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CSI: Atlanta
April 14-18, 2008
The Atlanta Sheraton
Atlanta, Georgia
Monday | Tuesday | Wednesday | Thursday | Friday
Monday April 14, 2008
Day facilitator: Lynette Walker, CORE
Newcomers’ Orientation: How You Can Get Involved, How You Can Benefit
Facilitator: Lynette Walker, Deputy Director, CORE Group
Working Group Chairs
PVO and partner staff new to CORE since last year’s Spring Membership Meeting were introduced to CORE Group activities and services. Working Group Chairs were on hand to talk about activities and answer questions.
SHOUT Interest Group Meeting
The SHOUT Group (SHOUT) is an informal 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 Sustainability Framework for planning and measurement of sustainability outcomes and determinants.
The SHOUT Group had its general meeting to discuss progress over the last year and make plans for the upcoming year, also held a session on measurement of organizational capacity and viability.
Opening Session
Welcome
Robin Davis, Executive Director, Global Health Action
Official welcome and start of this year’s CORE Group Spring Membership Meeting.
State of CORE
Karen LeBan, Executive Director, CORE Group
Karen LeBan introduced the research theme for the Spring Meeting and updated members and colleagues on child survival trends and CORE Group accomplishments over the past year. Lynette Walker presented an overview of the Spring meeting agenda.
CORE Board of Directors Report
Tom Davis, Chair, CORE Group Board of Directors, Director of Health Programs, Food for the Hungry
Tom Davis discussed the CORE Board of Directors’ activities over the past year, activities and direction for the upcoming year, and outlined needed bylaw changes.
Announcement of CORE Board of Directors Candidates
Henry Perry, Vice Chair, CORE Group Board of Directors, Future Generations
Henry Perry explained the Board of Directors election process and presented the slate of BOD candidates.
Welcome Reception
Thank you to Vestergaard-Frandsen for co-sponsoring the Welcome Reception.
Hosts: CARE, GHA, MAP International, Mercy Corps.
Tuesday April 15, 2008
Opening Announcements
Day Facilitator: Allyson Brown, Concern Worldwide
Welcome:
Bethann Cottrell, Team Leader for Child Health and Nutrition, CARE
Keynote Presentation: Practical and Pragmatic: Strategically Applying Gender Perspectives to Increase the Power of Global Health Policies and Programs
Sarah Kambou, Chief Operating Officer, Vice President, Health and Development Group, International Center for Research on Women
At the Millennium Summit in 2000, the United Nations made a commitment in the Millennium Declaration to achieve the Millennium Development Goals (MDGs) by the year 2015. As the clock ticks, the MDGs are challenging development experts to produce more, better, faster results in an ever waning time period. In those parts of the world where poverty is deeply entrenched, it is that much more difficult to address the entwined social, economic and structural factors that have entrapped families and communities in poverty for generations. Those who suffer most are women and children, as evidenced by high rates of maternal and child mortality, poor health and nutritional status, and in certain pockets of the world, the emerging feminization of the HIV epidemic. Despite uneven progress on the MDGs to date, with renewed political commitment among world leaders and ever increasing amounts of public and private dollars flowing to development, progress will be made.
This talk reflected on the role of the International Center for Research on Women (ICRW) in addressing global health problems and crafting gender-responsive, evidence-based solutions through research and advocacy. The critical role that NGOs have played in shifting priorities in global health was highlighted, followed by a discussion of three principles that have been derived from ICRW’s learning as an NGO. These three principles are:
- Base all action on evidence
- Trust in the power of partnership
- Monitor progress and evaluate results
Presentation: What are we doing? Finding a common language to discuss research
Peter Winch, Director, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
People employ a wide variety of terms when they communicate about research and research methods. More often than not these terms impede rather than promote partnerships in research. This brief presentation described the sources of confusion related to terminology, and proposed a common language conference participants might use in discussions during the conference.
Role of NGOs in Global Health Research and Development: Plenary panel on partnering with universities
Peter Winch, Director, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Moderator
Judy Lewis, Technical Backstop Haitian Health Foundation; Professor of Community Medicine and Pediatrics, Director of Global Health Education, University of Connecticut School of Medicine
Meredith Fort, Health Alliance International
Sarah Kambou, Chief Operating Officer, Vice President, Health and Development Group, International Center for Research on Women
Eric Swedberg, Child Health and Nutrition Advisor, Save the Children
This brief panel followed-up the presentations on NGO research. Panelists addressed whether and how it is possible for NGOs, universities and other research organizations to engage in mutually beneficial research. Key issues from the plenary were described by experienced "on-the-ground" research collaboratives.
