EOP Evaluation of BASICS iCCM Project Benin 2009 to 2012_Paul Freeman_4.25.13
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Transcript of EOP Evaluation of BASICS iCCM Project Benin 2009 to 2012_Paul Freeman_4.25.13
EOP Evaluation of BASICS iCCM Project Benin 2009 to 2012
USAID funded MSH implemented
Freeman PaulDeussom GabrielParaïso M Noël
Glèlè Yolaine
Acknowledgements• USAID Washington and USAID Benin• Ministry of Health Benin & Staff, National, 5 HZs• MSH Basics staff Parakou• Project Partners 5 NGOs & Africare, UNICEF, CRS• Bryan Comstock U of Washington- sampling• Community members, surveyors, supervisors 6 HZ
Disclaimer. All views expressed are those of the authors and do not necessarily reflect the opinion of USAID or the GH Tech team.
Idea for CC study from USAID Benin but all design, implementation and write up by team.
Benin
• Infant MR 73/1000 Child MR 115/1000 -2012• Malaria, ARI, diarrhea, anemia < 5 mortality• 47% of rural children < 5 stunted – 2012• 20% of rural children < 5 sleep under ITN-2012• Health Workforce Density < 0.05 /10,000p -2012
FrancophoneTraditional MuslimPopulation9, 100,000 (2011)DemocracyLife E at B 56.8yrsFertility 5.1 c/w
Project Interventions
• iCCM c.s. CHWs rural villages > 5 km from H. F.• Coordinate with MOH, UNICEF, Africare--CHW• Rx Malaria, ARI, diarrhea, refer/escort to HCs• CHWs home visits link mothers with HCs• CHWs ed about/support EPI, ITN• Supervisors/Educators/Drug Supply local HCs• Community based information system HCs• Local NGOs support CHWs –ESP remote areas
Project Site Northern Benin
5 Health Zones93 Health Centers
1048 CHWs trained193 trainer/supervisors
trained
202,116 Infants less than 5 yrs
~16-20% of the under 5 population of Benin
5 local NGOs associated with the project
Began :30 July 2009 Ended : 29 Ju;y 2012
34 / 36 Months
HZ Tchaourou
BORGOU
HZ Bassila
DONGA
HZ Djougou-Ouaké-Copargo
DONGA
COVADES
HZ HZ Kandi-Ségbana-
Gogounou
ALIBORI
HANDICAP PLUS
HZ Banikoara
ALIBORI
CBBE
GRADE
DEDRAS
Project Cost: $ 4,377,056
Evaluation Questions
• Coverage and quality of iCCM delivery
• Capacity and sustainability of HZs and local NGOs to support CHWs
• Achievement of project objectives & activities
• Lessons learned and best practices.
Evaluation Methods• Three intervention HZ selected- Kandi, Tchaourou, Djougou• Key Informant Interviews- at all levels- MOH, local partner NGOs,
UNICEF, Africare, CRS, others.
• Focus Groups- CHWs, mothers, community • leaders, HC staff• Document review
• Case Control study
• Standardized Observation of Clinical Skills of 120 CHWs Observation Checklist Source. Adapted from Community based Distributors Quality of Care Assessment IRC 2011
Case Control Study
• 3 Intervention HZs compared w 3 control HZIn villages 5 to 10 km from local HC in South • 30 clusters of 10 mothers w children < 5 who
had fever, cough, or diarrhea in the past two weeks versus 30 clusters of 10 control HZ (600 total)
• CHWs not trained in iCCM present in control.• Sampling power 80% to show differ > 10% • Standardized questions – trained interviewers
ResultsCHW Coverage Level by Health Zone
Banikoara Bassila D-C-O K-G-S Tchaourou Total
Total villages (>5kms)
462 104 472 348 330 1716
Covered Villages (>5kms)
181 54 250 147 109 741
RC/HZ trained
186 108 360 223 172 1049
%
coverage
39% 50% 69% 42% 33% 43%
Source: Project Data, January 2011, BASICS.
