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.
Program Booklet | Conference Report (upcoming!)
New Information Circuits
TABLE 1: SEEDPOD – 7 Steps to Successful Global Health Publication
Lydia Bologna, CORE Group Polio Project
Recently published authors spoke about their experiences on the road to scholarly publication. The CORE Group Polio Project staff, who served as technical leads for the 13-article scientific journal supplement in the American Journal of Tropical Medicine and Hygiene, provided an overview of the processes. Authors touched on technical lessons learned, from refining research questions, conducting research and analysis, to revising and re-writing multiple times for the purpose of ultimately developing high-quality manuscripts approved by peer reviewers and journal editors. The authors addressed challenges encountered along the way, such as competing interests for their time, and the worthwhile benefits of publication, including the unique opportunity that publication offers by giving voice to important work. Presenters wanted participants to share their experiences with publishing to address some of the challenges (budget, staff, etc.) that have prevented them or their colleagues from publishing and what type of support is needed to publish in the future.
TABLE 2: mHealth for Delivering Essential Feeding Interventions for Children Living with Disabilities
Doreen Alupo, The Association of Religious in Uganda
In this presentation, presenters demoonstrated an mHealth app as a potential solution for reaching children with disabilities with life-saving nutrition and feeding interventions. Infants and children with disabilities that impact feeding (e.g., cerebral palsy, developmental disabilities) often experience difficulties with functions such as safe swallowing, sucking, chewing, and sitting upright for mealtime. These unique challenges cannot be addressed with the ‘status quo’ infant and young child feeding interventions and require specialized tools, resources, and interventions.Count Me In is an app that enables caregivers to assess and monitor feeding difficulties of children with disabilities over time and generates specialized feeding techniques and care plans for each child to improve safety, skill-building, and social development. The app complements feeding interventions with growth monitoring to track the child’s response to feeding strategies. It also generates, in real-time, nutrition indicators to assist with decision-making. Attendees participated in a demo of Count Me In and heard from a local trainer in Uganda about her experience and approach to incorporate the app at community-based rehabilitation centers.
TABLE 3: Early Childhood Development CREDI Scores and a Digital Care for Child Development Community Health Worker Tool in Zanzibar
Allyson Nelson, D-Tree International
D-Tree International and the Zanzibar Ministry of Health are implementing a national, digitally-enabled community health volunteer (CHV) program. They conducted a household survey to assess caregivers’ behaviors, home environments, and child development outcomes among 2-year old children. Development outcomes were measured in cognition, language, motor and social-emotional domains using CREDI. Four times more Zanzibari children fall in the area of developmental concern compared to the standard reference population (9.6% compared to 2.5% with a z-score < -2SD below the mean). Cognitive and language domains were of highest concern, with 10.2% and 12.7% of children scoring < -2SD below the mean. Caregiver engagement, in particular the frequency of play, was significantly associated with child development outcomes. Given the complexity of factors linked to child development, a holistic approach to community health that incorporates health, nutrition and parenting practices is likely to be most successful, but challenging to execute. D-tree is rolling out a digital system to guide 2,200 CHVs to provide tailored care and counseling for optimal health, nutrition, home environments, and care for child development.
TABLE 4: The Power of Edutainment to Advance SRH Information and Services Among Young People in Uganda
Patrick Segawa, Public Health Ambassadors Uganda
Worldwide, entertainment is core to the well-being of adolescents and youth.It alters their moods, furnishes much of their slang, dominates their conversations and greatly influences their behavior. This is the rationale of the Edutainment, Informative and Performance Arts (EIPA) approach, which sets out to educate youths and adolescents on issues of SRHR by creating an interactive and fun environment for learning through skits, plays, poems, dance narratives and flash mobs that are in cooperated with targeted SRHR messages. EIPA puts youth and adolescents at the center of planning, organizing and implementation SRHinformation projects so that they develop creative and performance pieces with relevant to their local context. Youths appreciate and associate themselves with music, dance and drama and any information that is incorporated in this approach tends to stick in their mind longer on contrarily to conventional lectures and speeches. EIPA also provides a supportive and safe environment for other young people and community members to access SRHR information and services such as free condoms, counseling and HIV testing.
TABLE 5: Building Capacity of Healthcare Workers Via a Fun, Engaging Way – Gaming!
