The 2019 Global Health Practitioner Conference on May 6-9 in Bethesda, Maryland, USA welcomes implementers, academics, donors, private sector, and other community health advocates 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 will also highlight different innovations for community health work, from technology to methodologies and processes. The objectives are:
- 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
Session presentations will be made available after the conference.
Program Booklet (upcoming!)
Conference Report (upcoming!)
New Information Circuits
Tuesday, May 7, 2019 | 2:00PM-3:00PM EST | Ballroom | Part 1
TABLE 1: Tools for Easing the Workload of Community Health Volunteers in Case Management
Katrina Mitchell, Picture Impact
Capacity building of community health volunteers, particularly those involved in case management approaches: Delivering program content to households in a customized manner requires skill, it is especially difficult if you have lower literacy and cannot rely upon complicated assessments and required forms in the way a trained social worker can. Picture Impact has created several tools for use by a community health volunteer to simplify and streamline the work of case management while increasing engagement with the household and the quality of the intervention. Community health volunteers are thrilled to have something which helps them spend their time together with families truly assessing and planning for the future, rather than distracted by a seemingly academic set of items they must complete. The resulting family case plans are much more customized, and households are excited to be a part of the program—they can see how the program helps their family.
TABLE 2: Capacity Development for Lasting Partnerships – How Can Implementing Partners More Sustainably Meet Country’s Needs?
Lyubov Teplitskaya, Health Policy Plus Project (HP+), Palladium
Implementing partners work closely with country governments to generate critical data and evidence to improve the development, implementation, and monitoring of key priority policies. However, sufficient capacity development is often overlooked, and often not driven by country context nor responsive towards existing levels of capacity across key institutions. How can we ensure that the tools, approaches, and methodologies developed through these partnerships are embedded within the government institution for sustained use in the future? This new information circuit will examine an innovative partnership between the Health Policy Plus (HP+) Project and Government of Indonesia National Institute of Health Research and Development (NIHRD). The purpose of this partnership is to develop NIHRD capacity to conduct quantitative analysis to inform evidence-based maternal and newborn health policy-making in Indonesia. HP+ will highlight the multidimensional capacity development approaches used in this partnership, including day-to-day mentoring through embedded staff at NIHRD, skills and tools transfer, and structured training workshops.
TABLE 3: Optimization of Care and Resources Through Technology: A Partnership-Based Lifecycle Approach
Arti Varanasi, Advancing Synergy
The use of appropriate technology to leverage limited resources in community health settings within a partnership-based lifecycle framework: Discussion will raise awareness about priority global health targets as part of a health system that can be collectively supported and enhanced through technology. To address gaps in continuity of care among breast cancer patients, we will share a web-based knowledge and communication application, designed especially for low-income breast cancer patients and their care providers, in a randomized controlled trial. The technology was developed through an interactive process that began with patient and provider input and culminated in a user friendly, web-based application designed to support a virtual outreach program of clinical and social support to bridge the gap in breast cancer treatment and care for all individuals, especially racial and ethnic minorities, poor and underserved women. The application was well-received by patients in both the intervention (access to virtual outreach program) and control (access to information via publicly available websites) groups, and that adherence was improved among individuals in the intervention group.
TABLE 4: New Global Indicators to Monitor Family Planning Task Sharing Programs
Tishina Okegbe, FHI 360
Family Planning Task Sharing Indicators list, developed by the Family Planning Task Sharing Technical Working Group: for use in routine monitoring and evaluation (M&E) for task sharing programs and research studies in family planning (FP). These indicators were drawn from several implementers with experience piloting task sharing programs and research. All partners conducting task sharing programs or research can use these quality, tested indicators to ensure that the most important information is collected to inform program implementation. By using these standardized indicators, program implementers and managers can ensure that measures have been independently validated, which makes cross-country comparisons possible.
TABLE 5: Measuring Outcomes Among Street Children, Children Working in Mines, and Children of Female Sex Workers – How Should Global OVC Programs Measure the Impact of Interventions on Wellbeing Outcomes Among Children Who Are the Hardest to Reach and the Most Vulnerable?
Jackie Hellen and Lisa Parker, Palladium
In 2013, MEASURE Evaluation released the Child, Caregiver and Household Well-being Survey Tools for Orphans and Vulnerable Children (OVC) Programs. The tools were developed to support OVC programs in collecting information on the children and caregivers within households they target to better understand and improve beneficiary outcomes. These tools are intended for use within family household units. There are numerous programs internationally that support children in adverse situations, such as children working in mines, children living on the street, and children of female sex workers (FSW). These programs require information on outcomes specific to child populations in extreme adversity to provide more specialized support. MEASURE Evaluation has developed a suite of survey tools and an implementation manual to guide programs supporting these highly vulnerable children to effectively measure the impact of their interventions on well-being outcomes. The tools and manual fill an important gap that will allow programs serving these children to better understand their target population and to evaluate their programs effectively to inform evidence-based service delivery and ultimately ensure child well-being is improved.
