HealthStart 2: a report


Posted on
02nd Nov 2018
by Ellie Dawes


It was Child.org's biggest, most ambitious and complex programme to date. Using our first ever Comic Relief funding, we scaled our comprehensive school health programme to 25 schools at a cost of £316,056. But did it work?

We've just finished creating a full report on HealthStart 2: what we spent, what we learned and what we achieved. The full report is available for anyone to download at the foot of this page, this blog will give you the headlines!

Where did HealthStart 2 come from?

HealthStart 2 is the second iteration of Child.org's school health programme, HealthStart. HealthStart advocates a holistic approach to child health, tackling a whole range of health issues for children at once, helping them get the most from their education. 

The first version of HealthStart was a pilot, which we're now imaginatively referring to as HealthStart 1. This ran in two schools in Kisumu, Kenya for two years. We wanted to prove how effective this comprehensive approach to child health could be. It worked: we delivered a whole suite of health interventions at once, and the effect on the health of pupils in the schools, and their educational attainment, was transformational. HeathStart 1 was entirely funded by our visionary partners, Festival Republic. 

The success of HealthStart 1 meant that Child.org were successful in applying for our first ever Comic Relief grant, to run HealthStart for another three years, this time in 25 schools. This time, HealthStart 2 would aim to deliver a comprehensive school health programme for less money and in a more sustainable way. Having proved the concept, we wanted to find ways for schools to deliver a similar holistic school health programme themselves. Here's what happened...

Schools delivered their own interventions

This iteration of HealthStart was all about strengthening systems within schools, their relationships with external bodies and their communication with their wider community. We wanted to show that schools could deliver their own health interventions, if they were provided with the right structures and health information about thier pupils. 

This was a fantastic success, and it meant that schools received the interventions that they most needed. For example:

  • Three schools built wells and created new water systems
  • Five schools installed hand-washing facilities
  • Four schools built additional classrooms
  • Two schools built fences around the school grounds
  • Two schools focussed on environmental protection, planting over 300 trees between them
  • One school fundraised from the local community to build new latrines for the pupils
  • Over 120 issues were dealt with that had been reported from the pupils to the school boards

None of these changes were funded by HealthStart. The schools identified their own solutions as a result of working together and applying to the government, the community or other organisations to help them to strengthen their weakest areas. (And our HealthStart school health audits helped them to identify the areas that needed improvements.) 

We reached more children than ever before

​The programme provided worming medication and health education to 11,690 children. In total, counting community members and parents, this programme impacted on the lives of 56,985 people.

We made HealthStart cheaper

HealthStart 2 was delivered at a cost of £25 per child. This low cost for such a comprehensive, three year programme is down to this iteration of the programme being designed with sustainability in mind. The biggest cost of HealthStart 2 was staff time, implementing the programme (you can read a full breakdown of what was spent in the report, below.)

We faced challenges

There were two key areas that presented particular challenges during HealthStart 2: digital data collection and management; and the political environment. 

We initially planned to develop our own data collection tool for HealthStart 2, but before investing in this we decided to try an existing tool called SnapStory. (We had accepted that the majority of the data would need to be collected by hand, but wanted to introduce a digital system to speed up the process and to reduce opportunities for error.) While we had some success with this, it became clear that the app was slowing down our team. Whilst in the field, the team quickly reverted back to using their tried and tested method; writing the results down on paper. We managed to reach a compromise at later project sites by taking laptops and inputting directly into spreadsheets, therefore reducing the opportunity for error. We have recorded some key learnings from this experience that should enable us to improve the process next time. 

The biggest setbacks and difficulties we faced during the programme were due to the political climate. Kenya has a relatively stable potitical environment, but big events like the elections and political unrest last year impacted on the programme. To mitigate this next time, we'd prefer to run the programme over a longer time frame, to give everyone more time to catch up after short term disruptions.

We had
accepted that the majority would need to be
collected by hand but wanted to introduce a
digital system to speed up the process and to
reduce opportunities for error associated with
collecting by hand and inputting into
software later.

We reached beyond the schools 

As we learned in our HealthStart 1 pilot - community engagement beyond the schools is key to making sure we deliver long-term change. We wanted to make sure the messages that children were receiving about their health at school were reaching home and being reinforced int he wider community. It was also very important to provide parents and caregivers with health information about their child.

