Strategic Approach - The key strategic approach of MINI 2 is to work through the MOHP infrastructure, and with I/NGO and donor partners, to define, test and evaluate the most efficient model for scaling up CB-management of neonatal sepsis and to determine the effect on health worker performance and program coverage when external support is decreased.

 MINI 2 will test the hypothesis that by streamlining the MINI I model, refining the training, supervision and recording/reporting mechanisms to fit within the existing CB-IMCI program, the program can be expanded to several new districts within the life of the project, utilizing other donor funds, and TA from the core MINI group.

 MINI 2 will address some critical issues, such as the cost of replication, the effects (positive or negative) on other DPHO programs, the potential impact on neonatal mortality (to be derived indirectly through coverage, quality and usage rates) and the policies that need to be revised to facilitate expansion. 

The MINI 2 team will provide strategic input and technical assistance at different levels to address these issues: within  Morang district, at the national level and in new districts.

Current Status and implementation strategy for this Proposal - MINI-1 is implemented through the District Public Health Office (DPHO), originally in 21VDCs, but now expanded to all the remaining 44 VDCs in Morang district. An excellent data collection and analysis system has been set up by MINI and for the next year (through December 2007), NFHP/USAID will continue to support technical staff for supervision, monitoring and analysis. This will allow the unique opportunity to augment the longitudinal data base, informing the MOHP, partners and a larger global audience about the evolution of the program intervention, patterns of disease, changes in care-seeking, health worker fatigue, impact on the other public health programs of the district, etc. The total population of these 21 VDCs in currently estimated at 305,000.

The remaining 44 VDCs have just completed FCHV-level training and the intervention now will serve an additional population of approximately 462,000. Under MINI 2, these 44 VDCs will be considered as 2 separate groups: 36 VDCs, with a population of about 415,600 and 8 hill VDCs, with a population of about 46,510. The rationale is as follows. In Nepal, the average district population is about 342,000. In Morang, in these new VDCs, MINI 2 will define and test a streamlined model of supervisory support, similar to that which can be provided by the MOHP through the regular program structure. Under MINI 2, these 36 VDCs will have this decreased external support, referred to as MINI-lite supervision model and the quality of the program performance and other indicators will be tracked to determine an adequate level of supervisory support required for the successful implementation of the program. This will answer “how much support is enough?”

In the 8 hill VDCs the same implementation model will be used, but monitored to allow documentation of the constraints and limitations to utilizing this model in areas with difficult terrain, with long distances to be travelled between the health workers and the home of the sick baby.  This documentation will be valuable for informing policy makers when designing an appropriate program model for the hills and mountains of Nepal, which may include the introduction of a simplified UNIJECT injection system for administration of gentamicin .

Support for this proposal will allow definition, testing and evaluation of the optimal supervisory model while monitoring program quality, and will use the expertise developed under MINI 1 to facilitate expansion to other districts.  In addition, this support will allow exploration of approaches to be used in hill districts and provide a field study area that can help other countries plan their programs.