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CSHGP MNH Lunch Roundtable_Koblinsky_0.11.12


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CSHGP MNH Lunch Roundtable_Koblinsky_0.11.12

  1. 1. CSHGP Program LearningAgenda: Maternal and Newborn Health Marge Koblinsky Senior Maternal Health Advisor, USAID CORE Group Fall Meeting October 11, 2012 1
  2. 2. Presentation Outline Purpose of consultancy Methods Findings from project reviews Conclusions and recommendations 2
  3. 3. Purpose of Consultancy Devise a prospective learning strategy to link NGO efforts in maternal/newborn health to global/national policy and strategy discourse Highlight patterns of learning —the what and how -- guided by stakeholder needs, literature and capacity 3
  4. 4. Methods Stakeholder Interests  TAG—25 people  Stakeholder interviews —10 people Project doc review--purpose, avail data, conclusions  Past (closed) projects — ―intrapartum care pkg‖ • Reviewed 17 projects>40% LOE MNCH; 5 in-depth  Current (active) projects (36) • Reviewed 4 with 100%MNC, OR grant (16>40% LOE MNCH) Global literature review – community MNH 4
  5. 5. CSHGP projects reviewed (N = 21) 5
  7. 7. Stakeholders’ main priorities process of working with  costs of these TBAs; effectiveness interventions packages effect of specific and approaches community approaches for  CB-HMIS and its use in improving implementation decision-making and costs and access for MNH of implementation interventions  NGO contributions to decision making re the strengthening referral selection of MNH systems intervention packages and  Postpartum and postnatal the implementation care: access and approaches implementation 7
  8. 8. Findings: Stakeholder interests & availability of dataTopic Stakeholder question Indicators Project info/commentsTBAs -Process of working with TBAs % trained -TBA not delivery distinguished by -New roles attendant indicator from any (Other Std MNC trained delivery -Best practice for TBAs indicator) attendant; not key word; -How they link to big picture -Because of MOH -How effective are TBAS? What policies TBA info not do they do? incorporated into project reports shared with MOH - May have qual data 8 and know # trained
  10. 10. Proj purpose and data available 5 completed & 4 OR projectsProject info Data collected CommentsPurpose Enhance demand &/or Vulnerable not generally quality of govt program- defined vulnerableStudy Design Pre-post ¾ OR –comparison areaIntervention package DIP- planned; Typically not stratified to Complex interventions test cpts of complex intervention; outputs not collectedOutcome data YES! (next slides) No cost dataImpact data Deaths not reported OR projects: may collect death data-VAs 10
  11. 11. Example of project inputs Aim: Enhance demand and/or quality of govt programs (e.g., AKF Pak implementing CMW program of GOP; Nepal HealthRight—CB-NCP program of GON) Interventions:  Many known effective MNH interventions  Delivered through trained, supervised skilled works in setting with QI system  Access: village comm; grp meeting, CHWs , TTBAs, savings groups, emergency transport plans  Awareness—comm mob, BCC, mass media 11
  12. 12. Women delivered in a health facility in selected CSHGP projects (13), base/endline surveys (%) Latin Africa Asia America 100 80Percent (%) 60 40 20 0 Baseline Endline
  13. 13. CONCLUSIONS 14
  14. 14. Limitations of review Sample projects reviewed may not be representative of all MNH projects in the portfolio Copious project documentation restricted in- depth review Variation in response to reporting guidance 15
  15. 15. General Conclusions Project information simply not easily accessible—spread over 500 or more pages • Needs to be captured in one relatively brief document with objectives, methods, intervention description, results, discussion/interpretation, conclusion Study design appropriate for question • Effectiveness studies—quasi exp design • OR—aim to improve implementation of a known effective intervention 16
  16. 16. Conclusions: Stakeholder interests Effectiveness and cost effectiveness  Standard projects not designed to address questions of effectiveness/cost-effectiveness  Outputs not reported so don’t know adequacy of implementation • ―Use data‖ e.g., of delivery kits, BPCR, not widely available; relationship with use of SBA or facility not available 17
  17. 17. Learning to-date and Recommendations1. Cross-cutting themes (e.g, Community case management)2. Monitoring and evaluation of on-going projects3. Operations research 18
  18. 18. Conclusions: Project Reviews Learning to-date Cross-cutting themes (e.g, Community case management) • External person surveys the projects in place/reviews project reports • Limited number of such efforts • Potential topics: – What factors most affect the sustainability (or integration) of community based approaches/interventions (e.g., CHW or TTBA outreach, women’s groups? – What mechanisms are available for integrating such community approaches into the formal health system? 19
  19. 19. Conclusions: Project Reviews Learning to-date Monitoring & evaluation of on-going projects • Pre-post surveys, specified indicators • Across project learning possible—and there are increases in coverage noted (above)—but in individual project cannot state it was due to project inputs • Potential M&E: – Are inputs and outputs on target to achieve the desired outcomes: Specify at a population level – Who is the recipient of the interventions (equity)? – What contextual factors impact the projects? (eg. Road density, transport available; supply availability) (see CI) – Country case studies 20
  20. 20. Conclusions: Project Reviews Learning to-date Operations Research  Excellent beginning toward contributing to global discourse  Improve with more specificity, less complex intervention packages and approaches  Potential OR: • Are community or professional providers more appropriate for counseling messages? Where? • Can new technologies (mobiles) improve community worker performance? 21
  21. 21. Recommendations OR projects  What is of interest to local policy/program managers?  Collect right indicators at right levels—linking inputs, activities, outputs, outcomes • Look beyond mortality at morbidity esp for MH • Develop quality of care indicators (eg., disrespect/abuse)  Develop succinct reports accessible to outside groups that follow normal journal requirements—and publish! 22
  22. 22. General Recommendation Decrease amount of time on descriptive info, increase time for analytical and interpretive information/project  Project development stage -- formative research/ analysis /writing  Midterm–adequacy surveys that measure inputs and outputs  Final – evaluation survey plus 12 months to analyze what happened/why, how to communicate results! 23
  23. 23. Many thanks to JenniferYourkevitch, Kirsten Unfried, Leo Ryan, Nazo Kureshy Thank you! Follow us on: