Final Report on the Parivartan (“Transformation”) Child Survival Project India, Jarkhand State, Sahibganj District World Renew (formerly CRWRC) In Partnership with: Evangelical Fellowship of India Commission on Relief (EFICOR) Cooperative Agreement No: GHS‐A‐00‐07‐00025‐00 September 30, 2007 through March 31, 2013 Kohima Daring – Team Leader for India and Bangladesh, World Renew Nancy TenBroek – Asia Region Health Advisor, World Renew Prashant Missal – Parivartan Project Manager, World Renew Stephanie Sackett – Associate Director for Grants, World Renew Alan Talens – Health Advisor, World Renew (Contact Person) Dr. Grace Kreulen – External Consultant and Final Evaluation Team Leader, Primary Final Evaluation (FE) Report Author World Renew 2580 Kalamazoo Avenue SE Grand Rapids MI 49560 Tel: (616) 224‐0740 x 2150 [email protected] Date submitted: June 18, 2013 TABLE OF CONTENTS Acronym List ………………………………………………………………………………………………... iii A. Executive Summary………………………………………………………………………………….. 1 B. Overview of Project Structure and Implementation…………………………………… 3 C. Evaluation Assessment Methodology and Limitations………………………………… 6 D. Data Quality and Use………………………………………………………………………………… 7 E. Presentation of Project Results………………………………………………………………….. 8 F. Discussion of Results………………………………………………………………………………… 12 1. Contribution toward project objectives 12 SO‐1. Strengthen public‐private partnerships for MCH………………………… 12 SO‐2. Improve utilization of quality MNC……………………………………………... 17 SO‐3. Improve nutrition among children……………………………………………… 18 SO‐4. Prevent and properly treat infectious diseases……………………………. 19 Lives saved analysis……………………………………………………………………………. 20 2. Contextual factors……………………………………………………………………………….. 21 3. Key partners………………………………………………………………………………………... 22 4. Overall design factors that influenced results: 22 Contribution to global learning …………………………………………………………... 22 Sustainability …………………………………………………………………………………... 24 Dissemination and information use ……………………………………………………. 24 G. Conclusions and Recommendations…………………………………………………………... 24 Annex 1. Learning Briefs …………….……………………………………………………………….. 27 Annex 2. List of Publications and Presentations…………………………………………….. 31 Annex 3. Project Management Evaluation …………………………………………………….. 32 Annex 4. Work Plan Table…………………………………………………………………………….. 35 Annex 5. Rapid CATCH Table………………………………………………………………………… 41 Annex 6. Final KPC Report……………………………………………………………………………. 42 Annex 7. CHW Training Matrix……………………………………………………………………… 100 Annex 8. Evaluation Team Members and Titles……………………………………………… 101 Annex 9. Evaluation Assessment Methodology………………………………………………. 102 Annex 10. List of Persons Interviewed and Contacted during Final Evaluation… 111 Annex 11. Final Operations Research Report…………………………………………………. 112 Annex 12. Special Reports……………………………. …………………………………………….... 118 Annex 13. Project Data Form…………………………………………………………………………. 119 Annex 14. Grantees Plans to Address Final Evaluation Findings……………………… 132 Annex 15. Report on the Six month No Cost Extension…………………………………….. 134 Annex 16. Summary of Sustainability Scores/Dashboard………………………………… 142 ACRONYM LIST ARI Acute Respiratory Infection ANC Antenatal Care AWC Anganwadi Center AWW Anganwadi Worker ANM Auxiliary Nurse Midwife BCC Behavior Change Communication CBO Community Based Organization CCM Community Case Management CCI Community Capacity Indicators CDPO Child Development Program Officer, ICDS CHC Community Health Center CHW Community Health Worker CSP Child Survival Project CRWRC Christian Reformed World Relief Committee (now World Renew) CS Cluster Supervisor or Civil Surgeon CSSA Child Survival Sustainability Assessment DPO District Program Officer DPT Diphtheria, Pertussis, and Tetanus vaccine EBF Exclusive Breast Feeding EFICOR Evangelical Fellowship of India Commission on Relief GMC Growth Monitoring and (nutrition) Counseling GMP Growth Monitoring Program GOI Government of India HMIS Health Management Information System HSC Health Sub‐Center HTC Household Timed Counseling ICDS Integrated Child Development Services of GOI IFA Iron Folic Acid (tablets) INC or IPC Intra‐natal Care or Intra‐partum Care ITN Insecticide Treated Net JK Jharkhand JSV Janani Suraksha Yojana (GOI scheme to provide cash incentives to women who attend ANC and deliver at the health facility) KPC Knowledge Practice Coverage survey LLIN Long Lasting Insecticidal Net LOE Level of Effort LQAS Lot Quality Assurance Sampling MCH Maternal Child Health M&E Monitoring and Evaluation MH&FW Ministry of Health and Family Welfare MHIS Ministry of Health Information System MNC Maternal Newborn Care MNCH Maternal Newborn Child Health MOIC Medical Officer In‐Charge, NRHM MTE Mid‐Term Evaluation iii MW&CD Ministry of Women and Child