Concurrent Technical Sessions
1. Working at the local level: Using research to improve programs
Pierre-Marie Metangmo, Dean of Future Generations Graduate School of Applied Community Change and Conservation, Moderator
Henry Perry, Carl E. Taylor Prof. of Equity and Empowerment, Health
Vandana Tripathi, Program Director, Doctors of the World-USA
Jennifer Olson, Program Manager, Doctors of the World-USA
Carolyn C. Kruger, Ph.D. Maternal Child Health Sector Specialist, World Vision US
Pierre-Marie Metangmo of Future Generations moderated a panel which examined the hands-on, directly utilized research process used by NGOs to answer questions at the local level for program improvement. Panelists focused on operations research (OR) issues that NGOs may hold in common, using their field experiences to set a context for the discussion. Challenges for ensuring successful OR include asking the right questions, selecting an appropriate research design and methods, and ultimately using the results to improve programming. OR is also an opportunity to build the capacity of field staff.
Pierre-Marie and Henry Perry shared with the panel how Future Generations, through its Graduate School Master's Program, teaches and facilitates OR with students and partner organizations in their respective communities.
Doctors of the World-USA: Using Implementation Research to Understand the Effectiveness of A Semi-Mobile Clinic Model for Rural AIDS Treatment
Vandana Tripathi, Program Director, Doctors of the World-USA
Jennifer Olson, Program Manager, Doctors of the World-USA
Doctors of the World-USA (DOW) is partnering with Indiana and Moi Universities to deliver HIV/AIDS services in the rural West Pokot District of Kenya by adapting the Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) for use with a more dispersed, semi-nomadic population. To better serve HIV-positive clients in these rural areas, DOW initiated semi-mobile clinics in which a team of clinicians and social workers from the District Hospital organizes monthly visits to five rural health centers to provide ARVs, clinical monitoring, and psychosocial support. After implementing semi-mobile clinics for one year, DOW sought to determine whether this model for rural care was effective – whether semi-mobile clinics had maintained quality of care, been acceptable to patients, and lowered obstacles to access for rural communities. DOW conducted a case study, reviewing patient records from semi-mobile clinics and the District Hospital and conducting interviews with patients and providers. DOW used these data to compare demographic information, distance/time required to reach care, care-seeking behaviors, adherence, and satisfaction. The presenters reviewed the process of identifying and narrowing research questions and gathering data; summarized the key findings; and discussed the ways in which lessons learned from both the research process and findings have been used or will be used to strengthen the project.
World Vision India Operations Research on Standard Days Method and Lactational Amenorrhea Method
Carolyn C. Kruger, Maternal Child Health Sector Specialist, World Vision US
Contraceptive prevalence is low and unmet need high in the state of Uttar Pradesh (UP) India, and particularly in Ballia district. The overall aim of the study was to introduce Standard Days Method (SDM) and Lactational Amenorrhea (LAM) to the existing range of methods in a community-based child survival project. Using a timed series design with intervention and control groups, the study trained community volunteers and supported counseling and provision of the methods. Cohorts of post-partum mothers were tracked over a series of pre and post intervention points. The introduction of SDM and LAM has significantly increased the use of modern contraception among mothers of children aged 0-11 months. It is feasible to integrate these methods into the existing range of FP methods within the setting of a community based child health program.
By the end of the session, participants gained an appreciation for a community -based model that introduced new FP methods that significantly increased the use of modern contraception among mothers of children aged 0-13 months and has been an effective way of meeting unmet needs for FP among post partum mothers.
2. Strategies to improve access to artemisinin-based combination therapy for malaria
Eric Swedberg, Child Health and Nutrition Advisor, Save the Children, Moderator
S. Patrick Kachur, Chief, Strategic and Applied Sciences, Malaria Branch, Centers for Disease Control and Prevention
Katharine Haxall, Child Survival and Health Program Officer, International Rescue Committee
Improving access to antimalarial combination therapies: Lessons from implementation research
S. Patrick Kachur, Chief, Strategic and Applied Sciences, Malaria Branch, Centers for Disease Control and Prevention
Enhancing equitable access to effective malaria treatment with artemisinin-containing combination treatment (ACT) is a global malaria control priority. Unfortunately there is less clarity on how this can be best achieved. Regulatory authorities often seek to enclave ACTs in the formal health care delivery system where it is perceived that they will be better controlled and deployed rationally. Authorities often cite concerns about drug quality, antimalarial drug resistance, costs, and risks of side effects in defending their position. Malaria control officials increasingly consider deploying ACTs more broadly through community health workers or retailers in order to overcome the coverage limitations of the former health system. They frequently argue that these interventions are needed to ensure adequate and equitable access, contribute to the reduction in malaria transmission, and produce gains in child survival. Advocates on neither side are supported by a clear evidence base. In this session presenters reviewed recent findings from ACT implementation research projects and considered how they contribute to the debate over access to ACTs. In particular, discussion focused on evidence relevant to policy makers.
Breaking the Policy Barrier
Katharine Haxall, Child Survival and Health Program Officer, International Rescue Committee
Home management of malaria, also referred to as community case management (CCM), has been shown to reduce all-cause child mortality by 40% . CCM of malaria is cited as an important means to increase access to prompt treatment and make progress toward achieving Millennium Development Goal 4. There has been little scale-up of this effective intervention to date, due in part to difficulty operationalizing policy at both local and national levels. Eighteen countries have established a permissive policy for home management of malaria, but many are not implementing it.
