1. Knowledge Practice and Coverage (KPC) 2013 Revision Process CORE Spring Meeting April 2013 Jennifer Winestock Luna

2. Why are we revising now?  KPC modules are outdated  USAID gave MCHIP funding to revise them and is committed to the revision  CSHGP grantees that started Oct 2012 are implementing baselines with revisions, although modules not finalized  KPC tool is useful beyond the CSHGP projects

3. Agenda  Brief overview of tool  Issues addressed by revision  Where we are with the process  Discussion of recommendations from CORE  Next steps for CORE involvement in revision

4. Overview: Knowledge Practice and Coverage Survey (KPC)  Developed by JHU / CSSP 1990  Based on 30x7 cluster methodology used by EPI  Rapid survey methodology; small sample sizes  Household selection done in the field  Computer simulations conducted validated EPI methodology  Used by CSHGP PVO grantees since 1991  Collected at baseline, midterm, and final  Intervals 2-3 years

5. Overview: Child Survival and Health Grants Program (CSHGP)  Grants to PVOs since 1985 - Projects 3-5 years  Currently 35 active projects  Africa, Asia/Near East, Latin America, Europe and Eurasia  Rural and urban; Sub-national, district level; mostly community oriented  Emphasis on program learning and operations research  Traditionally, Integrated Projects with Technical areas:  Immunization; CDD; Nutrition; Breastfeeding; Birth Spacing/FP/HTSP; ARI/Pneumonia; Malaria; MNC;

6. Overview: Purpose of KPC  Grantees  Understand the health situation in project area  Measure progress toward results  Operations research  USAID (CSHGP) to measure the contribution of the portfolio of grants to improved health

7. Overview: Characteristics  Easy for PVOs to implement  Developed to collect standardized information from a variety of technical areas  Traditionally, targets mothers of children 0-23 months  Modules: questionnaires, indicators, tab plans, instructions  Grantees select modules relevant to technical areas of project  Within each module, grantees select questions & indicators relevant to interventions

8. Issues being addressed by revision 1.Technical areas advanced; updated indicators 2.CSHGP emphasis on operations research  Some new awards narrowly focused; Others integrated  Now requiring in-depth indicators from technical areas addressed by the project; Before standardized indicators from all technical areas (Rapid CATCH)  Previous standardized sampling plan changed to sampling tailored to each OR

9. The Revision Process  Over one year (MCHIP YR5)  Modules differ in amount of updating needed  Team effort, lead by MCHIP PVO/NGO support  SNL, newborn indicator working group  MEASURE Evaluation – Malaria  MCHIP FP – Family Planning/Healthy Timing and Spacing of Pregnancies (HTSP), birth spacing  Input from CORE

10. The Process: Basic Steps 1.Review of indicators from other sources:  DHS, MICs  Measure Evaluation  CCM task force  PMI  LiST Tool  SNL

11. The Process: Basic Steps Simultaneously 2. Consult experts MCHIP, MEASURE Evaluation; CORE Group, USAID, others 3. TA to CSGHP grantees to integrate most recent state-of-art indicators into baselines Conducted Dec. 2012 – May 2013 4. Draft revised modules

12. The Process – Basic Steps 5.Further consultation with USAID 6.Finalize modules 7.Approval by CSHGP USAID 8.Post on MCHIP PVO/NGO support website 9.Disseminate widely

13. The Process: Where we are now Soon: Water &Sanitation Respondent Background Health Contacts Possibly Gender

14. The Process: Malaria Challenges:  International indicators developed for large surveys (DHS, MIS); adaptation needed for smaller sample surveys  PMI has new behavior change indicators

15. PMI BCC example: Strongly agree Somewh at agree Somewh at disagree Strongly disagree Malaria is the most serious health problem in my community. 1234 People in this community only get malaria during the rainy season. 1234 Each year, many children in this community get malaria. 1234

16. The Process: Malaria Challenges:  Malaria programs emphasize universal ITN  ITN coverage obtained though net roster of ITN use by all who sleep in a home; Time consuming for traditional KPC; Target population different from other indicators that focus on children and mothers  Coverage of treatment: Children 0-59 months  KPC traditionally targets children 0-23 months  For an integrated program requiring information on young children (i.e. breastfeeding) and malaria parallel sampling needed

17. The Process: Malaria  Draft indicators and questions developed; Incorporated into baselines in Benin  CRS Project: RDT use with appropriate treatment with ACTs; acceptability by CHWs, Communities, Caretakers  MCDI Net integrity; increased knowledge and modified behavior of IPTp2 and prompt care seeking for fever

18. The Process: Malaria Next steps:  Consultation with CORE  Further consultation with USAID  Special instructions for analysis of PMI BCC questions  Development of module

19. The Process: HTSP  Extensive updating – previous version 2000  Comparison with other sources, i.e. FlexFund  Extensive discussion by MCHIP FP team  Extensive consultation with USAID  Indicators developed  Includes integration indicators  more on the way at request of USAID (CBA2I)

20. The Process: HTSP  Draft module being developed  IRC Liberia will incorporate into baseline  Project focuses on integrating FP into primary health care services including post partum  HealthRight Kenya will incorporate CBA2I indicators

21. The Process: MNC  Incorporated work of SNL  Developed and tested newborn indicators  Hosted newborn indicator working group Participation of MCHIP, DHS, MICS, Others  Some highly tested; others recommended but should have further testing  Initial consultation with newborn expert at USAID - Allisyn Moran

22. The Process: MNC  Incorporated newborn indicators into Concern Worldwide Kenya’s baseline (CSHGP)  Held debrief conference call  Draft module developed with newborn indicators  Consultation in progress for Respectful Maternal Care indicators  HealthRight Kenya will incorporate in baseline  Working with MCHIP MH on other indicators

23. The Process: ARI, CDD, IYCF  ARI; CDD: CCM task force indicators incorporated into Concern Worldwide Kenya and CRS Benin baseline  Revised WHO IYCF module adapted to baseline surveys by Concern Worldwide (Kenya) and World Relief (Rwanda)  Next step: Develop guidance for adapting WHO module to KPC Rapid Surveys

24. Resources http://www.mchipngo.net/controllers/link.cfc?method=tools_mande http://www.mchipngo.net/controllers/link.cfc?method=tools_mande  KPC modules:  Questionnaires; tabulation plans; indicator definitions; instructions; consent forms  KPC Trainer of survey trainers (TOAST)  The Rapid Household Survey Handbook

25. Resources  Lot Quality Assurance Sampling (LQAS)  LQAS Trainer’s Guide  Assessing Community Health Programs: Using LQAS for Baseline Surveys and Regular Monitoring Participants Module  LQAS Protocol for Parallel Sampling  LQAS Frequently asked Questions