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The Program Assessment GuideStructuring Contextual Knowledge and Experience to Structuring Contextual Knowledge and Experience to
Improve the Design, Delivery and Effectiveness of Improve the Design, Delivery and Effectiveness of Nutrition InterventionsNutrition Interventions
David PelletierDavid Pelletier
Division of Nutritional SciencesDivision of Nutritional Sciences
Cornell UniversityCornell University
CORE Spring MeetingMay 1, 2012
Wilmington, DE
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AcknowledgmentsAcknowledgments
Collaborators on the MN Tool ProjectCollaborators on the MN Tool Project Allison Corsi, Lesli Hoey, Suzanne Gervais, Allison Corsi, Lesli Hoey, Suzanne Gervais,
Cornell UniversityCornell University
Funders and Facilitators of the MN Tool ProjectFunders and Facilitators of the MN Tool Project The World BankThe World Bank Micronutrient InitiativeMicronutrient Initiative Centers for Disease ControlCenters for Disease Control UNICEFUNICEF GAINGAIN A2Z (USAID and Gates Foundation)A2Z (USAID and Gates Foundation)
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?
The Challenge
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Why Implementation Why Implementation Science?Science?
Efficacy-to-EffectivenessEfficacy-to-Effectiveness Knowledge-to-ActionKnowledge-to-Action Evidence-Based InterventionsEvidence-Based Interventions Evidence-Based DecisionsEvidence-Based Decisions Evidence-Based Policy MakingEvidence-Based Policy Making Scaling UpScaling Up Etc.Etc.
p2
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OutlineOutline
1.1. Genesis of the projectGenesis of the project
2.2. Overview of the PAGOverview of the PAG
3.3. Adaptations and next steps for the PAGAdaptations and next steps for the PAG
4.4. Q&AQ&A
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Genesis of This ProjectGenesis of This Project
Micronutrient Forum (May 2009) Micronutrient Forum (May 2009) • From Evidence to Large Scale ProgramsFrom Evidence to Large Scale Programs
The Innocenti Process (Sept 2008)The Innocenti Process (Sept 2008)• Country implementers, donors, researchersCountry implementers, donors, researchers• Review of evidence for effectiveness at scaleReview of evidence for effectiveness at scale• Identification of overarching issues needing attentionIdentification of overarching issues needing attention
Country implementers requested stronger Country implementers requested stronger guidance on identifying and resolving guidance on identifying and resolving implementation bottlenecksimplementation bottlenecks
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The Micronutrient Program ToolsThe Micronutrient Program Tools Program Assessment Guide (PAG)Program Assessment Guide (PAG) Program Documentation Guide (PDG)Program Documentation Guide (PDG)
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Laying the Groundwork
Three-DayWorkshop
Follow-Through
The PAG Process
3-12 months 1-3 years
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Program Assessment Guide (PAG)Program Assessment Guide (PAG)
1. Action Plan to Address Barriers & Enablers
2. Operations Research Agenda
3. Issues for Inclusion in M&E
4. Strategic Plan to Build Support, Capacity & Sustainability
Outputs
Participatory Procedures To Strengthen:
• The Systematic Integration Of Evidence, Contextual Knowledge & Experience
• Shared understanding, commitment, ownership, motivation & capacity to advance the micronutrient agenda
•Links with the broader nutrition and health agendas in the country
Processes
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Nine modules:• Purpose• Rationale• Instructions• Templates• Examples
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Laying the GroundworkModule 1: Clarifying the Problem and the Solution Module 2: Goals and Associated ValuesModule 3: Delivery SystemsModule 4: Hard to Reach PopulationsModule 5: People, Roles and Responsibilities
Program Assessment Guide
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Building or Strengthening the InterventionBuilding or Strengthening the Intervention Module 6: Needs, Inputs, Activities and System ChangesModule 6: Needs, Inputs, Activities and System Changes Module 7: Action PlanningModule 7: Action Planning Building Support Systems and the Enabling EnvironmentBuilding Support Systems and the Enabling Environment Module 8: Monitoring, Evaluating and Quality Improvement Module 8: Monitoring, Evaluating and Quality Improvement Module 9: Organizing, Leading and ManagingModule 9: Organizing, Leading and Managing
Program Assessment Guide
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1. 1. Delivery Systems as Social Systems (Module 3)Delivery Systems as Social Systems (Module 3)
2. The Five Needs Tool (Module 6)2. The Five Needs Tool (Module 6)
3. The Stress-Testing Tool (Module 6)3. The Stress-Testing Tool (Module 6)
4. Clear definition of roles and responsibilities (Modules 5,7) and 4. Clear definition of roles and responsibilities (Modules 5,7) and responsibility for follow-up (Module 9)responsibility for follow-up (Module 9)
Some Distinctive Features of the PAG
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Module 3: Delivery systems as social systems Module 3: Delivery systems as social systems
A
National Regional Clinic Community
D HJ
Functionaries (barriers and enablers)
Household& Caregiver
Significant Others (barriers and enablers)
CB EI
GF
District
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National Oblast Clinic Community
Caregiver
Rayon
• How Will Gulazik Get from the National Level to All Caregivers?• How Will Gulazik Education Get to All Caregivers?
