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

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

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