Results Highlight. The SECI (Community Epidemiology Surveillance System) Methodology SECI is a powerful, mobilizing strategy that helps communities improve their health through a community and facility-based health information system. Using SECI methodology and tools, community health Promoters and health service providers consolidate primary health care data that they have collected using simple forms and community maps. These data are consolidated every month and then presented to the community in easy to understand graphics so that together, providers and communities can obtain and analyze new information about community health problems and articulate health priorities that reflect the community’s perspective. Community representatives share the consolidated information, plans, and strategies that have been developed and other results of these community meetings at district level information analysis meetings. SECI helps communities and health staffers make decisions on resource allocation and monitor progress toward achievement of agreed upon objectives. From 2000-2004, in the midst of a rapidly changing, complex sociopolitical and cultural context in rural Bolivia in three districts of Oruro (445 communities) reaching a total population estimated at 104,500, including 13,500 children under five, the Wawa Sana (“Healthy Child”) project was highly successful, having achieved or surpassed nearly all of its objectives, in large part due to SECI’s powerful ability to mobilize communities. Key accomplishments include: • Pentavalent-3 vaccine coverage increased from 32% to 85% in infants.12 • Acute respiratory infections treated by health services and Promoters increased 224% from 2001 through 2003 in CS-16 intervention areas.13 • Families increased their children’s fluid intake during diarrheal diseases from 21% at the start of the program to 54% at final evaluation.14 • Most CS-16 communities now place health at or near the top of their agenda in sharp contrast to prior to Wawa Sana when health was low or absent completely. • Municipalities, communities, and health service providers learned to share and analyze community health information to set priorities, plan, act, and evaluate progress resulting in stronger working relationships. • At least 15 other NGOs and government health services throughout Bolivia have adopted and adapted Xxxx Xxxx’s SECI methodology. SECI is a powerful, effective, and feasible methodology to mobilize communities for health. It effectively put int...
Results Highlight. The goal of the Plan XX XXX project was to create a sustained reduction in infant and child mortality through increased access to community-based health care and improved quality of health services in the project area. This goal was achieved through the implementation of a pilot project using the IMCI approach, which improved local access to preventive and curative services through capacity building interventions that targeted households, communities and health facilities. The project supported the MOH community outreach policy to empower communities to improve local health resources and increase access to health services. Sustainability has been ensured by strengthening the capacity of community resource persons (Health Area Committee Representatives, TBAs), community-based organizations (women’s groups), and the MOH staff (HCNs, community pharmacy workers) to provide quality services in the project area. Project interventions were strengthened using BCC activities designed to raise awareness about health issues and promote health-seeking behaviors. At the same time that communities were being empowered to take charge of their health needs, the project worked through its MOH partnership to strengthen the services of the health facilities by providing needed supplies and equipment and re-training staff. In addition, the project set up systems to assure delivery of outreach services to affiliated communities. It also worked to improve the functioning of the Health Area Committees. The XX XXX project was located in three Health Districts of the western part of Cameroon’s heavily forested Eastern Province. The province is Cameroon’s poorest and borders the Democratic Republic of Congo. Plan has been working in this large, sparsely populated province since 1996. The project benefited inhabitants of 267 villages (a total population of 211,2643) located in 27 Health Areas of Bertoua, Doume and Nguelemendouka health districts. The project targeted approximately 95,024 beneficiaries with 38,009 children under five, 8,447 infants 0 to 11 months and 48,568 women of reproductive age (15 to 49). Significant results were demonstrated using the IMCI approach, as shown in the table below. IMCI Indicator Baseline Final Trained Final Untrained The number of children 0-23 months seen at health facilities that were assessed for all danger signs 10.5% 72% 42.3% The number of caretakers who were correctly counseled about their sick child 36.3% 97% 65.4% The number of caretaker...
Results Highlight. The Strength Project in the impoverished districts of Nacala-Velha and Memba, in Nampula province, northern Mozambique, has set to contribute to: (1) sustainably reduce MMR, and U5MR; (2) sustainably improve the capability of DHOs and communities to respond to health needs; and (3) develop innovative approaches to inform policy and practices of SC and other partners. The main strategies are: (1) Partnership and Institutional Development for District Health System Strengthening through a Program Management Team (PMT) to enhance SC-DHO partnership for program planning, monitoring and evaluation, capacity-building and sustainability of program activities, and (2) Strengthening community component of maternal and child health through support for Community Health Teams (CHTs) that would monitor and support the activities of community health workers in the Regulados. The institutional capacity building approach is not novel in Mozambique and many attempts have been tried at national, provincial and lately district level with somewhat uncertain results. However, capacity building at the community level is unique in Mozambique and Nacala-Velha and Memba are the pilot districts. In here, 46 regulados, geographic and traditional authority areas, were identified, with a beneficiary population of 134,229 reproductive age women and children under five. Contacts were made with the xxxxxx and his advisor, the apiamwene, to create a CHT that includes respectable members of the community such as traditional healers, traditional birth attendants, religious leaders, teachers, health activists and mothers. These 46 CHTs, totaling a total of 332 people with balanced gender participation, have received training to provide the communities with the tools and skills they need to promote their own ongoing development, including leadership, organizational skills, health education, behavior and information. CHT have been active since and are well on their way to effectively discuss and solve their health problems. As it was stated by the staff “they see change happening”. A spillover of this democratic approach is empowerment of women. Women now speak in public when before they would not dare, limiting themselves to silent listening during palestras or health talks. Now they are active, ask more questions and have started demanding services from the district health authorities especially for more traditional birth attendants and more FP services. They also attend more preventative se...
