Assignment Reports – Health and Education Advice and Resource Team http://www.heart-resources.org Providing DFID staff and other development actors with health, education and nutrition knowledge and expertise from around the world Fri, 02 Mar 2018 13:10:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.4 Social Health Protection in low- and middle-income countries: the practical challenges, a brief discussion paper http://www.heart-resources.org/assignment/social-health-protection-in-low-and-middle-income-countries/ http://www.heart-resources.org/assignment/social-health-protection-in-low-and-middle-income-countries/#respond Tue, 23 Jan 2018 17:30:24 +0000 http://www.heart-resources.org/?post_type=assignment&p=30315 Read more]]> A seminar organised by Oxford Policy Management in June 2017 brought together practitioners and policy makers to exchange insights on practical challenges for the implementation of social
health protection (SHP) programmes, and social health insurance (SHI) in particular. Kicked-off with a presentation of recent experiences from Bangladesh and Pakistan, the discussion touched
on a range of issues, including how to reach and incorporate the poor and non-poor in the informal sector, working with private providers and moving towards strategic purchasing.

There was agreement that SHI means far more than raising contributions, as it is sometimes construed, and reaches into deep health sector reforms. These require careful staging, sustained political commitment and a focus on good governance, but also a continued engagement with core principles of universal health coverage (UHC), primarily equity. Nevertheless, some of the implementation challenges faced today are not new. Investing further in the existing health system learning mechanisms, formal and informal, will be key to avoid repeating implementation failures of the past.

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Transition and Recovery of Nepal’s Health System: Project Completion Review http://www.heart-resources.org/assignment/transition-recovery-nepals-health-system-project-completion-review/ http://www.heart-resources.org/assignment/transition-recovery-nepals-health-system-project-completion-review/#respond Fri, 12 Jan 2018 17:00:09 +0000 http://www.heart-resources.org/?post_type=assignment&p=30289 Read more]]> This project completion review (PRC) provides details on the outputs, lessons and recommendations from the DFID funded programme ‘Transition and Recovery of Nepal’s Health System’ which came to a close in May 2017.

The aim of the programme was to provide technical assistance to support the recovery of Nepal’s damaged health services, across 31 districts affected by a series of catastrophic earthquakes and aftershocks in April-May 2015.

Overall, outcome and output indicator results demonstrate that the programme has been successful, though not all targets were achieved by the close of the programme.

The follow-up actions required following project closure are as follows:

  1. For DFID: in order to fast-track the mobilization of support in case of emergencies in disaster-prone countries, to consider the inclusion of an earmarked budget allocation to respond to disaster situations in all health sector operations. Such budget could be re-allocated before programme closure in case no emergencies arise.
  2. For DFID: given the familiarity and success of the combined Financial Aid and Technical Assistance aid modality in Nepal, both in the regular support to the health sector and the earthquake response programme, a similar aid modality should be considered for future disaster recovery and relief operations.
  3. For MoH and DFID: to limit the number and severity of permanent disabilities resulting from spinal cord injuries during future earthquakes, ensure that a public awareness campaign is launched on the safe transport and correct referral process of people possibly having injured their spinal cord. Such campaign should be targeted at the public, rescue workers, para-medical personnel and health workers. This action would also reduce the risks for people injured during other accidents, especially in road traffic accidents and accidents in the construction sector.
  4. For the TA team: to continue monitoring the progress and quality of the unfinished infrastructure work initiated under the programme.
  5. For MoH and DFID: to maximize the durability of the infrastructure financed under the programme, permanent as well as semi-permanent (the pre-fabricated structures), advocate with the National Planning Commission and the Ministry of Health for a reasonable budget in the Annual Work Plan and Budgets for maintenance.
  6. For DFID and TA team: to elaborate a module for the prevention of gender-based violence and physical abuse (e.g. awareness and anger management counselling) to be used in the immediate aftermath of possible future earthquakes or other disasters.
  7. For DFID and the TA team: in order to be able to again respond effectively in case of any future disaster, to engage with the government and other External Development Partners (EDPs) on changing disaster preparedness modalities as the devolution in Nepal evolves and changes in decision making, operational structures and procedures, and communications channels materialize. For instance, the role 
of the District Officer of Health may change under the upcoming provincial structure and support to her/his office may have to be re-directed to provincial and/or municipal structures.
  8. For MoH, DFID and External Development Partners: to build on progress made in mental health in terms of the institutional arrangement, treatment protocols and people trained in both the diagnosis and treatment of mental health problems and provide resources for its sustainability and scale-up.

