Scale-Up Assessment for the Mphatlalatsane Project—“Early Morning Star”—In Lesotho

MEASURE Evaluation August 2019 Scale-Up Assessment for the Mphatlalatsane Project—“Early Morning Star”—in Lesotho Introduction quickly and more effectively1), the United States Agency for International Development (USAID) asked its funded The HIV epidemic has a profound effect on children project—MEASURE Evaluation—to assess the scalability in sub-Saharan Africa, where more than 15.1 million of the ECD-integrated intervention in each country. children have lost one or both parents. In 2014, as part of its orphans and vulnerable children (OVC) programming, This document outlines intervention and assessment the United States President’s Emergency Plan for AIDS results in Lesotho. The Mphatlalatsane project, or “Early Relief (PEPFAR) announced a special initiative for Morning Star,” was implemented by Management Sciences children under five years old affected by the epidemic. for Health (MSH), in partnership with Stellenbosch University, University College London, and Oxford The initiative funded interventions and research in southern University. The aim was to increase HIV testing and Africa (Lesotho, Eswatini [formerly Swaziland], and treatment while improving early childhood development Zimbabwe) to generate data on successful approaches that outcomes in the mountainous Mokhotlong District. The result in improved health, to establish evidence to improve project was implemented through existing early childhood and inform programming, and to determine the potential for 1 program scale-up. Adamou B, et. al. (2014). Guide for Monitoring Scale-up of Health Practices and Interventions. Chapel Hill, NC, USA: MEASURE Evaluation, University of North Carolina. Retrieved from https:// The programs integrated OVC programming with pediatric www.measureevaluation.org/prh/resources/guide-for-monitoring- treatment and prevention of mother-to-child transmission scale-up-of-health-practices-and-interventions (PMTCT) of HIV. Evaluations of each intervention generated data on successful approaches that improve health and early childhood development outcomes; the evaluations also established evidence to improve programs. However, evidence of effectiveness is not enough to ensure that interventions become part of routine program implementation elsewhere. Achieving that end requires early planning and strong advocacy from multiple stakeholders. To prepare for potential scale-up after the results of the evaluation become available (scale- up pertains to efforts to reach more people with a proven practice, more Photo by James Walsh, Sinamatella Productions MEASURE Evaluation August 2019 care and development (ECCD) centers to evaluate the Results intervention in a remote and hard-to-reach region. The Intervention The intervention targeted all families and caregivers of Content on health topics and book sharing techniques was children ages one through five in the area, who were delivered by a trained intervention facilitator and a community welcomed to join without the typical fee. Enrolled mentor to a group of three to eight caregivers. During book- caregivers (defined as a family member in the child’s sharing sessions, caregivers learned how to sit and share a household responsible for providing daily care) attended book with a child for about seven minutes a day. A new book a series of nine weekly sessions at the local ECCD center was provided each week. The nine sessions were followed in groups of three to eight. During the two-hour sessions, by a community outreach day, during which health services trained facilitators and community mentors delivered were offered to children, their families, and other members information on health and demonstrated book sharing of the community: birth registration, nutrition screening, TB techniques with a child. screening, and testing for HIV/AIDS. The objectives of the scale-up assessment were to describe The sessions were given by pairs of trained facilitators the intervention, its stakeholders, and their relationships; and community mentors for the Mphatlalatsane project, to assess the interest and readiness of stakeholders to scale delivered in ECCD centers. MSH, with support from up; to identify opportunities and barriers to scale-up; and Stellenbosch University, recruited facilitators in the to generate information for strategy and recommendations Mokhotlong and Maseru Districts. Successful candidates for scale-up. This brief summarizes the background, data had backgrounds in ECCD or social sciences or experience collection methods, analysis, findings, and recommendations with group facilitation. Candidates were trained by a team of this scale-up assessment. from Stellenbosch University and two ECCD experts from the University of Reading. Methods Facilitators and community mentors were trained on book The scale-up assessment included a desk review, qualitative sharing, nutrition, use of local food for cooking, food data collection, and cost estimation. Qualitative data preparation and sanitation, HIV transmission, importance of were collected through 26 key informant interviews with knowing HIV status and adhering to antiretroviral therapy, program implementers, government and civil society and information on TB. The book-sharing component stakeholders, and donors, using a semistructured set of data focused on building relationships, developmentally collection tools adapted for each audience. appropriate techniques for sharing stories with children, The cost-estimation phase of the assessment included a costing and ways to discipline a child appropriately. Caregivers questionnaire and a cost-estimation tool. We considered scale- also learned how children typically express their emotions. up scenarios in which the intervention was continued with an A facilitator’s level of education was not thought by the international and a local implementing partner. We also varied implementers to be as important as their comfort with the number of sessions provided as part of the intervention in children and knowledge of the local language. five PEPFAR priority districts of Lesotho. Data were collated and analyzed in Microsoft Excel Project Training Materials through matrices developed to identify commonalities and Training materials were developed by Stellenbosch University differences across interviews. Qualitative analysis identified and refined in consultation with representatives from the broad themes and factors affecting scale-up, identified Lesotho Ministry of Education and Training (MOET). assumptions and program elements not documented Program materials were manuals for the facilitators and elsewhere, and assessed support for scale-up. mentors, books for the families, instructional videos, battery power banks, and battery-powered lamps. Program 2 MEASURE Evaluation August 2019 Photo by James Walsh, Sinamatella Productions materials, food, and supplies for each week were transported employment rates.2 Project managers could select candidates by the facilitators and mentors who traveled to their posts in who worked best with children. Facilitators were given the Mokhotlong District. in-depth training and ongoing supervision, and refresher trainings were delivered halfway through. Facilitators An advisory committee with district representatives from and mentors reported they were well-versed in the subject the MOET, the ministries of health, agriculture and food material and could switch roles as needed. In addition, security, local government and chieftainship, and social preexisting ECCD centers provided a readily available venue. development provided support in planning for community outreach days. Local chiefs were engaged to provide Coordination of stakeholders community support to the project. Stakeholders from the MOET, the MOH, and the Ministry of Social Development (MOSD) also spoke highly of the Assessment of Intervention Strengths and intervention’s approach, saying that stakeholders from the Challenges various ministries were engaged throughout the planning and implementation process. They also thought it was important Intervention Strengths that the intervention had avoided stigmatizing people living Increased exposure to ECCD concepts with HIV by inviting participants from all families. Stakeholders at all levels had positive opinions about the Multisectoral approach to HIV testing and treatment project. Session facilitators and community mentors said Stakeholders from USAID and nongovernmental ECCD the sessions facilitated community building among the organizations spoke about the value of combining an caregivers and that the book sharing strengthened the intervention focused on HIV/AIDS—which is a sensitive relationship between caregivers and children. Facilitators also subject—with ECCD, a nonsensitive subject. The outreach thought the sessions exposed the community to important component was a good way to deliver services to hard-to- concepts related to child development, such as emotional and reach populations who often don’t have access to testing developmental milestones. Readily available workforce 2 According to the United Nations, unemployment in 2017 was Program facilitators for implementation were easily 27.5% of the labor force; secondary school gross enrollment ratio was 62% female and 46% male (http://data.un.org/Coun- recruited, owing to Lesotho’s high level of education and low tryProfile.aspx?crName=lesotho#Social). 3 MEASURE Evaluation August 2019 and treatment in their communities. The intervention was tuberculosis screening, birth certificate registration, and successfully

Load more