Developing Ministry Capacity and Partnerships for Sustainability and Scale

- the case of USAID funded Maternal and Child Survival Project in Rural Ghana

Mohammed Ali, Health Program Manager – CRS Ghana

CORE Group Meeting – Portland USA

May 18, 2016

Introduction

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• Project Title: EPPICS, USAID

funded • Goal: Contribute to

reduction in maternal/child mortality

• Partner: Ghana Health Services

• Location: East Mamprusi district

• Target: 51,000 direct beneficiaries

East Mamprusi

The Problem Analysis

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Baseline MCH Indicators EM, NR and National- 2010/11

East Mamprusi

Northern Region

Ghana

Antenatal visits (1st trimester)

30 49 55

Antenatal visits(4+)

46 58 78 Supervised deliveries

43 38 46

IPT2+ 51 33 44 ITN use 36 45 Institutional MMR

275 95 68 Under 5 Mortality Rate

138 137 80

Poor uptake of MCH services → High morbidity and mortality

Low Government capacity →poor service delivery Poor community engagement→ low patronage of services

How did we partner with MoH?

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Partnerships

CRS maintains partnership at multiple level with the Government

- National, Regional, Districts --- across varied sectors

Key for pooling resources to facilitate cost effectiveness

Revolves around defined roles and responsibilities

Build on mutual trust, respect for each other and long term relationships

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EPPICS Partnership Framework

.

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Project success and sustainability SUPPORTIVE

Technical, Resources, Funds etc

ACCOMPANIMENT Implementation

&MEAL Promising strategies

for scale-up

COLLABORATIVE Joint Assessment &Consultations

for Project Design

EPPICS Partnership Framework –cont.

1. Collaborative- consultative - (assessments/design) a) Identify core, immediate and underlying causes b) Formulate goals and strategies 2. Supportive/Facilitative - Technical, Resources funds/logistics) a) Training of Trainers – stepdown for CHOs &CBAs,

MEAL/IQAT b) Fuel, motorbikes, tools including equipment

3. Accompaniment (Implementation & MEAL) a) Joint implementation with GHS as lead b) Joint monitoring and evaluation

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Facilitators in partnering with MoH

Trust/relationship built over time

Track record cultivated over time

Shared goal/objectives including theory of change

Technical capacity- CP, Regional and HQ

Appreciate roles/responsibilities – including strengths and weaknesses

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Key Outcomes

38% increase in exclusive breastfeeding

43% increase in adoption of improved feeding practices

60% increase in skilled assisted deliveries

97% increase in post-natal visit within 2 days of delivery

130% increase in Essential Newborn Care

109% reduction in institutional maternal mortality

131% reduction in institutional infant mortality rate

80% reduction in neonatal mortality rate

37% improvement in quality antenatal care

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Impact: Mortality based Indicators from 2010 - 2015

• .

10

295

131

76

47 57 51

62

44

25 19 13 13 7 8 5 5 4 3 2010 2011 2012 2013 2014 2015

Figure 1: Indicators of Mortality in East Mamprusi District (2010 - 2015)

Institutional Maternal Mortality Rate Infant Mortality Rate Neonatal Mortality Rate

Mechanisms for sustainability and scale

Sustainability

MoH led- right from the design stage

Transfer of knowledge and skills – ripple effect

Existing Systems and structures strengthened

Tools and guidelines developed to guide replication

scale

Already scaled up into five additional districts

MoH sourcing funds to replicate in 5/10 regions of Ghana

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Challenges to Partnerships

Health worker attrition- transfers

Delayed Government subventions

Many partners - one Government (Push – Pull factors)

Late submission of activity and financial reports

Clash of values – Artificial contraceptives

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Conclusions

In resource poor settings, partnership is key to achieving results

Public private collaboration is needed to enhance achieving the objectives of community-based maternal and child health interventions

Pooling resources and working together is the surest way of making difference in interventions

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Funding for this project was made possible by USAID

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THANK YOU