  • 25% of parents told us they had applied knowledge learned from HealthStart to improve the health of their families 
  • We witnessed improvements to hygiene practices in pupils' homes
  • 45% of parents used the new Health Cards we introduced to improve their knowledge of the health of their children
  • Caregivers reported improved knowledge on nutrition and communicable diseases 
  • Community sessions strengthened communication between the schools and the community 

We improved health education

By ensuring schools were familiar with Kenya's schoool health policy, providing educational materials and by creating and training up school Health Clubs, we increased understanding of a whole range of health issues and behaviour.

  • 87% of School Health Club members feel that they are having a positive impact on the health of pupils
  • There was a 42% increase in pupils reporting they are given information at school about how to stay healthy and avoid sickness
  • 94% of older children now know how to protect themselves from unwanted pregnancies
  • We noticed improvements to children’s confidence about reporting sexual harassment

What's next?

We're seeking funding for two further iterations of the HealthStart programme. Having previously run HealthStart in and around Kisumu, HealthStart 3: Narok will bring HealthStart to a new area of Kenya, where children face different health difficulties. This will help us test the flexibility of HealthStart, and build contacts and relationships in a new area of Kenya. HealthStart 4 will be a huge project, where we work with government agencies to scale the programme to run across an entire county. This has the potential to reach 200 schools, and over 50,000 children. 

 

It costs Child.org a significant amount of money to apply for funding to deliver a huge programme iteration like HealthStart 3 and 4. (It also costs us money to write blogs and produce reports, which we do because we believe in being transparent about the fantastic work we're achieving with your donations, and to encourage further support!) We rely on your donations to make this happen. If you believe in what we do, and you want to donate money that could have an enormous impact, do something amazing. Donate

Read the full report

Download the full report as single pages or in spreads (whichever is easiest to read on your device.)

If you would like to request a printed copy of the report, drop Francine an email at hello@child.org.

Download single pages PDF

Download double page spreads PDF

The Problem

Sierra Leone is one of the most dangerous countries in the world for mums, babies and children.



An estimated one in 17 women in Sierra Leone will die as a result of pregnancy or childbirth (compared with one in 5,800 in the UK). This West African country has the highest rate of maternal mortality in the world - and the 4th highest rate of child mortality.

Some of the biggest problems lie in the country’s health system, which is critically underdeveloped, understaffed and under-funded. This means the care that people receive from the health service is often poor and ineffective.

Thanks to the work of development organisations, the situation has been improving in recent years, with more local health volunteers and equipment. However, provision is still poor. For example:

  • Health services have chronic low levels of staff. In community health centres, approximately a third of posts are unfilled (either due to lack of funds or lack of qualified personnel), a third are voluntary, and just a third are employed
  • Salaries for employed staff are low and sometimes not paid at all. This leads to high levels of demand for ‘under-the-counter’ payments which exacerbate poverty and disadvantage the poorest members of society
  • Supplies of essential drugs and equipment often run out – leading to mothers and families having to buy from private shops locally, not get treatment, or travel to another facility
  • Many health facilities do not have secure power and some have no water or sanitation
  • The quality of data, reporting and surveillance is variable and often incomplete
  • Preventive health services and health promotion are limited and not always coordinated

This lack of reliable health care deters poor families from seeking care and perpetuates continued belief and use of traditional practices. (Some of these practices may be helpful - but some also harmful.)

Goals

Much of the excellent work conducted by organisations in Sierra Leone has aimed to improve the provision of health services. Child.org and the World Health Organisation (WHO) have started working together because we believe that there are missed opportunities to improve the quality of care.

What is quality of care?

Quality of care is about what actually happens when a person accesses a health service. Were they treated with dignity and given privacy? Were they treated with kindness and afforded equity? Was the person treating them provided with the right information, and did they pass this information on to the patient?

Changes to quality of care are less reliant on ongoing funding than changes to provision (which might involve hiring more staff or providing more equipment.) But quality of care can have a big impact. If we can make people’s experiences of accessing healthcare more positive, they will be more likely to seek help again, and they will be more likely to receive and pass on vital health information.


