ADDRO IECD Programme Report 2019 – Q1

EXECUTIVE SUMMARY

This report covers Integrated Community Case Management (iCCM), Early Childhood Development (ECD) and Saving with Education (SwE) activities carried out from January to March, 2019 under the Integrated Early Childhood Development (IECD) Programme.

Facilitator engaging members of Anyenya Group during at Azugyeri during a training meeting

The iCCM focuses on capacity building especially for Community Based Agents (CBAs) to provide curative and preventive services. With the curative services, CBAs diagnose and provide treatment to children under five years suffering from malaria, diarrhoea and Pneumonia (MDP) in rural communities. During the quarter, 775 children under five years were treated for malaria, 275 for Pneumonia, 281 for diarrhoea and 1,277 children referred to health facilities for further investigations and management. The huge referrals were due to stock-outs of iCCM medicines in some of the districts especially Karaga, Sefwi Wiawso, Bawku West, Builsa North and Parkro. These stock outs are from ADDRO and Ghana Health Service (GHS). The preventive services include monthly households’ visits and sensitization on malaria, diarrhoea and pneumonia (MDP). CBAs visited a total of 812 primary caregiver’s households (HH) reaching out to 1,629 household members with health messages on malaria, diarrhoea and Pneumonia during the quarter. Apart from the household visits and sensitization, project officers do also organize community durbars as part of the preventive services to sensitize community members and caregivers/mothers on MDP. There were no durbars organized during the quarter due to delays in releasing funds.

The Early Childhood Development aims at building primary caregivers’ capacities on good parenting practices that contributes to cognitive, motor, language and emotional development of children from conception to 3 years of age. Under the ECD, ECD promoters conduct monthly HH visit to build capacities of caregivers to carry out positive parenting practices (playing, nurturing activities) with their children at the household levels. During the quarter, ECD Promoters reached out to 293 caregivers (289 females and 4 males) with messages on positive parenting practices through these monthly home visits. In addition, they hold monthly caregiver support and learning meetings with these caregivers to share their experiences on the positive parenting practices at home. A total of 334 caregivers participated in these monthly caregiver support and learning sessions. Also, 20 faith leaders and 75 ECD committee members from various backgrounds have been identified to be trained to support ECD work in communities.

Under the Saving with Education (SwE), Two (2) new SwE groups were formed during the quarter bringing the total groups formed from 2016 to date to 40.  These groups comprise 919 members of which 814 are females and 105 males.  ADDRO staff continued to provide supportive monitoring visits to these SwE groups formed during the reporting period. Details of the SwE activities carried out are provided under field activities.

2. FIELD ACTIVITIES

Planned Activities

The following activities were planned for the quarter:

  • Organize Caregiver groups monthly meetings and support and learning sessions for the 2018 caregiver groups
  • Conduct monthly home visit by ECD promoters
  • Field monitoring and data collection.
  • Participate in coordination meetings with GHS – Review Meetings
  • Identification of ECD Management Committee members
  • Identification of Faith Based Leaders for Training on ECD
  • Form and train Savings with Education(SwE) group members
  • Organize quarterly ECD promoters toy making sessions with caregivers
  • Organize monthly reflection meeting for 2018 ECD promoters to share experiences
  • Organize monthly sensitization sessions for community members and mothers/caregivers on malaria, Diarrhoea and Pneumonia (MDP).

Planned Activities not carried out and reason

  • Organize quarterly ECD promoters toy making sessions with caregivers
  • Organize monthly reflection meeting for 2018 ECD promoters to share experiences
  • Organize monthly sensitization sessions for community members and mothers/caregivers on malaria, Diarrhoea and Pneumonia (MDP).

The monthly sensitization sessions for community members and mothers/caregivers on MDP could not be carried out due to delays in finalizing the 2019 work plans. However, this delays will not affect results since more sensitization sessions would be carried out in the remaining quarters.

The quarterly toy making sessions and monthly reflection meeting with ECD promoters could not be organized during the first quarter due to late rollout of the ECD in the communities. These activities would be carried out in the subsequent quarters.

Planned Activities carried out

The following planned activities for the quarter were successfully carried out:

Home Visits by ECD Promoters

One key role of ECD promoters is monthly home visits to build the capacities of caregivers/mothers to care for their children. The 40 trained ECD promoters started the monthly home visits and nurturing/play activities for caregivers with children 0-3 years from January 2019. During the quarter under review, a total of 293 caregivers (289 females and 4 males) were reached out to with messages on importance of play, communication, nurturing, health, nutrition, rights and protection- positive parenting practices during the household visits.

