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Evaluation database

Evaluation report

2015 Burkina Faso: Independent evaluation for « Acceleration of maternal, neonatal and child morbidity and mortality reduction » project in Burkina Faso



Author: Ministry of Health

Executive summary

Background:

In a move to improve the health indicators for children under 5 years Burkina Faso committed, since many years ago, to accelerate the reduction of child mortality. In this regard, under the financial support of the Bill and Melinda Gates Foundation (BMGF) together with technical support from UNICEF, a PMNCH (Partnership for Maternal, Neonatal and Child Health) project was put in place, from 2008 to the end of 2013 in the Nord and Centre-Nord regions. The overall goal of this initiative was to reduce by 25% the U-5 mortality during the implementation period. Although the initial project targeted six strategic areas, the single principle intervention that was implemented was the community case management (CCM) of diarrhea and malaria as well as the screening of malnutrition. CCM of pneumonia was, however, piloted in two districts of the nine project targeted zones. This evaluation of this project implementation was conducted by a team of independent evaluators commissioned by the BMGF.

Purpose/Objective:

The principle goals of the project were: 1) measure the intervention coverage levels, 2) measure the project impact on child health using the Lives Saved Tool (LiST), taking stock of the implementation and scaling up of CCM interventions by the Ministry of Health (MOH) with support from partners.

Methodology:

The evaluation was conducted using a method with multi-faceted steps. It started with a randomized sampling in order to update the data collection tools including the use of Smartphones and the manuals by the community health workers (CHWs). This phase was followed by the training of 100 data collectors for 20 days. The data collection and field level activities took place in the following order: i) awareness sessions for administrative, health and communal authorities about the evaluation, its objectives and expected results, ii) data collection and data quality control/data cleaning, iii) data analysis and interpretation of results per targeted districts grouped in four zones as well as control districts for comparison purposes.

Findings and Conclusions:

In general terms, the response rate was high at 94.9% in the intervention zones and 94.3% in the control zones. The findings concerning the project implementation and quality of care demonstrated that there was insufficient quality of care by the CHWs and demand for care as well as utilization by the mothers and caretakers; a situation which led to non-achievement of the desired coverage level and child mortality reduction level. However, this project implementation registered positive changes on policy and program design namely: the development of CCM policy and strategic documents, putting in place a directorate in charge of community health and the elaboration of the national CHWs’ profile. The project implementation also led to synergies and leveraging of partnership with (i) the Micronutrient Initiative (MI) for the subsidy of the CCM of diarrhea with ORS+Zinc in Burkina Faso, and (ii) the integration of iCCM into the Global Funds (GFATM) proposals for the New Funding Model (NFM) resource mobilization. Likewise the results showed that the preventive interventions rose to a 90% coverage among children U-5, an increase in exclusive breast-feeding practices and a rise in the increase of the number of households owning LLINs during the project period.
Nonetheless, the application of the LiST tool results demonstrated only a 6.2% reduction in child mortality compared to the 25% target, and there was no significant difference in mortality reduction between the intervention and control zones (4.2%).

Recommendations:

  • Integrate the iCCM data into the overall health information system (HIS),
  • Elaborate iCCM supervision tools which include the direct observation of case management by trained CHWs,
  • Ensure an all-time supply of emergency supplies (medicines and consumables) to emergency departments (or the pediatric departments),
  • Ensure continuous availability of tools (iCCM work-sheets, manuals, counselling cards…) for the implementation of clinical IMNCI, 
  • Review the organization of the CHWs supervision plan with special focus zones with many CHWs in view of harmonizing the CHWs/supervisor ratio,
  • Systematic coaching of health providers in all basic health facilities on iCCM in order for them to ensure CHWs capacity strengthening as a way to address response to identified challenges,
  • Ensure periodic and regular refresher training as a means to reinforce CHWs competencies,
  • Train much more basic health center in-charges as a means to ensure response to the increased mobility of health providers,
  • Review the procurement process of CHWs in medicines and medical supplies,
  • Enhance community and social mobilization to increase demand for services from CHWs.

Lessons Learned:

Below is an account of the lessons learnt from the evaluation of the PMNCH project  :

  • iCCM is feasible in Burkina Faso but systematic and regular financial motivation of CHWs is very necessary in order to ensure full retention and functional CHWs as well as ensure a sustainable approach,
  • The joint project monitoring and supervision activities conducted by the Ministry of Health (MoH) and the partner agencies (UNICEF, WHO and UNFPA) demonstrated that the project visibility, increase in the health service utilization and motivation of the health workers as well as CHWs,
  • The health promotion practices demonstrated that there is an extra value added when community authorities and leaders are involved in the whole process as well as the contribution of local radios, TV and other social mobilization mechanisms,
  • The availability of drugs was one of the major success factors for the sustainability of the CCM project, hence if a strong community level supply chain system is not in place, the performance of CHWs and the demand for services will relatively be impacted, 
  • Systematic and constant communication with field/community level actors is necessary in order to reinforce commitment at all levels for the implementation of interventions including continued CHWs’ mobilization as a motivation factor and a way to the iCCM success. 


Full report in PDF

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Report information

Year:
2015

Country:
Burkina Faso

Region:
WCARO

Theme:
Early Childhood Development (ECD) - Home Based Care

Type:
Study

Partners:
UNICEF, WHO, National Institute of Statistics and Demography

Language:
French

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