INDEPENDENT EVALUATION OF THE PMNCH RAPID SCALE-UP CONCEPTUAL FRAMEWORK

Transcription

1 INDEPENDENT EVALUATION OF THE PMNCH RAPID SCALE-UP CONCEPTUAL FRAMEWORK Evaluation Core Group Johns Hopkins University Bloomberg School of Public Health

2 PMNCH: 1 st objective To engage governments and partners in concerted, accelerated efforts sufficient to achieve coverage levels for highimpact MNCH interventions consistent with at least a 25% reduction in child mortality within three years in Burkina Faso, Mozambique and Malawi ("jump start" countries).

3 Evaluation framework: objectives identify indicators to be measured in the evaluation; plan for the timely collection of data on these indicators; assess whether implementation is taking place as planned; assess whether the strength of implementation is compatible with the desired rate of reduction in underfive mortality.

4 Conceptual framework for the independent evaluation NATIONAL Mobilize partnerships Strengthen district capacity DISTRICT LOCAL Select effective interventions Procure supplies PMNCH introduction Leverage funds Deploy, train, supervise HWs Plan for implementation Implement community activities Attain high and equitable coverage with key interventions REDUCE MORBIDITY AND MORTALITY Set up M&E Monitor implementation

5 NOTE This is a generic framework that needs to be adapted to each country.

6 National level: tasks Mobilization of governments and partners at country level, including WHO, UNICEF, WB, UNFPA and other bilateral and multilateral donors Application of tools or processes for situation assessment and the estimation of potential impact from different subsets of interventions Definition of sets of interventions likely to lead to underfive mortality reduction of 25% or more (Partners please add specific goals for maternal health) Clear definition of the scope of implementation (e.g. national scaling-up or pilot district/province approach, or a combination of both) Preparation of national action plan and budget on the basis of the modeling exercise Development of a plan for country-driven MNCH M&E Leveraging resources for implementation Influencing national policies, human resource strategies and funding activities relevant to MNCH. Support and monitoring of implementation activities(these activities are described in greater detail in the middle section of the framework) Production of annual summaries of implementation and coverage levels, with recommendations of actions needed. Preparation of country-specific plans for sustaining interventions supported by the project and expansion to additional interventions in next three-year period ( ).

7 Linking tasks to indicators/ milestones (examples) Task Mobilization of governments and partners at country level, including WHO, UNICEF, WB, UNFPA and other bilateral and multilateral donors Application of tools or processes for situation assessment and the estimation of potential impact from different subsets of interventions Evaluation indicators/ milestones National steering committee is established. Committee meets regularly with participation of all partners. National implementation plan is prepared. National implementation plan is compatible with overall PMNCH approach. Governments and partners agreeable to and involved in situation assessment and estimation exercises. High-quality input data for estimation obtained. Estimation exercise performed adequately. National capacity built in use of assessment and impact estimation.

8 District/province level: tasks Implementation districts are identified and contacted Capacity building at district level Supply of equipment and deliverables is ensured IEC activities planned Human resources deployed Human resources trained and performing Supervision activities are in place Monitoring system is operational Equipment and deliverables reach the community level Access and utilization of interventions are high and equitable Intervention coverage is high and equitable

9 Linking tasks to indicators/ milestones (examples) Implementation districts are identified and contacted Capacity building at district level Supply of equipment and deliverables is ensured IEC activities planned. Workplan and timeline for district implementation are defined. Number of districts with workplans that include PMNCHrelated activities is compatible with national scaling-up plan. Equity issues are taken into account in deciding how to phase implementation. DHMT staff motivated and if applicable trained on implementation. Trainers are trained. Partners to discuss other approaches to capacity building (in addition to training). Deliverables are transferred to the districts in sufficient quantity on a timely manner. Equipment for delivering the commodities is available. Stockouts at district level are infrequent or non-existent. IEC messages are adequate. Media for delivering IEC are compatible with high population coverage.

10 Conceptual framework for the independent evaluation NATIONAL Mobilize partnerships Strengthen district capacity DISTRICT LOCAL Select effective interventions Procure supplies PMNCH introduction Leverage funds Deploy, train, supervise HWs Plan for implementation Implement community activities Attain high and equitable coverage with key interventions REDUCE MORBIDITY AND MORTALITY Set up M&E Monitor implementation

