Conference Overview
The 2019 Global Health Practitioner Conference on May 6-9 in Bethesda, Maryland, USA welcomed 332 implementers, academics, donors, private sector, and other community health advocates from over 14 countries representing over 107 organizations to explore the dynamic and ever-evolving profile of partnerships existing between different stakeholders working to advance community health at various levels of policy and implementation. The conference also highlighted different innovations for community health work, from technology to methodologies and processes. The objectives were:
- EXAMINE the successful elements that contribute to meaningful partnerships for results at the community, national, regional and global levels
- SHARE innovative health models that can be scaled; determine how as a community we can address gaps in scaling up known evidence-based models
- CATALYZE plans for consortium building, technical capacity building and strategic focus for improved community health, in a cross-sectoral manner
Session Presentations: Monday | Tuesday | Wednesday | Thursday
Program Booklet | Conference Report (upcoming!)
Poster Sessions
Wednesday, May 8, 2019 | 5:30PM-7:00PM | Hyatt Regency Terrace
The Power of Partnership: Collaborating to Develop a Deploy a Digital System for Egypt’s Community Health Workers
Amy Mangieri, Save the Children US
In partnership with the Ministry of Health and Population (MoHP), the Maternal and Child Survival Program (MCSP) in Egypt has developed a health management information system (HMIS) for the national community health worker (CHW) cadre, the Raedat Refiat (RR), by adopting the Principles for Digital Development as a framework. The community HMIS provides practical solutions to current gaps in the system – e.g., the migration from paper-based forms to the HMIS aims to improve the speed and reliability of data quality and informed decision-making. Working hand-in-hand with the MoHP, MCSP Egypt is piloting the system in two governorates with plans for national scale-up, ultimately reaching more than 14,000 RRs. The poster will describe the experience of designing, developing and deploying a mobile system to support RR activities in health promotion and behavior change communication. The poster will provide an overview of MCSP Egypt’s current partnerships and collaborations to promote the system’s sustainability and ensure long-term impact.
Meeting the SDG’s Leave-no-one-behind Agenda with Better Nutrition for Children with Disabilities: A Uganda Case Study
Stephanie Auxier, SPOON Foundation
The inclusion of children with disabilities in the efforts to combat malnutrition is not only ethical, but imperative for aligning with the Sustainable Development Goals’ leave-no-one-behind Agenda—an aspiration shared by the Scaling Up Nutrition Movement. Children with disabilities, especially those with feeding difficulties, suffer at an alarming rate from preventable malnutrition and dangerous feeding practices (e.g., supine feeding, rapid feeding, inappropriate food textures) that place them at risk for aspiration, pneumonia, and premature death. Interrelated factors such as stigmatizing attitudes, lack of social support, increased care burden on the caregiver, poor access to nutrition and health services, and gaps in skills among healthcare professionals contribute to the children’s poor nutritional status. Therefore, it is essential that partnerships and interventions span governments, health systems, community programs, and academia. This poster presentation will draw on SPOON’s work in Uganda to illustrate gaps, needed partnerships, and potential strategies to prevent and manage malnutrition for children with disabilities and will highlight key considerations and lessons learned.
Partnerships with Traditional Institutions: The Key to Polio Eradication
Oro-ghene Adia, Catholic Relief Services Nigeria
Nigeria has celebrated two years without a confirmed case of Wild Polio Virus and looks forward to certification as polio-free in 2019. However, noncompliant households threaten Nigeria’s progress towards eradicating polio. Fathers often refuse to have their children vaccinated, citing reasons such as ‘no felt need for vaccines’ and ‘too many rounds of vaccination’. CORE Group Polio Project (CGPP) volunteers set out to resolve these cases of noncompliance in two local government areas, through ‘in-between round’ (IBR) community dialogue. The CGPP volunteers took advantage of the increased availability of men during Ramadan to convene fathers and their Hakimis (ward-level heads) and Sarkis (community-level heads) to dialogue sessions on noncompliance, followed by house-to-house vaccination in the company of the Hakimis and Sarkis. Through this optimized in-between round activity (OIBRA), the CGPP team leveraged the authority of the traditional institutions to enforce compliance, and successfully vaccinated 89 children in 58 habitually non-compliant households. Partnership between health teams and traditional institutions can be used to implement community health programs and other social interventions successfully.
