Core Group

Plenary

Hearing the Unheard Cry: Three pillars to improve newborn survival.

Newborn deaths are a steadily increasing proportion of under-five deaths, currently representing more than 40%. Addressing newborn mortality is essential to achieving MDG 4, is closely linked to achieving MDG 5, and requires scaling up of evidence-based interventions through various delivery platforms by governments and NGO partners. Recent attention to stillbirths has increased awareness that interventions focused at the time of birth have triple benefit to reduce maternal mortality/morbidity, reduce neonatal deaths due to intra-partum-related events, and reduce intra-partum stillbirths. Coverage of key life-saving maternal and newborn interventions, however, remains unacceptably low, especially for the poorest families.

This session emphasized three evidence-based pillars of successful strategies to improve newborn survival: (1) increasing availability/access of evidence-based interventions, (2) improving ‘demand’ and use of key interventions, and (3) improving quality of care.

Pillar 1: Increasing availability/access of evidence-based interventions. Where access and use of facility-based care is low, there is clear evidence that using community health workers to make well-timed home visits can save newborn lives.  Based on this evidence, the UN agencies recently released a WHO/UNICEF Joint Statement, Home Visits for the Newborn Child: a strategy to improve survival.  The Joint Statement calls for governments and partners to analyze the country situation, and to implement early postnatal home visits for mothers and newborns, especially where families’ postnatal contact with health facility providers may not be feasible.

Pillar 2: Improving demand and use of key interventions.  Creating demand and changing household practices for newborn care is especially challenging due to strong cultural traditions and norms around childbirth. Therefore, programs should include evidence-based strategies to mobilize communities around maternal and newborn care to improve key household practices and to increase timely and appropriate care seeking for maternal and newborn complications.  There is expanding global evidence of impact of demand creation strategies, and increasing need for effective implementation at scale of these approaches.

Pillar 3: Improving quality of health care interventions.  Whereas 1 million annual newborn deaths are due to intra-partum-related events (termed “birth asphyxia”), basic newborn resuscitation is a life-saving intervention that must be available to all newborns who do not breathe at birth. Health providers must be able to quickly assess and recognize the condition, take immediate simple steps, and have the essential basic equipment. Unfortunately, there are many ‘missed opportunities’ to provide quality resuscitation at lower levels of the health system, such as health clinics and district hospitals. Recent developments, however, hold new promise. New, simple tools now exist to train health care providers/workers. With USAID leadership, partners are now collaborating through a newly created Global Development Alliance to scale up quality newborn resuscitation in weak health systems using these new training tools.

Introduction and Session Overview

Increasing Access through Postnatal Home Visits:  Implementing the WHO/UNICEF Joint Statement
Stephen Wall, Senior Advisor, Technical Leadership & Support, Saving Newborn Lives, Save the Children (Washington, DC); Moderator and Presenter.

Hearing the Unheard Cry: Pillars To Improve Newborn Survival

Increasing Demand for Maternal & Newborn Care Practices and Care Seeking:  Implementing evidence-based approaches
Joseph de Graft-Johnson, Maternal and Newborn Health Advisor, Save the Children, Saving Newborn Lives (Washington, DC, USA and Addis Ababa, Ethiopia); Team Leader, Newborn and Community Health, MCHIP Program

Increasing demand for maternal & newborn care practices and care seeking: Implementing evidence-based approaches

Preventing Intrapartum-related Neonatal Deaths (deaths due to “birth asphyxia”):  New tools (Helping Babies Breathe) to improve quality of care in low-resource settings including global burden
Susan Niermeyer, Professor of Pediatrics, Section of Neonatology, University of Colorado Denver School of Medicine

Helping Babies Breathe

New, Affordable Technologies to Improve Quality of Care at Childbirth– Presentation and hands-on demonstration
Tore Laerdal, Executive Director, Laerdal Foundation for Acute Medicine

Laerdal: Helping Save Lives

Scaling up Newborn Resuscitation – New strategies and global implementation plans through partnerships
Lily Kak, Senior Maternal and Newborn Health Advisor, Bureau for Global Health, USAID

Concurrent Sessions

Early Childhood Development: The perfect Venn diagram

Shannon Senefeld, Senior Technical Advisor for HIV, CRS, Moderator
Janine Schooley, Senior Vice President for Program, PCI; Moderator
Session presenters shared information on different approaches to responding to early childhood development (ECD) needs within the context of MCHN, HIV and other programming, including recent successes, lessons learned, promising practices and tools. Participants had the opportunity to ask questions of the presenters about their programs and approaches. Full group discussions focused on how ECD can be better utilized by CORE members as an integrator, able to link education, OVC, IYCF, pediatrics, and other elements.

Overview of Early Childhood Development
Jack Bryant, Senior Faculty Associate, Johns Hopkins School of Public Health, Department of International Health
The presentation added any context, issues for discussion, challenges, and priorities that were not already covered in Tuesday’s plenary presentation.  Jack  focused on raising issues that might be useful to discuss in small groups, challenging the group to think strategically and outside of the box.

