Original OR idea was to test different motivation financière versus motivation non financièreNew MOH CHW policy in May 2010 required project to provide financial incentives and therefore we could not conduct our researchThe MOH suggested that the use of the toll-free telephone network for CHW supervision and support was a promising avenue to explore but we decided to choose an innovation which was closer to our first topicTogether with The Director of Community Health and the director of maternal and child health for the Ministry of HealthWe decided to test community collaborative approach to improve CHWs performance and retention
For our OR, we have set up four collaboratives, each one including from six to nine villages. Each village has a QIT.Each of the collaborative has as topic one element of the National package of High Impact Interventions for the Reduction of Maternal, Neonatal and Child Mortality at community levelFamilial preventive health and WASHNewborn careInfant and young child nutritionCommunity Case Management of Malaria, diarrhea and ARI
We chose the collaborative approach for a few reasonsOne of PRISE-C’sintermediateresultsis: Increased engagement of the community with the community health delivery system
Nous sommes le premier projet à prendre l’enfant dans sa globalité et à appliquer toutes les directives du MS Nous mettons un accent particulier sur la priorisation des femmes pour réaliser l’approche genre, dans DAGLA, seulement 31% des relais de DAGLA sont femmes contre 52% pour SAO, il s’agit ici de la sante de l’enfant et en communauté, la personne la plus proche de l’enfant est la femme
We recently held the first learning session. In order to allow the community level QITs to fully understand their data, we have developed visual aids for indicator monitoring.Each indicator has a drawing to represent it. Here we have one indicator here: percentage of children from 0 to 59 months who sleep under netTrees represent indicator levels. In the last column there is a large tree bearing fruit, which represents 100%. We put the large tree in the last column to make the QIT understand that the large tree (100%) is the goal, and that they should be conducting activities which improve their indicators and make their trees grow towards the large tree.
We have had many challengesFor the DIP and OR development, we found that harmonizing the DIP and OR Development with MOH policies, project and USAID objectives and project budget can be a real challenge.Other challenges were the lack of french guidance documents from USAID. WE have to translate all the guidance documents which takes time and money. Motivation of non-CHW QIT members who don’t receive financial incentives. QIT members are really engaged and work with the CHWs to improve the indicators in the village, but they have not been included in the plans to receive financial motivation. We are considering different non-financial motivations to keep them engaged.The control and intervention zones were chosen at random, and baseline indicators in the control area are higher than the intervention area. We will take this into account in our analysis.It is difficult to limit bias between the 2 zones, for example UNICEF decided to train additional CHWs in our intervention zones, so we have to train additional CHWs in the control zone. But UNICEF is taking a long time to decide how many more CHWs and when the training will be, so we have to wait to see what they will do so that we can match it in the control zone.
Bringing Operations Research to Life_Akogbeto_Riese_5.2.12
CORE Group Spring MeetingCHS Benin OR PresentationPartnership for Community Management of Child Health (PRISE-C) Chief of Party: Mme Marthe Akogbeto Technical Backstop: Sara Riese, MA, MPH
Project background• 22nd out of 193 countries in under-5 mortality• Maternal mortality ratioof 410/100000• Poor accessibility and qualityof health services for womenand childrenCHS Benin’s PRISE-C projectaims to improve maternaland child health outcomesin three health interventionareas of SAO, DAGLA andAZT
To improve maternal and child health Goal/Impact outcomes in the 3 health intervention areasStrategic To accelerate the delivery of proven, low costObjective maternal and child health interventions by strengthening community health delivery systemIntermediate Increased Increased Strengthened Results community demand for performance and engagement community sustainability of with community preventive and the community health delivery curative health delivery system services system Create a Improve Improve support to conducive knowledge, attitu CHWs by theStrategies environment for des and practices Health Facility the promotion of towards maternal Workers community and child health maternal and Reinforce the child health Promote uptake knowledge and of mutuelle skills of CHWs membership
Where we started• Original OR idea: to test different motivation strategies (financial, non- financial)• New MOH CHW policy in May 2010 required projects to provide financial incentives• Suggestion to use mHealth but we decided to choose an innovation to increase community engagement with CHWs• Together with MOH stakeholders we decided to test community collaborative approach to improve CHWs performance and retention
What is the collaborativeapproach?• The collaborative approach is an experience sharing process between a network of teams for quality improvement (32 villages with their Quality Improvement Teams in our case)• QITs identify context-specific methods to implement a model of specific interventions to resolve their priority problems, and obtain meaningful results at low cost and in a short time• Best practices are identified through this process and then scaled up in other villages
Where we started (2)Why did we choose the collaborative approach?• Linked with overall project strategy• URC-CHS area of expertise• We thought that the community-level collaborative approach would improve community participation leading to improved CHWs performance and retention• The collaborative approach has not been rigorously tested at the community level• We worked with our in-house research expert on the concept paper and in September 2011 it was approved
Where we are now• Formative research completed in Dec 2011: – Reorganized QIT membership – Recognized the need to ensure adequate female representation, all QITs are now 50% female• Formative research results will be disseminated during meetings with MOH staff and in the project report
Challenges• Harmonizing DIP and OR development with MOH policies, project and USAID objectives and project budget• Lack of French guidance documents• Motivation of non-CHW QIT members, who do not receive financial incentives• Baseline indicators level is higher in control area than intervention area• How to minimize bias between control and intervention areas
Lessons learned• When all the partners participate in DIP and OR development, the implementation is easy• QIT members need close coaching to better understand their roles and continuous quality improvement• Need to be creative to modify tools for the community level