Comprehensive Evaluation of the Community Health Program in Rwanda. Concern Worldwide. Theory of Change

Transcription

1 Comprehensive Evaluation of the Community Health Program in Rwanda Concern Worldwide Theory of Change

2 Concern Worldwide 1. Program Theory of Change

3 Impact Sexual and Reproductive Health Maternal health Newborn and U5 mortality Infant and young child nutrition Decreased prevalence of HIV/AIDS, TB and malaria Increased, equitable coverage of an essential package of interventions along the continuum of care Intermediate Outcomes Family Coverage of ANC, SBA and PNC IYCF Immunization coverage Treatment of ARI, malaria and diarrhoea TB cure and detection rates Hygiene and nutrition practices Immediate outcomes Outputs Improved key household practices Care seeking behaviours at household level MNH Increased access to/utilization of essential interventions Timely detection and referral for preventive and curative services 1 ASM 2 Binomes 1 ASM and 2 Binomes deployed in each village and delivering a defined community health package of promotive, preventive and curative services iccm Nutrition TB DOTs Community engaged in planning community health and in assessing local health need Activities Recruitment of Training of Supply of drugs, equipment and consumables Supervision/ mentorship of Reporting Motivation and retention (C-PBF and Cooperatives) Resources mobilization Review/design of policies, plans, protocols, and guidelines Monitoring and Evaluation Coordination and Management Inputs Funding Technical assistance Human Resources Coordination Partnership Leadership

4 Concern Worldwide 2. Key Assumptions

5 From Inputs to Activities Activities Recruitment of Training of Supply of drugs, equipment and consumables Supervision/ mentorship of Monitoring and Evaluation Reporting Motivation via Cooperatives Resources mobilization at central and local level Review/design of policies, plans, protocols, and guidelines Coordination and Management Assumptions. High level political commitment to deliver CHP at scale. Donors and partners commitment to support CHP. Funding from donors is catalytic to leverage local resources for CHP. Relevant line Ministries (MINALOC, MINECOFIN, MOH) plan in coordination at all levels. Institutional capacity to deploy sufficient, skilled health care managers to oversee and coordinate the CHP. Institutional capacity to deploy sufficient, skilled health care workers in charge of direct supervision of at District and Facility level. Sufficient volunteers at community level meeting minimum requirements to be enrolled as. Sufficient means in place to allow managers and healthcare workers to coordinate and supervise the CHP. Coordinated approach to procurement of equipment and medical supplies for CHP., management and supervision strategy and tools in place and consistently adopted in all sites. Technical assistance provided to set up and implement all the CHP activities at all levels and in all sites. Clear coordinating structure consistently in place at all levels. Policies, protocols and guidelines for CHP internally consistent, available at all levels and updated. Local support from partners consistent with plans and needs Inputs Human Resources Funding Leadership and means Technical assistance Partnership Coordination

6 From Activities to Outputs Outputs 1 ASM and 2 Binomes deployed in each village and delivering a defined community health package of promotive, preventive and curative services Assumptions Recruitment and retention. Communities elect as needed, and in respect of minimum eligibility criteria. 3 are regularly in post in each village. Financial incentives and participation to cooperatives motivate to stay in post. maintain a respectful attitude and behaviour so that they are not replaced by communities. New are recruited timely as needed to replace those who leave the post Training. Training guidelines, curricula and tools are in place for each level of the CHP ToT cascade. There are sufficient trainers to support ToT from central to district, facility and community level. training improves their knowledge and practice. All receive training as per guidelines. A policy for refresher training is in place and it is implemented. Funding and means are in place to sustain training. Partners support training centrally or at local level in line with national guidelines and as needed Supply of equipment and drugs. There are clear guidelines defining the minimum equipment for and its replacement policy. All the equipment is procured and distributed to all new. Equipment is duly maintained and used by Medicines are regularly procured and available to. Health facilities distribute medicines to as per guidelines. Quantification of community needs is appropriate, and it is monitored and reviewed at cell, facility and district level. Stock out are timely reported and addressed via rapid replenishment. Expiry of drugs is monitored and timely reported Supervision and Reporting. Sufficient HRH in place to allow for regular, quality supervision. Supervision guidelines and tools in place. Supervision improves performance. Means and resources available to perform supervision at cell and district level. Cell coordinators and in-charges at HF are skilled and motivated to perform supervision Reports are regularly produced at all levels. Quality, accuracy and timeliness of reports overseen and managed. Reports inform decisions. Feed back mechanisms in place Monitoring and evaluation. Routine data from HMIS, Siscom and Rapid SMS regularly collected at all levels. Quality, timeliness and accuracy of data assessed and quality control mechanism in place. Sufficient skilled HRH at central, district and facility level to manage routine data. Routine data regularly analysed and core indicators used for decision making and to improve performance A CHP research agenda informs studies on CHP implemented in Rwanda. All evidence is centrally collected, updated and used by policy makers. Evaluation function defined and regular evaluations of CHP performed Activities Recruitment and retention of Training of Supply of drugs, equipment and consumables Monitoring and Evaluation Supervision/ mentorship of Reporting Resources mobilization at central and local level Review/design of policies, plans, protocols, and guidelines Coordination and Management

7 From Outputs to Immediate Outcomes Immediate outcomes Improved key household practices Care seeking behaviours at household level Increased access to/utilization of essential interventions Timely detection and referral for preventive and curative services Community engaged in planning community health and in assessing local health need Assumptions. regularly perform health promotion activities. Local leaders and other influential people in communities support the health promotion delivered by. Health Promotion Campaigns organized by the health sector support activities performed by. Communities access health promotion services. Improved knowledge leads to change in practices. regularly perform all services as per CHP curriculum. regularly access households to offer services. Quality of services leads to trust and acceptance from communities. Communities perceive clear advantages in seeking advice or care from a CHW rather than other sources of care (private provider; formal health system). Communities demand for services. All communities access services. Danger signs requiring immediate care are known at household level. are able to detect danger signs and to assess whether referral is needed. Communities know their and are able to reach them quickly at any time, in case of health emergencies. have regular access to Rapid SMS (phone; chargers; credit). Rapid SMS triggers and immediate response from the health facility. Ambulance services readily available if needed. Communities participate to the election of their. participate to community level activities (planning, campaigns, etc). Local leaders, traditional authorities and religious leaders support and promote the work of. There is coordination at community level between civil society organizations, community volunteers and other cadres. Communities are engaged in defining health plans at local level Outputs MNH 1 ASM 2 Binomes 1 ASM and 2 Binomes deployed in each village and delivering a defined community health package of promotive, preventive and curative services iccm Nutrition TB DOTs