power point slide presentation - mchip · presentation outline i. background ii. objectives...
TRANSCRIPT
Complementary Evaluation for EIP and Documentation of scale of Integrated Community Case Management in
Rwanda
- Key Findings -
Presented by: Laban Tsuma, MD, MPH PVO/NGO Support Advisor MCHIP, Washington DC
Presentation Outline
I. Background II. Objectives III. Methodology IV.Results V. Lessons Learned VI.Next Steps
2
Background
EIP CSHGP Program: •Focused on iCCM, CHW training, supervision and supply chain
•Encouraging peer support through modified care groups
Contributions to Scale: •Opportunity to learn about intervention(s) going to scale
•What was Rwanda’s planned versus actual pathway to scale for iCCM?
•How did EIP contribute to pathway?
Cross-District Comparisons: •Opportunity to compare quality of CCM delivered in EIP districts vs non-EIP districts
•Does the “modified care group” approach affect the quality of CCM? If so, how?
Objectives of Complementary Study
Scale Study:
To test the following Hypotheses
•NGO supported actions around HBM (2004) and iCCM (2007) were essential in leveraging MOH support for scale
•Strong leadership and political will in Rwanda were key in moving CCM to scale
Comparative Study:
To assess care group attribution to CCM status
4
Methodology
The Complementary Study comprised of 2 different tasks.
Document Review + Qualitative elicitation of narratives by 17 key informants (central level stakeholders) to “tell the story” of iCCM in Rwanda over time (2001-2011)
Qualitative assessment of CCM status in one non-EIP district (Ruhango) targeting different groups
5
Interviews and FGDs Conducted Target Done
Central MOH & Central Partners (USAID, UNICEF, WHO, PNILP, NGOs)
5
Technical persons 1 MOH 11 NGO/Bilaterals
District Health Officer 1 Health professionals (Titulaire, CSC)
2
CHWs FGDs Mothers / Caretakers
FGDs
Cooperative Officials FGDs Focu
s G
roup
In
terv
iew
s
Results
A historical timeline for iCCM was elaborated. Also NGO contribution to some of these steps was mapped.
CHW Services are appreciated by both users and MOH.
Caregroups at the CHW level provide a natural peer support group and help with Community mobilization and BCC.
7
CCM Timeline in Rwanda – Abridged Version
HBM Strategic Plan 2004
Expansion of HBM to 12 of 19
“endemic” Districts 2006
HBM Evaluations 2006 and 2007
using ACT
iCCM Pilot in Kirehe 2007
iCCM Tool Development and
revision 2008-2010 2009-Introduction
of RDT at community level
Expansion of iCCM to 30 Districts
2009-2010
1990’s 2003 2010 2006 2007 2008
PHC
DIARRHEA
MALARIA
PNEUMONIA
Home-based fluid and ORS and Zinc in Kirehe
First pneumonia case treated by a CHW in the country in Kirehe district Feb 2008
POLICY CH Policy + community health desk.
2005
RDT Policy Change
2009 2004
Pilot AQ at village level in 6 districts
Oct 07: Bukora HC, first ACT treatment by CHW
HBM Strategic Plan
C-PBF to incentivize CHWs
EXPANSION Expansion of iCCM to 30 Districts 2009-2010
CHW CCM Cadre mooted
HBM TWG
IMCI TWG
MCH CH TWG takes over from IMCI TWG.
Expansion of iCCM to 16 Districts 2008 (Phase 1)
HBM in 6 Districts
HBM in all 19 endemic Districts
Individual CSHGP Projects are awarded to 3 NGOs
Other Important Critical Events for CCM in Rwanda 1
Vision 2020 Umurenge of 2000 and Decentralization Policy of 2001
Global Fund Round 3 WHO TA and HBM Strategic Plan 2004 NGOs piloting HBM, CORE/PMI support
2004 CHW Recognition by the Presidency -
“Itorero” call; Cellphones 2008, IDHS 2008 10
Other Important Critical Events for CCM in Rwanda 2
Setting up of MOH Community Health Desk; BASICS TA for iCCM Pilot 2007
Rwanda MOH exchange visit to Senegal to examine CCM 2006; Re-districting in Rwanda
Global Fund Round 5 –DHS 2005; CBHI RCC and Global Fund Round 8; RDT
Introduction 2009; C-PBF roll-out C-PBF rollout; New staff cadre for CHW
Supervision nationally; DHS 2010
11
Lessons Learned 1
The EIP played a significant role in the scaling up of iCCM in Rwanda by intervening at critical points in the pathway to scale.
12
Lessons from Rwanda CCM evolution
HBM Scaling CCM has
been at 2 levels:- coverage or #districts, depth (+Pneumonia +Diarrhea +RDT +MUAC screening)
Clear MOH Policy and CH Desk
Strong Community confidence of CHWs and CCM program
Good funding levels via several partners including GF Rounds 3,5 RCC and 8, and PMI and USAID
Initial Planning always had scale in mind.
Rapid scale-up Unique Innovations
have been embraced like CBHI, c-PBF and SIScom
CCM Challenges that care groups could help alleviate
Key CCM Factors EIP Districts (with CHW Peer Support Groups aka Care Groups)
Non-EIP Districts (without CHW Peer Support Groups)
Improving Task Competency for CCM e.g. use of timer, use of MUAC, use of RDT
+
-
Improved Reading and Counseling on RDT result
+ -
Minimizing stock-outs by sharing inventory among peers
+ -
Technical Supervision by Peers + - Sharing Cases among CHWs to maintain CCM proficiency
+ -
14
Lessons Learned 2
Immediate take home lessons for MCHIP following this study include consideration
-to support a validation study for CHW RDT application and reading;
- to co-opt peer support group formation and networking module in CHW training;
- for different CHW restocking models/ supervision models
15
Lessons Learned 3
Immediate lessons to global stakeholders include
-Increased efficiencies in the evaluation process due to shared resources and expertise of different but complementary partners;
-Shared learning/Adopting lessons learned into ongoing programs/Sustainability
16
Next Steps
Consider comparing DHS clusters from EIP and non-EIP areas from the recent DHS (2010)
Convene a face to face meeting for mutual agreement of CCM events timeline
17
Thank you!
wwww.mchip.net
Follow us on: