORT ORGANIZATION LSO-
Federation of Village organizations at UC Level
LSO leaders, Executive Committee and General Body
Executive Committee: All VO Leaders
General Body: All CO Leaders
All villages represented in LSO
VILLAGE ORGANIZATION VO-
Federation of Community Organizations
Leaders and General Body (all CO Presidents & Managers)
All mohallas/ settlements represented in VO
100% inclusion of poorest households through COs
COMMUNITY ORGANIZATION CO-
Participatory body (Leaders and Members)
Separate COs for Men and Women (if required)
Each CO to have 15-25 members
Social Mobilization: Federating the COs
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
5 » Skills enhancement » Networking » Linkages with government and service providers
2.5. WISE Programme
The National Rural Support Programme (NRSP) designed a key initiative named WISE (Water, Immunization Sanitation and Education) for mobilizing communities and equipping them with the information, means and resources to improve indicators in the target union councils.
NRSP has been striving to foster institutions of people which are enabled to do many things on their own for improving their quality of life and the feedback from the community institutions showed improved quality of life due to several income generating activities. Based on the NRSP social mobilization experience (that includes 3.57 million households across Pakistan), each Union Council (UC) with an estimated population of 25,000 is the smallest administrative unit of the provincial government. In rural communities NRSP has a well-established 3-tier institutional mechanism of social mobilization managed by the communities including Community organizations, Village Organizations and Local Support Organizations.
NRSP has a well-established 3-tier institutional mechanism managed by the communities. Currently this includes 857 LSOs, 7,762 VOs, and 225,913 COs working on local priorities, community driven work plans, fund generation, and collective bargaining for public services. The programme was piloted in union councils having three tier structure with an idea to engage these organized communities in initiatives to improve social indicators in post project period.
NRSP piloted the WISE programme in 18 union councils in 18 districts across the country in all four provinces and regions including AJ&K.
Based on the pilot phase achievements and experience, NRSP scaled up this programme in 02 tehsils -one in Punjab and the other in Sindh- in 2017. Seven union councils of Tando Muhammad Khan Tehsil of district Tando Muhammad Khan in Sindh and 11 union councils of tehsil Hasilpur, district Bahawalpur were selected. The idea was to engage the organized communities (LSO/VO/CO) in development-related initiatives to address the multidimensional poverty. This would occur through bridging the lowest tier of the public institutions with communities. Demand creation and facilitation of community members and service providers were the strategies for improving access to public services especially health, education, WASH and immunization.
2.6. Objectives of WISE Programme
» Increasing access of households to safe drinking water sources or adopt water treatment methods at HH level
6 |
W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
» Improving the coverage of immunization for children less than two years of age and women of reproductive age in the target areas and developing a sustainable system to maintain it
» Ensuring households become habitual of proper disposal of Solid Waste and improve Sanitation conditions and a system of ensuring the disposal is developed and sustained
» Increasing the enrolment of out of school children of 4-12 years of age in primary schools
2.7. Objectives of the WISE Evaluation
NRSP commissioned Child Advocacy International (CAI), a research organization in Pakistan to undertake the project evaluation. The objectives of this evaluation were to assess the following in both tehsils:
1. Acceptability, feasibility, adoption, fidelity and sustainability of WISE project implementation 2. Impact of WISE interventions at the community level across the two tehsils 3. Policy level impacts across sectors collaborating with WISE project
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
73. Research Methodology
3.1. Study Design
Mixed methods approach was used and both qualitative and quantitative data were collected.
3.2. Qualitative Methods
Following qualitative methods were used stepwise.
I. Desk review
Desk review was an important part of the assessment as a first step. All available data related to WISE project was collected, organized, and synthesized. This provided the researchers an understanding of the project activities, priorities, and outcomes and equally important, identified gaps in the knowledge that were then addressed in the interviews. Following secondary data was reviewed.
Table 1: List of reviewed documents
Sr # WISE Project Documents
1NRSP-Organization’s Background/Introduction, Aims/Goals, themes for working and scope of the organization.
2
WISE Projects Background, components, Objectives, Project design, Projects planning, 3 Tiers of Community Organization, Implementation strategy, Project Monitoring, Interventions, Outcomes, Impact, Demographic Profile of the catchment area of Hasilpur & TMK
3WISE Proposals for the two tehsils Hasilpur-district Bahawalpur (Punjab) and TMK (Sindh)
4 WISE MOUs signed documents with Government in Hasilpur & TMK5 Original WISE based ToRs for impact evaluation
6Work plans of Social Organizers, Community Resource Persons and Monthly Progress Report
II. In-Depth Interviews
Semi structured interview guides were developed to elicit participant views in all the 4 areas of wise project. Moreover, questions about fidelity, reach, feasibility and sustainability were also included. Interview guides were translated in local languages for both districts, the field team of researchers that included women and men were trained for 2 days in the classroom and questioner was pilot tested. After pilot testing instrument was revised and field supervision of data collectors
8 |
W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
was done during interviews. Interviews were audio recorded and later transcribed. Data from the following respondents was collected after informed consent (Table 2). Verbatim notes of interviews were taken. Notes were read carefully, transcribed and analyzed. The interviews brought out personal confession, stories and slice of life vignettes relating to the project.