Total numbers of cases treated by CHWs
Number of Children agedLess than 5 yearsTreated by CHWs
During project Treated for Male Female Total
Malaria 22357 19467 41824
Diarrhea 2497 2220 4717
Source .Project CHIS Cough/Pneumonia 3742 3461 7203
Household Homevisits by CHWs
FY 2011 FY20120
5000
10000
15000
20000
25000
30000
35000
40000
Household Visits by CHWs
Case Control General Results
• Demographics of guardians same by sex, age• Mothers home only I 183 (63%) v C 110 (37%• Education no F.ED I 264 (86%) v C 181(62%
• There were CHWs untrained in iCCM in control• 236 mothers sought HC for child from CHW in
intervention area c/w 108 who sought HC from CHW in control
Person/s Approached for Initial Care INTERVENTION CONTROL TOTAL
CHW 240 (78.7%) 108 (36.2%) 348 (57.7%)
Health Center 26 ( 8.5%) 95 (31.9%) 121 (20.0%)
Local Store 15 ( 4.9%) 82 (27.5%) 97 (16.0%)
Traditional Practitioner
4 ( 1.3%) 9 ( 3.0%) 13 ( 2.1%)
Parent/Friend 20 ( 6.6%) 4 ( 1.4%) 4 (0.7%)
305 (100%) 298 (100%) 603
Time Delay Before Seeking Health Care In Intervention And Control Areas
INTERVENTION CONTROL
Delay in seeking health care
Less than 12 hours 117 (49.6%) 11 (10.2%) 128
12 to 24 hours 77 (32.6%) 36 (33.3%) 113
24 to 48 hours 25 (10.6%) 46 (42.6%) 71
More than 48 hours 17 ( 7.2%) 15 (13.9%) 32
N 236 (100%) 108 (100%) 344
Use Of Health Care Before The Presence Of local CHW Compared With Control
Initial Source of health care
INTERVENTION
CONTROL Total
Health Center
147 (61.25%)
86 (79.63%)
223 (66.95%)
P = 0.000
Self-Medication
67 (27.92%)
43 (39.81%)
110 (31.16%
P = 0.027
Traditional Practitioner
3 (1.25%)
10 (9.265) 13 (3.74%)
P = 0.000
N 240 (100%)
108 (100%)
348
Mothers’ Perception Of The Benefit Of Having CHW Care For Their Children
Project CONTROL Total
CHWs live nearby 193 (80.42%)
76 (70.37%)
269 (77.3%)
P = 0.038
Accessibility to health care
177 (73.75%)
53 (49.07%)
230 (66.09%)
P < 0.0001
Availability of medications
130 (54.17%)
62 (57.41%)
192 (55.17%)
P = 0.57
240 (100%)
108 (100%)
348
Mother’s perception of the quality of care given by CHW
PERCEPTION INTERVENTION CONTROL
Correct treatment given by CHW
90.5% 70.3%
Satisfied with health care given
97.5% 87%
Access to follow up health care valued
50% 23.1%
Skills of CHWs observed
• Simulation of the examination a two old child presenting with fever (Real mothers and child)
The 119 RCs observed: • Asked
– about the age of the child in 94%, – about fever in 93%, – about diarrhea in 82%, respiratory symptoms in 75.6% – and length of time of symptoms in 94% of cases.
• Examination– 49.6% uncovered the child’s chest– 51% counted the child’s respiratory rate using a counting device.
Use of LLIN by Project Households
•
0
1000
2000
3000
4000
5000
6000
7000
8000
Oct-1
0
Nov-
10
Dec-
10
Jan-
11
Feb-
11
Mar
-11
Apr-1
1
May
-11
Jun-
11
Jul-1
1
Aug-
11
Sep-
11
Oct-1
1
Nov-
11
Dec-
11
Use of LLIN by Households in the Community
Children having slept undera LLIN the previous night
Households with a LLINconfirmed installed
Major Implementation Lessons
• Collaboration – regular contact- CHW same• Local NGOs• Work AIDS – job, supervision, HIS HZ comp• CHWs locally chosen—CHW referrals followed• Local links-community-HC-HZ-central MOH• Collaborative supervision
Local NGO members
22
Workaids Developed by Project
Supervision Clinical Skills
• July 2011 assessment of CHW clinical skills found widespread deficiencies
• Collaborative Approach developed.• Individual coaching of CHW on-site and • during CHW visits to local HC using Check List
At HC visits CHWs give one another feedback/help.Within each village local quality teams established to work with local CHW.
Performance of the CHWs and Supervisors in Clinical Assess. On FU.
020406080
100
Results Obtained
Post Training Follow-upSupervision at 3 monthsSupervision at 6 months
Evolution of the Copargo Commune CHW performance within 6 months of the implementation of the Collaborative Ap-
proach
Hidden details
• 85% of CHWs were male
Thank you ! The team
Reasons Given for not using CHWs
Reasons given for
not using CHW
Intervention Control TOTAL
Nil answer given 15 (23.0%) 32 (16.8%) 47 (18.4%)
Do not use them 19 (29.2%) 80 (42.1%) 99 (38.8%)
Absence of information about CHWs
18 (27.7%) 55 (28.9%) 73 (28.6%)
They are not available 13 (20%) 23 (12.1%) 26 (10.1%)
N 65 (100%) 190 (100%) 255 (100%)