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CCM Benchmarks,framework and indicators
as a tool for documentingcountry programs
Baltimore, May 12th 2011
1
Serge Raharison, MD, MScChild Health Technical officer
Content
1. CCM benchmarks, framework and indicators
2. Application of the framework in Senegal3. Key findings and implications for the
CCM national program in Senegal
2
THE CCM BENCHMARK MATRIX
Part 1
3
The origin of the Concept
Shared understanding of evidence supporting CCM
Different stages of country implementation
Diversity of country programs and NGO experiences
“Unsuccessful pilots have lacked key components of a comprehensive health system.”
4
The origin of the Concept
Inter-Agency working group, including WHO, UNICEF, USAID and International NGOs
Technical Working Group at the Global level
Systems strengthening approach to CCM
5
Eight components
1. Coordination and Policy Setting2. Financing3. Human Resources4. Supply Chain Management5. Service Delivery and Referral6. Communication and Social Mobilization7. Supervision and Performance Quality
Assurance8. M&E and Health Information Systems
6
Advocacy and Planning
Pilot and Early Implementation
Expansion and Scale-Up
…indicators…
THE CCM DOCUMENTATION
Part 2
7
Rationale
Assist countries in surpassing their previous targets to impact mortality, malaria, pneumonia and diarrheal disease: Inform CCM-related policy and programmatic
decision-making in the countries assessed Share with other countries about how to
accelerate progress towards their CCM targets
Objectives
• General Objective:– Inform the design of programs and program
monitoring during the anticipated expansion of iCCM.
• Specific Objectives:– Document successes and promising strategies
that have supported CCM programming success– Document existing bottlenecks in program
implementation and approaches to overcome them
– Draw lessons learned
The framework
The original CCM framework
The framework
INSTITUTIONAL PLATFORM : Policy and Institutional Support
STRATEGIC ELEMENT 2:Services and Information from CHWs available to the Communities
STRATEGIC ELEMENT 1:Link between the Health System and the Communities
Coordination and Policy Setting Supply Chain Management Financing
Service Delivery and Referral
Supervision and Performance Quality Assurance
M &E and Health Information Systems
…an adapted framework
STRATEGIC ELEMENT 3:Behavior Change
Communication and Social Mobilization
Human resources
KEY FINDINGS IN SENEGAL
Part 3
12
CCM Senegal: Historical overview
1990 2003 20102006 2007 2008
PNEUMONIA
Research on Cotrimoxazoe at health hut level
DIARRHEA
ORS treatment provided at health huts
Zinc pilot USAID community bilateral
Second extension USAID community bilateral
Decree 92-118: official status to health committees
Adoption of ACT for the national Protocol
POLICYApprobation of the use of Cotrim at health huts
2005
First extension of Cotrim at health hut
MALARIA Chloroquine treatment provided at health huts
ACT at health huts USAID community bilateral
Pilot RDT and ACT PECADOM
Introduction of RDT USAID community bilateral
20092004
Current program status
Beginning of 2010: More than 1,600 functional health huts 13/14 regions 58 of the 69 health districts
14
90 90
524
1,2971,371
1,620
1,465
0
500
1,000
1,500
2,000
2004 2005 2006 2007 2008 2009 2010
# health huts offering CCM
1. Coordination and Policy Setting
Advocacy and Planning
Pilot and Early Implementation
Expansion/Scale-up
Mapping of CCM partners conducted
Needs assessment and situation analysis for package of services conducted
Stakeholder meetings to define roles and discuss current policies held
National policies and guidelines reviewed
MOH leadership to manage unified CCM established
Discussions regarding ongoing policy change (where necessary) completed
MOH leadership institutionalized to ensure sustainability
Routine stakeholders meetings held to ensure coordination of CCM partners
15
1. Coordination and Policy Setting
Advocacy and Planning
Pilot and Early Implementation
Expansion/Scale-up
USAID and UNICEF self-positioned as partners to support MoHP
Feasibility study conducted to facilitate introduction of innovative idea
Stakeholder meetings to define roles and discuss current policies held
National guidelines reviewed but no written policy
MOH leadership to manage unified CCM established
Discussions regarding ongoing policy change completed
MOH leadership institutionalized but engagement at the regional level reduced.
CCM task-force has stopped functioning.
16
7. Supervision & Performance Quality Assurance
Advocacy and Planning
Pilot and Early Implementation
Expansion/Scale-up
Appropriate supervision checklists and other tools, including those for use of diagnostics developed
Supervision plan, including number of visits, supportive supervision roles, self-supervision etc. established
Supervisor trained in supervision and has access to appropriate supervision tools
Supervision visit every 1-3 months, includes reviewing of reports, monitoring of data
Supervisor visits community, makes home visits, provides skills coaching to CHWs
CCM supervision included as part of the CHW supervisor's performance review
CHWs routinely supervised for quality assurance and performance
Data from reports and community feed-back used for problem solving and coaching
Yearly evaluation that includes individual performance and evaluation of coverage or monitoring data
27
7. Supervision & Performance Quality Assurance
Advocacy and Planning
Pilot and Early Implementation
Expansion/Scale-up
Appropriate supervision checklists and other tools, including those for use of diagnostics developed
Supervision plan, including number of visits, supportive supervision roles, self-supervision etc. established
Supervisor trained in supervision but not have access to appropriate resources and tools
Supervision visit every 1-3 months, includes reviewing of reports, monitoring of data
Supervisor provides skills coaching to CHWs but does not systematically visit community nor make home visits,
No CCM supervision is not part of the CHW supervisor's performance review
CHWs routinely supervised but limited data available on quality assurance and performance
Limited use of data from reports and community feed-back for problem solving and coaching
No formal program evaluation carried-out
28
8. M&E and Health Information Systems
Advocacy and Planning
Pilot and Early Implementation
Expansion/Scale-up
Monitoring framework for all components of CCM developed and sources of information identified
Standardized registers and reporting documents developed
Indicators and standards for HMIS and CCM surveys defined
Research agenda for CCM documented and circulated
Monitoring framework tested & modified accordingly
Registers and reporting documents reviewed
CHWs, supervisors and M&E staff trained on the new framework, its components, and use of data
Monitoring and evaluation through HMIS data performed to sustain program impact
OR and external evaluations of CCM performed as necessary to inform scale-up and sustainability
29
8. M&E and Health Information Systems
Advocacy and Planning
Pilot and Early Implementation
Expansion/Scale-up
Monitoring framework was developed but not detailed enough to include all components of CCM and sources of information
Standardized registers and reporting documents developed
CCM indicators defined but not part of HMIS
Research agenda documented and circulated for piloting the introduction but not for monitoring the progress
Monitoring framework tested & modified accordingly
Registers and reporting documents reviewed
CHWs, supervisors and M&E staff trained on the new framework and its components, but little focus on the use of data
Limited M&E through HMIS data performed to sustain program impact
No OR and no external evaluations of CCM systematically performed to inform scale-up and sustainability
30
Questions
What information do we get from the tables?
How can we use this information? What isn’t captured?
31