REPLICATING MAMATOTO: PROCESS EVALUATION REPORT 2020 Matovelo, Dismas;Brenner, Jenn; Mercader, Hannah;Shabani, Girles;Kanuti, Victoria; © 2020, DISMAS MATOVELO This work is licensed under the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/legalcode), which permits unrestricted use, distribution, and reproduction, provided the original work is properly credited. Cette œuvre est mise à disposition selon les termes de la licence Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/legalcode), qui permet l’utilisation, la distribution et la reproduction sans restriction, pourvu que le mérite de la création originale soit adéquatement reconnu. IDRC Grant/ Subvention du CRDI: 108024-001-Replicating the MamaToto Program in Rural Tanzania (IMCHA) REPLICATING THE MAMATOTO PROGRAMME IN RURAL TANZANIA Final Process Evaluation Report September 202 0 Prepared for the International Development Research Centre Innovating for Maternal and Child Health in Africa (IMCHA) Initiative Table of Contents Study Team and Acknowledgements ....................................................................................... 3 1. Executive Summary.............................................................................................................. 5 2. List of Acronyms .................................................................................................................. 7 3. Background ......................................................................................................................... 8 3.1 Context ...................................................................................................................................... 8 3.2 Study Rationale .......................................................................................................................... 9 3.3 Intervention Description .......................................................................................................... 11 4. Methods ............................................................................................................................ 13 4.1 Study Setting ............................................................................................................................ 13 4.2 Study Overview ........................................................................................................................ 13 4.2.1 Research Question 1 – Clinical Effectiveness ............................................................................................ 15 4.2.2 Research Question 2 – Process Evaluation ............................................................................................... 15 4.3 Methodology ........................................................................................................................... 19 4.3.1 Operational Project Data & CHW Retention ............................................................................................. 19 4.3.2 Health Facility Survey ................................................................................................................................ 20 4.3.3 MNCH Coverage Survey (Household Survey) ............................................................................................ 21 4.3.4 Qualitative Endline Evaluation – Focus Group Discussions and Interviews .............................................. 22 4.3.5 Consolidated Framework for Implementation Research (CFIR) – Rapid Evaluation ................................. 25 4.3.6 Simulation-Based Training and Peer-to-Peer Learning ............................................................................. 26 4.3.7 Partner Reflection and Feedback .............................................................................................................. 27 4.3.8 External Evaluation ................................................................................................................................... 27 4.4 Study Ethics and Trial Registration ........................................................................................... 29 5. Results ............................................................................................................................... 30 5.1 Adoption .................................................................................................................................. 30 5.2 Reach ....................................................................................................................................... 30 5.3 Implementation ....................................................................................................................... 30 5.3.1 Level of Program District Integration ........................................................................................................ 31 5.3.2 District Leadership Capacity ...................................................................................................................... 34 5.3.2.4 Adaptations and Fidelity ........................................................................................................................ 38 5.3.3 Facility Management/Quality Improvement Capacity .............................................................................. 38 5.3.4 Functional CHW Network .......................................................................................................................... 46 5.4 Effectiveness ............................................................................................................................ 52 5.4.1 Summary of Key MNCH Indicators from the MNCH Coverage Survey ...................................................... 52 5.4.2 MNCH Health Outcome Indicators – Qualitative Findings ........................................................................ 54 5.4.3 MNCH Non-Health Outcome Indicators – Qualitative Findings ................................................................ 58 5.5 Maintenance (Sustainability) .................................................................................................... 60 5.5.1 Leadership Engagement ............................................................................................................................ 60 Replicating the MamaToto Programme in Rural Tanzania | Final Process Evaluation Report | September 2020 1 5.5.2 Education and Training at All Levels (District, Health Facility, and CHWs) ............................................... 61 5.5.3 CHW Retention .......................................................................................................................................... 62 5.6 Evaluation of SOPETAR – CFIR Rapid Analysis & Partnership Feedback and Reflections ............ 64 5.7 Partnership Evaluation ............................................................................................................. 67 6. Knowledge Dissemination ................................................................................................. 69 7. Lessons Learned & Best Practices for Implementation ....................................................... 70 7.1 Implementation ........................................................................................................................................... 70 7.2 SOPETAR – Implementation Process ............................................................................................................ 71 7.3 Partnership ................................................................................................................................................... 73 8. Updates to the Mama na Mtoto Package: A Focus on Readiness ....................................... 75 9. Discussion .......................................................................................................................... 76 9.1 Summary of Key findings .......................................................................................................... 76 Research Question 1: Clinical Effectiveness ....................................................................................................... 76 Research Question 2: Process Evaluation .......................................................................................................... 77 Sustainability ...................................................................................................................................................... 82 Other Considerations for Implementation ......................................................................................................... 83 9.2 Evaluation of Program Theory (Logic Model) ............................................................................ 83 9.3 Limitations & Strengths ............................................................................................................ 84 9.4 Future Directions ..................................................................................................................... 85 10. Conclusion ....................................................................................................................... 86 11. References ....................................................................................................................... 87 12. Appendices ...................................................................................................................... 90 Replicating the MamaToto Programme in Rural Tanzania | Final Process Evaluation