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Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts.

ABSTRACT: Background:Maternal, Child Health and Nutrition improvement Project is a World Bank-funded project implemented in all then ten regions of Ghana, which aims at improving access and utilization of community-based maternal, child health, and nutrition services in order to accelerate progress. This study is aimed at determining the implementation status of the project in the Eastern region by evaluating the processes involved and identifying implementation barriers from the perspective of implementors. Methods:The study was a cross-sectional in design and employed a quantitative data collection approach in ten Community-based Health Planning and Services (CHPS) centres in five districts in the region. The project coordinators and Community Health Officers were interviewed using a structured questionnaire. The project implementation reports at the facility level were reviewed using a checklist. Tertile statistic was used to describe the status of the project implementation. Result:The finding from this study indicated "complete implementation status" for maternal, child health, and nutrition activities of the project. However, none of the facilities evaluated had satisfactorily implemented all the governance processes and were therefore rated as "partially complete." The main implementation barriers emerged from the study were related to restrictions placed on the use of project funds and delays in the fund disbursement to CHPS facilities. Conclusion:The evidence gathered from the study showed very good implementation status for community-led maternal and child health service delivery, indicative of a positive response to the guidelines by service providers at the periphery and can have positive impact on the project's objectives and goals. Governance component of the project, however, revealed inadequate alignment with guidelines which might have been influenced by the lack of knowledge as a result of lack of training for implementers. This therefore calls for in-service training and improved supportive supervision at both administrative and service delivery levels.

SUBMITTER: Amponsah SB

PROVIDER: S-EPMC7520675 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts.

Amponsah Solomon Boamah SB Osei Eric E Aikins Moses M

BioMed research international 20200918

<h4>Background</h4>Maternal, Child Health and Nutrition improvement Project is a World Bank-funded project implemented in all then ten regions of Ghana, which aims at improving access and utilization of community-based maternal, child health, and nutrition services in order to accelerate progress. This study is aimed at determining the implementation status of the project in the Eastern region by evaluating the processes involved and identifying implementation barriers from the perspective of im ...[more]

PMID: 33015152

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Project description:BackgroundThe current paper examines the level of use of evidence and factors affecting the use of evidence by frontline maternal, newborn and child health (MNCH) and reproductive and child health (RCH) staff in practice decisions in selected health facilities in Ghana.MethodsData on use of evidence and its correlates was collected from 509 frontline healthcare staff drawn from 44 health facilities in three regions in Ghana. Means were used to examine the level of use of evidence, whiles cross-tabulations and Partial Least Squares-based regression were used to examine factors associated with the use of evidence in practice decisions by frontline MNCH/RCH staff.FindingsThe findings suggest a high level of use of evidence by frontline MNCH/RCH staff in practice decisions (score of 3.98 out of 5), albeit that evidence use is skewed towards the use of practice guidelines and policies. For the antecedents of evidence use, attitude had the highest score (3.99), followed by knowledge (3.8), access to evidence (3.77) and organizational structure (3.57), using a threshold of 5. The regression results indicate that attitudes and knowledge of frontline MNCH/RCH staff, organizational structure (strongest association), years of experience, being a male and working in a mission health facility are significantly positive correlated with evidence use, whiles working in a private health facility or in the post-natal clinic is negatively correlated with the use of evidence.ConclusionWe argue that any effort to improve the use of evidence by frontline MNCH/RCH staff in practice decisions should focus on improving attitudes and knowledge of staff as well as challenges related to the structure of the organisation. Given however that the score for attitude was relatively high, emphases to improve evidence use should be on access to evidence and organizational structure in particular, which had the lowest score even though it has the strongest association with the use of evidence.

