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3. Ridde, évaluation de l'implantation

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3. Ridde, évaluation de l'implantation

  1. 1. Évaluation de l’implantation du programme national de lutte contre le paludisme à Kaya et Zorgho Valéry Ridde, Thomas Druetz, Serge Poppy, Seni Kouanda, Slim Haddad
  2. 2. IMPACTS EFFETS ACTIVITÉS Morbidité MILDA Mortalité Infection Épisodes fiévreux  Létalité paludisme Gravité épisodes paludisme Anémie PECADO Séquelles neurologiques  Mortalité Infanto juvénile
  3. 3. ACTIVITÉS IMPACTS EFFETS Morbidité •Acquisition MILDA •Distribution MILDA •Campagnes de sensibilisation dans la communauté •Achat intrants (CTA) •Recrutement, formation des ASC •Dotations CTA aux ASC •Recyclage du personnel •Partenariat et collaboration OSC •Possession, rétention et utilisation appropriée des MILDA •Changements cognitifs et d’attitudes pratiques de prévention •Changements d’attitudes face à la maladie et sa prise en charge •Recours précoces aux ASCs •Recours et références appropriés aux services de santé •Traitements présomptifs des fièvres •Prises en charge appropriées des épisodes de paludisme grave Mortalité Infection Pl. Falcip. Épisodes fébriles  Létalité paludisme Gravité épisodes paludisme Anémie Séquelles neurologiqu es  Mortalité Infanto juvénile
  4. 4. MODÉRATEURS • Contexte • Acteurs (mécanismes) INTERVENTION FIDÉLITÉ • Contenu • Couverture • Temporalité IMPACTS Adapté Hasson 2010 et Carroll et al. 2007
  5. 5. PROGRAMME PALUDISME • Programme national – Volet préventif : distribution de MILDA – Volet curatif : PECADO • 47 composantes d’implantation (doc. + 8 entrevues) – 35 pour PECADO – 12 pour MILDA • Regroupement des 47 composantes en 4 fonctions – recrutement & formation – dotation de matériel – conduites des activités – rémunération
  6. 6. Exemples de composantes MILDA • Recrutement et formation – Recrutement d'agents recenseurs Formation d'agents recenseurs (1 jour) – Formation des ICP au recensement (2 jours) – Formations des animateurs au recensement (2 jours) • Activités – Distribution des MILDA – Suivi des MILDA par les ASC et animateurs – Recensement
  7. 7. Exemples de composantes PECADO • Recrutement et formation – – – – Recrutement d'un ASC par le village Participation de la communauté à la sélection de l'ASC Recrutement d'un animateur Formation des ASC (3 jours) • Activités – – – – 3 VAD par mois (ASC) 1 causerie éducative par mois (ASC) Suivi des ASC (animateur) Sketches et projections (animateur)
  8. 8. MÉTHODES • Observations de terrain (10 semaines) • Analyse documentaire (cinq documents de projets et les multiples fiches des ASC et des centres de santé) • 48 entretiens individuels – juin-août 2011= 7 (Zorgho) et 14 mois après (Kaya) • Transcriptions • Accord inter-juge
  9. 9. RÉSULTATS
  10. 10. CONTENU - MILDA Implanté comme prévu Implanté comme prévu ou modifié Modifié Ajouté Non implanté Z - Rémunération K - Rémunération Z - Activités K - Activités Z - Recrutement et formation K - Recrutement et formation 0% 25% 50% 75% 100%
  11. 11. CONTENU - PECADO Implanté comme prévu Implanté comme prévu ou modifié Modifié Ajouté Non implanté Z - Rémunération K - Rémunérations Z - Activités K - Activités Z - Dotation de matériel K - Doration de matériel Z - Recrutement et formation K - Recrutement et formation 0% 25% 50% 75% 100%
  12. 12. COUVERTURE KAYA ZORGHO MILDA PECADO MILDA PECADO 96 % 76 % 71 % 77 % - 70 % - 69 % Activités 84 % 83 % 87 % 76 % Rémunération 97 % 95 % 63 % 76 % Recrutement & formation Dotation en matériel
  13. 13. TEMPORALITÉ • 6 sur 47 activités (13%) avec délais/dates • MILDA : : 2 à 6 mois de retard (sept, oct, janvier), après saison • PECADO : en place à Kaya; Zorgho nombreux retards dont CTA en octobre, après saison
  14. 14. CONCLUSION • Globalement, une bonne fidélité d’implantation • Aucune activité essentielle oubliée • Mais risque de décalage des effets possibles à cause des retards • Problème de stocks de CTA • Réflexions sur la pérennité

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