Development NFHS National Family Health Survey (R = rural) NRHM National Rural Health Mission NGO Non‐Government Organization OCI Organizational Capacity Indicators OPV Oral Polio Vaccine ORS Oral Rehydration Solution ORT Oral Rehydration Therapy Pf Plasmodium falciparum (parasite that causes malaria) PHC Primary Health Center PIT Project Implementation Team PM Project Manager PMT Project Management Team PNC Postnatal Care POU Point of Use (water treatment) PPP Public Private Partnership R‐HFA Rapid Health Facility Assessment Rs Rupees SBA Skilled Birth Attendant SBPS Sass Bahu Pati Samellan (BCC community theater) TTBA Trained Traditional Birth Attendant TT Tetanus Toxoid U5 (Children) Under Five Years of Age UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development VHND Village Health Nutrition Day VHSRC Village Health Committee and Sahiya Resource Centre VHC Village Health (Sanitation and Nutrition) Committee WHO World Health Organization iv A. EXECUTIVE SUMMARY World Renew designed and implemented the Parivartan Child Survival Project in partnership with EFICOR and the GOI in the rural Sahibganj district of Jharkhand State, India, targeting the entire district with an estimated population of one million people, including 350,461 women and children with very poor health status. Parivartan was primarily funded by USAID as a standard category child survival project from September 2007 to March 2013. The goal of Parivartan was to reduce mortality among mothers, newborns and children under the age of five through building and sustaining community capacity via achievement of four strategic objectives: SO-1. Strengthen public-private partnerships for maternal and child health services. SO-2. Improve access to quality maternal and newborn care. SO-3. Improve nutrition among children. SO-4. Prevent and properly treat infectious diseases among women and children. The goal of the operations research conducted during Parivartan was to examine risk factors for mortality due to Plasmodium falciparum malaria among children under 6 years of age. Key technical interventions for the project were maternal and newborn care (40%), nutrition (20%), immunization (10%), malaria (10%), diarrhea (10%), and ARI (10%). The primary cross-cutting interventions were community mobilization of village health committees (VHC), behavior change communications through community health workers (Sahiya and Anganwadi Worker), and quality improvement for care delivery at the health facilities (Health Sub-Centers). A summary of key accomplishments of Parivartan is presented in Table 1. The project experienced significant improvement (p ≤ 0.05) from baseline to endline and/or achievement of targets for 23 of 27 KPC indicators in the M&E plan and appreciable gains in capacity indicators for the partner NGOs, community-based organizations and local public health services. Table 1: Summary of Major Project Accomplishments Inputs Activities Outputs Outcome SO-1 Training & support in Well functioning, Strong public-private partnership at local, Capacity PHC, HMIS, CSSA, balanced project team block, district and state levels foundational development for BCC, M&E, financial committed to goal to success of project at all levels EFICOR & staff management, technical achievement intervention, advocacy SO-1, 2, 3, 4 1,407 VHCs identified, 250 VHCs empowered - 250 empowered VHCs: 77% have written Staff time and assisted to obtain untied for MCH (increased to policies and procedures, 57% have village effort for funds, and supported to 500 VHCs after the six health plans, 63% ensure proper capacity govern for health of month extension); functioning of their HSC and VHND building of village and coordinate additional 667 (Increased to 500 VHCs after the six VHCs for MCH with HSC facilitated to get untied month no cost extension) funds and began - 1,070 of 1,407 VHCs in district now have functioning open bank accounts to receive untied funds SO-1, 2, 3, 4 141 ANMs in 141 Local level tracking of - 46% point increase in women with 3+ Training facilities trained and ANC/IPC/PNC, ANC visits (23% to 69%) materials, supported in leadership immunizations, - 34% point increase in children receiving basic supplies and supportive malaria, ARI, diarrhea DPT 3 vaccination (21% to 55%) supervision of Sahiya, during monthly - 23% point increase in children fully AWW and VHC convergence planning immunized in first year (10% to 33%) members from the 5-7 meetings occurring on - 51% point increase in care seeking for villages in HSC Wed. at 141 HSCs in ARI - (41% to 92%), 29% point increase in 1 Table 1: Summary of Major Project Accomplishments Inputs Activities Outputs Outcome catchment area district care seeking for fever (56% to 85%) SO-1, 2 Networking,