Knowledge Practice and Coverage (KPC) 2013 Revision Process MCHIP BBL March 28, 2013 Baltimore Jennifer Winestock Luna

Agenda  Brief overview of tool  Issues addressed by revision  Where we are with the process  Specific modules  Resources

Overview: Knowledge Practice and Coverage Survey (KPC)  Developed by JHU / CSSP 1990  Based on 30x7 cluster methodology used by EPI  Rapid survey methodology; small sample sizes  Household selection done in the field  Computer simulations conducted validated EPI methodology  Used by CSHGP PVO grantees since 1991  Collected at baseline, midterm, and final  Intervals 2-3 years

Overview: Child Survival and Health Grants Program (CSHGP)  Grants to PVOs since Projects 3-5 years  Currently 35 active projects  Africa, Asia/Near East, Latin America, Europe and Eurasia  Rural and urban; Sub-national, district level; mostly community oriented  Emphasis on program learning and operations research  Traditionally, Integrated Projects with Technical areas:  Immunization; CDD; Nutrition; Micronutrients; Breastfeeding; Birth Spacing/FP; ARI/Pneumonia; Malaria; MNC; STI; HIV/AIDS

Overview: Purpose of KPC  Grantees  Understand the health situation in project area  Measure progress toward results  Operations research  USAID (CSHGP) to measure the contribution of the portfolio of grants to improved health

Overview: Characteristics  Easy for PVOs to implement  Developed to collect standardized information from a variety of technical areas  Traditionally, targets mothers of children 0-23 months  Modules: questionnaires, indicators, tab plans, instructions  Grantees select modules relevant to technical areas of project  Within each module, grantees select questions & indicators relevant to interventions

KPC - Characteristics  Two standard sampling methodologies  30x10 cluster sample of 300 (coverage for entire project area) May increase sample size for operations research; may need parallel sampling  LQAS sample of 95 (coverage for entire project area) or 19/supervision area to determine areas that need additional attention Recommended for monitoring, but not for operations research

Timeline for implementing KPC  Normal time from planning to discussion of results is 30 days of full work.  Includes questionnaire development, field work, data entry/ analysis, developing action plan, (report writing)  HKI Baseline Niger Time (21 days)  14 days for questionnaire design, sampling frame, cluster selection and logistics planning  2 days training in country  5 days field work (September 2005)  Can be completed in 30 days  From questionnaire design to tabulation; information available for program use

Issues being addressed by revision 1.Technical areas advanced; updated indicators 2.CSHGP emphasis on operations research  Some new awards narrowly focused; Others integrated  Now requiring in-depth indicators from technical areas addressed by the project; Before standardized indicators from all technical areas (Rapid CATCH)  Previous standardized sampling plan changed to sampling tailored to each OR

The Revision Process  Over one year (MCHIP YR5)  Modules differ in amount of updating needed  Team effort, led by MCHIP PVO/NGO support  SNL, newborn indicator working group  MEASURE Evaluation – Malaria  MCHIP FP – Healthy Timing and Spacing of Pregnancies (HTSP)

The Process: Basic Steps 1.Review of indicators from other sources:  DHS, MICs  Measure Evaluation  CCM task force  PMI  LiST Tool  SNL

The Process: Basic Steps Simultaneously 2. Consult experts MCHIP, MEASURE Evaluation; CORE Group, USAID, others 3. TA to CSGHP grantees to integrate most recent state-of-art indicators into baselines Conducted Dec – Apr Draft revised modules

The Process – Basic Steps 5.Further consultation with USAID 6.Finalize modules 7.Approval by CSHGP USAID 8.Post on MCHIP PVO/NGO support website 9.Disseminate widely

The Process: Where we are now Soon: Immunization Water &Sanitation Respondent Background Health Contacts Possibly Gender

The Process: HTSP  Extensive updating – previous version 2000  Comparison with other sources, i.e. FlexFund  Extensive discussion by MCHIP FP team  Indicators developed  Includes integration indicators  Consultation with USAID on indicators almost complete

The Process: HTSP  Draft module being developed  IRC Liberia will incorporate into baseline  Project focuses on integrating FP into primary health care services including post partum

The Process: MNC  Incorporated work of SNL  Developed and tested newborn indicators  Hosted newborn indicator working group Participation of MCHIP, DHS, MICS, Others  Some highly tested; others recommended but should have further testing  Initial consultation with newborn expert at USAID - Allisyn Moran

The Process: MNC  Incorporated newborn indicators into Concern Worldwide Kenya’s baseline (CSHGP)  Held debrief conference call  Draft module developed with newborn indicators  Setting up meeting with MCHIP maternal health team to discuss maternal indicators  Quality of ANC and Delivery Services; Respectful care

The Process: Malaria Challenges:  International indicators developed for large surveys (DHS, MIS); adaptation needed for smaller sample surveys  PMI has behavior change indicators based on Likert scale (KPC usually has multiple choice responses)

PMI BCC example: Strongly agree Somewh at agree Somewh at disagree Strongly disagree Malaria is the most serious health problem in my community People in this community only get malaria during the rainy season Each year, many children in this community get malaria. 1234

The Process: Malaria Challenges:  Malaria programs emphasize universal ITN  ITN coverage obtained though net roster of ITN use by all who sleep in a home; Time consuming for traditional KPC; Target population different from other indicators that focus on children and mothers  Coverage of treatment: Children 0-59 months  KPC traditionally targets children 0-23 months  For an integrated program requiring information on young children (i.e. breastfeeding) and malaria parallel sampling needed

The Process: Malaria  Indicators incorporated into CRS Benin Baseline  Project: RDT use with appropriate treatment with ACTs; acceptability by CHWs, Communities, Caretakers  Indicators focus on:  Prompt care seeking for fever; use of RDT; ACT for RDT+ only, IMCI for treatment of RDT-; mother included in decision for care seeking  PMI behavior change questions

The Process: Malaria  Draft indicators and module developed Next steps:  Further consultation with USAID  Incorporation of PMI BCC indicators  Special instructions for analysis

The Process: ARI, CDD, IYCF  ARI; CDD: CCM task force indicators incorporated into Concern Worldwide Kenya and CRS Benin baseline  Revised WHO IYCF module adapted to baseline surveys by Concern Worldwide (Kenya) and World Relief (Rwanda)  Next step: Develop guidance for adapting WHO module to KPC Rapid Surveys

Resources  KPC modules:  Questionnaires; tabulation plans; indicator definitions; instructions; consent forms  KPC Trainer of survey trainers (TOAST)  The Rapid Household Survey Handbook

Resources  Lot Quality Assurance Sampling (LQAS)  LQAS Trainer’s Guide  Assessing Community Health Programs: Using LQAS for Baseline Surveys and Regular Monitoring Participants Module  LQAS Protocol for Parallel Sampling  LQAS Frequently asked Questions

 More questions?  More comments?  Do you want to hear more?  Do you want to use the KPC tool? Please contact me Thank you