CSHGP MNH Lunch Roundtable_Koblinsky_0.11.12


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  • Objective of this exercise:Learning strategy aimed at showing value added (otherwise program could be run out of missions?) Strengthen program leaning potentialshow how info may be analyzed and organized across projects through systematizing efforts to harness learning for future evals and Developed further through upcoming M&E and OR plans .Need framework and roadmap for next 5 years (ck CCM) Input to a short publishable paper –frontiers of learning with NGOs for Jl Implementation & Research (new USAID jl??)
  • For project review, 40% LOE in MNH was used as threshold.Within the OR portfolio there are 16 active MNH projects with 40% or more LOE in MNC. With the aim of learning about the MNH objectives, research questions and means used to answer these questions, four projects with 100% LOE in MNC, an operations research grant, DIPs and mid-term evaluation reports, were selected for in-depth analysis. They include AKF Pakistan (begun in 2008 and will complete in 2013), HealthRight Nepal (2009-2013), CRWRC Bangladesh (2009-2014) and CHS Ecuador (2009-2014). In sub-Saharan Africa, only five projects had 60% or more LOE in MNC and four began in 2010 or 2011. 17 closed projects (since 2000) met criteria. Of these, 5 were examined in more depth to garner qualitative data related to interventions.
  • From past, chose 21 projects reviewed in some depth;Haiti (3 closed), Peru (2 closed), Kenya (2 closed), Nepal (2 – 1 active, 2 closed), Bangladesh (2 – 1 active, 1 closed)Other active – Ecuador & Pakistan Other closed – Honduras, Nicaragua, Senegal, Malawi, India, Vietnam, East Timor
  • Output data: measure of engagement with the interventions depending on approach used. Not required indicators (eg, % mothers who report a PP visit within 2 days of delivery (home or facility)May collect “capacity indicators”—plans of the organization Input data—population levels of inputs not specified (may have # women groups, and # their meetings)Contextual information may be in DIP but not carried forward –eg., SES, demog, health services—available pub/priv, fac/pop ratio etc, road density, travel time,
  • Projects not stratified nor
  • AMREF 2005-2010Health Right 2006-2010Kenya DHS 2003 & 2008-09 -------Plan & CARE 2007-2010Nepal DHS 2006 & 2011-------Future 2005-2009INMED 2006-2010Peru DHS 2004-06 & 2010 (both continuous)
  • 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! wwww.mchip.net Follow us on: