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The Faces and Facets of Quality
April 24-28, 2006
The Tidewater Inn
Easton, Maryland
Monday April 24, 2006
Pre-Spring Meeting Event
SBC Workshop: From Determinants to Interventions -- Strategic Choices for Effective Programming
This workshop seeks to assist CORE members in improving their SBC programming through understanding the determinants of different interventions and how to effectively bridge from formative research to selection of interventions. By the end of the workshop, participants will:
1. Understand how the BEHAVE Framework is applied as a planning tool.
2. Understand that the effective packaged behavior change approaches work because they address determinants.
3. Apply an analytical process of identifying determinants addressed by specific packaged approaches in order to make strategic decisions about whether a specific approach addresses their own local determinants and should be part of their project.
4. Articulate and apply decision tools which ensure that approaches selected for use address determinants identified through formative research in the PVO's target communities / among target populations.
Newcomers' Orientation: How You Can Get Involved, How You Can Benefit
Facilitator: Lynette Walker (CORE Group)
PVO and partner staff new to CORE since last year's Spring Membership Meeting are invited to an introduction to CORE Group activities and services and a Q/A time.
Conversation with Jane Vella
CORE Spring Meeting keynote speaker Jane Vella, founder, Global Learning Partners, will hold "office hours" for CORE members who want one-on-one consultation on issues related to quality.
SHOUT Interest Group Meeting
The SHOUT Group (SHOUT) is an informal theme group of PVO practitioners, CORE members, CSTS+, USAID, researchers, and consultants interested in advancing the practice, the art and the science of designing and implementing health programs leading to more sustainable health outcomes in poor communities of the
developing world. The group developed the Child Survival Sustainability Assessment (CSSA) framework and methodology.
The follow is the agenda for the meeting:
1. Continued discussion of the CSSA framework and indicators
2. Outcomes of key meetings (NYC meeting, Bangladesh, etc.)
3. TOR for Group and activity planning for next year
4. Use of the new SUSPRO software for construction of sustainability dashboards
Working Group Chairs Meeting
Working Group Chairs will discuss cross-cutting WG issues and planning processes for FY07 workplans.
Welcome Reception (ADRA Hosting)
Tuesday April 25, 2006
Opening Announcements
Day facilitator: Debbie Herold, ADRA
Welcome Address
Anthony Stahl, Bureau Chief for Program Management, ADRA International
Keynote Workshop: The Faces and Facets of World Class Quality
Jane Vella, Founder, Global Learning Partners, Inc.
This opening session set the tone of the work of the week in its search for salient and practical concepts and skills from Dialogue Education that can assure quality in the home office and in the field. Dr. Vella worked with Principles and Practices of Dialogue Education, Quantum Principles of Management, the Learning Needs and Resources Assessment, and the Learning Task and Evaluation Indicators as tools for both managers and community health educators.
By the end of the workshop, participants had: Used Dialogue Education to examine and test specific concepts, principles and practices and skills that relate to their management and community education issues.
Announcement of CORE Board of Directors Candidates
Sanjay Sinho (CARE)
Lunchtime Roundtable: Dialogue Education
An opportunity to talk more with Jane Vella about the principles discussed during her keynote workshop.
State of CORE
Karen LeBan, Executive Director, CORE Group
Karen introduced new CORE Group member organizations, presented results of the Fall 2005 CORE Group member satisfaction survey, and provided guidance on future directions for CORE.
Working Group Planning Time
Working Groups used this time to review 2006 workplans; move key activities forward; develop FY07 workplans; and discuss technical issues.
USAID's Child Survival and Health Grants Program: Update
Susan Youll, Program Manager/CTO, Child Survival & Health Grants Program, USAID
Wednesday April 26, 2006
Opening Announcements
Day facilitator: Leo Ryan, CSTS+
Announcement of CORE BOD Elections Results
Diana DuBois of the Nominations Subcommittee announced the newly elected members for open positions on the Board of Directors:
Henry Perry (Future Generations) Vice-Chair
Mari Stephens (CARE) Treasurer
Will Story (Christian Reformed World Relief Committee) At-Large Member
Film Clip: My Sister, My Self
This short advocacy film communicates women's joy in birth and motherhood,
as well as their sorrow over the loss of babies, the deaths of sisters,
daughters, friends, aunts and cousins. Its contemporary soundtrack reflects both women's courage and pain.
