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Assessment of Iccm Implementation Strength and Quality of Care in Oromia, Ethiopia

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Assessment of Iccm Implementation Strength and Quality of Care in Oromia, Ethiopia Assessment of ICCM Implementation Strength and Quality of Care in Oromia, Ethiopia Final report January 2013 i ACKNOWLEDGMENTS STUDY TEAM Study conception: Nathan Miller, Agbessi Amouzou, Jennifer Bryce, Cesar Victora, Robert Black Study implementation: Nathan Miller, Mengistu Tafesse, Agbessi Amouzou, Elizabeth Hazel, Markos Feleke, Eyob Kifle, Taye Tolera Report writing: Nathan Miller Report editing: Agbessi Amouzou, Jennifer Bryce, Cesar Victora, Robert Black, Elizabeth Hazel We would like to thank UNICEF and the Canadian International Development Agency for funding this survey. Special thanks to UNICEF, the Ethiopian Federal Ministry of Health, the Oromia Regional Health Bureau, the Jimma and West Hararghe Zonal Health Bureaus, the Last 10 Kilometers Project (L10K), and the Integrated Family Health Program (IFHP) for their strong support of this research. The survey was implemented by ABH Services, PLC. The successful completion of the survey was due to the hard work and dedication of Mengistu Tafesse, Markos Feleke, Eyob Kifle, and Taye Tolera. We would also like to express our appreciation to the survey personnel, whose commitment and willingness to work through difficult conditions made the survey possible. Finally, a special thanks to the survey participants, including the Health Extension Workers, patients, and caretakers who gave us their cooperation and time to provide us with valuable information about their experiences. Suggested citation: Miller NP, Amouzou A, Bryce J, Victora C, Hazel E, Black RE. Assessment of iCCM implementation strength and quality of care in Oromia, Ethiopia. Baltimore, USA and Addis Ababa, Ethiopia: Institute for International Programs, Johns Hopkins Bloomberg School of Public Health; 2013. CONTENTS ACRONYMS ....................................................................................................................................... iv EXECUTIVE SUMMARY .......................................................................................................................1 1. INTRODUCTION ...........................................................................................................................7 1.1 BACKGROUND .......................................................................................................................7 1.2 SURVEY OBJECTIVES ............................................................................................................ 11 1.3 SURVEY ORGANIZATION ...................................................................................................... 11 1.4 STUDY POPULATION ............................................................................................................ 11 1.5 INCLUSION CRITERIA ........................................................................................................... 12 1.6 SAMPLING DESIGN & SAMPLE SIZE ...................................................................................... 13 1.6.1. Sampling Frame & Sample Selection .................................................................................... 13 1.6.2. Sample Size ........................................................................................................................... 13 1.7 QUESTIONNAIRES ............................................................................................................... 14 1.8 DATA COLLECTION PROCEDURES ......................................................................................... 14 1.8.1. Pre-testing ............................................................................................................................. 14 1.8.2. Recruitment and Training of Survey Personnel .................................................................... 15 1.8.3. Piloting the Survey ................................................................................................................ 15 1.8.4. Data Collection ...................................................................................................................... 15 1.8.5. Quality Assurance ................................................................................................................. 18 1.8.6. Data Management ................................................................................................................ 18 1.8.7. Data Analysis ......................................................................................................................... 19 1.8.8. Ethical Considerations .......................................................................................................... 19 2. SAMPLE CHARACTERISTICS ........................................................................................................ 20 2.1 ENROLLMENT ...................................................................................................................... 20 2.2 CHARACTERISTICS OF THE SAMPLE OF HEALTH POSTS .......................................................... 20 2.3 CHARACTERISTICS OF THE SAMPLE OF HEWS ....................................................................... 22 2.4 CHARACTERISTICS OF THE SAMPLE OF CHILDREN ................................................................. 24 3. IMPLEMENTATION STRENGTH ................................................................................................... 29 3.1 COVERAGE OF ICCM ............................................................................................................ 29 3.2 COVERAGE OF DEPLOYED HEWS .......................................................................................... 29 3.3 TRAINING ............................................................................................................................ 29 3.4 SUPERVISION ...................................................................................................................... 30 3.5 AVAILABILITY OF COMMODITIES, SUPPLIES, & JOB AIDS ....................................................... 32 4. QUALITY OF CARE ..................................................................................................................... 41 4.1 ASSESSMENT OF SICK CHILDREN .......................................................................................... 41 4.2 CLASSIFICATION OF SICK CHILDREN ..................................................................................... 43 4.3 MANAGEMENT OF SICK CHILDREN ....................................................................................... 44 4.4 COUNSELING ....................................................................................................................... 47 5. ICCM UTILIZATION & SERVICE PROVISION .................................................................................. 49 5.1 UTILIZATION ....................................................................................................................... 49 5.2 SERVICE PROVISION ............................................................................................................ 54 5.3 HEALTH PROMOTION AND DEMAND GENERATION .............................................................. 57 ii 6. REGISTER REVIEW ..................................................................................................................... 59 7. DISCUSSION .............................................................................................................................. 63 7.1 DISTRIBUTION OF ILLNESSES ................................................................................................ 63 7.2 RECRUITMENT OF SICK CHILDREN ........................................................................................ 63 7.3 IMPLEMENTATION STRENGTH ............................................................................................. 64 7.4 QUALITY OF CARE ................................................................................................................ 65 7.5 UTILIZATION & SERVICE PROVISION ..................................................................................... 67 7.6 REGISTER REVIEW ............................................................................................................... 69 7.7 METHODOLOGICAL LESSONS AND IMPLICATIONS FOR FUTURE EVALUATIONS ...................... 69 8. RECOMMENDATIONS ................................................................................................................ 70 8.1 IMPLEMENTATION STRENGTH ............................................................................................. 70 8.2 QUALITY OF CARE ................................................................................................................ 70 8.3 UTILIZATION & SERVICE PROVISION ..................................................................................... 70 8.4 REGISTER REVIEW ............................................................................................................... 71 9. LIMITATIONS............................................................................................................................. 72 APPENDICES .................................................................................................................................... 73 APPENDIX 1: ICCM IMPACT MODEL .............................................................................................. 73 APPENDIX 2: CLINICAL ERRORS ANALYSES15 FOR CHILDREN WITH ICCM ILLNESSES ........................ 74 APPENDIX 3: SUPPLEMENTAL DATA TABLES .................................................................................
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