Local Innovation for Better Outcomes for Neonates (LIBON) Project PLAN Nepal Child Survival Project XXII Sunsari, Parsa, and Bara Districts in Nepal
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Local Innovation for Better Outcomes for Neonates (LIBON) Project PLAN Nepal Child Survival Project XXII Sunsari, Parsa, and Bara Districts in Nepal Final Evaluation Report 30th September 2007 to 29th September 2011 Cooperative Agreement No. GHN-A-00-07-0006-00 1 Report Prepared By Mahesh K. Maskey – Lead Evaluator, Final Evaluation Team Bhagawan Das Shrestha – Field Program Manager – LIBON Dipak Dahal - Monitoring and Evaluation Officer – LIBON Sher Bahadur Rana – Health Coordinator – Plan Nepal Harpreet Anand – Program Manager -- Plan USA Submitted: December 23, 2011 Plan International USA HARPREET ANAND, PROGRAM MANAGER, FIELD PROGRAM SUPPORT Plan International USA, Inc. 1730 Rhode Island Avenue, NW, Suite 1100 Washington, DC 20036 Tel. (202) 223-8325 [email protected] Plan International NEPAL BHAGWAN DAS SHRESTHA, FIELD PROGRAM MANAGER Plan International NEPAL Shree Durbar, Pulchowk-3 P. O. Box: 8980 COUNTRY, ZIP CODE: 44700 Tel. + 977 1 5535 560 extensión 135 [email protected] 2 ACRONYMS and ABBREVIATIONS AHW Auxiliary Health Worker ANC Antenatal Care ANM Auxiliary Nurse Midwife BCC Behavior Change Communication BPP Birth Preparedness Package CB-IMCI Community-based Integrated Management of Childhood Illness CB-NCP Community-based Neonatal Care Program CBO Community-based Organization CDK Clean Delivery Kit CDP Community Drug Program CHD Child Health Division (MoHP) CHW Community Health Worker CHX Chlorhexidine CS Child Survival CSHGP Child Survival and Health Grants Program CSSA Child Survival Sustainability Assessment CSTS+ Child Survival Technical Support + DAG Disadvantaged Group DDC District Development Committee DHO District Public Health Office DHS Demographic and Health Survey DIP Detailed Implementation Plan DPHO District Public Health Office DTOT District Training of Trainers EDP External Development Partner FCHV Female Community Health Volunteer FE Final Evaluation FGD Focus Group Discussions FHD Family Health Division (MoHP) FP Family Planning HA Health Assistant HF Health Facility HFMC Health Facility Management Committee HMIS Health Management Information System HQ Headquarters HP Health Post IEC Information, Education, Communication IDI In-Depth Discussions IMCI Integrated Management of Childhood Illness IOM Institute of Medicine KPC Knowledge, Practice and Coverage LBW Low Birth Weight LIBON Local Innovation for Better Outcomes for Neonates LQAS Lot Quality Assurance Sampling (statistical method) i MCHW Maternal and Child Health Worker MDG Millenium Development Goal M&E Monitoring and Evaluation MG Mothers Group MINI Morang Innovative Neonatal Intervention MNC Maternal Neonatal (or Newborn) Care MNCH Maternal, Neonatal and Child Health MoHP Ministry of Health and Population MOU Memorandum of Understanding MTOT Master Training of Trainers NFHP National Family Health Program NGO Non-governmental Organization NHEICC National Health Education and Information Communication Center NHSP-IH Nepal Health Sector Programme – Implementation Plan NNH Neonatal Health NNM Neonatal Mortality PHC/ORC Primary Health Care / Outreach Clinic ORS Oral Rehydration Solution ORT Oral Rehydration Therapy PHC Primary Health Center PNC Postnatal Care PSBI Possible Severe Bacterial Infection PVO Private Voluntary Organization PWG Pregnant Women’s Group RCSD Resource Center for Sustainable Development (Sunsari NGO Partner) RHC Reproductive Health Committee RHCC Reproductive Health Coordination Committee RHFA Rapid Health Facility Assessment SA Supervision Area SBA Skilled Birth Attendance/Attendant SHP Sub Health Post SLC School Leaving Certificate SM Safe Motherhood STD Sexually Transmitted Disease TBA Traditional Birth Attendant TRM Technical Reference Material TT Tetanus Toxoid UNICEF United Nations Children’s Fund USAID United States Agency for International Development USG United States Government VDC Village Development Committee VHW Village Health Worker WHO World Health Organization WRA Women of Reproductive Age ii Acknowledgement We express our deep gratitude to PLAN Nepal and PLAN USA for entrusting us the task of final evaluation of Local Innovation for Better Outcomes for Neonates (LIBON) project in Sunsari, Parsa, and Bara Districts of Nepal. In particular, the support of Mr. Donal Keane, Plan Country Director, and Mr. Subhakar Baidya, Plan Program Support Manger is highly appreciated. Our special thanks to Dr. Bal Krishna Subedi, Chief, Policy and Planning Division, MOHP, Nepal, Mr. Parashuram Shrestha, Chief CB-IMCI, Child Health Division, and Dr. Shilu Aryal, Chief, Safe Motherhood Unit, Family Health Division who contributed their experience and expert opinion in the Final Evaluation