Project description:Abstract Objectives Little is known about how level of participation affects nutrition outcomes in rural interventions. This study examined the association between participation level in a nutrition-sensitive agriculture intervention (NSA) and children's diet and anthropometric outcomes. Methods The Nutrition Links was a 2016–17 cluster RCT (clinicaltrials.gov NCT01985243) which enrolled caregivers with children < 18 mo in rural Ghana. Women in the intervention communities self-selected to receive poultry layers for egg production as part of a loan package, garden inputs, and nutrition education. Weekly meetings were used for education, for the staff to document egg production, and for the women to repay their loan and purchase feed. After endline, project participation was evaluated with a summative score that reflected 5 criteria: 1) egg productivity 2) timely and complete payment for feed and loan 3) meeting attendance 4) answering questions and making comments during the meetings and 5) attentiveness and helpfulness with the group. The field staff evaluated all criteria – from 1 (very poor) to 5 (excellent) – for each intervention woman who received poultry. Their participation was classified as high, medium, or low, based on tertiles. The participation of intervention women who never received poultry was ‘none’. Logistic and linear regressions tested the likelihood of consuming eggs and having a minimum diverse diet (MDD) and changes in anthropometric indices for the participation levels compared to those of the controls, who received standard-of-care services. Results In comparison to the control group, only a high participation level was significant for having a MDD (aOR  = 3.1, 95% CI [1.1, 8.8]). Both medium and high participation levels were associated with an increased likelihood in egg consumption (aOR = 2.1, 95% CI [1.0, 4.1]; aOR = 2.7, 95% CI [1.3, 5.4]), and length‐for‐age (LAZ)/height‐for‐age (HAZ) z‐scores (β = 0.4, 95% CI [0.2, 0.6]; β = 0.4, 95% CI [0.2, 0.7]), and weight‐for‐age (WAZ) (β = 0.2, 95% CI [0.0, 0.4]; β = 0.2, 95% CI [0.0, 0.5]), respectively. Conclusions These results show the potential effect of NSA interventions and highlight the importance of facilitating high participation of beneficiaries. Funding Sources Global Affairs Canada, Heifer International, World Vision, McGill University, International Development Research Centre.

Project description:BackgroundWith the date for achieving the targets of the Millennium Development Goals (MDGs) approaching fast, there is a heightened concern about equity, as inequities hamper progress towards the MDGs. Equity-focused approaches have the potential to accelerate the progress towards achieving the health-related MDGs faster than the current pace in a more cost-effective and sustainable manner. Ghana's rate of progress towards MDGs 4 and 5 related to reducing child and maternal mortality respectively is less than what is required to achieve the targets. The objective of this paper is to examine the equity dimension of child and maternal health outcomes and interventions using Ghana as a case study.MethodsData from Ghana Demographic and Health Survey 2008 report is analyzed for inequities in selected maternal and child health outcomes and interventions using population-weighted, regression-based measures: slope index of inequality and relative index of inequality.ResultsNo statistically significant inequities are observed in infant and under-five mortality, perinatal mortality, wasting and acute respiratory infection in children. However, stunting, underweight in under-five children, anaemia in children and women, childhood diarrhoea and underweight in women (BMI < 18.5) show inequities that are to the disadvantage of the poorest. The rates significantly decrease among the wealthiest quintile as compared to the poorest. In contrast, overweight (BMI 25-29.9) and obesity (BMI ? 30) among women reveals a different trend - there are inequities in favour of the poorest. In other words, in Ghana overweight and obesity increase significantly among women in the wealthiest quintile compared to the poorest. With respect to interventions: treatment of diarrhoea in children, receiving all basic vaccines among children and sleeping under ITN (children and pregnant women) have no wealth-related gradient. Skilled care at birth, deliveries in a health facility (both public and private), caesarean section, use of modern contraceptives and intermittent preventive treatment for malaria during pregnancy all indicate gradients that are in favour of the wealthiest. The poorest use less of these interventions. Not unexpectedly, there is more use of home delivery among women of the poorest quintile.ConclusionSignificant Inequities are observed in many of the selected child and maternal health outcomes and interventions. Failure to address these inequities vigorously is likely to lead to non-achievement of the MDG targets related to improving child and maternal health (MDGs 4 and 5). The government should therefore give due attention to tackling inequities in health outcomes and use of interventions by implementing equity-enhancing measure both within and outside the health sector in line with the principles of Primary Health Care and the recommendations of the WHO Commission on Social Determinants of Health.

Dataset Information

Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts.

Publications

Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts.

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