TABLE 6: The Marginalized Community in the Driver’s Seat: A Mixed-Method Evaluation of Pregnancy Complications Managed at Casa Materna Rural Birth Centers
Elijah Olivas, The University of Iowa
In Guatemala, indigenous women have a maternal mortality ratio nearly twice that of non-indigenous women. Long-standing marginalization results in health services that are linguistically, economically, culturally, and physically inaccessible to rural, indigenous women. Curamericas Global developed a comprehensive maternal-child health program that includes peer health education and community owned and operated birth centers, Casas Maternas Rurales (Casas). Outcomes include improved maternal outcomes in a population of 8,702 Mayan people living in the western highlands of Guatemala, where trained nurses provide high-quality, culturally-acceptable clinical care. Curamericas Global reported an apparent elimination of maternal deaths in partner communities during the study period. To better understand this success, we combined a retrospective review of Casa clinical records of pregnancy complications with a qualitative study of contributing factors, utilizing focus group discussions, questionnaires, and key informant interviews. 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. Staff attribute their success to frequent high-quality trainings, task-shifting, and a network of consultative support.
TABLE 7: Prevention > Treatment: Very Young Adolescent Sexual and Reproductive Health and Gender Program Design Guide
Jennifer Gayles, Save the Children
Who feels more awkward talking about sex than tweens and teens? Probably no one! But who needs information on that topic more than this age group? Probably no one. Programs focused on sexual and reproductive health (SRH), gender and related social norms capitalize on the power of prevention and can multiply positive health effects as very young adolescents (VYA) ages 10-14 age. However, such programs must be age-appropriate, evidence-informed and participatory in order to achieve their intended goals. Save the Children’s VYA SRH and Gender Program Design Guide leads readers step by step through the building blocks of program development, implementation and monitoring adapted to VYA’s unique needs. We know that the most successful VYA programs recognize and engage with the interconnected web of other individuals and institutions that support these adolescents, so this Guide proposes programmers design interventions that touch all levels of the socio-ecological model, including family, community and government services. This session will provide a summary of the Guide’s key information before leading participants through a mock program design process.
TABLE 8: Family MUAC – Supporting Entire Communities to Screen for Acute Malnutrition
Sarah King, Action Against Hunger
The most practical and scalable means to detect acute malnutrition at community level is through the measurement and classification of mid-upper arm circumference (MUAC). Regular MUAC screening and case finding at community level has been the primary responsibility of community health workers (CHWs) or community volunteers (CHVs). However, there is mounting evidence to suggest families can carry out reliable MUAC screening in their own communities. Family MUAC (or Mother MUAC as it is sometimes called) is a community screening approach which empowers mothers, caregivers and other family members to screen their own children for acute malnutrition using color-coded MUAC tapes. Involving mothers and caregivers in MUAC screening enables them to develop a better understanding of the signs of malnutrition, be engaged in monitoring their children’s nutrition status and increases the frequency of child screening at community level. When combined with ICCM+, Family MUAC allows for the early identification and improved management of malnutrition, hence contributing significantly to the number of malnourished children being treated.
TABLE 9: Specialized Care in Humanitarian Health, Mental Health, Prosthetics and Physical Rehabilitation
Amy Kunert, Relief International
In Turkey, Relief International partners with local organizations to deliver specialized services for conflict affected Syrians. Each month, approximately 100 Syrians that have lost limbs due to the conflict are provided with state-of-the-art prosthesis and enrolled in physical rehabilitation. To address potential accompanying mental health complications, each client is assigned a case worker and enrolled in the mental health program.
TABLE 10: Health Kiosk at Faith Worship Centers: Innovation to Maximize Access to HIV Services at Faith Worship Centers in Zimbabwe
Gloria Ekpo, World Vision US
Faith-based organizations (FBOs) continue to play a critical role in achieving the UNAIDS Fast-Track Targets of ending the HIV epidemic by 2030. An estimated 84% of the world has a religious affiliation and leveraging a well-informed and mobilized faith community is essential to controlling the HIV epidemic. Faith-based platforms can be maximized to improve literacy around HIV prevention services; strengthen referrals to health services; and support adherence and retention in HIV care. This session is for people who are new to the field of HIV or have been involved in the HIV response for some time but seek to learn about an innovative intervention that can build interfaith bridges to improve HIV prevention, care, and treatment, use faith worship centers as entry point to scale up best practices in HIV prevention. The session shall be facilitated by experienced Public Health Practitioners through presentation on the Health Kiosk program, with its processes, progress, results and impact in improving access to information and HIV services within HIV prevention treatment cascade of reaching 95-95-95 UNAIDS Fast Track targets.
