Curatio International Foundation conducted evaluation of UNICEF’s contribution to reduction of under 5 mortality in five countries: Kazakhstan, Kyrgyzstan, Moldova, Serbia and Uzbekistan. The evaluation covered 12 years from 2000 – 2012 and was performed in 2014-2015.
UNICEF’s Regional Office for the CEE/CIS commissioned this Multi-Country Evaluation, as one of a series of such exercises, to a) document progress in reducing under-5 and infant mortality and morbidity and to generate lessons on how this was accomplished; b) inform programs aimed at scaling-up evidence based and equity focused interventions; and c) enable better partnering with national governments to advance the child health and rights agenda.
The evaluation was based on a Theory of Change to reduce and close the equity gap in under-5 and infant mortality and morbidity in the CEE/CIS and applied both UNICEF MoRES framework and the WHO essential health system functions approach.
Evaluation findings are assembled across the following key areas: Impact on health status of children; Equity; Relevance; System level changes; UNICEF’s contribution; Sustainability
The study found reduction of infant and under-5 mortality and morbidity over the evaluation period, although equity gaps exist in different geographical, gender and socio-economic groups. The evaluation concluded that UNICEF-supported programmers addressed the most important causes of infant and under-5 morbidity and mortality and were mostly successful in identifying and applying the right interventions to address the health system bottlenecks.
The evaluation recommended to sharpen equity-focus of programming, consider not sufficiently addressed underlying causes of child mortality and morbidity and addressing persisting bottlenecks at health system and community levels.
To learn more, download full evaluation report.
Aim of the project was to identify deficiencies in children birth and death registration system and identify quality of child health care rendered by family medicine practitioners at primary health care level; The project was funded by the World Bank. Duration: May 2010 – May 2011.
Project encompassed the following two components:
Part I: Qualitative research to identify attitude, practice and barriers to effective collection of data related to child births and deaths registration. The data were collected in selected regions from health officials and staff responsible for health data reporting at the different administrative levels (health facilities, local government, rayons, oblasts and central levels) and different groups in the community (women and men) to identify the factors that prevent them from registering child birth and death cases. Analytical report provided specific policy and operational recommendations for the government and donor community.
Part II: Primary Health Care (PHC) facilities survey in selected regions using the IMCI Health Facility Survey methodology. The survey covered 70 PHC centers stratified by centers with and without personnel trained in Family Medicine. The study report along with main findings provided specific policy and operational recommendations to improve child health care services at the primary care level;
The findings of both surveys were disseminated at the workshop in Dushanbe in May 2011.
From 2001 to 2006, the government of Georgia and the Partners for Health Reformplus (PHRplus) project collaborated to strengthen two components of the Georgia Health Information System (HIS): the immunization management information system (MIS) and infectious disease surveillance system (IDS). The work was funded by USAID/Caucasus and coordinated by a multidisciplinary expert group of stakeholders. Participating expert group members came from the Ministry of Labor, Health and Social Affairs, the Department of Public Health, the National Center for Disease Control and Medical Statistics, local Centers of Public Health (CPH), and several international donors (USAID, UNICEF, and the World Health Organization). Implementation was the responsibility of the Georgian nongovernmental organization Curatio International Foundation, subcontracted by PHRplus. View the document.
National Health Accounts (NHA) is an internationally recognized methodology for monitoring financial resource flows into the health sector from the various sources of funds to financial agents, and from financial agents to providers and functions. The NHA sub-analysis for reproductive health is presented to evaluate resources for reproductive health services within the overall NHA framework. The NHA reproductive health sub-analysis for Georgia was carried out by a team of experts from Curatio International Foundation, Abt. Associates Inc. and the National Institute of Health of Georgia (NIH), with the financial assistance of USAID Caucasus for the CoReform project. The purpose of this paper is to present the estimates of reproductive health spending during 2001-2003 and derive policy relevant results, to inform the reproductive health policy development process that is currently taking place in the country.Published: 2005. Authors: Ketevan Chkhatarashvili, George Gotsadze, Alexandr Turdziladze. View the document.