11 Mortality impact will depend upon choice and coverage of interventions Roadmap Quantified Lancet Lancet Lancet for Spectrum estimate INTERVENTIONS Africa CS NS MS maternal modelling WHO of impact Note: boxes with red corners include comments Frmwk series series series health tool MBB Choice available? Diseases (with variable degrees of evidence) FAMILY/COMMUNITY CARE Water, sanitation, hygiene x x x x Diarrhea Insecticide-treated nets x x x? x T x Malaria, IUGR Handwashing / hygiene x x x O x Diarrhea Birth preparedness x x Maternal and neonatal deaths that result from any complication of delivery eg hemorrhage, obstructed labor with uterine rupture or birth asphyxia/trauma. Clean delivery & cord care x x x x x x B x Maternal infections, neonatal tetanus, sepsis/pneumonia Early breastfeeding & temperature management x x x x x E x x Hypothermia, neonatal sepsis/pneumonia Comm.-based care of low birthweight infants x x x Neonatal sepsis/pneumonia, malnutrition Exclusive breastfeeding 0-5 months x x x x C x Diarrhea, pneumonia, neonatal sepsis/pneumonia Breastfeeding 6-11 months x x O x Diarrhea, pneumonia Complementary feeding after 6 months x x M x Diarrhea, pneumonia, measles, malaria Therapeutic feeding for severe malnutrition x P x Malnutrition Oral rehydration therapy x x x L x x Diarrhea Zinc for diarrhea x x x E x Diarrhea Vitamin A for measles x x x T x Measles Comm.-case-management of malaria x x x E x Malaria Comm.-case-management of pneumonia x x x D x x Pneumonia Comm.-case-management of neonatal pneumonia x x x x x Pneumonia OUTREACH Family planning x x x Complications of abortion, maternal and neonatal conditions arising from short birth spacing and higher parity Periconceptual folate x x x x x Congenital malformations Use of condoms in risk situations x AIDS, STDs Proper diet and nutrition in pregnancy x x Maternal malnutrition (including anemia), IUGR Antenatal care x x x x See under specific interventions provided through ANC Calcium supplementation in pregnancy x x x x Pre-eclampsia, preterm delivery IPT for malaria in pregnancy x x x x x x x IUGR, maternal malaria Tetanus immunization in pregnancy x x x x x x x x Tetanus Deworming in pregnancy x x Maternal anemia Detection & treatment of asymptomatic bacteriuria x x x x x x Preterm delivery, urinary infection in mother Detection & treatment of syphilis in pregnancy x x x x x x Congenital and maternal syphilis Prevention & treatment with iron in pregnancy x x Anemia VCT & nevirapine & appropriate infant feeding x x x x x x AIDS Cotrimoxazole for infants of HIV+ mothers x AIDS complications Immunization: BCG x Tuberculosis Immunization: Polio x Polio Immunization: Diphtheria x Diphtheria Immunization: Tetatus x Tetanus Immunization: Pertussis x Pertussis Immunization: Measles x x x x x Measles Vitamin A supplementation x x x x x Diarrhea, measles, malaria Immunization: Hib x x x x Pneumonia, meningitis Immunization: Pneumococcus x x Pneumonia Immunization: Rotavirus x Diarrhea Immunization: Hepatitis B x Hepatitis B in adults IPT for malaria in children x Malaria Zinc supplementation x x x x x Diarrhea, pneumonia, malaria CLINICAL CARE Skilled delivery care (site not speficied) x x x x x x Maternal and neonatal conditions, depending on the actual interventions being provided Resuscitation for newborn asphyxia x x x x x x x Asphyxia Antenatal steroids for preterm labor x x x x x x x Respiratory distress syndrome Antibiotics for PPROM x x x x x x x Preterm delivery, neonatal sepsis/pneumonia, maternal infections ARVs & care for mothers & children with AIDS x x AIDS Detection & management of pre-eclampsia x x x Eclampsia, preterm delivery Management of neonatal infections x x x x x x x Sepsis/pneumonia Antibiotics for pneumonia at PHC level x x x x Pneumonia Vitamin A for measles x x x x Measles Antimalarials at PHC level x x x Malaria Zinc for diarrhea at PHC level x x x Diarrhea Antibiotics for dysentery x x x Diarrhea Antimalarial CT for pregnant women & children x x x x Malaria Basic EMOC & immediate neonatal care x x x x x Maternal and neonatal conditions, depending on the actual interventions being provided Caesarean section for breech delivery x x xx Birth trauma, obstructed labor Management of severely sick children (referral) x x Pneumonia, diarrhea, sepsis/pneumonia Clinical management of neonatal jaundice x x Neonatal jaundice Kangaroo mother care for LBW infants x xx Hypothermia, sepsis/pneumonia Universal emergency neonatal care x x x x Neonatal conditions, depending on the actual interventions being provided Management of resistant AIDS at 1st referral level x AIDS Comprehensive obstetric & neonatal care x x x x x Maternal and neonatal conditions, depending on the actual interventions being provided