Table 2: Study participants from the two study areas
IDI with official Hasilpur Punjab TMK SindhDeputy District Health Officer 1 1Tehsil Superintendent Vaccination 1 1Vaccinators 6 4Social Organizer 4 4Project Coordinator 1 1District Programme Officer 1 1Regional General Manager 1 1Deputy District Education Officer 2 2Assistant Education Officer 3Head Teachers 17 6Sub Total IDIs 38 21
Total IDIs 59
III. Focus Group Discussions
A total of six FGDs with community were held across the two tehsils that provided information on the community representative’s perceptions about the project outcomes. The participants of FGDS were kept homogenous and a debate and open discussion was encouraged. Participation of women was 67% in these groups. Following participants were included. The FGDs were recorded in long hand, translated, transcribed and reduced to hard copy. Themes were generated after coding and analyzing the data manually.
Table 3: Participants of FGDS conducted in Tehsils- HSP & TMK
Total number of participants 106LSO 33VO 25CO 25LHW 2CRP 21
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
94. Quantitative Methods
4.1. Household Survey
A household survey was conducted in the two study areas. The questionnaire for HHs information was developed in Urdu and Sindhi. Since NRSP is implementing WISE Project in two tehsils Hasilpur (Punjab) and TMK (Sindh). The communication with HHs in Hasilpur was possible in Urdu whereas it was not possible to gather information from the HHs in TMK (Sindh), therefore the translated version of the same questionnaire was developed in Sindhi. Both the versions (Urdu and Sindhi) are per annex 5 & 6 respectively.
4.2. Sampling method and study area
A sample size of 540 HHs was calculated for survey from both Tehsils. These Tehsils had 18 UCs and six UCs (33%) were randomly selected. The Selection of the UCs was through simple random sampling approach. From each UC two villages from each were selected and 30 HHs from each village were taken having target of 0-12 years children for both Immunization and school enrolment outcomes.
» Total Number of UCs = 18 (HSP= 11+TMK=07 » UCs selected for the survey= 6 (33%) » Villages selected from each UC=2 » Total Villages from all UCs=2x6=12 » HH from each Location =30 » Total HHs =30x12= 360 » Design effect = 1.5x360= 540 HHs » # of HH surveyed = 540 » Out of all 540 HH, 360 HH were surveyed from Tehsil HSP & 180 HH were taken from TMK.
HHs Clustering: For convenience in data gathering and its better management, HHs were organized into clusters. Each cluster consisted of 30 HHs with 18 clusters in total across the two tehsils (18x30=540). The division of clusters among two tehsils was such that there were total 12 clusters in Tehsil Hasilpur (12x30=360) and 6 clusters (30x6=180) in TMK.
Quality Assurance in Data Collection
Selection & Training of Enumerators for Household Survey: Five field researchers and one supervisor were recruited for this component of the evaluation in both the tehsils. Researchers were shortlisted based on their qualifications, previous experience, written test and interview. After their selection they were trained in a two days training. The Training was based on interactive
10
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
discussions and role plays. Upon completion of the two days classroom training, the assessment teams practiced in the field. Each person conducting five household surveys followed by a debrief supervision session to help clarify coding issues or issues in understanding any of the items. This also helped establish inter-rater reliability among the surveyors. The classroom training covered the following topics:
» Introduction of the team members building rapport » Overview of WISE Project and its key interventions » Objectives of the end of project evaluation » Sensitivity around working and interacting with the communities Detailed review of the
questionnaire and each item to ask for » How to ask question and coding of each item? » How to fill in the HH survey form? » Door marking
Training of Team Supervisor & His Role: The supervisor was imparted training on all above subjects. Besides, his role and responsibilities prior to, during, and by the close of the survey were clarified. These included:
» Overall planning for the survey » Logistic support » To ensure security and safety of the teams » Monitoring & supervision » Validation of filled Survey forms » Handing over filled survey forms to CAI office » Sharing next day’s planning &discussion on the day’s survey with evaluator.
4.3. Data Collection
Post-training and field practice sessions, the actual data collection in Tehsil Hasilpur went on from 25-02-2020 to 05-03-2020. While in Tehsil Tando Muhammad Khan data collection was done from 09-03-2020 to 13-03-2020 during the study period. The household survey questionnaire use for this art of the study is enclosed as annex 5 & 6 in this report.