Delivering Immunization Services Through Innovative Partnership and Community Health Approaches
Samuel Usman, CORE Group Polio Project Nigeria
CORE Group Polio Project (CGPP) is a multi-partner USAID-funded community health program providing immunization services in difficult, hard-to-reach and insecure areas of Northern Nigeria through partnerships with international and local organizations. Since 2014, CGPP has been working with Catholic Relief Services (CRS), Save The Children International (SCI) and International Medical Corps (IMC) to implement immunization programs specifically to strengthen Nigeria’s Routine Immunization (RI) program and support the country’s Polio Eradication Initiative. Volunteer Community Mobilizers (VCMs) from partner organizations conduct awareness raising activities aimed at dispelling rumors and misconceptions about the Polio vaccine and use unique opportunities like naming ceremonies “Suna” to vaccinate children less than five years. Across the five states, the percentage of newborn children vaccinated with Oral Polio Vaccine (OPV) within the first week of life ranged from 81% in Yobe to 99% in Kaduna in 2018. Through this partnership, innovation and targeted approach at the community level, 598,781 households were mobilized, and an estimated 2,600,000 caregivers reached with awareness raising messages on Polio and RI in 2018.
Sustainability of Evidence-Based Intervention: The Care Group Approach
Halkeno Tura, The University of Iowa
Care Group Approach (CGA) is a community-based strategy for maternal and child health interventions that uses Care Group Volunteers (CGV). While there is strong evidence-based support for the short-term impact of the use of this approach there is limited evidence related to the long-term sustainability of its impacts. To assess the sustainability of impact of the use of CGA, we replicated the methodology used at the end of the program and collected data from a random sample of ex-beneficiaries (N=489) of the program and CGV (N=17). Improvements made regarding anthropometric measure, and five indicators of feeding practices were maintained during the follow-up period through 2015. Community members, especially women’s, interest in CGV work, recognition by spouse and community leader, self-efficacy, and self-motivation were reported as the top four possible motivations for CGV to continue working after the end of the program. This study, together with the prior evaluation, suggests that the Care Group Model is a promising approach to sustaining the impact of key maternal and child interventions and reducing under-5 mortality in Sub-Saharan Africa.
From Three Districts to 103: Lessons Learned and Considerations for Scaling Up Innovative QI Approaches
Tewodros Alemayehu Abebe, John Snow Inc.
JSI’s Universal Immunization through Improving Family Health Services (UI-FHS) project aims to strengthen the routine immunization system across Ethiopia through the Reaching Every District using Quality Improvement (RED-QI) approach. RED-QI gives program managers and health workers tools to enable the timely identification and vaccination of every eligible child. UI-FHS scaled the RED-QI approach from 3 to 103 districts in Ethiopia with varied demographics, sociocultural/livelihood contexts (e.g. nomadic populations), and health system strength using adaptive management approaches. Findings suggested scale up is facilitated if the approach can easily integrate into the existing health system. The scale up model must be adapted based on context; implementers must be willing to compromise on the fidelity of a technical approach, allowing for organic adaptation as it is introduced in new contexts. Lastly, QI tools are complex, requiring orientation and iterative support; ongoing capacity building must be built-in to the approach for uptake. Iterative support in UI-FHS districts resulted in a 49% increase in management scores from first to final visit.
