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Impact Evaluation of the Child survival Project

Impact Evaluation of the Child survival Project. Presenter: Bockarie Sesay-DM&E Officer Koinadugu District-CARE International Sierra Leone Co-Authors:

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Impact Evaluation of the Child survival Project

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  1. Impact Evaluation of the Child survival Project Presenter: Bockarie Sesay-DM&E Officer Koinadugu District-CARE International Sierra Leone Co-Authors: Ahmed A.G Aboubacrine-DM&E Coordinator, Yuki Suehiro-Health sector Coordinator, Sowo Lebbie-CSP Project Manager, Sayoh Francis- Assistant CSP Project Manager NONIE, AfrEA, 3IE Cairo Conference 2009

  2. Project location NONIE, AfrEA, 3IE Cairo Conference 2009

  3. Projectbeneficiaries • 19,198 - children under five years • 27,101 - women of reproductive age • 54 Direct and 429 indirect communities of five chiefdoms NONIE, AfrEA, 3IE Cairo Conference 2009

  4. Project Goal and Objectives • To improve the health status of children under five and women of reproductive age in Koinadugu District • Strengthened family and household knowledge and decision-making skills • Enhanced community capacity to form groups and institutions that sustain health initiatives, demonstrate social cohesion, and promote good governance mechanisms; • Improved quality and accessibility of services provided by MOHS personnel and MOHS extension services; and, NONIE, AfrEA, 3IE Cairo Conference 2009

  5. Project implementation focuses on the following four interventions through the C-IMCI strategy: • The expanded programme on immunization (EPI) Intervention focuses on raising vaccination coverage of children and pregnant women. CARE is working with communities and MOHS to promote EPI outreach through the Community Health Clubs (CHCs). The second prong of the EPI strategy is to encourage CHCs to use appropriate BCC strategies to increase demand for and utilization of EPI services. NONIE, AfrEA, 3IE Cairo Conference 2009

  6. Interventions conts. • The nutrition intervention works through CHCs; Community Based Growth Promotion volunteers, also members of CHC; and PHU staff to promote early initiation of breastfeeding, exclusive breastfeeding, complementary feeding and improved Vitamin A (VA)/iron intake for women and children. NONIE, AfrEA, 3IE Cairo Conference 2009

  7. The malaria intervention The strategy is to train PHU staff to recognize malaria and provide standard case management, capacity building of CHC members and through them the community members, while promoting active involvement of VDCs in promotion and distribution of ITNs. Interventions conts. NONIE, AfrEA, 3IE Cairo Conference 2009

  8. Interventions conts. • The Maternal and Newborn Care (MNC) intervention The strategy focused on capacity building of CHCs, involvement of TBAs in promotion of institutional deliveries, formation of pregnant women support groups, birth waiting homes and later establishment of VS&L groups. NONIE, AfrEA, 3IE Cairo Conference 2009

  9. Project Strategies • Capacity-building of institutions and partners • Behavior change communication (BCC) • Quality assurance initiatives • Health system strengthening NONIE, AfrEA, 3IE Cairo Conference 2009

  10. The Impact evaluation-August 2008 • Findings of the evaluation • Best practices and overarching lessons learned from the project • Contribution of participatory impact evaluation methodology to an effective learning process NONIE, AfrEA, 3IE Cairo Conference 2009

  11. METHODS AND PROCESSESS USED IN THE IMPACT EVALUATION Three step process • Health facility assessment (April 08): Client Oriented Provider Efficient (COPE) Assessment was done in collaboration with DHMT. • Quantitative (June 08): A standard KPC 2000+ 30x15 cluster survey was done by an external consultant. • Qualitative (August 08): Participatory qualitative assessment was done which involved an external consultant, stakeholders and partners. • Key questions to be addressed – Why and How? Are the changes brought by the project sustainable? If yes, to what extent? NONIE, AfrEA, 3IE Cairo Conference 2009

  12. Purpose of Final Evaluation • To assess if the project met the stated goals and objectives • To review the effectiveness of the project technical approach as well as cross-cutting approach • To identify the most important achievements • To determine the sustainability of the project’s health achievements • To analyze the determinants of success, constraints and other factors affecting project performance • To elaborate best practices and overarching lessons learned from the project • To come up with recommendations NONIE, AfrEA, 3IE Cairo Conference 2009

  13. FE Qualitative: Participatory Process (1) FE is an effective learning experience which involved all partners. Assessment team included: • External consultant (Team leader) • MOHS representative • DHMT members • District Council representative • Community representatives • NGO representatives – IRC, CAUSE Canada, CAD • Radio Bintumani representative • CARE Sierra Leone staff across different projects NONIE, AfrEA, 3IE Cairo Conference 2009

  14. FE Qualitative: Participatory Process (2) • Key informant interviews with DMO, DHMT, District Councilor, MOHS, UNICEF, USAID, and Radio Bintumani • Review of background information – project overview, outputs, and quantitative survey key findings • Preparation and finalization of FGD/IDI tools • Training of the assessment team on FGD/IDI • 5 day field work to conduct FGD/IDIs - split into 5 teams, one per chiefdom • 2-day synthesis session to reach the consensus on findings and recommendations NONIE, AfrEA, 3IE Cairo Conference 2009