Zoya Mohamed, inSupply Health, Ltd.
We live in a digital age where technology changes faster than we can keep up. Since the majority of people spend most of their time on their phones, gaming on a mobile platform holds tremendous potential for increasing health literacy of individuals and in particular helps build capacity amongst health workers. inSupply Health partnered with SNTL Publishing to develop Health Games which consists of a series of games, that is accessible on smartphones or internet-enabled device, covering various topics such as sexual and reproductive health, nutrition, non-communicable diseases, and supply chain management to improve health literacy. Health Games provides unrestricted access to content and minimizes the barriers of traditional classroom-based learning and workshops. The platform employs behavioral techniques such as gamification elements and self-motivated learning that incentivize gamers to play and learn continuously Today, traditional techniques for capacity building tend to be costly, ad-hoc exercises that do not provide the ability to measure return on investments via knowledge acquisition. Health Games has the potential to revolutionize the current gap and the future of capacity building.
TABLE 6: Tackling Malnutrition in Arid and Semi-Arid Regions of Turkana County in Kenya through an Integrated Nutrition, WASH and Livelihoods Project
Penninah Mathenge, International Rescue Committee
The people of Turkana County are pastoralists who depend heavily on animals as their source of livelihood. With frequent droughts, there is less time for recovery leading to increased vulnerability, especially on children, Pregnant and Lactating Women(PLW). Reduced food production and pasture for the animals, leads to migration away from health services and lifesaving interventions. In 2018, Turkana County had global acute malnutrition rates at 25.2% above the World Health Organization emergency threshold of 15%. The IRC has leveraged emergency response programming through an integrated Nutrition, WASH & Livelihood approach to increase community resilience and reduce morbidity and mortality. The results of this integrated approach are: reduced movement away from health services; regular nutrition screening for children in order to detect early signs of malnutrition; improved family diet through diversified revenue streams generated through income generating activities; established platforms for hygiene and sanitation promotion (held during health and nutrition screening sessions); improved sanitation and hygiene; and established network of community health workers for outreach and home follow-ups.
TABLE 7: Integrating Community Feedback Using the Community Voice Approach (CVA) Approach for Better RMNCH/Malaria Services
Rosine Bigirimana, IntraHealth International
Lack of awareness prevents communities and leaders to know that health services are unsatisfactory. Users ignore that these services should be offered according to the government standards. In collaboration with World Vision Rwanda, a social accountability model “Citizen Voice and Action” (CVA) that brings together services users, providers and authorities is being integrated in RMNCH services in 20 districts supported by USAID Ingobyi Activity in Rwanda. Methods: A small group of community members is trained on CVA Model to become facilitators. Using existing platforms, they raise awareness of the community on health services standards and how to contribute in improving what is unsatisfactory. Facilitators conduct meetings to identify issues in health services, propose corrective actions. Results: Since May to August 2019, 61 health facilities have functional CVA groups. Meetings are conducted monthly, one hundred key issues identified, more than a half solved immediately by the facility managers and local authorities.Conclusion: The integration of CVA in RMNCH services engage both the community, providers and government authorities in solving issues identified in health service delivery.
TABLE 8: New Materials for Community-based NCD Care in Humanitarian Settings
Victoria Mshiki, International Rescue Committee
In 2018, the International Rescue Committee received funding from the U.S. Office of Disaster Assistance to deliver new initiatives on behalf of the Working Group for NCDs in Humanitarian Settings. The Working Group includes humanitarian organizations, UN agencies, and academic partners.One initiative is the development of a package of materials to support NCDs in humanitarian contexts. The materials include clinical tools and also resources to support CHWs in humanitarian settings.The CHW package includes: Animation video on diabetes and hypertension aimed at CHWs; CHW protocols; Integrated management of diabetes and hypertension; Chronic respiratory diseases; Epilepsy; Health Education and Counselling on Healthy Behaviors; Support for Tobacco Cessation; Patient self-care guides; Heart attacks and Strokes o Living with epilepsy. The video was shown to attendees, and the draft protocols and self-care guides were presented and discussed. Participants also heard about the methodology that was used to field test the materials, how the findings shaped the final versions, and lessons learnt from the process!