An Innovative Text Message Based Program to Improved Pregnancy Outcomes in Kenya
Bob Gold and Shelley Schenfeld, GoMo Health
Aga Khan Health Services in Kenya and GoMo Health partnered to pilot a project using GoMo’s Prenatal Personal Concierge™ platform that was designed to serve as a virtual care coordinator to remotely support moms through all stages of prenatal care. GoMo Health Concierge Care personalizes patient interactions using our proprietary science, BehavioralRx®, The Science of Population Health, building trust and credibility to motivate higher levels of reciprocity and actions. GoMo Health Prenatal Personal Concierge delivered 2-3 care messages per week via text message for the duration of the pregnancy. offering tips and guidance to pregnant women to activate them to manage their own health care and the health and wellness of their family. 100% of survey respondents reported that the program helped them better manage their health and pregnancy, there was a pre-term birth average of 0.5% for women participating in program, compared to a Kenya national average of 12% A text message-based program designed to engage, educate and motivate pregnant woman in Kenya was not only well received, but showed very favorable outcomes.
Building Coalitions for Advocacy and Action to Promote and Protect Breastfeeding through HKI’s Assessment and Research on Child Feeding (ARCH) Project
Jennifer Nielsen, Helen Keller International
This presentation will describe a cross-sectoral and multi-stakeholder effort in Cambodia to monitor and enforce the Code of Marketing of BMS (breast-milk substitutes) led by a coalition of four government ministries (Health, Commerce, Industry, and Information) and supported by an informal alliance comprised of HKI/ARCH, Save the Children, and the World Health Organization (WHO, UNICEF, and the SUN Civil Society Network). Timely evidence from ARCH project revealed widespread marketing and use of BMS at the same time DHS showed a drop in exclusive breastfeeding. Training of government, business owners, health officials, students, media and others on The Code has raised awareness and vigilance. Formation of an Oversight Board comprised of representatives from ministries of health, industry, information, and commerce to develop work plans for monitoring and enforcing national legislation on BMS marketing and labelling. Significant trust building occurred among ministry and non-governmental partners through frequent meetings and reinforced by breastfeeding champions at the Ministry of Health Engagement of often-overlooked partners: for example, identifying the role and responsibilities of the Ministry of Commerce built commitment to enforcement.
Working with the Communities to Support Feeding the Children at ECD with Locally Available Food
Molly Kumwenda, Catholic Relief Services
Malawi has recently it has renewed its commitment to scaling up nutrition by reviewing its multi-sectoral nutrition policy, covering nutrition specific and nutrition sensitive interventions. The current focus is strengthening nutrition and early childhood development (ECD). Catholic Relief Services (CRS) is implementing several ECD related projects approaches that are now being utilized by the government. One of the projects that CRS is implementing is the Nutrition and ECD integrated project in Mzimba district in northern Malawi to improve the lives of the under five children in areas, of health, nutrition and child development. One of the challenges that most of the stakeholder’s face with ECD community-based interventions is how to sustain feeding at these centers. This specific project is trying to learn how best to work with communities and other structures on how to sustain nutritional feeding at the centers using locally available food. This poster will engage participants in discussing the meaningful engagements at different levels (national, district and community) to work together and improve the lives of under five children.
Community Involvement for Early Identification and Warning of Epidemic Prone Disease Under Surveillance through the Community Watch and Alert Committee Strategy in Senegal
Randriamanantenasoa Felicien Paul, Catholic Relief Services
A rapid response to infectious disease outbreaks is the difference between whether the outbreak is controlled in the community where it started or spreads into an epidemic. The rate of response is quickest if surveillance starts at the community level and there is proactive involvement of community members to report diseases. In Senegal, Catholic Relief Services (CRS) implemented a project on surveillance for epidemic-prone diseases at the community level that involved Community Watch and Alert Committees (CVAC). Each CVAC member is to investigate each suspected case of the seven diseases under surveillance and any other unusual event related to infectious disease. Any identified alert by a CVAC member is immediately relayed by telephone to the health post’s head nurse (ICP) who conducts the necessary investigations within 48 hours to confirm or reverse the alert. If confirmed, the ICP follows the Ministry of Health and Social Action procedure for the management of suspicious cases. One year after implementation, 369 alerts were received, out of which 347 were investigated and 172 confirmed suspect cases.
