www.brac.net

Evaluation arrangements for Improved Implementation: The OTEP case of BRAC

Md. Hasib RezaResearch and Evaluation Division (RED)

BRAC, Bangladesh

Presentation for the workshop on- Evaluation for Policy Making

27-31 October 2014, Suzohu City, Jiangsu Province,

China

www.brac.net2

BRAC: At a Glance

Overview of OTEP

Taking Science Where the Diarrhoea Is

Piloting and Continuous Learning: Ingredients for Scale Up

Linking Evaluations to Actions for Improved Implementation of OTEP

Lessons Learned

Outline

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BRAC: At a Glance

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Established in 1972 in Bangladesh

Goal: Empowering people to lift themselves out of poverty

Currently operates in 11 countries

Served 135 millions of lives

1,20,000+ Staff

Budget in 2014: US$ 900m (70% self)

www.brac.net

Overview of OTEOP

Oral Therapy Extension Programme

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An ORW teaching a mother; PC- BRAC

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Overview of OTEOP

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10 year-long (1980-90) > 13 million mothers > 75,000 villages > Treat diarrhoea at home > Semi-literate ORWs

Phases Year HHs taughtField trial 1979 (Feb-Apr) 145 HHsPilot project (OTP) 1979-80 0.06 mExtended prog. (OTEP) 1980-90 11.80 m

Phase I 1980-83 2.5 m

Phase II 1983-86 5.0 m

Phase III 1986-90 4.3 mTotal   12.6 m

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Taking Science Where the Diarrhoea Was

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In 1970s, diarrhoea was the major cause of infant mortality in Bangladesh

Ideas took shape: Options for interventions

1. Treat all diarrhoea patients by trained personnel

2. Diarrhoea prevention through safe water & sanitation

3. Marketing of Oral Rehydration Solution (ORS)

4. Teach mothers how to make ORS at home with easily available ingredients

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Taking Science Where the Diarrhoea Was

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Challenge emergedDeveloping a simple formula for home-made ORS

The ‘kitchen experiment’:Lobon (salt)-Gur (brown sugar) Solution (LGS)

Harinagar & Anandapur: From Kitchen to the field

- Contents of educational message- The recipients of education- Method of teaching- The teachers

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Taking Science Where the Diarrhoea Was

Lessons learned from the first field trial

- Rural mothers were capable in preparing ORS

- ORWs could provide education on ORT

- Quality enhancing monitoring and corresponding logistic systems could be developed

Should BRAC go for a national level programme?

“Small is beautiful but big is necessary”

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Piloting and Continuous Learning: Ingredients for Scale Up

Oral Therapy Programme (OTP): The pilot project

Solved crucial implementation and management issues and served as the blue-print for OTEP

-Developed team building and training methods for ORWs

-Introduced incentive based salary system

-Ensured safe and effective solution

-Developed monitoring and logistic systems9

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Piloting and Continuous Learning: Ingredients for Scale Up

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Felt importance of continuous learning through real-time evaluations from BARD case of 1970s

Chowdhury and Cash (1998)

In-house Research and Evaluation Division (RED) emphasized on real-time process evaluation of OTEP

Arranged supports from ICDDR,B, Government agencies and Technical Advisory Committee (TAC)

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Linking Evaluations to Actions for Improved Implementation of OTEP

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Altering LGS formula: ORWs showed the way

A pinch of salt (lobon); PC- BRAC

A fistful of brown sugar (gur); PC- BRAC

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Linking Evaluations to Actions for Improved Implementation of OTEP

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Improving quality of teaching and learning

An ORW teaching mother using flipchart; PC- BRAC

A mother preparing LGS under the watchful eye of an ORW

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Linking Evaluations to Actions for Improved Implementation of OTEP

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Increasing male involvement in the programme as well as medical professionals

Village men were taught by male staff; PC-BRAC

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Linking Evaluations to Actions for Improved Implementation of OTEP

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Ensuring higher usage of LGS

Problems identified

-Misperception about ORWs

-Mothers were not convinced

-Fear of becoming ‘sterile’

-Local perception about diarrhoea- 4 types

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Linking Evaluations to Actions for Improved Implementation of OTEP

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Ensuring higher usage of LGS

Devised solutions

-Extended length of stay of ORWs and the team

-Tasting LGS by ORWs in front of the mothers

-Revised “Ten points” messages

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Linking Evaluations to Actions for Improved Implementation of OTEP

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Ensuring higher usage of LGS

Results

Types of diarrhoea

% using LGS

Areas taught 24 months previously

Areas taught 12 months previously

CRP areas taught 12 months previously

Dud-haga 2.0 12.2 12.3

Ajirno 4.0 7.9 9.8

Amasha 1.6 2.9 4.0

Daeria 25.6 31.6 52.2Source: Chowdhury and Cash (1998)

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Type of mortality index Before OTEP After OTEPNeonatal (per 1000 live births) 85.3 (519) 78.0 (424)

Post Neonatal* (per 1000 live births)

71.3 (434) 60.9 (331)

Childhood** (per 1000 live births aged 1-4 years)

26.5 (451) 17.2 (306)

Figures within parentheses indicate the number of deaths.

* p < .05; **p < .01

Source: Chowdhury and Cash (1998)

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Linking Evaluations to Actions for Improved Implementation of OTEP

Impact evaluation on mortality

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Lessons Learned

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NGOs can implement national level programme

Up scaling must take into account organization’s capability

In-house research and evaluation can play a critical role in programme’s development

National and international support can be obtained if the process is opened and information is shared

www.brac.net19

Thank youWebsite of RED: www.brac.net/research