CSHGP Operations Research Findings_Jennifer Weiss and Khadija Bakarr_5.8.14


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  • 1 Animator oversees a team of Promoters
    Each Promoter facilitates an average of 9 Care Groups
    Each Care Group consists of 10-15 Mother Leaders or Care Group Volunteers
    Each CGV visits 10-15 neighbor women / households with pregnant women and/or children under 5
  • Integrated model was designed to reduce the dependence of Care Group implementation on full-time, paid NGO staff, while increasing integration with the local MOH structure. This is accomplished through task shifting of Care Group facilitation and supervision duties from project staff to appropriate MOH staff and CHWs, while still satisfying the established Care Group Criteria
    Still contained all the key activities of CG meetings, household visits, supervision, data collection as described earlier
  • Target = 80% based on global CG standards
    Looking for difference of 15% between two models
  • CSHGP Operations Research Findings_Jennifer Weiss and Khadija Bakarr_5.8.14

    1. 1. Results from Concern’s Operations Research initiatives in Burundi and Sierra Leone Jennifer Weiss, Health Advisor, Concern US Khadija Bakarr Field Operations Manager Concern Sierra Leone CORE Spring 2014 Global Health Practitioner Conference
    2. 2. Burundi • USAID CSHGP-funded project in Mabayi District, Cibitoke Province, Burundi • October 2008 – September 2013 • Technical interventions: malaria, diarrhea, pneumonia, IYCF • Operations Research to test MOH-led Care Group model
    3. 3. What are Care Groups? Care Groups create a multiplying effect to equitably reach every household with a pregnant woman or child under five years old with interpersonal behavior change communication
    4. 4. The ‘Integrated’ Care Group Model CHWs instead of Promoters Key difference: CHW only supervises 2 CGs DHT is trained by Project Animators to serve in ‘Animator’ role
    5. 5. Operations Research Study: Questions 1. Does the Integrated Care Group model achieve at least the same improvements in key knowledge and practices as the traditional model? 2. Does the Integrated Care Group model function as well as the traditional model? 3. Is the Integrated Care Group model as sustainable as the traditional model?
    6. 6. Operations Research Study: Methods • Quasi-experimental, cluster randomized pre-post study Traditional Area Integrated Area # Care Groups 51 45 # Care Group Volunteers 503 478 # Children Under 5 and Pregnant Women 7,758 6,630
    7. 7. Operations Research Results: Knowledge and Practices Indicator Type Example of Indicators Collected Total # % ‘non- inferior’ Knowledge • Danger signs in sick children • Critical times for hand-washing • Breastfeeding and complementary feeding practices • Food groups and components of balanced diet 13 85% Preventive Practices • Iron supplementation during pregnancy • Immediate and exclusive breastfeeding • Complementary feeding practices • Hand-washing • ITN use 13 100% Sick Child Practices • Diarrhea: care-seeking, use of ORS, increased fluids and food • Malaria: care-seeking within 24 hours, treatment with ACT • Pneumonia: care-seeking and treatment with antibiotic 10 90% Contact Intensity • Contact with trained health information provider • Attendance at community meetings where health of child was discussed 4 100% OVERALL 40 90%
    8. 8. Operations Research Results: Functionality and Sustainability % of CG meetings with at least 80% Volunteer attendance
    9. 9. Operations Research Results: Functionality and Sustainability % of HHs who received at least one visit by a CGV in the last month
    10. 10. Summary of Results 1. The Integrated Care Group model achieved at least the same improvements in key knowledge and practices as the traditional model 2. The Integrated Care Group model functions as well as the traditional model 3. The Integrated Care Group model is as sustainable as the traditional model  In at least the six month period following end of project support to CG activities, project staff still active in area supporting other (non-Care Group) project activities such as CCM  Post-project sustainability study required
    11. 11. Learning • CHWs are able to serve as Care Group Promoters through a modified model: • No more than 2 CGs per CHW • Monthly support (training) from health facility • Head nurses do not have time for Care Group / CHW supervision – delegate to a more junior nurse “focal point” • Integrated Model allows for community health data to be directly incorporated into Ministry HIS
    12. 12. Policy Implications for Burundi MoH Ministry has demonstrated keen interest in model, with national applications for Community Health Strategy Key Questions to be Addressed to Inform Scale-up: •Who will initiate the approach? (Role of NGOs) •How will behavior change materials be re-produced? •How will quality control and supervision be provided? •What costs are involved and how will these be covered?
    13. 13. Sierra Leone • USAID CSHGP-funded project in 10 slum communities of Freetown, Sierra Leone • October 2011 – September 2016 • Technical interventions: maternal and newborn health, malaria, diarrhea, pneumonia, nutrition • Operations Research to test a Participatory Community-based Health Information System (P-CBHIS); in partnership with JHU
    14. 14. What is a P-CBHIS? • Based the Community Based Impact Oriented (CBIO) approach • Hypothesizes that if community members have access to health information, they will be empowered to make informed decisions on health programming in their community • Key activities: • Monthly household visitation to collect vital event (birth and death) data • Verbal autopsies to determine cause of death • Participatory feedback sessions and activity planning based on data collected
    15. 15. Operations Research Questions Formative Research Question: What are the key factors, inputs, and processes required to establish an effective Participatory Community- based Health Information System? Evaluative Research Questions: 1.What is the extent to which the P-CBHIS facilitates data use to plan and implement key maternal and child health interventions? 2.What is the extent to which the P-CBHIS contributes to improved health outcomes for the interventions most closely related to leading causes of child illness and death identified through the P-CBHIS.?
    16. 16. Intervention group Comparison group • Baseline/endline assessment of community structure data management capacity • Census to identify all target HHs • Identify and train CHWs and supervisors • Collect birth and death data • Periodic KPC surveys to compare key health outcome data • Collect vital event data • Verbal autopsy to explore cause of death • Training for Health Management Committee, Ward Development Committee on how to manage and interpret data • Community-feedback mechanism on morbidity and mortality data • Collect vital event data
    17. 17. Community Based Household Census As first phase of CSP Operations Research
    18. 18. Community Based Household Census Results
    19. 19. Supervisors Feedback and Reporting
    20. 20. Learning and Implications • Census is important first step to any community information systems to ensure accurate counting of all project beneficiaries • Census increased visibility of project in the community, high levels of interest among community structures through their participation in process • Census data collection tools and procedures for quality assurance showed us the best way to train community enumerators to collect household data • Conducting a household data in an urban slum environment poses unique challenges and requires high levels of community involvement to ensure accurate data (mapping, community boundaries)
    21. 21. Next Steps • Currently training CHWs on BCC messages and household data collection • Refining data collection tools to be in line with MOH CHW reporting tools • Development of Verbal Autopsy tool for use by CHWs • Development feedback meeting protocol • Strengthen relationship with OR Steering Committee to ensure our findings are broadly disseminated at national level
    22. 22. Thank you! For additional information: Jennifer Weiss, Health Advisor, Concern Worldwide, US jennifer.weiss@concern.net Khadija Bakarr, Field Operations Manager, Concern Sierra Leone khadijatu.bakarr@concern.net www.concernusa.org