Early Childhood Development: Emerging Concepts II - The Place of the World Bank in Support of ECD

Establishing an Essential Package for Young Orphans and Vulnerable Children (OVC)
Nicole Richardson, Program Coordinator for the Hilton Initiative, Quality Improvement Specialist for OVC, Save the Children
Nicole presented an overview of a two-year initiative being funded by the Conrad N. Hilton Foundation. The initiative’s main objective is to develop an Essential Package for young orphans and vulnerable children which will include age-appropriate program quality standards.

Developing an Essential Package for Young Children Affected by HIV/AIDS

Say and Play: A tool to help adults support the psychosocial needs of young children
Janine Schooley, Senior Vice President for Program, PCI
While older OVC are more likely to be reached with psycho-social support through primary school and trained home-based caregivers, OVC under-5-6 are often underserved and unable to benefit from psychosocial support until primary school, by which time the psychosocial damage may be extensive. The recently launched Say and Play tool developed by PCI/Zambia was presented, and included a brief orientation to the tool, how to access it, and ideas for utilization.

Say and Play

Improving Your Community Health Worker Program: An interactive introduction to the CHW-AIM tool and approach

Leo Ryan (ICY Macro International), Moderator
Rebecca Furth, Senior Technical Advisor, Initiatives Inc.
Alison Wittcoff, Quality Improvement Specialist, URC- HCI Project
The global public health community has recognized the importance of community health workers to achieving the Millennium Development Goals and providing critical health services to underserved populations. Despite the recognition of the important contributions that CHWs can make and the rapid expansion of health service delivery, no tools exist for helping program managers and key stakeholders assess and strengthen CHW programs. This interactive session introduced participants to the CHW Program Assessment and Improvement Matrix (CHW-AIM) tool and process. CHW-AIM offers a framework for a participatory assessment of CHW programs – based on defined standards in fifteen key CHW program elements – and action planning for program strengthening.  In this session, participants will engage in an interactive exercise to apply the CHW-AIM tool. The exercise was followed by a discussion of the approach and of experiences in applying CHW-AIM.

CHW Program Assessment and Improvement Matrix

Operations Research in Maternal and Child Health Programs: Measurement challenges

Peter Winch, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maternal and Child Health Integrated Program (MCHIP), Washington DC
Jennifer Luna, Maternal and Child Health Integrated Program (MCHIP), Washington DC
The session started with an overview of opportunities for NGOs to be engaged in operational research. It then turned to a presentation on measurement of the mechanisms through which community-based programs achieve their impact.  Much emphasis in recent years has been on how to measure key coverage and health outcome indicators in a standard way. Much less effort has been invested in measurement of the mechanisms through which community-based programs achieve their impact. One reason for this is that it is challenging to measure abstract concepts such as empowerment and social capital. A second reason is that community-based programs frequently seek to affect the entire health system, from the household to the referral facility, to strengthen connections and establish a solid continuum of care. Such a broad undertaking again poses a number of measurement challenges. The session also summarized how MCHIP is working to support NGOs to examine these mechanisms.

Improving measurement through Operations Research

Operations Research In MCH Programs: Measurement Challenges - How MCHIP is working to Support PVOs

Dory Storms Award

Each year at the Annual Spring Meeting, CORE presents the Dory Storms Child Survival Recognition Award to “a person(s) recognized for exceptional efforts resulting in more effective child survival program implementation and increased impact in improving the health of the poorest of the poor including mothers, children, and infants in underserved communities throughout the world.” Each NGO has one vote to select the recipient of the Dory Storms Award from among this year’s nominees.

This year's winners are Dr. Abhay and Dr. Rani Bang.

Roundtables

Roundtable: Operations Research Discussion

Peter Winch, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maternal and Child Health Integrated Program (MCHIP), Washington DC
Jennifer Luna, Maternal and Child Health Integrated Program (MCHIP), Washington DC
This session provided  an opportunity for people with questions concerning specific operations research studies in which they are engaged to ask questions or share experiences. A range of topics were discussed, including: study design and data collection to analysis and paper writing.

Roundtable: Improving Your Community Health Worker Program: The discussion continues

Leo Ryan (ICF/ Macro International), Moderator
Rebecca Furth, Senior Technical Advisor, Initiatives Inc.
Alison Wittcoff, Quality Improvement Specialist, URC- HCI Project
The roundtable continues the discussion begun during the morning Concurrent Session “Improving Your Community Health Worker Program.”  New participants were welcomed to join in the discussion around the CHW Program Assessment and Improvement Matrix (CHW-AIM) tool and process.

Roundtable: Dot-mocracy Results: Burning Issues/Gaps

Natalie Campbell, MSH, Ann Hendrix-Jenkins, CORE Group, Burning Issue Champions, TBD earlier that day…
Champions of the burning issues that emerged during the morning session will meet over lunch to pitch their issue and link up with other interested parties. By the end of the session, participants were able to: describe in some detail what the burning issues and gaps were, and how CORE Group’s Community Health Network should move them forward.

