Conclusion: Findings and Evaluation

Abstract

The objectives of the evaluation were to assess the effect of the IHSS on the following: • Relevance: Alignment with national priorities and plans, enhanced policy environment and promotion of gender equity. • Effectiveness: Effect on strengthening the health system and the capacity of government and/or civil society organizations to train, equip, deploy and supervise front-line health workers to deliver a limited package of high-impact health interventions. • Impact: Effect on coverage of health and nutrition interventions supported by the IHSS; as well as the effect on the number of additional lives saved calculated using the Lives Saved Tool (LiST). • Sustainability: The cost of implementing iCCM and the organizational and financial sustainability of the programme. At the time of the evaluation, the IHSS in Mozambique was still in the process of going to scale. Therefore, the evaluation served as a mid-term assessment and is not intended as an endline evaluation. Key conclusion 1: The IHSS programme was well aligned with the policies of the Government of Mozambique. The evaluation found that the IHSS supported the Government of Mozam-bique's commitment to increasing access to essential primary care health services , especially in remote areas. Through a series of interventions, including child health weeks, the distribution of ITNs, the promotion of immunization and improved quality of treatment for childhood illnesses, the reach of the health system was extended considerably in rural areas in Mozambique. Significantly, the evaluation team found a clear sense of ownership of the programme by the Ministry of Health. Key conclusion 2: By training more than 900 community health workers, the IHSS strengthened Mozambique's health system. However, supervision remains a challenge. The evaluation team found that the APE training programme is well designed and the curriculum appropriate. The four-month training programme covers health promotion, disease prevention and iCCM. By mid-2013, 2,800 APEs were trained, 905 of them using IHSS funding. Most of the APEs interviewed by the evaluation team seemed knowledgeable, highly motivated and articulated a sense of service to their communities. The evaluation team concluded that the training and deployment of APEs significantly improved the reach of the health system in Mozambique, increasing by 50 per cent the number of children under five years of age with access to basic primary health care services. The IHSS also invested in the supervision of APEs. Facility-based health professionals are responsible for overseeing the work of APEs through monthly Evaluation of UNICEF's Integrated Health Systems Strengthening (IHSS) Programme in Mozambique • March 2015 Table 1: Summary of all trend indicators included (% and 95% confidence intervals) Indicator Mozambique rural areas DHS 2003 (pre IHSS) MICS 2008 (baseline) DHS 2011 (endline) Average annual rate of change pre-IHSS (2003-2008). Data shown as % per year Average annual rate of change during IHSS (2008-2011). Data shown as % per year Tetanus toxoid vaccination of pregnant women (at least two doses) Exclusive breastfeeding 32 (28-37) 38 (N/A) 40 (36-45) 1.20 (0.07-2.33) 0.80 (-1.10-2.70) IPT No Data 39 (N/A) 17-7.2 [-7.9-(-6.6)] Vitamin A supplementation* 0.60 (-0.03-1.23) 1.50 (0.57-2.43) ITN No Data 22 (N/A) 33 (N/A)-3.8 (3.2-4.3) Care-seeking of suspected pneumonia 53 (47-59) 65 (57-71) 44 (33-55) 2.38 (1.24-3.52)-6.90 [-10.31-(-3.49)] ORS coverage 42 (37-47) 37 (34-41) 50 (45-56)-0.86 [-1.67-(-0.05)] 4.33 (2.94-5.72) Care-seeking for fever 46 (42-50) No Data 50 (45-55)-Malaria treatment 16 (13-19) 27 (23-31) 32 (28-36) 2.18 (1.71-2.65) 1.67 (0.54-2.80) IPTp = intermittent preventive treatment of malaria for pregnant women; ITNs = insecticide-treated nets; DPT = diphtheria, pertussis and tetanus; ORS = oral rehydration salt; N/A = Not Available? * Used 2003 as a baseline Decrease in rate of change between pre-IHSS and IHSS programme period Stable coverage rate between pre-IHSS and IHSS programme period Increase in annual rate of change between pre-IHSS and IHSS programme period