Online Program

Role of Poverty on Participation and Outcomes in an Integrated Child Survival-Early Childhood Development Project in Rwanda

Tuesday, November 3, 2015 : 10:56 a.m. - 11:09 a.m.

Bridget Lavin, PhD, Payson Center for International Development, Tulane University, New Orleans, LA
Amy Coombe, PhD, Independent Consultant, San Francisco, CA
Jacqueline Nzaramba, CARE International in Rwanda, Kigali, Rwanda
Joseph Ngamije, International Consultant, Juba, Sudan
Khrist Roy, MD, Nutrition, CARE USA, Atlanta, GA
background: A four-year integrated child survival (CS) and early childhood development (ECD) project sought to improve maternal and child health and child development outcomes in a pilot site in Rwanda.  A mixed-methods evaluation explored whether the project achieved its objectives and equitably provided services designed to support individual- and community-level benefits.

methods: Knowledge, Practice, and Coverage (KPC) survey data measured household characteristics, maternal and child health behaviors and practices, and program exposure among baseline and endline cross sections of women with a child under two years of age in intervention and comparison sites. Endline qualitative data were collected via focus group discussions with community health workers and participating mothers.

results: Based on qualitative data, despite equitable access to the project and a policy whereby no one was turned away, poorer families were inclined to self-regulate their participation when unable to contribute to project costs. Child absence from ECDs also was attributed to poor health, linked to an inability to afford health insurance and seek care. Poorer families reportedly had a harder time understanding instructions, maintaining food security and purchasing supplies for high nutrient feeding and ECD activities. There remained significant differences at endline in CS-related KPC outcomes by socio-economic status, particularly for indicators of child underweight and stunted, treatment access for childhood illnesses, and contraceptive use.

conclusions:  The intervention had limited ability to fully address poverty-related inequities on child survival outcomes. Future efforts should incorporate adaptive and participatory approaches benefitting the most poor, in conjunction with poverty reduction programming.  

Learning Areas:

Administer health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Identify the poverty-related differences in participation and outcomes uncovered by the evaluation of this child survival-early childhood development project in Rwanda Discuss methods of reducing poverty-related differences in future iterations of the project

Keyword(s): Child Health, Poverty

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator for this work, collaborating on the research concept and leading the baseline and endline data collection and analysis. I have over ten years of program evaluation experience, including five years of experience evaluating health and development programs in Rwanda.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.