CORE Variety Show
CORE's eight Working Groups (HIV/AIDS, IMCI, Malaria, M&E, Nutrition, Safe Motherhood & Reproductive Health, Social & Behavioral Change, Tuberculosis) will present skits, interviews, advertisements, songs or other creative demonstrations to convey the goals and activities of each group.
Concurrent Technical Sessions:
1. Using Quality Improvement Checklists To Improve Health Worker Performance
Kimberly Cutler, Health Program Officer, Food for the Hungry
Lauren Erickson-Mamane, Child Survival and Nutrition Programs Coordinator, Food for the Hungry
Do all of the health workers in your project have the same vision of perfect performance?
Do they ever enjoy being supervised? Quality Improvement and Verification Checklists (QIVCs) provide a detailed check of health workers' performance on their key processes in order to monitor and improve their performance, identify "system problems," and to encourage them. QIV checklists are being used in many countries throughout the world to improve key processes in Child Survival projects. QIV checklists not only help us in monitoring our work, they also serve as tools for improving our work. For that improvement to take place, supervisors need to become excellent at offering encouragement to the people with whom they work and in gaining their commitment to change. QIV checklists can be used in a way that provides an opportunity for positive monitoring while sharing a vision of what "perfect performance" looks like. Participants in this session were educated on how to create QIV checklists and use them in a way that helps people to grow personally and professionally and to be encouraged.
By the end of the session, participants had:
- Discussed the purpose and importance of QIVCs;
- Reviewed things that should be done in every educational session;
- Observed a demonstration on how to use QIVCs and filled out a QIVC on Educational Sessions and pulled out the principles of QIVC use from a skit;
- Learned feedback techniques to encourage workers, gain their commitment to change, and help them to enjoy the supervision process;
- Reviewed evidence on the effectiveness of QIVCs in improving health worker performance;
- Practiced calculating a QIVC score, and reviewed data to identify "system problems" and "people problems," and what to do about each kind of problem;
- Reviewed several sample QIV checklists;
- Listened to a talk on how to prepare a QIVC, and identified what types of things can be monitored with a QIVC;
- Reviewed guidelines on how to prepare a new checklist in a group, and discussed several of the more important guidelines.
2. Best Practices in Community-Based Family Planning
Virginia Lamprecht, Senior Technical Advisor, USAID
Elizabeth Warnick, Senior Technical Advisor, USAID
Erin Anastasi, Technical Advisor for Health, ADRA International
Diana DuBois, Executive Director, MIHV
Mahmooda Khaliq Pasha, Program Coordinator, MIHV
Catharine McKaig, Director, ACCESS-FP
Moving Best Practices Forward: Priority Practices to Enhance Family Planning
While 'best practices' are ubiquitous, many key practices which have demonstrated improvement in family planning outcomes remain underutilized at the field level. USAID, with its partners, is seeking opportunities to systematically mainstream ten priority practices to improve the quality of family planning programs. Elizabeth Warnick of USAID will discuss these practices with Erin Anastasi from ADRA, who will discuss how ADRA plans to implement these best practice packages at the field level.
Postpartum Family Planning: Challenges and Opportunities
Community-based programs aimed at maternal and newborn health offer an opportunity to incorporate family planning. This presentation will focus on identifying opportunities to incorporate family planning during the postpartum period, and how to use empirical information for program planning. The session will also focus on community-based LAM and the transition to modern contraception.