Download the full report for further details.

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Jordan – Education Sector Fiduciary Risk Assessment Update http://www.heart-resources.org/assignment/jordan-fra-update/ http://www.heart-resources.org/assignment/jordan-fra-update/#respond Fri, 01 Dec 2017 13:19:02 +0000 http://www.heart-resources.org/?post_type=assignment&p=30011 Read more]]> The purpose of this Fiduciary Risk Assessment (FRA) for Jordan is to update and expand on the FRA that was prepared in May 2016 at the country level for the education sector, including with a focus on the implementation of the Jordan Compact Education Programme, which is supported by the Department of International Development (DFID).

The FRA finds that the Public Financial Management (PFM) reform of the Government of Jordan (GoJ) continues to see steady, albeit slow, progress, and several positive developments have taken place since May 2016.

These include:

  • New Organic Budget Law prepared and submitted to Parliament for approval;
  • Macro-Fiscal Unit established at the Ministry of Finance (MoF);
  • Further roll-out of the Government Financial Management Information System (GFMIS) so it now covers almost all GoJ entities and all modules (except for budget preparation);
  • Public Investment Management (PIM) unit set up in the Ministry of Planning and International Cooperation (MoPIC);
  • Budget transparency improvement;
  • Initiation of a mid-year budget review process
  • Annual financial reporting now in accordance with international standards
  • Expenditure arrears being monitored and reduced;
  • Withdrawal of the Audit Bureau from pre-audit activities in ministries/departments; and,
  • Electronic procurement system under implementation.

However, many weaknesses remain across all elements of the GoJ’s PFM system, and for some areas there have been few, e.g. procurement, or no developments, e.g. external audit.

On this basis, the overall fiduciary risk level is assessed as moderate (pre-mitigation), similar to the 2016 FRA, which means that the trajectory of change overall is considered stable.

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Integrated Evaluation Report of the WINNN Programme: ORIE http://www.heart-resources.org/assignment/orie-nigeria-final-integrated-report/ http://www.heart-resources.org/assignment/orie-nigeria-final-integrated-report/#respond Wed, 02 Aug 2017 08:26:08 +0000 http://www.heart-resources.org/?post_type=assignment&p=29909 Read more]]> ORIE research on WINNN consisted of operations research, a mixed-methods impact evaluation, economic evaluation, and gender analysis which were conducted over a period of five years. This report integrates findings from this research to provide a high-level summary of WINNN’s achievements along with an overview of the key messages and recommendations that emerge from research findings.

The WINNN programme improved mother’s attendance at Maternal Neonatal and Child Health Week (MNCHW) events and mother’s IYCF knowledge and practices but had no impact on anthropometric indicators. The research finds that WINNN was well-aligned with government priorities and that government planning, coordination and forecasting improved during the course of the programme. In terms of efficiency, the CMAM and IYCF components of the programme are found to very cost-effective relative to international standards. While WINNN contributed to an increase in political commitment and funding for nutrition initiatives in Nigeria, funding levels are still not sufficient to meet necessary scale-up targets.

A summary of the report is available here.

Suggested citation: Hansford, F., Visram, A., Jones, E., Ward, P. (2017), ‘Integrated Evaluation Report of the WINNN Programme: Operations Research and Impact Evaluation’, Oxford Policy Management, Oxford, UK

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Strengthening nutrition sector governance: Lessons from the WINNN programme http://www.heart-resources.org/assignment/strengthening-nutrition-sector-governance-lessons-winnn-programme/ http://www.heart-resources.org/assignment/strengthening-nutrition-sector-governance-lessons-winnn-programme/#respond Tue, 01 Aug 2017 20:03:53 +0000 http://www.heart-resources.org/?post_type=assignment&p=29883 Read more]]> This brief is produced by the Operations Research and Impact Evaluation (ORIE) project, led by Oxford Policy Management (OPM), and it summarises the learning about strengthening nutrition sector governance from the Working to Improve Nutrition in Northern Nigeria (WINNN) programme implemented in five states in northern Nigeria (Jigawa, Katsina, Kebbi, Zamfara and Yobe).