International Rescue Committee (IRC) reported on its experience in Sierra Leone, the country consistently ranked with the highest under-five mortality rate in the world. No CCM policy existed in Sierra Leone prior to the IRC’s program, which began as a pilot project in two areas with the highest concentration of health facilities. Several conditions helped to establish such a policy.
3. Building effective partnerships for HIV-MCH programming
Ann Hendrix-Jenkins, Coordinator, TB Working Group, CORE Group, Moderator
William C. Philbrick, Program Manager, Sr. Technical Advisor, HIV/AIDS Unit, CARE, USA
Lessons Learned from Consortium Partnerships
William C. Philbrick, Program Manager, Sr. Technical Advisor, HIV/AIDS Unit, CARE, USA
There is a new paradigm developing in the way NGOs and other members of civil society operate. Under this new paradigm, specialists and organizations in various sectors (health, economic development, and education) are increasingly recognizing the advantages, and even the necessity, of working in collaboration and partnership. Discussion in this session focused on CARE’s experience in working through partnerships that involved both the traditional HIV and health sectors, specifically MCH.
The speaker identified the characteristics of effective inter-sectoral partnerships, as well as the pitfalls that impact the ability of partnerships working in the HIV and health sectors (e.g. MCH) from achieving their objectives. For many working in the HIV world, there is a tendency to not fully appreciate the role that MCH objectives play toward the larger overall objectives of HIV policymakers.
By the end of the session, participants aquired a better understanding of:
- what factors are necessary for a successful partnership, as well as the pitfalls that tend to undermine programmatic partnerships
- various strategies for developing, linkages and collaborations between potential partners in the traditional HIV and health sectors, and being able to advocate with decision makers in each of those sectors of the advantages of inter-sectoral linkages, collaborations and partnerships
Lunch Roundtable: "I want to publish but don’t know where to start."
Peter Winch, Director, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
David Marsh, Save the Children USA
This informal lunchtime discussion was for people who have thought about trying to get their results published, but haven't known where to start, or even if it is worth trying. Participants shared their ideas and questions about publishing. Peter and David provided feedback on possible next steps.
USAID Directions
Nazo Kureshy, Team Leader CSHGP, USAID
Erica Lutz, Technical Advisor CSHGP, USAID
Leo Ryan, Project Director, CSTS+
Nazo Kureshy opened this session with a presentation on USAID global initiatives in MCH, followed by more detail on the CSHGP and a particular focus on the CSH Network with Erica Lutz. Leo Ryan concluded with some key points about CSTS+.
Working Group Directions: "CSI Investigates"
Marilyn Patton, HOPE worldwide, Moderator
Working Group Planning Time
Working Groups used this time to review 2008 workplans; move key activities forward; develop FY09 workplans; and discuss technical issues.
Malaria Working Group
RMB Presentation
Matthew Lynch, Director, Global Program on Malaria, Center for Communication Programs
Global Fund Round 8 Collaboration
Global Fund for AIDS, TB, and Malaria Round 8 offers an unprecedented opportunity for PVO involvement in proposal submissions. The GF has mandated that each country has a civil society organization (CSO) as principal recipient and is encouraging involvement of civil society consortia. Those interested in working in a country with other CORE Group members shared their ideas. Proposals are due in June: this is the time to act.
Community Based Primary Health Care Working Group Meeting
CBPHC is currently an area of increased interest and funding by major donors such as UNICEF, WHO and the World Bank. Now is a good time to get involved in this area. Participants heard updates on the Working Group's activities including its review of the evidence base for CBPHC funded by the above donors, research scholarships, annual workshop at the APHA meeting and other activities promoting CBPHC.
Wednesday April 16, 2008
Opening Announcements
Day facilitator: Ruth Madison, Project HOPE
Welcome:
Chris Palusky, Director, Humanitarian Affairs and Relief Office, MAP International
Announcement of CORE BOD Elections Results
Henry Perry presented the newly elected members for open positions on the Board of Directors.
Concurrent Technical Sessions
1. Opportunities for NGO-CDC collaboration in TB
Elena McEwan, Senior Health Technical Advisor, Catholic Relief Service, Moderator
Peter Cegielski, Team Leader, Drug-Resistant TB, International Research and Programs Branch, Division of TB Elimination, Centers for Disease Control and Prevention
CDC’s Division of TB Elimination works internationally with many NGOs including professional associations, foundations, academic institutions, contract research organizations, humanitarian organizations, corporations, and donor agencies. Examples include the Stop TB Partnership, the International Union Against TB and Lung Disease, the Royal Dutch TB Foundation (KNCV), Medecins Sans Frontière, Partners in Health, Socios en Salud (Peru), the International Federation of the Red Cross, the Tropical Disease Foundation (Manila), Management Sciences for Health, the American Thoracic Society, the American Lung Association, the Infectious Diseases Society of America, Harvard Medical School, Emory University, the Bill and Melinda Gates Foundation, the Foundation for Innovative New Diagnostics, the Global Alliance for TB Drug Development, Aeras Vaccine Foundation, CARE, and many others.
