evaluation arrangements for improved implementation: the otep case of brac md. hasib reza
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Evaluation arrangements for Improved Implementation: The OTEP case of BRAC Md. Hasib Reza Research and Evaluation Division (RED) BRAC, Bangladesh Presentation for the workshop on- Evaluation for Policy Making 27-31 October 2014, Suzohu City, Jiangsu Province, China. Outline. - PowerPoint PPT PresentationTRANSCRIPT
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Evaluation arrangements for Improved Implementation: The OTEP case of BRAC
Md. Hasib RezaResearch and Evaluation Division (RED)
BRAC, Bangladesh
Presentation for the workshop on- Evaluation for Policy Making
27-31 October 2014, Suzohu City, Jiangsu Province,
China
www.brac.net2
BRAC: At a Glance
Overview of OTEP
Taking Science Where the Diarrhoea Is
Piloting and Continuous Learning: Ingredients for Scale Up
Linking Evaluations to Actions for Improved Implementation of OTEP
Lessons Learned
Outline
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BRAC: At a Glance
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Established in 1972 in Bangladesh
Goal: Empowering people to lift themselves out of poverty
Currently operates in 11 countries
Served 135 millions of lives
1,20,000+ Staff
Budget in 2014: US$ 900m (70% self)
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Overview of OTEOP
Oral Therapy Extension Programme
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An ORW teaching a mother; PC- BRAC
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Overview of OTEOP
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10 year-long (1980-90) > 13 million mothers > 75,000 villages > Treat diarrhoea at home > Semi-literate ORWs
Phases Year HHs taughtField trial 1979 (Feb-Apr) 145 HHsPilot project (OTP) 1979-80 0.06 mExtended prog. (OTEP) 1980-90 11.80 m
Phase I 1980-83 2.5 m
Phase II 1983-86 5.0 m
Phase III 1986-90 4.3 mTotal 12.6 m
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Taking Science Where the Diarrhoea Was
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In 1970s, diarrhoea was the major cause of infant mortality in Bangladesh
Ideas took shape: Options for interventions
1. Treat all diarrhoea patients by trained personnel
2. Diarrhoea prevention through safe water & sanitation
3. Marketing of Oral Rehydration Solution (ORS)
4. Teach mothers how to make ORS at home with easily available ingredients
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Taking Science Where the Diarrhoea Was
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Challenge emergedDeveloping a simple formula for home-made ORS
The ‘kitchen experiment’:Lobon (salt)-Gur (brown sugar) Solution (LGS)
Harinagar & Anandapur: From Kitchen to the field
- Contents of educational message- The recipients of education- Method of teaching- The teachers
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Taking Science Where the Diarrhoea Was
Lessons learned from the first field trial
- Rural mothers were capable in preparing ORS
- ORWs could provide education on ORT
- Quality enhancing monitoring and corresponding logistic systems could be developed
Should BRAC go for a national level programme?
“Small is beautiful but big is necessary”
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Piloting and Continuous Learning: Ingredients for Scale Up
Oral Therapy Programme (OTP): The pilot project
Solved crucial implementation and management issues and served as the blue-print for OTEP
-Developed team building and training methods for ORWs
-Introduced incentive based salary system
-Ensured safe and effective solution
-Developed monitoring and logistic systems9
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Piloting and Continuous Learning: Ingredients for Scale Up
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Felt importance of continuous learning through real-time evaluations from BARD case of 1970s
Chowdhury and Cash (1998)
In-house Research and Evaluation Division (RED) emphasized on real-time process evaluation of OTEP
Arranged supports from ICDDR,B, Government agencies and Technical Advisory Committee (TAC)
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Linking Evaluations to Actions for Improved Implementation of OTEP
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Altering LGS formula: ORWs showed the way
A pinch of salt (lobon); PC- BRAC
A fistful of brown sugar (gur); PC- BRAC
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Linking Evaluations to Actions for Improved Implementation of OTEP
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Improving quality of teaching and learning
An ORW teaching mother using flipchart; PC- BRAC
A mother preparing LGS under the watchful eye of an ORW
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Linking Evaluations to Actions for Improved Implementation of OTEP
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Increasing male involvement in the programme as well as medical professionals
Village men were taught by male staff; PC-BRAC
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Linking Evaluations to Actions for Improved Implementation of OTEP
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Ensuring higher usage of LGS
Problems identified
-Misperception about ORWs
-Mothers were not convinced
-Fear of becoming ‘sterile’
-Local perception about diarrhoea- 4 types
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Linking Evaluations to Actions for Improved Implementation of OTEP
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Ensuring higher usage of LGS
Devised solutions
-Extended length of stay of ORWs and the team
-Tasting LGS by ORWs in front of the mothers
-Revised “Ten points” messages
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Linking Evaluations to Actions for Improved Implementation of OTEP
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Ensuring higher usage of LGS
Results
Types of diarrhoea
% using LGS
Areas taught 24 months previously
Areas taught 12 months previously
CRP areas taught 12 months previously
Dud-haga 2.0 12.2 12.3
Ajirno 4.0 7.9 9.8
Amasha 1.6 2.9 4.0
Daeria 25.6 31.6 52.2Source: Chowdhury and Cash (1998)
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Type of mortality index Before OTEP After OTEPNeonatal (per 1000 live births) 85.3 (519) 78.0 (424)
Post Neonatal* (per 1000 live births)
71.3 (434) 60.9 (331)
Childhood** (per 1000 live births aged 1-4 years)
26.5 (451) 17.2 (306)
Figures within parentheses indicate the number of deaths.
* p < .05; **p < .01
Source: Chowdhury and Cash (1998)
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Linking Evaluations to Actions for Improved Implementation of OTEP
Impact evaluation on mortality
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Lessons Learned
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NGOs can implement national level programme
Up scaling must take into account organization’s capability
In-house research and evaluation can play a critical role in programme’s development
National and international support can be obtained if the process is opened and information is shared