Introduction and Implementation Examples from Madagascar Nepal and Nigeria Moving along the chlorhexidine implementation trajectory Planning to scaleup Introduction Planning Scaleup ID: 713841
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Better Cord Care Saves Babies' Lives: Mapping Chlorhexidine Introduction and Implementation Examples from Madagascar, Nepal and NigeriaSlide2
Moving along the chlorhexidine implementation trajectory: Planning to scale-up
Introduction
Planning
Scale-up
Ongoing advocacy
Analyze
existing environment, human resources,
and systems
Determine
needs and priorities
Adv
ocate to ensure
buy-in
for introductionEngage stakeholders in working groupPrepare implementation “roadmap”Identify success metrics and establish monitoring &evaluation systemGet policy approval for introductionAmend the essential drug list to include chlorhexidineDesign supply chain system Identify supplier baseIdentify customer needs through client acceptability studyDevelop manufacturing specifications, quantify needs, and procure productDesign system for delivering servicesTrain service providers Mobilize beneficiaries/community representatives
Convene working group to coordinate implementation of planEstablish governance platform, including lines of accountabilityDevelop guidelines and procedures to ensure adherenceIncrease public awareness in the introduction of chlorhexidineStrengthen supply chain system, building capacity of staff to manage productsStrengthen local supplier baseLink suppliers and other stakeholders with information about demandQuantity, procure, and manage productsStrengthen service delivery system, building capacity of staff Generate provider/client demandAssess client satisfaction
Governance
Products
Services
Explore feasibility
of and resources for
scale-up
Decentralize decision making to facilitate innovations and system improvement
Publish experiences and proven strategies
Plan
for national/subnational reviews
Facilitate study exchanges
Revise supply chain system, and build capacity of staff and supervisors nationally
Link
local and external suppliers with new
programs
Quantity, procure,
and manage products
R
evise service delivery system, and build capacity of staff and supervisors
Integrate
chlorhexidine
into existing work plans and programs (i.e., MNCH)Slide3
Madagascar: Planning for introduction (1)
Baseline study conducted, which identifies information on current cord care practices
Pilot planned to introduce
chlorhexidine gel in Mahabo district (Western region)
Chlorhexidine will be integrated into on-going program managing childhood illness and providing family planning and other services
1
2
5
3
4
Technical working group established to provide coordination of
pilot
activities
(MOH provides overall technical leadership/coordination)Product acceptability study and field testing of product name, logo packaging, and design (PSI)Conduct trainings for health workers (MCHIP) and community health workers (CHW) (JSI)Procure Chlorhexidine
from manufacturer in Nepal (JSI)Monitor the intervention at the community level (JSI)Background and context for pilot introduction
Steps in planning for pilot introduction
Newborns
like this childin Mahabowill soon beprotectedfrom sepsiswhenchlorhexidineis available in
the district.Slide4
Madagascar: Moving towards implementation (2)
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53
4
Conduct official
launch of project
in Mahabo
Lobby and
raise
awareness
of Chlorhexidine at
regional and local levels Train health workers and CHWsTrain referral providersAdapt data collection tools (e.g., register, report form, booklet) Put in place a field supervisor to oversee CHWs with NGOs implementing partnersConduct quarterly field monitoring and annual assessmentIntegrate misoprostol - chlorhexidine for community based service provision
First CHWs training, September 2013Steps in implementation
Job aid
for CHWs
6
7
8
On-going: Assessing the feasibility of scale-upSlide5
Nigeria: Introduction of chlorhexidine in Sokoto
The context for introduction: Profile for Sokoto & Bauchi States
After 12 months: 9.33% coverage in Sokoto
References
: National
Demography & Health Survey (NDHS)
2008; Nigeria
Bureau of Statistics,
2012; TSHIP
Reports
1
2
5
3
4
Conducted
re
search to understand current practices, receptiveness, and user preferencesUndertook state and national advocacy/policy efforts to support Sokoto State Gov’t to launch chlorhexidine programAdded chlorhexidine to essential drug list
at federal, state, and local government levelDesigned and strengthened
systems to deliver services and productsBrief 244 Ward Development Committees (WDC) in Sokoto
Train 440 community volunteers & 1220 drug keepers within 6 monthsIncorporate into routine monitoring systemProcured chlorhexidine gel (4%) from Nepal; simultaneously built capacity for local production
Steps in
introducing chlorhexidine
in Sokoto
Indicators
Bauchi
Sokoto
Nigeria
Fertility rate
8.1
8.7
5.7
ANC Coverage
50%
14%
60%
Home
Delivery
87%
95%
62%
Skilled Birth Attendance
13%
5%
35%
No One
at Birth
34%
25%
19%
Sokoto introduction efforts result in:
Government and community making a firm commitment to scale-up
13 of 36 States being ready to introduce
c
hlorhexidine
Target @ 80% coverageSlide6
Nepal: Achieving coverage at scale
Preliminary studies on efficacy of product and community acceptability
(gel versus Aqueous), show preference for gel Pilot study in 4 districts to determine coverage and compliance in Nepal context proves successfulIn 2011, Government of Nepal approves use of 4% chlorhexidine as part of essential newborn care
Background and context
Scale-up plan aims to bring
chlorhexidine
to newborns in at least 63 of 73 districts in over 3 years (2011 – 2013). Progress shown below:
Scale-up plan and progress
Incorporate
c
hlorhexidine into
essential newborn care related program and packages
Train all service providers and community health volunteers
Include chlorhexidine in essential drug list and multi-year procurement plansInvolve private sector to ensure quality supply of productUndertake BCC activities Include chlorhexidine activities in routine health management information system Engage active involvement of stakeholders throughout implementation processConduct advocacy at different level and forums (professional societies and conferences) Activities required for scale-up
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6
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