International Evaluation Expert UNICEF

UNICEF works in over 190 countries and territories to save children s lives, defend their rights, and help them fulfill their potential, from early childhood through adolescence.

For every child, the right to survive and thrive

Background

Kangaroo Mother Care Intervention in Iraq

In 2018, UNICEF supported the establishment of a Center of Excellence for KMC and the government of Iraq plans to scale up the KMC countrywide as the main approach to managing prematurity and low birth weight. While a standardized framework to measure implementation and progress towards effective coverage of KMC has been developed, this framework is not implemented in the context of Iraq, and there is a knowledge gap about the barriers of implementation, especially when it comes to implementation in vulnerable and low socioeconomic status communities in Iraq.

To achieve SDG goal 3: good health and well-being, target 3.2. by 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births, the Government of Iraq has adopted KMC as the key intervention to be scaled up.

With the aim to improve the survival rate of small and sick newborns, the groundwork for KMC was laid in 2018 with the Ministry of Health endorsing the KMC concept and establishing a dedicated Center of Excellence in Baghdad with the focus on:

• Developing National Guidelines;
• Training: Training of Trainers (ToT) model, and curricula for quality Antenatal Care/Postnatal Care counselling;
• Initiating KMC services in Baghdad in a major maternity hospital;
• Providing training and coaching to staff in other facilities including on essential newborn care

As a result of these efforts, intermittent KMC has been initially introduced in 7 hospitals then expanded to 16 additional hospitals across 12 Governorates.

UNICEF support included:

• Participation of a national delegation in Regional UNICEF KMC workshop in Beirut, Lebanon in 2017;
• Attendance of 25 hospital healthcare staff in a three-day local courses in Baghdad, Iraq
• Rehabilitation of Newborn Care Unit (NCU).
• Kangaroo Mother Care (KMC) packages to 23 hospitals.
• Social Behaviour Change activities covered healthcare staff and community

Evaluation use

Evaluation findings will support developing an evidence-based model and a strategy for scaling up KMC in Iraq which will reduce neonatal mortality in the country.

• Ministry of Health (Federal and KR) will strengthen national KMC implementation, guide scale-up efforts, ensure program sustainability, and inform policy development.
• Healthcare Facilities will be guided with regards to implementation improvements, will be enabled to address facility-specific challenges, and will be use best practices.
• UNICEF Iraq will tailor its interventions to enhance current program effectiveness.

Evaluation scope

• With regards to thematic scope, the evaluation will cover all the aspects of the KMC adaptation and implementation by UNICEF in Iraq.
• With regards to time scope, evaluation will look into KMC programme since the beginning of its implementation in 2017.
• With regards to geographic scope, evaluation will take place at nationwide federal level and at KR level, at governorate level, and at healthcare facility level.

Methodology

Evaluation Approach

The overall methodological approach shall be based on United Nations Evaluation Guidelines (UNEG) norms and standards and will comply with relevant UNEG and UNICEF guidance materials. The methodology will be further elaborated during the inception phase, and the annexes of the inception report will include the research instruments and evaluation matrix.

The methodology shall be framed around the OECD/DAC evaluation criteria of relevance, coherence, effectiveness, efficiency, sustainability, while also incorporating UNICEF s guiding principles on gender equality, disability inclusion, equity, and human rights. In doing so, the methodological approach will pay attention to vulnerable or at risk groups to ensure that their needs are identified, represented, and addressed through the data collection and analysis techniques.

The evaluation will follow a theory-based approach. The evaluation team will suggest in the technical note and later refined in the inception report, a specific and detailed evaluation design that outlines how evaluation questions will be addressed. The evaluation team will outline its approach to answering the evaluation questions in a comprehensive evaluation matrix.

The evaluation matrix may include, but not be limited to, key indicators related to newborn care practices and health outcomes, such as how quickly newborns gain weight, bond with their mothers, and transition successfully to the home environment. The number of trained healthcare workers and the percentage of mothers practicing Kangaroo Mother Care, as well as monitoring neonatal mortality rates and assessing parent (mothers, fathers, and caregivers) satisfaction with the program, may also be included.

The evaluation will consist of desk review, data collection, and data analysis & report writing phase.

Desk Review will consist of review of existing guidelines, treatment protocols, and training modules related to KMC, community KMC and community follow-up care and facility KMC discharged babies, and related literature. Furthermore, as part of the technical note and subsequent inception report, a proposed approach for benchmarking KMC implementation in Iraq against good practices and models from comparable countries, is required. This should include:

• Desk review and analysis of KMC implementation strategies in settings with similar health system constraints, socioeconomic factors, and cultural contexts to Iraq;
• Identification of good practices, innovative solutions, and lessons learned that are relevant and potentially adaptable for Iraq.

Key deliverables and timeline

Key deliverables for this evaluation are as follows:

• Inception report including Methodology and Tools
• Presentation of preliminary findings workshop with key stakeholders
• Draft Final Evaluation Report of findings (executive summary of findings, findings per each evaluation criteria, lessons learned and recommendations)
• Final Evaluation Report and PowerPoint presentation Deck (executive summary of findings, findings per each evaluation criteria, lessons learned and recommendations)