Final performance evaluation of transform health in developing regions (HDR) activity

as part of USAID/Ethiopia’s Transform Monitoring, Evaluation, Learning, and Adapting (Transform: MELA) Activity. Transform: MELA conducted this final performance evaluation to measure the progress made towards achievements of results by the activity towards improving maternal, newborn, child health, and family planning (MNCH/FP). Results are presented in terms of effectiveness in improving MNCH/FP outcomes; contributions to local ownership and sustainability and coherence with the existing health system; gender dynamics in design and implementation; and learning and use of evidence. Compared to the baseline, the evaluation confirmed that Transform HDR contributed to improvement in essential newborn care and early initiation of breastfeeding, measles coverage, Vitamin A supplementation and ARI and diarrhea treatment. However, performance on most MNCH/FP key performance indicators (KPI) declined by the endline, despite progress at the midterm. For almost three quarters of the KPIs, at endline performance in Transform HDR intervention areas descended below the respective baseline values. Despite these obstacles, Transform HDR intervention areas had better performance at endline compared to the non-Transform intervention areas. The evaluation also reviews the ways in which Transform HDR facilitated local ownership and sustainability, adopted a gender focus; and was coherent with Ministry of Health objectives. Findings were that Transform HDR: 1) adopted participatory approaches and worked in alignment with the existing health system to ensure ownership; 2) considered gender in most of its activities including supporting traditional women-only community structures; 3) was flexible and adaptive in addressing the changing needs of the health system and dynamic contexts. The report ends with recommendations for future programming in developing regions with specific recommendations for the Ministry of Health and USAID/Ethiopia.