Does community-based approaches have a role in HSS?

Maternal and Child Health Transformation (MaCHT) Project

Warrap State, South Sudan Presented By Alfonso Rosales

CCIH 2015 Conference

PRESENTATION OVERVIEW • BACKGROUND

• METHODOLOGY

• MAJOR FINDINGS

• LiST ANALYSIS

• LIMITATIONS

• CONCLUSIONS

• RECOMMENDATIONS

BACKGROUND

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

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

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?

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.

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

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

LiST ANALYSIS RESULTS

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

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

RECOMMENDATIONS

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