Conference Overview
The 2019 REGIONAL Global Health Practitioner Conference on October 14-16 in Nairobi, Kenya welcomed 253 implementers, academics, donors, private sector, and other community health advocates from over 21 countries representing over 108 organizations. GHPC Kenya was CORE Group’s first regional conference convening stakeholders under the following objectives:
- Leverage community voices and experiences of frontline health workers, community health workers, community nurses, and other service delivery providers to help identify the kinds and levels of services needed;
- Link individuals, organizations, governments, United Nations, donors, private sector, and many other key players both inside and outside the community towards addressing social determinants of health and ensuring everyone works together for improved health outcomes and breaking down silos; and
- Learn about best practices and innovative approaches in community health within national and local health systems, as well as consortium building and technical capacity building with strategic focus for improved community health.
The multi-day conference focused on enabling stakeholders to share progress and identify solutions to persistent community health challenges; strengthening the role of community health workers in line with the Sustainable Development goals and Universal Health Coverage; and informing global, national and local policies and plans through evidence, success, and adaptive learning.
Session Presentations: Monday | Tuesday | Wednesday
Program Booklet | Conference Report (upcoming!)
Poster Sessions
Tuesday, October 15, 2019 | 6:00PM-7:30PM | Jambo Hall Foyer
Unheard Voices: Gaps and Challenges of Lady Health Worker Program in Rural Sindh
Farina Abrejo, The Aga Khan University
The purpose of Lady Health Workers (LHWs) program in Pakistan is to bring positive change in the society for the provision of preventive and curative health services. However, LHWs serving in far remote areas in Sindh, health indicators are not satisfactory enough to reflect the hard work of this cadre including Thatta district, Sindh. A survey carried out to understand demographic characteristics of LHWs, facilitating and hindering factors, and to identify the workload of LHWs in Thatta district. Though gaps were identified in different domains of the LHW program, the findings were similar to the evaluation of LHWs program held a decade ago. Therefore, the study can easily be generalized for Sindh Province. This survey highlighted that LHWs are overburden. As they fulfill responsibilities other than their core tasks, there is a weak referral system at the public facility which affects the work of LHWs and there is a lack of motivation and acknowledgment from the government.
The Impact of Service Delivery Environment on Community Health: The Case of Family Planning Use: Multilevel Analysis
Bekele Tefera, Pathfinder International
Transform: Primary Health Care is a five-year project funded by USAID to contribute towards the successful achievement of the national goal of preventing maternal and child deaths. The project collects data through annual random follow up visits. This study aims to fill the gap in the literature and knowledge base through examining the association between the service delivery environment and current use of modern methods of contraception. The findings indicate that service delivery environment is a significant predictor of modern contraceptive use. It’s added to the growing body of evidence illustrating the importance of FP method choice availability in the facility and its relationship with the use of modern contraception. However, further interventions on service delivery environment are needed such as improved contraceptive method choices in facilities who offered fewer contraceptive methods.
Malnutrition in Children <5 Years with Orofacial Clefts in Low- and Middle-income Countries: An Audit of Smile
Train Global Database
Barbara Delage, Smile Train and London School of Hygiene and Tropical Medicine
In resource-poor settings, with reduced access to timely specialist services, orofacial clefts are associated with a variety of health challenges. Specifically, a cleft of the palate prevents normal feeding and thus requires immediate care. Widespread malnutrition, high disease burden, and unmet medical/surgical needs in low- and middle-income countries (LMICs) further raise the risks of malnutrition, poor growth, and death for these children. We estimated the prevalence of underweight using anonymised records from 638,988 children who presented for cleft surgery between 2008 and 2018 in Smile Train-sponsored local hospitals across LMICs. The overall prevalence of underweight at the time of primary cleft surgery was 28.6% – a figure well above the global underweight prevalence in non-cleft under-5 children estimated at about 13.5%. Our findings support the need for advancing universal health coverage with special pro-poor efforts to increase timely nutrition care and access to surgery for the most disadvantaged children. The data is informing Smile Train’s ongoing efforts to scale cleft nutrition programs and design interventions to alleviate this burden.
