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Operations research luna


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  • 1. 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
  • 2. 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
  • 3.
    • 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
  • 4. 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?
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. Continuum
  • 9. 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
  • 10. 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
  • 11. Overview of OR Studies
    • 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
  • 12. Overview of OR Studies
    • 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
  • 13. Concern Worldwide – Mabayi District, Burundi
  • 14. Concern Worldwide
    • Determine if health outcomes of adapted model similar to traditional
    • Quasi-experimental
      • 2 study arms: traditional Care Group, adapted Care Group