In Sierra Leone
1 in 17 women
will die as a result of pregnancy or childbirth

Evidence

 

Who defines quality of care and how do we measure it?

The term "quality of care" is defined by the World Health Organisation (WHO), and they also provide a framework for improving the quality of care for mothers and newborns. Sierra Leone has recently joined the international Quality of Care Network, but at the moment it has no data or basic tools to provide consistent evidence about the experience of health service users.

Without this evidence, Sierra Leone can't identify where low or zero-cost improvements in quality and experience may be possible. It's also impossible for local health services, government or WHO to monitor improvements.

This is why Child.org are keen to prioritise the development of these data and tools - as you'll see from the methodology outlined below.

The proportion of births in developing countries attended by skilled health personnel
up from 56% to 68%
between 1990 and 2012
Globally
99% of maternal deaths
occur in developing countries

Evidence based on:

Standards for improving quality of maternal and newborn care in health facilities (WHO) Read article
The Master Plan from Child.org (outlining our programming approach) Read article

Where we work

Child.org are working with the Department of Public Health at the University of Makeni. 

We are proposing our first health needs assessment to run in the population served by Yoni Community Health Post. This is close to one of the university's outlying campus buildings, allowing for us to start the project together with fewer start-up logistics and costs. 

Yoni Community Health Post covers a population of 3,144 people spread across nine rural villages on the outskirts of Makeni. These villages were disproportionately affected by Ebola - in one village over 50 people were killed.

 

Methodology

Child.org’s work in Sierra Leone is about investigating to find clever little, inexpensive changes that will have a big impact. As the data and assessment of care in Sierra Leone is scant - our first move is to collect this information to help us to identify the biggest opportunities to improve quality of care.

1. Assessment tools

We will develop simple tools to assess the experience of using health services by mothers, families of newborns, children and adolescents in Sierra Leone. 

The assessment tools we develop will be based on existing tools used across a range of diverse countries.  They will help collect data linked to key indicators and international rights-based standards.

The data sets and tools we create can then be used by WHO and Government of Sierra Leone to drive improvement priorities and reporting indicators. They will also be used by district and local health services in Bombali and Makeni (plus Child.org and other partners) to identify and inform further interventions.

2. Improving quality of care and encouraging access

Child.org, and the organisations we are working with, will use the information gathered to act on opportunities to improve the quality of care for mothers, babies and children. We are investigating ways to help people to identify when they need to seek healthcare, and encouraging them to do so.

For example, we are proposing a pilot study to identify pre-term and underweight babies born at home using a simple foot measurement card.

How you can help

Child.org's work in Sierra Leone is in its infancy.

If you're interested in supporting an important and innovative stream of international development programming, right from the very beginning, please consider joining making a donation, and make sure you check the box to receive our newsletter. We'll update you as things develop!

 

Note: The photographs we're currently using to illustrate our work in Sierra Leone on this website were actually taken in Kenya on our other programmes. We have not yet had the opportunity to photograph our new work in this country, but we hope to have some photographs from Sierra Leone soon!

Operations Assistant

Join our operations team to work right at the core of Child.org and help make things happen.

Apply now
Contract Permanent, Part time (3 days per week) Salary 21,000 per annum, on a pro-rata basis Holiday 28 days pro-rata Location City Road, london Start date As soon as possible Application deadline Applications will be assessed each week, on a rolling basis until we find the right person. Contact hello@child.org

The role

Child.org are looking for a smart and capable person to join our Operations team, supporting the Operations Manager in keeping the organisation moving and making things happen. Child.org has a range of products and projects, which fund our programming work in Kenya. These products, projects and programmes mean we need a strong operational core to keep each element of what we do on track, your role will be to support and evolve the systems, finance, processes and strategies that are in place for these products.

As our Operations Assistant, you will: have oversight on an organisational timeline and suggest improvements; help schedule sought-after creative time effectively; keep on top of budgets, accounts; understand our finance and governance requirements; maintain our processes and suggest ways of making them more efficient. We need someone great - a quick learner who wants to leave their impact - to help make this happen.

The successful candidate will work closely with the Operations Manager in the areas of finance, human resource, office management, and governance.

