A system approach to improving maternal and child health care delivery in Kenya: innovations at the community and primary care facilities (a protocol)

Esamai, Fabian; Nangami, Mabel; Tabu, John; Mwangi, Ann; Ayuku, David; Were, Edwin

doi:10.1186/s12978-017-0358-6

Reproductive Health

Table 5 Programme monitoring and evaluation framework

From: A system approach to improving maternal and child health care delivery in Kenya: innovations at the community and primary care facilities (a protocol)

Goal:
To contribute to improvement of maternal and child health in Kenya through health system strengthening initiatives at community and primary care levels
Objective 1:Conduct a baseline survey on maternal and child health interventions to improve access and quality of care at tiers 1 and 2 in select counties
Activities/inputs	Output/Deliverables	Means of verification	Objectively Verifiable Indicators	Timelines
Activities/inputs	Output/Deliverables	Means of verification	Objectively Verifiable Indicators	2015	2016	2017	2018	2019
Review and develop tools	Reviewed tools Develop tools	Survey tools	# tools
Recruit survey team	Survey team in place	Advertisements, Interviews	letters of appointments
Train survey team and pilot tools	Trained RAs	Logistics Venue	# trainings, # staffs trained
Prepare for Community entry	Logistics and costs Set dates for entry	Sensitized community	# meetings with the community and county
Conduct the survey	Survey instruments	Baseline data	# field tools
Develop data entry template	Software	Ready template	Templates for qualitative & Quantitative data
Data entry and interpretation	Data clerks Software	Entered data	Data in template
Analyze and write report	Draft report	Findings/Report	# Reports
Disseminate the findings	Write ups	Reports	# dissemination meetings # media appearances # policy briefs
Objective 2:Adapt and implement the EHC package using the FLTR strategy to improve access and quality of care of maternal and child health at level 1 (community) and level 2 (primary care facilities) in the intervention cluster,
1. Identification CORPs-Domiciliary nurses and CHVs in specified counties	Write ups	MOUs Contract letters	#CORPs
2. Training	Curriculum	Pre & post assessment	#trainings #staffs trained
3. Review HMIS forms	Forms	Types of forms	#forms reviewed
4. Prepare the community for intervention		Minutes/ reports	#sensitization meetings Budgets
5. Roll out the intervention	Intervention in place	HF records, endline evaluation	changes key indicators
Objective 3: To explore and facilitate partnerships for innovative approaches (IGAs and Chama) to incentivize CORPs (Community owned resource persons - volunteers), CHWs and Community Midwives (CMWs) to effectively participate in increasing access and retention of pregnant women and children in the intervention cluster.
6. Review documents and identify potential partners	Functional CBOs, Chamas, SACCO	Agreements/ MOUs	#partners #MOUs #Meetings with partners
6.Develop advocacy communication and social mobilization strategy for the programme	sensitized community, policy makers, healthworkers	Meetings Minutes Reports Documents	#meetings #media appearances #ACSM strategy
7. Create partnerships	private sector engaged	Minutes MOUs	#CORPs engaged #Task shifting- CORPs as birth a
8. Review documents and identify potential partners	sustainable partnerships	Agreements/MOUs	#partners #MOUs #Meetings with partners
Objective 4: To assess the effectiveness and sustainability of the implementation of FLTR and EHC in the improvement of the efficiency of the referral system between the community (level 1), primary care facilities (level 2) and County referral facilities (level 3) for pregnant women in the intervention area
Activities	Output	Means of verification	Objectively Verifiable Indicators	Timelines
				2015	2016	2017	2018	2019
Develop advocacy communication and social mobilization strategy for the programme	sensitized stakeholders	Meetings Minutes Reports Documents	#meetings #media appearances #ACSM strategy
Provide Mobile telephony to CORPs	quality data collected & used	Numbers Timely referrals Usage	#mobile phones provided
Conduct a customer satisfaction survey and use lessons learnt to improve service	satisfied pregnant women & mothers	Report Survey Tools	Report #recommendations Improvement in quality
Determine numbers of still births	reduced no. still births	Numbers	#still births
Objective 5: To build capacity of health workers to conduct health systems research and inculcate a culture of use of evidence to strengthen the performance of health systems through on-job training, in-service certificate and degree programmes
Recruit program staff and monitor their performance	SHWs	Appointment letters Reports	#staffs recruited Improved service
Develop short courses and enhance capacities in leadership, governance and management of systems	HSR, LMG skills	Curriculum Trainings	#Curriculum #Trainings
Admit 4 masters’ students into the program and assist them choose topics relevant to the program, determine gaps and propose interventions	graduates, thesis and publications	Graduates Titles of study	#graduate students admitted Progression rates #intervention gaps Policy influence Abstracts Manuscripts Conference appearances
Admit 2 PhD candidates within the 5 year period and involve them in identifying research problem and designing interventions	admissions graduates thesis articles	Candidates Titles of study	#candidates admitted Progression rates #intervention gaps Policy influence Abstracts Manuscripts Conference appearances
Sensitize CORPs on safe motherhood	sensitizes CORPs	Sensitization sessions Numbers Reports	#trainings Change in knowledge & attitudes
Training on indications for referral of pregnant mothers and sick child	KSP for CHWs & CORPs	enhanced Curriculum	#CORPs trained #health talks
Objective 6:Conductendline survey/evaluation on levels of maternal and child health indicators, status of health system and existing programs in the study areas at the end of the project in all the study clusters.
Review baseline tools to include indicators on program relevance and effectiveness	revised tools	hard copies	# of tools
Recruit and train RAs	trained RAs, tools	survey teams	minutes, letters, list
Collect data	completed tools	field schedule	letters of release and payment schedule
Analyze and interpret data	tables, results	hard copies	outputs and verification forms
Write evaluation report documenting findings; project report (overall)	reports	draft reports	submission of drafts, feedback, meeting with stakeholders
Disseminate findings to appropriate audience and partners	report briefs	minutes, emails, feedback	letters/emails submission, final feedback

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ISSN: 1742-4755

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