Speaking at the 2015 CCIH Annual Conference, Dr. Alfonso Rosales, Maternal and Child Senior Advisor, World Vision International, examines a study in South Sudan involving illiterate community health workers, suggesting that a process to measure and maintain clinical skills of community health workers is an important element of program design.

1. Does community-based approaches have
a role in HSS?
Maternal and Child HealthTransformation (MaCHT) Project
Warrap State, South Sudan
Presented By Alfonso Rosales
CCIH 2015 Conference

2. PRESENTATION OVERVIEW
• BACKGROUND
• METHODOLOGY
• MAJOR FINDINGS
• LiST ANALYSIS
• LIMITATIONS
• CONCLUSIONS
• RECOMMENDATIONS

3. BACKGROUND

4. BACKGROUND
• Fragile Post-Conflict state
• Weak Health system
• Severe shortage of health workforce
• Poor health infrastructure
• Poor population health with severe mortality
indicators
• USAID centrally funded child survival project
focused on MCH

5. METHODOLOGY
• The evaluation uses a mixed-methods approach: Quantitative
and Qualitative
• Quantitative:
• quasi-experimental before and after
• two-stage random selection (two-stage 30 cluster
sampling).
• Target population: mothers of children aged 0-23 months)
• Qualitative: purposive sampling
• Focus groups
• Key informants

6. EVALUATION QUESTIONS
Three Questions
1. To what extent did the project accomplish and/or contribute
to the results as described in the detailed implementation
plan?
2. What were the key strategies and factors, including
management issues that contributed to what worked or what
did not work?
3. Which elements of the project are likely to be sustained?

7. MAJOR FINDINGS
1. To what extent did the project accomplish and/or contribute
to the results as described in the detailed implementation
plan?
• Increases were noted in antenatal visits, prenatal tetanus
toxoid vaccinations, active management of third stage of labor,
skilled attendance at birth, iron supplementation, treatment of
malaria, ORS, and insecticide-treated bed net use.
• The project supported basic infection control at the PHCU
level by supplying delivery kits.

12. MAJOR FINDINGS
2. What were the key strategies that contributed to what
worked or what did not work?
• Limited impact on selected indicators highly correlated with a
dysfunctional supply management system and a fragile state
status,
• Strengthening capacity of the health system to deliver
essential services
• Supply of the health workforce: recruitment and selection plus task-
shifting to mitigate health resource acute shortage, as well as pre-
service education and training
• performance of the health workforce: in-service training, and
performance appraisal

13. MAJOR FINDINGS
3. Which elements of the project are likely to be sustained?
• Refocus its efforts on maternal and child health projects in
the area.
• Linkages of community efforts with health facility

14. LiST ANALYSIS RESULTS

15. LIMITATIONS
• Poverty
• Civil instability
• Limited infrastructure
• Limited skills capacity
• Rural areas with poor roads
• Seasonal flooding, no bridge
• Only one vehicle
• Frequent staff and
management turnover
• Inconsistent supply of drugs
• Unexpected costs

16. CONCLUSIONS
• MaCHT successfully initiated
community-based health care
services through HHPs,
CHWs, and other community
organizations
• MaCHT successfully worked
with the State and County
MOH to increase quality and
access of services
• Some aspects of the project
will continue through other
WVSS projects as a result of
MaCHT

17. RECOMMENDATIONS
• Partnerships with MOH
• Operations Research
• Health Pooled Fund project
• Supply Chain and Infrastructure
• Staffing and Capacity