Your responsibilities will include:

  • Financial duties: Monthly accounting tasks (reconciliation, categorisation of payments etc.), management accounts, payment runs and VAT returns (no experience necessary, just keen to learn).

  • Managing Group, team and board meetings

  • Office assistance (eg. Office & storage organisation, Google drive permissions and structure)

  • Preparation of payroll

  • Onboarding and offboarding processes for staff

  • Maintaining, evolving and adding to our policies and processes

  • Assist Operations Manager to maintain an organisational timeline

  • Other operational assistance as required

About you

You do not need any experience to do this role. But we are looking for someone very particular:

  • You are smart and pick new things up easily.
  • You have the organisational skills and attention to detail to manage a range of different tasks and responsibilities.
  • You have great ideas and are happy to take initiative. Everyone at Child.org has a say in where it’s going, and we want someone who’ll always be thinking about whether there’s a better way to do something.
  • You are the kind of person that is excited by a day that could include everything from preparing a report of our spending for the board; to creating a mega big plan for Child.org’s year ahead; to organising the payroll; to arranging a crew of volunteers to come and paint the new office!
  • You are someone who wants to have an impact, who likes to throw themselves into something. There is no room for someone who looks forward to 5pm arriving so they can leave.

You'll be really good at

1. Being organised

This role is about keeping Child.org organised - whether that’s managing our range of policies, or allowing the senior management team to make strategy decisions by producing useful management accounts each month. To do this, you’ll need to keep on top of a range of different tasks, being sure to hit deadlines, prioritise efficiently and report effectively on what’s going on.

2. Utilising digital apps and services

In this role you’ll be using a range of digital applications and services. You need to be able to learn to use these, to adapt them to your needs, and be confident finding new ways to constantly improve efficiency in what we do. We also use these tools to communicate, so it’s vital that you are able to make your tools understandable to other team members.

Some of the programmes we use already are - Google Drive, Google Sheets/MS Excel, Digisigner, CharlieHR, CiviCRM, Xero, Toggl, Float, Slack, and Podio.
 

3. Self-starter

You will have the support of the whole team behind you, because that’s how we work at Child.org. There are also some pretty amazing trustees and volunteers who will be on hand to help. However, we are a small charity and there’s a huge amount to do. This means we need someone who is able to work proactively and under their own initiative, someone who thrives on the chance to prove what they can really do.

Applying for the role

Required experience

Obviously, we’d love you to have experience in all sorts of areas of finance and operations, but we know you likely won’t have all of those. This is a role for someone starting their career and who is serious about making organisational management what they are really good at. Maybe you want to be MD one day, or run large efficient teams - it’s you we’re after.  If you are driven, capable, smart and can explain why you could do this job really well then we will consider you.

Application guidance

We do want to see your CV, but we also want a cover letter that explains why you will be really good at the job. Focus less on your passion for the cause, and more on how your skills and experience will help Child.org become more efficient and run more smoothly - because this is what enables the organisation to have the most impact. Tell us what you like about what we do; or what you think we should be doing. Give us a flavour of what having you as part of the team will be like.

Apply now


Why work for Child.org?

Be on the cutting edge

Child.org do what works. That means we innovate often and react fast to new information and trends, ensuring we're always doing what will help us have the very best long-term sustainable impact in the lives of the children we're here to support.

Feel your impact

Our small team means you'll have a clear insight into everything we do, from designing our website to funding our projects in the field. If you don't like feeling like a small cog in a big machine, Child.org is for you.

Develop

The Child.org team make our own opportunities. Child.org is the kind of place where driven employees can go from interning to launching and managing fundraising events worth tens of thousands of pounds, within months. If you're innovative and ambitious, we'll help you bite off more than you think you can chew.

Love your job

We love dramatic Spotify work music, animated gif memos and fancy dress Fridays. We love Kinder Surprise meetings and wearing Child.org t-shirts on our days off. We love post-work pina coladas and the sound of rain. We smile when we get to the office in the morning. If you think you might love some or all of these things, you'll love working at Child.org.

Baby Boxes - A first look at some results!


Posted on
02nd Nov 2018
by Doreen Omitto


Since the launch of the Baby Box program in May 2018, our team have handed out 380 boxes. We're now getting the first results back that tell us how the boxes are being used, and the impact this is having on families.