12 Lancet CS series Lancet NS series Lancet MS series Roadmap for maternal health Spectrum modelling tool Quantified estimate WHO of impact Choice available? Diseases (with variable degrees of evidence) INTERVENTIONS Note: boxes with red corners include comments Africa Frmwk MBB FAMILY/COMMUNITY CARE Water, sanitation, hygiene x x x x Diarrhea Insecticide-treated nets x x x? x T x Malaria, IUGR Handwashing / hygiene x x x O x Diarrhea Birth preparedness x x Maternal and neonatal deaths that result from any complication of delivery eg hemorrhage, obstructed la Clean delivery & cord care x x x x x x B x Maternal infections, neonatal tetanus, sepsis/pneumonia Early breastfeeding & temperature management x x x x x E x x Hypothermia, neonatal sepsis/pneumonia Comm.-based care of low birthweight infants x x x Neonatal sepsis/pneumonia, malnutrition Exclusive breastfeeding 0-5 months x x x x C x Diarrhea, pneumonia, neonatal sepsis/pneumonia Breastfeeding 6-11 months x x O x Diarrhea, pneumonia Complementary feeding after 6 months x x M x Diarrhea, pneumonia, measles, malaria Therapeutic feeding for severe malnutrition x P x Malnutrition Oral rehydration therapy x x x L x x Diarrhea Zinc for diarrhea x x x E x Diarrhea Vitamin A for measles x x x T x Measles Comm.-case-management of malaria x x x E x Malaria Comm.-case-management of pneumonia x x x D x x Pneumonia Comm.-case-management of neonatal pneumonia x x x x x Pneumonia OUTREACH Family planning x x x Complications of abortion, maternal and neonatal conditions arising from short birth spacing and higher p Periconceptual folate x x x x x Congenital malformations Use of condoms in risk situations x AIDS, STDs Proper diet and nutrition in pregnancy x x Maternal malnutrition (including anemia), IUGR Antenatal care x x x x See under specific interventions provided through ANC Calcium supplementation in pregnancy x x x x Pre-eclampsia, preterm delivery IPT for malaria in pregnancy x x x x x x x IUGR, maternal malaria Tetanus immunization in pregnancy x x x x x x x x Tetanus Deworming in pregnancy x x Maternal anemia Detection & treatment of asymptomatic bacteriuria x x x x x x Preterm delivery, urinary infection in mother Detection & treatment of syphilis in pregnancy x x x x x x Congenital and maternal syphilis Prevention & treatment with iron in pregnancy x x Anemia VCT & nevirapine & appropriate infant feeding x x x x x x AIDS Cotrimoxazole for infants of HIV+ mothers x AIDS complications Immunization: BCG x Tuberculosis Immunization: Polio x Polio Immunization: Diphtheria x Diphtheria Immunization: Tetatus x Tetanus Immunization: Pertussis x Pertussis Immunization: Measles x x x x x Measles Vitamin A supplementation x x x x x Diarrhea, measles, malaria Immunization: Hib x x x x Pneumonia, meningitis Immunization: Pneumococcus x x Pneumonia Immunization: Rotavirus x Diarrhea Immunization: Hepatitis B x Hepatitis B in adults IPT for malaria in children x Malaria Zinc supplementation x x x x x Diarrhea, pneumonia, malaria CLINICAL CARE Skilled delivery care (site not speficied) x x x x x x Maternal and neonatal conditions, depending on the actual interventions being provided Resuscitation for newborn asphyxia x x x x x x x Asphyxia Antenatal steroids for preterm labor x x x x x x x Respiratory distress syndrome Antibiotics for PPROM x x x x x x x Preterm delivery, neonatal sepsis/pneumonia, maternal infections ARVs & care for mothers & children with AIDS x x AIDS Detection & management of pre-eclampsia x x x Eclampsia, preterm delivery Management of neonatal infections x x x x x x x Sepsis/pneumonia Antibiotics for pneumonia at PHC level x x x x Pneumonia Vitamin A for measles x x x x Measles Antimalarials at PHC level x x x Malaria Zinc for diarrhea at PHC level x x x Diarrhea Antibiotics for dysentery x x x Diarrhea Antimalarial CT for pregnant women & children x x x x Malaria Basic EMOC & immediate neonatal care x x x x x Maternal and neonatal conditions, depending on the actual interventions being provided

13 Evaluation framework: next steps Discuss with partners Adapt at national level Adapt at district level Adapt at local level

14 Not to be confused! Implementation Impact plan modeling Independent tool evaluation Routine M&E function