Key messages

  • Political commitment to the nutrition sector was strengthened by evidence-based advocacy, underpinned by collaboration among champions for nutrition in government, development partners and civil society.
  • Civil society engagement in the nutrition sector helped to strengthen political commitment and accountability.
  • Increased attention to malnutrition in the media has been influential in increasing awareness of the problem and political commitment to addressing it.
  • Close collaboration among numerous development partners on nutrition sector policy, planning and coordination strengthened both the coherence and the impact of WINNN’s work to strengthen governance.

While there has been progress in public financing for nutrition, public funding is still very low compared to the need. Nutrition work remains largely reliant on donor funding. State governments should be continuously encouraged to increase their funding for nutrition, and to access funding from federal and donor sources.

ORIE briefs are also available on the following themes:

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Gender barriers to nutrition services: Lessons from the WINNN programme http://www.heart-resources.org/assignment/gender-barriers-nutrition-services-lessons-winnn-programme/ http://www.heart-resources.org/assignment/gender-barriers-nutrition-services-lessons-winnn-programme/#respond Tue, 01 Aug 2017 20:00:56 +0000 http://www.heart-resources.org/?post_type=assignment&p=29880 Read more]]> This brief is produced by the Operations Research and Impact Evaluation (ORIE) project, led by Oxford Policy Management (OPM), and it summarises the learning from the Working to Improve Nutrition in Northern Nigeria (WINNN) programme, a programme implemented in five states in northern Nigeria (Jigawa, Katsina, Kebbi, Zamfara and Yobe).

Gender roles and relations can have a powerful effect on development processes and outcomes. WINNN successfully influenced some of the gender-related barriers in northern Nigeria in order to increase service use and behaviour change.

key messages

  • Nutrition-specific interventions are more effective in improving nutritional outcomes if they take context-specific gender roles and relations into account.
  • Understanding relations among women and men in households and communities can unlock effective strategies for service uptake and behaviour change.
  • Messages targeted directly at fathers can help to reduce resistance to the use of nutrition services.
  • Finding ways to reach adolescent mothers is especially important, given the low level of autonomy of young mothers in relation to their husbands and older women in northern Nigeria.

ORIE briefs are also available on the following themes:

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Improving micronutrient supplementation among women and children: Lessons from the WINNN programme http://www.heart-resources.org/assignment/improving-micronutrient-supplementation-among-women-children-lessons-winnn-programme/ http://www.heart-resources.org/assignment/improving-micronutrient-supplementation-among-women-children-lessons-winnn-programme/#respond Tue, 01 Aug 2017 19:58:32 +0000 http://www.heart-resources.org/?post_type=assignment&p=29876 Read more]]> This brief is produced by the Operations Research and Impact Evaluation (ORIE) project, led by Oxford Policy Management (OPM), and it summarises the learning from an intervention to improve micronutrient supplementation in five states in northern Nigeria (Jigawa, Katsina, Kebbi, Zamfara and Yobe) with the support of the Working to Improve Nutrition in Northern Nigeria (WINNN) programme.

Key messages

  • Increasing attendance at periodic, preventative health events like MNCHWs requires intensive community engagement and mobilisation to ensure that the target population receives the information and is convinced of the benefits of attending. Information should be targeted at both mothers and fathers.
  • Political commitment to such events, and adequate and timely public funding, are essential to ensure effective planning, delivery, and sustainability.
  • Technical capacity among local government officials and health workers is key to ensuring good planning and implementation and adequate supply of key commodities.
  • Additional efforts are needed to ensure that micronutrient supplementation reaches the poorest mothers, younger mothers, mothers with no formal education, and mothers living further away from health facilities.

ORIE briefs are also available on the following themes:

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Improved infant and young child feeding (IYCF): Lessons from the WINNN programme http://www.heart-resources.org/assignment/improved-infant-young-child-feeding-iycf-lessons-winnn-programme/ http://www.heart-resources.org/assignment/improved-infant-young-child-feeding-iycf-lessons-winnn-programme/#respond Tue, 01 Aug 2017 19:54:56 +0000 http://www.heart-resources.org/?post_type=assignment&p=29873 Read more]]> This brief is produced by the Operations Research and Impact Evaluation (ORIE) project, led by Oxford Policy Management (OPM), and it summarises the learning from an Improved infant and young child feeding (IYCF) intervention implemented in five states in northern Nigeria (Jigawa, Katsina, Kebbi, Zamfara and Yobe) with the support of the Working to Improve Nutrition in Northern Nigeria (WINNN) programme.

