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Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda
There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the S...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Global Health: Science and Practice
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168622/ https://www.ncbi.nlm.nih.gov/pubmed/25276581 http://dx.doi.org/10.9745/GHSP-D-13-00165 |
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author | Igras, Susan Sinai, Irit Mukabatsinda, Marie Ngabo, Fidele Jennings, Victoria Lundgren, Rebecka |
author_facet | Igras, Susan Sinai, Irit Mukabatsinda, Marie Ngabo, Fidele Jennings, Victoria Lundgren, Rebecka |
author_sort | Igras, Susan |
collection | PubMed |
description | There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes. |
format | Online Article Text |
id | pubmed-4168622 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Global Health: Science and Practice |
record_format | MEDLINE/PubMed |
spelling | pubmed-41686222014-09-30 Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda Igras, Susan Sinai, Irit Mukabatsinda, Marie Ngabo, Fidele Jennings, Victoria Lundgren, Rebecka Glob Health Sci Pract Original Articles There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes. Global Health: Science and Practice 2014-05-04 /pmc/articles/PMC4168622/ /pubmed/25276581 http://dx.doi.org/10.9745/GHSP-D-13-00165 Text en © Igras et al. http://creativecommons.org/licenses/by/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/ |
spellingShingle | Original Articles Igras, Susan Sinai, Irit Mukabatsinda, Marie Ngabo, Fidele Jennings, Victoria Lundgren, Rebecka Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda |
title | Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda |
title_full | Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda |
title_fullStr | Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda |
title_full_unstemmed | Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda |
title_short | Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda |
title_sort | systems approach to monitoring and evaluation guides scale up of the standard days method of family planning in rwanda |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168622/ https://www.ncbi.nlm.nih.gov/pubmed/25276581 http://dx.doi.org/10.9745/GHSP-D-13-00165 |
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