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ANFPP: Maternal Health Improvement

Course : MPH

Subject : Program planning and Evaluation in Public Health

Assignment 1 :Development of an Evaluation Plan and Program Logic

words : 2500 

references : 25 or more ( Harward referencing)

Description :

You're asked to provide an evaluation plan and program logic (not actually to evaluated anything) and you need to select any program, project or intervention of relevance to the public health or primary health care field to work on. There are loads of these you can access on the internet (if you go to some relevant NGO or Government sites you can hunt some down) or you can select one to do with your workplace. The idea is to select an intervention that is of interest to you, so a program to test pills at festivals is great.

You then have a choice about whether to explore exactly what the strategies are/would be for the program and rearticulate some of these in your evaluation plan (which would make the plan more relevant in practical terms), or you can work out yourself how the program 'might' work and who might be involved (remember you're not planning a full evaluation here but specifying 3-4 objectives addressing two or more stakeholder groups). It might be that you identify a program or intervention which has a general description (the tangled ball of wool I mentioned in the lecture) which you'll need to unravel yourself into strategies and objectives/outcomes for this exercise.  Once selected you'll need to think about two stakeholder groups that the program may be addressing and put together some sensible program objectives or changes for these stakeholders that the program should bring about to be successful. In this part you may need to be creative if the program you have chosen does not have its objectives clearly stated or if these are poorly worded

However, when it comes to the program logic description, you can broaden this out quite a bit to include more logically ordered additional outcomes as well as information about how the program might look (inputs and outputs). Remember the outcomes in you evaluation plan should also appear in your program logic, but the latter will probably have additional outcomes which would need to be achieved before or after them. Through developing a program logic, you effectively will be presenting a theory of change here brought about by the program/intervention; in essence you will applying this theory of change  to the practical situation addressed by the program. In the program logic you will rearticulate the outcomes as short, intermediate and long term logically. You'll also include inputs and outputs (which you may be able to identify from the program descriptions or you can deduce yourself as what would be needed). When doing this in the 'real world' what often happens is that constructing the program logic identifies 'gaps' in the program (e.g inadequate inputs or outputs to bring about outcome changes, or outcomes which don't logically 'follow' from the program outputs), which would be highlighted to the program planners for revision; so it is not an issue if your presented program logic for this assignment does not match the program exactly (you may identify the need for a strategy or output that they haven't considered for example) - once you have selected the program and have a good understanding of what it seeks to achieve, you can be creative. The exercise is to demonstrate and apply your understanding of evaluation planning and program logic.

Answer

The Australian Nurse-Family Partnership Program (ANFPP) to improve maternal health and early childhood development among Aboriginal and Torres Strait Islander people

1. Introduction:

The selected program is Australian Nurse-Family Partnership Program (ANFPP) for improving the maternal health as well as early childhood development of Aboriginal and Torres Strait Islander people (Munns and Walker, 2015). This program is fully relevant for the public health and primary care and aboriginal and Torres Strait Islander People have been deprived of many necessities of healthy living in the country. Thus, the government of commonwealth has started the said program for the benefit of those people and for giving them the desired standard of living (Barratt-Pugh and Rohl 2015). The evaluation plan and program logic is provided in the present report. The research further explores the strategies of the program and the relevancy of the same given in the evaluation plan (Rollans, etal., 2016). It is also seen as to who the stakeholders are of the concerned plan. The strategies as well as objectives/outcomes of the program are reflected in the report. The stakeholders groups of the program are identified. The program logic having inputs, outputs and outcomes (short, immediate and long term) is also being given. The efforts have been made to identify the gaps in the program and the same would be highlighted to planners for review and revision of the program. The intensive and extensive studies of different relevant material available in the library and that available online have been done for preparing this report.

2. About Program: ANFPP

The Australian Nurse Family Partner Program (ANFPP)has been launched for the benefit for future of Aboriginal and Torres Strait Islander people and to secure the lives of these communities. It has been committed that the Australian Government would take all necessary steps for improving the health as well as wellbeing conditions of the Aboriginal and Torres Strait Islander people.Started in the year 1977 by Professor David Olds in conjunction Colorado University of USA, the ANFPP aims for providing support and advices to would-be mothers in aiding with their baby’s developmentin the childhood or early years and to allow them to become better parents (Stampet al., 2016). There is provision for voluntary participation in this program and based on five core principles:

  1. The heart’s desire should be followed i.e. people should work as per their consciousness; 
  2. The people are expert of their own life; 
  3. The solutions should be the central focus; 
  4. The strengths should be focused; 
  5. Small changes can lead to big results and thus people should aim for small changes. 