Community-Based Family Planning: The MIHV Somali Family Planning/Child Spacing Program
MIHV has worked on international family planning issues for the past 25 years in 7 countries. Since 2000, they have taken many of their community-based family planning lessons learned from overseas work and begun to apply them to their work with the burgeoning Somali refugee community in Minnesota since the state is now home to the largest concentration of Somalis in the US. This presentation will highlight the work of the MIHV Somali Family Planning/Child Spacing program and will showcase which community-based family planning techniques were used. The presentation will describe the framework used by MIHV to implement program activities and the emphasis on assuring quality. Presenters will also discuss the creation of culturally appropriate materials and resources, and how to gain trust and credibility within the community. Finally, the presentation will emphasize how best to conduct outreach and disseminate materials to a largely Muslim community.
By the end of the full session, participants will be able to:
- Name the priority, evidence-based practices USAID is recommending to be incorporated into community-based family planning programs;
- Discuss key challenges and opportunities in incorporating family planning in MNCH community-based programming; and
- Identify how PVO experiences can inform the quality of family planning programs in the United States.
3. Global Implications and Challenges for Community-based Interventions
Tom Schaetzel, BASICS
Dr. Doyin Oluwole, Director, Africa 2010, AED
Adam Slote, USAID
Pierre-Marie Metangmo, PLAN International
Lynette Walker, CORE
This session will explore different global and regional initiatives and discuss strategies for increasing commitment for community-based interventions. Participants will learn about current directions from USAID, WHO, UNICEF, and the World Bank and discuss strategies for aligning PVO efforts with these initiatives in order to expand the scale of community-based programming efforts.
Dory Storms Award Vote
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 PVO has one vote per organization to select the recipient of the Dory Storms Award from among this year's nominees.
Roundtable: What's New in Family Planning Web-Based Materials?
Come learn about the new MAQ IUD Toolkit and the Basics of FP Training Curriculum. The IUD toolkit offers the best available information on how to develop and expand IUD services in RH programs. It includes tools and resources to help implement a variety of IUD-related activities; a compilation of the most up-to-date knowledge and best practices on IUDs; and case studies on IUD-related activities from several countries. The Basics of FP Training Curriculum, piloted earlier this year in Tanzania, is organized around the key components to consider and include when implementing a community-based FP program. It reflects the input and materials of many leading agencies in the field of FP and is currently under revision based upon feedback from the workshop.
Working Group Planning Time
Working Groups used this time to review 2006 workplans; move key activities forward; develop FY07 workplans; and discuss technical issues.
Concurrent Technical Sessions
1. Quality Doesn't Improve Itself - What Do We Do Now?
Janine Schooley, Project Concern International
Bonnie Kittle, Director, Health of Women and Children, Project HOPE
Judiann McNulty, Independent Consultant
Have you ever wondered why the same quality issues keep showing up time and time again? Would you like to have the skills needed to pinpoint, diagnose and eradicate those pesky quality issues? Would you like to better understand how you can help foster those skills in your fellow staff? This session will provide an opportunity to identify and practice the critical skills needed to improve program performance using a composite case study and facilitated small group work.
By the end of the session, participants will have:
- Read and analyzed a case study revealing quality issues.
- Identified several of the most common issues impacting the quality of CS programs.
- Diagnosed factors contributing to these common areas of poor quality using root problem analysis and the "5 Whys."
- Determined who should be involved in the process of quality improvement for different issues.
- Identified the critical skills needed by staff at HQ and in the field so that they are as equipped as possible to diagnose, understand and improve areas of poor quality.
- Recommended the role of HQ backstops in fostering these critical skills in themselves and field staff.
2. Pediatric HIV/AIDS
Ronnie Lovich, Senior HIV/AIDS Advisor, Save the Children
Chewe Luo, Senior Programme Adviser for HIV and Health, UNICEF
Mary Lyn Field-Nguer, Director, HIV/AIDS Programs, JSI/DC and Pediatric AIDS Advisor, BASICS Project/JSI
The session included two presentations on pediatric HIV-related care and treatment. Chewe Luo provided an overview on Pediatric HIV treatment in low resource settings: Challenges and future direction. This will help us to deepen our understanding of the pediatric HIV burden and disease progression in children, the current state of the art of pediatric HIV programming, and where the field is heading. Mary Lyn Field-Nguer presented Targets of opportunity for reaching infants and child with pediatric HIV care, which will review opportunities (and missed opportunities) for reaching children who are HIV- exposed and infected through child health programs and services.
