Attachment_J-7_Logical_Framework.pdf

ATTACHMENT J.7 – LOGICAL FRAMEWORK

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Project Description Performance Indicators Means of Verification Assumptions concerning linkages

Project Goal:

Increase the use of selected health services and products and to improve practices

Maternal Mortality Ratio;

Modern Contraceptive Prevalence Rate;

% of women with unmet FP need;

Infant/Child Mortality Rate

Demographic and Health Survey (DHS);

Millennium Development Goals Survey

This project-level goal is associated with a Development Objective from the FY2011 PPR and is the most accurate goal statement. The mission is currently revising its Results Framework.

--------------- Project-level Log Frame -------------

Project Purpose:

Increase community based primary health care service uptake and the adoption of healthy behaviors

% of children fully immunized;

% of children exclusively breastfed for 6 months;

Median number of Antenatal Care visits;

Child diarrhea, pneumonia, and malaria prevalence;

Anemia prevalence;

% of HH using improved sanitation.

Proxy/project evaluation surveys;

Outcome Monitoring Surveys MDG Survey

Malagasy people with improved health status recognize and value the economic and social benefits leading to the promotion and reinforcement of behaviors that resulted in improved health and creating a virtuous circle.

Sub-Purpose 1: Sustainably develop systems, capacity, and ownership of local partners

# of annual audits of local NGOs partners with no material findings;

% of CHVs with increased savings and access to credit;

% of CHVs with improved community status.

Audit reports;

COSAN Savings and Loans Impact Evaluation

Local capacity and ownership compels responsibility which catalyzes actions to improve health practices resulting in improved health status.

Outputs:

1. Number of local NGOs with transparent internal control systems institutionalized;

2. Improved governance and organizational structures within local partner NGOs;

3. Local NGOs eligibility for direct awards from USAID and/or other donors increased ;

4. Women’s participation and leadership in COSANs, CCDSs, and local NGOs improved;

5. Functional Social Development and Health Committees expanded ;

6. COSAN savings and loans established.

# of passable pre-award surveys;

# of direct awards;

# of results reports meeting minimum standards;

# of Communes with functioning COSANs;

# of Communes with functioning CCDSs;

# of Committees with action plans for health improvement;

# of COSAN Savings and Loans received;

Total dollar value of COSAN Savings and Loans fund balances;

% of CHVs attending monthly COSAN meetings out of the total # of CHVs in the health center catch ment area (disaggregated by sex);

% of CHVs attending monthly CCDS meetings out of the total # of CHVs in the health center catch ment area (disaggregated by sex);

# of local partner NGOs with by-laws and board of directors.

Pre-award surveys;

Signed award documents;

Result reports;

Site monitoring visits;

Social Accountability/Quality Scores and Reports

Well-functioning and effective local groups are necessary to ensure local ownership and sustainability.

Activities:

1. Conduct USG rules and regulations training

2. Supervise and coach local partners

3. Carry out technical assistance on procedure manuals and tools

4. Facilitate access to credit by developing guidelines, training modules and tools for COSAN Savings and Loans funds

5. Conduct women empowerment and leadership trainings and/or forums

# of people trained with increased knowledge and skills (disaggregated by sex);

# of supervision / coaching reports with actionable recommendations to improve internal control systems;

% of recommendations that have been addressed;

# of guidelines, training modules, and tools produced or revised;

Total dollar value of CSLAs awarded as a result of project facilitation;

# of women empowerment and leadership trainings conducted and forums held.

Project reports;

Manuals, guidelines, tools

Training, technical assistance, systems, and tools are necessary for local groups to function well and transparently manage funds.

Sub-Purpose 2: Increase availability of and access to primary health care services in project target communes

% of CHVs that have no stock-outs of selected commodities;

% of CHVs that have no stock-outs of selected equipment, materials, and tools (consumables) to carry out their work;

% of the population accessing selected MNCH, malaria, and FP services through CHVs;

% of children with fever, diarrhea, cough treated from CHVs;

% of children with fever

CHV surveys;

Project service statistics / population estimates Malaria Indicator Survey

Improved access to health services will contribute to uptake of those services and the adoption of improved health behaviors leading to improved health status.

receiving an RDT;

Couple Year Protection;

% of CHVs aware of LAPM service availability;

% of children under 2 years weighted during GMP in last 2 months;

% of births attended by a skilled provider;

% of women who received 2 doses of SP during last pregnancy;

# Of cases referred and seeking care at the nearest health provider for Antenatal Care, neonatal and obstetric emergencies, LAPMs, and severe illness episodes.

Outputs:

1. CHVs ability to provide integrated select health services increased;

2. Regular local supervision of CHVs conducted by CCDSs, NGOs, and implementing partner improved;

3. Increased availability of selected health commodities and services;

4. Improved referral and transport for facility services (severe illness, ANC, long-acting and permanent FP

# of functioning polyvalent CHVs;

# of services provided by CHVs;

# of CHV with no stock outs # of local (CCDS and local partners) supervision visits completed;

# of Monthly Activity Reports (MARs) received timely and complete;

# of MARs validated.

Project reports;

Site monitoring visits

More service delivery points offering integrated services will improve workload distribution, increase availability and reduce access barriers.

methods)

5. Timely, complete, and accurate reporting improved;

6. Essential health commodities stock-outs reduced.

Activities:

1. Conduct technical cross-training;

2. Facilitate collaboration and coordination between community organizations to hold the CHVs and CCDSs accountable for improving the health status of their respective communities;

3. Conduct supervisory visits;

4. Hold monthly reporting meetings;

5. Establish socials funds with

CSLA (to support commodity resupply).