The main focus of the ANFPP is on first time mothers of Aboriginal or Torres Strait Islander. She is encouraged to be part of the program even before 26 weeks of her pregnancy (Niederhauser, 2016). If she is becomes the part of the program, she is allotted a Nurse Home Visitor and a worker who conductsperiodic or scheduled visits (O’Brien et al., 2015). It is made clear that the visits may happen at the home or at the designated centres as preference of would be mothers. The visits start from the pregnancy and is continued till the child attains the age of 02 years (Frohmader & Chaboyer, 2016). With the passage of time, the government has been extending the program for access of more and more people and new sites or centers are being opened for it (Taft, et al., 2015). It is necessary to put here that the government spends necessary money and incurs huge expenditure for the success of the program. Regular reviews and researches are conducted based on the geographic areas, data related to population health which included birth rates as well as existing services (Mosher, et al., 2017). It is expected that long-term gains will be achieved in the health conditions of Aboriginal and Torres Strait Islander people if some investments are carried out in the early years of life and the children and thefamilies are supported at this stage of life cycle. The positive responses too have been in the lives of women, children as well as the families. It is further clarified that Australian Nurse Family Partner Program has focus on the citizen in developing the vision forthe family’s future. The department involved for implementation of ANFPPis the department of Urban Indigenous Health. 

3. Evaluation plan 

Evaluation is the systematic assessment of the process and / or outcomes of a project or program, compared to a set of explicit or implicit standards (Aylward, 2005).

The government of any country is committed for all-round development and well-being of its citizen and the Australian Government is no exception. Further, there is focus on the people who have been socially and economically backward for one or the other reasons (Mosher, et al., 2017 and Aylward, 2005). In Australia, the conditions of Aboriginal and Torres Strait Islander people have not been good for many decades and the government in the year 2006, took a decision for funding the evidence-based program for supporting the mothers as well as babies of the said communities (Niederhauser, 2016). For this cause, Australian Nurse Family Partner Program was chosen. Initially the program was started at a few sites, but with the passage of time and success of the program, it has been implemented at various sites. The people of Aboriginal and Torres Strait Islander families are getting benefitted with the program (Rollans, et al., 2016). 

Key strategy StrategiesProcess IndicatorsData collectionImpacts/Outcome IndicatorsData collection
1. Consulting would be mothers
Appointment of Nurse

Appointment of Nurse supervisor
Nurses recruited

Regular visits of nurses
Document review
Advising the women

Promoting Personal health
Document review
2. Counseling of women 
Structuring of support centers

Appointment of support staff
Visiting of women at support centers

Visiting of staff at home
Document review
Relation with Family and friends

Better family ties and social relationships
Document review
3. Immunization
Buying of vaccines

Preservation at support centers

Providing regular and periodic vaccines for disease preventionDocument review
Maternal role, safe motherhood and healthy children

Better care of infants
Document review
4. Prevention of drug abuse and alcoholism
Counseling of women

Necessary medication
Counseling of womenDocument reviewPromoting Environmental health

Reduction on domestic violence

Healthy family relations
Document review
5. Awareness about education and job 
Appointment of counselors


Meeting with women and family members
Counseling of women

Discussion with nurses and staff
Document review
Life course development

Raising of standard of living 
Document review
6. prevention of child diseaseVaccination and health services up to second birthday of childReduction of mortality ratesDocument review
Health and human services

Birth of healthy children

Reduction in child-mortality rate

Better future generations
Document review


3.1. Strategies of the program 

In the ANFPP, a Nurse Home Visitor is selected and she delivers the program content regarding home visiting guidelines to various targeted population. The duty of the Nurse Home Visitor is to work therapeutically with the clients as well as thefamilies (O’Brien, et al., 2015). She has to use the program materials and strive for achievement of program outcomes. The reflective supervision is used for ensuring the expertise, quality and best practice (Davidov, et al., 2014). The Nurse Supervisor manages the effective operation of the program, utilizing the local contracts as well as budgets. She has also to supervise the local teams consisting of Nurse Home Visitors, administrative staff and Family Partnership Workers (Lorch, et al., 2015). It is responsibility of the all the concerned workers that the program is delivered appropriately and with the fidelity (Niederhauser, 2016). The strong relationships are maintained with the all concerned organisaiton and persons. The recruitment as well as the engagement of prospective clients is done by the Nurse Supervisor.  Apart from all these, the Nurse Supervisors has to mentor and supervise the ANFPP National Program and acts as a chain between the Centre and other workers (Rollans, et al., 2016). 

