I have prepared an imaginary article that could be used as a
case for training and orientation on results chain to identify the goal,
outcomes and interventions.
An international development agency was interested to
undertake a public health project in one of the least developed countries. Experts
from the agency reviewed the findings of Demographic Health Survey (DHS) and
found that Nepal was one of the least developed countries having high child mortality
rate for decades. DHS 1996 of Nepal data showed that the under-5 mortality rate
was 118 deaths per 1,000 live births. Although that was reduced to 61 in a
decade (DHS 2006) but the rate was still high. Under-5 mortality is defined as
the probability of dying between birth and the fifth birthday. Then, the agency
decided to undertake a project in Nepal, but was not clear which part of Nepal
would be appropriate for the intervention. Then, the experts contacted Ministry
of Health in Nepal to get the detailed dataset of child mortality rate in
different parts of Nepal for past two decades. The MoH authority then directed
the agency to New ERA in Nepal and ICF in the USA for the detailed dataset which
had provided technical support to MoH to collect DHS data periodically. The international
agency experts then reviewed the detailed dataset and found that one village in
………….foot hill had significantly higher under-5 mortality rate of 95 in 2006. Then, the agency selected the village and undertook
public health project for a decade. Afterward a decade, the same experts from
the agency visited to evaluate the project achievement in 2017.
The experts started journey towards the village and noticed
several changes. They noticed that open fecal discharge along the village roads
were non-existent which was highly prevalent a decade ago. There were no bad
smells, rather flowers were found blooming and spreading good smells along the
roads. Every house in the village had toilet. Some houses had pit toilets and
others had drained toilets. The experts interacted with the community members
about the changes and noticed that some offenders in the communities a decade
ago who did not favour to construct toilet in their houses were happy to share
their positive attitude. Those offenders were turned to the change agents
advocating for construction and use of toilet. The change agents formed the
youth forum and provided training to youth volunteers and mobilized to orient
community people through street drama. The change agents placed hoarding boards
along the community roads and community displaying the message to encourage the
construction and use of toilet and fined those defecating open. The fined money
was used for awareness, cleaning and sweeping campaigns. The Village Development
Committee (VDC) declared the VDC as the Open Defecation Free (ODF) zone.
The project had supported the community houses to construct
biogas plants linking the animal sheds with the house toilets. The project had
supported to purchase animals such as cows, buffaloes and goats for income
generation as well as use of dungs for producing biogas. The project supported
for fodder and forage for animals. That increased annual farm income from $1000
before the project to $1500 after the project. The household consumption of
fuelwood for cooking purpose decreased from 800 kg of fuelwood to 300 kg per
months after the project.
The project had supported to construct the toilets in the
schools and public places and also the biogas plants linking the toilets. The
project had supported to construct water collection ponds and electric water
pumps for water supply in the schools and public places. Besides, the project
had supported for household water supply system for drinking and sanitation purposes. As a result, people started to drink hygienic water and also use and clean toilet in their houses, schools and public places. The community people
shared that the diarrhea and dysentery related check up and consultation visit to the health post reduced from every month to only two
times a year. On the top of that, the District Public Health Office record showed
that the under-5 mortality rate reduced to 35 over the decade. DHS 2016 shows
that the current under-5 mortality rate for Nepal is 39.
The agency experts visited local government agencies, the Village
Development Committee office, ward offices and village Water Sanitation and
Hygiene Committee to interact about the project support and changes. The local
government authorities shared that they did not certify any household for sale
or purchase of land without verifying that the house has constructed the toilet
and used it. The authorities shared that they did not certify the new building
construction without the provision of a toilet and did not issue the house
construction completion certificate without verifying that the house has
constructed a toilet also. The authorities shared that they certified the
household members for education scholarship or any other government support
after verifying that the house has a toil and members are using it. The project
had supported the local government agencies and committee to develop the
guidelines and monitoring support for verification of toilet construction and
use. Overall, several interventions were attributable to the project
contributing to achieve the goal.