Discussion followed the presentations, with an aim toward identifying particular needs and opportunities that child health programs could better address.
By the end of the session, participants were:
- familiar with the current situation in Pediatric AIDS treatment roll out in resource constrained settings
- able to identify critical linkages and synergies between pediatric AIDS work and child survival programs
- interested in integrating activities related to pediatric HIV/AIDS with child health programs
3. Access, Equity and Appropriate Use: A Discussion on Global Malaria Prevention and Control Activities
Chris White, Malaria Program Director, African Medical and Research Foundation (AMREF)
Keith Holmes, Global Strategic Marketing Manager, BASF Corporation
Thomas Soerensen, Regional Director, Vestergaard Frandsen
Lisa Goldman, Marketing Consultant Sumitomo Chemical, Global Vector Control
Matt Lynch, Malaria Advisor, USAID
Suprotik Basu, Public Health Specialist, World Bank
This session provided participants an opportunity discuss the mechanisms by which malaria commodities are distributed to communities. NGOs were educated about partner perspectives on what is needed to ensure equitable distribution, and discuss NGO roles in conducting behavior change programming for malaria.
By the end of the session, participants:
- Understood how the private sector and donors perceive NGO contributions to global malaria efforts.
- Discussed the NGO role in ensuring that commodities reach the community.
- Discussed the importance of behavior change interventions to ensure appropriate use of drugs, ITNs, and insecticides.
CORE Board or Directors Meeting/Dinner
The newly elected (and continuing) members of the CORE BOD met.
Thursday April 27, 2006
Opening Announcements
Day facilitator: Ndunge Kiiti, MAP International
Update on GAO Audit
Nicole Bates, Global Health Council
Concurrent Technical Sessions:
1. Measuring quality of care at the facility and community levels: sharing of experiences from PVOs using different methodologies
John M. Barrows (International Eye Foundation)
Joan Jennings (CARE): COPE methodology in Sierra Leone
Sarah Porter (Project Hope): WHO/Basics tools in Uzbekistan
Erin Anastasi (ADRA): QIQ methodology in Madagascar and Nepal
Dr. Adelaida Gallardo-DeGregorio (Pathfinder Intl./SCF): PDQ Operations research in Nepal
Bill Weiss (CORE PEI): LQAS to measure quality of service in Nepal
We all seek reliable, low-cost methods for monitoring quality of care at the health facility and community level. Participants will evaluate a variety of strategies, methods, and tools for measuring quality. Five presenters will present their experiences using -- Client-Oriented Provider-Efficient (COPE); WHO/Basics Facility Assessment; Quick Investigation of Quality (QIQ); Partnership Defined Quality (PDQ) and; Lot Quality Assurance Sampling (LQAS) with practical advice on adapting these tools to diverse settings and countries.
Important questions will be explored such as: Do our strategies, methods, and indicators provide a robust picture of the state of quality at the health center and community level? What does quality look like from the perspective of the health provider, the patient, or to families and leaders in the community? Are these methods practical for everyday use in child survival programs and by our government Ministry of Health partners?
Important methodological lessons and practical advice on adapting strategies to different settings will be highlighted. Methods for observing provider-client interactions through observation of counseling and use of clinic protocols; conducting exit-interviews to collect information about the quality of care from the clients' perspective; conducting patient-flow and waiting time studies; conducting facility audits and inventories; and applying LQAS sampling for routine monitoring will be explored. The gap in viewpoints often found between the health workers' definition of quality and the community's definition of quality and how to resolve those gaps will be explored. Issues related to preparation, training, cost, reporting, and sustaining efforts will be reviewed.
By the end of the session, participants were able to:
- Gain new information on approaches and tools that measure quality in a wide range of settings.
- Evaluate the role and appropriate application of these methods that highlight different perspectives and dimensions of quality.
- Recognize the important adaptations made and lessons learned from use of these methods.
- Determine whether these methods are appropriate for your own projects.
