Using an example of a case study, the steps in Evaluation of Health Education Programme are explained. Read the case study and the questions following it. Try to answer the questions on your own.
Diarrhoea was a cause of concern in Sakshi’s village Shastrinagar. Quite a few children have died in the past one year due to diarrhoea. Sakshi found awareness about causes and prevention of diarrhoea was poor. Awareness about ORS and home available fluids for diarrhoea management was poor. The mothers withheld foods and fluids to children with diarrhoea. The PHC and Subcentre did not have adequate stock of ORS.
Medical Officer of PHC along with his team decided to start focused health education programme in Shastrinagar with the aim of reducing deaths due to diarrhoea in children below five years. No. of children below 5 years of age is 300 and mothers with child aged is 200.
The objectives of the health education programme were to educate
75% of the mothers with children below five years of age regarding signs/symptoms, and prevention of diarrhoea
50% of the mothers with children below five years regarding preparation of ORS
The following strategies were planned
training of ASHA workers and Anganwadi workers
8 health talks for mothers in groups of 20 to be held at the anganwadi, the panchayat office and the local temple to inform mothers regarding the signs/symptoms, prevention of diarrhoea and preparation of ORS using flip charts and videos. Pre and Post-test would be administered before and after each session.
10 sessions were planned on demonstration of ORS for women in batches of 10.
All activities scheduled to be completed in 3 months period.
Medical Officer with his team decided to consider the health education sessions to be effective if the following effect was seen.
Average Post-test score should be atleast more than 75.
Mothers are able to retain their knowledge for 3 months or more verified by a post-test score >=50.
Atleast 50% of the mothers are able to correctly demonstrate the steps of ORS preparation.
Qts 1: State the goal of health education programme.
Answer
Goal of the health education programme is to reduce deaths due to diarrhoea in children aged less than five years in Shastrinagar.
Qts 2: Who is the Population of Interest in health education programme?
Answer
Mothers with children aged 5 years or less
Children aged 5 years or less (Though children are not direct beneficiaries, the entire purpose of the health education sessions is to prevent diarrhoeal deaths. Therefore children also are considered as population of interest in this case.)
Qts 3: State the outcome objectives that the Medical Officer planned to achieve.
Answer
The outcome objectives are
Average Post-test score should be atleast more than 75.
Average Post-test score after 3 months of receiving health education session should be atleast more than 50.
50% of the mothers should be able to correctly demonstrate the steps of preparing ORS.
Qts 4: List all the strategies that were planned.
Answer – Strategies planned
Training of ASHA worker and AWW by MO-PHC.
Make ORS available at SC and PHC (Service approach of HE).
Take Sarpanch’s help in mobilising.
Collaborated with Anganwadi worker.
Conducting Awareness session - Group Health Awareness.
Demonstration of ORS to mothers.
Teaching Aids - Flip chart, Video, Demonstration.
Pre-Post test to assess knowledge.
Qts 5: List the activities that were planned for the Population of Interest.
Answer
Health Awareness sessions for mothers (20 in a batch).
Demonstration of ORS to mothers (10 in a batch).
Qts 6: List the resources required to implement the programme.
Answer
Manpower - ASHA assisted by AWW supervised by ANM.
Health Education Aids used - Flip chart, Video’s, Material needed for demonstration of ORS
Training Hall
Qts 7: List the process objectives.
Answer: The Process objectives are
To conduct 8 health awareness sessions.
To conduct 10 demonstration sessions.
To educate 75% (150) of the mothers with children below five years of age regarding signs, and symptoms of diarrhoea, and prevention in the next three months in Shastrinagar.
To educate 50% (100) of the mothers with children below five years regarding preparation of ORS in the next three months in Shastrinagar.
Sakshi started conducting the sessions from 1st April to 30th June with assistance from the Anganwadi worker and guidance of the ANM. Sakshi conducted six awareness sessions which were attended by 125 women. Before and after each session, she conducted a pre and post-test to assess their knowledge. Eight Demonstration sessions were conducted in which 110 mothers participated.
Flip charts and Videos were used for awareness and demonstration sessions. Demonstration of preparing ORS was not done. A record of all the women who attended awareness & demonstration session were kept. Photos were taken of session.