Key messages

  • While political support for IYCF services has increased since baseline, more needs to be done to sustain and scale up the services at health facilities and in communities.
  • Effective implementation of facility-based IYCF counselling requires considerable health worker time. This is a challenge in the Nigerian context, given the inadequacy of human resources for health.
  • Engaging community leaders in IYCF counselling is critical for both community acceptance of CVs’ work and uptake of the IYCF recommendations.
  • A family-centred approach to IYCF, including targeted messaging toward fathers and grandmothers, is important for achieving behavioural change.
  • Finding ways to reach adolescent mothers is especially important, since they have particularly limited autonomy in infant feeding decisions in northern Nigeria.
  • Community members’ fears about not giving water to infants is a key challenge for exclusive breastfeeding. Further work is required to develop effective messages that address this concern.

ORIE briefs are also available on the following themes:

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Community management of acute malnutrition (CMAM): Lessons from the WINNN programme http://www.heart-resources.org/assignment/community-management-acute-malnutrition-cmam-lessons-winnn-programme/ http://www.heart-resources.org/assignment/community-management-acute-malnutrition-cmam-lessons-winnn-programme/#respond Tue, 01 Aug 2017 19:52:27 +0000 http://www.heart-resources.org/?post_type=assignment&p=29870 Read more]]> This brief is produced by the Operations Research and Impact Evaluation (ORIE) project, led by Oxford Policy Management (OPM), and it summarises the learning from a Community management of acute malnutrition (CMAM) intervention implemented in northern Nigeria, with the support of the Working to Improve Nutrition in Northern Nigeria (WINNN) programme.

Key messages

  • Political support for CMAM services is critical for public financing and sustainability, and can be developed through evidence-based advocacy to highlight the severity of the problem of malnutrition in northern Nigeria.
  • Engaging community leaders and local organisations in CMAM oversight promoted strong local ownership and community support.
  • The resources required to treat the current burden of SAM in northern Nigeria are many times higher than the amounts currently spent. Continued advocacy is needed to increase awareness among senior political leaders of the health and economic benefits of effective treatment of SAM.
  • Alternative ways of treating SAM may be needed in severely under-resourced health systems, like those in northern Nigeria. These could include integration of RUTF provision with existing primary health care services, or less frequent visits to health facilities by caregivers to collect RUTF (which will be trialled in Sokoto).
  • Inadequate human resources for health were a key challenge for the provision of CMAM services. CMAM services require adequate planning and allocation of human resources. The government will need to consider hiring more health workers if it is to sustain and scale up the CMAM service.

ORIE briefs are also available on the following themes:

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Integrated Evaluation Report of the WINNN Programme – summary report: ORIE http://www.heart-resources.org/assignment/orie-nigeria-final-integrated-report-summary/ http://www.heart-resources.org/assignment/orie-nigeria-final-integrated-report-summary/#respond Tue, 01 Aug 2017 19:44:39 +0000 http://www.heart-resources.org/?post_type=assignment&p=29866 Read more]]> ORIE research on WINNN consisted of operations research, a mixed-methods impact evaluation, economic evaluation, and gender analysis which were conducted over a period of five years. This report integrates findings from this research to provide a high-level summary of WINNN’s achievements along with an overview of the key messages and recommendations that emerge from research findings.

The WINNN programme improved mother’s attendance at Maternal Neonatal and Child Health Week (MNCHW) events and mother’s IYCF knowledge and practices but had no impact on anthropometric indicators. The research finds that WINNN was well-aligned with government priorities and that government planning, coordination and forecasting improved during the course of the programme. In terms of efficiency, the CMAM and IYCF components of the programme are found to very cost-effective relative to international standards. While WINNN contributed to an increase in political commitment and funding for nutrition initiatives in Nigeria, funding levels are still not sufficient to meet necessary scale-up targets.

The full version of the report is available here.

Suggested citation: Hansford, F., Visram, A., Jones, E., Ward, P. (2017), ‘Integrated Evaluation Report of the WINNN Programme – summary report: Operations Research and Impact Evaluation’, Oxford Policy Management, Oxford, UK

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