2. Developing Quality Partnerships
Sanjay Sinho, MD, Director, Health Unit, CARE
Gerald Walterfang, Chief Executive Officer, Kenya NGO Alliance Against Malaria (KeNAAM)
Alfonso Rosales, LACRO Health Adviser, Christian Children's Fund
Betsy McCallon, Safe Motherhood Advisor, White Ribbon Alliance Global Secretariat
Milton Amayun, World Vision
Partnership is a term used in everyday language, although it also has a specific legal and business application. In recent years, organizations working in development have loosely applied the term to many kinds of inter-institutional collaborations (i.e., Sub-grant, Sub contracts, Joint Venture, Network and consortiums), often using the word to put a positive spin on one-sided or hierarchical relationships. This has led to much ambiguity about what partnership really means.
The session will explore the dimensions of a successful quality partnership by examining lessons learnt from different types of partnerships at global, regional as well as national level. The essential attribute of a successful quality partnership "mutual trust and accountability" can only be fostered if adequate & balanced attention is paid to the mechanics as well as relationship aspect of partnerships.
By the end of the session, participants will:
- Define what is meant by a quality partnership
- Understand attributes of a quality partnership
- Understand different process and systems (mechanics) used by different organizations for creating a sustainable, synergistic partnerships
- Understand the approaches used by different partnerships organizations for building trust among different partners (chemistry)
Concurrent Technical Sessions:
1. Scaling Up and Sustaining Quality Improvement
David Nicholas, Director Quality Assurance Project, URC
Erin Mielke, Regional Coordinator for Latin America and the Caribbean, EngenderHealth
Scaling up and sustaining Improvement Collaboratives
The Improvement Collaborative was originally developed by the Institute for Healthcare Improvement (IHI) in Boston as a way to rapidly spread best practices to multiple settings in the USA. Its use spread to Europe and it has been introduced in 14 developing countries by the Quality Assurance Project (QAP). A collaborative is an organized effort of shared learning by a network of sites (or teams) to:
- Adapt to their local situations a best practice model of care for a specific priority health problem
- Achieve significant results in a short period of time (12-18 mos.) and thus reduce the gap between best and current practice
- Scale up the adapted model throughout the organization using an intentional spread strategy
QAP began to adapt the use of the Improvement Collaborative to developing countries in 1999. Since then, QAP has implemented 21 collaboratives in 14 countries, the majority in Africa. Rapid results have been achieved in these collaboratives, for example a reduction in neonatal mortality due to respiratory disease by 67% in 18 months in the Tver Oblast in Russia.
After an initial "demonstration collaborative," the work has usually scaled up to a "spread collaborative" involving an expanded number of districts or regions. For example, from four districts in two Silais (provinces) in Nicaragua, the Essential Obstetric Care (EOC) Collaborative has now been scaled up to 14 of the country's 17 Silais. In Ecuador, the EOC Collaborative is now operating in 12 of 22 provinces and, as part of that work, the Advanced Management of the Third Stage of Labor (AMTSL) using Oxytocin has now increased from 17% to 63% of facility deliveries. During this spread phase, the collaborative can gradually evolve to a permanent "community of practice," which is network of people or organizations with similar professional goals who communicate to share best practices, research and results to advance the state of the art and improve outcomes and impact. Up until now, the project's work in collaboratives has focused primarily in the clinical area in facilities. QAP believes that the collaborative model can be applied to community programs including Community Nutrition Therapeutic Centers, Community IMCI, Care of Orphans and Vulnerable Children.