Module 3: Delivery systems as social systems Module 3: Delivery systems as social systems
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Five Universal Needs1.Awareness2.Knowledge, Information, Skill3.Motivation/ Commitment4.Resources5.Support from Others
Module 6: Strengthening the delivery system
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Village-levelHealth Volunteer
Role/Responsibility:
Provide mothers with information and education to encourage proper use of Gulazik
Awareness
Information, Knowledge,& Skills
Commitment/Motivation
Resources
Support from others
Inputs, Activities& System Changes
What is required in order for these needs to be met?
What does the village health volunteer need in order to be successful?
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Module 6: What does each functionary and significant other NEED in order to fulfill their role/responsibility of the Sprinkles program (on a daily basis) and what inputs, activities and system changes are required to ensure their needs are met?
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Systematizing and stress-testing contextual Systematizing and stress-testing contextual knowledge and experience (Module 6)knowledge and experience (Module 6)
Proposers Challengers
Village-levelHealth Volunteer
Role/Responsibility:
Provide mothers with information and education to encourage proper use of Gulazik
Awareness
Information, Knowledge,& Skills
Commitment/Motivation
Resources
Support from others
Inputs, Activities& System Changes
What is required in order for these needs to be met?
What does the village health volunteer need in order to be successful?
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Identifying Functionaries and Significant Othersin the Delivery and Support Systems
A
National Oblast Clinic Community
D HJ
FunctionariesCaregiver
Significant Others
CB EI
GF
Rayon
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Systematizing and stress-testing contextual Systematizing and stress-testing contextual knowledge and experience (Modules 6-8)knowledge and experience (Modules 6-8)
Proposers Challengers
Village-levelHealth Volunteer
Role/Responsibility:
Provide mothers with information and education to encourage proper use of Gulazik
Awareness
Information, Knowledge,& Skills
Commitment/Motivation
Resources
Support from others
Inputs, Activities& System Changes
What is required in order for these needs to be met?
What does the village health volunteer need in order to be successful?
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Inputs, Activities& System Changes
Identifying Functionaries and Significant Othersin the Delivery and Support Systems
A
National Oblast Clinic Community
D HJ
FunctionariesCaregiver
Significant Others
CB EI
GF
Rayon
Actions to address barriers and enablers in the Action Plan
Questions for Operations Research
Issues to track in monitoring and QA
Outputs
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Implementation WGs OperationsResearch WG
Monitoring, Evaluationand QI WG
Coordination & Support WG
Relationships Among Working Groups
Module 9: Responsibilities for Follow-Upto the Workshop
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Experiences from Kyrgyzstan,Bolivia and HaitiExperiences from Kyrgyzstan,Bolivia and Haiti
1. Sponsorship, Responsibility, 1. Sponsorship, Responsibility,
Commitment, Follow-upCommitment, Follow-up
2. Timing2. Timing
3. Preparation3. Preparation
4. Participants4. Participants
5. Contextuality (selection and sequencing)5. Contextuality (selection and sequencing)
6. Time constraints6. Time constraints
7. Facilitation7. Facilitation
Before the workshop
During the workshop
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Next Steps for the PAG
Produce additional versions for:Produce additional versions for:• More complex interventions (ag, livelihood, social protection, etc)More complex interventions (ag, livelihood, social protection, etc)• Integrated (multi-intervention) programsIntegrated (multi-intervention) programs• Sub-national planning (district, project level)Sub-national planning (district, project level)• Diverse countriesDiverse countries
Partner with NGOs to gain experience applying the PAG Partner with NGOs to gain experience applying the PAG in the above contextsin the above contexts
Develop and field test the Adoption Guide, Facilitators Develop and field test the Adoption Guide, Facilitators Guide and Workshop Planning GuideGuide and Workshop Planning Guide
Develop and fiedld test training & coaching approachesDevelop and fiedld test training & coaching approaches
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Q&AQ&A
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An ExampleAn ExampleBreastfeeding BCC programs often improve EBF rates by a Breastfeeding BCC programs often improve EBF rates by a
modest amount, e.g., 20% at baseline to 40% at endline.modest amount, e.g., 20% at baseline to 40% at endline.
Using the five needs tools, analyze why this might be?Using the five needs tools, analyze why this might be?
Five Universal Needs1.Awareness2.Knowledge, Information, Skill3.Motivation/ Commitment4.Resources5.Support from Others
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Five Universal Needs1.Awareness2.Knowledge, Information, Skill3.Motivation/ Commitment4.Resources5.Support from Others
Module 6: Strengthening the delivery system
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Behavior-centered design of interventions and delivery and support systems (PAG)
Results Frameworks , Logic Models (USAID, PIP, etc)
High Level Frameworks for Scaling Up (WHO/RH, WHO/ExpandNet, MSI, CMH, CORE, etc)
PAG in the Context of OtherFrameworks and Models for Scaling Up
GeneralGuidance
DetailedAnalysis &Planning