recent findings from an evaluation of the core group polio project_ward & lynch_5.11.11
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CORE Group Spring MeetingMay 11, 2011
Midterm Evaluation ResultsCORE Group Polio Project
Project Background
Project Background
Current USAID project cycle: October 2007 – September 2012
Donors:
1999 – September 2012
December 2008 - December 2013
Structure of the CGPP
CGPP Angola
CGPP Ethiopia
CGPP Uttar Pradesh, India
Project Background
Increased routine vaccination rates
Increased/ sustained participation in quality SIAs
Increased/ sustained reporting of suspected AFP cases
OUTCOMESCommunity-based Social MobilizationDoor-to-door Counseling + Child TrackingGroup Education SessionsInfluencer InvolvementKey Surveillance InformantsOther Country-specific Activities
Capacity-building for Local Health SystemsTraining OpportunitiesTechnical Assistance for MicroplanningChild Tracking
Country-specific high-level contributionsCampaign Quality Monitoring – AngolaRegional Advocacy Workshops – EthiopiaSMNet Partner - India
PROJECT ACTIVITIES
Presentation Focus
Community-based Social MobilizationDoor-to-door Counseling + Child TrackingGroup Education SessionsInfluencer InvolvementKey Surveillance InformantsOther Country-specific Activities
Country-specific high-level contributionsCampaign Quality Monitoring – AngolaRegional Advocacy Workshops – EthiopiaSMNet Partner - India
PROJECT ACTIVITIES
Increased knowledge of and participation in routine vaccination
Increased/ sustained community acceptance of and demand for SIAs
Increased/ sustained awareness of AFP and proper reporting procedures
OUTCOMESCapacity-building for Local Health SystemsTraining OpportunitiesTechnical Assistance for MicroplanningChild Tracking
Evaluation Questions
Has polio and RI immunization coverage in children 12 – 23 months of age in the geographic areas where the CORE Group Polio Project is working improved compared to baseline (2008)?
Has AFP surveillance in the areas where the CORE Group Polio Project is working improved compared to baseline (2008)?
Baseline & Midterm Design
HOUSEHOLD SURVEY
KEY STAKEHOLDER INTERVIEWS
Household Survey
Angola Ethiopia India
Baseline
n 387 2109 605
Design Features
One set of 30 clusters
Set of 30 clusters in each of 7 states
Set of 30 clusters in each of 2 project regions
Midterm
n 450 887 603
Design Features
One set of 30 clusters
Set of 30 clusters in each of 3 areas
Set of 30 clusters in each of 2 areas
Caregivers of children 12 – 23 months of ageSimilar surveys 30 Cluster SamplingData collection
Baseline - summer 2008Midterm - summer/fall 2010
Baseline/Midterm Comparisons
CGPP Volunteer/Worker ContactDOOR-TO-DOOR COUNSELING
*
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
CGPP Volunteer/Worker ContactGROUP EDUCATION SESSIONS
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
Vaccination Attitudes
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
*
Routine Immunization
Routine Immunization- AngolaCARD RETENTION
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
Routine Immunization - Angola
* *
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
Routine Immunization - EthiopiaCARD RETENTION
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
Routine Immunization - Ethiopia
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
OPV0 OPV0 OPV0OPV3 OPV3 OPV3Penta1 Penta1 Penta1Penta3Penta3Penta3
* * ** ** ** *
Baseline n=883Midterm n=286
Baseline n=602Midterm n=281
Baseline n=593Midterm n=263
Routine Immunization - IndiaCARD RETENTION
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
Routine Immunization - India
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
*
Routine ImmunizationANGOLA Overall positive trend Significant improvements in OPV3 and Penta3 Registries operational since midterm/Additional coordination with MOH
ETHIOPIA Semi-pastoralist & pastoralist gains; Agrarian stagnancy Consider additional supervision in areas with low results Continue with key messages on OPV0 Explore non-literate vaccination registries
INDIA Very modest overall positive trend Focus on supplementary immunization activities Explore additional barriers to target behaviors
Supplementary Immunization Activities
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
* * * **
Supplementary Immunization Activities
ANGOLA Solid improvement in SIA performance in a country where successful campaigns are critical
INDIA SIA coverage high at baseline Maintaining near complete coverage an accomplishment Artifact in final indicator?
Acute Flaccid Paralysis Surveillance
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
**
Acute Flaccid Paralysis Surveillance
* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.
* *
Acute Flaccid Paralysis Surveillance
ANGOLA AFP surveillance needs renewed emphasis Currently being addressed in revised volunteer training + materials
ETHIOPIA AFP surveillance needs renewed emphasis – not unexpected, but must be addressed for certification Also currently being addressed in revised volunteer training + materials
Volunteer ContactASSOCIATIONS - VOLUNTEER/WORKER CONTACT & PROJECT OUTCOMES
Door-to-door counselingGroup education sessions
Positive associations between project activities & vaccination outcomes in all countries
Ethiopia – strongest associations between outcomes & group sessionsIndia – strongest associations between door-to-door counseling and campaign outcome
Strong associations between project activities and AFP knowledge and attitudes in Angola onlyReflects de-emphasis in India and concerning findings in Ethiopia?
Plans for further analysis
Questions that didn’t work
When was the last vaccination campaign?Is it meaningful to remember a date?Inconsistent frequency of campaigns.
Do you believe children can receive polio vaccinations too often?Translation problems - ambiguity
Lifetime doses of polio vaccineRecall reliability – inconsistent with other vaccination measures
Questions/Comments?