Strategies for making COPE and other quality improvement (QI) tools sustainable
COPE®, which stands for "client-oriented, provider-efficient services", is a process and a set of tools designed to help health care staff at a service delivery site continuously improve the quality of their services. COPE was introduced by EngenderHealth to the FP sites' staff in 1988 in Kenya and Nigeria. Now it is used in more than 50 counties worldwide, and COPE tools have been translated into at least 15 languages. Over the years, EngenderHealth has expanded the tools including other areas of reproductive health such as maternal care, child health, prevention of mother-to-child transmission of HIV, cervical cancer prevention, emergency obstetric care, and adolescent reproductive health. EngenderHealth has developed strategies for making the use of COPE and other quality improvement (QI) tools sustainable, which are being used successfully in many countries including the United States. Those strategies are:
- Build local capacity to continuously use and diffuse the use of COPE within a facility (training for internal COPE facilitators and developing and introducing Guidelines and Tips for Adapting COPE);
- Build local capacity to expand the use of COPE within the region/state/country (TOT for COPE facilitators);
- Follow-up on sites and TOT trainees;
- Create organizational support (training on facilitative approach to supervision);
- Create institutional support (work with the MOH);
- Use COPE activities to introduce other QI tools and approaches (Community COPE, the Quality Measuring Tool, Cost Analysis Tool, and the Whole-site Training Approach)
Sustained results and the continuous use of COPE have been reported from Mongolia (since 2000), Jordan (since 2000), Vietnam (since 1999), Cameroon (since 2004), Tanzania (1990), and the United States the State of Oregon (since 2001). This presentation will address EngenderHealth's experiences with making COPE sustainable in a variety of settings.
By the end of the session, participants were able to:
- Understand what a collaborative is, how it evolves to scaling up and then a sustainable community of practice. They were also informed of opportunities to become involved in collaboratives themselves.
- Describe EngenderHealth's strategies for making COPE® and other quality improvement tools sustainable.
2. Capturing Missed Impact: Measuring the Effectiveness of PD/Hearth Programs
Oxford Room
Juan Carlos Alegre, Director of Monitoring & Evaluation, Project HOPE and Chair, CORE M&E Working Group
Judiann McNulty, Independent Consultant
Child Survival projects tend to monitor impact only through KPC surveys at baseline and mid-term or possibly by using sampling such as LQAS for annual monitoring of specific indicators. When the project includes a short-term, high-impact component or approach such as PD/Hearth, the impact of that intervention, which targets a sub-set of the total target population, may not show up adequately in a population-based sample a year or two later. To complicate matters, PVOs and other agencies implementing PD/Hearth are currently using different indicators in different settings, making it difficult to document the effectiveness of the approach in general.
In this concurrent session, participants will take steps to begin the process of harmonizing indicators related to nutritional status and to identify a set of potential behavior change indicators. They will also learn about appropriate sampling methods for sub-sets of a target population. This session is a must for all PVOs implementing or planning to implement PD/Hearth. Others are invited to participate to strengthen their understanding of indicator development and about sampling sub-sets.
- Elluminate Recording: (Presentation Pending)
By the end of the session, participants were:
- able to identify key indicators to measure the effectiveness of PD/Hearth programs in the context of Child Survival projects
- able to identify additional behavior change indicators related to the PD/Hearth approach
- educated on appropriate techniques to measure the effectives of PD/Hearth programs among sub-sets of a target population
3. New findings and programmatic implications for diarrhea prevention and control
Gold Room
Merri Weinger, Program Manager, Hygiene Improvement, Bureau for Global Health, USAID
Julia Rosenbaum, Deputy Director, USAID Hygiene Improvement Project, AED
Meg Galas, Program Manager, New Product Development, PSI
Chuck Szymanski, PSI
Kate Gilroy, Johns Hopkins University
Kate Tulenko, Public Health Specialist, Coordinator of the Global Handwashing Secretary, World Bank
Despite impressive gains made in the 1980s and 1990s, diarrhea remains the second largest infectious disease killer of children under 5. Unsafe water, inadequate sanitation and poor hygiene, the primary causes of diarrhea, are still glaring problems, and use of diarrhea control measures, such as oral rehydration therapy (ORT), is declining in many countries. This presentation describes a package of simple, low-cost interventions for diarrheal disease prevention and management, which should serve as a catalyst for renewed commitment to preventing and controlling diarrhea.
