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Lufwanyama Integrated Neonatal and Child Health Project in Zambia

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Lufwanyama Integrated Neonatal and Child Health Project in Zambia Lufwanyama Integrated Neonatal and Child Health Project in Zambia (LINCHPIN): Final Evaluation Building Community Systems to Improve the Health of Newborns and Children in Rural Zambia Cooperative Agreement: GHS-A-00-09-00013-00 Project Dates: 1 October 2009 – 30 September 2014 Category: Innovation Location: Lufwanyama District, Copperbelt Province, Zambia Submitted by: Save the Children Federation, Inc. 501 Kings Highway East, Suite 400, Fairfield, CT 06825 Telephone: (203) 221-4000 - Fax: (203) 221-4056 Authors: This publication was produced at the request of the United States Agency for International Development and prepared independently by: John Murray, Team Leader Final Evaluation; Karen Z. Waltensperger, Senior Advisor, Community and Child Health, Save the Children; David Marsh, Senior Child Survival Advisor, Save the Children; John Kabongo, Program Officer for Health and Project Manager, Save the Children/LINCHPIN; Stephen Filumba, Deputy Project Manager; Gail Snetro, Senior Africa Area Capacity Building Advisor for Health, Save the Children; Sharon Lake-Post, Editorial Consultant, Save the Children. Contact Persons: Eric Swedberg, Director, Child Health and Nutrition Carmen Weder, Associate Director, Department of Health and Nutrition Submitted to USAID/GH/HIDN/CSHGP February 6, 2015 This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Save the Children and do not necessarily reflect the views of USAID or the United States Government For the Final Evaluation Brief and other Child Survival and Health Grants Program materials, please visit http://www.mcsprogram.org/CSHGPproducts Table of Contents Page Acronyms………………………………………………………………………….. iii Executive Summary……………………………………………………………….. 1 Evaluation Purpose and Evaluation Questions……………………………………. 4 A. Project Background……………………………………………………………. 4 B. Evaluation Methods and Limitations………………………………………….. 10 C. Findings, Conclusions and Recommendation Highlights……………………… 11 D. Conclusions and Recommendations…………………………………………… 22 Annexes Annex 1: Program Learning Briefs: Evidence Building………………………… 26 Annex 2: List of Publications and Presentations Related to the Project………… 32 Annex 3: Project Management Evaluation………………………………………. 33 Annex 4: Work Plan Table………………………………………………………. 37 Annex 5: Rapid CATCH Table…………………………………………………. 40 Annex 6: Final Knowledge, Practice and Coverage Report……………………. 48 Annex 7: Community Health Worker Training Matrix…………………………. 94 Annex 8: Evaluation Scope of Work……………………………………………. 98 Annex 9: Evaluation Methods and Limitations…………………………………. 104 Annex 10: Data Collection Instruments………………………………………….. 107 Annex 11: Sources of Information……………………………………………….. 118 Annex 12: Disclosure of Any Conflicts of Interest………………………………. 120 Annex 13: Statement of Differences……………………………………………… 144 Annex 14: Evaluation Team Members, Roles and Their Titles…………………. 145 Annex 15: Final Operations Research Report……………………………………. 146 Annex 16: Operations Research Brief……………………………………………. 229 Annex 17: Stakeholder Debrief PowerPoint Presentation……………………….. 230 Annex 18: Project Data Form…………………………………………………….. 250 Annex 19: Optional Annexes…………………………………………………….. 259 A. Project Indicator Table B. Learning Brief on CHW attrition C. iCCM Summary Table for Lufwanyama District D. Published Papers from Project 1. Teaming Feasibility 2. Prevention and Management of Neonatal Hypothermia 3. Beyond Distance: An Approach to Measure Effective Access 4. Measuring Teamwork and Taskwork E. Community Collective Action for Improved Maternal, Newborn and Child Health in Lufwanyama District LINCHPIN Project LINCHPIN Zambia (CS-25), Final Evaluation Report, February 2015, Save the Children Page ii Acronyms ACT Artemisinin Combination Therapy ANC Antenatal Care CAC Community Action Cycle CBD Community-based Distributor CCM Community Case Management CDE Classified Daily Employee CGHD Center for Global Health and Development CHAZ Christian Health Association of Zambia CHW Community Health Worker CSHGP Child Survival and Health Grant Program (USAID) DHMT District Health Management Team DIP Detailed Implementation Plan EHO Environmental Health Officer ENC Essential Newborn Care FANC Focused Antenatal Care FE Final Evaluation HBB Helping Babies Breathe HC Health Center HF Health Facility HW Health Worker iCCM Integrated Community Case Management IMCI Integrated Management of Childhood Illness KPC Knowledge, Practices and Coverage LBW Low Birth Weight LINCHPIN Lufwanyama Integrated Neonatal and Child Health Project in Zambia LUNESP Lufwanyama Neonatal Survival Project (of Boston University) MCDMCH Ministry of Community