Abstract
BACKGROUND: Although the need for multi-faceted and multi-sectoral approaches to address the multidimensional issue of child marriage is well-acknowledged, there is a dearth of documented experience on the process of implementing and managing such programmes. METHODS: WHO evaluated a district-level, government-led multi-sectoral intervention to address child marriage in Jamui, Bihar and Sawai Madhopur, Rajasthan, implemented by MAMTA Health Institute for Mother and Child (MAMTA). We evaluated the intervention's design, implementation, monitoring, and outputs and identified key challenges and successes. RESULTS: Through actions at the state and district levels, the intervention succeeded in creating a cascade effect to stimulate more concerted action at block and village levels, with tangible intersectoral convergence occurring at the village level. The success factors we identified included an experienced partner NGO that was committed to supporting this effort, context-specific design and implementation, and a flexible and responsive approach. However, despite contributing to informal coordination between various stakeholders, the intervention did not succeed in developing a sustained joint-working mechanism at the district level. Shared ownership for prioritization of child marriage across national- and state-level sectors was not established, due in part to lack of directives transcending ministerial/departmental boundaries. Nevertheless, due to its efforts at the district-level, the intervention was able to enlist leadership from the District Magistrates and Child Marriage Prohibition Officers, in line with their duties outlined in the 2006 Prohibition of Child Marriage Act. The challenges we identified included lack of clear directives and institutional support for collaboration, obstacles to monitoring, administrative challenges, differing perspectives on strategy among district leaders, community resistance, and intervention over-commitment. CONCLUSIONS: The findings of this evaluation reveal the potential of multi-sectoral approaches to prevent and respond to child marriage and provide insight into obstacles that affect multi-sectoral coordination. We point to actions that MAMTA could take to strengthen collaboration on this and other initiatives. We also recommend further documentation and evaluation of projects and programmes in this area.