Scaling up Chlorhexidine gel for umbilical cord care in Nigeria - - PowerPoint PPT Presentation

Scaling up Chlorhexidine gel for umbilical cord care in Nigeria

Systematically studying and implementing a scale-up effort

Jenna Wright, MPH Broad Branch Associates / Maternal and Child Survival Program Olayinka Umar-Farouk, MD, MBA Save the Children / Maternal and Children Survival Program Jim Ricca, MD, MPH Jhpiego / Maternal and Child Survival Program December 5, 2017 Arlington, VA

Contents

a) Background b) Study objective, methods and results c) Application of results

Vision Intervention description Utilization of 4% Chlorhexidine gel (CHX) will increase to 52% after the fifth year of national scale-up, saving up to 55,000 newborn lives What & Who:

• 1. Application of CHX to the newborn’s umbilical stump once a day for 7

days, starting within 90 minutes of birth, for all births

• 2. First application by the birth attendant (skilled birth attendant,

traditional birth attendant or community health worker); remaining applications by the client

• 3. Client counseling on correct application and general cord care

Where: All birth settings (health facilities, community). Supplied through both public and private delivery channels

The Nigerian government seeks to scale up utilization of Chlorhexidine gel to reduce umbilical cord infections that lead to newborn sepsis and death

MCSP assists the Nigerian government expand service delivery and institutionalize supports for the intervention

Reference: MCSP Stages of Innovation, Descriptions and Guidance (based on USAID Innovation to Impact, 2015)

Pathway from Innovation to Sustainable Impact at Scale

Study objective: identify barriers to service expansion and institutionalization Assess relevant and actionable CFIR constructs within three domains

1. Intervention characteristics 2. Outer setting 3. Inner setting

We collected ordinal qualitative data from national, state and external participants using two instruments

Readiness for Organizational Change tool

Source: Holt DT et al. Readiness for Organizational Change: The Systematic Development of a Scale. Journal of Applied Behavioral Science 2007; 43; 232

Intervention scalability assessment

Modified from: Cooley L et. al. Scaling Up––From Vision to Large-Scale Change: A Management Framework for

• Practitioners. Management Sciences International, 2012.

Key barriers related to intervention characteristics

CFIR construct Barrier Relative advantage Perception that CHX does not hold a relative advantage

• ver methylated spirits or dry cord care for facility-

based births Investment costs Concerns among domestic manufacturers that demand will not match supply and pay off their investment Certain clients in most need of CHX cannot afford to buy the product through private distribution outlets

Key barriers in the outer setting

CFIR construct Barrier Cosmopolitanism Federal Ministry of Health (FMOH) has limited power to drive implementation at state level Government actors have limited experience with and capacity to scale interventions within private channels External policy & incentives Many decision makers need to be involved in agreeing to adoption and management of the intervention

Key barriers in the inner setting (1)

CFIR construct Barrier Networks & Communication Lack of routine mechanism for reporting and tracking CHX availability and utilization Culture Perception among some policymakers and health workers that encouraging CHX use by traditional birth attendants sends the wrong signal (since facility-based birth is a national priority) Certain traditions in the community (traditional cord care management by elder family members, traditional naming ceremonies) may be affected by the intervention

Key barriers in the inner setting (2)

CFIR construct Barrier Implementation climate

Less perception of change efficacy among national level respondents (FMOH) than among respondents from states or partners

1.0 2.0 3.0 4.0

I do not anticipate any problems adjusting to the work I will have when this change is adopted I think I can do all the tasks that will be required when we change When we implement this change, I feel I can handle it with ease I have the skills that are needed to make this change work When I set my mind to it, I can learn everything that will be required when this change is adopted My past experiences make me confident that I will be able to perform successfully after this change is made

Federal (avg; N=6) State (avg; N=5) Partner (avg; N=8) Strongly disagree Disagree Agree Strongly Agree 1 2 3 4 Key:

1.0 2.0 3.0 4.0

Our senior leaders have encouraged all of us to embrace this change [My organization's] top decision makers have put all their support behind this change effort Every senior manager has stressed the importance of this change This organization’s most senior leader is committed to this change I think we are spending the right amount of time on this change given the senior mangers want it implemented Management has sent a clear signal [my organization] is going to change

Federal (avg; N=6) State (avg; N=5) Partner (avg; N=8)

Key barriers in the inner setting (3)

CFIR construct Barrier Readiness for Implementation Less strong management support for the intervention among government than among partners

Strongly disagree Disagree Agree Strongly Agree 1 2 3 4 Key:

MCSP supports FMOH and states apply a systematic approach to scale-up that mitigates barriers

Mitigation of intervention characteristics barriers Mitigation of outer setting barriers Mitigation of inner setting barriers

• Support states form

multi-stakeholder teams and manage scale-up

• Support FMOH and states

to adjust policies and processes (e.g. State Essential Medicine List)

• Develop public-private

partnerships

• Build leadership and staff

buy-in for the intervention and the scale-up activities

• Support implementers to

use timely information to adapt/adjust scale-up activities

• Develop and implement a

communications and

• utreach strategy
• Mobilize continuous

resources and promote

• ngoing procurement
• Develop a distribution

strategy to improve access

For more information, please visit www.mcsprogram.org

This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.

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