Terms of Reference for End of Project Evaluation – Puntland State Of Somalia

1. Background

The effects of climatic shocks, including repeated below-average/failed rainy seasons, droughts, and conflicts, have exacerbated Somalia’s humanitarian impact. This has resulted in livestock deaths and devastating consequences for people’s livelihoods and food security forcing drought-induced migration and population displacements. The last national emergencies due to drought have been declared in Somalia in January 2022. Therefore, the UN estimated the number of internally displaced people (IDP) to 746’000 in Somalia and the number of people affected by food insecurity to 7.1 million. In 2022, around 1.2 million children under the age of 5 years were at risk of acute malnutrition, only 11% of 12-23months children are fully vaccinated, maternal mortality rate is 692/100’000 and 79% of deliveries are done at home without skilled birth attendant.

This situation led to a deterioration of nutritional and health indicators of the climate change-affected populations. Malnutrition status has been worsening in all affected areas, increasing the number of children in need of urgent treatment and nutrition support. And there is a low coverage of antenatal consultations (ANC) and postnatal consultations (PNC) for pregnant women. In addition, recurrent disease outbreaks in those regions have a greater incidence because of the high malnutrition rate and the reduced availability of safe drinking water.

Against this background, SRCS with the support of Norwegian Red Cross implemented an emergency project aimed at improving the healthcare status of people whose lives have been affected by the ongoing drought. The project targeted the catchment population of 13 health centers (7 in Mudug, 3 in Nugaal) already supported by NorCross.

• Overall Goal and Expected Outcomes of the Project

To reduce malnutrition rate among drought affected populations in Somalia through cash and voucher assistance for health.

Expected Outcomes of the Project

Outcome 1: Ensure the immediate health and nutritional needs of drought affected populations (PLW, children <5 SAM/MAM) are met.

Output 1.1: Cash assistance provided to at risk groups of women and children facing financial barriers in need of health care services.

Output 1.2: Targeted households receive conditional cash transfers and vouchers to purchase health /water commodities and services so that income is maintained where income sources are disrupted because of need for health.

Output 1.3: Community-based health and nutrition promotion is provided to the target population.

Output 1.4: Targeted households have improved access to health and nutritional services.

2.2 Target groups

• Child <5 years with Severe Acute Malnutrition with MUAC score <115mm (11.5cm)
• Pregnant woman with MUAC <210mm (21cm) and BMI <18.5kg/m2
• Lactating woman with MUAC <210mm (21cm) and BMI <18.5kg/m2 (MUST exclusively breastfeeding, i.e., child is under 6 months old)
• Child <5 years with Moderate Acute Malnutrition with MUAC score >115mm (11.5cm) and <125mm (12.5cm)

Vulnerability criteria

• Patient is from a women-headed or child-headed household.
• The head of patient’s household has some form of impairment Washington criteria.
• Patient is a pregnant woman unable to access to health facilities.
• Patient’s household has one or more disabled or chronically ill members.
• Patient’s household has more than 6 members.
• Patient’s household has 3 or more children under 5 years of age.
• Patient’s household has one or more elderly people (above 65 years old) with disability.
• Patient’s household has lost their livelihood means due to the drought.

Households (HH) in the catchment areas with malnourished pregnant and lactating women as well as children under 5 with severe and moderate acute malnutrition were chosen. Each household was to be provided with a cash transfer and with vouchers every month, in a 50:50 split of the total transfer value. This was to enable beneficiaries to purchase nutritional items, medicine/health commodities or services, water and hygiene items, and to help address other financial barriers preventing them from seeking health services e.g., to help meet transportation costs from their homes to health facilities. However, a supplier assessment conducted at the start of the project revealed risks that were not mitigatable for utilizing vouchers in Somalia, including an insufficient number of suppliers in each region. It was therefore decided to transfer the amount allocated for vouchers, to the beneficiaries, in addition to the cash transfer they would receive each month.

1240 HH from the two regions received six rounds of monthly cash transfers during the project period starting from November 2022 up to April 2023. Transfer amounts varied by region and were based on the September 2022 Minimum Expenditure Basket (MEB) recommendations from the Somalia Cash Working Group (CWG). Total transfer value was US$ 98 in Nugaal and US$80 in Mudug.

1. Purpose and objectives of the evaluation

The purpose of this endline evaluation is to provide sufficient information to SRCS and partners with the project impact and performance at all levels. The evaluation will in particular seek to assess project design, implementation strategies, the extent to which project results have been achieved, capacities built and recommend areas for improvement and learning for future interventions.

Specific objectives

The evaluation’s objectives are outlined below.

• Assess the relevance, effectiveness, efficiency, and sustainability of project results.
• To assess the project performance against its objectives and evaluate the intended and unintended results of the project.
• Identify and document key lessons learned and best practices and propose practical recommendations for follow-up interventions.

1. Evaluation questions

The final evaluation will assess the completed project against the following criteria: –

Terms of Reference CVA EOP Evaluation