operations research in mch programs: measurement challenges
DESCRIPTION
Operations Research In MCH Programs: Measurement Challenges - How MCHIP is working to Support PVOsJennifer Luna, MCHIPCORE Group Spring Meeting, April 28, 2010TRANSCRIPT
Operations Research In MCH Programs: Measurement ChallengesHow MCHIP is working to Support PVOsCORE Spring Meeting, April 28, 2010Wednesday 11:00-12:30
CSHGP history of implementing community oriented programs since 1985
Tradition of collecting rigorous information Since 1991 Grantees implemented baseline and
final KPC surveys Health Facility Assessments Sustainability Assessments Complemented by qualitative information
Traditional baseline and final information is rigorous enough for judging: If projects met targets If the health situation improved in the project
area after project implementation was completed If quality of services improved Calculating estimated lives saved from
interventions implemented
Questions remaining:
International community not always convinced that this is enough evidence to recommend scaling up (i.e. WHO, Universities, National Governments, other Donor
organizations) Those of us implementing community oriented
programs may not have enough evidence to compare effectiveness of different approaches to recommend one approach as a best practice
• i.e. Is the Care Group model as traditionally implemented the best approach for scaling up or could it be adjusted to facilitate scaling up?
Solution: Innovation Grants
New category started 2008 (2 rounds of grants) Emphasis on including OR
Purpose to contribute to the evidence base for community oriented programming
Opportunity for grantees to include strong research designs as part of their projects Grantees have flexibility to:
• Propose a variety of interventions/approaches to study• Define research questions/ hypotheses• Develop appropriate study designs
Builds on the strong history of collecting rigorous baseline and final information
Role of MCHIP
Work with grantees to ensure that: Studies are focused and can be practically
implemented within a CSHGP project Research designs are logical for the questions being
asked Facilitate exchange of information/ experience
among innovation grantees Recently held OR workshop for grantees Develop guidance Support USAID in communicating about the studies
Challenge: Cookie cutter approach to evidence building not appropriate Grantees flexibility to propose a variety of
interventions/approaches Community oriented programs usually work at multiple
levels to achieve success; It is important to explain these mechanisms: Community organization; community management of
health; referral between community and facility level health providers; new relationships between health care providers
Some interventions/approaches have been implemented many times (some evidence of success); others are new (no evidence); others are in the middle Requires different study designs
Continuum
Study Designs
Emphasis on formative One study arm, no comparison group
Combination formative and summative Quasi-experimental; comparison group Quasi-experimental; 2 different intervention
groups Cluster randomized trial
Overview of OR Studies
Topics include: MNC; CCM; Telemedicine; Nutrition Working with illiterate/low literate women Male involvement Public-private (civil society) partnership Community based vs. Facility based interventions Less expensive Care Group model Community financial support for health workers
Overview of OR Studies
Baitadi district of Nepal Innovation of combining homestead food
production (HFP) + essential nutrition actions (ENA)
Determine whether it can significantly improve child nutrition (anthropometry and anemia status)
Well documented interventions by HKI Summative Cluster-randomized, pre/post design
comparing treatment and control areas
Overview of OR Studies
Chitral district Innovation: community financing
scheme to support trained community midwives (CMWs)
Determine whether CMWs can earn enough to sustain work; communities can pay enough; quality maintained
New intervention (formative and summative)
Quasi-experimental
Concern Worldwide – Mabayi District, Burundi
Concern Worldwide
Determine if health outcomes of adapted model similar to traditional
Quasi-experimental 2 study arms: traditional Care Group, adapted
Care Group