Healthy Women in Georgia (HWG) project was funded by U.S. Agency for International Aid (USAID) and implemented by JSI Research & Training Institute Inc. in collaboration with Curatio International Foundation, Save the Children, Orthos. The duration of the project was September 2003 – July 2006.
The objective of the project was to improve women’s health in Georgia. The HWG Program targeted selected facilities in the Imereti region at regional and district levels, and ten ambulatories at the primary health care level. The program developed “Women- Friendly” health care information, counseling and services in facilities and communities. District and ambulatory health providers, pharmacists, and “sakrebulo” (village council) leadership were engaged in the program.
“Parents’ Schools” for patients and clients were established in three district-level health care facilities, to provide information and counseling in formal courses. The HWG Program established a peer education system for adolescents in schools and community gathering places, and reached out to women in communities who did not attend health facilities.
Georgia has one of the highest abortion rates in the world. The HWG Program strengthened access to and availability and quality of modern methods of contraception for family planning, as safe and effective alternatives to abortion.
The objectives of the project:
Establish sustainable, accessible, and high quality “Women-Friendly” services in “combined” facilities (which respectively include a Maternity Hospital, Women’s Consultation Center, and Reproductive Health Cabinet) at regional and district levels in Kutaisi, Zestaphoni and Chiatura;.
Strengthen provision of women’s health information, counseling, and services, including antenatal care, contraception, and family planning at primary health care level in ten “ambulatories”, located in the coverage areas of the two facilities in Zestaphoni and Chiatura, develop referral procedures from primary to secondary level facilities, and encourage health providers to reach out to the village-based;.
Target women, men, and adolescents (patients/clients, service “drop-outs,” and those who have never attended health facilities) living in the coverage areas of the regional, district, and primary care facilities, increase their knowledge, and affect their practices and behaviors to improve healthy life styles and women’s health status;.
Increase availability and use of modern contraceptives as an alternative to present high rates of abortion, and to prevent sexually-transmitted infections (STIs) and contribute to the health of mothers and infants;
Update and improve women’s health care knowledge and skills among health care providers, with reference to WHO standards and international research-based medical and program evidence.
The Community Investment Program – West was funded by BP/CARE Int. and implemented in partnership with CARE Int., ICCN, TAG, Constanta, and Curatio International Foundation (CIF) in the period of March 2003- December 2005. In the frame of this project, CIF was responsible for conducting the trainings of PHC staff available in village ambulatories (Doctors and nurses) on different health issues, including Antenatal Care, Immunization, Chronic diseases prevention, Geriatric disorders, etc. CIF conducted trainings for community members on First Aid and psycho-social care of the elderly. In addition to conducting trainings, CIF also designed and implemented the Psycho-social network for the elderly and community based health financing schemes. CIF developed and implemented the education, communication, and information campaign for communities on prevention measures of Chronic diseases, as well as STD/HIV/AIDS and alcohol and drug addiction. The informational materials have been printed and were distributed in the communities.
The project Safe Motherhood Initiative was funded by U.S. Agency for International Development (USAID) and implemented by Management Science for Health (MSH) in partnership with Curatio International Foundation, Program for Appropriate Technology (PATH), and Emory University. The duration of the project was September 2000 – January 2003.
The Project consisted of four components: Management and Information system development; community mobilization and provider-client interactions; enhancement of maternal and perinatal clinical performance; STD/Anemia prevalence study.
In the frame of Safe Motherhood Initiative Project, a new Perinatal Surveillance system was developed by the American and Georgian experts. This system aimed to render critical data for regional (and facility) level decision-making and response planning, which the experts hoped would improve the quality of rendered services to the population. The system enabled decision makers to catch majority of the deliveries, which took place in Region (Rayon).
Safe Motherhood InitiativeSafe Motherhood Initiative
Georgia Safe Motherhood Initiative (SMI) project was funded by U.S. Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH) in partnership with Curatio International Foundation, Program for Appropriate Technology (PATH), and Emory University. The duration of the project was September 2000 – January 2003.