TABLE 9: In the Sexual and Reproductive Health Sector: The Big Brothers and Big Sisters of Quarters are the Key Persons in the Behavior Change of Adolescents
Eric Mabika, Save the Children
In Democratic Republic of Congo, adolescents represent more than 30% percent of the population and are subject to numerous issues (e.g early pregnancy, early marriage, transmissible sexual disease, HIV…). In addition, adolescents often have a lack of information concerning their sexual and reproductive health and rights. In our project “Bien Grandir Plus” implemented by Save The Children in DR Congo ( Kinshasa), the approach used in the community is to sensitize the community, parents of adolescents, gender champions as well as the big brothers and big sisters of quarters. Big brothers and big sisters of quarters are key persons who can enable behavior change of adolescents because they are well listened to and understood by adolescents and are considered role models. That is why, in the Project “Bien Grandir Plus”, big brothers and big sisters of quarters are sensitized on sexual and reproductive health, gender equality, and the consequences of social norms on adolescent health and development to provide adolescents information that enables them to exercise their sexual and reproductive health and rights.
TABLE 10: Translating 1st ANC into 4th ANC, SBA, Child Health and FP Results: A Journey of Young 1st Time Mothers Through Peer to Peer Strategies: A Case of Binti Kwa Binti (BKB) Groups in Kilifi County
Sharon Otieno and Zebedee Mkala, Pathfinder International
In order to ensure the retention of 1st time mothers enrolled on their 1st ANC Pathfinder International implemented a peer to peer strategy dubbed “Binti kwa binti” (BKB). The strategy has translated into enormous successes in terms of Cohort retention, as pregnant women of the same gestation age are enrolled into a group and followed up longitudinally by; mobilizing women into health facilities,undertaking; facility tours through “maternity open day”. The mothers then undergo pregnancy health assessment with tailored group need-based educational activities and peer support. The groups continued up to 9 months post-delivery to foster exclusive breast feeding, family planning, ensure the infants and their mothers receive PNC services and immunization services. From 12 cohorts followed there were zero maternal deaths, 99% live births, 94% children born with normal birth-weight, 100% practicing exclusive breastfeeding, 95% of the children fully immunized at 9 months. The intervention has also led to improved client’s retention across the MNCH Cascade including 4th ANC; SBA and FP uptake. Grandaunts have become champions of change leading to sustainability of outcomes.
TABLE 11: Lessons Learned from Scaling Up Left Behind Children’s Health and Wellness Program in China
Jenelle Williams, Global Health Action
To address the needs of children and adolescents stemming from one of the greatest human migrations of all time, Global Health Action (GHA) and its Chinese collaborators, the Nanjing International Training Center (NITC), and the Jiangsu Province Family Planning Association, developed a comprehensive adolescent health education program to improve access to information, psycho-social support, and health care for vulnerable, left-behind youth in rural China.It is estimated that there are 60 million left-behind children in China due to the changing economic climate in China where parents move to bigger cities for work leaving their children behind in their home communities. The project was initially piloted in the Lupu Township and expanded to 12 counties in Jiangsu province supporting 12,000 students.As a result of the success of the local and provincial programs for the adolescents, the National Health Commission created the National Rural LBC Program in 2016 based on the Jiangsu Left-behind Children program with GHA as a national partner. This project has impacted over 570,000 children in 27 cities across 12 provinces in China.
TABLE 12: Empower Community Leader to Support Improved Care and Inclusion for Children with Disabilities and their Families in Kilifi County
Loice Maluki, Kuhenza for the Children Foundation
The WHO estimates that 1 billion people (15% of the world’s population) have a disability. UNICEF says children with disabilities are likely to experience poverty and discrimination than those without. In Kenya, although some community leaders support children with disabilities, many others share inaccurate information about disability causes, thus encouraging discrimination, neglect, and abuse. Cultural beliefs surrounding disability cause leaders to encourage families to pursue spiritual remedies instead of medical care. Intervention Kuhenza’s low-cost, 1-day disability trainings teach pastors, traditional healers and government leaders about disability definitions, causes, treatments and existing laws that require them to support and protect children with disabilities.Results Over 18 months Kuhenza collected data from a sample of 100 community leaders who had completed the disability trainings. Monthly reports and individual interviews indicated that,these leaders had sensitized 50,162 community members on disability justice and inclusion, counseled 7,907 families impacted by disability and referred 671 children with disabilities to education and medical facilities. Conclusion After each Kuhenza training, 60% of participants take action on behalf of children with disabilities.