During these monthly home visits, ECD promoters uses the FAMA cards learning dialogue technique to generate discussions on the importance of play and communication with children during the first 1000 days (from conception to 2 years), rights and protection, nutrition and health needs of children among other developmental needs of children. These discussions help caregivers from reflection to taking action on an issue. The FAMA stands for Facts, Association, Meaning and Action. The FAMA cards has two sides, A and B. Side A has pictures of a particular topic that the ECD promoter shows to the caregivers for reflection. Side B has questions that guide the ECD promoter to ask the care givers to guide the discussions.

Monthly ECD Caregiver support and learning group meetings

A series of monthly caregiver support and learning meetings were organized across the 20 communities in both Chuchuliga and Sapeliga/Googo Subdistricts. A total of 20 caregiver support and learning groups were formed. These meetings were facilitated by the ECD promoters with support from ADDRO field Officers responsible for the sub districts.

 A total 334 caregivers participated in these monthly care giver support and learning group meetings. Of this, only two were male care givers, the remaining 332 were females. Since the home visits started late due to late start of the ECD rollouts in the communities, no much experiences were shared. However, some caregivers who started playing with their children indicated that they realized some strong bond between them and their children. Others also indicated that playing with children make them active and happy. They however appealed to ADDRO to involve men in these experience sharing meetings for them to appreciate the relevance of playing with children. ADDRO also introduced the Saving with Education to caregivers as part of economic strengthening that will help caregivers save, lend or borrow or start business. Caregivers were happy and willing to form the SwE groups anytime ADDRO is ready to do so.

Identification of ECD Management Committee members

ADDRO has identified members ready to be trained as ECD Management committees at the community levels.  A proposed 15 ECD committees (8 for Chuchuliga and 7 Sapeliga/Googo) will be formed instead of the 20 planned. The reason is that some communities are proximal to each other, so will have one ECD committee. Each ECD committee is made up of 5 members giving total membership of 75. These ECD Management committees are made up of representatives from GHS, Ministry of Food and Agriculture (MoFA), Ghana Education Service(GES), and traditional authority. The committees will be responsible for supervising, managing issues that may arise and providing supportive monitoring of the ECD promoters. The committees will meet quarterly to review and advise on the work of ECD Promoters.

Identification of Faith Based Leaders for Training on ECD

ADDRO has started identifying faith based leaders in the various communities for orientation on ECD. So far twenty (20) faith based leaders (10 in Sapeliga/Googo and 10 in Chuchuliga) have been identified. The identification process is still on going and hopefully the target of 40 Faith Based Leaders will be achieved by end of April, 2019. The faith based leaders comprises pastors, priests, catechists, Imams and elders from identified churches and mosques across the various communities in the sub-districts.

These Faith leaders are very influential in the communities and will use several avenues such as pulpits, religious events etc. deliver key messages on the importance of ECD and good parenting practices, using scripture to reinforce the importance of both male and female roles in good parenting practices.

Saving with Education (SwE) Activities

During the quarter under review, two new SwE groups were formed in addition to the existing 38 SwE groups under the IECD. This gives a total of 40 SwE groups with 919 members. Of this 919, 89% (814) are males with only 11% (105) being males. ADDRO continued to provide supportive monitoring to these SwE groups during the quarter. It was realized during monitoring that 22 out of the 38 formed in the previous years had ended their cycles and started new cycles. SwE members continued to mentions how they have tremendously benefited from the SwE. One remarkable benefit mentioned came from a SwE group called Adabi savings group in Adabinsa. This group was able to successfully commence a group farm. In 2018, the group members cultivated an acre of rice farm and harvested 6 bags of rice. They have acquired another piece of land for dry season farming. They have transplanted rice on this farm at the Tono irrigation field within their community. The table below gives details of the SwE groups from 2016 to 2019.

Table1. SwE groups formed from 2016 to 2019.

