CCP and CROWN team members at the Abuja convening – feels like yesterday!
Dear CROWN Friends,
I don’t know about you, but from where I’m sitting, 2024 has flown by! It seems like just last month we were learning and sharing together in Abuja, and now we are already preparing for the 2025 CROWN Convening (more on that below).
In this newsletter, I want to highlight a project that has made major strides in the last year which you might not have heard much about – the Vulnerability Project. This is a project being undertaken under the CROWN umbrella, focused on improving institutional delivery rates in Ethiopia, implemented by our colleagues from CCP. The Vulnerability team wrapped up the first of two phases of the project this summer with promising results, so we wanted to share those achievements and shine a light on that work.
The other “shining light” of the Vulnerability Project is Project Director Tewabech Tesfalegn, who you can read about below! Tewabech is ready to see you all at the 2025 Convening (and challenge you to some table tennis there too).
I hope these last two months of 2024 bring you warmth, safety, and some time to slow down and enjoy the fruits of your labor.
All the best,
Daryl Stephens
CROWN Program Manager
Updates from the field: CCP Vulnerability Project
CCP Vulnerability team reviewing design workshop outputs
What is the Vulnerability Project?
Ethiopia is among countries with the highest maternal and child mortality, but due to context-specific driving factors of vulnerability, many women do not access maternal and child health services. Vulnerability segmentation within the general population is becoming an emerging focus in bridging the gap in implementation science and policy redirection in low-resource countries. Identifying factors that mitigate vulnerabilities in maternal health service uptake, as well as those factors which contribute to vulnerability, can help practitioners develop and implement evidence-based, targeted interventions.
The Vulnerability project therefore aims to develop and test the effectiveness of HCD solutions in promoting institutional delivery (ID), antenatal care (ANC) visits, and nutritional supplementation among pregnant women in Ethiopia, and assess the feasibility and acceptability of the intervention. This three-year implementation research study is being carried out by CCP in Ethiopia (alongside the Adherence project) with assistance from the CROWN team.
What has the Vulnerability project achieved in 2024?
- Refined HCD Solutions:
- HCD prototype solutions were identified after conducting multi-level design workshops with stakeholders, then evaluated based on a feasibility and impact matrix
- A self-paced family conversation prototype was prioritized for its highest perceived feasibility and impact.
- Completed HCD Adaptive Implementation:
- The final prototype includes audio content, told by storytelling players, and visual print materials, along with home-to-home visits by Health Development Army (HDA) volunteers.
- Implementation was carried out in two woredas (districts) for four consecutive months
- 83 healthcare providers and woreda heath office staff participated in workshops, and 321 HDAs were trained in the intervention woredas
- Trained HDAs screened 736 vulnerable pregnant women per the Vulnerability Screening Tool, reaching 603 women with solutions
- Carried out Baseline Evaluations:
- 1189 vulnerable pregnant households were identified via house-to-house identification, from which 470 randomly sampled pregnant women were recruited and interviewed as a panel study (239 intervention, 231 control)
- The overall interest in ID at baseline was 45.6% in the intervention group and 49.2% in the control group, which indicated no big difference between study groups.
- Found promising results in the Midline Evaluation:
- Preliminary results of the midline evaluation (mixed-method quantitative survey with qualitative interviews) have shown a significant increase in ID.
- Overall ID was 54.5% (intervention=57.5% and control=52.3%) which indicates about an 11.9% increase in health facility delivery after 4 months of baseline intervention. The increase in the control group was 3.1%.
Whoa! 11.9% increase in ID – way to go, Vulnerability team. What’s next??
- Based on Phase I findings, the HCD solution is effective but needs to be refined to a form that is easily feasible by the existing health system.
- Thus, we refined the Phase II design challenge to be more scalable, feasible, adaptable and to be integrated into the health system.
Group discussions with husbands of vulnerable women
Team Spotlight: Tewabech Tesfalegn
Tewabech Tesfalegn is not just an excellent CROWN Convening emcee – she is also a Project Director at CCP Ethiopia, where she leads implementation research efforts to improve adherence to nutrition supplementation and enhance ID uptake for vulnerable pregnant women. She earned a Master’s degree in Human Nutrition and Bachelor’s in Public Health from Hawassa University in Ethiopia.
With over 25 years of experience in various regions of Ethiopia, Tewabech has managed numerous health, reproductive health, family planning, HIV/AIDS prevention, care and support and nutrition projects. In her current role, she oversees the overall project implementation of these projects at the JHU/CCP country office.
Tewabech’s areas of expertise include reproductive health, particularly family planning, maternal and child health, HIV/AIDS prevention, care, and support, as well as community-based social and behavior change communication, monitoring, and evaluation.
Role on CROWN Vulnerability Project: Project Director
What this project means to you: It is one of the most interesting projects, it enables me to be part of the team to identify the best strategies to reach the most vulnerable women’s to access for maternal health.
Notable achievements or proud moments: One of the most significant achievements in this project has been the ability to facilitate discussions among vulnerable household couples on maternal health and encourage husbands to support pregnant women in various household chores, even when it goes against community norms.
Hobbies outside of CROWN: My hobbies are playing Volleyball and playing table tennis. If you want to join me, I will show you in India.
Upcoming Events
Late Nov/Early Dec. 2024: “Lunch and Learn” on the Vulnerability Project: Want to hear more from the Vulnerability team on their research, HCD process, or incredible midline findings? We will arrange a virtual “lunch and learn” presentation from CCP for anyone who is interested to attend (in or outside of CROWN)!
We will arrange more sessions like these in the future with other CROWN projects – stay tuned!
March 17-19, 2025: Save the date for the 3rd Annual CROWN Convening! We are looking forward to hosting everyone in Neemrana, India for three days of learning and sharing. Will we see you there?