Getting to 2020: The Introduction of DMPA-SC via Community Health Workers in Benin
Tishina Okegbe, FHI 360
In 2013, the Government of Benin made three commitments to improve national health indicators, including increasing provision of family planning services at the community level to expand access to services for women. Since 2016, the Advancing Partners & Communities (APC) project has supported the Benin Ministry of Health to increase provision of family planning services at the community level by introducing DMPA-SC through a lay community health worker cadre, known as relais communautaire (RC). DMPA-SC, also known as Sayana Press®, is an easy-to-administer, discreet sub-cutaneous injectable product that provides three months of contraceptive protection. Beginning in May 2017, DMPA-SC was introduced via cascaded training in a phased approach in 10 USAID-supported health zones encompassing 149 health centers and 614 villages. This poster presents an assessment of service delivery records and provider reports from June 2017 to June 2018 were evaluated to determine the number of new DMPA-SC users compared to new users of other methods, DMPA-SC user continuation rates, provider experiences administering DMPA-SC, and reports of adverse effects.
BFS+: Process Evaluation of an Integrative Health Approach for Lactating Women and Their Babies in Humanitarian Emergencies in Nguenyyiel Refugee Camp in Gambella, Ethiopia
Armelle Sacher, Action Against Hunger
Children under age 2 are a critical population to target in humanitarian emergencies, as infectious disease during this period is common and has long-term impacts on physical and cognitive developmental trajectories. During crises, Action Against Hunger implements Baby Friendly Spaces (BFS), an integrated maternal and neonatal health intervention for lactating mothers with children under 2 years. This study of BFS+ aims to strengthen the implementation, effectiveness, and acceptability of BFS+ delivered in Nguenyyiel refugee camp, Ethiopia. This study uses mixed-methods to evaluate the trajectory of maternal and child health (MCH) outcomes and assess how participation in different components of the BFS program are differentially related to key MCH outcomes. We sought to understand from staff and South Sudanese mothers’ perspectives how BFS could be more acceptable, feasible, and relevant to the target population. This study expects to observe a decrease in child morbidity, as well as improvements in mothers’ wellbeing and quality of child care practices. We aim to contribute evidence and guidance to humanitarian actors on how to implement BFS+ in crisis-settings.
The Birth of a CHEW Program: Stakeholder Perspectives on Initiating Uganda’s New National Strategy
Camille Collins Lovell, Pathfinder International
Using in-depth interviews with a range of stakeholders at national, district and community levels to supplement project experience, we present a case study of the complex political process required to develop, finalize, and roll-out Uganda’s new Community Health Extension Worker Strategy. Pathfinder International’s USAID-funded project, Integrated Systems Strengthening for CHW Programming, has supported the government’s conceptualization, refinement, and operationalization of the strategy, together with other non-governmental organizations. Our analysis considers the challenges to meeting the 15 recommendation areas covered in the WHO guideline on health policy and system support to optimize community health worker programs. We examine the process of policy development, especially the importance of continuous advocacy, consultation and buy-in from a wide array of political leaders, district leaders, and NGOs. Reasons behind stakeholder concerns about the supplanting of existing community health volunteers with a new cadre of paid community health workers is explored. Finally, we will describe the process of reaching agreement on short, medium, and long-term financing mechanisms with policy makers, especially parliamentarians who must appropriate resources for CHEW salaries.
Beyond the Outbreak: Strategies for Post-Ebola Recovery
Jeffrey Sanderson, John Snow Inc.
