Spring 2017 Global Health Practitioner Conference | Thursday, April 20

 WELCOME ADRESS AND KEYNOTE

Welcome
Judy Lewis, Chair, CORE Group Board of Directors

KEYNOTE

PRESENTATION_OBREGON

CONCURRENT SESSIONS

Mary DeCoster, The TOPS Program, Food for the Hungry; Claire Boswell, The TOPS Program, Food for the Hungry; Beth Outterson, Medical Teams International; Jean Meyer Capps, Independent Consultant; Debora B. Freitas López, Chemonics International (Moderator)

There are growing synergies between development and humanitarian assistance and Social & Behavior Change (SBC) approaches for increasing resilience in the targeted populations. In this interactive session, participants learned about integrating SBC to inspire behavior change and to best contribute to preparedness, response, and recovery efforts, including in protracted emergency settings and Ebola outbreaks. Participants heard about how different SBC approaches that are often used in long term development, such as community-led total sanitation, and empowering community health volunteers as agents of change can be effectively applied and integrated after sudden onset emergencies as well as chronic emergencies in an effort to promote and enable resilience and care-seeking behaviors. Participants also discussed what tools could be used and what gaps need to be addressed through more information, resources, and research.

Applying SBC in nutrition programs helps implementers make data-driven decisions to prioritize efforts and achieve greater impact. Participants heard about how to craft a social and behavior change strategy for large-scale nutrition impact in nine steps exploring aspects of designing for scale using a design process, decision-making tools, and workshop plan with exercises that allow implementers to use their own data to create strategies that should result in rapid, large-scale changes in nutrition behaviors. Participants also learned about nutrition-sensitive agriculture programming with a behavior change lens exploring aspects of designing for integration. This design process helps agriculture programmers in a given context to identify, prioritize, and effectively promote nutrition-sensitive practices which complement specific agriculture and livelihood practices they already promote. Finally, participants learned about improving interpersonal communication for Nutrition Assessment, Counseling and Support (NACS), exploring ways to improve the quality of counseling. Participants left with a package of tools developed to address persistent weaknesses in the “C” in NACS. This approach applies proven SBC principles to help health care providers deliver effective nutrition counseling.

WORKING GROUP SESSIONS: PLANNING AND INNOVATIONS FOR FY2017

Community-Centered Health Systems Strengthening
Co-Chairs: Alfonso Rosales, World Vision; Megan Christensen, Concern Worldwide

Alfonso Rosales and Megan Christensen led the Community-Centered Health Systems Strengthening Working Group in a review of the annual work plan, facilitated a discussion on the progress achieved to date, and made amendments to the work plan including prioritization of activities. We reviewed thematic areas for which members have local success stories, learning, and evidence that can be pitched at international conferences and other forums to increase visibility and advocacy for community health systems. Topics included  review of recent publications, recent conferences and events, and review of survey results from the Working Group.

PRESENTATION_NAMBURETE

Social and Behavior Change
Co-Chairs: Tom Davis, Independent; Joseph Petraglia, Pathfinder International; Debora B. Freitas López, Chemonics International

The Social and Behavior Change Working Group provided updates on current work plan-related activities, reviewed priorities as expressed in the last CORE Group Conference, and discussed progress on those priorities as well as the broader strategic vision for the working group.

Nutrition
Co-Chairs: Jen Burns, Catholic Relief Services; Kathryn Reider, World Vision; Gwyneth Cotes, SPRING, JSI

Working group efforts focused on the double burden of malnutrition, the Essential Nutrition Actions framework, CMAM/CCM integration, nutrition-sensitive integration, multi-sectoral anemia, and a technical webinar series. In addition, we began gathering ideas for the next year’s work plan and fall conference. Finally, Julia Rosenbaum of the WASHPals Project will present recent findings of a literature review on the links between ingestion of soil and animal feces, disposal of infant & child feces, environmental enteric dysfunction, and undernutrition. Participants discussed potential interventions to prevent exposure through much-ignored disease pathways.

PRESENTATION_ROSENBAUM

Monitoring & Evaluation
Co-Chairs: Claire Boswell, The TOPS Program, Food for the Hungry; Dora Curry, CARE

The M&E Working Group reviewed our overall vision and objectives for any new members; determined small, actionable steps for the next six months; and identified specific “Show and Tell” topics for upcoming webinars.

Reproductive, Maternal, Newborn, & Adolescent Health
Co-Chairs: Regina Benevides, Pathfinder International; Mychelle Farmer, Jhpiego; Corinne Mazzeo, USAID’s Maternal and Child Survival Program, Save the Children; Cindy Uttley, Samaritan’s Purse

The RMNAH Working Group reviewed technical accomplishments, discussed current priorities and strategic directions for working group members, and assigned tasks for priorities moving forward.