By the end of the session, participants were better informed about DTBE’s international work with NGOs.
2. Advancing the evidence for child survival
Using the Lives Saved Calculator
Jim Ricca, Capacity Development Advisor, CSTS+, Macro International
Update of the Review of the Effectiveness of CBPHC in Improving Child health
Henry Perry, Carl E. Taylor Prof. of Equity and Empowerment, Health, Future Generations
Jim Ricca, Capacity Development Advisor, CSTS+, Macro International
Nazo Kureshy, Team Leader CSHGP, USAID
Jim Ricca demonstrated actual use of the Lives Saved Calculator, discussing the results that are obtained, their meaning, and limitation of the data. Henry Perry and Nazo Kureshy followed with a brief update on the CBPHC review and the Expert Review Panel meeting held March 27-8 at UNICEF in New York City. The focus shifted to application of the calculator: Jim Ricca led this discussion with the review and identification of highly cost-effective projects prepared at CSTS+. Various PVO staff followed-up informally through sharingd their own experiences with the calculator. The focus was on how the calculator was used, what was concluded, and what cautions or potential drawbacks were observed in using it.
3. Community-based strategies for newborn care
Lisa A. Bowen, Reproductive, Maternal and Newborn Health Advisor, Plan USA, Moderator
Davidson H. Hamer, Associate Professor of International Health and Medicine, Center for International Health and Development, Boston University Schools of Public Health and Medicine
Judith Standley, UNICEF Maternal-Newborn Consultant
Stephen Wall, Senior Research Advisor, Saving Newborn Lives, Save the Children
The Lufwanyama Neonatal Survival Project
Davidson H. Hamer, Associate Professor of International Health and Medicine, Center for International Health and Development, Boston University Schools of Public Health and Medicine
The Lufwanyama Neonatal Survival Project (LUNESP) is a randomized, controlled trial of a package of interventions designed to reduce neonatal mortality in Lufwanyama District, an impoverished rural site in the Copperbelt Province of Zambia. This study is being carried out in close collaboration with the Lufwanyama District Health Team. Traditional birth attendants (TBA) in the intervention arm have been trained to provide a simplified form of neonatal resuscitation in babies with respiratory distress, perform a simple measure to reduce the risk of hypothermia, help mothers to identify babies with potential neonatal sepsis, and provide initial treatment for possible serious bacterial infections before referring to the local health centers whereas the TBAs in the control arm are following routine clean delivery practices without the supplemental interventions.
Introduction to the Home-based Mother and Newborn Training Package
Judith Standley, UNICEF Maternal-Newborn Consultant
It is a myth that advanced technology and medical care are needed to substantially reduce the burden of death and disease among newborns. In a case controlled study in Gadchiroli District, Maharashtra State, India, the neonatal mortality rate decreased by 62% over a period of 3 years by training local women with limited education to provide essential interventions during pregnancy, at the time of delivery, and in the crucial first days and month after delivery. Although maternal mortality could not be measured in this study, maternal morbidities were reduced by 50%. These findings are being replicated in other countries and settings as well. Essential interventions include drying the newborn and keeping him/her warm, initiating breastfeeding as soon as possible after delivery and supporting the mother to breastfeed exclusively, giving special care to low-birth weight infants, screening for maternal and newborn danger signs, and referral/treatment as appropriate. Experts estimate that with the provision of essential interventions at scale, the neonatal mortality rate can be reduced up to 70%.
This presentation reviewed the home-based model (SEARCH and others) and explained how the UNICEF Home-based Care for Mother and Newborn package was developed. The main components of the package were discussed and excerpts from the accompanying skills DVD shown.
Community-Based Identification and Management of Newborn Infections: Research Findings and Program Implications
Stephen Wall, Senior Research Advisor, Saving Newborn Lives, Save the Children
Newborn infection is the leading cause of neonatal mortality, and most neonatal deaths due to infections can be averted by known preventive and management interventions. Community case management of newborn infections requires timely identification of signs of illness, with prompt initiation and completion of an appropriate course of antibiotics. This session presented updated evidence on the effectiveness and feasibility of community-based management of newborn infection. New evidence on algorithms to detect newborn illness were also shared. The session concluded by detailing the current research steps underway to develop simplified antibiotic regimens that are feasible to deliver by community health workers, acceptable to families, and effective in improving newborn survival.
