1 Evaluation of the Effectiveness of Most Vulnerable Children Quality Improvement Trainings in five Regions of Tanzania Author: Flora Nyagawa 1 ; Kusekwa Sono 1 ; Jared Mussanga 1 ; Diana Chamrad 1 ; Astou Coly 1 ; Davis Rumisha 1 Evelyn Kamote 2 Affiliation: 1 University Research Co., LLC (URC), 2 Ministry of Health and Social Welfare

USAID HEALTH CARE IMPROVEMENT PROJECT Background University Research Co., LLC (URC) through the USAID Health Care Improvement Project (HCI), has supported the Department of Social Welfare (DSW) and Implementing Partners (IPs) supporting Most Vulnerable Children (MVC) to ensure the national guidelines for improving quality of care, support and protection of MVC are communicated and implemented at the point of service delivery Since April 2010, HCI in collaboration with DSW has been supporting IPs to organize and conduct Quality Improvement (QI) trainings to other IPs and government staff in various regions whereby a total of 19 regions have been reached After two years of trainings, a cross sectional evaluation was conducted to assess effectiveness of these trainings in MVC service provision

USAID HEALTH CARE IMPROVEMENT PROJECT Objective Overall Objective To evaluate the effectiveness and impact of MVC QI trainings in improving service delivery to MVC and their households Specific Objectives 1.To examine the extent to which various stakeholders use and communicate to others information on the: (1) national MVC guidelines, essential actions, desired outcomes and prioritized indicators and (2) quality improvement approach and methods 2.To investigate the extent to which QI training and awareness of National Guidelines has improved provider skills and influenced the way they work 3.To examine how NGOs and LGAs serving MVC have changed as a result of QI training and implementation of National Guidelines 4.Identify challenges and best practices encountered in implementing QI Intervention in service delivery to vulnerable children and households 5.Gather Evidence on effect of program on client level (end result)

USAID HEALTH CARE IMPROVEMENT PROJECT Methods This evaluation was conducted in Tanzania Mainland in selected 5 regions of Mbeya, Morogoro, Pwani, Kilimanjaro and Shinyanga between March-April 2012 Data were collected from targeted NGOs and government staff who are involved in MVC service provision and activities at national, regional and Local Government Authorities (LGA); as well as from beneficiaries of services at MVC households Both qualitative and quantitative data were collected using questionnaires, by face to face interviews. Data were entered in Epi Info software. All qualitative data were coded to facilitate analysis

USAID HEALTH CARE IMPROVEMENT PROJECT Key results 1 :Evaluation of the MVC QI program in 5 regions revealed over 80% of beneficiaries have access to basic services

USAID HEALTH CARE IMPROVEMENT PROJECT Key results 2: Evaluation of the MVC QI program in Bagamoyo shows over 95% of beneficiaries have access to basic services

USAID HEALTH CARE IMPROVEMENT PROJECT Results The evaluation shows significant familiar and application of MVC QI guideline at different levels such as regional 73% and LGA/councils 78%, however it was low at community level with the Most Vulnerable Children Committees (MVCCs) 38%. QI trainings have contributed stakeholders to: –Plan for activities to support MVC by looking into the problems identified and setting priorities; –Apply guidelines while providing services; –Involve beneficiaries during planning and service provision; –Close follow-up to MVC households; strengthen local structures i.e. MVCC, by educating them on how to provide quality support to MVC

USAID HEALTH CARE IMPROVEMENT PROJECT Results Beneficiaries also rated satisfactions on services provided to them:- RateMVCCaregiver Very good2.75%5.33% Good33.49%32.79% Fair33.94%25.41% poor29.82%36.48%

USAID HEALTH CARE IMPROVEMENT PROJECT Challenges Limited resources (Financial and HR) among different stakeholders Wrong perception of community members on supporting MVC (NGOs Responsibilities) Economic hardship/poverty among community members Improper ID of MVC during service provision Inadequate referrals and linkages among different stakeholders Lack of motivation among different volunteers

USAID HEALTH CARE IMPROVEMENT PROJECT Discussion, Conclusion and Recommendations The MVC QI trainings has contributed to different stakeholders to understand and apply the guidelines in planning and implementation of MVC interventions In order for QI interventions to bring positive impact to beneficiaries, there is a need to investing more in translating policies and standards at the grassroots structures so that they can be able to interpret and apply them to improve the wellbeing of MVC Regular coaching and mentoring to local structures after trainings and involvement of beneficiaries during service provision is paramount

USAID HEALTH CARE IMPROVEMENT PROJECT Acknowledgement MOHSW; RAS in Kilimanjaro, Mbeya, Shinyanga, Morogoro & Pwani; MVC IPs ;CSOs; MVC and Caregivers.

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