Identification of eligible HHs: In each location, we started from the right side of the lane/roundabout, knocked at the door and interacted with the HH. The data collection started by greeting the respondent, introducing themselves and telling the objective of visiting the HH. After developing rapport asked them whether the HH have target child 0-12 Years, and if yes then obtained permission for taking HH information. Question items were asked one by one, registering response in to given codes and filling the HH survey form. Once Interview was completed, the respondent was thanked the door marked with the respective allocated number specific to each enumerator.
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
11Door Marking: After completing HH survey, the door marking was done with white chalks. The
objective of the door marking was to make the survey clear, specific, avoiding confusion and reducing error rate and making validation easy as well as accountability of the surveyors since each surveyor was allocated specific HH numbers.
4.4. Data Management:
The data was collected through coded questionnaire. Printed hard copies of the questionnaire were used for the quantitative data collection from the HHs. Printed survey forms used to provide to the enumerators on daily basis at the start of survey and all the survey team return filled forms daily to Supervisor who then deposit in CAI office. The forms collected back were placed in the survey files and put under lock and key in the CAI office.
Data Cleaning: The data was entered in MS Excel spread sheet, verified and validated by the evaluator. The reviewed and verified data was saved and set aside for analysis. The hard copies of HHs survey form data was dispatched to CAI office through courier and soft data through e-mail. The quantitative data was entered into Excel spread sheet and analyzed using MS Excel to run analysis and generate descriptive statistics. The results are presented below.
Monitoring of HH Survey: Besides on hands guidance by the supervisors who used to stay with them for supervision throughout the survey time, 10% filled forms were validated from the HHs by the Supervisors and 2% by the Evaluator.
The quantitative data was entered into Excel spread sheet and analyzed using MS Excel to run analysis and generate descriptive statistics. The results are presented below.
12
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
5. Results
5.1. Water
Overall 99.7% of sampled HHs in both districts have access to safe drinking water. Water testing done by WISE indicates that out of 456 communal sources of water 79.5% have been found safe (and painted Green) for drinking purposes. While 95.5% HHs had the knowledge of treating water to make it safe for drinking, 96.5% acknowledged NRSP’s contribution to making safe drinking water accessible for the communities.
All the households in Hasilpur have access to safe drinking water while almost half of them use underground water, 31% filtration plants and 21% use public water supply. Ninety five percent HHs had knowledge of treating water to make it safe for drinking; 93% find it feasible to use any of the methods and 93%acknowledged NRSP’s contribution to making safe drinking water accessible for the communities Eleven percent of HHs have to travel more than one kilometre distance to access safe water sources.
In tehsil Tando Muhammad Khan (TMK) 99.4% households had access to safe drinking water whereas 96.1% HHs are using underground water, 3.3% filtration plant and 0.6% are using water channel. Ninety six percent of households had knowledge of treating water to make it safe for drinking, 99% HHs find it feasible to treat the drinking water and all the HHs acknowledged NRSP’s contribution in making safe drinking water accessible for the communities.
During the qualitative interviews with LSOs, VOs and COs about safe drinking water, the contribution of NRSP’s WISE Project featured very frequently and the organization acknowledged by saying
99% 96%
Hasilpur Tando Muhammad Khan
HH having information of treating waterAccess to safe drinking water
100% 95%
Graph 1: Access to and information about safe drinking water in the two districts
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
13“this is all because of NRSP” they “test and then label/paint the hand pumps which have safe
drinking water - green and red hand pumps have made our life easy”
The contribution was also recognized by the fact the communities observed impacts of safe drinking water especially on the health of their children. An LSO said
“Safe drinking water has reduced diseases in children like diarrhea. Through WISE activities we now also know about boiling water, especially in case of disease among children like diarrhea.”
Some challenges were also highlighted around the access to safe drinking water by a few LSO, VO and CO especially in Hasilpur, they reported
“Safe drinking water is a high ranking priority for us; some of us have to bring safe drinking water from far-flung areas”.
5.2. Immunization
Overall, 98.5% of the children (under 23 months of age) were vaccinated with Penta-3, as reported by their mothers in both districts. Out of these vaccinated children, 88% also had EPI cards with them at the time of survey.
Tehsil Hasilpur 97% (0-23 months) children were found vaccinated against Penta-3 while 92% HHs have EPI cards. Ninety eight percent HHs know the importance of vaccination, 99.7% endorsed that getting immunization to their children is feasible. Ninety six percent HHs recognized that NRSP has major contribution in increasing the immunization coverage.