Sakshi made it a point to keep the Sarpanch informed about the progress of her work and took his help in mobilising the women whenever she faced a problem. Medical Officer kept a check on whether the sessions planned were being conducted.
The Evaluation team collected the following data.
Number of activities and beneficiaries
6 health awareness session - total 125 mothers
batch size for awareness sessions - 10,15,15,30,40,15
8 demonstration sessions - total 110 mothers
batch size for demonstration sessions 12,20,10,12,13,15,10,18
Teaching aids used
Flip chart used, Video to demonstrate ORS preparation
Teaching method used
Group Health Talk
Change in knowledge score before and after the session
Average Pre-Test score of 125 mothers – 35
Average Post-Test score of 125 mothers – 70
Average score of survey using similar questions - 45
Percentage of mothers correctly performing the steps of ORS preparation
3 of the 30 mothers selected from the list of participants
The Evaluators interviewed the ASHA worker, Anganwadi worker, Sarpanch and Medical officer and summarised the information as follows.
2 Awareness and 2 demonstration sessions were cancelled because only 2-3 mothers turned up for the programme.
Timings and days of some of the sessions was inappropriate as informed by Sarpanch.
One of the venue i.e. temple had very few mothers turning up as those of lower caste and were not allowed to enter temple premises.
On some of the days of demonstration sessions, the AWW was called for meetings or training and could not assist the ANM.
ORS packets were in short supply and could not be spared for demonstration. In some sessions more than anticipated number turned up, and the hall was small, congested and noisy.
Qts 8: Who are the key stakeholders of the health education programme?
Answer
Community Leaders - Sarpanch
ASHA worker
Anganwadi Worker
ANM
Health Assistant Female(Supervisor of ANM)
Medical Officer
Taluka Medical Officer, District Health Officer
Mothers of under-five children
Qts 9: What type of evaluation approach is needed to answer the Evaluation Questions - Was the health education programme implemented as planned?
Answer: Process Evaluation
Qts 10: What type of evaluation approach is needed to answer the Evaluation Questions -" Were the health education sessions effective in bringing about about a change on knowledge" ?
Answer: Outcome Evaluation
Qts 11: What type of evaluation approach is needed to answer the Evaluation Questions - Did the health education programme succeed in reducing mortality due to diarrhoea?
Answer: Impact Evaluation
Qts 12: As an Evaluator, what will you measure for the evaluation question, “Was the health education programme implemented as planned”?
Answer
Number of activities and beneficiaries attended awareness and demonstrtion session
Teaching aids used
Teaching method used
Qts 13: As an Evaluator, how will you obtain or collect the data for the evaluation question, “Was the health education programme implemented as planned”?
Answer
The information can be collected from the
Programme reports
Interviews of programme staff (ASHA worker, ANM, Medical Officer etc)
Qts 14: As an Evaluator, when will you collect the data for the evaluation question, “Was the health education programme implemented as planned”?
Answer
At the end of completion of the health education programme, the data can be collected.
Qts 15: As an Evaluator, from whom will you obtain or collect the data for the evaluation question, “Was the health education programme implemented as planned”?
Answer
ASHA worker or Medical Officer who will have the report of activities done.
Also the ASHA worker, Anganwadi worker, ANM, Medical Officer can be interviewed.
Qts 16: Analyse the data on awareness and demonstration sessions obtained by the Evaluator.
Answer
Awareness sessions conducted
6 of the 8 planned awareness sessions conducted (75%)
62.5% (125/200) of mothers attended awareness sessions
Demonstration sessions conducted
8 of the 10 planned demonstration sessions conducted (80%)
55% (110/200) of mothers attended awareness sessions
Qts 17: Interpret the data regarding beneficiaries.
Regarding the number of mothers
The percentage of mothers who participated was 62.5% for the awareness sessions as against their objective of 75%.
The poor participation in the awareness session could be because of the inappropriate timings and days of the sessions.
Also one of the venue i.e. temple was inappropriate as many of the mothers staying in the surrounding were of lower caste and were not allowed to enter temple premises.