The story so far...

Back in May, at the start of the programme, Child.org trained four research assistants to conduct a baseline survey in informal settlements in Westlands, Nairobi. The women surveyed were from Kangemi, Kibagare and Githogoro. This survey consisted of preliminary questions asking the expectant mothers about their knowledge of childcare, maternal health and prenatal care (you can read about the results in Marti's blog here).

In July we started registering pregnant women to receive the boxes when their babies were born. Over a period of three weeks we had 500 women registered. So far we have handed out 380 boxes and will continue until they have all been allocated. We are working itwo health centres in Nairobi.

As with all our new programmes, Child.org worked in an agile way - responding quickly to solve problems. For example, the health centres we were working with initially had some challenges when it came to postnatal care service delivery. We worked quickly to address this to make sure that all women would receive postnatal check ups before they receive the baby box to guarantee their attendance. Thirteen women did not receive the postnatal care at the start of the programme, so for these mums, Child.org organised for two nurses to conduct home visits. We conducted a postnatal care training session, in collaboration with the ministry of health, for the nurses and health care volunteers. This was designed to help build the capacity of their teams, and bridge any gaps in their knowledge which applied to our programme.

After a slow start, things started to pick up in August and we have received a constant flow of women collecting boxes ever since. 

We originally expected to have given out all the baby boxes by the second week of October as we were registering women already in their third trimester. However, we now know that this will not be possible due to various reasons, including:

  • There are sometimes long queues for the postnatal check ups (some women go home instead of waiting)
  • Many mothers do not know their correct scan or due dates, so our estimates about when boxes would be collected were not always correct

 

What's happening now?

Now that so many boxes have been collected, the team have been visiting families at home to find out how they have been impacted by the programme. (You can read about some of the first mums we visited in this box post.) We have been collecting data on three core areas: 

  • Use of the baby box

  • Breastfeeding

  • Support structures / groups for mums

We have conducted 78 home visits to date, and these are already giving us extremely useful information about the impact of this pilot programme. The results below are from our findings on these home visits, we will collect more in-depth data and information through our endline survey.

 

Some early findings from our home visits

  • Just 5% (four women) told us they do not use the baby box

One of these mums mentioned that she fears visitors will judge her. Others mentioned that their baby was not comfortable in the box, and that it was not culturally acceptable for a baby to sleep in a baby box

 

  • 87% only use the baby box during the day

Roughly 10% use the baby box during both the day and the night. This suggests that the boxes themselves do not discourage cosleeping at night. However many mums found the box incredibly useful during the day, particularly those who had to return quickly to work and took the box with them to keep the baby safely by their side. 91% of women told us that they slept with their baby at night. 

 

  • 54% of women use additional bedding when cold

 

  • 40% of women only use the bedding provided by Child.org

 

  • 82% percent of women read the instructions on the lid of the box about safe sleeping

Of these women, we found that 14 did not understand the intructions.

 

  • 95% of mums received their postnatal check up

And most received it early: 42% of women came back for their post-natal check ups after two weeks, 30% after one week, 3% after three weeks, one percent at 4 weeks, 19% after more than 4 weeks.

 

  • 96% of women are exclusively breastfeeding

However, 22% reported that they had trouble breastfeeding, with issues including painful breasts, not enough milk being produced, mastitis and the issues with latching the baby to the breast in the correct way. 

 

  • 33% of women lacked a support system around them

We're discovering more and more that mums, even in bustling Nairobi, lack a source of emotional support and advice.

_

​We are hoping to have handed out all the baby boxes by November, if not before, and we also hope to begin the endline survey. This is the final question and answer feedback sheet we fill out by interviewing the women who received the baby box. This will be an in-depth survey on maternal and child healthcare that will help us find out the impact of the project, where progress can be made and difficulties solved.

We aim to have the endline survey completed by the end of November. We look forward to sharing the results with you!

 

You can read more about our Baby Box programme at child.org/babyboxes. If you like the way Child.org do things, please consider supporting us with a donation, so we can reach more mums and babies. Thank you!

This blog was edited by Millie Shoebridge on her Charity Fast-Track Content Placement. If you wish you worked at Child.org, you should apply for Charity Fast-Track

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