A Discussion of Evidence Generated by CSHGP Grantees: Results from 13 Final Evaluations Submitted in 2010, and Implications for MCHIP and Other Global Health Programs June 23, 2011

Agenda  Introduction of PVO/NGO support BBL series and CSHGP  Evidence of improved health outcomes  Standardized household surveys  Analysis  Results  Discussion next steps

CSHGP Project Map: 1985 – 2010

Active CSHGP Projects

CSHGP Projects: 1985 – 2010

PVO/NGO Learning Themes Rationale: 1.GHI Principles 2.MGDs 3.MCHIP

Active CSHGP Projects by End Year Ethiopia (GOAL)Afghanistan (WV)Burundi (Concern)Bangladesh (CRWRC) Malawi (Project Hope)Burundi (WRC)Honduras (CFI)Benin (CHS) Malawi (PSI)Ethiopia (SC)Ecuador (CHS)Cambodia (IRD) Malawi (SC)India (CRWRC)India (CARE)Indonesia (Mercy Corps) Nepal (CARE)Nepal (HKI)Liberia (Curamericas)Liberia (Africare) Nepal (PLAN)Nicaragua (CRS)Nepal (HealthRight)Mozambique (WRC) Niger (RI)Uganda (ERD)Pakistan (AKF)Niger (Concern) Rwanda (Concern)Zambia (CARE)Uganda (MTI)Peru (Future Generations) Tanzania (Wellshare)Rwanda (CARE) Russia (PIH) South Sudan (WV) Zambia (SC)

Evidence of improved health outcomes  Background  Standardized household surveys  Analysis  Discussion  Results  Next steps

Standardized household surveys Knowledge, Practice and Coverage (KPC)  Rapid population based survey  Developed by JHU / CSSP (1990)  Updated by Macro and CORE to align with DHS and to reflect internationally-accepted standards (2000)  Based on 30x7 cluster methodology used by EPI program  Used by PVOs since 1991  Collect baseline, mid-term and final

KPC consists of:  12 modules (technical areas)  Indicator definitions, questionnaires, tabulation plans  Grantees select modules relevant to technical areas of project  Within each module, grantees select questions and indicators relevant to interventions  Rapid CATCH questions and indicators  All grantees collect regardless of technical interventions  Currently 18 indicators

KPC  Targets mothers of children 0-23 months  Two standard sampling methodologies  30x10 cluster sample of 300 (coverage for entire project area)  LQAS sample of 95 (coverage for entire project area) or 19/supervision area to identifying SAs that need priority attention  Updated to be compatible with:  DHS; USAID priority indicator; LiST Tool; Common Evaluation Framework; MEASURE Evaluation; Malaria MERG; findings from SNL; future MCHIP findings  Next update planned for MCHIP YR4

Analysis Background  Review of Rapid CATCH data  15 projects ended in 2010  13 Final Evaluations (No FE surveys performed in Haiti due to earthquake) Expanded ImpactNew PartnerStandard CRS DR Congo FH Mozambique PLAN Cameroon CRWRC Bangladesh GHA Haiti Health Partners Uganda HOPE WW India INMED Peru IRD Cambodia MTI Liberia AMREF Kenya Concern Haiti HealthRight Kenya MC Indonesia SAWSO Zambia

Analysis  Comparison of baseline & endline with CI’s  Data only from projects with activities that address the indicator  7 grantees used 2000 Rapid CATCH  6 grantees used 2006 Rapid CATCH  Results grouped to look at patterns

Results – Grouped 1.Projects with strong breadth of improvement  Care Groups, CRWRC People’s Institute 2.Expanded Impact projects  FH Mozambique, PLAN Cameroon 3.Indicators with strongest performance  Exclusive BF, ITN, Hand washing, Maternal TT 4.New indicators with strong performance  IYCF, Post-natal visit 5.Nutrition

Projects with Breadth FH MozambiqueMTI LiberiaPLAN CameroonCRWRC Bangladesh Moved 11 indicatorsMoved 10 indicatorsMoved 9 indicators Maternal TT Sick child Hand washing ITN HIV/AIDS Danger signs Post-natal visit Danger signs Underweight Fever Underweight EBF DPT3 EBF Full immunization Measles DPT1 Measles Vitamin A Comp. feeding IYCF SBA Comp. feeding SBA Pneumonia ORT

Grantees who Implemented Care Groups  FH Mozambique  MTI Liberia  SAWSO Zambia

Care Groups: FH Mozambique

Care Groups: MTI Liberia

Care Groups: SAWSO Zambia

People’s Institutes: CRWRC Bangladesh

Indicators – Strongest performance 6 Projects Maternal TT 8 Projects Exclusive Breastfeeding 7 Projects ITN Use Hand Washing

Indicators – Strongest performance

2000 Indicator2006 Indicator

Indicators – Strongest performance

New indictors with significant increase Post-natal care visit 4 projects Infant & young child feeding (IYCF) 3 projects

New Indicators – Post-natal care visit within 3 days

New Indicators – Complementary Feeding vs. IYCF

Expanded Impact Projects  FH Mozambique  Moved 11 indicators  PLAN Cameroon  Moved 9 indicators

Expanded Impact: FH Mozambique

Expanded Impact: PLAN Cameroon

Nutrition: Underweight

Nutrition: Grantee Sessions/ Villages Results FH1-on-1 work PD/Hearth CRWRC11 sessions 73% rehabilitated (69/94) IRD30 villages 505 enrolled in program 403 completed the program 76.4% within 2 SDs at discharge PLAN3 villages 1320 children weighed 621 underweight (47%) 584 rehabilitated (94%)

Next Steps  Look at data from EI projects that end in 2011  Continue to highlight EBF success  Look at indicators that are difficult to move  Look at LiST analyses of the projects  Look further into strategies used in projects that were able to successfully move indicators  Suggestions?

Thank you!

Indicators – Strongest performance PVO %ITN InputsITN Activities in Project Area (as reported in final evaluation reports) AMREF33*10,000 Project procurement & distribution; PSI distribution pre-project CRS674*20,000+ Project procurement & distribution FH267* MOH ANC distribution HR36*34,000+ PSI procurement; Project partnered for distribution at facilities MTI292* NMCP (supported by PMI & GF) procurement; Project partnered distribution PLAN682*39,000 Project & ACSM procurement & distribution 1 st half of project; MOH ANC distribution 2 nd half of project SAWSO199*? CHAZ, NMCP, MOH, distribution; PLAN & project partnered distribution; USAID Mission & SFH partnered social marketing; Unanticipated project procurement during year 1 * Indicates a statistically significant increase; PMI: President’s Malaria Initiative, GF: Global Fund, NMCP: National Malaria Control Program, CHAZ: Church Health Association of Zambia, SFH: Society for Family Health ITN Use