Region/Subdist 2016  SwE members 2017 SwE members 2018 SwE members 2019 SwE members Male Female Total
Upper East, Chuchuliga 163 119 69 44 26 369 395
 Upper East, Sapeliga 103 121 118 0 34 308 342
Northern, Karaga 0 0 58 0 1 57 58
Upper West, Nanville 0 0 125 0 45 80 125
Total 266 240 370 44 105 814 919

ICCM activities by CBAs

Under the ICCM, CBAs continued with their monthly home visits and sensitization of household members on malaria, diarrhoea and pneumonia including the relevance of Antenatal (ANC) and Postnal (PNC) clinics visit. In addition to the monthly home visits and sensitization, CBAs provided treatment to children under five years diagnosed with malaria, diarrhoea and Pneumonia in their respective communities. Children under five years who could not be treated by these CBAs were referred to health facilities for further investigations and management. Treatment of these children under five are made possible through regular capacity building of CBAs and other logistical support they receive such as bicycles Rapid Diagnostic Test kits(RDTs), counting beads, Amoxicillin suspension, Oral Rehydration Salt(ORS), Artemisinin Combination Therapy(ACTs), Tabs Zinc, and treatment guides they receive from ADDRO. The details of these CBAs activities are  in the table below:

Activity Number
# of children brought to CBA to be checked for illness 2438
# of children with fever 1438
# of children with fever tested with RDTs 862
# of children tested positive 779
# of children tested negative  83
# of children given A/A 769
# of children treated without testing with RDT 6
# of children seen with fast breathing 275
# of sick children with fast breathing (pneumonia) given Amoxicillin 135
# of children seen with diarrhoea 281
# of sick children with diarrhoea given ORS 135
# of sick children with diarrhoea given Zinc 146
# of children referred 1277

Participated in Ghana Health Service Review Meetings

During the quarter, ADDRO participated in the Ghana Health Service(GHS) 2018 performance review meeting at the Districts and Regional level. The field officers participated at the GHS district review meetings whilst the regional review meeting was attended by the Programme Coordinator. The theme for 2018 review meeting was: “Quality data and equitable human resource distribution, key ingredient for achieving universal health coverage”. This performance review meeting usually serves as a platform for Ghana Health service and its development partners to assess work done in the ending year and the way forward for the coming year. In these review meetings, GHS acknowledged sub-districts, and districts as well as development partners that have contributed to achieving various health indicators. ADDRO was acknowledged by GHS both at the districts and regional level as one of the development partners that have contributed to the fight against malaria, Diarrhea and Pneumonia in its operational Districts.

3.  FIELD MONITORING

ADDRO regional Coordinators continued to monitor field activities in their respective project communities. In addition, Programme Coordinator, M&E Officer, Head of Programmes provided supportive monitoring to project communities in Upper East, Upper West and Northern regions. In Some of these monitoring visits, GHS joined the team for the monitoring especially the ICCM communities. During the monitoring visits and interaction with project participants (CBAs, ECD, Community members), it was realized that peoples’ lives have been impacted positively by the programmes. Members continued to express their gratitude to ADDRO for introducing such programs to help them stay healthy and have easy access to financial services; loans to expand their business, starting new business, carry out their faming activities enabling them to take care of their families. Considering these positive feedbacks from project participants, it can be deduced that the programme is on course to achieving its objectives of improving maternal and child health in rural communities.

4.  CHALLENGES & RECOMMENDATIONS

Despite the positive impact of the programme on beneficiaries, there were some few challenges observed in the field during the monitoring visits. In some communities, there were no existing structures/shades such as schools, churches that could be used as venues for the ECD caregiver monthly support and learning meetings. In such communities, participants held the meetings under trees. However, this may not be possible during the rainy season.  In some communities, there were structures or shades for these meetings but not centrally located, so other caregivers would have to travel far to such venues due to disperse nature of settlements. In some instances, there was no furniture for caregiver groups to sit.  In such communities, building or erecting shades for ECD caregiver support and learning meetings may be helpful. In these communities, ADDRO will work with ECD Committees to assist in getting shades for meetings.

Documentation of SwE group financial transactions continue to be a challenge for some groups due to high illiteracy among group members. In such SwE groups, field Officers had to be present on their meeting days to assist them in recording the group’s transaction. ADDRO is working to identify replicators to assist the groups that have challenges in the documentations.

In some sub districts such as Sapeliga/Googo, Chuchuliga and Zandua, some CBAs had almost used up (finished) their registers (CBA Community Register) and needs replacement. We have discussed this with Ghana Health Services which some are ready to assist the CBAs but others seem not to have the registers readily available at the districts and have to request from the regional medical stores. ADDRO shall follow up with GHS to get these registers for the CBAs.  

