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Operations research luna


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Operations research luna

  1. 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. 2. CSHGP history of implementing community oriented programs since 1985 <ul><li>Tradition of collecting rigorous information </li></ul><ul><ul><li>Since 1991 Grantees implemented baseline and final KPC surveys </li></ul></ul><ul><ul><li>Health Facility Assessments </li></ul></ul><ul><ul><li>Sustainability Assessments </li></ul></ul><ul><ul><li>Complemented by qualitative information </li></ul></ul>
  3. 3. <ul><li>Traditional baseline and final information is rigorous enough for judging: </li></ul><ul><ul><li>If projects met targets </li></ul></ul><ul><ul><li>If the health situation improved in the project area after project implementation was completed </li></ul></ul><ul><ul><li>If quality of services improved </li></ul></ul><ul><ul><li>Calculating estimated lives saved from interventions implemented </li></ul></ul>
  4. 4. Questions remaining: <ul><li>International community not always convinced that this is enough evidence to recommend scaling up </li></ul><ul><ul><li>(i.e. WHO, Universities, National Governments, other Donor organizations) </li></ul></ul><ul><li>Those of us implementing community oriented programs may not have enough evidence </li></ul><ul><ul><li>to compare effectiveness of different approaches </li></ul></ul><ul><ul><li>to recommend one approach as a best practice </li></ul></ul><ul><ul><ul><li>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? </li></ul></ul></ul>
  5. 5. Solution: Innovation Grants <ul><li>New category started 2008 (2 rounds of grants) </li></ul><ul><li>Emphasis on including OR </li></ul><ul><ul><li>Purpose to contribute to the evidence base for community oriented programming </li></ul></ul><ul><li>Opportunity for grantees to include strong research designs as part of their projects </li></ul><ul><ul><li>Grantees have flexibility to: </li></ul></ul><ul><ul><ul><li>Propose a variety of interventions/approaches to study </li></ul></ul></ul><ul><ul><ul><li>Define research questions/ hypotheses </li></ul></ul></ul><ul><ul><ul><li>Develop appropriate study designs </li></ul></ul></ul><ul><li>Builds on the strong history of collecting rigorous baseline and final information </li></ul>
  6. 6. Role of MCHIP <ul><li>Work with grantees to ensure that: </li></ul><ul><ul><li>Studies are focused and can be practically implemented within a CSHGP project </li></ul></ul><ul><ul><li>Research designs are logical for the questions being asked </li></ul></ul><ul><li>Facilitate exchange of information/ experience among innovation grantees </li></ul><ul><li>Recently held OR workshop for grantees </li></ul><ul><li>Develop guidance </li></ul><ul><li>Support USAID in communicating about the studies </li></ul>
  7. 7. Challenge: Cookie cutter approach to evidence building not appropriate <ul><li>Grantees flexibility to propose a variety of interventions/approaches </li></ul><ul><li>Community oriented programs usually work at multiple levels to achieve success; It is important to explain these mechanisms: </li></ul><ul><ul><li>Community organization; community management of health; referral between community and facility level health providers; new relationships between health care providers </li></ul></ul><ul><li>Some interventions/approaches have been implemented many times (some evidence of success); others are new (no evidence); others are in the middle </li></ul><ul><ul><li>Requires different study designs </li></ul></ul>
  8. 8. Continuum
  9. 9. Study Designs <ul><li>Emphasis on formative </li></ul><ul><ul><li>One study arm, no comparison group </li></ul></ul><ul><li>Combination formative and summative </li></ul><ul><ul><li>Quasi-experimental; comparison group </li></ul></ul><ul><ul><li>Quasi-experimental; 2 different intervention groups </li></ul></ul><ul><ul><li>Cluster randomized trial </li></ul></ul>
  10. 10. Overview of OR Studies <ul><li>Topics include: </li></ul><ul><ul><li>MNC; CCM; Telemedicine; Nutrition </li></ul></ul><ul><ul><li>Working with illiterate/low literate women </li></ul></ul><ul><ul><li>Male involvement </li></ul></ul><ul><ul><li>Public-private (civil society) partnership </li></ul></ul><ul><ul><li>Community based vs. Facility based interventions </li></ul></ul><ul><ul><li>Less expensive Care Group model </li></ul></ul><ul><ul><li>Community financial support for health workers </li></ul></ul>
  11. 11. Overview of OR Studies <ul><li>Baitadi district of Nepal </li></ul><ul><li>Innovation of combining homestead food production (HFP) + essential nutrition actions (ENA) </li></ul><ul><li>Determine whether it can significantly improve child nutrition (anthropometry and anemia status) </li></ul><ul><li>Well documented interventions by HKI </li></ul><ul><li>Summative </li></ul><ul><li>Cluster-randomized, pre/post design comparing treatment and control areas </li></ul>
  12. 12. Overview of OR Studies <ul><li>Chitral district </li></ul><ul><li>Innovation: community financing scheme to support trained community midwives (CMWs) </li></ul><ul><li>Determine whether CMWs can earn enough to sustain work; communities can pay enough; quality maintained </li></ul><ul><li>New intervention (formative and summative) </li></ul><ul><li>Quasi-experimental </li></ul>
  13. 13. Concern Worldwide – Mabayi District, Burundi
  14. 14. Concern Worldwide <ul><li>Determine if health outcomes of adapted model similar to traditional </li></ul><ul><li>Quasi-experimental </li></ul><ul><ul><li>2 study arms: traditional Care Group, adapted Care Group </li></ul></ul>