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CORE C-IMCI Survey Results: Feedback Session

Presenter: Karla Pearcy (consultant to the CORE Group).

Session Objectives:

1. to provide the membership with a summary of results from the recent CORE PVO C-IMCI Survey; and
2. to facilitate small group discussion for further analysis and planning for next steps based on key survey findings.

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C-IMCI Survey Results: Karla Pearcy (Consultant to CORE)

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The CORE C-IMCI Survey Effort:
The CORE IMCI Working Group initiated a qualitative survey effort to gain a better understanding about the C-IMCI work being done by CORE members and the issues they face in relation to its implementation. Given the recent development of the C-IMCI framework and the fact that many PVOs are in the initial stages of applying it to their work, it is clear that the integration and application of the framework on child health efforts will be a long-term process. This study is one effort contributing to the documentation of diverse PVO experiences with the C-IMCI framework to date.

The purpose of the survey was to improve information and resource sharing between PVOs on C-IMCI, based on their experiences in various developing countries.

Methodology:
Telephone interviews were conducted with a total of 41 headquarters health staff from 34 PVOs between November 2001 and January 2002. A 17 question survey instrument was used to gather information in the following areas: 1) PVO understanding, experiences and future plans in relation to the framework; 2) Country specific efforts in C-IMCI field implementation and operations research; 3) Areas of expertise in relation to C-IMCI; 4) Experience with in-country collaboration efforts; and 5) PVO questions or challenges in relation to C-IMCI. Results are reported by "grouping" responses and percentages to indicate trends in relation to their experiences and perceptions, and are not intended to reflect statistical significance.

Study Conclusions:
PVOs bring rich experiences and resources to C-IMCI through their links with community and local partners around the world. Through their C-IMCI efforts, PVOs have demonstrated impact, long-term presence at the district and sub-district levels, diverse implementation efforts, and involvement in advocacy and leadership in the child health field.

The C-IMCI framework, albeit in its initial stages of use, offers PVOs and their local partners an opportunity to engage in dialogue with global, regional, and national leaders to improve child health and nutrition through community-based action. The framework has offered a way for PVOs and their partners to "speak the same language" to describe their work, consolidate their efforts with others, and to better define their niche in health.

C-IMCI Framework at a Communication Tool:
The majority of PVOs perceive the C-IMCI framework as a positive and beneficial communication tool that adequately represents their current community-based child health and development activities. The framework provides a common language for PVO health staff to communicate and share ideas within their organizations, with PVO and NGO colleagues, and with the ministries of health.

The framework has also proven useful for the CORE Group to describe PVO community-based health initiatives to colleagues in USAID, WHO, UNICEF and other agencies. A unified PVO communication strategy for child health has proven to be effective and powerful at the US and global levels.

C-IMCI Framework as a Programming Tool:
Before the framework is more widely used and endorsed as a programming tool, PVOs would like to see practical examples of its positive effects at the field level. Many PVOs follow an experience-based community programming strategy and need to witness the application and positive results of the framework at the national and district levels. (Continued next page)

Since PVOs are now using the framework in proposal submissions and ongoing project efforts, this evidence should be available in the next few years.

C-IMCI as a Strategy:
Even with the positive benefits that C-IMCI has brought into the child health arena, many PVOs may feel more comfortable using the framework to describe their community approach to child health rather than as their C-IMCI "philosophy". In the survey, CORE members cited several factors that have undermined a more rapid acceptance of C-IMCI by the PVO community.

In some countries, the MOH has not yet endorsed C-IMCI. In other countries, C-IMCI is directly linked to health facilities, which is problematic when IMCI training is not rolled out quickly or efficiently, or in underserved areas where facilities/MOH services do not yet exist.

At global, regional, and national levels, definitions of an appropriate C-IMCI strategy differ, and are often equated with modified IMCI training guidelines for health personnel.

In some countries, MOH counterparts are not well versed in community strategies, and have inadequate resources to support community-level activities.