Beyond the Outbreak is an online toolkit designed for organizations and individuals involved the challenges of recovery efforts following an infectious disease outbreak, such as the 2014-2016 Ebola virus disease (EVD) epidemic in West Africa. The toolkit has three major sections – Helping Survivors Recover, Rebuilding Health Systems and Global Health Security – and was designed as a resource for governments, donors, nongovernmental organizations (NGOs), implementing partners, and survivor groups, among others. Comprised of multiple resources, the toolkit includes documents on best practices and lessons learned, tools and templates, national guidelines and policies, research and journal articles, as well as various videos and technical briefs produced by the program. The toolkit was produced by the USAID-funded Ebola Transmission Prevention & Survivor Services (ETP&SS) program under the Advancing Partners & Communities project. In Guinea, Sierra Leone, and Liberia, the three countries most affected by the Ebola outbreak, the ETP&SS program was managed by JSI Research & Training Institute, Inc. (JSI) and implemented by JSI and various in-country partners. www.advancingpartners.org/ebola-toolkit
Live More Abundantly: An ADRA Approach for Addressing Chronic Diseases in LMIC
Sharon Tobing, ADRA International
Non-communicable diseases (NCDs) have reached epidemic proportions in Low and Middle-Income Countries (LMIC), yet a gap exists for lifestyle approaches for prevention and management. ADRA is currently testing its Live More Abundantly (LMA) approach for reduction of NCD risk factors for effectiveness in LMIC. LMA is a contextualized version of the evidence-based Complete Health Improvement Program (CHIP). CHIP has been shown to prevent and arrest chronic diseases in High Income Countries (www.chiphealth.com). ADRA developed LMA to contextualize CHIP’s key messages and utilize the REFLECT methodology (http://www.reflect-action.org/), which is a contemporary empowerment and behavior change approach which facilitates adult learning and social change. The poster presentation provides brief background on LMA development then highlights research from a 30-day cluster-RCT, prospective cohorts with no controls. LMA outcomes to-date are mainly positive and comparable to CHIP. Significant reductions were found for most biometrics at 30 and 90 days. Results from Fiji, Cambodia, Nepal and possibly Thailand will be shared. Study results will continue to guide ADRA in further development and expansion of the LMA program in LMIC.
Exploring Willingness to Pay and Determinants of Using a Household Water Treatment Product of Haiti
Bram Riems, Action Against Hunger
During 2018, continued efforts to fight cholera in Haiti resulted in the lowest transmission since the beginning of the epidemic in 2010. Cholera elimination now seems within reach and household water treatment (HHWT), is a key behavior to help stop the spread. To bring this behavior to scale, Action Against Hunger (AAH) is exploring social marketing of locally produced liquid chlorine in high-risk areas. In January 2019, a barrier analysis paired with a willingness to pay survey was conducted to understand behavioral determinants as well as household demand for HHWT. Willingness to pay was measured with contingent valuation and Becker-DeGroot-Marschak (BDM) elicitation methods. Preliminary results suggest that the approach is feasible, with 75% of respondents stating a maximum price equal to or above the current market price. The BDM experiment however resulted in a significantly lower result, although respondents were still willing to pay 64% on average of the market price. The experiment will now serve AAH, the private sector, local distributors and NGOs to develop an effective social marketing and behavior change strategy.
Saving Maternal Lives in the Rural Highlands of Guatemala: A Mixed-Method Evaluation of Pregnancy Complications Managed by Casa Materna Rural Birth Centers
Jacqueline Williams, Curamericas Global
In Guatemala, indigenous women have a maternal mortality ratio nearly twice that of non-indigenous women, partly due to long-standing marginalization leading to barriers to care. To improve maternal outcomes in a population of 8,702 Mayan people living in Guatemala, Curamericas Global developed a comprehensive maternal-child health program that includes peer health education, culturally-acceptable clinical care, and community owned and operated birth centers, Casas Maternas Rurales (Casas). To better understand this success of Casas, we combined a retrospective review of Casa clinical records with a qualitative study. Between 2009 and 2016, 1,411 women presented to the Casas for pregnancy-related care. Of the 238 complications encountered, 45% were resolved at the Casas and 55% were referred to a higher-level facility. One referral resulted in maternal death, a complication survival rate of 99.6%. Staff attributed their success to frequent high-quality trainings, task-shifting, and a network of consultative support. We conclude that the Casas model offers a viable strategy for reducing maternal mortality in rural indigenous populations.