TABLE 11: Engaging New Allies in the Health Equity Movement: A Look at Promising Strategies and Future Directions
Renata Schiavo, Health Equity Initiative, Columbia University Mailman School of Public Health
Health Equity Initiative and its partners convened the second partnership summit in 2018 as part of its mission of building and sustaining a global community that engages across sectors and disciplines to advance health equity. The summit included several Innovation Think Tanks. Facilitated by experienced leaders in a variety of fields and disciplines that are key to the health equity movement, the Think Tanks relied on strategies for participatory planning and human-centered design to (a) elicit information exchange and consensus building among community leaders and professionals in attendance and (b) provide all participants with an opportunity to reflect on the Summit’s main topics, co-develop solutions to common challenges, and jump-start a process that would ideally help strengthen partnerships to advance health equity and community health outcomes. This presentation focuses on highlights and recommendations that emerged from the Innovation Think Tanks as well as action steps and promising strategies for multisectoral collaborations in support of health equity and/or interventions to overcome social discrimination and other barriers to health equity across issues of racism, poverty, and gender/LGBTQIA+ bias.
TABLE 12: Community-Led Total Nutrition: A Community-led Approach to Addressing Malnutrition
Vicky Veevers, Catholic Relief Services
An innovative community-based model to address very high (~47%) stunting rates among CU5: this model mobilizes all community members to recognize that specific forms of malnutrition exist and that they have the capacity to address it. Communities commit to using existing resources such as: increasing the number of homestead gardens with nutrient rich crops; advocating to government for increased boreholes; or fathers committing to take children to monthly GMP sessions. Two years programming in Madagascar are promising. Recognizing the additional nutrition needs of adolescent girls and their future potential as mothers CRS plans to more purposefully include them in future sessions by developing education sessions/materials, skits and promoting adolescent health as one of the key indicators to include on the community scoreboard. We will share various SBC strategies (puppet skits, district level televised videos, community level change agents) for raising awareness. Collaboration with various government ministries was key to moving toward policy adoption. The approach can be tailored to other countries as it currently being implemented in Niger and Tanzania. We will share current additional research to further refine the approach for use in other contexts.
TABLE 13: Delivering Acute Malnutrition Treatment through Low-literate iCCM Community Health Workers: Experiences and Lessons Learned from a User-centered Design Approach to Develop a Global, Simplified Toolkit
Bethany Marron, International Rescue Committee
Evidence showed that community health workers (CHWs) who have an uninterrupted supply of medicines can effectively treat most children with pneumonia, diarrhea, and malaria from their homes through the integrated community case management (iCCM) community health strategy. However, malnutrition treatment is not included in the iCCM package despite the fact that low-cost, proven treatment also exists. IRC will share experiences and lessons learned from the Simplified Tools Working group, a collaboration between IRC, Save the Children, Malaria Consortium, Concern Worldwide and Action Against Hunger to develop and test simplified tools and job aids which have enabled iCCM CHWs to provide malnutrition treatment in 4 countries. Participants will be introduced to the tangible tools and job aids as well as the user-centered design process used to develop them. Latest CHW performance results and treatment outcomes from 3 countries will be shared.
TABLE 14: Decreasing Child Stunting by Reducing Maternal Depression
Erin Pfeiffer, Food for the Hungry
Evidence is clear that improving household behaviors can reduce malnutrition and prevent up to 45% of child deaths and further gains can be made with improvements in quality healthcare at the facility and community level provided by equipped and accountable providers. Linear growth is a window into overall child wellbeing that reflects multiple dimensions of a health system. In addition to traditional nutrition-specific influencers of child growth, an increasing body of research suggests that maternal depression is a significant risk factor for poor physical growth and development in young children. Based on a growing body of evidence, we believe development of children is compromised if a mother is unresponsive to the infant’s cues and needs, and that treatment of maternal depression can improve nutrition behaviors and growth outcomes. This information circuit will explore an effective community-based method for decreasing depression: Interpersonal Psychotherapy for Groups (IPT-G)—a proven, low-cost, community-based approach for decreasing depression in low-resource settings.