Concurrent Technical Sessions
1. Partnering with universities
Judy Lewis, Professor, Departments of Community Medicine and Pediatrics, University of Connecticut School of Medicine; Technical Backstop KOMBIT, Haitian Health Foundation, Moderator
Bette Gebrian, Director of Public Health, Haitian Health Foundation
Eric Swedberg, Child Health and Nutrition Advisor, Save the Children
Meredith Fort, Health Alliance International
Mary A. Yetter, Sr. Advisor Sexual and Reproductive Health, CARE USA
Judy Austin, Head: Research, Monitoring and Evaluation, The RAISE Initiative, Columbia University
This session addressed the benefits and pitfalls of NGO - university research collaborations and provided examples of successful collaborations. After an introduction by Judy Lewis, presenters shared brief descriptions of recent research collaboration including the topic of the research, how the partnership was established, funding, examples of the process of conducting research (successes/challenges), how the research was used by the NGO to improve program services, and advice about how to approach developing partnerships for research. Issues with Institutional Review Boards were also discussed.
2. Community case management: Research to reality
Alfonso Rosales, LACRO Health Advisor, Christian Children’s Fund, Moderator
David Marsh, Save the Children USA
Kate Gilroy, Assistant Scientist, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Peter Winch, Director, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Davidson H. Hamer, Associate Professor of International Health and Medicine, Center for International Health and Development, Boston University Schools of Public Health and Medicine
Anna West, Child Health Coordinator, CORE Group
This session focused on community case management (CCM), a critical strategy to increase access to appropriate treatment for malaria, pneumonia, and diarrheal diseases among young children in developing countries. Grounded in high quality training and supervision of community health workers (CHWs) to assess, classify, treat, and refer major infectious causes of mortality in young children, CCM is rapidly becoming a preferred strategy for service deliver in low-resource environments where access to fixed health facilities is limited and/or utilization is low.
Presenters shared research findings and discussed implications for CCM advocacy, program design, and scaling-up. David Marsh presented findings from a study of policies and implementation of CCM for pneumonia in 57 countries in Africa and Asia, focusing on questions of advocacy, coverage, scale, and monitoring CCM efforts at the national level. Kate Gilroy discussed research in Mali on elevated antibiotic use the community, emphasizing implications for CCM program design and related advocacy messages. David Hamer shared preliminary results from a collaborative study underway with SAWSO and two district health management teams in Zambia that examines multiple operational parameters for CCM, including the use of rapid diagnostic tests (RDTs) and treatment with ACTs for malaria, and treatment with amoxicillin versus referral for pneumonia. Peter Winch shared recent findings from a study in Mali that examined gains in zinc and ORS utilization following the introduction of one or more CHWs in a village setting. Anna West previewed an upcoming joint publication of CORE, BASICS, and Save the Children that will provide guidance to field program managers for design, implementation, and evaluation of CCM programs. Discussion focused on practical implications of research findings for NGOs engaged in collaborative efforts to expand access to treatment services through CCM strategies.
Community case management of pneumonia: at a tipping point? (David R Marsh, Kate E Gilroy, Renee Van de Weerdt, Emmanuel Wansi & Shamim Qazi)
David Marsh, Save the Children USA
Pneumonia is the leading cause of child mortality globally. Community case management (CCM) of pneumonia by community health workers is a feasible, effective strategy to complement facility-based management for areas that lack access to facilities. We surveyed experts in the 57 African and Asian countries with the highest levels and rates of childhood mortality to assess current policies, implementation, and plans regarding CCM of pneumonia. About one-third [37% (20/54)] of countries reported policies supporting CCM for pneumonia, and another third [33% (18/54)] reported no policy against the strategy. Half (27/54) the countries reported some implementation of CCM for pneumonia, but often on a small scale. A few countries sustain a large-scale program. Programs, community health workers and policy parameters varied greatly among implementing countries. About half of non-implementing countries [46% (12/26)] are planning to move ahead with the strategy. Momentum is gathering for CCM for pneumonia as a strategy to address the pneumonia treatment gap and help achieve Millennium Development Goal 4. Challenges remain to: (1) introduce this strategy into policy and implement it in high pneumonia burden countries; (2) increase coverage of this strategy in countries currently implementing it; and (3) better define and monitor implementation at the country level.
By the end of the session, participants were able to characterize the shift in global policy, practice, and plans for the community case management of pneumonia – and use the evidence to advocate for resources to scale up and sustain the strategy.
Elevated antibiotic use: What are the implications for CCM programs?
Kate Gilroy, Assistant Scientist, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
The international community has called for widespread introduction of the community case management of pneumonia (CCM/P) in order to reach MDG-4. Many of the early CCM/P research studies and pilot experiences took place where access to antibiotics in the community was limited. As the CCM/P strategy is introduced into new areas, the existing use of antibiotics in the community must be taken in to consideration. Through household surveys, complemented by qualitative data collection, JHU found elevated rates of antibiotic use among children sick in the previous two weeks in southern Mali. Forty-five percent of children received an antibiotic during the course of their illness and over 65% of antibiotics were obtained from an unauthorized source of treatment, such as itinerant vendors, small shops, and/or market stalls. Among children with suspected pneumonia, 52% received an antibiotic; however, half of the antibiotics were from a health facility and half were from unauthorized sources. Discussion focused on the ramifications of high levels of antibiotic use in the community (outside of health facilities or authorized community health workers) on the 1) expected mortality impact of CCM/P programs, 2) program design and measurement, and 3) advocacy for CCM/P programs.