TABLE 13: Leaving No One Behind on the Path to UHC: Tools to Improve Family Planning Access Among Adolescents and Youth, Women and Adolescent Girls Affected by Crises, and Those with a Disability
Laura Raney, Family Planning 2020
This presentation introduces three new tools based on lessons learned from Family Planning 2020’s increasing emphasis on the principle of equity and actions taken to ensure that all women and adolescent girls, no matter where they live, have access to lifesaving contraceptives. The Adolescent-Friendly Contraceptive Services Scorecard can be used both to rank a country’s adolescent and youth family planning policies and programming and to create evidence-based advocacy messages based on the High Impact Practices in Family Planning (HIP). The HIP Strategic Planning Guide: Preparing and Recovering from Humanitarian Crises shares collaborative learning from supporting countries as they improve their preparedness and reach of family planning (FP) services to crises-affected populations. To support women and adolescent girls with disabilities, who suffer disproportionately from lack of access to FP, FP2020 and partners have created a guide and curriculum to raise the awareness of FP providers on disability inclusion and build their capacity on how to support young persons with disabilities. Copies of all three tools were distributed.
TABLE 14: Point-of-Care Data Driven Reviews for Improved Retention in Care: Experience of Doctors with Africa CUAMM USAID RHITES Project
George Aguze, Doctors with Africa – CUAMM
Doctors with Africa-CUAMM, a lead community partner in the JSI USAID RHITES-North, Lango project commits to building community health platforms to attain high impact in the population of Lango sub region. The sub-region has 2.1 million people; 80% are rural and 50% below age 15, HIV prevalence at 7.2%. By Jan-March 2019, retention of HIV clients in care remained below the ceiling at 62% and 69% for 6 and 12 months’ cohorts. A Point of Care (POC) Data Driven Reviews was conducted at 22 selected ART sites with poor retention based on data retrieved from DHIS2. Using the updated records, lost clients were line listed and assigned to community volunteers for active follow up. Results showed that 15 (68%) had improved retention with 9 (60%) above 95% and 5 (33%) above 90%. Thus data driven reviews and real time follow up significantly improved retention of HIV Clients in Care. It is therefore critical to provide routine technical support to the available community structures to enhance real time client tracking and follow up mechanisms for improved retention in care.
TABLE 15: Proactive Community Case Management (ProCCM): Ensuring Rapid Universal Coverage at the Community Level
Madeleine Beebe, Muso
Participants discussed Proactive Community Case Management (ProCCM), an innovative system of care delivery optimized to save lives by reaching patients early. ProCCM consists of four elements:Proactive Search: Community Health Workers (CHWs) search for patients through daily home visits, connecting them with care early. Doorstep Care: CHWs provide a package of diagnostic and treatment services in the home. Rapid-Access Clinics: Muso builds capacity at government clinics to ensure they can respond to increased patient volume and provide quality care. Care Without Fees: Muso removes the barrier of user fees at both the community and facility levels. ProCCM is currently implemented in rural and periurban Mali, covering a population of 350,000. The ProCCM model is associated with a tenfold increase in access to care and a tenfold difference in child mortality rates. A 2018 study documented a reduction in under-five child mortality from 154/1000 at baseline in 2008 to 7/1000 in 2015. The peri-urban areas of Mali where ProCCM is deployed now have the lowest documented rates of child mortality in sub-Saharan Africa.
TABLE 16: Tom Brown: A New Approach for Management of Moderate Acute Malnutrition
Pauline Adah, Catholic Relief Services
In many contexts, children with moderate acute malnutrition (MAM) do not benefit from recommended supplementary feeding programs due to capacity or funding constraints, inadequate supply chains, and the prioritization of services for children with severe acute malnutrition (SAM). In war-torn North East Nigeria, global acute malnutrition rates have remained above emergency thresholds for years. While many actors are treating children with SAM, there have been few programs targeting children with MAM. Appropriate services for children with MAM can save lives and prevent deterioration to SAM.The intervention targets children 6-59 with MAM, providing supplemental feeding and group and individual counseling on infant and young child feeding and care practices.After several rounds of piloting and fine tuning, the approach is showing promise and achieving recovery rates above the SPHERE standard of 75%.The local production of Tom Brown strengthens the local markets and empowers farmers. This innovative approach to engaging the caregivers in preparing and packaging for distribution is also an opportunity to reinforce learning on how to feed and care for children.