In Tehsil TMK 100% (0-23 months) children were found vaccinated against Penta-3 while 84% HHs have EPI cards. All the HHs know the importance of vaccination and endorsed that getting
Graph 2: Vaccination coverage in the two districts
100% 84%
Hasilpur Tando Muhammad Khan
Penta-3 HH having EPI Card
97% 92%
14
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
immunization to children is feasible. Similarly 100% have recognized that NRSP has major contribution in increasing the immunization coverage.
These high rates of penta-3 vaccination in the sampled households (even with high proportions of them having EPI cards) was resonated by the District Health Officers in both the evaluation areas.
“Without NRSP’s support for the vaccinators in routine immunization, we could not have achieved an increase in the coverage that we now have”.
They further added that
“the CRPs from the community have been a value addition by NRSP. CRPs have helped increase coverage particularly in LHW uncovered areas, where household access was difficult. They helped increase motivation among parents to get their children vaccinated and substantially reduced numbers of defaulters and missed children during campaigns”.
The role of CRPs was also substantiated by the community in FGDs across the tehsils with LSO, VO, CO members, they said
“in the beginning, mothers used to hide their children from the vaccinator, due to the fear of post-vaccine fever, pain etc, but now with motivation and CRPs intervention, mothers ask the vaccinators schedule to have their children vaccinated”.
5. 3. Sanitation
In the sampled households of both districts 96% had dustbins or any intermediary site in their villages and 93.5% were also using those for garbage disposal. Around 97% HHs thought that dustbins are a good idea and 94.5% found it feasible to use.
100% 100%
Hasilpur Tando Muhammad Khan
HH having dustbins in village HH using dustbins
92% 87%
Graph 3: Households having and using dustbins in the two districts
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
15Hasilpur 92% HHs have dustbins or any intermediary site in their village and 87% are using the
dustbins. Ninety five percent HHs recognize that it is a good thing to use dustbin and 94% agreed that they can use dustbins easily. Moreover 94% HHs accede that NRSP has vital contribution in providing dustbins.
In TMK 100% HHs have dustbins or any intermediary site in their village and all of them are using the dustbins. Every HH recognizes that it is a good thing to use dustbin and agreed that they can use dustbins easily. Moreover 100% HHs accede that NRSP has vital contribution in providing dustbins.
This was one of the indicators that seemed challenging as it depended on the individual household behaviours of disposing off solid waste including general cleanliness across both the tehsils. In one of the FGDs with members of LSO, VO and CO said
“we faced a lot of resistance and difficulties initially to make people change their habits on waste disposal mainly due to non-existent sanitation system in the area. Now things are gradually getting better”.
In Hasilpur a challenge of long distances to cover for disposing off waste was highlighted along with smaller number of dustbins compared to the number of households in an FGD.
5.4. Education
In the two districts, overall, 98.5% of sampled HHs had their children (between 04-12 years of age) enrolled in schools. About 99% HHs were aware of the enrolment campaign carried out by WISE Project. Hasilpur 98% HHs assessed for the children (aged 04-12 years) were enrolled in the schools.98% HHs had awareness about enrolment campaign by NRSP. 97% thought it
Graph 4: School enrolment of children in the two districts
99% 100%
Hasilpur Tando Muhammad Khan
Enrolled Child (4-12y) HH having awareness about NRSP enrol. campaign
98% 98%
16
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
possible to take child to school easily while 96% HHs thought it NRSP’s contribution in increasing the enrolment.
In TMK 99% HHs assessed for the children (aged 04-12 years) were enrolled in the schools.100% HHs have awareness about enrolment campaign by NRSP. 100% endorsed that it is possible to take child to school easily while 100% HHs thought it a NRSP’s contribution in increasing the enrolment.
During in-depth interviews with the education dept, the contributions of NRSP leading to higher rates of enrloment in schools was mentioned. It was stated that
“increased rates of enrolment has been NRSP’s wonderful contribution. This was done through mobilizing communities, supporting the schools in activating School Councils and furnishing schools with missing facilities like constructing boundary walls and latrines. This helped raise confidence of parents in sending their girls to school which they were not before these facilities. Through WISE, parents have also received stationary, uniforms and satchels for deserving students as support which promoted enrolment”.
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
176. Findings pertaining to the implementation of WISE Project
Acceptability: There was no dissenting voice from any of the respondents about the overall acceptability of WISE programme and/or any of its interventions or its multisectoral approach to harness partnerships. In fact, any difficulties in working closely with government sector, in the early days, gradually were resolved as time passed. For example during an in-depth interview with of the health officials the following was said
“at the very start, NRSP did a baseline survey and found immunization rates to be different to what the programme had; through a process of communication and verification mechanisms this was resolved and eventually that baseline helped in increasing the eventual coverage of routine immunization.”