sharing workshop. We also want to acknowledge the active participation in the FGDs and IDIs by Ms. Naramaya Limbu, Aid Development Program Management Specialist, USAID, Nepal, and Ms. Mangala Manandhar, Senior Public Health Officer, Family Health Division, DoHS, MOHP Nepal during their field visits. We at the same time gratefully acknowledge the kind support, enthusiasm and active participation of all the government staffs and staffs of Plan offices in the district and sub- district level the district health and public health officers, health facility in-charge, and FCHVs of Wards visited all have shown high motivation and enthusiasm in ensuring data quality of the final evaluation field visit. Finally, we are indebted to the pregnant women, members of mothers groups, the mothers-in- law, and husbands who participated in the FGDs and IDIs and provided valuable information to the final evaluation team. The collection of qualitative data and triangulation of quantitative data would not have been possible without their cooperation. iii Table of Contents ACRONYMS AND ABBREVIATIONS ....................................................................................... i PART A. EXECUTIVE SUMMARY ...........................................................................................v PART B. INTRODUCTION – PROJECT OVERVIEW .............................................................. 1 PART C. EVALUATION ASSESSMENT METHODOLOGY ................................................... 8 PART D. DATA QUALITY AND USE ......................................................................................12 PART E. PRESENTATION OF PROJECT RESULTS ...............................................................13 PART F. DISCUSSION OF RESULTS .......................................................................................20 PART G. DISCUSSION OF SUSTAINABILITY OUTCOMES ETC .......................................25 PART H. CONCLUSIONS AND RECOMMENDATIONS .......................................................28 PART I. ANNEXES .................................................................................. attached as separate files Annex 1: Results Highlight – Evidence Building ............................................................................. Annex 2: List of Publications and Presentations Related to the Project ........................................... Annex 3: Project Management Evaluation ....................................................................................... Annex 4: Workplan Table ................................................................................................................. Annex 5: Rapid CATCH Table* ....................................................................................................... Annex 6: Final KPC Report .............................................................................................................. Annex 7: CHW Training Matrix ....................................................................................................... Annex 8: Evaluation Team Members and their Titles ...................................................................... Annex 9: Evaluation Assessment methodology ............................................................................... Annex 10: List of persons interviewed and contacted during Final Evaluation ............................... Annex 11: Final operations research report on Chlorhexidine on umbilicus stump ......................... Annex 12: Special reports ................................................................................................................. Annex 13: Project Data Form ........................................................................................................... Annex 14: Annex 14: Grantee Plans to Address Final Evaluation Findings ................................... Annex 15: Grantee Response to Final Evaluation Findings ............................................................. Annex 16: Social Mapping Mat ........................................................................................................ Annex 17: Mother’s Card ................................................................................................................. Annex 18: Govt. of Nepal CB-NCP Final Evaluation Report .......................................................... iv A. Executive Summary The Local Innovation for Better Outcomes for Neonates (LIBON) project (2007-2011) of PLAN Nepal is designed to assist the Ministry of Health and Population (MoHP) in reducing neonatal mortality in three districts of lowland Terai region of Nepal. In Sunsari and Parsa, the LIBON project primarily assists the Community-Based Newborn Care Program (CB-NCP) run by the Government of Nepal. In Parsa, an additional Chlorhexidine (CHX) component for