The purpose of the SMI activity was to improve maternal and infant health in Georgia through strengthening of integrated maternal and perinatal health services. The project assessed the quality of perinatal services provided and began to support the transformation of the existing system of women’s care into a more integrated and effective one. This had to result in the delivery of continuous, high quality, and patient oriented services, and in increased women’s awareness of the importance of perinatal care for themselves and their child’s health. The project directed its activities toward the regional and local level. This strategy fully supported the Ministry of Labour, Health and Social Protection policy of strengthening primary health care.
Main components of the project:
Management and information system development;
Community Mobilization and Provider-Client Interactions;
Enhancement of maternal and perinatal clinical performance;
STD/Anemia Prevalence Study
Enhancement of maternal and perinatal clinical performance
SMI project supported development of the National Maternal and Perinatal Clinical Guidelines, which addressed clinical, as well as organizational issues of perinatal services. Twenty nine leading Georgian specialists in the field of Obstetrics/Gynecology, Pediatrics, and Health Care Managers worked over the course of nine months to produce this document. This team was supported by two US experts, who provided comments and valuable literature. Significant time and resources were devoted by the project to consensus building efforts that helped to inspire the thinking of national level experts and program managers to develop and agree on guidelines that call for new organization of perinatal services and that propose new approaches in clinical aspects of case management. The Guidelines were tailored to the Georgian reality, and they were evidence-based and, where applicable, comparable to International standards. The training materials were developed based on Maternal and Perinatal Clinical Guidelines. The package contains manuals both, for trainees and trainers. The training was designed to upgrade the knowledge and clinical skills of the Primary Health Care providers, including their acquisition of counseling skills in order to educate their clients on defined topics of Maternal/Infant health and care. Seventeen National experts from diverse fields (General Practitioners, Obstetricians, Pediatricians, and Counselors) worked on the development of the clinical training materials. A smaller number of experts was involved in actual provider training process in the project targeted areas. The target audience for the training was Obstetricians/Gynecologists, Pediatricians, Internists, Nurse/Midwifes. A total of hundred and ten members of the Primary Heath Care providing system benefited from this effort.
STD/Anemia prevalence study
Objectives of the study were:
Estimate the prevalence rates of five specific STDs and anemia in non-high risk sexually active women;
Provide essential data for monitoring trends and impact of STDs and anemia in order to carry out adequate policy development for the prevention and control programs;
Strengthen technical capacity of local epidemiological, laboratory, and clinical based study investigators.
The study was conducted by the local experts group, with technical support from CDC consultants. Laboratory tests were performed by local laboratories in Georgia. A total of thousand women were investigated.
First time since its independence (in 1991), Georgia obtained invaluable data on prevalence rates of STDs and anemia among non-high risk population, which enabled the country to consider the results of the research for the purpose of creating clinical guidelines, formulating policy, and updating clinical practice/protocol.
The SMI for Georgia paid significant attention to the health system components (financing, continuity of care, the workforce, community participation, and public health functions). From the beginning of the project, service deficiencies were identified and activities were planned for their resolution.
During the project implementation stage, the management approach ensured the empowerment of national/local governments, NGOs, professional groups, and communities. Continuing dialogue between the Georgian and US experts helped to tailor technical inputs to the specific needs of Georgians, rather than proposing ready-made solutions. The latter approach assured national ownership of the program results, which could serve as a guarantee for sustainability and replication to other areas.
The processes described above required significant staff attention and careful management of financial resources. Continuous on- the- ground presence of local project management helped ensure the attainment of the intended results.
The overall goal of the assessment was to promote a development of the national policy on family planning in Georgia through provision of updated and reliable information about the family planning/reproductive health (FP/RH) in the country. A panel of experts and a task force was created composing of top specialists in FP/RH in order to elaborate major FP/RH indicators, to design a survey, to develop a questionnaire and to analyze the obtained data. The survey covered 9 regions of Georgia. Face-to-face interviews were conducted from 7/9/96 to 22/9/96. The sample size was 1,440. Two types of questionnaire were used: one for males (~24 min.) and another for females (~39 min). The age for respondents ranged between 14 and 49.