Similarly through the CRPs household became more acceptable to vaccinations as mentioned above. This being an example of a multi-sectoral collaboration, on one hand, is also a unique example of acceptability of a public sector organization to work with a private sector organization to improve outcomes. Although, some pending issues were highlighted in terms of acceptability at the community level about the enrolment of girls in schools without female teachers. This non-acceptability is an ongoing challenge for both the education sector as well as WISE project. In one of the FGDs with members of LSO, VO and CO in TMK said that
“to help increase enrolment of our girls, female teachers need to be appointed as being taught by male teachers is not culturally acceptable for us.”
Feasibility: In terms of the overall feasibility of WISE programme, like its acceptability, no major concerns were raised by any of the respondents. Neither approaches nor interventions were found to be non-feasible. Perhaps the only area that did raise some concerns around feasibility was that of addressing behaviors of the community around sanitation. WISE project staff clearly articulated that this improving sanitation outcomes have been challenging. Though gradually some of the communities in TMK
“have been constructing their own dustbins themselves” said an LSO in a FGD. However in Hasilpur sole reliance on hired sweepers became evident when
“communities demanded to have sweepers restored and made to pick up household solid waste”
Via the programme rather than disposing waste on their own reported members of LSO and VO in Hasilpur. This same was reflected in around 5% households too reporting waste disposal not being feasible.
18
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
Adoption: The adoption of WISE related strategies across all tiers and across sectors was found to be very acceptable. The level of adoption is also indirectly reflected in the adherence (and fidelity see below) of WISE interventions. One of the strengths that NRSP has is their time-tested social mobilization - and that is the key to all the uptake and adoption of interventions at the community level tiers. This is reflected in by all the indicators ranging in the range of 90% (in all the randomly sampled households in the current survey). Thus due to the adoption e.g. in some areas of Hasilpur, beneficiaries travel more than a kilometer to get safe drinking water rather than risk consuming contaminated water. The success story of improved school enrolments and immunization is also reflective of adoption at all levels and sectors working at these indicators.
Fidelity: In terms of WISE Project interventions and plan implemented as intended ie fidelity, there was a high degree of fidelity seen via review of project documents, annual plans, records and qualitative interviews with programme and community-based respondents. Detailed Implementation plans (DIP) are prepared on a yearly basis and comparing these against the implementation ground revealed that it was implemented as per the plans. Some minor exceptions were there, as reported by one of the WISE Project staff in an in-depth interview that
“all other activities of the WISE project were being done as per detailed Implementation Plan except the education sessions on family planning, civic rights and registration of birth, death and divorce. This in turn has a positive effect on the enrolment rates of children since CNICs and B-Forms are required for enrolment.”
It is noteworthy that a few of the things in the implementation plan like family planning was not originally part of WISE.
Sustainability: In terms of the NRSP’s WISE project’s sustainability there were a number of important aspects highlighted through this evaluation. WISE project has clearly been successful in developing excellent liaison with all stakeholders e.g. Health and Education government departments and elected representatives and led to showing its impact on all of its outcomes. This was reflected across multiple interviews with all stakeholders. However, the issues around sustainability were also voiced for example one of the health officials in Hasilpur and TMK said
“without NRSP’s support in routine immunization we could not have achieved the current level of coverage that we now have. The incentive of rupees 1500-2000 for vaccinators secondary to their performance has been a great value addition by WISE project, however if they leave it will be difficult to maintain the current level of coverage”.
However apart from this financial aspect, there are clear indications that through the social mobilization a strong and skillful community-based structures based on volunteerism seem to be sustainable and generating indigenous solutions at the level of LSO. This is reflected by examples from Hasilpur one of the LSOs arranged a donkey drawn cart to help children’s commute to and
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
19from the school that was more than 2 km away. These are indications of communities taking
initiative on their own. Similarly, the community in of the areas with some difficulty are trying to manage sweepers without WISE based financial support. There are a number of synergistic programme funding being acquired by NRSP which will aid the over sustainability to hold key yet bare minimum structures of WISE in place to help ongoing implementation.
Policy Impact: Vignettes
Improving School Enrolments - a priority supported by WISE Programme for Hasilpur Tehsil, Punjab The Deputy District Education Officer of Bahawalpur district expressed concerns about the number of out of school children and that improving school enrolments was one of the priorities of the department of education. The department through the WISE programme and its collaboration made inroads into the communities to help improve school enrolments. Provision of some facilities at one hand and raising community awareness on the other hand has been the greatest contribution of this three-way partnership since 2017.
Immunization Coverage Improved using a Public-Private Multilateral Partnership Model in Tehsil Tando Muhammad Khan, Sindh & Hasilpur, Punjab.
