An international Non-Government Organization (NGO) has been providing Primary Health Care

Services, including maternal health services, through a Primary Health Care Centre (PHCC) in a

rural Angolan district for the last 5 years. The maternal health package is the basic Essential

Obstetrical Care (EOC) package. Two and a half years ago, the program realized however, that

despite providing services to over one thousand antenatal presenters per month, deliveries

represented only 2.5% of antenatal presenters. Further, many women were presenting with

obstetrical injuries as a result of poorly managed prolonged or obstructed labour. In addition, the

Centre had an average caseload of 3.6 neonatal tetanus cases per month. It seemed that women

were unable to fully utilize the maternal health services.

To address this, a TBA outreach program was established. The overall goal of the program was

to decrease maternal and child mortality and morbidity as a result of childbirth. The program

aimed to do this through the provision and training of TBAs who can provide clean delivery

services at home and promote increased client care-seeking behaviour and utilization of trained

maternal health care providers. The program also aims to act as a bridge between the PHCC

facility and women in the village facilitating access to the PHCC. The program consists of three

main components:

1. Training TBAs using a competency based curriculum;
2. Fortnightly coordination and re-supply meetings which also aim to foster information sharing

and problem solving and rotations through the PHCC maternity unit;

3. Provision of folding stretchers to villages that are part of the TBA outreach program to

facilitate access to the PHCC for pregnant women as for most clients access to the PHCC is

by foot, often over long distances and was identified as another barrier to access (stretchers

are kept in the house of the village leader where there is no TBA based in the village).

The project is now nearing the end of its second year and the NGO feels an evaluation of

the pilot should be undertaken. You have been asked to design the evaluation. You only

need to choose one aspect (or one component) of the program to evaluate.

1) Briefly outline the steps you would take in planning the proposed evaluation (5

marks)

2) Define an evaluation research question of your choice and clearly state the

objectives and reason(s) for your evaluation. (10 marks)

3) Discuss the most appropriate evaluation research methodology (including

sampling, data collection methods and analysis) you would employ to investigate

this question. (12 marks)

4) Outline your justification for the methodology chosen. (8 marks)

5) Describe two safeguards you would take to maximise the credibility or validity

and reliability of data collected. (5 marks)