TABLE 15: A First Time Parents Package: Integrating Postpartum Family Planning with Maternal and Child Health in West Africa
Akim Assani Osseni, Pathfinder International
The First Time Parents (FTP) program in Zinder, Niger established an innovative collaboration across maternal, newborn, family planning and adolescent health sectors to improve outcomes for young parents and their children. Zinder has some of the highest rates of early marriage, early childbearing, fertility and maternal mortality in Sub-Saharan Africa. Young women face pressure to bear children soon after marriage, and often have closely spaced pregnancies thereafter. Alongside improvements in youth-responsive clinical services, Pathfinder International’s recently concluded FTP program established a set of program activities to holistically address individual, family, social and community needs and norms. The package, currently in French, can be adapted for FTP in other settings. The effectiveness of this approach is evidenced by the increase in young women reporting having used a modern method of contraception, (3% at baseline to 97% at end line, two years later). Gender-equitable attitudes and behaviors among male partners also improved; more husbands had spoken to their wives about birth spacing (67% to 98%), and fewer husbands thought that women alone are responsible for domestic tasks (97% to 46%).
TABLE 16: The First 42 Days: A Mobile Health App for Creating Partnerships Between Facility and Community Health Providers to Improve Postnatal Care in Rural India
Ravinder Kaur, USAID’s flagship Maternal and Child Survival Program India
India has remarkable success in institutional delivery rates and has trained 8.2 million women as Accredited Social Health Activists (ASHAs), to improve home-based care of mothers and newborns, including postnatal care. Yet, from 2013-14 only 13% of home births and 46% of institutional births received PNC within 48 hours (3). To address this gap, USAID’s Maternal and Child Survival Program tested an innovative approach that builds on the concept of enhancing partnerships between facility providers and ASHAs to attain quality postnatal care. “First 42 Days,” a mobile health application, takes advantage of India’s digital know-how. Piloted in Nuapada, the app has recorded over 80% of the total institutional deliveries of three intervention blocks of the district and an estimated 40,000 SMSs have been sent to families and community health workers. The average number of postnatal home visits has increased from 4.8 days to 5.6 days. After receiving messages and automated calls, 47% of high-risk cases (mother/baby) were visited jointly by ASHAs and nurse-midwives. Additionally, 100% of the entered cases were linked to the nurse-midwife within their local Village Health and Nutrition Day for further routine maternal and child health care, immunizations and nutrition support.
TABLE 17: Supporting Smart Investments in Digital Health – Introducing the Digital Health Investment Review Tool
Lisa Kowalski, USAID’s flagship Maternal and Child Survival Program
A consortium of funders and implementers developed and launched the Digital Health Investment Review Tool (DHIRT) over an iterative 3+ year process. The aim: to translate the widely accepted Principles for Digital Development and Donor Alignment Principles in Digital Health into action and equip Ministries of Health, funders, and implementing partners with a tool to help them promote more effective digital health solutions and rational use of funding. This tool breaks down the Principles into a set of scoring criteria and resources that can assist stakeholders with little or no tech experience in making investment decisions for digital health activities. The Digital Health Investment Review Tool (DHIRT) will be presented and discussed through community-level case studies within small groups. Lessons learned from developing the tool among multiple stakeholders will be included throughout the session, as well as applications of the tool in community health project settings Participants will be introduced to the Principles and learn how they can be included in digital activities, using the DHIRT as a guideline.
TABLE 18: Digital Health and the Tools You May Not Be Using But Should!
Steve Ollis, John Snow Inc.
Digital health can play a powerful role to help achieve global health goals. The field has matured considerably with an increasing number of how-to guides, frameworks and reference materials available for all stages of health programs; however, many of these global resources are not utilized to their full extent. We will provide an overview of why digital health matters and how USAID works to support and invest in sustainable, scalable, interoperable, and standards-based digital health tools and technologies. We will: Convey the role that digital health plays to better deliver life-saving medicines where they’re most needed, support universal health coverage, enable patient information to follow them across the care continuum, and impact other areas that improve health outcomes at a community level. We will take a deep-dive into some of the digital health resources available today, e.g. the WHO Digital Health Atlas, the Principles for Digital Development website, and ORB. Outcome: a better understanding of how digital health can be integrated into their community-level activities as well as hands on experience working with several of the resources.
Thursday, May 9, 2019 | 9:30AM-11:00AM EST | Ballroom | Part 2
TABLE 1: Using Programmatic M&E Systems for Research
Margaret Lillie, Evidence Lab at the Duke Global Health Institute
Catholic Relief Services is collaborating with the Evidence Lab at the Duke Global Health Institute to conduct evaluations of early childhood development programs in Cameroon, Ghana, and Kenya. These programs already have robust M&E data platforms and protocols. We will highlight and discuss the opportunities and challenges of collecting data electronically that can serve both research and program deliverables. We will present a set of guidelines for similar partnerships in the future to use, based on our collaborative use of CommCare by Dimagi, to collect program and evaluation data in Siaya County, Kenya and in Northern Ghana.
