Introduction Increasing need for effective monitoring and evaluation in global health programs to improve

project management, track progress and scale-up successes. Program evaluations often take too long limiting use of data to support implementation

or make improvements The Care Community Hub (CCH) pilot in Ghana follows a 2 year mixed methods, theory-drive

(Figure 1) evaluation model to assess how the provision of the Community Health Nurse (CHN) on the Go mobile health application influences the job satisfaction, motivation and health knowledge of nurses.

Objective: To highlight the evaluation approach to understanding the pathways through

which the outcomes are reached in order to make programmatic changes throughout the project.

Care Community Hub CHNs posted to rural areas as part of Ghana's government's Community-based Health Plan-

ning and Services system lack motivation due to professional isolation and lack of support CCH seeks to provide knowledge, learning, motivational and communication tools through

mobile technology (see details in Figure 3) to CHNs to improve their well-being, connectedness and motivation.

The pilot is implemented by Grameen Foundation from June 2014 to May 2016 in 5 districts in Ghana (Figure 2).

Data collection methods Mixed method approach with multiple time points of data collection and review: outcome

evaluation with baseline and endline assessments, routine monitoring and process documen-tation throughout the project.

Theory-driven approach that acts as a framework that guides program design as well as its evaluation.

The Theory of change displays the pathways through which the various CCH application modules work to increase

the motivation and job satisfaction levels of the participating CHNs , improving their perfor-mance and ultimately the quality of maternal, newborn and child health care.

Evaluation in tandem with program development and implementation activities, utilizing data from CHNs to feedback into the intervention design

Main purpose of ongoing monitoring and process documentation driven by the TOC is: 1.To assess how well the CCH activities adhered to the original design of the project during im-

plementation (fidelity) including the level of activities delivered and participation (dose deliv-ered and received/reach), the level of satisfaction among participants, and quality of program management;

2. To examine the proposed change pathways in the theory of change to document the emer-gence of preconditions, intermediate and direct outcomes, explore the underlying drivers of change, and assess the integrity of the project design;

3. o examine the role of contextual factors on the CCH intervention; and 4. To provide data during the course of implementation to facilitate real-time, or close to real-

time, feedback to program staff thus facilitating a continuous learning process and program adaptation. The mixed-method approach utilizes different activities to collect data from key populations of interest and stakeholders throughout the lifetime of the project outlined in Figure 4.

Results Results from 2 rounds of process documentation and ongoing monitoring are summarized in Figure 4.

CONTRIBUTION OF MULTIPLE ASSESSMENT METHODOLOGIES IN A THEORY-DRIVEN

EVALUATION OF MOTIVATION AMONG COMMUNITY HEALTH NURSES IN GHANA

1. THEORY OF CHANGE

ASSUMPTION: CHNs feel unmotivated and frustrated with their jobs.

SOUMYA ALVA, PhD, JSI Research & Training Insitute Inc.

SOPHIA MAGALONA, MPH, JSI Research & Training Insitute Inc.

LINDA VESEL, PhD, Concern Worldwide US

Innovations for Maternal, Newborn & Child Health, an initiative of Concern

Worldwide U.S., accelerates the discovery and testing of creative solutions

to understand and overcome barriers that prevent essential health services

from reaching women and children. JSI Research & Training Institute, Inc.

collaborates with Innovations to provide technical oversight and support

for research, monitoring, and evaluation along with Ivy League Consult Af-

rica, the in-country research partner.

3. CHN ON THE GO MOBILE APP

Ada East, Ada West, & Ningo

Prampram

South Dayi & South Tongu

Health Centers & CHPS

Community Health Nurses

Supervisors

Pilot districts

50

215

55

4. EVALUATION ACTIVITIES

2. PROJECT AREA

HOME SCREEN LEARNING CENTER POINT OF CARE PLANNER

ACHIEVEMENT CENTER STAYING WELL SUPERVISOR APP