Operations Research In MCH Programs: Measurement Challenges How MCHIP is working to Support PVOs CORE Spring Meeting, April 28, 2010 Wednesday 11:00-12:30

MCHIP PVO/NGO Support  Expanded work with CSHGP to include Operations Research  Briefly explain purpose, MCHIP’s role and give some examples

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

Guidance - ( Overview of basic details to be defined as part of study design  Sections: Formative research; Summative research  Research objectives, questions  Hypothesis (evaluative)  Study populations  Information collection methods  Sampling (Evaluative)  Study arms

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