The Need to Reprioritize Older Populations in HTS Programs: Data from Nairobi, Kenya
Caren Oburu, IMA World Health
In Kenya, national programming to achieve the 95-95-95 targets for 2030 has traditionally focused heavily on individuals in the 15-49 age category. However, the 50+ population demonstrates the highest levels of non-conformity to testing over time. Driven by fears of stigma associated with HIV, older populations delay seeking HIV testing and treatment services. However, the USAID/Kenya and East Africa Afya Jijini Program data indicates higher testing yields among the 50+ population than those in the 15-49 age category with testing yields double those of the overall project yield, making a compelling case for greater targeted programming for 50+ people.
Using Human Centered Design to Create Demand and Increase Utilization of SRH Services Among Young People in
Uganda. A Case Study of Hoima and Masindi District.
Patrick Segawa, Public Health Ambassadors Uganda
Statistics show evidence of inadequate or lack of accurate SRHR information and services among young people in Uganda. For instance, teenage pregnancy is higher among uneducated girls: 45% of girls without education have already had a baby, compared to 16% of girls with secondary education. (UBOS and Macro International Inc 2011). Young people are poorly informed about issues of HIV, STI and family planning hence making them more vulnerable to engage in risky sexual behaviors. Several myths and misconceptions exist among teenagers: 54% of young people think a girl cannot get pregnant the first time she has sex. (Straight Talk Foundation 2013). In line with above, only 5% of public health facilities in Uganda provide Youth Friendly Sexual and Reproductive Health services. (Ministry of Health, 2011).
Broad Communication Messages Support in Adopting Positive Behaviour for Polio Eradication in Uttar Pradesh,
India
Rina Dey, CORE Group Polio Project
During the polio campaign, the reliance on traditional mass media along with polio drives did not offer much success. After door to door campaigning was introduced in 1999, huge resistance encountered in selected parts of India against polio dropped. CORE deployed volunteers from the same community. For long periods the mobilizers were reaching families/communities with one message and had limited effect on their behavior towards polio vaccination. In order to effectively communicate the need, we had to add new messages that were not only pertinent to the target audience but also had connection with polio eradication. Prior to every polio campaign the community mobilizers would reach each house and inform, educate, and mobilize families to come for polio vaccination at the immunization site or get your child immunized during house to house vaccination. Since 1999 CORE Group Polio Project has worked in 12 districts of Uttar Pradesh through a three-tier network of mobilizers that conducts social mobilization activities for polio eradication and routine immunization.
Kangaroo Mother Care (KMC) for Newborns Following Discharge From the KMC Unit: Mothers’ Experience of Support
at Home and with Follow-up Care
Pauline Njoroge, Save the Children
Kangaroo Mother Care (KMC) promotes early discharge from care. However, 25% of babies discharged from KMC units, to continue with KMC at home, die within two months without proper post-discharge care. A study was undertaken to examine KMC practice at home and through follow-up care. Interviews were conducted with a sample of 152 mother-baby dyads recently discharged from KMC at either Kenyattaor Pumwani Hospitals in Nairobi, Kenya. 97% practiced KMC at home for at least one month, for an average of 6.6 hours/day. 59% faced difficulties while practicing KMC at home with the main challenges being household chores (50%) and health issues for mother or baby (27%). 48% of the interviewed cohort returned to the health facility for follow up within 7 days of discharge and 78% had returned within 2 weeks of discharge. Women returned for various reasons (weight checks, immunizations, feeding issues), but relatively few stated that they returned for KMC visits. There is a need to strengthen the post-discharge components of KMC to support optimal care and practice of KMC at home.
The Impact of Gender Mainstreaming and Integration on Norms and Social and Behavior Change Approaches: A Scoping Report
James Matheka, Population Council
Gender mainstreaming and integration are used to address gender norms, equity and equality, and empowerment as part of social and behavior change (SBC) approaches and interventions. These strategies ensure integration of gender perspectives into organizational activities, such as research, advocacy, and resource allocation; and planning, implementing, monitoring, and evaluating SBC programs to affect social and cultural norms. A preliminary scoping report gathered evidence from peer reviewed and grey literature from 2005-2015 on approaches employed by several actors seeking to incorporate gender mainstreaming and integration into programming. It informs a set of lessons learned and promising practices on incorporation of identified elements into programming. It also presents emerging themes and key focal areas, encompassing more than SBC with implications on social and cultural norms, to address among program staff, at organizational/institutional-level, or during program design and implementation. An expanded scoping report considers literature from 2016- 2019 to inform up-to-date lessons learned and best practices. As the report is updated to include new literature, pragmatic products will be developed for practitioners to use to achieve these objectives.
