CORE Group Spring Meeting 2012

During CORE Group’s Spring Meeting pre-session day, Christopher Szecsey facilitated a participatory workshop to teach participants the fundamentals of AI for community health, as a conceptual framework and for application. The workshop emphasized cross-sharing, including case studies from different countries.

Introduction to Appreciative Inquiry- Christopher Szecesy
Essentials of Appreciative Inquiry: A Roadmap for Creating Positive Futures
AI Practioner: The Impact of Appreciative Inquiry on International Development

To learn more about AI, check out some of the resources below:

Appreciate Inquiry Commons
Appreciate Inquiry Practitioner
Center for Appreciative Inquiry

Finding the Sweet Spot: Suggestions for Strategic Engagement with your Agriculture Colleagues

Paul Sommers, Mercy Corps

Leveraging agricultural interventions for improved nutritional outcomes is viewed as fundamental to achieving genuine and sustained household level food security, especially for the most vulnerable. However, reality tells us nutrition and agriculture staff often talk past each other. Nutritionists feel agriculturalists can be insensitive to the nutritional needs of the vulnerable. Agriculturalists feel nutritionists don’t understand the complexities of what they do. So the end result is that both work in their silos and opportunities for joint programming is lost. In this session participants explored strategic openings for having meaningful conversations with agricultural staff.

Finding the Sweet Spot: A “How-To” Conversation Linking Nutritionists and Aggies

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Tuesday May 1, 2012

Welcome and Overview

Karen LeBan, Executive Director, CORE Group
Ann Hendrix-Jenkins, Director of Partnership Development, CORE Group
Rowena Luk, Dimagi
Demet Gural, Vice Chair, CORE Group Board of Directors (BOD), Pathfinder International

A welcoming activity opened the meeting with an introduction to the meeting’s theme on demystifying and using data usage for community health impact. Following, there was an update on CORE Group activities, including including membership trends,the Food Security& Nutrition (FSN) Network and collaboration with TOPS, the Polio Project, the partnership with MCHIP, and Working Group accomplishments over the past year. Afterwards, the mHealth grant winners were announced and congratulated and the CORE Group BOD presented CORE Group’s key directions and 2012 goals, followed by presentation of the 2012 BOD’s slate of candidates.

State of CORE Group- LeBan

KEYNOTE SPEAKER:

David Pelletier, Associate Professor of Nutrition Policy, Cornell University

Implementation science seeks to improve the effectiveness of large-scale programs by strengthening the frameworks, tools and evidence base for identifying and minimizing implementation bottlenecks. Implementers can make major contributions to this field because of their extensive knowledge, experience and influence in the implementation process. This session provided an overview of this emerging field and introduced one of the many conceptual frameworks in the literature for guiding the assessment and improvement of the implementation process.

Using Data for Impact: A Critical Examination Through the Lens of Implementation Science- Pelletier

Concurrent Sessions

Many Actors, One Goal: Tackling Anemia in Mothers and Children – A Mali Case Study

Kathleen Hill, Senior Technical Advisor, USAID Health Care Improvement Project and  USAID Translating Research into Action (TRAction) Project, URC/CHS
Evelyn Kamgang, Project Coordinator for MNCH/FP, USAID Health Care Improvement Project, URC/CHS\

The World Health Organization ranks anemia as one of the top 10 global burden of disease risk factors. Many countries have failed to reduce anemia rates for mothers and children in recent years despite known effective interventions targeting main causes of anemia that can be delivered as part of routine community and facility antenatal, birth, post-partum and early childhood services. In Mali, for example, a 2010 survey demonstrated that 85% of children 6-59 months and 76% of pregnant women suffer from anemia, and that the rate of 85% exceeds the last measured 2006 national childhood anemia rate of 81% (Demographic Health Survey). Using Mali as a country case-study, presenters reviewed the results of a baseline assessment of coverage and quality of anemia control interventions carried out in two Mali districts in early 2012 followed by interactive discussions and group work around specific challenges and opportunities for improving delivery of multi-sector anemia control interventions, including uptake of household anemia-prevention practices.