TABLE 2: Partnerships Without Borders: An Innovative Model for Nomadic Healthcare
Nana Apenem Dagadu, Save the Children US
Sixty percent of the world’s estimated 50-100 million nomads and semi-nomads live in Africa. Various strategies (including One Health, mobile/outreach services, and community directed interventions) have been tried to improve access to health services for these populations. However, there remains a dearth of information on approaches to address underlying inequitable social and gender norms that compromise service uptake among these populations, build sustainable, responsive system strengthening mechanisms to support service delivery, and bolster community ownership and participation. In Kenya, a country aiming to increase its modern contraceptive prevalence rate (mCPR) to 56 percent by 2020, putting in place strategies to increase demand for and access to quality family planning (FP) services in the most marginalized communities will be essential in attaining FP2020 global partnership commitments. Visit this new information circuit to learn how the Contraception without Borders project in Kenya used health facility assessment and formative research data to adapt existing community health strategies to develop a promising model that addresses both supply- and demand-related barriers to access and use of quality FP services in nomadic and semi-nomadic communities living in six sub-counties in Wajir and Mandera. Through an engaging activity with stakeholder profiles, explore how we are harnessing innovation, leveraging resources, and developing and strengthening local and regional learning partnerships and fora to support the refinement, documentation, and potential adoption of this model beyond the Kenyan context.
TABLE 3: EGPAF’s Affiliation Model – Civil Society Capacity Building and Partnership
Leah Petit, EGPAF
In 2009, EGPAF developed the Affiliation Model to ensure countries have robust national civil society organizations, equipped with strong technical, programmatic and operational capacity to lead and advocate for HIV services in their countries. With support from CDC/PEPFAR, EGPAF established three independent, national organizations governed by autonomous boards and affiliated to EGPAF with shared missions, logos, and brands in Tanzania, Cote d’Ivoire, and Mozambique. Set-up of the local NGOs required EGPAF to recruit Board members and staff, legally register each affiliate and adapt EGPAF’s institutional systems, processes and policies to affiliates prior to transition, ensuring that the organizations were fully operational upon receiving US government funding. To support ongoing organizational excellence, affiliates agree to uphold eight core principles monitored by a data driven accreditation process. Affiliates are fully integrated into the EGPAF’s learning network and they participate in global and country specific trainings and workshops. Today, EGPAF affiliates are recognized as technical and programmatic leaders by their governments and international donors. Affiliates support approximately one quarter of all PEPFAR supported people on ART in their countries, their research has been published in global journals, and their expertise informs national and global guidelines. Their collective budgets increased from 11 million to 73.6 million USD and each organization has seen seamless transitions among executive leadership and/or board members. The success of the model was dependent on two important elements – strong business structure with dynamic learning. Both elements have contributed to a lasting partnership that has evolved overtime and led to improved HIV services for communities.
TABLE 4: Community Health Toolkit: Building Open-Source Technology Together
Alix Emden, Medic Mobile
A group of leading organizations serving the hardest-to-reach communities has come together to collaborate on the Community Health Toolkit (CHT). The CHT is a collection of open-source technologies and open access resources shared as a global public good to advance universal health coverage. High-impact community health programs increasingly require complex task management, decision support, and performance management capabilities from technology solutions. The CHT is designed for these capabilities and supports full-featured, scalable digital health apps that improve primary health care. App developers can develop five highly configurable areas of functionality: messaging, task and schedule management, decision support workflows, longitudinal person profiles, and analytics.
TABLE 5: Introducing Community Health Impact Coalition
Madeleine Ballard, Community Health Impact Coalition
Forty-five countries have committed to making community health workers (CHWs) the front line of their health systems. More than 90 randomized controlled trials later we know that community health workers can safely deliver health services as diverse as birth control injections to HIV care management and that they can ultimately reduce morbidity and mortality. Yet, outside of a research study context, poor system design and implementation mean CHWs are typically not given the support they need to perform. The three most recent studies on national CHW programs delivering care for childhood illness— in Burkina Faso, in Ethiopia, and in Malawi—documented zero mortality impact. To address the community health quality crisis, we must do things differently – not just with medical innovation, but with practitioner collaboration for better design. The Community Health Impact Coalition is a field catalyst to accelerate the adoption of high-impact community health systems design. Rather than going the typical technical assistance route of parachuting into new countries on a short-term mission, we work with those who are already accompanying ministries of health (e.g. norm-setting bodies, funding agencies, technical assistance bodies, INGOs). We aim to support each of these actors to get high-impact practices “baked in” to how they do business, and in so doing, improve national health systems across the world. Multiple CORE Group members have already come together via the Coalition to work on collaborative research projects or targeted advocacy. Join us to learn more about how your organization can get involved or how the Coalition can be a resource in your pursuit of high-quality community health delivery.