Association of Health Facility-based Counselling and Community Outreach with Maternal Diet in Tanzania
Benesta Masau, IMA WorldHealth
Maternal diets are critical to the well-being of mothers and children; however, in many less-industrialized countries, practices related to maternal diet are sub-optimal. Government outreach to improve women’s diets through health facilities and in communities is limited. Additionally, counselling on maternal diets is often neglected in favor of counselling for the child. The Methods examined baseline data from a large, integrated nutrition project (ASTUTE) that included 5,000 primary caregivers of children < 2 years of age in North-western Tanzania to better understand the role of counselling on women’s dietary practices. The results showed that mothers’ dietary practices were sub-optimal. Less than one in ten mothers (8.0%) ate more than usual during pregnancy. 23% of mothers had eaten two or fewer times in the previous 24 hours. Only a third of mothers (32.7%) received advice about maternal nutrition before and or during pregnancy. Only 5.9% had been counselled by a community health worker (CHW) regarding maternal nutrition. Facility-based counselling and community outreach are promising strategies to improve dietary practices in Tanzania.
Understanding Integration in Practice and Learning from Community Health Workers in Malawi
Chikosa Ngwira, London School of Hygiene & Tropical Medicine
Evidence partly attributes Malawi’s achievement of MDG 4 on reducing child mortality to expanded access to integrated maternal, newborn and child health (MNCH) and family planning (FP) services, through community health workers (CHWs) called Health Surveillance Assistants (HSAs). Despite HSAs’ importance, little was known about their integration in practice. This study explored community-level delivery of the three packages of MNCH and FP and identified how these interventions were being integrated in practice. Data was collected in four months using observations, focus group discussions and in-depth interviews. HSAs used three integration models (single interaction, multiple visits and referrals). HSAs experienced shortages of resources (staff, infrastructure, drugs and supplies), inadequate supportive supervision and gendered power relations at household and community levels. However, flexibility was a key distinctive feature in HSAs’ work, and community health volunteers played a critical supportive role. Supporting the integration of health services at the community level is critical in contributing to the achievement of universal health coverage.
Screening Practices and Decision-Making of Mothers Trained on MUAC Measurements in Marsabit, Kenya
Nancy Mbae, Concern Worldwide
This is a mixed-methods study to determine whether mothers’ use of MUAC screening can improve early detection, referral and prevention of malnutrition among children under five years. Quasi-experimental design matched 20 sites into 10 pairs. Random selection of 449 mothers in the intervention arm were trained to conduct MUAC screenings on their children while in the comparison group, refresher training occurred for 60 community health volunteers (representing 452 children). Data is being collected at baseline, time 1, 6 and 12 months post training and end line on: Screening practices, associated decisions with MUAC reading, reliability of mother’s screening, child feeding practices, mother’s knowledge attitude and practice towards child nutrition.
Baseline and time one data have been collected to-date. Findings show increases in mother knowledge, attitude and practice of child nutrition after training. This mixed-methods study based on community practice, has the potential to ensure all children under-5 can be screened and monitored for undernutrition.
ICT4D to Reduce Drug Stock Outs among Community Health Volunteers
Everlyn Matiri, Catholic Relief Services
One challenge is poor Health Management Information System leading to malaria medication stock outs. Health center data is often submitted late, and quality of reports and data are incomplete, inaccurate and/or unreliable. In 2017, Catholic Relief Services (CRS) partnered with the Ministry of Health (MOH) to provide support to health centers in 46 villages within 7 communes in southeastern Madagascar. CRS trained 115 community health volunteers and 51 health center staff in Community-Based Integrated Management of Childhood Illnesses (c-IMCI) as well as using monitoring and reporting tools and provided the health staff on smart phones and training in using smart phones for data collection, monitoring and reporting. Using an open source data collection software called Kobo Collect, health staff sent data to district staff in almost real time and the quality of reports improved significantly. The improved system allowed district staff to quickly analyze data and maintain accurate stocks of malaria medication in health centers. Stock outs of malaria medication at health centers reduced from 14 to 9 days.
