NGOs working in local communities often create innovative solutions to improve child health outcomes by overcoming common obstacles for development. Many of these obstacles (e.g., referral, drug availability, community ownership, behavior change) are present in communities around the world. Innovations created by one organization can assist others in improving child health; however, they are often not well documented or diffused. Innovations tend to stay within one community or organization and are not transferred or developed in a way that enables others to learn about, evaluate, and apply program approaches for wider benefit.

CORE is interested in diffusing NGO innovations that demonstrate a proven track record in improving the effectiveness, sustainability, equity or scale of child health outcomes. To achieve this objective, in 2003-2004 CORE disbursed six awards to its members for diffusion of promising child health innovations to a larger audience. The winning innovations include:

Completed Projects:

• Helen Keller International: The Integration of Vitamin A Supplementation Into Community-Directed Treatment with Ivermectin: A Practical Guide for Africa Based on their experience with implementing this approach in six states in Nigeria and one district in Cameroon, HKI developed, produced and disseminated an English and French "How to Guide" that includes details on costing, training, and logistics and management information system. They also: 1) organized and conducted two-day dissemination workshops in Nigeria, Cameroon, and the Democratic Republic of the Congo; 2) organized and facilitated a two-hour session at the bi-annual meetings of the NGDO Coordination Group for Onchocerciasis Control; and 3) prepared a draft manuscript for submission to a peer-reviewed journal.

• World Relief: The Care Group Difference: A Guide to Mobilizing Community-Based Volunteer Health Educators
  This Guide, developed by World Relief, explores the evidence base for the Care Group model, offers criteria to assist project managers in determining the feasibility of using this approach within their own programs, and provides a step-by-step guide for starting and sustaining care groups. A care group is a group of 10 to 15 volunteer, community-based health educators who regularly meet together with project staff for training, supervision and support. Care group volunteers provide peer support, develop a strong commitment to health activities, and find creative solutions to challenges by working together as a group. World Relief pioneered the Care Group model as part of its Vurhonga child survival projects in Mozambique (1995-2003). The Guide is available in hard copy and in CD format.
  • A Diferenca Dos Grupos De Assistencia (The Care Group Difference/Portuguese)

• Save The Children: Diffusing Partnership Defined Quality (PDQ) - A Proven Approach To Improve The Quality Of And Access To Child Health Services
  PDQ is a methodology to equitably unite community members (users and non-users of health services) with providers to define quality, identify and prioritize problems and create solutions to strengthen the quality, access and use of services that improve the health status for all. Originally designed for family planning / reproductive health programs, Save adapted this methodology to include maternal and child health programs. Save piloted the approach in Pakistan, Uganda, Rwanda, Azerbaijan, the West Bank, Georgia and Ethiopia and developed an implementation guide with step-by-step instructions for field use. Through the diffusion award, Save developed a training supplement to this guide that enables facilitators to conduct a PDQ training designed to equip participants with all the skills necessary to adapt and implement PDQ in their programs. CORE support also funded a workshop on the approach held in Bankok in July 2004.
  • La Qualité Définie en Partenariat: manuel pour la collaboration entre la cammunauté et les agents de santé dans l'amélloration de la qualité (PDQ Manual - French)

• Food For The Hungry: Overcoming Obstacles To Behavioral Change Via The Development And Diffusion Of A Barrier Analysis Manual And Training
  The purpose of this tool is to help community-level staff members working in child survival, Title II, and other development programs to better identify barriers to behavior change that (if adopted) would have a significant positive impact on the health, nutrition, or wellbeing of targeted groups (e.g., preschool children) in a project area. The tool also helps staff members to identify positive aspects of behaviors which can be used in health promotion efforts. The tool is in some ways similar to Doer/NonDoer Analysis (which is part of the BEHAVE framework), but focuses on a much broader list of possible determinants and barriers. The manual focuses on:
  • perceived susceptibility;
  • perceived severity;
  • perceived action efficacy;
  • perception of social norms;
  • perceived self efficacy;
  • cues for action;
  • perception of divine will; and
  • positive and negative attributes associated with the action.

  Given its generic nature, the methodology can easily be modified to identify a wide range of barriers to behavior change in health, agriculture, nutrition, or other domains, and is applicable to any geographic location in the world. The entire barrier analysis process when used in the field can be completed in 2-3 days for a small set of key behaviors.

  Barrier Analysis was initially developed in the early 1990s using behavioral change principles that were applied to a community-level child health project in the Dominican Republic. The tool was further developed by FH staff members and has been used to train over 100 FH field staff from Mozambique, Kenya, Bolivia and Ethiopia in identifying barriers to behavior change. Since the late 1990s, the tool has been used in Haiti, Kenya, Mozambique, Ethiopia, and Bolivia to discover key barriers to behavior change regarding breastfeeding, other nutritional practices, latrine use, agricultural practices, HIV/AIDS behaviors, and other intervention areas.

• Curamericas: Census-Based, Impact-Oriented Methodology: A Resource Guide for Equitable and Effective Primary Health Care Curamericas has developed and tested a model of health service delivery called the Census-Based, Impact-Oriented (CBIO) approach in Bolivia, Guatemala, Haiti and Mexico over the past 20 years. The CBIO approach is a community-based primary health care model that allows local health care staff to better understand and more effectively treat the most common causes of sickness and death within their communities. Because of its unique approach to measuring community health, the CBIO methodology provides a basis to accurately measure health service outcomes and impacts, including mortality reduction. The CBIO methodology seeks to ensure that: 1) scarce resources and services are appropriately targeted to the most common causes of avoidable illness and death; 2) service outreach and utilization are equitable, reaching those of greatest need within targeted communities; and 3) outcomes and impacts (including changes in mortality) are well measured.

  The manual provides information to gauge the appropriateness of the strategy in specific program areas, and then guides the reader through the steps of program implementation including: conducting a census; engaging the community in decision-making; strategies used to achieve full coverage and regular contact with beneficiaries; quality control; maintaining registries; health information system requirements and forms; collection and analysis of surveillance and vital events data; and behavior change. Additionally, Curamericas has provided copies of all the data collection forms they use that can be locally adapted and training materials for field staff.

• CRS: Framework For An Integrated Community Approach To Obstetric And Neonatal Emergencies
  From 1999 to 2004, CRS Honduras implemented a safe motherhood program aimed at decreasing maternal and neonatal mortality in rural settings with limited access to care by strengthening the management skills of traditional birth attendants (TBAs). CRS' approach was based on the "life saving skills" methodology developed by the American College for Nurses and Midwives. CORE provided support to CRS to disseminate several products arising from the project, available in both English and Spanish. These products include a TBA manual; a training plan for TBAs and maternal health aides; and facilitator's guides for training TBAs and community emergency transport committees.

Effective diffusion requires the buy-in of key stakeholders and often results from the collaborative experiences of multiple organizations. A collaborative approach to improving diffusion may occur through one or more of the activities listed below.