The Humanitarian-Development Task Force met for the first time to review and discuss the terms of reference, develop priorities for the group, and decide on directions, tasks, and responsibilities moving forward.

PRESENTATION_BOWEN and HARTNESS

NEW INFORMATION CIRCUITS

Table 1 | Innovating and Integrating Community Led Action to drive change
Alex Tran, GOAL Global

Participants explored how an extensively implemented and well-evidenced Social and Behavior Change (SBC) approach can be replicated across development and emergency contexts. This approach was adapted and integrated to achieve successful outcomes in sectors beyond that of its original application, as well as integrated as a component of multi- faceted programs to amplify impact. A case study of innovating the Community Led Total Sanitation model for the Ebola response in Sierra Leone in 2014 showed how this approach has been further modified and incorporated into a current GOAL and PSI-led program in Malawi addressing Sexual and Reproductive Health and Climate Change Adaptation behavior simultaneously.

Table 2 | Community Action for Diabetes and Cancer
Sarah Shannon, Hesperian Health Guides

People living in poverty today are some of the most vulnerable to non-communicable diseases (NCDs) like diabetes and cancer. NCDs kill 38 million people each year, more than three-quarters of whom die in poor countries. People working in agriculture and other industries are exposed to chemicals and pollution that cause cancer, and often the disease is stigmatized as the result of personal misconduct. People in these settings often cannot afford cancer screenings, and lack information about prevention. Community Health Workers can play a huge role in addressing, preventing, and supporting people affected by NCDs such as diabetes and cancer. This roundtable provided information from Hesperian’s NEW chapters of “Where There Is No Doctor” covering diabetes and cancer.

Table 3 | Use of Barrier Analysis in Emergency Settings
Caroline Abla, International Medical Corps

International Medical Corps conducted several barrier analysis assessments in Lebanon, Jordan, and Turkey to study the determinants of several IYCF and maternal nutrition and health behaviors. The setting in Lebanon was refugees living among host communities, as well as living in tented settlements. In Jordan the setting was a closed refugee camp, while in Turkey it was with refugees living in urban areas. In Turkey the focus was on adolescent girls while in Lebanon and Jordan, it was pregnant and lactating women of all ages. This roundtable session helped to understand maternal and health challenges facing refugees, as a first step in finding solutions.

Table 4 | Review of HMIS Systems for Maternal, Newborn and Child Health
Emma Williams, USAID’s Maternal and Child Survival Program, Jhpiego

USAID’s Maternal and Child Survival Program is reviewing the availability of key data elements related to maternal, newborn and child health in the 24 USAID priority countries, including indicators related to community health programs. This review can help country and global stakeholders understand which MNCH indicators can be currently calculated using data available in routine information systems. Participants learned details of the findings and how to access the data.

Table 5 | Integrating Strategies for Controlling Cholera: Vaccine and WASH
David Sack and Anne Ballard, Johns Hopkins Bloomberg School of Public Health

Oral cholera vaccine is now being scaled up to control cholera outbreaks as well as reduce the threat of endemic cholera. The vaccine is recommended by WHO, and is funded by GAVI, but many agencies still lack information on its appropriate use and how to integrate the vaccine with ongoing WASH interventions. This roundtable from the DOVE project at Johns Hopkins provided an overview of the vaccine, how it is now being used in many countries in Africa, Asia and Haiti, where to find resources for the vaccine, and how to integrate use of the vaccine with WaSH.

Table 6 | Grow Together: An Integrated Community Stunting Prevention Program Focusing on Priority Social and Behavioral Outcomes in Health, WASH and Agriculture
Melissa Antal, The Manoff Group

The USAID-funded NOURISH Project in Cambodia addresses stunting prevention in the community by focusing on priority social and behavioral outcomes tied to nutrition, WASH and agriculture to achieve improved nutrition outcomes for women and children in the first 1,000 days. SBC products and tools used in communities were demonstrated and discussed. Among the products united under a “Grow Together” theme that were featured are: a series of audio soundbites for community volunteers to play on their mobile phones for caregivers, the child length mat to help communities to visualize and take action around children’s growth, and a life-sized data dashboard for community dialogues that tracks community progress on nutrition, WASH and agriculture.

Table 7 | Let’s Play! Community Health Volunteers Play Games to Address Social Norms and Family Planning Use in Nepal
Gabrielle Nguyen, Save the Children

Despite Nepal’s relatively high contraceptive prevalence rate (50%), 27% of married women have an unmet need for family planning (FP). Formative research among five unique districts of Nepal showed that low FP use was related to three factors:

1) individuals had limited knowledge about fertility and family planning methods;

2) women had misconceptions about FP side effects; and

3) social norms impact birth timing and couples’ decision making.