Concurrent Sessions

Gender Equity: A dialog about focusing on gender inequity in order to improve health programming

Facilitators: Jennifer Luna, Jennifer Yourkavitch, Debra Prosnitz,
NGO/PVO Support Team, Maternal Child Health Integrated Project, ICF/Macro International
Panelists: Sunita Kishor, Senior Gender Advisor for the Demographic and Health Surveys, ICF/Macro; Kavita Sethuraman, Senior MCHN Advisor, AED; Elena McEwan, Senior Technical Advisor in Health, CRS

Are you concerned about reducing gender inequalities in order to improve health outcomes? This session provided an opportunity to discuss concerns with gender experts and other participants and to hear ideas on how to address gender in health programs.  This session was part of a process of developing a guidance document for incorporating equity into community focused programs. Participants’ suggestions will be used for this guidance. This session involved a panel presentation from gender experts, small group discussions and dialog between participants and panelists.

Gender Equity: A dialog about using this focus to improve health programming

Sex and Gender: What is the difference?

Gender responsive programming: An approach to planning and implementation

We must hang together, gentle colleagues...else, we shall most assuredly hang separately: Visioning future CORE collaborations

Dora Ward, Sr. Technical Advisor, CORE Group Polio Project
Meg Lynch, Program Associate, CORE Group Polio Project

Using the Secretariat Model of the CORE Group Polio Project, this session will be a facilitated discussion of the factors that contribute to NGO collaboration success and the ways such collaborations can enhance our impact. Presenters described the CORE polio secretariat model and invited descriptions of other collaborative experiences from participants. Participants then identified some of the key features various models have in common and any striking differences.  Finally, presenters led the group in idea generation about future collaborative projects for CORE members and the best structures to use for those potential projects.

By the end of the session, participants were able to:
• describe the CORE secretariat model and its similarities and dissimilarities to other collaborative projects;
• list features that it and other successful collaborative projects have in common, as well as common challenges to collaboration;
• discuss how the technical content and political context of an initiative can influence the optimal structure for collaborative work;
• generate specific, detailed descriptions of potential future collaborative projects in areas of child health among CORE Group members, including suggestions for how a collaborative mechanism should be structured.  (Ideally these projects will lead to further discussion and eventually to seeking resources jointly.)

Lessons Learned Providing Life Saving Interventions through Community Case Management

Yolanda Barbera, Community Case Management Technical Advisor and Senior Coordinator, International Rescue Committee
Amina Issa Mohamud, Regional Community Case Management Coordinator, International Rescue Committee
Jeanne Koepsell, Community Case Management Advisor, Save the Children
Megan Wilson, Child Survival Program Manager, Population Services International

With Canadian International Development Agency (CIDA) funding, IRC, PSI and Save the Children are working to establish an evidence base for the impact on child mortality rates attributable to the community case management (CCM) approach. These programs are large-scale, multi-country initiatives to increase access to life-saving interventions for children under five by providing diagnosis and treatment free-of-charge in communities where no health facility is present. It is estimated that these programs can reduce under-five mortality by between 30 to 40% in the catchment areas and generate high quality data to support potential significant, future investments in CCM to achieve the Millennium Development Goals. Representatives from International Rescue Committee, Save the Children, and Population Services International discuss progress and lessons learned so far; small group work addresd barriers to CCM scale-up.

Community case management: IRC’s experience and considerations for scale up

PSI’s experience in Community Case Management programs

Save the Children’s Community Case Management Initiative

Plenary: How Do Disasters Affect our Work? Health systems, community health & emergencies - Reflections from Haiti, the Influenza Pandemic and more

Janine Schooley, Senior Vice President for Programs, Project Concern International, Moderator
Cate Oswald, Program Manager for Mental Health and Psychosocial Support Services, Partners In Health
Marci Van Dyke, Technical Advisor, Pandemic Preparedness and Response Group, Avian and Pandemic Influenza Unit, Office of Health, Infectious Diseases and Nutrition Global Health Bureau, USAID

CORE Group Members: 
Judy Lewis, Haitian Health Foundation; Director, Global Health Education, Professor, Departments of Community Medicine and Pediatrics, University of Connecticut School of Medicine
Sharon Tobing, Technical Advisor, ADRA China/Independent Consultant
Monica Trigg, Sr. Program Officer Influenza, CARE USA
Ann Varghese, Program Officer, IMA World Health
Kathryn Bolles, Project Director, H2P Initiative

An exciting panel representing diverse programs discussed lessons learned and ongoing challenges to effective preparedness and response posed by the earthquake in Haiti, pandemic flu and other emergencies. Panelists looked at how collective preparedness for and response to disasters, programming and collaboration can be improved. Drawing on their experiences, speakers also discussed the “relief to development continuum” and the “two-prong approach of emergency response and development” as they looked at how best to move forward and be better prepared in the future. A collective participation and discussion period helped to further extrapolate additional perspectives and promising practices.