Is one community health worker per village enough? Findings from a zinc introduction study in Mali
Peter Winch, Director, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Diarrhea remains one of the top causes of under-five child mortality in developing countries. Zinc has been proven efficacious in reducing the duration and severity of diarrhea. Presenters showcased selected results from a study in Mali on introduction of zinc for diarrhea through health centers and community health workers. The study was a collaborative effort between Save the Children, the University of Bamako, the Mali Ministry of Health, and Johns Hopkins University. The study was conducted in 12 health zones of Bougouni District, Sikasso Region in southern Mali from May 2005 to August 2007, 6 randomly assigned to each of two study arms. Oral rehydration salts (ORS) and 14-day courses of dispersible zinc sulphate tablets (20mg) were available through first-level health facilities and community health workers (CHWs), and promoted through counseling, radio programmers, and community meetings. In the Intervention Arm, zinc tablets were available from health facilities and CHWs. In the Comparison Arm zinc was available through first-level facilities only. Baseline and final household surveys were conducted to assess and evaluate the impact of the intervention. ORS and zinc use increased considerably in both study arms, but more in the intervention arm. There is a strong and significant association between living in a village having a drug kit and ORS use, and the association is even stronger for villages with two drug kits. Significant gains in ORS use were observed when zinc was available at the community level. The results raise the issue of how many drug kits or other distribution points should be established per village in community case management interventions.
The Zambia Integrated Management of Malaria and Pneumonia Study
Davidson H. Hamer, Associate Professor of International Health and Medicine, Center for International Health and Development, Boston University Schools of Public Health and Medicine
The Zambia Integrated Management of Malaria and Pneumonia Study is a randomized, controlled trial that is evaluating two different modes of delivery of treatment for malaria and pneumonia in young children by community health workers (CHWs) in two rural districts in the Southern Province of Zambia. This project is being carried out in collaboration with the Salvation Army World Office, the Chikankata Health Service, and the Siavonga and Mazabuka District Health Management Teams. Intervention CHWs have been trained to use a simple algorithm to identify children with possible malaria and/or pneumonia, perform a rapid diagnostic test for malaria, and treat positive cases with artemether-lumefantrine. The intervention CHWs also have been supplied with amoxicillin for the treatment of non-severe pneumonia. In contrast, the control CHWs are following the same algorithm but they are treating possible malaria episodes empirically with artemether-lumefantrine and referring children with pneumonia to the nearest health post for treatment.
Community Case Management Essentials: A Guide for Program Managers
Anna West, Child Health Coordinator, CORE Group
"Community Case Management (CCM) Essentials: A Guide for Program Managers" is a collaborative effort led by a steering committee from the CORE Group, Save the Children, and BASICS. The guide fills a gap in operational guidance for community-based treatment of major infectious causes of child mortality in low- and middle-income countries, including malaria, pneumonia, and diarrheal disease. The guide is designed to complement the new community health worker treatment guidelines and training materials that have been developed by WHO’s Division of Child and Adolescent Health and Development. Contributors include senior technical experts who provide detailed guidance on the design, implementation, and evaluation of CCM programs, building on decades of experience in NGOs, donor agencies, governments, and research institutions. The guide’s primary audience is NGO/PVO program managers and their MOH counterparts at the district-level: the guide will also be useful to central-level MOH planners and others interested in developing community case management programs from pilot to large-scale initiatives. This presentation highlighted opportunities for CORE Group members to participate in field-testing the guide in preparation for publication later this year.
3. Nutritional Technical Update, Session 1: Investing to reduce maternal and child undernutrition: What do you get in return?
Paige Harrigan, Advisor, Food Security and Nutrition, Hunger and Malnutrition Unit, Save the Children
Reynaldo Martorell, Robert W. Woodruff Professor of International Nutrition, Hubert Department of Global Health, Rollins School of Public Health, Emory University
This presentation reviewed recent advances in understanding the long term consequences of improving pre-school nutrition for human capital formation and economic productivity. Presenters drew on recently published analyses of cohort studies in 5 developing countries and on new analyses based on an experimental nutritional intervention during early childhood and its effects on adult outcomes measured a quarter century later on the same individuals in Guatemala. This new work provides the strongest evidence to date of the considerable long-term benefits of investing in nutrition in the first 2–3 years of life.
By the end of the session, participants gained a clear understanding of the cause and consequences of malnutrition in early childhood.
Dory Storms Award Vote
Each year at the Annual Spring Membership 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."