# of people trained with increased knowledge and skills;

# of Health Committee meetings;

# of CHVs participating in meetings;

# of supervision visits completed;

# of social funds established;

Total dollar value of social funds.

Pre/post training tests;

Project reports;

Site monitoring visits

Community work will facilitate the organization and integration of an increased number of CHVs;

technical training will provide skills necessary to offer integrated services.

Sub-Purpose 3: Improve quality of community-level primary health care services

% of CHVs achieving minimum quality score for community case management and FP counseling.

CHV Service Quality Impact Evaluation;

Project service statistics / population estimates

Increased quality will improve client satisfaction which will lead to increased demand; this virtuous circle will increase service uptake leading to improved health status.

Outputs:

1. Increased proportion of CHVs achieving the minimum quality score for community case management and FP

# of certified CHVs;

% of CHVs receiving a passing score on a regular knowledge assessment;

# of services delivered

Project reports;

Project service statistics;

Site monitoring visits

CHV certification will ensure a minimum level of service quality;

likewise a minimum number of services provided on a monthly basis will enable CHVs to counseling;

2. Increased number of certified and competent CHVs;

3. Increase proportion of CHVs able to identify (knowledge) illness;

4. Increased community case management for pneumonia, diarrhea, and malaria correctly treated or referred to health facility;

5. Improved assessments of patient symptoms by CHVs;

6. Increased patient cases diagnosed correctly by CHV;

7. Engagement of local technical experts increased.

(pneumonia, diarrhea, and malaria cases treated or referred; number of regular FP users; number of individual growth monitoring sessions, etc.);

# of cases referred and seeking care at the nearest health center for ANC, neonatal and obstetric emergencies, and severe illness episodes;

# of hours of support provided to COSANs and individual CHVs by local technical experts.

maintain skills; community satisfaction will contribute to an increase in demand.

Activities:

1. Conduct quality, skills-based training;

2. Conduct refresher trainings;

3. Carry out regular, skills-based technical supervision;

4. Train CHVs on quality standards and disseminate the proper tools to ensure CHVs uphold to these standards.

# of people trained with increased knowledge and skills;

# of supervision visits made;

# of supervision / coaching reports with actionable recommendations;

# of recommendations that have been addressed;

# of manuals and tools produced or revised to train CHVs.

Pre/post training tests;

Project reports

CHVs need quality technical training to meet certification standards and regular supervision to provide quality services.

Sub-Purpose 4: Increase adoption of healthy behaviors and practices

% of HH using improved sanitation % of children fully immunized;

% of children exclusively breastfed for 6 months;

Median number of Antenatal (place marker for FP/ Youth) % of women (15-24) having already used a contraceptive method—per method)

Project reports Project service statistics / population estimates

Improving access and availability to quality health services is not enough to overcome barriers to increasing adoption of health behaviors and practices.

Outputs 1.) Locally tailored and appropriate BCC strategies and materials developed and distributed through existing networks and new partnerships;

2.) Communities and opinion leaders actively engaged in promotion of healthy behaviors and care seeking practices;

3.) Sustainable advocacy platforms developed for local community actors, target groups (e.g. youth, Mother groups);

4.) Strengthened collaboration and referral linkages between CHVs and youth leaders.

# of BCC strategies and materials developed and distributed for key areas of improvement (e.g. growth monitoring, hygiene and sanitation , exclusive breastfeeding, benefits of FP) # of action plans related to the promotion of health services created by CCDSs and other local actors # of group counseling sessions through GMP # of youth advocacy platforms developed for RH # of community based FP providers with improved attitudes towards youth;

Project reports Individual behavior change does not result from improved knowledge alone, and cannot be promoted in isolation from the broader social context in which it occurs. Thus enhancing environments for improved health practices at community and institutional levels is critical to increase demand and catalyze adoption of healthy behaviors.

Activities 1.) Train and retrain CHVs on health messaging, counseling skills, and sensitization;

2.) Conduct “how-to” advocacy trainings for local partners and target groups;

3.) Train and engage CHVs, CCDSs, and local partners on developing and distributing locally tailored BCC messaging;

4.) Conduct operations research (OR) to inform optimal strategies for adoption of healthy behaviors, and care seeking practices;

5.) Incorporate use of mass communication where appropriate for BCC (e.g.

radios, youth hotlines).

# of people trained with increased knowledge and skills;

# of tools and guides disseminated to local actors # of strategic revisions to BCC strategies incorporated as a result of OR findings # of people exposed to IEC/BCC messages--disaggregated by element where feasible (e.g. FP, MCH, Nutrition, WASH)

Project reports Pre/post training tests

CHVs need to receive proper training in effective health messaging and sensitization to increase the knowledge of their clients. Community leaders and mobilizers need the proper skills and tools to advocate and own their health programming to influence BCC and adoption of healthy behaviors.