3.2. Relevancy of the program 

The Australian Nurse Family Partner Programis quite relevant and suitable for the people intended for. It is the duty of the government to remove all sorts of disparity and sufferings of the citizen (Lorch, et al., 2015). This program is a right step in this regard. It may be clarified that there are six domains of the home visits incorporated in the program. These may be enumerated as:

  • Promoting Personal health: When the mother’s knowledge is increased and confidence is built up for engaging herself in good practices related to positive health and maintenance, promotion of mental health etc. the half complete family and in turn complete society is going to be benefitted (Mosher, et al.., 2017).
  • Promoting Environmental health: The mother’s awareness is increased regarding adequacy at home, education and work levels. She is assisted in improving the environments and to remain far from dangerous situations. 
  • Life course development: The would-be mother is supported in exploring goals and developing a vision for future life (Baird, et al., 2015). 
  • Maternal role: Motherhood is one of the pious and complex period of women’s life. Hence, she is assisted in adjustment to her maternal role and development of required knowledge, confidence and skills. He is allowed to improve her abilities in promoting the health as well as the development of children. 
  • Relation with Family and friends: The would be mother is counseled at different stages of motherhood or pregnancy and thus helped in marinating the relationshipsand identifying the people who may assist her in child care and provide needed support (Lorch, et al., 2015). 
  • Health and human services: Australian Nurse Family Partner Programalso does the working of linking the families with the services for needs and also provides the services where the family resources are not adequate.

4. Program logic 

As stated in the evaluation plan, the Australian Nurse Family Partner Program is made for the people who are socially and economically backward in the country. The commonwealth government has taken efforts in the form of the said program for making the better citizen. In this program the would-be mothers are contacted and provided support during their pregnancy and the child-birth till child attains the age of the 02 years. By, this program, the women and the families are also empowered through this program and the life standards of the people are attempted to increase (Mosher, et al., 2017). It may be noted that intended people are not much educated and they have lagging in achievement of various resources. By the medium of this program, they come in contact of trained nurses and other educated people who are able to guide and teach the necessary lessons of maternity and child care. This not only increases the awareness but the life-long learning and betterment of life (Barratt-Pugh &Rohl, 2015).  

4.1. Inputs

Following are the inputs of Australian Nurse Family Partner Program:

  • Appointment of nurses, nurse supervisor and other supporting staff
  • Identification of families and would be mothers (Andrew, et al., 2015)
  • Visits of nurses and support workers to the families
  • Guidance and teaching/counseling of the would be mothers (Baird, et al., 2015)
  • Rendering necessary services/facilities at home
  • Establishment of support centres (Andrew, et al., 2015)
  • Providing the services and facilities at support centres
  • Establishment of contract program

4.2. Outputs 

Following are the outputs of the Australian Nurse Family Partner Program:

  • Counseling of would be mothers (Andrew, et al., 2015)
  • Access to better health care
  • Awareness of the duties and role as mother among women
  • Development of healthy life styles (Baird, et al., 2015)
  • Avoidance unnecessary disease
  • Improvement of family and social life
  • Social development 

4.3. Outcomes 

The outcomes of Australian Nurse Family Partner Program can be classified into 03 categories. These may be enumerated as follows:

4.3.1. Short term Outcomes

In the short term, the program improves the maternal as well as the child health of the Aboriginal and Torres Strait Islander families. It also assists the would-be mothers in engagement of practices leading for better and preventative health conditions. After birth of the child, this program supports the parents in improving the mother’s as well as the child’s health and development (Andrew, et al., 2015). 

4.3.2. Immediate Outcomes

Australian Nurse Family Partner Program in due course of time assists the parents in developing the vision for thefuture. It also enables them in finding the sources of better and education and work prospects. (Catherine, et al., 2016).