Many Actors, One Goal: Tackling Anemia in Mothers and Children – A Mali Case Study- Hill & Kamgang

Inspiration Today Leads to an Inspirational Future: The Success of SHOUHARDO

Faheem Khan, Chief of Party, SHOUHARDO II Program, CARE Bangladesh
Bethann Witcher-Cottrell, Director of Child Health and Nutrition, CARE USA (Moderator)

The SHOUHARDO Program of CARE Bangladesh operated from October 2004 to May 2010. Funded by USAID and the Government of Bangladesh, this $126 million program reached over 2 million of the poorest people in some of the harshest and hardest-to-reach areas of Bangladesh. The final evaluation of the program testified this to be a remarkably successful initiative where the prevalence of stunting was reduced by 4.3 percentage points per annum, compared to a global average of 2.4 percentage points per annum. This session focused on how SHOUHARDO was able to achieve such results, showing that multiple “coordinated” interventions are critical in bringing about such impact.

The SHOUHARDO Program Impact (Transforming Lives) CARE Bangladesh- Khan

Moving from “Lack of Resources” to “Resourcefulness”: How to Improve Quality of Programs amidst Funding Constraints

Diana Chamrad, Senior QI Advisor for Orphans and Vulnerable Children, USAID Health Care Improvement Project, URC/CHS
Ram Shrestha, Senior Quality Improvement Advisor for Community Health and Nutrition, USAID Health Care Improvement Project, URC/CHS
Lani Marquez, Knowledge Management and Communication Director, USAID Health Care Improvement Project, URC/CHS

This mini-workshop provided a brief overview of state of the art quality improvement as applied to community health. It demystified some of the terminology associated with different QI methods/approaches and boil down the fundamental principles of any improvement effort using the “Model for Improvement”. Drawing upon a large body of improvement work in different sectors, presenters described a way of thinking about how to improve the way we work using “change concepts”.

Moving from “Lack of Resources” to “Resourcefulness”: How to Improve Quality of Programs amidst Funding Constraints- Chamrad, Shrestha, Marquez

Mhealth for Community Health: The Nuts and Bolts Behind Success

Susana Mendoza Birdsong, Program Officer, Institute for Reproductive Health, Georgetown University
Liz McLean, Senior Program Associate, Management Sciences for Health
Rowena Luk, Senior Engineer, Dimagi
Ann Hendrix-Jenkins, Director of Partnership Development, CORE Group

Mhealth is new territory for many for us. While the basic concepts are clear and the evidence of value is starting to mount, what’s not clear are the steps for conceptualizing, designing, budgeting, implementing and sustaining an mhealth activity.Participants learned about social networking analysis using the net-mapping tool; formative research and its application to proof of concept; and the five basic concepts every technology expert would like you to know.

The Value of Formative Research & Partnerships in mHealth- Birdsong
Reaching Beyond the Grid: K4Health Malawi Demonstration Project- McLean
mHealth: Nuts & Bolts- Luk
mHealth for Community Health- Hendrix-Jenkins

Lunchtime Roundtables

Food Security and Nutrition Network Web Portal

Joan Whelan, Knowledge Management Senior Specialist, Food Security and Nutrition Network/TOPS Program
Natalie Neumann, Communications Associate, CORE Group

The Food Security and Nutrition (FSN) Network launched its new interactive web portal (www.fsnnetwork.org). Participants learned about the site, and its features which include a 1) comprehensive implementation-focused resource library of food security and nutrition tools, guides and training manuals, 2) collaborative work and discussion spaces for FSN Network Task Forces and Interest Groups and 3) an online venue for community-wide facilitated discussions on topics of interest.

Newcomer Lunch

Shannon Downey, Community Health Program Manager, CORE Group

Shannon welcomed new members and associates and provided an overview of CORE Group activities and benefits.

CORE Group Overview- Downey

CORE Group Practitioner Academy for Community Health: Trip to Jamkhed

Ann Hendrix-Jenkins, Director of Partnership Development, CORE Group

Ann provided an overview of CORE Group’s first Practioner AcademyCommunity Health Learning trip. In January 2012, 14 public health practitioners traveled to visit to the Comprehensive Rural Health Project in Jamkhed, India. Described by some as the “gold standard” for community health projects, this 40 year-old effort is based on a system of community health volunteers, mobile health teams and a referral system for secondary care. The major project tenets link directly to current hot topics in global health, including payment (or not) of community health workers, gender and equity, integrated and multi-sectoral programming, bottom-up participatory approaches versus top-down medical models, and project sustainability.

Humanitarian Photography Group

Jim Stipe, Photo Editor, Catholic Relief Services

This roundtable discussion discussed how NGOs can get better photos while fostering a process to address ethical and practical issues.