Results Highlight. Integrated Partnerships with the MOH Yields High-Impact Results Strong integration of KIDCARE partners with the DMOH, shepherded by Plan Kenya, significantly contributed to achieving major increases in coverage for multiple high- impact5 child survival interventions. Even though the DMO changed four times during the life of the project, DMOH commitment to the partnership and the CSP was so strong that each new DMO became fully engaged with the jointly-designed workplan as soon as they arrived. Plan facilitated DMOH leadership in child survival interventions by helping to form and support the District health Stakeholders Forum, a group charged to develop a joint district workplan or Annual Operational Plan (AOP) and coordinating all activities of the partners. The AOP also served as a template for assessing progress towards the goals and objectives of the program and developing activity action plans. Partnership collaboration (DMOH, Plan, AKHS, PSI, and XXXXX XX) was strong enough that synergies of each partner’s specific capacities were credited with the ultimate results. This all took place in the context of implementing the National Child Health Plan in Kilifi. This was so successful that the national MOH recognized Kilifi District as the highest performing district in Coast Province and third highest in the nation (only two Nairobi- area districts performed higher). High coverage increases were possible in spite of high food insecurity, drought, low literacy rates and poor infrastructure in some parts of the district. (Kenya declared a Food Security State of Emergency during the Final Evaluation in August 2009). The DMOH further demonstrated commitment and constructed 3 new health centers, locating them in some of the hardest to reach and most underserved areas. In addition, beneficiary communities cited project-initiated structures such as Care Groups and CHWs and linking them to health centers and health workers through Village Health Committees (VHCs) and health facility Dispensary Health Committees (DHCs) as factors responsible for significant improvements in their health behaviors. These communities said that everyone could see the decreases in sickness and deaths of mothers and children. Neonatal tetanus and measles, once common in Kilifi communities has all but disappeared. DHCs were trained how to write proposals and now have capacity to apply for Constituency Development Funds (CDF) from MPs. HIS capacity building provided by the project gave D...
Results Highlight. The CS-16 program activities have been successfully implemented by SC in Memba and Nacala- a-Velha, in collaboration with the provincial and district level health workers. The Strength Project focused on: (a) the establishment of system strengthening through the establishment of a Program Management Team (PMT) at the district level to enhance SC-DHO partnership for program planning, monitoring, evaluation and sustainability of program activities; and (b) the establishment of Community Health Teams (CHTs) at the community level through strengthening the community component of MCH to monitor and support the activities of the community health workers. The above two aspects of program activities were reviewed during the FE and it was confirmed through interviews and document review that this novel approach that focused on capacity building of health workers at the district and community levels has been a success. This innovative approach should be shared with partners in Mozambique so that it can be replicated in other parts of Mozambique, where such an approach has not been fully tested.
Results Highlight. Maternity Waiting Homes (MWH) As a Strategy to Reduce Maternal and Neonatal Mortality: Maternal Waiting Homes are residential facilities located within easy reach of a hospital or health center. The purpose of a MWH is to house women near an essential obstetric facility during the final weeks of pregnancy. By using this strategy, PMNH aims to improve access to skilled delivery in partner facilities for women living in distant villages and to improve maternal and neonatal outcomes by averting care-seeking delays. MWHs are a promising practice because, while they have often been used as a strategy to reduce maternal mortality, there is insufficient research documenting their efficacy in all settings. Utilization rates and user satisfaction are also insufficiently documented. In Y3, the PMNH committed to establishing five MWHs in the partner facilities in the Pokot Districts. All interested HFMCs were encouraged to submit proposals to PMNH outlining the designs for the MWH as well as their intended contributions to the construction and the long-term maintenance. Three of the project sites have already been selected and provided with the initial funding. All of the selected sites must agree to collect careful data through partographs, registers, patient files and client satisfaction surveys. The PMNH intends to use this information to monitor use and effectiveness as well as for improving the MWH strategy based on feedback from the clients. HealthRight intends to conduct assessments at three levels - the community, the MHW and the health facility. Community knowledge and attitudes will be evaluated at baseline and at 4 months, using convenience sampling to identify community respondents. At MHWs, demographic profiles of clients and their satisfaction will be compiled through a short questionnaire administered to every patient. Functioning of MHWs will be assessed monthly through indicators such as the number of beds occupied, ratio of beds to population in catchments’ area, drop out rate, mean duration of stay, availability of staff and operating costs and staff satisfaction. At the health facility, indicators of maternal and neonatal outcomes are collected monthly. In addition, qualitative information will be collected to supplement and support findings. Focus group discussions will be conducted with community members to understand their views and to evaluate suggestions that emerge from satisfaction surveys. In- depth interviews will be conducted with key he...
