Community-based child growth monitoring and promotion training and implementation program in Zambia: a scope & context evaluation.

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Zulu, Caroline
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The University of Zambia
Zambia amidst the chronic shortage of HRH, has been striving for almost two decades now, to "Provide cost effective health care services, as close to the family as possible". Children being most vulnerable have suffered chronic high child mortality rates still as high as 88 per 1,000 live births. Implementation of Child Survival Programs in Zambia mainly Community-Based Child Growth Monitoring and Promotion Programs (CCGMP) which heavily relay on CHW for implementation. It is therefore necessary that clear and feasible guidelines for training, designing, implementing, monitoring and evaluating child growth monitoring and promotion programs (CCGMPs) are available, enforced and regularly evaluated. The main objective of this study was to evaluate the scope, content, context and depth of training and implementation programme for CCGMPs in order to improve child survival in Zambia. An evaluation study conducted in Lusaka and Chirundu districts of Zambia. Mixed method design was applied, to increase the strength of the study through triangulation by applying five methods; systematic document review, cross sectional survey, uninterrupted direct observation, one-on-one exit interviews with mothers, and focus group discussions. Two different respondents were engaged; CCGMPs and mothers. Several methods of data collection and analysis were intentionally applied to allow comparing results from these different methods in order to triangulate and mitigate possible bias. Study population comprised of the following according to the data collection methods that were applied: Five (5) curriculum related documents were systematically reviewed to determine curriculum content, duration of training and ethodologies used during training. To ensure fair representation, proportional sampling with regard to population size between urban and rural areas while using simple random sampling, three (3) areas were selected from Lusaka and two areas from Chirundu from which a total of 400 CCGMPs were selected for the cross sectional survey. For qualitative case studies; uninterrupted direct observation, 50 CCGMPs were observed as they performed their tasks at GMPs, 50 mothers were systematically selected for one-to-one exit interview and 50 leaders of CCGMPs were included in the focus group discussions. Ten (10) participants from each of the five (5) areas selected of the two (2) study sites were included giving a total of 50 participants for each of the three (3) qualitative methods that were applied. This study discovered inadequacies in the key components for training and implementation of CCGMP and child survival programs. Theoretical and practical training were both inadequate VI which contributed to incompetent services provided by the CCGMPs and mothers‘ dissatisfaction This study coined the “triple C index”, a combination of three components: context, competency and contentment as essential elements for the training and implementation of CCGMP program. Standard curriculum content, context and competencies of training, practice and evaluation of CCGMPs programme needs to be established and adhered to in order to meet the contentment and organisations need to be accredited to relevant regulatory bodies in order to meet demand of their services.Suggestion was made on application of the “triple three index”, a combination of the three (3) concepts that should be, systematically merged and well synchronised for any training program to be successfully designed, implemented, monitored and evaluated.
Thesis of Doctor of Philosophy in Nursing Sciences.