Concurrent Sessions

Program Assessment Guide

David Pelletier, Associate Professor of Nutrition Policy, Cornell University

The PAG was developed in response to a request from national implementers for stronger guidance on how to identify and address bottlenecks in large-scale micronutrient programs. Since then it has been applied to large-scale micronutrient programs in Kyrgyzstan, Bolivia, Haiti, Nepal and Tanzania. Plans now are underway to modify it for application to more complex and multi-component programs in health, agriculture and food security and to identify field sites for such programs. This session provided an introduction to the PAG, shared some experiences from field applications to-date and obtained input on how to modify it for these more complex programs.

The Program Assessment Guide- Pelletier

One Size Doesn’t Fit All: Integrating Family Planning into Youth Programs

Victoria Graham, Senior Technical Advisor, Bureau of Global Health, USAID (Moderator)
Sadia Parveen, Reproductive Health Specialist, ChildFund
Angela Venza, Program Director, IYF
Beth Outterson, Advisor, Adolescent Health, Save the Children US

Over half the people on earth are under the age of 25. Helping young people make responsible decisions about family planning is a key component of comprehensive reproductive health programs for youth. This dynamic session featured a panel of youth experts who offered three different examples of approaches to FP programming. Panelists provided 1) Examples of FP programs for youth; 2) Entry points for FP services and information; 3) Successes and challenges of youth FP programs.

Planning for Life: Integrating Reproductive Health into Youth Development Programs- Venza
Integrating FP into Youth Programs: Zambia Family Planning Integration Project- Parveen
Integrating Family PLanning into Youth Programs- Outterson

New Frontiers in NCDs: Integration, Indicators and Evaluation

Gloria Sangiwa, Director of Technical Quality and Innovation, Management Sciences for Health
Rebecca Firestone, Researcher, Population Services International
Charlotte Block, Global Health Program Officer for NCDs/Nutrition, Project HOPE

Non-communicable diseases (NCDs) have recently come to the global health and development forefront. From the UN High Level Meeting on NCDs last September a political declaration was developed urging the need for NCD global targets and a monitoring framework to be finalized by the end of 2012. This panel looked at NCD targets and indicators, presented examples and lessons learned for NCD program integration and discussed about opportunities, challenges and ways forward to address the rising burden of NCDs.

The Decade of Chronic Communicable Diseases (C-NCDs)- Sangiwa
Integrating NCD Interventions: PSI’s experiences to date- Firestone
Measuring NCD Indictors- Block

ProPAN: Process for the Promotion of Child Feeding

Joy Del Rosso, Senior Nutrition Advisor, Save the Children (Moderator)
Chessa Lutter, Regional Advisor, PAHO, Senior Advisor for Food and Nutrition, WHO
Roger Mir, Computer Scientist, Epidemiology and Analysis Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, CDC

Panelists presented an overview of four ProPAN modules, provided an interactive demonstration of the ProPAN software, and described the experiences in different countries where ProPAN has been used.

ProPAN (Process for Promotion of Child Feeding- Lutter
Epi Info/ ProPAN- Mir

 Scale Experience from CSHGP’s Expanded Impact Category 2006-2011

Laban Tsuma, Senior PVO/NGO Advisor, MCHIP, ICFI (Moderator)
Jennifer Weiss, Health Advisor, Concern Worldwide US
Karen Waltensperger, Senior Advisor, Health – Africa Region, Save the Children
Ashley Latimer, Senior Program Coordinator, Population Services International

The Expanded Impact Category within the CSHGP was implemented between the years 2003 and 2011 and included a total of thirteen Grantee projects. The hallmark of this category was that the Grantee projects worked at appreciable scale in terms of geographical coverage and impact. Two of these projects were awarded under the “bundled” sub-category which involved multiple INGOs working together in a single project. The other eleven were implemented by single INGOs. This panel looks at what intervention(s) they took to scale, lessons learned in terms of modifying the intervention and leveraging partnerships for scale, and notable successes and challenges.

Scale Experience from CSHGP’s Expanded Impact Category 2006-2011
The Rwanda Expanded Impact Child Survival Program- Weiss
Malawi Newborn Health Program- Waltensperger
Integrated WASH in Malawi- Latimer

Targeting the Vulnerable, Marginalized, and Underserved? What Does Health Equity Mean and How Do We Know We Are Achieving It?

