Executive Summary The current OFDA and DFID funded Water and Sanitation, Nutrition, Health Promotion and Environment activities are on track to achieve their objectives by the end of their respective funding periods. Objectives where the project exercises greater controls such as water point construction and cure rates are likely to be met, which is particularly noteworthy as project staff were able to access the location for approximately 30% of the time. Other indicators which are more contingent on the local population’s participation such as malnutrition prevalence, and latrine adoption are not performing well and may not be met. These activities are much more subject to local security conditions grounded in long-term change factors rooted in local custom, tradition and context. Unexpectedly, attempts to provide services or build communal assets to serve all communities involved in the conflict have positively contributed to a local de-escalation of tensions. Sectoral activities and methodologies were consistently shown to be appropriate and competently implemented. Activity constraints varied by sector. • Water & Sanitation technologies were appropriate both in their design and by their ability to redress both chronic and acute needs. They were constrained by the degree of community engagement and cross-sectoral linkages in the project. • Health Promotion & Children’s Activities also demonstrated very strong methodologies and cost-effective approaches. However the activities are not likely to fit within future government priorities or budgetary capacities. Without project support, community capacity or desire to sustain these activities is also weak. • Environmental Health & Livelihoods, supports valued and appropriate activities at the household level. These activities are not critical for public health. Their impact and sustainability are also premised on a local partner whose organisational capacity is weak. • Nutrition activities show very strong clinical, case and project management. Issues related to the supplementary programming limit sectoral performance overall. The mix of project activities was seen to be responding to the fluid security context. The project is making a valued contribution in building household resilience and community coping capacity (public health -water, hygiene and nutrition). General Recommendations Despite the current stable security conditions, the threat of insecurity strongly necessitates a continued project presence. In this relatively stabilised environment, acute needs were observed to be less pronounced than ones of recovery and development. Water, latrine, HPCA coverage levels and nutrition centres of activity are met and established. Rather than more capital investment in these sectors, activities to support local capacity to sustain activities, increase their impact and respond to emergencies should be emphasised. While continuing to provide services and making investments that de-escalate local tensions. Recommendations for strategy A new strategic plan should be developed for the final period based on the recommendation above. The programmes approach to conflict sensitivity should be specifically articulated by preparing a tension reduction strategy through equitable service provision based on the conflict sensitivity report already produced. Each potential activity should be recognised as a political act and balanced against explicit acknowledgement of how the activity could go wrong and the cost to Tearfund or other communities of getting it wrong. Sustainability plans for Nutrition should be reviewed, and capacity building efforts limited to stabilisation and management of severe cases. This substantive change to the programme is currently being planned and developed as part of the new nutrition strategy. Other recommendations Other recommendations included setting sectoral quality standards with which all activities should comply in 2009 – 2010 (ie water installations, nutrition coverage and measurement). In response to this Tearfund are establishing acceptable lowest quality standards for periods of remote management, but will continue to monitor against external standards for each sector during times of access. It was suggested integration could be improved by appointing a single staff member to be the point person for a community, and each sector to take responsibility for promoting positive health behaviours not just Health Promotion. Tearfund have responded by focusing on improving integration., one example is the Health Promotion sector have already conducted joint training with nutrition and Watsan staff to promote better integration. Sectoral plans should be made together with local partners to locally manage / continue activities in case of future staff evacuations, and to respond to acute crisis, ie large displacement. In response Beida projects have pre-positioned stock in place and are ready to respond to new displacement in coordination with partners should this occur.