TABLE 6: Taking Charge: Scaling ‘Sex, Test and Treat’ in Cameroon
Ghislaine Fouda, CARE International Cameroon
The Sex, test and treat (STT) innovation is implemented by the Continuum of prevention, care and treatment of HIV/AIDS with Most-at risk Populations (CHAMP) program in Cameroon, led by CARE International. The intervention addresses barriers faced by clients of female sex workers (CFSW) to access HIV testing including: proximity of services; fear of getting tested; low risk perception; and avoidance of health facilities. Among men, CSFW have high acquisition risks for HIV in Cameroon. In a 2017 study of clients of FSW in Yaoundé, the majority of clients living with HIV were previously undiagnosed. In 2016 CHAMP piloted STT to provide immediate, non-stigmatizing access to HIV testing services for CFSW. The strategy provides small cash incentives (equivalent of USD $1) to FSW who successfully refer their clients for testing. FSW at high-volume ‘hotspots’ are given coupons with unique identifier codes and basic training to refer their clients to a counselor and laboratory technician located in a nearby room. HIV testing services can be provided to clients immediately, rather than relying on referrals and attendance at a drop-in center or health facility. The program operates during peak days and hours, specifically Thursday, Friday, and Saturday evenings (8 PM to 1 AM). During the pilot (10/16 to 9/17) the number of CFSW who tested increased from an average of 274 clients per quarter to an average of 1,000 clients per quarter. The table discussion will focus on sharing key elements of the innovation, challenges, and how the project is addressing challenges to improve case finding and bring the innovation to scale.
TABLE 7: The Model Household Approach: A Toolkit for Integrated Health Promotion
Camille Collins Lovell, Pathfinder International
A Model Household (MHH) approach has been used in fishing communities in the Lake Victoria Basin (Uganda and Kenya) by Pathfinder International in its Population Health and Environment (PHE) work. Households that meet set criteria —including the use of a sanitary latrine, compost pit, energy-saving stove, hand washing, family planning, and other key health behaviors – are open to the community as learning sites for integrated health and environmental practices. At any time, neighbors can visit a model household for demonstrations on and knowledge about healthy sustainable practices. Uganda’s new national Community Health Extension Program will scale-up MMH to cultivate increased local ownership and responsibility for health. The USAID-funded project, Integrated Systems Strengthening for CHW Programming, supported MOH learning visits, adaptation, and integration of MMH into the CHEW strategy. The existing cadre of community health volunteers (VHT) will be the first to be trained as model households, while the new community health extension worker cadre (CHEW) will be trained to support the approach and expand the number of MHH in a community. Learn more about MMH and the recently developed standard MHH toolkit which includes seven steps towards establishing model households.
TABLE 8: Focus on Couples
Janine Schooley, Project Concern International
This catalytic session will provoke thinking and discussion about innovative, out of the box ways that we can address the needs of couples, reach out to couples and engage couples as true partners in improving the health and well being of their families, households, and communities. Why is so much of our work aimed at men and women separately? When we know that so much of the world’s ills are related to power inequities such as gender inequality, why don’t we do more to work effectively and creatively with couples together? Why don’t we do more to help couples make joint decisions and manage household resources as a couple? What can we do to help people in the communities where we work see the value of functioning as a couple, as a partnership? How can we start with children, youth towards this end? What are the particular needs and opportunities provided by couples who must be apart due to migration, pastoralism? What are the issues facing polygamous families that should be taken into account? How can we get nutrition and health services, agriculture extension services, etc. to be more couple-oriented, vs. focusing separately on the men or the women and then wondering why there are barriers to attitude and behavior change?