This year the award went to Stanley Foster, a professor at the Rollins School of Public Health at Emory University. Dr. Foster has been a long-time champion of the role of NGOs in child survival and for the USAID Child Survival and Grants Program in particular. Stan has made a number of seminal contributions to the scientific literature on immunizations and child survival. Further, he has been a mentor and a source of motivation and inspiration to thousands of professionals, community health workers, and community members around the world. His life's work has improved the health and well-being of millions of people.
Lunchtime Roundtable: Working Group Chair Meeting
Working Group Planning Time
Working Groups used this time to review 2008 workplans, move key activities forward, develop FY09 workplans, and discuss technical issues.
Concurrent Technical Sessions
1. Integrating family planning and HIV
Judy Lewis, Technical Backstop Haitian Health Foundation; Professor of Community Medicine and Pediatrics, Director of Global Health Education, University of Connecticut School of Medicine, Moderator
Susan Allen, Professor, Department of Global Health; Director, Rwanda Zambia HIV Research Group, Rollins School of Public Health, Emory University
This session began with an overview of recent funding initiatives for integration of HIV and family planning programs. Two long term integrated programs were described, the Zambia-Emory HIV Research Project (ZEHRP) and the Project San Francisco (PSF) in Kigali, Rwanda. The remainder of the session was devoted to a discussion of how HIV and family planning can be successfully implemented in child survival programs, and included a small group exercise.
2. Eliminating the equity gap: from measurement to action
Meredith Fort, Health Alliance International, Co-moderator
Tom Davis, Director of Health Programs, Food for the Hungry, Co-moderator
Will Story, Child Survival and Health Technical Advisor, Christian Reformed World Relief Committee
Michelle Kouletio, Health Advisor, Concern Worldwide US, Inc.
The session began with an overview of equity and social determinants of health to provide context for two case studies and a group discussion. The overview included: definitions and frameworks of equity and social determinants of health, initiatives that are currently underway to measure and address inequities, and examples from the field. Two organizations presented their experiences measuring and assessing equity in their work, and how this has influenced their programmatic work. Specifically the questions that were addressed in the presentation of the case studies are: 1) Why each organization decided that it was important to measure and incorporate equity into its programming, 2) How equity was measured, 3) What results each organization found and how that has translated into changes in programmatic work, and 4) What lessons each organization has learned from the experience.
In the second half of the session, participants took part in small group discussions and a plenary focusing on how their organizations might measure, assess, and address inequities in health, as well as the challenges and opportunities that they have in doing so.
3. Getting published: "You can DO IT!"
David Marsh, Save the Children USA
Peter Winch, Director, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Many CORE members are professionals with post-graduate degrees who work for organizations that value creativity in tackling the vexing challenges in international health. In other words, CORE members have the freedom to innovate, a "license to test!" A sage (in an ivory tower) once said, "If it’s not documented, it didn’t happen, and if it’s not published, it doesn’t matter." Publishing is a pastime that requires many skills (including: recognizing publishable experience, identifying the central message, laying out the argument, and forceful writing) and attitudes (including, teach-ability and tenacity). Because few people have all these skills, most would-be authors partner with others. The speakers reviewed the process they undertook in the development of some of their own recent publishing efforts.
CORE Board or Directors Meeting (Dinner)
The newly elected (and continuing) members of the CORE BOD met to discuss strategic directions for CORE Group.
Thursday April 17, 2008
Opening Announcements
Day facilitator: Martine Polycarpe, ADRA
Welcome:
Carlos Cardenas, Director of Health Programs, Mercy Corps
Concurrent Technical Sessions
1. Nutritional Technical Update, Session 2: Building effective collaboration for improving breastfeeding practices- From the what to the how
Judiann McNulty, Independent Consultant, Moderator
Miriam Labbok, Professor of the Practice of MCH, Director, The Center for Infant and Young Child Feeding and Care, Maternal and Child Health Department, School of Public Health, UNC/Chapel Hill
Ira Stollak, Senior Program Specialist, Curamericas Global
Ruth Madison, Technical Advisor, Health of Women and Children Unit, Project HOPE
Save the Children
This session provided a programmatic and evidence-based review of experience to date in child nutrition, with a focus on exclusive breastfeeding. Article 3 from the Lancet Series, What Works? Interventions for maternal and child undernutrition and survival (Lancet 2008: 371:417-40), presents an evidence-based overview of the potential benefits of implementing health and nutrition interventions that are of proven efficacy and applicable in low-and middle-income countries. The article summarizes a short list of key interventions, including promotion of breastfeeding to improve child nutrition. A number of critiques have surfaced with the observation that much of the HOW was not included in the review. This session provided a forum for nutrition practitioners to discuss and review programming experience to start a dialogue that can contribute to the evidence base and to identify key questions to consider for subsequent (collaborative) operations research. Special emphasis was given to the practice of exclusive breastfeeding.
Following Miriam Labbok’s presentation, "Overview - Exclusive Breastfeeding: What Works and Proven Strategies for breastfeeding promotion and adoption of best practices in rural, urban, and high conflict settings and high HIV prevalence settings," staff from three PVOs, Ira Stollak (Curamericas Global), Ruth Madison (Project HOPE), and a representative from Save the Children, gave examples of "EBF and Field Realities;" what strategies were used, what results were achieved, and whether formative research was used.
