Improving Health Services and Outcomes Evaluation in the Ninewa Plains, Iraq

The total amount for the subaward was $3,255,000. The grant focused on six primary health care centers (PHCCs) and one secondary facility, Sinjar General Hospital (maternity unit). The key areas of activity support included primary health care, reproductive health care, mental health and psychosocial support (MHPSS) services, referrals and linkages, gender-based violence (GBV) prevention and response, and community health care. The grant's main objectives were to improve delivery of the essential package of primary health care services to minority populations in the Ninewa Plains, strengthen and integrate MHPSS services, post-traumatic treatment for children, and sexual and gender-based violence (SGBV) services in selected sites, and develop and implement a formal handover process for services provided under Objectives 1 and 2 by transitioning management and quality assurance of services in Ninewa to the Department of Health (DOH). The evaluation sought to answer five evaluation questions addressing project components' contribution to changes in service delivery, factors contributing to uptake in health services among women, the extent to which training improved MHPSS service quality and availability, ways the project supported improvements in continuity of care, and successes and challenges in the project handover to the DOH. The evaluation relied on secondary data analysis of project documents and qualitative analysis of responses from a small sample of key informants. Integration of program components was a key factor in the project's success, allowing women, girls, and vulnerable populations seeking care in the PHCCs to access services under the guise of receiving other, less stigmatizing care. The project provided MHPSS services to 2,107 people during the last 10 months of the grant across four locations. Facility rehabilitation was also a significant success, enhancing and establishing essential health services in the community, including rehabilitating and reactivating sites, providing essential equipment and supplies, and building staff capacity. Maternal and child health/family planning programming was another key area of success, with IMC integrating sexual and reproductive health services into routine primary health consultations in the Al-Mowafaqia, Al-Quba, Al-Qush, Sada, Bashiqa, and Wana PHCCs, and establishing maternity units in Bashiqa, Sinjar, and Wana. Supportive supervision was also critical, with IMC developing quality checklists for the services delivered to facilitate the project's supportive supervision component, and providing training and mentorship to address gaps in service delivery. Capacity building was a key strategy, with IMC building the capacity of the DOH, facility staff, CHWs, and community leaders, and providing training to over 1,045 individuals in primary health care, GBV services, and mental health care. The project's use of supportive supervision, capacity building, and integration of program components were key factors in its success, and these strategies can inform scale-up of similar interventions in Iraq and the surrounding region.