|Progress Toward Outcome
At the end of the project, PHC services (FGPs and soum health centers/SHC) in the project area have provided (and are able to continue to provide) products and services to reduce child chronic malnutrition to most under-3 year old children of their catchment population.
To achieve this objective, the project supported three main activities at the level of PHC services: (i) distribution of micronutrient powder (MMP sprinkles); (ii) procurement of standard child growth measuring equipment; and (iii) training of PHC services providers.
The following data comes from the baseline and the end-of project surveys.
(i) During project implementation, MMP was distributed in PHC services during 75,900 consultations for children under-3. During these visits, information on the appropriate consumption of MMP was also systematically provided to the mothers/parents/care-takers.
The end-of-project survey shows that 77 % of the surveyed children 6-35 months old had received MMP from PHC services, and 69.4% actually consumed it (a 38% increase from the baseline survey).
We can improve these results: the survey shows that 90.2% used the MMP they had received, but 10% did not. Only 57% of the children who consumed MMP used 60 or more MMP sachets. And there are significant differences in the consumption of MMP among project sites (but not by gender).
(ii) The baseline survey revealed that 57,5% of the PHC workers (FGP, SHC and bag feldshers) in the project sites had no or inaccurate standard scales and length/height measuring boards for child growth monitoring. Under the project, the following growth measuring equipment was procured and distributed: 224 scales for children and mother, 340 hanging scales, 340 children weighting pants, 262 wooden height measurement equipment, and 472 bedding height measurement equipment, in accordance with a distribution schedule approved by Health Ministerial decree.
(iii) 1159 PHC workers of the project area (79.6% of the target group) attended training on Community Based Integrated Management of Child Illness (C-IMCI) with a particular focus on nutrition. In accordance with WHO recommendation, the initial training needs to be followed up with on-the-job training. Of the 1159 health workers who participated in the initial training, 472 (40.6%) attended follow-up on the job training. 28 trainers for the C-IMC were prepared and handbooks for the trainers and participants were developed and distributed. As a result of these interventions, the number of trained health workers has increased by 13.3% from the baseline level of 2010.
The number of PHC health workers who organized information sessions for the population of their service area increased by 24.0%.
|Status of Implementation Progress (Outputs, Activities, and Issues)
The project successfully completed what was initially planned. MOH, the PIU, and ADB provided the necessary support to ensure a successful completion of the project activities.
Component A. The consultants prepared an in-depth analysis of the behavioral, operational, and structural issues hampering MOH's, private sector's, NGOs', and communities' performance in delivering PHN services: policy and strategy shortcomings, procedural and coordination imperfections, and practical constraints; and indicate directions for potential improvement. The analysis was accepted and provided a basis for communities, PHC workers, local government, NGOs, and the private sector to develop and test nutrition delivery approaches (component B) and offer information relevant to the revision and development of undergraduate and graduate PHN training programs in the Medical Sciences University (component C).
Core activities included (i) carrying out a comprehensive inventory of the food and nutrition sector and an assessment of its existing delivery systems; (ii) conducting an in-depth functional analysis of the institutional arrangements, mandates, funding and expenditures, and capacities in MOH institutions to deliver services, education, and research on nutrition of disadvantaged groups; (iii) analyzing the constraints faced by the private sector, NGOs, and communities in delivering effective services and goods aimed at reducing chronic malnutrition; (iv) holding a policy seminar and technical workshops for dialogue with and among the range of stakeholders and generating proposed improvements and solutions; and (v) producing a situational analysis report with draft policy recommendations.
Component B supported interventions directly aimed at reducing chronic malnutrition by (i) improving nutrition services at PHC level (FGPs and soum health centers/SHCs) in all project areas (subcomponents B.1 and B.2); and (ii) pilot testing innovative approaches to prevent and treat chronic malnutrition in infants, children below 3 years of age, and PLW in selected areas of Mongolia (subcomponent B3).