Todd Nitkin, Advisor in Monitoring and Evaluation and DC Representative, Medical Teams International
Jennifer Olson, Africa Program Director, HealthRight International
Debra Prosnitz, Program Associate, MCHIP
Jennifer Luna, Senior Monitoring and Evaluation Advisor, MCHIP

This session on health equity used mini-roundtable discussions to investigate the use of data to achieve and measure equity at each stage in programming, as outlined in the MCHIP Equity guidelines. Participants cycled through each table to contribute to the discussions and/or learn about current best practices that ensure equitable impact of health programs as well as the best means of measuring that impact.

Overlooked But Definitely Not To Be Forgotten: Promoting Evidence-Based Health Programs for Very Young Adolescents

Susan Igras, Director of Field Programs, Institute for Reproductive Health, Georgetown University
Beth Outterson, Advisor, Adolescent Health, Save the Children US

Very Young Adolescents (VYAs) get ‘lost’ between programs and services reaching children and older adolescents/adults. Yet because they are going through puberty, VYAs have a unique set of health needs and are assuming new social/ gender roles, both which lay foundations for later relationships and health attitudes and practices. This interactive session explored why HIV, child, and SRH programs need to invest in 10-14 year old girls and boys as a unique group. The state-of-the-art of health programs focusing on VYAs were shared, including challenges in VYA-serving programs and evaluation/measurement of these programs. Participants discussed barriers to integrating VYA-specific activities within HIV, child, and SRH services and programs, including reaching vulnerable sub-groups of VYAs such as HIV-positive and married VYAs.

Why Focus on Very Young Adolescent- Igras
Overlooked but Definitely Not to be Forgotten: Evidence-based Programs for Very Young Adolscents- Outterson

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Thursday May 3, 2012

Daily Facilitator: Bill Yaggy

Plenary

Using Ethnography to Generate Culturally-Based Interventions

Stephen Schensul, Professor of Community Medicine and Health Care and Director of the Center for International Community Health Studies, University of Connecticut

Steve Schensul, co-author of the “Ethnographer’s Toolkit”, a 7 book series, discussed the nuts and bolts of ethnographic research – definition, different methodologies, appropriate times for use in the project life cycle, how to deal with the amount of data collected, and ultimately how to use the data to transform interventions into culturally relevant interventions. Steve presented practical ethnographic methods he has used that contributed to the development of interventions that are salient to and sustainable by local communities.

Using ethnography to generate culturally-based interventions- Schensul

Concurrent Sessions

Purple Pinkies: Social Mobilization and LQAS for Hard-to-Reach Populations

Roma Solomon, Director, CORE Group Polio Project, India
Manojkumar Choudhary, Monitoring and Evaluation Officer, CORE Group Polio Project, India

This session explored the CGPP’s successful social mobilization process: NGOs form a consortium to support the national polio eradication program; community mobilizers make inroads into resistant communities to open doors for vaccinators; and sustained communication efforts lead to better vaccine coverage, both for polio as well as routine.The session also described the process and significance of incorporating Lot Quality Assurance Sampling (LQAS) technique in management framework of social mobilization interventions of CGPP India.

Purple Pinkies- Solomon
Application of LQAS for Improving Social Mobilization for Polio Eradication in India- Choudhary

Systems Analysis for Intervention Design

Stephen Schensul, Professor of Community Medicine and Health Care and Director of the Center for International Community Health Studies, University of Connecticut

Steve Schensul described an ethnographic approach to the development of innovative, multilevel intervention programs. The key to development of research and intervention projects is the generation of a set of “interrelated ideas, a “model” that hypothesizes “how things are currently working” to cause a particular problem, and how “things could work” with systematic modification of key elements of the model to reduce the occurrence of the problem. Participants worked in round tables to experiment with implementing the systems analysis and conceptualization methodology to develop research questions or interventions on a given issue area.

Using and Improving Indicators for Community Case Management of Sick Children

Tanya Guenther, Senior Specialist, Health, Monitoring and Evaluation, Save the Children
Justine Landegger, Health Technical Advisor, International Rescue Committee
Yves Cyaka, Technical Advisor Malaria & Child Survival Department, Population Services International

Integrated community case management programs have been implemented in various forms throughout many countries, ranging from disease-specific pilots to nationwide integrated treatment programs. Successful CCM programming depends on careful design and monitoring of CCM from a health systems perspective. In this session, participants learned more about the development and use of practical tools and guidance designed for improving quality, functionality, and sustainability across the life of programs.