TABLE 9: Reducing Enteropathy, Diarrhea, Undernutrition and Contamination in the Environment in the DRC (REDUCE Trial)
Nicole Coglianese, Food for the Hungry
Food for the Hungry (FH) supports research initiatives that generate scientific evidence to guide sound public health and nutrition practices. One such initiative is being carried out through the USAID Office of Food for Peace-funded Development Food Security Activity (DFSA) in the Democratic Republic of Congo (DRC). The Baby WASH study entitled, the Reducing Enteropathy, Diarrhea, Undernutrition and Contamination in the Environment (REDUCE) study is conducted in partnership with Johns Hopkins University Bloomberg School of Public Health. The objective of the trial is to identify the exposure pathways to fecal pathogens that are significant contributors to morbidity for children 6-23 months and to develop and evaluate scalable interventions reducing fecal contamination from these pathways. To achieve this objective, the REDUCE study conducted formative research and a cohort study to identify the household, environmental, and behavioral risk factors for enteric infections, environmental enteropathy, and impaired growth among children under-two in South Kivu, DRC. The findings from this research were used to develop Baby water, sanitation, and hygiene (WASH) interventions, which are being refined through a pilot study and evaluated through a randomized controlled trial (RCT), and will later be rolled-out throughout the DFSA program area. The findings will also be incorporated into FH Care Group lesson plans and used to create key behavior change modules on proper disposal of child feces, cleaning the child’s play space, stopping child mouthing of contaminated fomites, hand washing with soap, and water treatment methods. During the table presentation, the trial’s Principal Investigator, Dr. Christine Marie George (Johns Hopkins Bloomberg School of Public Health), and FH’s Sr. Health and Nutrition Technical Advisor, Nicole Coglianese will describe the methodology, identified facilitators and barriers to the adoption of the Baby WASH interventions, as well as report on the risk factors for environmental enteropthy, enteric infections, and impaired growth identified during the cohort study.
TABLE 10: Partnerships for Pre-Eclampsia: Engaging Stakeholders Using an Innovative Model to Strengthen Supply and Demand
Caroline Johnson, Population Council
We present a multi-faceted Primary Health Care (PHC) Pre-eclampsia/Eclampsia (PE/E) Model based on identified gaps in several countries and accepted global best practices. The basic premise is that: 1) frontline health providers (within PHC facilities and communities) can take on additional skills with adequate capacity building; and 2) communities want to have control over their own health. The health systems interface between pregnant women, PHC facilities, and communities can be strengthened by partnerships and can build women’s care-seeking and demand for services to enhance positive pregnancy outcomes. The PHC PE/E model describes a set of critical interventions for early detection and quality PE/E prevention and management. The model brings together WHO recommendations in antenatal care, task shifting, and prevention and treatment of PE/E. These include raising community awareness on PE/E signs and symptoms, emphasizing what pregnant women should expect and ask for at facilities during ANC, and elaborating on provider obligations to meet those demands. The model recognizes the necessity of an enabling environment, including partnerships and stakeholder engagement, elucidates a set of essential components including task-shifting to PHC providers and referral strengthening, and proposes other promising practices including community engagement and a need for postnatal follow up. Using pre-eclampsia as a lens on the quality of antenatal care (ANC) and postnatal care (PNC) services, preliminary implementation of this model demonstrates transfer-ability across countries and offers strategies to policy-makers and program implementers around care provision practices grounded in women’s experiences.
TABLE 11: Advocating for Integrated Approaches to Equity and Inclusion
Carolyn Moore, Global Handwashing Partnership and Julia Rosenbaum, FHI 360
The Clean, Fed, and Nurtured Coalition (CF&N) focuses on multi-sectoral advocacy for integrated approaches to growth and development in the first 1,000 days. We advocate for integration of MCH, nutrition, WASH, and ECD programming to improve child well-being. Now is a moment where all eyes are turning toward the earliest years and finding new ways of working that leverage and combine sectoral strengths to have a larger impact. In 2019, CF&N are exploring the concept of ‘leaving no one behind’ – enhancing equity across sectors. While individual sectors are engaging in advocacy efforts, most initiatives remain siloed. We need harmonized advocacy messages and actions focused on equitable multi-sectoral policies and programs. This session aims to bring together the global momentum around equity and inclusion, the global effort to strengthen multi-sectoral actions, and the vast expertise of participants in the Core Group gathering, to develop harmonized advocacy goals and messages to ensure no one is left behind in multi-sectoral programming and policy. The session explore where we stand with regards to equity and inclusion in each of the CF&N focus areas, and with integrated approaches across them. It will explore cross-sectoral definitions of equity, seeking to articulate whether the same groups are ‘left behind’ or emphasized by each sector. We will explore “low-hanging fruit” for integration advocacy as well as the areas of most need that require special attention, as both are needed to move forward with momentum and integrity. Members of CF&N will facilitate an interactive brainstorming session to identify joint advocacy opportunities and gather current experience, tools and ideas to develop harmonized advocacy messages for equity and inclusion. These will be refined into a simple roadmap and set of core messages so that organizations can speak with one strong voice for equity and inclusion in multi-sectoral programs.
