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Executive summary

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide. Refugees affected by NCDs face interrupted care and humanitarian and public health systems that are often weakened, overburdened, and ill equipped to manage chronic conditions. In partnership with Primary Care International (PCI), a United Kingdom-based nongovernmental organization focused on continuing medical education, UNHCR developed a capacity-building project, entitled “Caring for Refugees with NCDs Project”, which aimed to improve the quality of NCD care for refugees in UNHCR’s care. The project aimed to reduce NCD morbidity and mortality through the development of evidence-based clinical guidelines and their adoption by clinicians at community-level. The project’s objectives were: 1) to improve awareness of NCDs among public health and clinical staff; 2) to improve knowledge of NCD management among public health and clinical staff; 3) to improve NCD clinical practice among public health and clinical staff; and 4) to improve a systems approach to NCDs management. The project initially focused on Jordan, Kenya, Burkina Faso, Algeria, and Bangladesh from 2014 to 2016, and, later on Rwanda, Tanzania, Uganda, Democratic Republic of Congo, Ethiopia, Cameroon, Burundi, and Chad from 2017 to 2019. The main activities of the project were conducted through a Training of Trainers (ToT) approach. This involved a week-long, in-person ToT programme, provided by PCI staff to NCD champions selected from UNHCR and implementing partner teams. It was intended that these champions would then cascade training to their colleagues and lead the restructuring their programme’s NCD services. Follow-up support was provided via peer-led social media groups set up by PCI.

AIM: This evaluation aims to assess the relevance, coherence, effectiveness, efficiency, impact, and sustainability of the project and related organizational changes in UNHCR’s work on NCD care and management. The findings of the evaluation will be used to support learning and accountability; to guide programme practices to improve NCD care in refugee operations; and to document lessons learned from implementation and field practice.

METHODS: The evaluation was guided by the Organisation for Economic Cooperation and Development - Development Assistance Committee (OECD-DAC) criteria for evaluation of humanitarian action, to understand whether the project did the right things (relevance); whether it fit the different contexts in which it took place (coherence); whether it achieved its objectives (efficiency); how well resources were used (effectiveness); what difference the intervention made (impact); and finally, whether the benefits would last (sustainability). Four countries were selected for the evaluation: Cameroon, Rwanda, Tanzania, and Jordan. The methods used included a) a review of programme materials provided by PCI and UNHCR and b) semi-structured qualitative interviews of purposefully- selected UNHCR, PCI or implementing partner staff. Interviews were conducted in English or French. Interviewees included PCI (8); UNHCR headquarters (4); UNHCR country level programme officers (PHOs, 6); and field implementing partner (18). Semi-structured interviews were guided by a topic guide, which was designed around the OECD-DAC criteria. They explored the organizational and contextual constraints to implementing the project. The evaluation was carried out remotely since the Covid19 pandemic-related travel restrictions prevented the evaluators from making planned visits to the country programmes. The evaluation was undertaken by a team of three public health researchers, with experience of working in humanitarian settings and with humanitarian implementing organizations. The team included members with health services research, evaluation, programme management and medical and nursing backgrounds.