The deputy commissioner Tando Muhammad Khan, Sindh highlighted the importance of working together achieving any task – especially immunization coverage. He expressed his admiration for the unique public private partnership created by NRSP between the health dept and the communities it serves. At the awards ceremony for recognizing best performances of Lady Health Workers (Health Department) and Community Resource Persons of NRSP collaboration within the National Immunization Days for Polio across the seven rural UCs of the district.
Deputy Commissioners of Tando Muhammad Khan and Bahawalpur districts highlight the importance of working together at different awards distribution ceremonies to acknowledge and highlight community workers.
20
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
7. Conclusions
This end-of-project evaluation of WISE indicates that the overall, the implementation of WISE project and the impact within the communities being served through the four interventions, across both the tehsils of Punjab and Sindh have been successful and met the overall programmatic objectives. Furthermore, WISE project was able to collaborate across sectors and influenced various levels of policy formulation.
The table below provides a summary of implementation related aspects that were assessed, namely acceptability, feasibility, adoption, fidelity and sustainability of WISE interventions. There was by and large a degree of uniformity in all the assessed aspects with good results seen across the four interventions and that too in both the sub-districts (Hasilpur and Tando Muhammad Khan). However, there was some variability in results seen regarding the sustainability of the interventions. The health department clearly stated across subdistricts that WISE inputs were needed if the coverage was to be sustained. Similar views were raised around education and sanitation.
Various aspects of implementation Water Immunization Sanitation Education
Acceptability ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓Feasibility ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓Adoption ✓ ✓ ✓ ✓ ✓ ✓ ✓Fidelity ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓Sustainability ✓ ✓ ✓ ✓ ✓
All tiers of the involved communities and the multiple governmental sectors (health, education, sanitation) engaged with WISE project, recognized the contributions made by the project. This overarching theme of contribution and good implementation also reflected in the impact seen at the household level. High degree of impact was seen across all the four intervention indicators among the households assessed (in Punjab and Sindh provinces). All the interventions of WISE had shown a positive impact on 90% or more households, which were included in the assessment. Policy level impact was also tangible in the form of specific multisectoral MoUs and a general sense of support in the policymakers.
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
218. Recommendations
» The WISE Project has successfully demonstrated that it can be scaled up to other areas of Pakistan, after local adaptation, with emphasize on social mobilization and multi-sectoral approach to improve water, immunization, sanitation and education.
» The social mobilization and multisectoral approach could possibly be extended to other areas and sectors like improving family planning and nutrition related outcomes within the communities.
» The overarching concept of “Systems Thinking” should be incorporated more tangibly in any further planning while scaling up is being considered taking into its ambit the district finance, planning, governance and social security systems
» NRSP has the standing and credibility in the rural communities and governance systems to pitch itself as an advocate for the community voices thus giving it a pivotal role for bringing together various sectors working for the social betterment of populations. This role should be further strengthened and formalized by the organization along with its partners.
» Considering the long-standing presence of NRSP in the system the doubts about “Sustainability” of interventions can be addressed by formalizing its role in the governance system in multisectoral initiatives at district and higher levels
» The approach of social mobilization used by WISE project, which has been the key to improved outcomes, needs to be taken up by health, education, water and sanitation sectors as part of their community outreach strategies to help maintain coverage and ensure sustainability in all similar projects
» It is important that projects which have demonstrated success should be nurtured by the government and appropriate structural changes be instituted within government systems, in order to continue reaping fruits of success
» NRSP along with likeminded organizations should consider a more proactive engagement with policy makers at national, provincial and district level to advocate for embedding multisectoral interventions, based on above experience, for improving the population wellbeing in a more efficient manner.
Annexures
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
23Annex 1: Questionnaire for IDI with DHO Preventive & DDHO, TSV for
Evaluation of WISE Project
Tentative time for Interview: 1-2 hr
Location Date
Name of Official Organization
Tehsil District:
Sr# Questions Responses Remarks1. Your date of joining/ working in this Tehsil /district please?
2. How do you know the working of NRSP in 11 Rural UCs of Tehsil Hasilpur of district BWP since 2017 and running a Water, Immunization, Sanitation and Education (WISE) project in line with SDGs 3,4,6?
3. I think you might be aware that increase in Immunization coverage is one of the key components of the WISE project?
4. Do you appreciate that NRSP has brought about a tremendous improvement in the Immunization coverage?
5. What type of support and value addition could NRSP engender in outreach coverage in the presence of a well established EPI department having vertical–horizontal synergy of the health workforce?
6. Do you have some written understanding with LSO/VO to reach out to the defaulter/unvaccinated/refusal children?
7. Can you please throw light upon to as to how you think NRSP contributed to or is trying to contribute to increasing immunization? To what extent to you think the collaboration between your dept (vaccinators especially) with NRSP has been useful? Any particular areas that were facilitated eg High Risk Mobile Populations (Nomades) in the area? Or any other challenging areas? Like catching Still Not Available (NA) and persistent Not Available (NA) kids during the project period?
