Using narrative approaches to assess animal and community health interventions in Laos: Most Significant Change Learning about project impacts through people’s stories

Fèvre, Sonia; Southammavong, Fongsamouth; Kaesombath, Lampheuy; Chittavong, Malavanh; Drew, Anne; Kongmanila Daovy; Vannasy, Sypachan; Chialue, Lithua

PENAPH Technical Workshop, 13 December 2012  

• About Most Significant Change (MSC)

• Introduction to Laos Ecohealth and Village Extension Project

• Methods & results using MSC in Laos Ecohealth project

• Lessons learnt

Outline

MSC is a type of participatory monitoring and evaluation. It

involves the collection of stories of change from the field, and the

systematic selection of the most significant of these stories by

groups of stakeholders & staff… Once changes have been

captured, various people… read the stories aloud and have…

in-depth discussions about the value of these reported changes.

What is MSC ?

(The ‘Most Significant Change’ (MSC) Technique. A Guide to Its Use. Davies & Dart 2005)

• Qualitative

• Uses stories

• Strength-based learning

• Not indicator-based

• Ongoing cycle (story collection/selection/feedback, then collect again)

• Fits into project cycle to evaluate and help plan future activities

Aspects of MSC

1. Define purpose for doing MSC

2. Collect stories (about 10-15 per collection cycle) and translate key points

3. Decide on 3-5 themes and classify the stories

4. Discuss each story and select most significant one for each theme (selection)

5. Document/record reasons for these choices

6. Feedback – to team, communities, managers, etc – some of most significant changes seen in project

7. Make recommendations for action

8. Adapt project activities based on discussions

Not just about collecting stories – focus is also on how we select what we think is significant

Key steps in MSC

6

‘ ‘Looking back over the last year…’ – It refers to a specific time period.

‘… what do you think was...’ – It asks respondents to exercise their own

judgment. ‘the most important (or significant)…’ – It asks respondents to be

selective, not to try to comment on everything, but to focus in and report on one thing.

The key question for MSC interviews

‘…change…’ – It asks respondents to be more selective, to report a change rather than static aspects of the situation or something that was present previously.

‘…because of your involvement with the project?’ – Helps establish boundaries.

Feedback and ethics

• Skills of interviewer • Sharing and dissemination of stories within the organisation, with project

participants, storytellers, etc • Offer choice of anonymity

• How stories used for monitoring purposes • How MSC is combined with other M&E • Acknowledging the difference between media interviews and MSC stories • Understanding benefits and limitations of strength based approaches

a) Who we choose to tell the stories b) Who selects the stories c) How we select the stories (what criteria)

• It can build staff capacity in analysing data and conceptualising impact – what impact have we had so far?

• It can be used to monitor and evaluate bottom-up initiatives that do not have predefined outcomes against which to evaluate

Strengths of MSC – “rich picture”

• Easy to communicate across cultures

• Easy to integrate with other project activities eg. village visits

• It captures outcomes which are more emotional/less tangible

• It captures non-predicted outcomes – maybe we are having an impact we didn’t expect (good or bad)

• It brings out people’s values and what they think is important

• It allows people telling & selecting stories to discuss what we think is important, & review core values of our work

Strengths of MSC – “rich picture”

Population Health

• 30 % of population lacks access to basic medical care • 40% + children malnourished • High risk of malaria, dengue fever, avian influenza

Agriculture and Veterinary Capacity

• 89 % of HH keep at least one species of livestock • Lack of veterinary expertise (less than 80 vets

nationwide, cf. Canada 11,386 vets)

Laos – Quick facts

Human population: 6.7 million, 80% rural

Laos

Village Ecohealth & Veterinary Extension Project

Animal health services

▫ 72% respondents vaccinated cattle/buffalo

▫ 15% brought in new animals, 39% of them separated animals first

▫ Only 11% respondents had received visits from animal health

worker in past 6 months

Communities in Xaythany District (2010 Baseline survey)

• Training and mentoring of Primary Animal Health workers • Livestock clinics for training and outreach

• Livelihoods project with low-income farmers – poultry

• Rabies campaign • Community Health Days

Training and mentoring for Primary Animal Health Care Workers

Livestock clinic in Somsamai village, courtesy of Anne Drew

PAHW Refresher Training, courtesy of Anne Drew

Community mobilisation

Rabies vaccination days, photos courtesy of Anne Drew

Community Health Day, Senoudom village

Project aims

• Local partners are empowered to provide relevant, good quality training and support to village animal health workers