Results Highlight. A highlight of CARE’s Child Survival Project in Matagalpa, Nicaragua, was the extremely successful breastfeeding promotion strategy. A comparison of the data from the Baseline Survey done in February 1999 and the final Knowledge, Practice, and Coverage Survey in August 2002 shows dramatic results. Exclusive breastfeeding for the first 6 months increased by 40.8% (from 10% to 50.8%). Continued breastfeeding
Results Highlight. Ichilo Province Nutrition and Health Behaviors Survey IEF/CEPAC conducted a nutritional survey in Ichilo Province, Santa Xxxx, Bolivia in the spring of 2001 to generate baseline data to design an effective nutrition intervention as part of IEF/XXXXX’s child survival project. Six hundred homes were visited, chosen at random from a 30-cluster sampling. The quantitative component of the survey consisted of a biochemical analysis of mothers’ hemoglobin concentration to detect iron deficiency anemia (XXX). Children under five were analyzed for XXX, vitamin A deficiency, and protein energy malnutrition (PEM). A Hemocue machine measured hemoglobin concentration, a dried bloodspot retinol indicator measured vitamin A deficiency, and anthropometric measurements (weight-for-height, weight-for-age, and height-for- age z-scores) measured PEM. A sub-sample of caretakers and children also gave feces samples to be analyzed for worm eggs, larvae, protozoan trophozoites, and cysts. The DBS methodology used in this study made it difficult to precisely determine the degree and potential causes of VAD in this population. Nonetheless, mean serum retinol concentrations are likely to fall between 19 and 22 mcg/dL, suggesting that regardless of DBS quality, nearly half the population is likely to fall close to or below the currently accepted cutoff for vitamin A sufficiency of 20 mcg/dL. Parasites were very common among women and children: approximately 62% of children and 75% of mothers had one or more types of parasites. Among children, parasitic infection became more common with increasing age (p< 0.001). Children were more likely to have parasites if their mother did (p = 0.03). The degrees of trichuris (pinworm) and uncinarias (hookworm) burden were related to the iron status of anemic women (i.e. 40% of mothers). Pinworm prevalence was relatively rare, found in 6% of children and 7% of mothers. Hookworm, however, was found in 16% of children and 26.8% of mothers. These worms may be the most likely parasites to adversely affect iron status in both mothers and children. Overall, 41.7% of children were anemic. In adjusted analyses, the odds of being anemic were approximately 1.5 times greater among boys compared to girls (p < 0.05), and anemia was a particular problem between 6 months and 3 and-a-half years of age. Using a field to defecate was highly predictive of anemia, with the odds of being anemic nearly 7 times greater among children who defecated outdoors compared to th...
Results Highlight. Plan Mali attempted to calculate the number of lives saved between 2001 and 2006 (Lives Saved Analysis) in the Kita project area by use of the Bellagio calculator. The Bellagio Group on Child Survival represents many technical agencies. It published the 2003 Child Survival and 2005 Neonatal Survival articles in the Lancet. The Bellagio group estimated the percentage of deaths attributable to the six most common causes of child mortality (diarrhea, pneumonia, measles, malaria, HIV/AIDS and neonatal causes) in 42 high mortality countries including Mali. It reviewed the literature for interventions supported by the evidence as effective against these six main causes and estimated the effect size of these interventions from the literature. The calculator estimates the number of deaths attributable to the six main causes and accounts for both the effects of malnutrition on mortality and the effect of interventions on multiple conditions (e.g. Vitamin A reduces measles, diarrhea and malaria deaths). It also avoids double counts. Lives saved for each intervention is given by the product of baseline number of deaths for that cause, intervention effectiveness and change of coverage. Given the dire baseline situation in Kita, the relative contribution of malaria to child mortality in the Kayes Region of Mali and the widespread availability and use of ITNs through the RBM, UNICEF’s ACSD and Kita CSP programs, the results of lives saved are very impressive. The project was able to save 2879 lives in the course of its 5 years which approximates to under $1000 per life saved. In the last year of the project alone it is estimated that it saved 514 lives from malaria, 304 lives from pneumonia, 205 lives from diarrhea, 93 lives from neonatal causes, 34 lives from measles and zero from HIV/AIDS for a total of 1151 lives saved. This makes the Kita CSP a highly efficient program worth emulation in the region.