Using Indicators for Quality Improvement: Overview of the IMCI Bulletin Tool- Landegger
Using and Improving Indictors for CCM of Sick Children- Cyaka

Developing and Localizing Materials to Empower Community Health Workers

Sarah Shannon, Executive Director, Hesperian Health Guides

During the last 30 years, Hesperian has developed a unique model for creating globally relevant health manuals that can be easily localized. Hesperian books, including Where There Is No Doctor, have been translated through an open copyright into more than 80 languages, and have been cut, pasted, and photocopied to create fliers, posters and more. Today, technology provides an opportunity to further facilitate the localization of these materials. In this session, participants learned about Hesperian’s library of images and a searchable, easily adaptable HealthWiki format for health materials, a mobile app on Safe Pregnancy and Birth, and a simple layout program, the Health Materials Workshop, that can be used on or offline.

Developing and localizing materials to empower Community Health Workers- Shannon

Lunch Roundtables

Cultivating Community Capacity to Implement Sustainability-Focused Approaches: An Example from HealthPartners in Uganda

Ilona Varallyay, Coordinator, CEDARS, ICFI (with support from Will Story, Consultant, who is unable to attend)

With the GHI’s increased focus on ‘sustainability,’ this has become a big buzz word in global health circles and you’ve probably heard about the importance of ‘building in” sustainability from the outset of a program. This session presented how HealthPartners Uganda has decided to do just that for their USAID-supported project, Health Collaborations, which focuses on helping local communities establish sustainable, community-owned health cooperatives to improve access to health care services. The session described the support ICF’s Center for Design and Research in Sustainability (CEDARS) provided HealthPartners to: 1) develop a tailored training of trainers (TOT) curriculum and conduct a TOT on sustainability planning for HealthPartners field team and 2) provide on-site technical assistance to the HealthPartners team in conducting a sustainability planning workshop with community stakeholders.

Global Realities Demand a New Emphasis: A Focus on Sustained Health at the Community Level as Part of Most Health and Development Programs

Paul Freeman, Consultant and Clinical Assistant Professor, Department of Global Health, University of Washington

We work in detail to develop good scientifically sound evidence-based interventions to improve community health but overall are our efforts sustainably addressing community health needs consistent with the real world? Through this session we will look at a synthesis of current real health needs at the community level, the evidence base of what works at this level and what we can realistically do to address these needs. Then this evidence will be brought together towards a renewed focus on helping communities sustainably address their own health needs as much as practical at the community level. What activities that we could do should be part of this focus?

Discussion: Development of a Guide for Social Mobilization of Hard-to-Reach Populations

Joan Haffey, Consultant

Joan led a discussion to help inform the creation of a new social mobilization guide since a high percentage of Community Health Network meeting participants know a lot about social mobilization and “reaching the hardly reached.” The CORE Group Polio Project has been especially innovative and effective in this arena for a decade; hence, CORE Group is capturing CGPP’s ideas, insights and experience, and building on that with input from a range of organizations. The outcome: A Guide of Social Mobilization for Hardly Reached Populations.This practical guide will help NGO and government staff think both practically and creatively about how to reach out to underserved groups with basic services like antenatal care, immunizations, and newborn visits.

Concurrent Sessions

Improving the Health of Mothers and Children: The Case for Integrating Nutrition and Family Planning

Holly Blanchard, Reproductive Health and Family Planning Senior Advisor, MCHIP, Jhpiego
Peggy Koniz-Booher, Senior Nutrition and SBCC Technical Advisor, SPRING Project, JSI Stephanie Martin, Program Officer, Maternal and Child Health and Nutrition, PATH
Leah Elliott, FP/RH Technical Advisor, ICFI
Elizabeth Tully, Toolkit Application Manager, Johns Hopkins Bloomberg School of Public Health Center for Communications Programs

Maternal, infant, and young child nutrition (MIYCN) and family planning (FP) programs and services are mutually beneficial for mothers and their children. For example, exclusive breastfeeding during the first six months has significant advantages for both mother and child, provides the best nutrition for infants AND provides an effective method of family planning. This session outlined the rationale for aligning MIYCN and FP interventions, summarized the evidence on the relationship between these two areas, and shared examples of integration from three country programs. In addition, participants had the opportunity to “walk through” the new K4Health Toolkit for MIYCN-FP that was  launched at this meeting.

