Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting: An Evaluation of Nested Delivery Models

Das, Ashis; Friedman, Jed; Kandpal, Eeshani; Ramana, G.N.V.; Gupta, Rashmi; Pradhan, Mohan Kumar; Govindaraj, Ramesh

doi:10.1596/1813-9450-6901

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…Of note, our study combined a small financial incentive with SS, and this model proved to be effective. Indeed, other studies have suggested that providing some sort of economic recognition is crucial for ensuring CHWs’ performance 39–41…”

Section: Discussionmentioning

confidence: 99%

Supportive supervision to improve the quality and outcome of outpatient care among malnourished children: a cluster randomised trial in Arua district, Uganda

Lazzerini

Wanzira²,

Lochoro

et al. 2019

BMJ Glob Health

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IntroductionSuboptimal quality of paediatric care has been reported in resource-limited settings, but little evidence exists on interventions to improve it in such settings. This study aimed at testing supportive supervision (SS) for improving health status of malnourished children, quality of case management, overall quality of care, and the absolute number of children enrolled in the nutritional services.MethodsThis was a cluster randomised trial conducted in Arua district. Six health centres (HCs) with the highest volume of work were randomised to either SS or no intervention. SS was delivered by to HCs staff (phase 1), and later extended to community health workers (CHWs) (phase 2). The primary outcome was the cure rate, measured at children level. Quality of case management was assessed by six pre-defined indicators. Quality of care was assessed using the national Nutrition Service Delivery Assessment (NSDA) tool. Access to care was estimated with the number of children accessing HC nutritional services.ResultsOverall, 737 children were enrolled. In the intervention arm, the cure rate (83.8% vs 44.9%, risk ratio (RR)=1.91, 95% CI: 1.56–2.34, p=0.001), quality of care as scored by NSDA (RR=1.57, 95% CI: 1.01–2.44, p=0.035) and correctness in complementary treatment (RR=1.52, 95% CI: 1.40–1.67, p=0.001) were significantly higher compared with control. With the extension of SS to CHWs (phase 2), there was a significant 38.6% more children accessing care in the intervention HCs (RR=1.26, 95% CI: 1.11–1.44, p=0.001) compared with control.ConclusionSS significantly improved the cure rate of malnourished children, and the overall quality of care, SS to CHWs significantly increased the crude number of children enrolled in the nutritional services. More studies should confirm these results, and evaluate the cost-effectiveness of SS.

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Section: Discussionmentioning

confidence: 99%

Supportive supervision to improve the quality and outcome of outpatient care among malnourished children: a cluster randomised trial in Arua district, Uganda

Lazzerini

Wanzira²,

Lochoro

et al. 2019

BMJ Glob Health

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“…Under the strategy, a supportive supervision model was institutionalised as an external concurrent monitoring mechanism to track progress and generate evidence to facilitate actions for strengthening high-impact RMNCH+A Interventions. Guided by the MOHFW, the RMNCH+A Supportive Supervision model was led by the partner agencies and integrated all five thematic areas for focused support and on-job facilitation 18–21…”

Section: Approach Adopted In the Reproductive Maternal Newborn Chimentioning

confidence: 99%

India’s RMNCH+A Strategy: approach, learnings and limitations

Taneja¹,

Sridhar²,

Mohanty³

et al. 2019

BMJ Glob Health

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Building on the gains of the National Health Mission, India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country’s health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the ‘Aspirational Districts Program’ to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.

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“…This paper investigates the correlates of two different malaria case management outcomes: (1) a female caregiver taking a child to a health facility and (2) the prompt treatment of febrile children with ACT. The authors were specifically interested in caregiver exposure to “Healthy Baby, Happy Mother.” One study has documented the effectiveness of SBCC as a means of changing care-seeking behavior for children under five with fever in India [ 6 ]. Aside from Kenny et al [ 7 ], no other studies examine correlates of a caregiver seeking care for a child with fever from a health facility in Liberia.…”

Section: Introductionmentioning

confidence: 99%

Correlates of social behavior change communication on care-seeking behaviors for children with fever: an analysis of malaria household survey data from Liberia

Awantang

Babalola

Koenker

et al. 2018

Malar J

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BackgroundIn 2010, malaria was responsible for an estimated 41% of deaths among children under the age of five years in Liberia. The same year, the Rebuilding Basic Health Services Project launched “Healthy Baby, Happy Mother,” a social and behavior change communication campaign. The campaign encouraged caregivers to take children under the age of five years to a health facility as soon as children developed fever. This study investigated correlates of two case management outcomes: care-seeking for children under five with fever during the past two weeks and administration of an artemisinin-based combination therapy (ACT) the same or next day as fever onset.MethodsData from a 2014 cross-sectional household survey from four counties was used to investigate correlates of two case management outcomes. Using multilevel analysis, the association between these outcomes and a caregiver’s recall of the campaign, her sociodemographic characteristics, and unmeasured characteristics of the community she lived in was investigated.ResultsCaregivers living in Grand Kru County were less likely (OR = 0.21, 95% CI 0.073, 0.632) to take a child to a health facility than those in Bong County. Caregiver recall of the campaign was positively associated with the odds that a child received an ACT promptly (OR 3.62, 95% CI 1.398–9.372), but not with the odds of a caregiver taking a child in their care to a health facility. While unmeasured community-level factors accounted for 19.0% of the variation in the odds that a caregiver’s child was brought to a health facility, they did not play a role in the odds of prompt ACT treatment.ConclusionsRecalling the “Healthy Mother, Happy Baby” campaign was positively associated with the odds that children received ACT promptly, even in the absence of other malaria prevention and treatment messaging. While caregiver exposure was not associated with care-seeking during the two weeks before interview, prompt care-seeking likely preceded prompt receipt of ACT since most ACT came from health facilities. Unmeasured community-level factors, such as distance from the health facility, may play a role in determining the odds that a caregiver takes a child to a health facility.

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Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting: An Evaluation of Nested Delivery Models

Cited by 8 publications

References 21 publications

Supportive supervision to improve the quality and outcome of outpatient care among malnourished children: a cluster randomised trial in Arua district, Uganda

Supportive supervision to improve the quality and outcome of outpatient care among malnourished children: a cluster randomised trial in Arua district, Uganda

India’s RMNCH+A Strategy: approach, learnings and limitations

Correlates of social behavior change communication on care-seeking behaviors for children with fever: an analysis of malaria household survey data from Liberia

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