4.3.3. Long term Outcomes

In the long terms, the Australian Nurse Family Partner Program has the following outcomes:

  • Decrease maternity deaths
  • Improvement of life expectancy-rate
  • Improvement of Early Childhood 
  • Education of families and physical Health
  • Improvement of Social and Emotional Wellbeing (Varcoe, et al., 2017)
  • Reducing of disadvantage caused due to Income Disparities (Catherine, et al., 2016)
  • Having positive parenting 
  • Having better future generation
  • Improvement of immunization rates
  • Parents’ engagement in child’s early learning
  • Prevention of drug and alcohol abuse during pregnancy (Hubbard, et al., 2016)
  • Improvement of family and social relations and thus a healthy society

5. Stakeholders of the plan/program

The stakeholders of the Australian Nurse Family Partner Program are:

  • Central government
  • Facilitation centres and its staff
  • Nurse supervisors
  • Nurses
  • Supporting workers and administrative staff
  • Would-be mothers and families

However, all the active stakeholders, the most affected stakeholders are the nurses who are deployed for visiting the families and would-be mothers (pregnant women) who remain in contact for about three years (Catherine, et al., 2016). 

6. The strategies of the program

The nurse visits the family of the pregnant women or in some cases the pregnant women are encouraged to visit the facilitation centre for about one to one and hour every week. It may be noted that the frequency and duration depends on the case and complexity of the pregnancy (Kemp, et al., 2018). The women targeted for the program may have around 16 weeks of gestation they remain attached to the program till 24 months of post-partum i.e. when the child attains the age of 02 years. A number of fidelity measures are taken at Australian Nurse Family Partner Program National Program Centre. The confidence and competency level of mothers are increases (Varcoe, et al., 2017). 

7. Objectives of the program

Following are objectives of Australian Nurse Family Partner Program:

  • Improvement of self-esteem of young women 
  • Empowerment of Indigenous people in address issues related to maternity and child health (Miller & Hendrie,  2015).
  • Motivation of Indigenous people in expression of ideas/thoughts regarding mental health and social well-being (Hesson, et al., 2018).
  • Liaison service providers as well as the Indigenous Community 
  • Engagement of Aboriginal workers in promoting the program and recruiting them for various activities (Kemp, et al., 2018).
  • Care of mothers during antenatal period 
  • Formation of strong links with the Aboriginal and Torres Strait Islander community (Miller& Hendrie, 2015)
  • Providing education, support as well as referral resources 

8. Gaps in the program 

It has been found that the health as well as social conditions of the Aboriginal and Torres Strait Islander people in still low (Hesson, et al. 2018). The mortality rate is high and the communities have been found to suffer from various diseases including but not limited to communicable diseases of  tuberculosis, influenza etc. The communities also experience the poverty, low engagement with work as well as education, welfare dependency,housing problems, etc. The mothers are not able to have the required diet during pregnancy and the children are bound to suffer. Not only this, there are cases of drug and alcohol abuse. There are instancesof pre-term births, low birth weights, etc. With the implementation of the Australian Nurse-Family Partnership Program since 2009, developments in various things have been observed (Miller& Hendrie, 2015). But, thing need more improvement and it is suggested that the people deployed for work must be trained to have the understanding of the client population and adversities faced by them. It is necessary to highlight here that the women still have habits of smoking during pregnancy(Hubbard, et al., 2016). Further, there have been lacking in correct evaluations, the women were seen with subjective views. 

 Program Logic Task 

program logic task

9. Conclusion 

It can be said that the Australian Nurse-Family Partnership Program designed for Aboriginal mothers as well as infants i.e. pregnancy to child's age upto 02 years is good program. It shows the concern of the government towards this community (Prosman, et al., 2015). It is adapted on the similar program of USA. It is intended for removing social disparities and disadvantages. With the implementation of about 10 years, the program may be said to have many achievements. But, since the life of the intended people is complicated and they are exposed to higher level of poverty, having housing problems, facing domestic violences, etc., the desired level of satisfaction and achievement is not obtained till date (Heerde, et al., 2018). It is not the case that the workers have not done their part, rather the correct reason is that there are challenges in the program delivery (Yingling, et al.., 2017). However, it is the matter of great satisfaction that sign of changes have started in the intended population (Heerde, et al., 2018). The workers, nurses and all concerned staff including the government is striving hard to improve the situation and extend the benefits of Australian Nurse Family Partner Program much people (Jack, et al., 2015). It is expected that in coming years, the situation will improve and the program will be a sure success removing all the gaps. The desired benefits will be extended to whole communities and they will be brought in par with the other citizen of the nation. 

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