Strengthening Community Health Systems and Cross-Sectoral Partnerships to Increase Access to Fistula Care: Evaluating the Implementation of a Complex Intervention
Charity Ndwiga, Population Council
This poster presents changes observed from a research-to-action collaboration to leverage existing and create novel referral mechanisms, linking community health volunteers or agents, primary health care (PHC) providers, private local transport actors to mitigate awareness, transportation and financial barriers to fistula care in Nigeria and Uganda. A mobile hotline and transportation vouchers were used to facilitate case identification and referral through community agents. Mixed methods data from multiple perspectives show increased referrals and use of fistula repair services, varied increases in PHC provider ability to recognize fistula and referral; increased community awareness on fistula and care options. Qualitative findings indicate reductions in psychological, transportation, and financial barriers, and inaccurate beliefs about fistula causes. Radio, hotline and community volunteer-driven strategies across study sites were preferred sources of information on prevention and treatment. But barriers to care including government and other health system factors persist. Learnings suggest expanding mobile hotline-based health messaging, screening, and referral in low-resource settings, exploring opportunities to integrate fistula – and other stigmatizing conditions – into existing community health platforms is required.
Prevalence and Correlates of Mental Health Status Among Pregnant Women Enrolled in an Early Childhood Development Program in Rural Northern Ghana
Raymond Owusu, Catholic Relief Services
Poor maternal mental health is a risk factor for poor child development outcomes in low-resource settings. Caregiver mental health is a critical factor for early childhood development, yet women lead complex lives that must take into account contributing factors for poor mental health. This study estimates prevalence of mental distress among a sample of pregnant women in Ghana and associated risk factors for poor maternal mental health. Bivariate analyses revealed lower hopefulness, moderate to severe hunger, intimate partner violence (IPV) in the past year, and insufficient support from female relatives were associated with depression. Low hopefulness and moderate to severe hunger remained significantly associated with depression in the multivariate analyses, with a higher hopefulness score associated with a lower risk of depression, and severe hunger associated with a tripling of the risk of depression (Risk ratio = 2.9; 95% CI 1.23, 6.89) vs. little to no hunger. Integrated ECD/maternal mental health programming should be cognizant of how to address familial and community level factors such as hunger, interpersonal violence, and social support.
“For Youth by Youth” an Effective Approach to Increase Youth Knowledge on Family Planning (FP) in Rwanda: the Case of Rural GISAGARA District”
Victor Pacifique Rwandarwacu, International Youth Alliance for Family Planning(IYAFP)
We selected 20 IYAFP volunteers aged 14-25, trained them about youth rights on SRH/FP
referring to the International Technical Guidance on Sexuality Education (UNESCO). Afterward, each volunteer conducted 5 teaching sessions made of 40-60 members of similar age range as volunteers. To assess knowledge of participants before the intervention quantitative data was collected using structured questionnaires as a baseline, and at the end of intervention same questions were asked to the same group. The program involved over 1,000 youth, which is far more than the intended goal. 2 in 3 youth reported that their main source of SRHR/FP information was from peers, At pre-survey level, only 59 respondents (31.0%) knew how to accurately count the menstrual cycle (MC), whilst the remaining 131 respondents (68.9%) did not. On post project survey, the number of respondents who knew how to count MC accurately had increased to 132 respondents (69.47%): an increase of nearly 40%. Hence, SRH/FP should be put in youth perspective because youth feel more comfortable with their peers.
Strengthening Community Health Supply Chains Using IMPACT Team Approach
Gertrude Muchibi, inSupply Health, Ltd.
In Siaya County Kenya, inSupply Health has implemented IMPACT teams – a people-centred, data-driven approach to improve supply chain performance – at the community level. The IMPACT team is composed of the community unit: community health volunteers, their supervisor and the health facility in charge of the link facility that is responsible for resupplying the CHVs. The IMPACT team has been implemented to complement cStock: a CHV mobile based reporting and resupply system.