The package includes:
- Hygiene improvement: Three key preventive practices - handwashing with soap, safe storage and treatment of water and safe feces disposal. Each practice typically results in a 30-40 percent reduction in diarrhea prevalence;
- Oral rehydration therapy (ORT), that is early replacement of fluids at home followed by oral rehydration solution, if necessary. Can decrease deaths due to dehydration;
- Zinc (20 mg for 10-14 days during and after diarrhea) to shorten the duration and decrease severity of the diarrheal episode and prevent a reoccurrence in the following 2-3 months;
- Continued feeding (and/or increased breastfeeding), and;
- On the horizon, the rotavirus vaccine is a potential preventive intervention which is being tested in some countries. Rotavirus is the cause of approximately one third of all diarrhea related cases.
The session will focus on different elements of this package, using country case studies and experiences with recommendations on how they can be integrated into ongoing programming for diarrhea prevention and control.
By the end of the session, participants were:
- Exposed to new research and innovative approaches for prevention and case management of diarrheal diseases.
- Able to apply relevant new approaches to their programming for diarrhea prevention and control.
Roundtable: Malaria efforts in Kenya, Tanzania, Uganda and Zambia (one country per table)
Malaria Secretariat Coordinators from Kenya, Tanzania, Uganda, and Zambia will be available during lunch to discuss their organizations, accomplishments, plans for the future, and CORE member involvement. This is an opportunity to learn more about the networks and how you can get involved.
Working Group Planning Time
Working Groups used this time to review 2006 workplans; move key activities forward; develop FY07 workplans; and discuss technical issues.
Concurrent Technical Sessions:
1. Community-based Therapeutic Care for Treatment of Acute Malnutrition
Fred Grant, Maternal and Child Health and Nutrition Specialist, The Fanta Project/AED
Valerie Gatchell, Concern Worldwide
Toby Stillman, Save the Children
Judiann McNulty, Independent Consultant
Tanya Khara, Technical Advisor, Valid International
Community-based Therapeutic Care (CTC) programs aim to provide rapid, effective, low-cost treatment of severely malnourished by treating the majority of cases at home with ready to use therapeutic foods (RUTF), rather than in traditional therapeutic feeding center (TFCs). CTC is a public health approach that attempts to maximize coverage, population-level impact and cost-effectiveness, which have been challenges to traditional TFCs. CTC utilizes and builds on existing community capacities, thereby helping to equip communities to deal with future periods of vulnerability.
This session will introduce participants to the CTC approach, contrast CTC with other community based nutrition rehabilitation programs, and present case studies of the experiences of two CORE Member organizations who have been implementing CTC. The session will also include a moderated discussion between the audience and the panelists.
By the end of the session, participants gained a working knowledge of Community-based Therapeutic Care and participated in a discussion about the strengths and weaknesses of the approach in various settings.
2. Avian and Pandemic Influenza: NGOs' Role and Response
Whitney Pyles, Avian Influenza Coordinator, CARE
Seth Nickinson, Senior Program Associate for Humanitarian Policy and Practice, Interaction
Milton Amayun, Senior Technical Advisor, The Hope Initiative, World Vision International
Avian flu has been a hot item in the news this year and has attracted a lot of attention from the NGO/PVO community. In this session, three panelists currently involved in avian flu work at their respective organizations will brief participants on the latest information pertaining to programming, staff safety and security, and advocacy.
Panelists will also speak about the partnerships being developed around avian flu, current activities in the field and potential response by civil society. Practical information concerning the best resources for NGOs will be available and time for Q&A will allow participants to discuss issues facing their organizations and meet others working on the issue.
By the end of the session, participants:
- Understood the role of NGOs and civil society in avian flu response
- Were brought up to date on current information concerning avian flu and its effects on programming, staff safety issues, advocacy and business continuity
- Were educated on the best available resources for avian flu
- Made contacts with others in the NGO world who are working on avian flu
3. Quality Program Messages: Science or Art?
Eric Swedberg, Child Survival Specialist, Save the Children
Ann Jimerson, Senior Program Officer, Academy for Educational Development
You've identified the behavior you will promote with the primary and secondary groups with whom you work. Through participatory research with priority group members, you have a short list of the behavior's determinants and a clear idea of the key factors that must be in place if your program is to succeed. Now: What will your program "say?"
