1. Results from Concern’s
Operations Research
initiatives in Burundi and
Sierra Leone
Jennifer Weiss,
Health Advisor, Concern US
Khadija Bakarr
Field Operations Manager
Concern Sierra Leone
CORE Spring 2014 Global
Health Practitioner
Conference

2. Burundi
• USAID CSHGP-funded project in
Mabayi District, Cibitoke Province,
Burundi
• October 2008 – September 2013
• Technical interventions: malaria,
diarrhea, pneumonia, IYCF
• Operations Research to test MOH-led
Care Group model

3. What are Care Groups?
Care Groups create a multiplying effect to equitably reach every household with a pregnant
woman or child under five years old with interpersonal behavior change communication

4. The ‘Integrated’ Care Group Model
CHWs instead of
Promoters
Key difference: CHW only
supervises 2 CGs
DHT is trained by Project
Animators to serve in
‘Animator’ role

5. Operations Research Study: Questions
1. Does the Integrated Care Group model achieve at least the same
improvements in key knowledge and practices as the traditional
model?
2. Does the Integrated Care Group model function as well as the
traditional model?
3. Is the Integrated Care Group model as sustainable as the traditional
model?

6. Operations Research Study: Methods
• Quasi-experimental, cluster randomized
pre-post study
Traditional
Area
Integrated
Area
# Care Groups 51 45
# Care Group
Volunteers
503 478
# Children Under 5 and
Pregnant Women 7,758 6,630

7. Operations Research Results:
Knowledge and Practices
Indicator Type Example of Indicators Collected Total # % ‘non-
inferior’
Knowledge
• Danger signs in sick children
• Critical times for hand-washing
• Breastfeeding and complementary feeding practices
• Food groups and components of balanced diet
13 85%
Preventive
Practices
• Iron supplementation during pregnancy
• Immediate and exclusive breastfeeding
• Complementary feeding practices
• Hand-washing
• ITN use
13 100%
Sick Child
Practices
• Diarrhea: care-seeking, use of ORS, increased fluids and food
• Malaria: care-seeking within 24 hours, treatment with ACT
• Pneumonia: care-seeking and treatment with antibiotic
10 90%
Contact Intensity
• Contact with trained health information provider
• Attendance at community meetings where health of child was
discussed
4 100%
OVERALL 40 90%

8. Operations Research Results:
Functionality and Sustainability
% of CG meetings with at least 80% Volunteer attendance

9. Operations Research Results:
Functionality and Sustainability
% of HHs who received at least one visit by a CGV in the last month

10. Summary of Results
1. The Integrated Care Group model achieved at least the same improvements
in key knowledge and practices as the traditional model
2. The Integrated Care Group model functions as well as the traditional model
3. The Integrated Care Group model is as sustainable as the traditional model
 In at least the six month period following end of project support to CG
activities, project staff still active in area supporting other (non-Care
Group) project activities such as CCM
 Post-project sustainability study required

11. Learning
• CHWs are able to serve as Care
Group Promoters through a modified
model:
• No more than 2 CGs per CHW
• Monthly support (training) from
health facility
• Head nurses do not have time for Care
Group / CHW supervision – delegate to
a more junior nurse “focal point”
• Integrated Model allows for community
health data to be directly incorporated
into Ministry HIS

12. Policy Implications for Burundi MoH
Ministry has demonstrated keen interest in model, with national
applications for Community Health Strategy
Key Questions to be Addressed to Inform Scale-up:
•Who will initiate the approach? (Role of NGOs)
•How will behavior change materials be re-produced?
•How will quality control and supervision be provided?
•What costs are involved and how will these be covered?

13. Sierra Leone
• USAID CSHGP-funded project in 10
slum communities of Freetown, Sierra
Leone
• October 2011 – September 2016
• Technical interventions: maternal and
newborn health, malaria, diarrhea,
pneumonia, nutrition
• Operations Research to test a
Participatory Community-based Health
Information System (P-CBHIS); in
partnership with JHU

14. What is a P-CBHIS?
• Based the Community Based Impact
Oriented (CBIO) approach
• Hypothesizes that if community
members have access to health
information, they will be empowered to
make informed decisions on health
programming in their community
• Key activities:
• Monthly household visitation to collect
vital event (birth and death) data
• Verbal autopsies to determine cause of
death
• Participatory feedback sessions and
activity planning based on data
collected

15. Operations Research Questions
Formative Research Question: What are the key factors, inputs, and
processes required to establish an effective Participatory Community-
based Health Information System?
Evaluative Research Questions:
1.What is the extent to which the P-CBHIS facilitates data use to plan and
implement key maternal and child health interventions?
2.What is the extent to which the P-CBHIS contributes to improved health
outcomes for the interventions most closely related to leading causes of
child illness and death identified through the P-CBHIS.?

16. Intervention group Comparison
group
• Baseline/endline
assessment of community
structure data
management capacity
• Census to identify all
target HHs
• Identify and train CHWs
and supervisors
• Collect birth and death
data
• Periodic KPC surveys to
compare key health
outcome data
• Collect vital event data
• Verbal autopsy to explore
cause of death
• Training for Health
Management Committee,
Ward Development
Committee on how to manage
and interpret data
• Community-feedback
mechanism on morbidity and
mortality data
• Collect vital event
data

17. Community Based Household Census As first
phase of CSP Operations Research

18. Community Based Household Census Results

19. Supervisors Feedback and Reporting

20. Learning and Implications
• Census is important first step to any community information systems to
ensure accurate counting of all project beneficiaries
• Census increased visibility of project in the community, high levels of
interest among community structures through their participation in
process
• Census data collection tools and procedures for quality assurance
showed us the best way to train community enumerators to collect
household data
• Conducting a household data in an urban slum environment poses
unique challenges and requires high levels of community involvement to
ensure accurate data (mapping, community boundaries)

21. Next Steps
• Currently training CHWs on BCC
messages and household data
collection
• Refining data collection tools to be in
line with MOH CHW reporting tools
• Development of Verbal Autopsy tool
for use by CHWs
• Development feedback meeting
protocol
• Strengthen relationship with OR
Steering Committee to ensure our
findings are broadly disseminated at
national level

22. Thank you!
For additional information:
Jennifer Weiss, Health Advisor,
Concern Worldwide, US
jennifer.weiss@concern.net
Khadija Bakarr, Field Operations Manager,
Concern Sierra Leone
khadijatu.bakarr@concern.net
www.concernusa.org