Development of a Culturally Appropriate Birthing Space at Matongo Health Center in Kisii County, Kenya
Dana Corbett, Cureamericas Global
This poster described a qualitative research study aimed at describing the components of a culturally appropriate birthing space and respectful care in Kisii, Kenya.
Building and Adolescent Health Program Using Human Centered Design
Shweta Verma, Children International
Children International in partnership with the Institute for Reproductive Health, Georgetown University led the program design of Adolescent Reproductive Sexual Health Program by incorporating human-centered design elements through participatory formative assessments, co-creation of the curriculum, intensive review of global best practices by reviewing 20+curriculums, and co creating the Monitoring, Learning and Evaluation process and tools with Youth, Parents and health staff across three countries in Asia, Africa and Latin America regions. The process followed: Formative Assessment with Human Centered Element: Primary research with VYA’s, OA’s and Parents in 3 countries using highly participatory tools; Incorporating global best practices with extensive review of 20+ curriculums; Co-creation curriculum design workshops; Involvement of youth, parents and staff from three countries in the curriculum design process through brainstorming and content creation; Co-creation of monitoring, evaluation and learning process; Test and learn in 10 countries and contextualize the program. The back bone of the design process was intensive involvement of youth, parents and country teams in each stage of the program development process.
Using Interactive Board Games to Reach Commercial Motorcycle (Bodaboda) Riders in Uganda with HIV/AIDS Information: A Case Study of Wakiso District
John Musinguzi, Public Health Ambassadors Uganda – PHAU
Boda Beeramu is a unique innovative project that was designed by Public Health Ambassadors Uganda-PHAU as a way of reaching Bodaboda riders in Wakiso district in Central Uganda with accurate information on HIV/AIDS prevention, treatment and care. We made consultations with several Bodaboda stages and found several of them enjoy playing Ludo, a popular board game among young men in Uganda usually played in street corners during their free time. With support from MTV Staying Alive Foundation PHAU has been able to roll out this project among Bodaboda riders using custom-designed Ludo boards to increase knowledge on HIV/AIDS treatment, prevention and care among the riders on select stages we work with.
The board game is designed with HIV messages on condom use, advocacy, sexual network, counselling and testing and complimented with question cards designed to assess riders’ knowledge about the above aspects. Each bodaboda stage has an HIV Awareness Champion, well-trained with basic knowledge on HIV prevention, treatment and care, who clarifies on contentious issues that emerge from his fellow bodaboda riders.
Scale up of Isoniazid Preventive Therapy: A Quality Management Approach in Nairobi County, Kenya
Eunice Omanya, IMA World Health
Kenya, a country with a high tuberculosis (TB) burden and a TB/HIV coinfection burden of 17%, has recently recommended IPT for six months to treat latent TB, but is experiencing low uptake of this recommended intervention. Through the introduction of Quality Improvement (QI) teams and use of root cause analysis at 42 health facilities in Nairobi City County, the USAID/Kenya and East Africa Afya Jijini program has improved uptake of IPT for latent TB cases from 31.8% to 80.1% over two years.
Understanding the Causes of Under-five Mortality in a Humanitarian Emergency Using Verbal Autopsy: Evidence
from Internally Displaced Persons (IDP) Camps in Somalia
Hani Mohammed, Concern Worldwide
People in humanitarian emergencies often experience adverse health outcomes and excess mortality. However, in these settings information on the causes of death is sparse due to a lack of vital registration systems. Verbal autopsy (VA) is the process of interviewing close caregivers of the deceased to gather data on the symptoms, signs and circumstances preceding death to determine its likely cause. It remains the best available option for assessing causes of death in such settings. In 2016/2017 Somalia experienced a severe drought that brought the number of people in need of humanitarian assistance to an estimated 6.2 million people and an estimated 1.2m displaced. This study was conducted to provide reliable and timely evidence on the causes of under-five mortality in Internally Displaced Persons (IDP) camps in Mogadishu, to inform humanitarian response planning and implementation, and to explore the suitability of VA for identifying causes of child death during humanitarian crises. This poster helped humanitarian actors learn that real time mortality surveillance using VA is feasible within the protracted humanitarian context of Mogadishu.