Development, Mother & Child Health MCH Maternal and Child Health MNCH Maternal Newborn and Child Health LINCHPIN Zambia (CS-25), Final Evaluation Report, February 2015, Save the Children Page iii MOH Ministry of Health MUAC Mid-upper Arm Circumference NHC Neighborhood Health Committee OR Operations Research ORS Oral Rehydration Solution ORT Oral Rehydration Therapy PNC Postnatal Care RDT Rapid Diagnostic Tests SBA Skilled Birth Attendant SC Save the Children SIDA Swedish International Development Agency SMAG Safe Motherhood Action Group SMGL Saving Mothers, Giving Life SNL Saving Newborn Lives TBA Traditional Birth Attendant TWG Technical Working Group UNICEF United Nations Children’s Fund USAID United States Agency for International Development WHO World Health Organization ZIMMAPS Zambia Integrated Management of Malaria and Pneumonia Study ZISSP Zambia Integrated Systems Strengthening Project (Abt Associates – USAID/Zambia bi-lateral Project) LINCHPIN Zambia (CS-25), Final Evaluation Report, February 2015, Save the Children Page iv EXECUTIVE SUMMARY: Lufwanyama Integrated Neonatal and Child Health Project in Zambia: Final Evaluation Evaluation Purpose The purpose of the Final Evaluation (FE) was to determine whether the Lufwanyama Integrated Neonatal and Child Health Project (LINCHPIN) increased use of evidence-based, life-saving interventions by caretakers and children in the Lufwanyama District of Zambia. The FE was conducted between September 1 and 14, 2014. Evaluation questions The FE drew upon existing data collected or compiled during the project cycle, as well as additional data collected during the evaluation for the following purposes: 1) To provide an overview of project goals, objectives, and key intervention strategies implemented; 2) To determine the extent to which the project accomplished the results outlined in the DIP and to present evidence of these accomplishments; 3) To describe key factors that contributed to what worked or did not work regarding some or all aspects of the program; 4) To identify the effectiveness and potential wider applicability of the CHW-TBA teaming approach; 5) To determine the sustainability of community-based newborn care, iCCM and community mobilization using NHCs and SMAGS in Lufwanyama District; and 6) To demonstrate how the project contributed to learning and evidence that is directly relevant to improving MOH policies and practices, as well as global learning about community-oriented health programming. Evaluation methods Five principal methods were used for the evaluation: 1) Review of 30-cluster KPC surveys, including those at project baseline and endline; and those conducted for the operations research (OR) project. 2) Review of community register data. 3) Document review – including policy documents, program reports, technical reports, reports of training activities, health worker (HW) registers, and training and health education materials. 4) Field visits – site visits were made to health centers (HCs) and communities and in-depth interviews conducted with health facility (HF) staff, community health workers (CHWs), Traditional Birth Attendants (TBAs), Neighborhood Health Committee members (NHC) and caretakers of young children. 5) In-depth interviews with District Managers, and partners and stakeholders at the national level. Project Background LINCHPIN is a five-year Innovation Project (CS-25 cycle) running between 1 October 2009-30 September 2014. The project is co-funded by the USAID Child Survival and Health Grant Program (CSHGP) and ELMA Philanthropies, with matching funding from Towers and Perrin and the Crown Family Philanthropies. Lufwanyama is a rural district with limited access to health care services. Malaria, pneumonia, diarrhea and under nutrition are the primary contributors to morbidity and mortality of children 1-59 months old, with newborns dying of asphyxia, prematurity/LBW and sepsis. Baseline surveys demonstrated that population coverage with key interventions to prevent or treat these conditions was low and showed gaps in the quality of care. The project strategic objective is increased use of key newborn and child health services and practices. All project activities were implemented in Lufwanyama District in the Copperbelt Province of northern Zambia. Activities were implemented in close collaboration with the District Health Office and several local partners. LINCHPIN Zambia (CS-25), Final Evaluation Report, February 2015, Save the Children Page 1 The project has four main components: 1) Integrated community case management (iCCM): CHWs are trained to assess, classify and treat sick children 2 to 59 months old with malaria, pneumonia and diarrhea – and to refer children and newborns with danger signs; 2) Community- based maternal and newborn care: TBAs are trained
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