• Primary animal health workers (PAHWs) have good basic skills in animal healthcare and help improve the health of animals in their communities

• Communities take an active role in improving the health and management of their livestock and contributing to human and animal disease prevention

• Farmers adopt integrated approaches to animal raising and farming which contribute to increased productivity, better access to markets, and food security

Using MSC to assess to assess animal and community health interventions in Laos

• Interviewees: project participants activities (PAHWs, Community Health Days)

• 23 stories collected from 3 villages over 2 weeks (January – February 2011)

• Interviewers: project team and new members

Story collection

Story themes

• Animal health care • PAHW skills and

knowledge • Environment and human

health

• Stories classified by theme

• Each story read and discussed by selection team (key project team members) – project purpose, story teller’s focus, etc

• Iterative selection process, leading to final selection of 3 stories: one story per theme

* Stories excluded if • unreliable • not enough detail • not a story of change

Story selection: 1 day

I am a Primary Animal Health Worker, and I attended the Community Health Day in my village. I was selected to become a PAHW because I submitted an application after the project team came to my village, and I was one of the three chosen. In 2010 I went for training at Nabong Faculty of Agriculture. It was my first training in veterinary health care. I learned about the use of vet equipment like syringe and needle, livestock crush, and how to inject in muscle and under skin. I learned about disease, how to use medicine to prevent disease and for treatments. After I completed the training, I worked at my village, but mainly on my own animals, because I was afraid to work on other people’s animals, and most people did not trust me yet. Then the project organized a second training last August 2010. Then I understood the work better, because it helped me review past lessons, and also learn new lessons. We practiced with animals, assessing the health of normal animals and signs of disease. We learned animal restraint, wound treatment, about vaccination, and use of medicines. Now I feel more confident working in my village. I have successfully cured animals, and am gaining more trust. Experts from the project come to visit and supervise regularly, and that increases my confidence and gives me more experience in improving animals’ health, little by little.

Mr Labou, Hat Viengkham village

Example story selected Skills and Knowledge theme

Example: story selected

Skills & knowledge

Story has good examples, clear information about before / after through what PAHW has learnt, what he thinks is significant, and how project can continue to support him

Theme: PAHW Skills and Knowledge - Mr. Labou • objective 1: the second training especially gave him

confidence, he mentions that experts from the project come to visit and supervise in the village • objective 2: he mentions specific

skills learned: use of medicines, disease diagnosis • objective 3: He talks about

lessons learned by the community

How did the stories support our project objectives?

Conclusions: What have we learnt from MSC?

• PAHWS (Primary Animal Health workers) continue to be enthusiastic and are serving their communities. They are still asking for more training and support in vaccination, injury treatment, obstetrics etc.

• Community members tell us they highly value having PAHWs in their villages, as PREVIOUSLY many of them had no-one to turn to if their animals were sick. They say their animals are healthier now.

• Community members (teachers, village chiefs and other villagers) have said they have changed habits since we conducted COMMUNITY HEALTH DAYS last year. For example, one man moved all his livestock away from his house to reduce disease transmission. Many women have said they wash their hands before touching food AND cook their meat more thoroughly now.

• Choice of interviewers and interviewer training are important for ensuring reliable, well told stories

• Details of a story can be verified at the time of collection e.g. if farmer says ‘less animals die now’ we need to ask ‘how many died before – when, and how many died this season’, when, how, why, etc.

General Conclusions

• Stories which highlight certain activities more than others show that conditions in those areas made for effective activities… we can learn from this

• MSC is most effective as part of a combination of mixed method evaluation approaches

• Given technical limitations (limited laboratory facilities, etc), it is easier to collect participatory data than clinical monitoring of animal health… how can we better merge the two approaches?

Thanks to partners: Faculty of Agriculture, National University of Laos

Faculty of Environmental Science, National University of Laos District Agriculture and Forestry Office

Xaythany Department of Health

Thanks to funders: Canadian International Development Agency (CIDA)

Canadian Food Inspection Agency Congrès Vétérinaire

Sonia Fèvre sonia.fevre@vwb-vsf.ca

www.vetswithoutborders.ca