The FACT Nepal project addresses these barriers to FP use through the use of nine participatory group games, led by Nepal’s network of volunteer community extension workers, to diffuse fertility awareness and FP messages to communities across five districts, specifically focusing on select underserved populations. The round table session demonstrated select games that best exemplify how game play can encourage critical reflection to initiate normative change and diffusion of information.

Table 8 | One Download at a Time: mPowering Frontline Health Workers Responding to the Zika Epidemic
Alex Kellerstrass, USAID’s Maternal and Child Survival Program, Jhpiego

mPowering’s ORB online training content platform helps frontline health workers. This roundtable provided a brief presentation of its use as a tool within USAID’s Maternal and Child Survival Program Zika Response activities. Discussions included evidence for the use of mobile training for health workers during an epidemic, as well as a brief overview of MCSP’s Zika response work in Latin America and Haiti. Participants learned about digital tools that support mobile training for community health workers specifically in the context of Zika. While this session did not teach participants how to use these tools in detail, it did provide an overview of each tool (with relevant examples). Participants learned how the use of ORB and mobile training can streamline health worker training and create opportunities for collaboration. Participants saw how ORB operationalizes the Principles of Digital Development and how they could use ORB to enhance their programs.

Table 9 | New WHO Program Reporting Standards for SRMNCAH work
Stephanie Levy, USAID

For the last 18 months, a WHO-led partnership (WHO, UNFPA, UNICEF, USAID, BMGF, NORAD, NIH, and the Norwegian Institute of Public Health) have been working to improve the building, reporting, assessment, and application of the evidence base for complex, multidisciplinary interventions, particularly social, behavioral, and community engagement interventions for MNCH, in order to show their value and give policymakers the information needed to ensure their uptake. One part of this work has been to develop program reporting standards (PRS) to provide guidance for complete and accurate reporting on the development, implementation, and monitoring and evaluation processes of SRMNCAH research and programs. The aim is to ensure that the required information to understand essential elements of implementation and sustainability and important contextual factors are documented and facilitate knowledge translation within and between different programs and sectors and contribute to processes to assess the evidence of intervention effectiveness. Participants became familiar with version 1.0 of the PRS now available for piloting and feedback.

Table 10 | New Cholera Prevention and Management Health Promotion Materials
Tom Davis, Independent

Participants got a first look at the CORE Group Cholera teaching module, a set of four lesson plans which can be used in Care Groups, Mother-to-Mother Support Groups and other health promotion group and home visit settings. Participants learned about how the modules were developed and how organizations can use these new materials to stop cholera epidemics in their tracks.

Table 11 | MAP-IT: Model for Assessment of Pediatric Interventions for Tuberculosis
Doris Rouse, RTI International

MAP-IT (Model for Assessment of Pediatric Interventions for Tuberculosis) model is a user-friendly, web-based tool that estimates the potential of expanded existing and new pediatric TB interventions to prevent children from contracting pediatric tuberculosis (TB) and to reduce mortality. Users can assess the impact on incidence and mortality for changes in a technology’s availability, use, or efficacy to understand the potential impact of various interventions. It also allows users to package interventions for simultaneous dissemination to see the impact of intervention synergies. Users can set their own parameters to assess comparative impact of intervention options. Citations and references are included for full transparency on the sources of data and assumptions. MAP-IT is available online at no charge: www.mapit4pedstb.org.

Table 12 | FANTA Guide to Anthropometry: A Practical Tool(kit) for Program Planners, Managers, and Implementers
Lesley Oot, FHI 360

The FANTA Guide to Anthropometry supports the effective use of anthropometry in health, nutrition, and food security programs. The guide helps development practitioners who implement or oversee food security, nutrition, or heath programs that collect and/or use anthropometric data as part of surveillance, service provision, monitoring and evaluation, or program design. Participants learned how the guide can support the collection of high quality anthropometric data, and how the guide can serve as comprehensive reference (across all age group) on how to conduct and interpret anthropometric data.

Table 13 | Integrated Programs for CHWs in Malawi: What Can We Learn?
Marc D. Mitchell, D-tree International

Malawi has relied on Health Surveillance Assistants (HSAs), to provide RMNCH services in rural areas. The services include IMCI, antenatal, postnatal and neonatal care and family planning. Working with the government, D-tree has developed a digital tool being used by 1200 HSAs that improves quality of care, supports supervision and improves logistics management in an integrated digital health system. Participants discussed: What were the barriers to integration by donors, government and users? How did we overcome these barriers? What are the lessons for future programs?

