FLAG: 3rd Party Audit

Facilitated Learning Action Group (FLAG) is an initiative of Department of Health and Family Welfare and National Health Mission (NHM), Jharkhand in collaboration with Ekjut and Children’s Investment Fund Foundation (CIFF), to use Participatory Learning Model to reduce neonatal mortality. Through Participatory Learning and Action (PLA) meetings, structured monthly meetings are conducted by Sahiyas (ASHAs) and Sahiya Saathi’s (ASHA facilitators) in the villages and hamlets. In the PLA process, women’s group members invite non-group members for learning, planning, carrying out, and evaluating activities in a participatory and sustained basis.

Objectives

Development Solutions assessed the program quality to strengthen the ongoing FLAG program by Children Investment Fund Foundation. The quality assessment is based on three aspects – the quality of PLA meetings at village level; the quality of training and the stakeholder perceptions and challenges. The quality assessment has been done over the last three quarters - October- December 2018; January- March 2019; and April-June 2019.

    The key aspects of quality being assessed, and audited/the objectives of the assignment are:
  • Review of meeting quality (coverage, participation, and facilitation)
  • Review of training quality
  • Understanding stakeholder perceptions and challenges

Approach & Methodology

The audit was undertaken in 21 districts of Jharkhand. Given the objectives of the assignment, a mixed method approach to assess and audit program quality was used:

  • Coverage, participation and facilitation of meetings- assessed through observation of meetings in 399 villages in each quarter- for a total of 7 quarters; brief interviews with ASHA/ASHA facilitator undertaken post the meetings. The observations and interviews are recoded using electronic structured quantitative tool
  • Review of training quality undertaken in two ways- observation of residential training and On-job training (OJT).
    • During residential trainings, observation of training of trainers and ASHA facilitators training undertaken. Post training, interviews with trainees were undertaken. The information is recorded using paper-based semi structured qualitative tool
    • During OJT, using electronic structured quantitative tool, observation of support provided by ASHA facilitator to ASHA during the meetings, and interviews with ASHAs is recorded
  • Qualitative interactions (In-depth interviews and Focus-group discussions) conducted with stakeholders, to understand program implementation and MIS, once every 6 months-3/4 times in the project duration. The stakeholders to be interviewed in the project duration are- ASHAs (120), ASHA facilitator (60), Block Officials (60), District officials (30), and FGD with community (30)

Results

In nearly 75 percent of the districts, the participation of pregnant and lactating mothers, based on the indicator of 30 percent of total participants has sustained over the three quarters. Across districts, the PLA meeting cycles vary, with some districts close to finishing the 18 meeting cycles; whereas, some districts lag. Interestingly some of the districts which are lagging in meeting cycles, are performing well in facilitation and engagement of participants. Across districts, meetings are being held regularly, as per plan, in 81 percent meetings. Facilitators were recalling and articulating the objectives of the meetings; the use of participatory methods such as games and activities were being used. The average attendance in the meetings and engagement of participants has remained more or less the same, across the three quarters. However, aspects like facilitation and the use of games and activities need more attention. The Sahiya Saathi's, who were getting trained, rated the overall training as ‘satisfactory.’ There was adequate space in the training hall for the participants to be seated comfortably, and drinking water was also made available. There was a provision of toilets in the venue. Based on the content of the training; use of participatory methods to engage the trainees; use of simple and local language; and the guidance provided on various aspects of facilitation, and participant engagement, the Sahiya Saathi's stated that the training met their needs and expectations. However, there is still a scope to work on infrastructural issues in the training venue such as quality of the toilets, uninterrupted provision of drinking water, and provision of water in the toilets.

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