Operations Research In MCH Programs: Measurement Challenges

Operations Research In MCH Programs: Measurement Challenges How MCHIP is working to Support PVOs CORE Spring Meeting, April 28, 2010 Wednesday 11:00-12:30

CSHGP history of implementing community oriented programs since 1985
Tradition of collecting rigorous information
Since 1991 Grantees implemented baseline and final KPC surveys
Health Facility Assessments
Sustainability Assessments
Complemented by qualitative information

Traditional baseline and final information is rigorous enough for judging:
If projects met targets
If the health situation improved in the project area after project implementation was completed
If quality of services improved
Calculating estimated lives saved from interventions implemented

Questions remaining:
International community not always convinced that this is enough evidence to recommend scaling up
(i.e. WHO, Universities, National Governments, other Donor organizations)
Those of us implementing community oriented programs may not have enough evidence
to compare effectiveness of different approaches
to recommend one approach as a best practice
i.e. Is the Care Group model as traditionally implemented the best approach for scaling up or could it be adjusted to facilitate scaling up?

Solution: Innovation Grants
New category started 2008 (2 rounds of grants)
Emphasis on including OR
Purpose to contribute to the evidence base for community oriented programming
Opportunity for grantees to include strong research designs as part of their projects
Grantees have flexibility to:
Propose a variety of interventions/approaches to study
Define research questions/ hypotheses
Develop appropriate study designs
Builds on the strong history of collecting rigorous baseline and final information

Role of MCHIP
Work with grantees to ensure that:
Studies are focused and can be practically implemented within a CSHGP project
Research designs are logical for the questions being asked
Facilitate exchange of information/ experience among innovation grantees
Recently held OR workshop for grantees
Develop guidance
Support USAID in communicating about the studies

Challenge: Cookie cutter approach to evidence building not appropriate
Grantees flexibility to propose a variety of interventions/approaches
Community oriented programs usually work at multiple levels to achieve success; It is important to explain these mechanisms:
Community organization; community management of health; referral between community and facility level health providers; new relationships between health care providers
Some interventions/approaches have been implemented many times (some evidence of success); others are new (no evidence); others are in the middle
Requires different study designs

Continuum

Study Designs
Emphasis on formative
One study arm, no comparison group
Combination formative and summative
Quasi-experimental; comparison group
Quasi-experimental; 2 different intervention groups
Cluster randomized trial

Overview of OR Studies
Topics include:
MNC; CCM; Telemedicine; Nutrition
Working with illiterate/low literate women
Male involvement
Public-private (civil society) partnership
Community based vs. Facility based interventions
Less expensive Care Group model
Community financial support for health workers

Baitadi district of Nepal
Innovation of combining homestead food production (HFP) + essential nutrition actions (ENA)
Determine whether it can significantly improve child nutrition (anthropometry and anemia status)
Well documented interventions by HKI
Summative
Cluster-randomized, pre/post design comparing treatment and control areas

Chitral district
Innovation: community financing scheme to support trained community midwives (CMWs)
Determine whether CMWs can earn enough to sustain work; communities can pay enough; quality maintained
New intervention (formative and summative)
Quasi-experimental

Concern Worldwide – Mabayi District, Burundi

Concern Worldwide
Determine if health outcomes of adapted model similar to traditional
Quasi-experimental
2 study arms: traditional Care Group, adapted Care Group

Operations Research In MCH Programs: Measurement Challenges

by jehill3 on May 03, 2010

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