Table 14 | Engaging Entrepreneurs in Developing Community Videos for Nutrition in the Sahel
Alix Harou, SPRING, JSI

The Sahel faces a challenging environment. Malnutrition in women and children is compounded by low employment, limited communication channels, and cultural barriers at the community level. To overcome these challenges, USAID’s Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project established an income generating community video approach to promote uptake of high-impact nutrition and hygiene behaviors. Participants learned about four video production hubs in Niger and three in Burkina Faso, where SPRING is building and reinforcing the hubs’ technical capacity in video production. Although too early to confirm whether this innovative investment in village-level private sector will result in sustainable, community video production resources, the project has identified some important lessons learned in establishing the hubs.

Table 15 | Emory WASHCon Tool to Measure WASH in Health Facilities
Precious Sancho, World Vision

The Emory WASHCon Tool (WASH Conditions Assessment Tool) is an easy-to-use mobile assessment tool which collects real-time data on the WASH conditions of healthcare facilities. The two-hour survey consists of interview and observation, focusing on five key domains: water supply, sanitation facilities, handwashing facilities, environmental cleanliness, and waste management. Based on the responses to each question, the program dashboard calculates a score that correlates to a red, yellow or green stoplight. This color-coded scoring helps facility staff to prioritize the areas of greatest need and helps implementers to compare between locations and over time. The Emory WASHCon tool, if utilized widely, will add to a much-needed evidence base on the conditions of WASH in healthcare facilities and will help facilities and implementers to strategically address WASH needs.

Table 16 | Nutrition-Sensitive Agriculture Project in Chin State, Myanmar (PACE Tool)
Julia Weatherson, Catholic Relief Services

Myanmar has one of the highest rates of stunting in children under five years old in ASEAN with stunting rates for children under five at 29% and peaking at 41% in Chin State. With the recent launch of a national campaign to tackle malnutrition by State Counsellor Aung San Suu Kyi in January 2017, Chin is a priority state for nutrition efforts to tackle malnutrition. Funded by Livelihoods Food Security Trust-fund (LIFT), PACE is an integrated agriculture and nutrition project in 60 remote villages in Chin focused on supporting smallholder farmers to increase sustainable farm production and pregnant and lactating women and children age 6-23 months to improve diet diversity. PACE employs SBC approaches in farmer demonstrations and cascade mother groups to promote and ensure adoption of improved agronomic and nutritional practices.

Table 17 | Social Norms and Networking Approach to Maternal and Newborn Health Practices
Ali Karim and Leanne Dougherty, JSI

The social network approach supports the idea that behaviors, such as maternal practices, diffuse through a society best through overlapping social networks that produce positive perceptions of self-efficacy, descriptive norms, and injunctive norms regarding the behaviors. This table presented findings from two John Snow, Inc projects that have integrated social norms and network (SNN) approaches to improve maternal and newborn health outcomes. First, we highlighted the SNN approaches adopted by The Last Ten Kilometers Project (L10K) to influence early postnatal care in the context of the service delivery system of Ethiopia’s health extension program (HEP). Second, we presented findings from an evaluation of the Community Benefits Health (CBH) project (conducted from 2014-2016).

Table 18 | We Decide Together: A Couple Strengthening Approach to Healthy Timing and Spacing of Pregnancies
Lauren VanEnk, Institute for Reproductive Health

Through the Strengthening Marriages and Relationships through Planning and Communication (SMART) Couples Project, Catholic Relief Services and the Institute for Reproductive Health are working together to improve healthy timing and spacing of pregnancies, shared decision making, and equality among couples in Niger, Burkina Faso, and Ghana, where social norms around gender and family planning negatively influence health outcomes. This innovative approach strives to improve healthy timing and spacing of pregnancies and engage men in reproductive health through couple-strengthening workshops. Participants learned about this new approach to strengthen couple relationships while at the same time improving family planning uptake in conservative settings with high unmet need. Discussion was had on factors contributing to poor health outcomes in West Africa and the value of a faith-based, couple-centered approach to address such issues as well as the feasibility of integrating FAM into multi-sector development programs.

Table 19 | Panicked by Nutrition in Emergencies? A Guide to the IYCF-E and CMAM Toolkits
Paul Wasike and Nicki Connell, Save the Children

There is a need for and interest in easy-to-use emergency response toolkits by actors in the public health arena globally. In response to this demand, Save the Children developed and translated two Toolkits: the IYCF-E Toolkit and the CMAM Toolkit. Both toolkits are publically available, ready resources for first responders to an emergency as well as for use in emergency preparedness and scale up of both IYCF and CMAM services and programs. Both are quick and easy-to-use starting points that consolidate IYCF-E and CMAM best practice and guidance with standardized operational tools that will allow Nutrition Advisors, Coordinators, and Program Managers to rapidly access needed inputs and begin implementation as soon as possible, without needing to spend a lot of time searching for certain tools. Both resources were developed using USAID OFDA and USAID Technical and Operational Performance Support (TOPS) program funding.

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