Subcomponent B.1 helped improve PHC nutrition services as part of community integrated management of child illness (C-IMCI), managed by FGPs and SHCs. Core activities included (i) tailoring, delivering, and testing in-service and on- the-job training of FGPs and SHCs in C-IMCI, with focus on improved counseling skills on exclusive breastfeeding and appropriate timing, frequency, adequacy, and composition of complementary feeding of infants and young children; (ii) providing support to technical improvements and increased coverage of the growth monitoring of under-2-year-old children managed by FGPs and SHCs; (iii) procuring, delivering, and promoting the use of MOH-agreed sprinkles among children 6 24 months old and PLW; and (iv) treating malnourished and low birth weight infants and children under 3 with supplemental iron and vitamin D for anemic and rickety children, respectively, and for PLW.
Subcomponent B.2 developed and implemented IEC/BCC methods and materials to improve the community and family awareness, skills, and behaviors for reducing chronic child malnutrition. Core activities under subcomponent B.2 included (i) in contrasting socioeconomic resource environments, carrying out a study of the constraints that mothers face in providing good infant and young child feeding (IYCF); (ii) capturing locally available knowledge, attitudes, and skills of mothers on good IYCF practices; (iii) developing informed, tailor-made educational materials and methods focused on good mother, infant, and child care, as well as IYCF practices; and (iv) subcontracting a community-based NGO with a track record in public social education to deliver IEC/BCC campaigns on good community and household behaviors for mother and IYCF and nutrition practices.
Subcomponent B.3 involved financing at least 10 pilot approaches with a grant of up to $40,000 each in response to proposals by partners in the food and nutrition sector willing and able to implement innovative approaches aimed at the Project's general objective and that complement the PHC approach through FGPs and SHCs. The Project would initiate at least three rounds of invitations for proposals, approximately 6 months apart. Pilot approaches could be of different scale and duration and would not be allocated exclusively to the traditional community-oriented food and nutrition development organizations. Specific selection criteria would be publicly announced in an effort to mobilize potential partners at all levels. Core activities included (i) active solicitation of short letters of intent to develop and deliver innovative approaches, followed by transparent selection and invitation to submit complete proposals, while offering assistance if needed; (ii) review and priority ranking of high-quality proposals; (iii) project funds permitting, entering into subcontracts for implementation of the selected approaches; (iv) provision of supportive supervision during implementation of pilot approaches; and (v) advocacy for promoting continuation and/or scaling up of successful approaches upon subcontract expiry.
Component C supported and coordinated the Health Sciences University and MOH in the revision, development, and testing of a PHN training curriculum for adoption in undergraduate and graduate health education programs for PHC workers of Mongolia. Experiences and information from components A and B were to be used to inform and continuously update the PHN training modules. Core activities included (i) agree on terms of reference and support the Health Sciences University; (ii) conduct an assessment of PHN training needs and the needs for research and services; (iii) develop a PHN training curriculum across undergraduate and graduate levels and support the provision of key teaching resources to effectively test and deliver PHN training in existent pre-service PHC training programs; and (iv) advocate for acceptance of PHN training as a formal module in the health training colleges (undergraduate) and in the medical, public health, and nursing schools (graduate) of the Health Sciences University.
Component D monitored and supported effective implementation of the project components A, B and C; facilitated inter-institutional coordination and supported policy analysis and development based on the results (knowledge output); Core activities included (i) establishing the project implementation unit (PIU); (ii) preparing the grant implementation manual; (iii) procuring and distributing expendables; (iv) performing annual audits; (v) providing oversight of progress in the deliveries of subcomponent B.3 activities by MOH partners; (vi) conducting studies, follow-up surveys, and experience-sharing workshops during implementation; (vii) monitoring and evaluating outcomes of the approaches and combinations of approaches in the project areas; (viii) conducting policy seminars; (ix) using the project data and experiences to produce a knowledge product; and (x) submitting draft policies to the Government.