Integrating Maternal, Infant, and Young Child Nutrition (MIYCN) and Family Planning Services in Kenya- Blanchard
Rwanda- The Integration Story: Multiple ‘Cs’- Koniz-Booher
Integrating Family Planning Messages into Maternal, Infant, and Young Child Nutrition Counseling Cards- Martin
K4Health Tookkits- Tully

Seven Steps to Use Routine Information to Improve HIV/AIDS Programs

Elizabeth Snyder, Data Demand and Use Specialist, MEASURE Evaluation

This session presented concrete steps and illustrative examples created to facilitate the use of information as a part of the decision-making processes guiding program design, management, and service provision in the health sector. Specifically, the seven steps to data demand and information were outlined in this session to help address barriers to using routinely-collected data by providing guidance in (1) linking programmatic questions of interest to existing data; (2) analyzing, graphing, and interpreting data; and (3) continuing to monitor key indicators to inform program improvements.

Seven Steps to Use Routine Information to Improve HIV/AIDS Programs- Snyder

Using Verbal Autopsies to Improve Child Survival Interventions

Henry Perry, Senior Associate, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Tom Davis, Senior Director of Program Quality Improvement, Food for the Hungry, Senior Specialist for Social & Behavioral Change, TOPS Project

How can we better tailor our child survival interventions to local realities? Mortality patterns vary in different areas of countries and there are often systemic reasons for why some types of child deaths persist. Patterns of delays in noticing symptoms, delays in seeking treatment, delays in receiving treatment, family resistance, health worker mistakes, and other problems may be occurring in your program areas without your staff being fully aware of them. Verbal Autopsies are a way to examine how and why children die in order to make changes in project processes that can prevent deaths in the future. This session focused on prevention of infant, child, and maternal deaths using VAs.

Verbal Autopsies: Data Analysis- Davis & Perry

Putting “Tigers” in CHWs’ Tanks: How Data, New Tools and Approaches Improve CHW Performance and Impact

Sarah Smith, Quality Improvement Advisor for Research and Evaluation, URC/CHS
Alison Wittcoff, Community Case Management Specialist, International Rescue Committee
Lt. Erin Nichols, Epidemiologist, CDC
Anne Liu, Health Systems Development Manager, Columbia University Earth Institute

This session covered four different topics: lessons learned from the field about the CHW AIM tool, assessing the quality of individual CHW performance through observation, the role of CHWs in improving civil registration and vital statistics, and lessons learned from the Earth Institute’s Millennium Villages Project (MVP) in trying to push data utilization, which includes quantitative information from the Millennium Villages’ mobile technology platform (ChildCount+) and experience in using the AIM tool in Kenya and Uganda as a qualitative program assessment component of a broader performance management strategy.

The CHW AIM: Lessons from the Field- Smith
What kind of care are your CHWs delivering?- Wittcoff
CHWs and their Role in Civil Registration and VItal Statistics- Nichols
The Millennium Villages Project: Use of data to improve decision-making- Liu

Working Group Sessions

Community Child Health

Alfonso Rosales, Child Fund
Megan Christensen and Adele Fox, Concern Worldwide

Comparative cost analysis findings looking at the community–based services and the formal health system at various distribution points, specifically for health services related to normal delivery, diarrhea and ARI for children under-5 years old. Results reveals that cost implementation for the integrated community based health model decreases out pocket expenses by 400%-2300% compared to cost of delivery of services in the formal health system. It concludes that the integrated community health model could complement the formal health system to protect the poor from becoming poorer due to health associated expenses.

The Integrated Care Group Model was designed by Concern Worldwide Burundi under the auspices of the Child Survival Health Grant Program- 2008 Innovations award to reduce the dependence of Care Group implementation on full-time, paid NGO staff, while increasing integration with the local Ministry of Health (MOH) structure. This is accomplished through task shifting of Care Group facilitation and supervision duties from full-time, paid NGO staff to appropriate MOH staff and Community Health Workers (CHWs), while still satisfying the established Care Group Criteria. This Integrate model is being compared to a traditional Care Group Model, in which Care Group Volunteers are trained and supervised by Health Promoters (full-time, paid NGO staff), who are supervised and supported by Supervisors (full-time, paid NGO staff). Each Health Promoter is usually in charge of training and supporting approximately nine Care Groups. Generally, CHWs are included in the Care Groups along with the other Care Group Volunteers, but they are not formally given the responsibility or training to facilitate the Care Groups themselves.

UCOS Costing Study, Honduras- Rosales
Mabayi Child Survival Project Cibitoke Province, Burundi- Christensen and Fox

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