Farta Child Survival Project
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FARTA CHILD SURVIVAL PROJECT Amhara National State,South Gondar Administrative Zone, Farta Woreda, Ethiopia Final Evaluation May 27 – June 11, 2007 Donald T. Whitson, MD, MPH Evaluator DATE OF SUBMISSION: December 2007 Cooperative Agreement No: HFP-A-00-02-0004600 October 1, 2002 - September 30, 2007This report was prepared by: Donald T. Whitson, MD, MPH 24/41 Sukhumvit Soi 18 Domus Condominium 18, 12th floor Khlong Toey, Bangkok 10110 Thailand Tel: +66-86-315-3454 E-mail: [email protected] Child Survival XVIII Project Final Evaluation 1 CARE Ethiopia May 27- June 11, 2007 CA # HFP-A-00-02-00040-00 ACRONYMS, ABBREVIATIONS AND DEFINITIONS AFP Acute flaccid paralysis ANC Antenatal care ARI Acute respiratory infection (pneumonia) BCC Behavior change communication CHW / CHA Community health worker / agent COPE “Client-oriented provider-efficient”: methodology for improving quality of health care delivery through special training and ongoing supportive supervision CORE Group of US-based NGOs with Child Survival projects; involved in polio-eradication programs CRP Community resource person CS Child survival DHS Demographic and Health Survey DIP Detailed implementation plan DPPO Disaster Prevention and Preparedness Office (the designated government liaison office for NGOs) DT Debre Tabor (capital of Farta Woreda) DTP Diphtheria, tetanus and pertussis vaccine. In Ethiopia, pentavalent vaccine is being used (DTP + Hepatitis B + Hemophilus influenza B) EOC Ethiopian Orthodox Church EPI Expanded program for immunization FCSP Farta Woreda Child Survival Project FGD Focus group discussion FWHO Farta Woreda Health Office GM Growth monitoring (not “genetically modified”---we’re not doing GM children yet!) HC Health center Health promoter Includes all community health workers (mother facilitators, EOC religious leaders, TBAs, CRPs, and others) HEARTH The HEARTH Nutrition model, a child nutrition methodology developed by Save the Children Federation using a positive deviance approach. HFS Health facility survey HIS Health information system HIV/AIDS Human immunodeficiency virus / Acquired immunodeficiency syndrome HP Health Post IFA Iron and folic acid (tablets, supplement during pregnancy) Child Survival XVIII Project Final Evaluation 2 CARE Ethiopia May 27- June 11, 2007 CA # HFP-A-00-02-00040-00 IMCI Integrated management of childhood illness IMNCI Integrated management of childhood and newborn illness (newer protocol than IMCI) Kebele A political sub-division of the Woreda (district). Labelled as “Peasant association” or “PA” in some earlier project documents. KPC Knowledge, practice and coverage (survey) LQAS Lot Quality Assurance Sampling (a sampling method for surveys) MCH Maternal and Child Health MOH Ministry of Health MTE Mid-term evaluation MTMSG Mother to mother support group NNT Neonatal tetanus OPV Oral polio vaccine ORS Oral rehydration solution (salts in packet) ORT Oral rehydration therapy (salts and/or other appropriate home fluids) RDF Rotating drug fund ToT Training of trainers VCHW Volunteer community health worker WHO Woreda health office Woreda A political sub-division of the region (South Gondar). Sometimes labeled as “District” in earlier SC documents. The Woreda is, in turn, subdivided into “kebeles”. Child Survival XVIII Project Final Evaluation 3 CARE Ethiopia May 27- June 11, 2007 CA # HFP-A-00-02-00040-00 Table of Contents Contents Pages A. Summary…………………………………………………………………..1 B. Assessment of the results and Impact of the project……........................3 1. Results: Summary Chart.............................................................................3 2. Results: Technical Approach......................................................................17 a. Overview of the project.........................................................................17 b. Nutrition.................................................................................................19 c. Acute respirator infections....................................................................27 d. Control of Diarrheal diseases...............................................................32 e. Immunization.........................................................................................35 f. Other interventions................................................................................41 g. New tools and appoaches......................................................................43 3. Results: Cross cutting approaches............................................................47 a. Behavioural changes Communication and Community mobilization........................................................................47 b. Skill development..................................................................................56 c. increase access to and availabiltity of quality health services............60 d.Capacity-Building approaches.................................................. .............63 i) CARE USA (Atlanta).............................................................................63 ii) Local partner organizations...................................................................64 iii) Health facilities......................................................................................71 iv) Health workers performance.................................................................71 e. sustainabilty strategy..............................................................................72 C. Program Management...............................................................................76 1. Planning.......................................................................................................76 2. staff training................................................................................................76 3.Supervision of the Program Staff................................................................77 4.Human Resources and Staff Mangement..................................................77 5.Financial Management...............................................................................78 6. Logistics Management...............................................................................79 7.Information Management............................................................................79 8. Technical and Administarative Support.....................................................83 9.Mission Support...........................................................................................84 10. Management Lessons learned.................................................................84 Child Survival XVIII Project Final Evaluation 4 CARE Ethiopia May 27- June 11, 2007 CA # HFP-A-00-02-00040-00 D. Other issues identified by the team...........................................................85 E. Conclusions and Recommendations..........................................................85 F. Results Highlights.......................................................................................88 Attachments: A. Evaluation Team Members and their titles - Attached B. Final KPC report - Attached C. Evaluation Assessment methodology- Attached D. List of persons interviewed and contacted – Attached E. Topic not applicable – T.B and FP F. Documents reviewed - Attached G. Exit Strategy – Attached H. Other relevant aspects- N/A I. Papers presented- page 63 J. HFA- Attached K. LQAS 2006- Attached L. Questionnaire and tools- Attached M. Project Data form - Attached Child Survival XVIII Project Final Evaluation 5 CARE Ethiopia May 27- June 11, 2007 CA # HFP-A-00-02-00040-00 A. Summary The Farta Woreda Child Survival Project is a five-year Child Survival Project implemented by CARE Ethiopia (October 1, 2002 to September 30, 2007). The project aims to improve the health of children under five and women of childbearing age by focusing on the following interventions: Nutrition (35%), Pneumonia Case Management (25%) and Control of Diarrheal Disease (20%). The project is located in a highland region of northwestern Ethiopia in a rural district with over 2400 villages and a population of about 278,000 people. The project focuses on children under five and women of childbearing age, and has the following objectives: 1. Promote the practice of healthy behaviors, including care seeking, by caregivers of children under five years and women, especially pregnant and lactating mothers. 2. Increase sustainable access to health education, quality care and essential medicines. 3. Ensure that quality health care is provided by health personnel, Community Health Workers (CHWs) and other service providers. 4. Strengthen local and community-based institutions and partners and build capacity to support child survival activities on a sustainable basis. The FCSP adopted three principal strategies to achieve these objectives: BCC and community mobilization, skill development and improvement of access to quality health services. The project achieved an impressive degree of behavior change, including an increase in exclusive breastfeeding from 0-6 months from 73% to 95% and the proportion of children receiving complementary feeding from 6-9 months from 38% to 98%. Appropriate care-seeking for fast and difficult breathing rose from 27% to 84%, appropriate disposal of children’s feces from 6% to 94%, and full immunization coverage (DTP, OPV, measales and BCG) in children 12-23 months of age from 19% to 61%. Communities and partners have noted the improvements in their children’s health, including notably fewer child deaths