  15. Key findings By intervention specifics: NONIE, AfrEA, 3IE Cairo Conference 2009

  16. Nutrition NONIE, AfrEA, 3IE Cairo Conference 2009

  17. Has malnutrition decreased? NONIE, AfrEA, 3IE Cairo Conference 2009

  18. Malnutrition by age groupcomparison CSP KPC 08 vs MOHS 07 NONIE, AfrEA, 3IE Cairo Conference 2009

  19. Malaria NONIE, AfrEA, 3IE Cairo Conference 2009

  20. Maternal Newborn Care NONIE, AfrEA, 3IE Cairo Conference 2009

  21. Has institutional deliveries increased? (Source: DHMT Koinadugu) NONIE, AfrEA, 3IE Cairo Conference 2009

  22. Expanded Program on Immunization NONIE, AfrEA, 3IE Cairo Conference 2009

  23. Morbidity patters in Koinadugu District (Facility based data: 2004-June 2008) NONIE, AfrEA, 3IE Cairo Conference 2009 (Source: DHMT Koinadugu)

  24. Mortality trend in Koinadugu District (Facility based data: 2003-June 2008) NONIE, AfrEA, 3IE Cairo Conference 2009 (Source: DHMT Koinadugu)

  25. sustainable NONIE, AfrEA, 3IE Cairo Conference 2009

  26. Sustainability Dashboard NONIE, AfrEA, 3IE Cairo Conference 2009

  27. How Sustainable? • Community structures is strong, will ensure sustenance of positive behaviors and demand for services. • Though behaviors will sustain as benefits are very apparent to the community, there is a need for focused plans for supervision and monitoring from MoHS and DHMT. The District HMIS needs to capture levels of community support through simple indicators • Strong savings and loan groups serve emergency needs, however mobility, outreach, access suffers due to road conditions • Health providers capable, competent and confident, will however require refresher trainings, continued supportive supervision and payment of salaries to maintain level of activities. • Continued engagement of VDCs and DLC by the DHMT will ensure the monitoring of community level activities NONIE, AfrEA, 3IE Cairo Conference 2009

  28. Continuing Challenges • Roads • Communities which are not close to PHUs or outreach points, continue to have a barrier in accessing immunization services on a regular basis. The timeliness of the vaccination seems to be affected by this factor despite increased knowledge and acceptance of the behavior. • Economic constraints and shortage of food • Uniform availability of all the entitlements • ITNs for males and older children • Availability of adequate trained human resources and their remuneration NONIE, AfrEA, 3IE Cairo Conference 2009

  29. Key Lessons Learnt • CHC strategy led to an amplified community action, promoted community led advocacy and scaling up of activities • Involvement of men ensured that positive health decisions were being made for mothers and children • VS&L is a good strategy to overcome economic barriers to health care and provides resources for other developmental activities • While bye laws of VDCs have helped promote health, they require monitoring to ensure appropriateness. • Complementary activities by other NGOs and governmental bodies contributed to the impact of the program • The partnership of TBAs and PHU worked positively for both partners • Involvement of local authorities made maternal neonatal health as everybody’s agenda NONIE, AfrEA, 3IE Cairo Conference 2009

  30. Contribution of participatory impact evaluation to an effective learning process • The District Medical Officer (DMO) during the debriefing with national-level stakeholders presented the findings of the final evaluation in the presence of MOHS senior officials, donors, and other NGO representatives. This exhibited a great ownership of the government of the project as well as the evaluation findings, which was acknowledged as one of the project successes by the participants of the debriefing. • A national-level MOHS officer participated throughout the data collection and synthesis for the final evaluation exercise. This contributed to the perceived credibility of the evaluation findings by senior MOHS officials and donors, which led to their willingness to take the best practice / lessons learned / recommendations forward. Interventions such as the birth waiting homes, the pregnant women support group, the village savings and loan were recognized as such best practices and the discussion was held on the scale up to other parts of the country. NONIE, AfrEA, 3IE Cairo Conference 2009

  31. Contribution of participatory impact evaluation to an effective learning process- Continue • Above-mentioned MOHS participant further used his experience with CSP final evaluation into another project implemented by another NGO: He replicated the evaluation methodology to assist baseline survey for the Health Unlimited child survival project in Bombali district. He indicated the usefulness of the CSP final evaluation questionnaire, sampling, and qualitative data collection methodology as somewhat standard approach that could be used for any reproductive and child health programming in future. • The donor who participated in the process of impact evaluation is now spontaneously disseminating lessons learned from the project in different national-level forum. • CARE-SL sister projects are using lessons learned during their implementation. Also implications drawn from the impact evaluation are made use of to develop new programme within CARE Sierra Leone. These include infant and young child feeding programme; social analysis on family planning to explore integration of family planning into current programming; and advocacy and research project on maternal health. NONIE, AfrEA, 3IE Cairo Conference 2009

  32. Live save calculator NONIE, AfrEA, 3IE Cairo Conference 2009

  33. THE END THANK YOU NONIE, AfrEA, 3IE Cairo Conference 2009

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