TABLE 17: Prevalence of HIV and Pre-Cervical Cancer Co-Morbidity in Women Under 25 Years of Age Compared to Women Over 25 Years of Age: Lessons from Zambia
Yvonne Mulenga, Project Concern International
Since 2011, Project Concern International (PCI) with support from the United State President’s Emergency Plan for AIDS Relief (PEPFAR) and the Pink Ribbon Red Ribbon (PRRR) through the United States Department of Defense HIV/AIDS Prevention Program (DHAPP), has been supporting the Zambia Ministry of Health and the Zambia Defence Force Medical Services to implement an integrated mobile cervical cancer screening and HIV testing program in 56—mostly rural and remote—primary health care facilities located in 20 districts in Zambia. In this session, PCI will share some interesting findings emanating from the implementation that show the prevalence of precancerous lesions in the younger age group (women below the age of 25) mirroring the prevalence of precancerous lesions in the older age group (women above the age of 25). If young women need to be prioritized for cervical cancer screening, further research is needed to inform policy. Current guidelines recommend cervical cancer screening for women 30 years and above as cases of cervical cancer in the younger age group are known to be rare.
TABLE 18: Predictive Validity of Living Goods Selection Tools for Community Health Workers
Howard Akimala, Living Goods
Community Health Workers (CHWs) can contribute effectively to addressing preventable disease burdens. One design feature that hasn’t received much attention is the selection of CHWs. An effective CHW program requires strong design features such as training, supervision, incentives while considering CHWs with the knowledge, skills and desired attributes like time-management, respect, kindness, empathy and diligence. An effective selection process would identify the most “trainable” CHWs and those with the highest levels of the skills and attributes that are less trainable. To evaluate the predictive validity of the existing selection tools for CHWs being used by Living Goods (LG), a cohort study of 547 CHWs working for LG in eight local areas of Kenya was undertaken. The results of this study were presented including the relationship between selection scores, pre- and post-training assessment scores and subsequent on-the-job performance.
TABLE 19: The International Institute of Primary Health Care – Ethiopia (IIfPHC-E): Promoting Health for All Through Primary Health Care
Mengesha Admassu, Luidina Hailu, Hiwot Tadesse, IIfPHC-E
As a result of Ethiopia’s immense progress in improving the health outcomes of its population, in 2016, the Ministry of Health established the International Institute for Primary Health Care (PHC) – Ethiopia, with a purpose to contribute to the accelerated progress in the achievement of Health for All through PHC by ensuring effective global implementation of robust community health programs. The Institute’s vision is to become a global center of excellence in PHC through local and international efforts by: 1. Providing formalized PHC training and capacity building to policy makers, program managers and those involved in service delivery, 2. Conducting and supporting implementation research and M&E that guide the ongoing strengthening of Ethiopia’s community health program: The Health Extension Program, 3. Systematically collecting and disseminating evidence-based best practices for PHC and 4. Developing partnerships to advance the global PHC agenda and to achieve universal health coverage. Achievements since the Institute’s inception include leadership and management capacity development training of over 400 Ethiopian health professionals and PHC related capacity building of over 100 international health professionals.
Table 20: Using mHealth and Data Technologies to Support A New Model of Community Health Care
Brian Ssennoga, Medic Mobile
Medic Mobile is a non-profit organization that has provided open-source software for community health workers since 2008. In 2018 Medic launched the CHT in a further step towards making its tools and workflows more accessible. Medic Mobile’s CHT is an innovation that enables the achievement of a world where the best ideas and tools for community health are free and open to those who want to use them. In doing so, Medic Mobile has employed a Human Centered Design approach to developing and implementing the CHT — a collection of software tools, documentation, guides, and other resources; available to a community of health practitioners and co-creators as an open-source project, with Medic Mobile serving as the technical lead and initial steward. Through the CHT, partners have access to open-source tools, share best practices and opportunities to collaborate on new workflows and system integrations while learning from one another.