2012 Cambodia: End-of-project Evaluation of Health Behaviour Change Ccommunication Project in Cambodia
Author: Eng Peou, Managing Director, Market Strategy & Development Co., Ltd (MSD) Cambodia, Pavithra Ram, Public & Social Research, Taylor Nelson Sofres (TNS) Vietnam
The importance of changing the behaviour of both health providers and their clients was recognized and highlighted in Cambodia’s first Health Sector Support Project (HSSP I) 2003–2007, which aimed to improve the sector’s capacity and performance through measures targeting the poor, particularly in rural areas, and lessening the impact of infectious diseases and malnutrition.
The project sought to strengthen the capacity of national, provincial and district health care providers to deliver effective health promotion and education services by improving skills, attitudes and behaviours with clients. In this way, the project could substantially improve the overall quality of health services, while also building awareness among the public of key health care practices, especially those affecting mothers and children.
The Health BCC project, jointly supported by the EC and UNICEF, was initiated on 1 January 2005 and had a total budget of 5.7 million euros over a six-year period. Originally, the project duration was five years, ending 31 December 2009. A one-year no-cost extension was provided (based on recommendations from the 2008 Midterm Report) for the project to transition from EC funding to other support and to allow results to be consolidated.
The main goals of the evaluation were:
1. To assess the project’s performance using standard evaluation criteria of relevance/appropriateness, effectiveness, efficiency, impact (potential) and sustainability
2. To document good practices and successes, to generate evidence-based lessons learned and recommendations, and to guide the way forward toward further strengthening ongoing efforts, new initiatives (including possible programme replication) and BCC expansion.
It is intended that the primary users of the evaluation will be MoH (in particular NCHP), the EC and UNICEF. In addition, the findings of the antenatal care (ANC) BCC project evaluation will be shared with a broader group of interested communication and development partners, including NGOs.
The assessment was conducted to ensure participation of stakeholders at the national, provincial, district and village levels. Methodology comprised three phases:
1. The desk review phase included comprehensive assessments of all project documents, log frames, EC monitoring reports, UNICEF annual progress reports, work plans, midterm reviews, a training needs assessment, a baseline survey on community health volunteers (CHVs) and data from the Cambodia Anthropometrics Survey (CAS) 2008 and the Cambodia Demographic and Health Survey 2005.
2. During the national-level phase, key people were interviewed from NCHP, EC, UNICEF and the PSC. These interviews built understanding of the relevance of the BCC project in the Cambodian context, the effectiveness of implementing the project, the challenges of working with multiple partners, and perspectives on sustainability.
3. During the provincial-level phase, interviews were conducted with representatives of PHDs, PHPUs, ODs, maternal and child health (MCH), district health promotion units (DHPUs), health centre staff and village health support groups (VHSGs). A baseline survey on key family practices was conducted among community and village health volunteers to obtain end-line data on knowledge, attitudes and practices (KAP) in terms of the 12 key family practices . Some additional questions about the volunteers’ role in the BCC project were also included. Paired interviews were conducted with community members (women with children) to understand their health-seeking behaviours, triggers and barriers.
Findings and Conclusions:
The evaluation’s overall conclusion is that the Health BCC project was relevant to the context and largely effective in contributing to Cambodia’s health promotion needs. The project was successful in meeting its objective as defined by the national-level log frame: strengthening national BCC policymaking and NCHP’s capacity to support BCC at the national and provincial level.
At the provincial levels, BCC training was provided to PHPUs and health providers. Health centre staff and VHSGs were also trained on counselling and interpersonal communication. Though the evaluation was unable to quantify the extent to which NCHP-developed BCC tools and resources were used, it showed that most provincial-level health providers found the training and IEC materials to be useful.
Second, and most importantly, NCHP’s long-term role and MoH’s vision for the institution as a pivotal point for health promotion remains unclear.
While the BCC resources developed during the initiative have wide applicability, the sustainability and expansion of the project’s BCC activities are doubtful due to the lack of a long-term approach for health promotion in Cambodia and necessary government funds. At the provincial level, while the benefits of health provider and provincial staff training can be sustained, expansion of the activities will be difficult. It is therefore imperative for NCHP to expand its donor base and leverage additional resources.
Overall, BCC is a strategic undertaking – a vision of a process of social transformation – and dealing with it as a project has been complicated. Despite the complex nature of the initiative itself, including partnerships between bilateral and multilateral organizations and an institute within a sector, the project can be largely considered a success.
Based on the evaluation, the following recommendations have been made for future activities:
1. NCHP should proactively collaborate with other vertical health programmes to integrate and coordinate BCC activities. This would require the institution to promote itself as the focal point for health promotion. As NCHP has the experience of working on two large BCC campaigns (ANC and complementary feeding), it should be able to promote itself as a capable, professional entity equipped to implement BCC campaigns.
2. NCHP should continue to seek other sources of funding by actively writing proposals for different funds. The evaluation noted that NCHP had already begun this process by writing a proposal to the Global Fund. Though the funds were not granted, NCHP views the experience as a lesson learned in improving future proposals.
3. Given that NCHP has a role in fundraising, it should consider to build capacities of its staff in proposal writing and results-based reporting in order to create successful proposals.
4. While the primary role of NCHP should be health promotion, the evaluation found that NCHP’s capacity as a lead institution in development and management of social research is high. Partners who worked with the institution on research projects have been impressed with staff abilities. Though this is outside the realm of health promotion, the NCHP skill base built over the last 10 years should be utilized. NCHP should therefore continue to nurture a separate research team for health development and promotion.
5. If an organizational restructure is not possible in the future, the NCHP team structure under the BCC project should be implemented institution-wide (i.e. teams for M&E, information services, protocols and guidelines, training and management), as the departments are more relevant than the current divisions (primary health care, tobacco and health, etc.).
Refer to the report for other recommendations.
Full report in PDF
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