Through a case study and hands-on practice, hone your skills in designing the messages - verbal and non-verbal - that your program communicates. Listen to priority group members in ways that make the job easier. Learn to walk the line between science and art as you fine-tune the program's explicit and implicit messages. Consider ways to monitor the messages' effects and adjust them as needed.
By the end of the session, participants will be able to name three principles of the art and science of message design.
Dinner and Social Event (Project HOPE hosting)
Friday April 28, 2006
Opening Announcements
Day facilitator: Rebecca Magalhaes, La Leche League International
The NEW WHO Growth Standards
Kristen Cashen & Judiann McNulty
CSTS+ Project Update
Leo Ryan, Director, CSTS+ Project
How Many Lives Are Saved By Child Survival Projects?
Jim Ricca, Capacity Development Advisor, CSTS+ Project
Rozalin Davoodnia, Concern Worldwide
Methods
The Bellagio Study Group methodology developed for the Lancet articles on child survival (2003) and neonatal survival (2005) was used to estimate the number of lives of children under five saved during project periods for all 13 recently completed CSHGP projects in "Bellagio countries." The needed information was abstracted from documentation for the thirteen projects that submitted their final reports in the last year (June 2004 - June 2005): beneficiary data and baseline/final coverage levels for each of 15 Bellagio Group evidence-based child survival interventions. This information was supplemented with national level DHS data to estimate baseline numbers of births and child deaths by cause in the project areas.
Findings
For $12.6 million USAID investment ($18.2 million total), these 13 projects are estimated to have saved 9,688 lives during their 3-5 year project periods (4.2y avg.). They are estimated to have reduced child mortality by an average of 13% (range 0.1 - 34%) at a cost of $1,235 per life saved ($1,005 counting only the resources allocated to Bellagio interventions). Four projects achieved mortality reductions of more than 25%. Each of the top three projects is estimated to have saved over 1,000 lives; costing $1.43, $3.95, and $4.84 per beneficiary; and $217, $486, and $935 per life saved (USAID cost). Assuming comparable levels of mortality reduction to these recently completed projects, it is predicted that the currently-funded portfolio of 71 USAID-supported NGO maternal and child health projects will collectively prevent 77,000-100,000 child deaths during their 4-5 year project periods.
Conclusions
The Bellagio Study Group estimated the impact that would be achieved by reaching universal coverage for about 30 neonatal/child survival interventions of known effectiveness. Applying this same methodology to 13 actual CSHGP projects that implemented 15 of these interventions, we estimate that CSHGP projects achieve an impressive level of impact at low cost when implementing comprehensive packages of these evidence-based interventions through integrated community-based delivery mechanisms.
By the end of the session, participants were be able to:
- Describe the method used for the Lives Saved analysis in the 2005 CSHGP Annual Results Review, which was the same method as was used in the 2003/2005 Lancet Child and Neonatal Survival articles
- Describe the outcomes and estimated level of impact of a group of recently completed CSHGP projects
Plenary: Working in Fragile States
Ron Waldman, Fragile States Consultant, BASICS Project and Professor, Mailman School of Public Health, Columbia University
Katharine Haxall, Child Survival and Health Program Manager, International Rescue Committee
One of the five new USAID core strategic goals for foreign aid is to "strengthen fragile states". USAID describes this goal as follows: "Reduce fragility and establish the foundation for development progress by supporting stabilization, security, reform, and capacity development in countries characterized by instability and weak governance, when and where US assistance can make a significant difference". DFID also has adopted strategic goals for "Difficult Environments" defined as "those areas where the state is unable or unwilling to harness domestic and international resources for poverty reduction." Ron Waldman explored some of the reasons that have brought about this shift in goals; how donors have begun to address states that are poor performers in terms of development outcomes; perceptions from different countries on their needs for development assistance; and operational approaches that can be used by the PVO/NGO community to strengthen pro-poor public services in difficult environments. Katie Haxall presented a case study of difficulties and opportunities presented by IRC's work in the Democratic Republic of Congo.
Meeting Wrap-Up
Rebecca Magalhaes, La Leche League International
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