TABLE 12: Malnutrition Prevalence & Prevention for Children Born with Cleft
Pamela Sheeran, Smile Train
Malnutrition is one of the main causes of death and disability for babies born with cleft lip and palate. Cleft is also one of the leading birth differences for children across the developing world, affecting more than 1 out of every 700 live babies (about 200K annually). We will explain recent nutrition research achieved in partnership with the LSHTM, and then present the innovate education resources that were designed in partnership with SPOON Foundation and hospitals on the ground. We will include a few interactive exercises to help the CORE community understand why malnutrition is such an important issue for our at-risk community, and also equip them with some basic understanding of effective feeding and nutrition practices.
TABLE 13: Adapting a “Low Dose, High Frequency” Capacity Building Approach to Improve Competence, Confidence, and Performance Among Egypt’s Community Health Workers
Issam El-Adawi, Save the Children Egypt
Egypt established the Raedat Refiat (RR) community health worker (CHW) cadre in 1994 to increase demand for family planning services. The RR workforce has grown to 14,000+ RRs tasked with promoting a range of health services reflective of the national Family Health Package. In 2015, the Ministry of Health and Population (MoHP) and partners assessed the RR program and found that, while RR are essential members of Egypt’s frontline health team and the government has invested significant financial resources, the program as designed could not demonstrate desired results or impact. A two-pronged approach was undertaken to strengthen the RR program: development of a new national strategy and an updated training program, targeting RR knowledge and skills development. Traditional “classroom” training approaches demonstrate limited effectiveness in provider skill retention. The use of competency-focused, interactive techniques delivered onsite and thoughtfully designed with opportunities for ongoing learning and practice are proven to optimize sustained improvements in service delivery and improved client outcomes. This “low-dose, high-frequency” (LDHF) approach to health worker capacity building was adapted and applied across 23 governorates to more than 10,000 RRs. The approach was tailored to the learning needs of RRs and their behavior change opportunities at household level. The content centered on information RRs “need to know”, allowing for hands-on learning, followed by continuous practice with feedback and coaching. The LDHF approach, facilitated by RR supervisors, included a one-day training at the primary health care unit, followed by a series of weekly practice sessions, including SBCC skills, case scenarios, role-plays, and learning games. Once a month, the RRs practiced sessions to build their skills in engaging with the facility or community. This session will describe how this innovative LDHF approach was applied to a national CHW cadre, highlighting evidence and recommendations for institutionalizing it within national programs.
TABLE 14: Blueprints for Better Family Planning: Creating Digital Design Global Goods to Support Frontline Health Workers
Kristen Devlin & Steve Ollis, Advancing Partners & Communities, John Snow Inc.
For years, ministries of health, organizations, and tech vendors have built mobile applications to support community health workers (CHWs) to deliver family planning (FP) services. Although developed for different contexts and users, these applications often have overlap in content, workflows, and design. Many have highlighted the challenges of this fragmented approach and the inefficiency in starting application design from zero, inspiring a nascent movement toward developing more standardized digital tools and guidelines. In 2018, the USAID-funded Advancing Partners & Communities (APC) project began to develop a “starter kit” of resources to use when designing FP mobile apps for CHWs. The resources aim to reduce duplication and improve the quality of digital FP tools, so that investments in digital health will have stronger impact on quality of service delivery among CHWs. So far, APC has coordinated with the WHO and others to create this family planning “global good”. During a circuit table presentation, APC will present lessons learned from the activity to date. We will share draft versions of resources from the starter kit, including workflow diagrams, user personas, content specifications, and an interactive prototype of a generic FP application. We will invite dialogue on how to best disseminate and catalyze adaptation of these starter kit resources in communities globally.
TABLE 15: Comprehensive Care for Pregnant and Lactating Women and Their Infants and Young Children: Reducing Missed Opportunities
Peggy Koniz-Booher and Jacqueline Wille, MIYCN-FP-Immunization Community of Practice
Though health is often consider one sector, services provided within health systems are far too siloed. Immunization, maternal, infant, and young child nutrition (MIYCN), and family planning (FP) services are all critical components of primary care, with overlapping contact points during the first year postpartum that all contribute to improved health status. Despite this, the services are often provided at different times and locations. Two related working groups, the MIYCN-FP Working Group and the FP-Immunization Integration Working Group, have recently joined together as a Community of Practice (CoP). The vision of the CoP is to reduce missed opportunities and increase coverage and quality of priority interventions for pregnant and lactating women and their infants and young children by linking these high coverage, high priority services: MIYCN, family planning, and immunization services. It is time for researchers, government leaders, program managers, and service providers working in these areas to forge partnerships in order to improve the provision of comprehensive services to all intended beneficiaries. At this table we hope to convince participants of the need to better link immunization, MIYCN, and family planning services and create greater awareness of the range of interventions that moms and young children should get at different contact points. In doing so, we will encourage participants to think beyond their usual sectoral boundaries and consider new ways of reaching their target populations.