1. CSHGP Program Learning
Agenda: Maternal and Newborn
Health
Marge Koblinsky
Senior Maternal Health Advisor, USAID
CORE Group Fall Meeting
October 11, 2012
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2. Presentation Outline
 Purpose of consultancy
 Methods
 Findings from project reviews
 Conclusions and recommendations
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3. Purpose of Consultancy
 Devise a prospective learning strategy to link
NGO efforts in maternal/newborn health to
global/national policy and strategy discourse
 Highlight patterns of learning —the what and
how -- guided by stakeholder needs, literature
and capacity
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4. Methods
 Stakeholder Interests
 TAG—25 people
 Stakeholder interviews —10 people
 Project doc review--purpose, avail data,
conclusions
 Past (closed) projects — ―intrapartum care pkg‖
• Reviewed 17 projects>40% LOE MNCH; 5 in-depth
 Current (active) projects (36)
• Reviewed 4 with 100%MNC, OR grant (16>40% LOE MNCH)
 Global literature review – community MNH
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5. CSHGP projects reviewed (N = 21)
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6. STAKEHOLDER INTERESTS
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7. Stakeholders’ main priorities
 process of working with  costs of these
TBAs; effectiveness interventions packages
 effect of specific and approaches
community approaches for  CB-HMIS and its use in
improving implementation decision-making and costs
and access for MNH of implementation
interventions  NGO contributions to
 decision making re the strengthening referral
selection of MNH systems
intervention packages and  Postpartum and postnatal
the implementation care: access and
approaches implementation
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8. Findings: Stakeholder interests
& availability of data
Topic Stakeholder question Indicators Project
info/comments
TBAs -Process of working with TBAs % trained -TBA not
delivery distinguished by
-New roles attendant indicator from any
(Other Std MNC trained delivery
-Best practice for TBAs indicator) attendant;
not key word;
-How they link to big picture
-Because of MOH
-How effective are TBAS? What policies TBA info not
do they do? incorporated into
project reports shared
with MOH
- May have qual data
8 and know # trained

9. FINDINGS FROM REVIEWS
-- COMPLETED PROJECTS
-- OR PROJECTS
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10. Proj purpose and data available
5 completed & 4 OR projects
Project info Data collected Comments
Purpose Enhance demand &/or Vulnerable not generally
quality of govt program- defined
vulnerable
Study Design Pre-post ¾ OR –comparison area
Intervention package DIP- planned; Typically not stratified to
Complex interventions test cpts of complex
intervention; outputs not
collected
Outcome data YES! (next slides)
No cost data
Impact data Deaths not reported OR projects: may collect
death data-VAs
10

11. Example of project inputs
 Aim: Enhance demand and/or quality of govt
programs (e.g., AKF Pak implementing CMW program
of GOP; Nepal HealthRight—CB-NCP program of GON)
 Interventions:
 Many known effective MNH interventions
 Delivered through trained, supervised skilled works in
setting with QI system
 Access: village comm; grp meeting, CHWs , TTBAs,
savings groups, emergency transport plans
 Awareness—comm mob, BCC, mass media
11

12. Women delivered in a health facility in selected
CSHGP projects (13), base/endline surveys (%)
Latin
Africa Asia America
100
80
Percent (%)
60
40
20
0
Baseline Endline

14. CONCLUSIONS
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15. Limitations of review
 Sample projects reviewed may not be
representative of all MNH projects in the
portfolio
 Copious project documentation restricted in-
depth review
 Variation in response to reporting guidance
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16. General Conclusions
 Project information simply not easily
accessible—spread over 500 or more pages
• Needs to be captured in one relatively brief document
with objectives, methods, intervention description,
results, discussion/interpretation, conclusion
 Study design appropriate for question
• Effectiveness studies—quasi exp design
• OR—aim to improve implementation of a known
effective intervention
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17. Conclusions: Stakeholder interests
 Effectiveness and cost effectiveness
 Standard projects not designed to address
questions of effectiveness/cost-effectiveness
 Outputs not reported so don’t know adequacy
of implementation
• ―Use data‖ e.g., of delivery kits, BPCR, not widely
available; relationship with use of SBA or facility
not available
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18. Learning to-date and
Recommendations
1. Cross-cutting themes (e.g, Community
case management)
2. Monitoring and evaluation of on-going
projects
3. Operations research
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19. Conclusions: Project Reviews
Learning to-date
 Cross-cutting themes (e.g, Community case
management)
• External person surveys the projects in place/reviews
project reports
• Limited number of such efforts
• Potential topics:
– What factors most affect the sustainability (or integration)
of community based approaches/interventions (e.g., CHW
or TTBA outreach, women’s groups?
– What mechanisms are available for integrating such
community approaches into the formal health system?
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20. Conclusions: Project Reviews
Learning to-date
 Monitoring & evaluation of on-going projects
• Pre-post surveys, specified indicators
• Across project learning possible—and there are
increases in coverage noted (above)—but in individual
project cannot state it was due to project inputs
• Potential M&E:
– Are inputs and outputs on target to achieve the desired
outcomes: Specify at a population level
– Who is the recipient of the interventions (equity)?
– What contextual factors impact the projects? (eg. Road
density, transport available; supply availability) (see CI)
– Country case studies
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21. Conclusions: Project Reviews
Learning to-date
 Operations Research
 Excellent beginning toward contributing to
global discourse
 Improve with more specificity, less complex
intervention packages and approaches
 Potential OR:
• Are community or professional providers more
appropriate for counseling messages? Where?
• Can new technologies (mobiles) improve
community worker performance?
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22. Recommendations
 OR projects
 What is of interest to local policy/program managers?
 Collect right indicators at right levels—linking inputs,
activities, outputs, outcomes
• Look beyond mortality at morbidity esp for MH
• Develop quality of care indicators (eg., disrespect/abuse)
 Develop succinct reports accessible to outside groups
that follow normal journal requirements—and publish!
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23. General Recommendation
 Decrease amount of time on descriptive
info, increase time for analytical and
interpretive information/project
 Project development stage -- formative
research/ analysis /writing
 Midterm–adequacy surveys that measure
inputs and outputs
 Final – evaluation survey plus 12 months to
analyze what happened/why, how to
communicate results!
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24. Many thanks to Jennifer
Yourkevitch, Kirsten Unfried, Leo
Ryan, Nazo Kureshy
Thank you!
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