8. What is your opinion as to how did the improvement shown in coverage of penta -3 shown by data (District Health Information System) of DHIS/EPI data during the project period came about?
9. How do you see this collaboration with NRSP has contributed in the Immunization by reducing the refusals, and zero dose list in real sense of the term?
10. Since community Organization is one of the key component of NRSP service delivery of the WISE, How do you see WISE project role in complementing vaccination campaigns for children and overcoming resistance and misconception?
11. Do you think that WISE project’s interventions are relevant and appropriate as per need of the community in general and public health needs in particular?
12. Do you think that WISE project’s interventions are culturally acceptable keeping in view local traditional and cultural Taboos and misconceptions about immunization?
13. Do you think that community can sustain this programme in the Immunization without NRSP support?
14. What do you suggest for NRSP and Community to go ahead in achieving maximum coverage (>95%)?
24
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
Sr# Questions Responses Remarks15. Do you think that the WISE project is feasible/viable in the current
scenario?
16. Any other comments please?
OBSERVATIONS
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
25Annex 2: Questionnaire for IDI with DEO/ DDEO Elementary/ AEO Primary
Schools/Teachers (M/F) for Evaluation of WISE Project
Tentative time for Interview: 1-2 hr
Location Date
Name of Official Organization
Tehsil District:
Sr# Questions Responses Remarks1. Your date of joining/ working in this Tehsil /district please?
2. How do you know the working of NRSP in 11 Rural UCs of Tehsil Hasilpur, district BWP since 2017 and running a Water, Immunization, Sanitation and Education (WISE) project in line with SDGs -3,4,6?
3. I think you might will be aware that increase in Enrolement of kids 04-12 years in schools is one of the key component of the WISE project?
4. Do you appreciate that NRSP has brought about a tremendous improvement in the enrolement of children 04-12 years in school?
5. What type of support and value addition could NRSP engender in the enrolement in terms of missing facilities in the WISE project’s catchment area schools like provision of furniture,uniform to poor student,stationary etc. the presence of a well established and the largest Education department?
6. How did the Education Department overcome the issues /challenges created as a result of increased enrolement of children to school like space and teachers in the school?
7. Keeping in view of community organization under WISE project,do you have some written understanding with LSO/VO in bringing out of school children to school for enrolement?
8. To what extent NRSP under “WISE” project enabled education Department to play its role in revitalization of the School Management Committees (SMCs)?
9. Can you please justify from your data base any improvement in enrolement of children 04-12 years to school as a result of WISE projects interventions?
10. How do you see the successful enrolement campaigns under NRSP’s WISE project has qualified the Education Department in achieving SDGs-4?
11. Since community Organization is one of the key component of NRSP’s WISE project in the service delivery , How do you see WISE project’s role in raising awareness of parent regarding importance of education thereby complementing enrolment campaigns for children?
12. Do you think that WISE project’s interventions are relevant and appropriate as per need of the community in the current scenario in general and education needs in particular?
13. Do you think that WISE project’s interventions are culturally acceptable keeping in view local traditional and cultural Taboos and misconceptions about NGOs?
14. Do you think that community can sustain this program as its own in collaboration with education department if NRSP exits?
26
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
Sr# Questions Responses Remarks15. Based on the community participation and feedback as a result of
NRSP’s WISE project do the Education department reviewed its any policy ?
16. Under the prevailing situation do think WISE project a viable/feasible project?
17. What do you suggest for NRSP and Community to go ahead in achieving 100% enrolment of children (04-12 year)?
18. Any other comments please?
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
27Annex 3: Questionnaire for IDI with NRSP WISE Project Staff
Date
Name of Official Designation
Tehsil District:
Sr# Questions Responses RemarksFIDELITY
A
Your date of joining at this position / working in this Tehsil / district please?
How do you know the working of NRSP in 11 Rural UCs of Tehsil Hasilpur, district BWP since 2017 and running a Water, Immunization, Sanitation and Education (WISE) project in line with SDGs -3,4,6?
During implementation of the WISE project did the WISE project is being implemented throughout its life as per initially planned?
If there was a slight change in its activities what was that?
During review of the WISE project at any point in time did some modification was made in terms of strategic planning and in interventions?
Did any addition or reduction in initiatives suggested during WISE implementation at any point in time?
Did a detailed implementation plan was designed for activities to reaching the results?
Did there ever happened any Dip in the initial plan?
B “The aspect of fidelity will be further assessed from NRSP documents by Comparing Project Operational planning compared with on ground actual implementation, work plans of the NRSP WISE project staff, progress reports, Monitoring system, Project Reporting system”
FEASIBILITY - ACCEPTABILITY1 You are working in a community since long for WISE project activities,
what is community perception about NRSP as an NGO?