PVO Strengths in the 3 Elements and Multi-Sectoral Platform:
PVOs have demonstrated diverse and successful strategies in the implementation of the three elements and the platform (the survey report includes illustrative examples of PVO implementation). Additional PVO exposure and application to the three elements and multi-sectoral platform is critical to a more in-depth clarification and use of the framework. Ways of communicating linkages and overlaps between the different elements also need to be clarified. PVO documentation of program examples of experiences in each element would facilitate further sharing, adaptation, and possible uptake of the framework by larger numbers of NGOs.

Operations Research:
PVOs are increasing their efforts in community-based child health program operations and applied research. Many of these activities are conducted with the support of universities, and some have resulted in published PVO OR activities in peer-reviewed journals. This is a trend that merits additional support and funding. In general, OR activities are isolated by PVOs and results are not widely shared. A coordinated response to address prioritized community-based child health key issues affecting many PVOs is a potential avenue for future collaborative OR work. Several topics have already been generated at various child health foras - it's a question of prioritizing research efforts, agreeing on a mutually acceptable process, and securing funding. There is a definite need to expand operations research efforts in order to enhance internal and external learning from PVO experiences worldwide.

Partnerships - Organized Collaboration:
A key strength of PVOs, emphasized by all CORE members surveyed, is their partnerships with communities. Partnerships with other colleague agencies (MOH, UNICEF, WHO, World Bank, USAID, cooperating agency community) are increasing at global, regional, national, and district levels but have yet to be maximized. Further documentation on positive examples of interaction at these various levels is needed. Many of these activities take place at country levels but are communicated within the broader child health community. Nurturing and strengthening of in-country PVO collaboration is needed, especially to support the costs of NGO secretariats (for workshops, coordinator time, small funds for activities, etc.). (Continued next page)

Since such secretariats enable PVOs to combine their experiences and expertise and speak in a unified voice, this would be one way to encourage more dialogue between the MOH and PVOs.

Systematized Information Sharing:
There is an ongoing need for PVOs to improve documentation efforts in order to communicate their efforts, lessons learned, and demonstrated impact. As part of this survey process, information was collected from PVOs on their country-specific C-IMCI efforts. It was challenging for the CORE consultant to complete summaries of country information by PVO as originally intended, due to the fact that the information received came in varying levels of detail, organization, and consistency with concepts of the framework.

It was also difficult for CORE to compile a complete list of countries where each PVO is implementing C-IMCI efforts, possibly because many organizations are highly decentralized and may not have comprehensive country-specific information at the headquarters level.

The survey effort involved documenting over 100 materials and tools recommended by PVOs as community-based child health resources for a CORE database. These tools were neither easy to obtain, nor comprehensive.

A more systematic process to document, collect and disseminate CORE PVO experiences and resources is necessary, in order to build on existing knowledge and to avoid "reinventing the wheel". PVOs have impressive field-based accomplishments and important lessons learned in community-based child health to share. The challenge is how to how best systematically capture this information and disseminate it.

Document and Database Introduced:
A draft survey report will be distributed to all PVO members at the CORE Annual Meeting before final dissemination of the document. A full, final report with complete survey findings will be released in late May.

A database currently under development by CORE will provide materials, tools, and other resources recommended by the PVOs surveyed to assist in community child health implementation efforts.

Country specific information on PVOs community-based child health efforts will also be available through this CORE database.

For further information on the survey report or the CORE database, contact:
Lynette Walker, IMCI Coordinator, The CORE Group. lwalker@worldvision.org
(202) 608-1892

Karla Pearcy has a background is in public health (MPH) and social work (MSW, LCSW). She has more than 15 years experience in maternal and child health programs, and is currently working as an independent consultant based in Portland, OR. Since November 2001, Ms. Pearcy has been working with the CORE Group on a PVO Household/Community IMCI (C-IMCI) survey. Previously, she served as Mercy Corps' Director of Health Programs, where she supported Child Survival and health sector strengthening efforts, and was a member of the CORE IMCI Working Group. She has worked with women's and children's health and development programs in Central America, the Caribbean, East Africa, the Caucasus, SE Asia and the Balkans.