Post on 03-Jul-2015
Cotopaxi EONC Project
USAID/CSHGP - CHS/Ecuador
Presenter:Mr. Andrew J GallContributorsDr. Kathleen HillDr. Jorge Hermida
Brief Introduction to CHS-Ecuador Child Survival Project
Process of addressing equity issues: ◦ Step 1: Understanding equity issues in project area◦ Step 2: Identify disadvantaged group to focus on◦ Step 3: Decide what is in project’s manageable
interest to change
Concluding thoughts about steps 4-6 for the CHS-Ecuador Child Survival Project
Cotopaxi Province Figures
Population 384,499
Project Target Population
(Women, Children,Infants)
72,437
Poverty Level 90.47%
Rural Population 67%
Indigenous Population 28%
Maternal Mortality 102 Deaths per 100,000 Live Births
Newborn Mortality 7.8 Deaths per 100,000 Live Births
ProvincialHospital (Surgery & Blood 4 hours)
CountyHospitals
AmbulatoryHealth Centers
(Parish Level)
TBAs(Community Level)(3,000 deliveries)
1,500 deliveries
Ministry of Health(3,000 deliveries)
Social Security NGOsPrivateproviders
Cotopaxi Provincial Health System: Fragmented; no continuum of care; inequitable access; poor quality of care
To reduce maternal and newborn mortality and morbidity in Cotopaxi province
Improved household health promotion practices and utilization of a continuum of high-impact community- and facility-based maternal newborn services provided as part of a coordinated network of CHW’s, health facilities
and social organizations.
Increased availability/ access to a coordinated
continuum of high-impact maternal
newborn care provided as part of a network of community and facility
services.
Improved knowledge / demand for evidence-based community and facility MNC services, including improved household health
promotion practices.
Improved quality of MNC services provided as part of a coordinated network
of CHWs and facilities
Improved policy environment for
coordination among community health
workers, health care institutions, and
community /social organizations
Goal/Impact
Strategic Objective
Results/Outcomes
1 2 3 4
Baseline Assessment addressed Steps 1a. and1b.
Methods:
Random selection 462 households rural parishes Cotopaxi Province (using census data)
Household Survey Questionnaire focused on: Project, OR and Rapid Catch Indicators
TBA assessment (qualitative and quantitative)
Reported
Service
Coverage
Reported Site of
Service Delivery
Total Sample
N=462
Indigenous
Indian
(28%)
Non-
indigenous
(72%)
Antenatal Care (4
sessions)
Health Center 88%
TBA/CHW 1%
Other 11%
69% 49% 77%
Skilled Delivery Care
Hospital: 51%
Health Center 9.5%
Private Clinic 13%
74% 36% 89%
Early Post-Partum Care
Home: 10%
Clinic/hospital 50%
Private clinic: 8.4%
5.4% -- --
HH Survey: Main reasons given by women for delivery at home included:
Traditional Practices: 37%
Geographical barriers: 18%
Not enough time: 23%
Lack of money: 6%
TBA focus groups highlighted TBA perceived lack of recognition by MOH facility providers
Lack of functional referral processes between TBAs and MOH institutions. For example, MOH facility health personnel do not respect TBA referral forms recommended by MOH provincial cross-cultural health (“Salud intercultural”) guidelines.
Baseline assessment results confirm lower coverage of high impact maternal newborn services for indigenous women as compared with non-indigenous women.
Based on baseline assessment results and cost considerations, final project strategy:
Prioritize parishes that meet one or both of 2 criteria:
◦ A. > 50% poverty level (national survey data)◦ B. > 50% indigenous Indian population (national survey
data)
Geographic Scope:
21/40 (52.5%) Cotopaxi parishes targeted
Step 4: Define equity goals, objectives and operational definition:
Step 5: Determine Equity Strategy◦ Increase coverage and quality of high impact home-based
MNH services (provided by TBAs & parish micronetwork health teams)
◦ Improve cultural responsiveness of institutional childbirth services
◦ Improve referral systems
Step 6: Develop Equity Focused M&E◦ Our project prioritizes parishes with high proportions of poor
and indigenous women◦ Could stratify selected indicators at baseline/endline for
advantaged vs. disadvantaged groups