5. PROGRAM PARTICIPANTS

The IECD programme participants include CBAs, ECD Promoters, caregivers/mothers, SwE group members, and Ghana Health Service Staff. CBAs and ECD Promoters conduct monthly home visits and sensitization of caregivers/mothers on MDP/good parenting practices. In addition, CBAs diagnose and provide treatment to children under five years suffering from MDP. SwE /Caregiver group members come together to save and borrow money amongst themselves, and also benefit from health education.

The caregiver group support and leaning group members come together to share their experiences on play/nurturing activities with their children. The Ghana Health Service provide technical advice and occasional supportive monitoring.

7.  NEXT PERIOD ACTIVITIES

  • Identify and train ECD Promoters and ADDRO staff on ECD MTM part1 
  • Train ECD promoters and ADDRO staff trained in 2018 on ECD MTN part 2
  • Organize ECD Roll out implementation meeting with Promoters
  • Organize and orientate ECD committees
  • Conduct quarterly ECD Committee meetings
  • Identify and form caregivers and toddler groups
  • Organize Caregiver groups monthly meetings and support and learning sessions for the 2018 caregiver groups.
  • ECD Promoters conduct monthly home visit
  • ECD promoters organise toy making sessions with caregivers
  • Print and laminate FAMA cards and visual guides for ECD promoters
  • Organise monthly reflection meeting for 2018 ECD promoters to share experiences
  • Participate in annual child health week
  • Organize ECD launch at district and community levels
  • Organize monthly sensitization sessions for community members on MDP.
  • CBAs conduct monthly home visits and health messaging on malaria, diarrhoea and pneumonia
  • Procure and Supply iCCM medicines and commodities to CBAs-  Amoxicillin, ORS, Zinc etc.
  • Organize orientation for caregiver groups in kitchen gardening and nutrition
  • Organize quarterly cooking demonstration for caregivers
  • Organize SwE/ refresher training for ADDRO staff
  • Form and train new Savings with Education groups
  • Field monitoring and data collection.

8.  HUMAN INTEREST STORY

Hajia Zenabu Abukari is about 72 years old and a member of Tini Yeda saving group in Karaga District in the Northern region of Ghana. Hajia Zenabu had a small fridge which she stocks and sells water from to make a living. Hajia had tried saving money to get a bigger fridge (a freezer) so she can stock plenty water for sale. However, this dream of buying a freezer came to fruition when Hajia Zenabu joined the Tini Yeda SwE group. On a monitoring visit to the SwE group, Hajia could not hide her excitement, so invited the monitoring team to her house where the new freezer is fully stocked with water and connected to electricity as a source of power for business. On reaching the house this was what Hajia Zenabu Abukari has to say about SwE; for over two years now, I have been managing with a small fridge (table top refrigerator) to do my pure water business. I have tried several times to save on my own from the sale of the water to buy a deep freezer but it did not work for me. Any time I saved a little, other issues came up and the money was spent. This kept on repeating hence, hindering me from buying the deep freezer. When you people (referring to ADDRO Regional Team) came last year and talk to us about Savings with Education (SwE), I Said to myself, let me try this one too and see if it will help me to achieve my dream of buying a deep freezer to expand my business. So I joined and praised be to Allah, when the first cycle funds were distributed in February this year, I had enough and so I added small money from my sales to buy a deep freezer. I am going to continue with this saving with education program so that next year, I will have a different story to tell you. This saving with education has helped us a lot. All my group members are happy and are ready to continue with this savings with education. I wish people will see the benefit that is in the program and come and form groups. Thank Allah for bringing the SwE to our communities.

10. MANAGEMENT & CONTRACTING ISSUES

During the period under review, the Executive Director of ADDRO, Rt Rev Dr Jacob Ayeebo passed on, on the 12th February, 2019. In the interim, the Head of Programmes, Mr George Dam Laar has since been appointed Acting Executive Director to lead the team in managing the organization. Subsequently, the Board of Directors informed Episcopal Relief & Development and shared the job description for input before advertising to recruit a substantive Executive Director to fill the vacuum. The recruitment process, which is done by the Board of Directors is still ongoing.

The period also witnessed the termination of six staff who were on the AMF project as the project ended. However, two regional coordinators on the IECD for Northern and Upper West regions had their appointments   terminated for under performance. Recruitment process is in progress to fill the vacancies created by the two regional coordinators.