CCM Benchmarks,framework and indicators

as a tool for documentingcountry programs

Baltimore, May 12th 2011

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Serge Raharison, MD, MScChild Health Technical officer

Content

1. CCM benchmarks, framework and indicators

2. Application of the framework in Senegal3. Key findings and implications for the

CCM national program in Senegal

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THE CCM BENCHMARK MATRIX

Part 1

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The origin of the Concept

Shared understanding of evidence supporting CCM

Different stages of country implementation

Diversity of country programs and NGO experiences

“Unsuccessful pilots have lacked key components of a comprehensive health system.”

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The origin of the Concept

Inter-Agency working group, including WHO, UNICEF, USAID and International NGOs

Technical Working Group at the Global level

Systems strengthening approach to CCM

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Eight components

1. Coordination and Policy Setting2. Financing3. Human Resources4. Supply Chain Management5. Service Delivery and Referral6. Communication and Social Mobilization7. Supervision and Performance Quality

Assurance8. M&E and Health Information Systems

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Advocacy and Planning

Pilot and Early Implementation

Expansion and Scale-Up

…indicators…

THE CCM DOCUMENTATION

Part 2

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Rationale

Assist countries in surpassing their previous targets to impact mortality, malaria, pneumonia and diarrheal disease: Inform CCM-related policy and programmatic

decision-making in the countries assessed Share with other countries about how to

accelerate progress towards their CCM targets

Objectives

• General Objective:– Inform the design of programs and program

monitoring during the anticipated expansion of iCCM.

• Specific Objectives:– Document successes and promising strategies

that have supported CCM programming success– Document existing bottlenecks in program

implementation and approaches to overcome them

– Draw lessons learned

The framework

The original CCM framework

The framework

INSTITUTIONAL PLATFORM : Policy and Institutional Support

STRATEGIC ELEMENT 2:Services and Information from CHWs available to the Communities

STRATEGIC ELEMENT 1:Link between the Health System and the Communities

Coordination and Policy Setting Supply Chain Management Financing

Service Delivery and Referral

Supervision and Performance Quality Assurance

M &E and Health Information Systems

…an adapted framework

STRATEGIC ELEMENT 3:Behavior Change

Communication and Social Mobilization

Human resources

KEY FINDINGS IN SENEGAL

Part 3

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CCM Senegal: Historical overview

1990 2003 20102006 2007 2008

PNEUMONIA

Research on Cotrimoxazoe at health hut level

DIARRHEA

ORS treatment provided at health huts

Zinc pilot USAID community bilateral

Second extension USAID community bilateral

Decree 92-118: official status to health committees

Adoption of ACT for the national Protocol

POLICYApprobation of the use of Cotrim at health huts

2005

First extension of Cotrim at health hut

MALARIA Chloroquine treatment provided at health huts

ACT at health huts USAID community bilateral

Pilot RDT and ACT PECADOM

Introduction of RDT USAID community bilateral

20092004

Current program status

Beginning of 2010: More than 1,600 functional health huts 13/14 regions 58 of the 69 health districts

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90 90

524

1,2971,371

1,620

1,465

0

500

1,000

1,500

2,000

2004 2005 2006 2007 2008 2009 2010

# health huts offering CCM

1. Coordination and Policy Setting

Advocacy and Planning

Pilot and Early Implementation

Expansion/Scale-up

Mapping of CCM partners conducted

Needs assessment and situation analysis for package of services conducted

Stakeholder meetings to define roles and discuss current policies held

National policies and guidelines reviewed

MOH leadership to manage unified CCM established

Discussions regarding ongoing policy change (where necessary) completed

MOH leadership institutionalized to ensure sustainability

Routine stakeholders meetings held to ensure coordination of CCM partners

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1. Coordination and Policy Setting

Advocacy and Planning

Pilot and Early Implementation

Expansion/Scale-up

USAID and UNICEF self-positioned as partners to support MoHP

Feasibility study conducted to facilitate introduction of innovative idea

Stakeholder meetings to define roles and discuss current policies held

National guidelines reviewed but no written policy

MOH leadership to manage unified CCM established

Discussions regarding ongoing policy change completed

MOH leadership institutionalized but engagement at the regional level reduced.

CCM task-force has stopped functioning.

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7. Supervision & Performance Quality Assurance

Advocacy and Planning

Pilot and Early Implementation

Expansion/Scale-up

Appropriate supervision checklists and other tools, including those for use of diagnostics developed

Supervision plan, including number of visits, supportive supervision roles, self-supervision etc. established

Supervisor trained in supervision and has access to appropriate supervision tools

Supervision visit every 1-3 months, includes reviewing of reports, monitoring of data

Supervisor visits community, makes home visits, provides skills coaching to CHWs

CCM supervision included as part of the CHW supervisor's performance review

CHWs routinely supervised for quality assurance and performance

Data from reports and community feed-back used for problem solving and coaching

Yearly evaluation that includes individual performance and evaluation of coverage or monitoring data

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7. Supervision & Performance Quality Assurance

Advocacy and Planning

Pilot and Early Implementation

Expansion/Scale-up

Appropriate supervision checklists and other tools, including those for use of diagnostics developed

Supervision plan, including number of visits, supportive supervision roles, self-supervision etc. established

Supervisor trained in supervision but not have access to appropriate resources and tools

Supervision visit every 1-3 months, includes reviewing of reports, monitoring of data

Supervisor provides skills coaching to CHWs but does not systematically visit community nor make home visits,

No CCM supervision is not part of the CHW supervisor's performance review

CHWs routinely supervised but limited data available on quality assurance and performance

Limited use of data from reports and community feed-back for problem solving and coaching

No formal program evaluation carried-out

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8. M&E and Health Information Systems

Advocacy and Planning

Pilot and Early Implementation

Expansion/Scale-up

Monitoring framework for all components of CCM developed and sources of information identified

Standardized registers and reporting documents developed

Indicators and standards for HMIS and CCM surveys defined

Research agenda for CCM documented and circulated

Monitoring framework tested & modified accordingly

Registers and reporting documents reviewed

CHWs, supervisors and M&E staff trained on the new framework, its components, and use of data

Monitoring and evaluation through HMIS data performed to sustain program impact

OR and external evaluations of CCM performed as necessary to inform scale-up and sustainability

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8. M&E and Health Information Systems

Advocacy and Planning

Pilot and Early Implementation

Expansion/Scale-up

Monitoring framework was developed but not detailed enough to include all components of CCM and sources of information

Standardized registers and reporting documents developed

CCM indicators defined but not part of HMIS

Research agenda documented and circulated for piloting the introduction but not for monitoring the progress

Monitoring framework tested & modified accordingly

Registers and reporting documents reviewed

CHWs, supervisors and M&E staff trained on the new framework and its components, but little focus on the use of data

Limited M&E through HMIS data performed to sustain program impact

No OR and no external evaluations of CCM systematically performed to inform scale-up and sustainability

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Questions

What information do we get from the tables?

How can we use this information? What isn’t captured?

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