2 Did the WISE implementation team faced any security threat or challenges in the field?
3 What value additions were brought about through WISE interventions to resolve community problems by the NRSP in your opinion?
4 How do you appreciate that NRSP has brought about a tremendous improvement through WISE interventions in accessing safe drinking water, Immunization coverage, Sanitation and enrolement of children to school?
5 What type of value addition could NRSP engender particularly in outreach coverage in immunization, Accessibility of water,sanitation and enrolement of children in schools?
6 How do you suggest a different strategy if adopted during implementation of WISE project can be more effective in resolving issues?
7 Since community Organization is one of the key component of NRSP's service delivery in the WISE project, How do you see LSO/VO role in complementing WISE interventions?
28
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
Sr# Questions Responses Remarks8 Do you think that WISE project's interventions are relevant and
appropriate as per genuine need of the community in general and public health needs in particular?
9 Do you think that WISE project's interventions are culturally acceptable keeping in view local traditional and cultural Taboos?
SUSTAINABILITY1 Do you think that community organization and motivation are strong
enough to sustain WISE project's initiatives without NRSP support?
2 What do you suggest for NRSP and Community to go ahead ?
BOTTLENECKS1 What obstacles did you experience during implementation of WISE
project? Please enlist?
LESSON LEARNT1 It is interesting to run a community based project because “here is
God’s plenty”human nature is different and they think differently. What lessons did you learnt during the WISE implementation.
CommentsAny other comments please?
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
29Annex 4: Questionnaire for Focus Group Discussion with Community
Representatives LSO/VO/CO
Date Union Council
LSO Name VO
Name of Participants:
Sr# Questions Responses RemarksACCEPTABILITY
Water1 What was the situation of safe drinking water before start of WISE
project?2 Did any other institution/organization /NGO has taken initiative to
provide safe drinking water?3 What change do you feel after provision of safe drinking water under
NRSP's WISE project? Far how long you think that your problem has resolved?
4 What is your ranking of drinking water among other issues in your community?
5 Is the system built by NRSP under WISE project is appropriate and sufficient for catering need of your community?
Immunization1 How many refusal cases have been noted before and after WISE project
in the catchment population? Did you see any positive change ?2 Did any other social organization to facilitate Immunization in the
target villages?3 In your opinion what value addition WISE has suggested to facilitate
routine Immunization to the target population?Sanitation
1 Before WISE project was there any system for sanitation in the community?
2 What do you think that sanitation was a priory issue in your community?
Education1 Was the enrolement of children 04-12 years too low to plan this
intervention?2 Whether the approach adopted under WISE was in consonance with
cultural norms ?3 How LSOs/VOs played role in increasing enrolement of children to
schools? 4 Did LSO/VOs made informal schools to cope with scarcity of schools in
the community?Impact
1 What do you think a conspicuous effect on the knowledge attitude and practices (KAP) of the community as a result of WISE project Intervention?
2 To what extent the access to safe drinking water has reduced the water borne diseases in the community?
30
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
Sr# Questions Responses Remarks3 Do you aware that sanitation and access to safe drinking are safeguard
for health?4 Whether or not LSO achieved its targets that were planned at the onset
of WISE project?5 How the LSO/VO convinced parents and as result the refusals have
been reduced thereby increase in Immunization coverage?6 Is there any occasion where of LSO approached to education
department and convinced for taking evidence based decision making and management?
SUSTAINABILITY1 Is there any occasion when LSO approached to education department
and convinced for evidence based decision making and management
2 How LSO has developed its capacity by learning during managing WISE activities with technical support of NRSP so as to carry on WISE intervention without technical support of NRSP?
3 How LSO/VO planning to continue WISE initiatives without NRSP support
4 What is LSO/VO motivational level and ownership of working voluntarily at their own after NRSP's exit from WISE project?
5 After close of the WISE project how LSO/VO has planned for funds generation required to continue the WISE initiatives?
6 How LSO views NRSP's phase out project strategy and exit plan?
7 How do you see Project Interventions’ Impact on changing in terms of knowledge attitude and practices (KAP) of the concerned communities?
FEASIBILITY1 How do you see Project Interventions’ are doable by the community?
2 How do see feasibility of the project?
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
31Annex 5: Household questionnaire (Urdu)
32
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
Wat
er, I
mm
uniz
atio
n, S
anita
tion
and
Educ
atio
n (W
ISE)
Pro
gram
me
Eval
uatio
n Re
port
|
33Annex 6: Household questionnaire (Sindhi)
34
| W
ater
, Im
mun
izat
ion,
San
itatio
n an
d Ed
ucat
ion
(WIS
E) P
rogr
amm
e Ev
alua
tion
Repo
rt
