cshgp operations research findings_jennifer weiss and khadija bakarr_5.8.14
TRANSCRIPT
Results from Concern’s Operations
Research initiatives in Burundi and Sierra Leone
Jennifer Weiss,Health Advisor,
Concern US
Khadija BakarrField Operations
ManagerConcern Sierra Leone
CORE Spring 2014 Global Health Practitioner Conference
Burundi
• USAID CSHGP-funded project in Mabayi District, Cibitoke Province, Burundi
• October 2008 – September 2013• Technical interventions: malaria,
diarrhea, pneumonia, IYCF• Operations Research to test MOH-led
Care Group model
What are Care Groups?
Care Groups create a multiplying effect to equitably reach every household with a pregnant woman or child under five years old with interpersonal behavior change communication
The ‘Integrated’ Care Group Model
CHWs instead of Promoters
Key difference: CHW only supervises 2 CGs
DHT is trained by Project Animators to serve in
‘Animator’ role
Operations Research Study: Questions
1. Does the Integrated Care Group model achieve at least the same improvements in key knowledge and practices as the traditional model?
2. Does the Integrated Care Group model function as well as the traditional model?
3. Is the Integrated Care Group model as sustainable as the traditional model?
Operations Research Study: Methods
• Quasi-experimental, cluster randomized pre-post study
Traditional Area
Integrated Area
# Care Groups 51 45
# Care Group Volunteers 503 478
# Children Under 5 and Pregnant Women 7,758 6,630
Operations Research Results: Knowledge and Practices
Indicator Type Example of Indicators Collected Total # % ‘non-inferior’
Knowledge
Danger signs in sick children Critical times for hand-washing Breastfeeding and complementary feeding practices Food groups and components of balanced diet
13 85%
Preventive Practices
Iron supplementation during pregnancy Immediate and exclusive breastfeeding Complementary feeding practices Hand-washing ITN use
13 100%
Sick Child Practices
Diarrhea: care-seeking, use of ORS, increased fluids and food Malaria: care-seeking within 24 hours, treatment with ACT Pneumonia: care-seeking and treatment with antibiotic
10 90%
Contact Intensity
Contact with trained health information provider Attendance at community meetings where health of child was
discussed4 100%
OVERALL 40 90%
Operations Research Results: Functionality and Sustainability
% of CG meetings with at least 80% Volunteer attendance
Operations Research Results: Functionality and Sustainability
% of HHs who received at least one visit by a CGV in the last month
Summary of Results
1. The Integrated Care Group model achieved at least the same improvements in key knowledge and practices as the traditional model
2. The Integrated Care Group model functions as well as the traditional model
3. The Integrated Care Group model is as sustainable as the traditional model
In at least the six month period following end of project support to CG activities, project staff still active in area supporting other (non-Care Group) project activities such as CCM
Post-project sustainability study required
Learning • CHWs are able to serve as Care
Group Promoters through a modified model:• No more than 2 CGs per CHW• Monthly support (training) from
health facility
• Head nurses do not have time for Care Group / CHW supervision – delegate to a more junior nurse “focal point”
• Integrated Model allows for community health data to be directly incorporated into Ministry HIS
Policy Implications for Burundi MoHMinistry has demonstrated keen interest in model, with national
applications for Community Health Strategy
Key Questions to be Addressed to Inform Scale-up:
•Who will initiate the approach? (Role of NGOs)
•How will behavior change materials be re-produced?
•How will quality control and supervision be provided?
•What costs are involved and how will these be covered?
Sierra Leone
• USAID CSHGP-funded project in 10 slum communities of Freetown, Sierra Leone
• October 2011 – September 2016• Technical interventions: maternal and
newborn health, malaria, diarrhea, pneumonia, nutrition
• Operations Research to test a Participatory Community-based Health Information System (P-CBHIS); in partnership with JHU
What is a P-CBHIS?
• Based the Community Based Impact Oriented
(CBIO) approach
• Hypothesizes that if community members have access to health information, they will be empowered to make informed decisions on health programming in their community
• Key activities:• Monthly household visitation to collect
vital event (birth and death) data• Verbal autopsies to determine cause of
death• Participatory feedback sessions and
activity planning based on data collected
Operations Research Questions
Formative Research Question: What are the key factors, inputs, and
processes required to establish an effective Participatory Community-
based Health Information System?
Evaluative Research Questions:
1.What is the extent to which the P-CBHIS facilitates data use to plan and
implement key maternal and child health interventions?
2.What is the extent to which the P-CBHIS contributes to improved health
outcomes for the interventions most closely related to leading causes of
child illness and death identified through the P-CBHIS.?
Intervention group
Comparison group
• Baseline/endline assessment of community structure data management capacity
• Census to identify all target HHs
• Identify and train CHWs and supervisors
• Collect birth and death data
• Periodic KPC surveys to compare key health outcome data
• Collect vital event data
• Verbal autopsy to explore cause of death
• Training for Health Management Committee, Ward Development Committee on how to manage and interpret data
• Community-feedback mechanism on morbidity and mortality data
• Collect vital event data
Community Based Household Census As first phase of CSP Operations Research
Community Based Household Census Results
Supervisors Feedback and Reporting
Learning and Implications
• Census is important first step to any community information systems to
ensure accurate counting of all project beneficiaries • Census increased visibility of project in the community, high levels of
interest among community structures through their participation in
process• Census data collection tools and procedures for quality assurance
showed us the best way to train community enumerators to collect
household data• Conducting a household data in an urban slum environment poses
unique challenges and requires high levels of community involvement to
ensure accurate data (mapping, community boundaries)
Next Steps
• Currently training CHWs on BCC
messages and household data collection• Refining data collection tools to be in line
with MOH CHW reporting tools• Development of Verbal Autopsy tool for
use by CHWs• Development feedback meeting protocol • Strengthen relationship with OR Steering
Committee to ensure our findings are
broadly disseminated at national level
Thank you!
For additional information:
Jennifer Weiss, Health Advisor,
Concern Worldwide, US
Khadija Bakarr, Field Operations Manager,
Concern Sierra Leone
www.concernusa.org