2. CHW Motivation Strategies: To Pay or Not to Pay?
Chris Bessenecker, Consultant, Moderator
Peter Winch, Director, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Emmanuel d’Harcourt, Senior Technical Advisor for Child Health, International Rescue Committee
Sujata S. Ram, Health Advisor, International Services, American Red Cross
Jean-Gregory Jerome, Partners in Health
There is increasing emphasis on using community health workers (CHW) as a strategy for implementation of maternal and child health interventions at scale. High rates of attrition threaten the effectiveness and sustainability of these programs. Rates of CHW attrition are influenced by the community context of their work as well as a range of monetary and non-monetary incentives. This panel reviewed some current experiences with CHW incentives and addressed the burning questions about how best to support, retain, and motivate CHWs.
Peter Winch introduced the panel with an update on CORE survey findings on CHW motivation. Emmanuel d’Harcourt, Sujata Ram, and Jean-Gregory Jerome present ed their PVOs’ experience with CHWs, addressing (1) whether CHWs should be paid and why, and (2) whether CHW programs should aim for nation-wide coverage or target areas with the greatest problems of access. Some of the questions the panel fielded included:
- What factor is more important for retention: how CHWs are selected or their workload? Why?
- What works best in terms of performance and retention? Female or male CHWs? Youth or settled and married? Why? What evidence do we have?
- Does government ownership of CHWs, e.g. government-led recruitment, official recognition of CHWs within human resources plans, patronage in meetings, etc., make a difference in terms of performance and retention? If so, how can it be fostered in countries that are not so involved or put less priority on CHWs?
- Should there be a career path for CHWs that leads to further training and the potential for a salaried position in the MoH or elsewhere?
3. Creative community mobilization for integrated TB programming
Ann Hendrix-Jenkins, Coordinator, TB Working Group, CORE Group, Moderator
Khrist Roy, Technical Advisor, CARE
Milagros A. Lasquety, Health Program Manager, Catholic Relief Services, Philippine Program
Melindi B. Malang, Behavior Change Communication Officer, Maguindanao TB Control Project, Catholic Relief Services, Philippine Program
This interactive session presented the how-to details on designing and implementing quality community mobilization activities using relatively simple mechanisms that build on the foundation of previous health project efforts. This type of approach not only leads to highly effective programming, but is also quite cost effective--building on previous work. In these cases, tuberculosis was the problem being addressed. Considering that WHO and the STOP TB partnership are calling for greater NGO involvement in community-level TB programming, this session also offered insights into this rapidly growing area of international public health.
Control of Tuberculosis through Community-based DOTS in the State of West Bengal, India: A collaborative initiative between communities, RNTCP and CARE
Khrist Roy, Technical Advisor, CARE
The CIDA supported project, Control of Tuberculosis through Community Based DOTS in West Bengal, has been implemented since December 2001 and is currently in its second phase. The project has been testing which interventions would lead to measurable change in the Case Detection Rate (CDR), using a case control model.
By the end of the session, participants had gained a better understanding of the study methodology and results, as well as the package of interventions used to mobilize the community to improve CDR
Lessons of community mobilization activities for integrated TB programming from Catholic Relief Services in the Philippines
Milagros A. Lasquety, Health Program Manager, Catholic Relief Services, Philippine Program
Melindi B. Malang, Behavior Change Communication Officer, Maguindanao TB Control Project, Catholic Relief Services, Philippine Program
In this session, participants learned innovative ways of increasing access to TB care services in underserved communities of Maguindanao Province in the Philippines. At the start of the session, participants were provided with an overview of the TB situation in the province. Participants worked in small groups to share ideas on how to respond to the TB problem presented. This was followed by the presentation on the project experience in addressing the "bottlenecks" in implementation that had been identified during the proposal stage. The Philippine experience demonstrates how empowerment of TB patients, community support groups, and local resources can significantly contribute to accelerating TB case detection and treatment.
Concurrent Technical Sessions
1. Get the most from your consultant: Write a great SOW!
Bonnie Kittle, Consultant
Judiann McNulty, Consultant
This was a ‘must-attend’ session for any CORE Group member staff who are responsible for writing Scopes of Work and/or hiring consultants to support their CS projects; and especially for people who are tired of being disappointed in the consultants they hire. Through a hands-on participatory approach, this 90 minute mini-workshop helped participants to identify the key elements of an effective Scope of Work, identify typical weaknesses, and practice writing specific sections of SOWs.
2. Measuring Community Capacity
W. Bramwell Bailey, Program Director of The Salvation Army World Services Office (SAWSO)
David Marsh, Save the Children USA
Thebisa Chaava, Technical Advisor HIV/AIDS, The Salvation Army World Services Office (SAWSO)
Jacqueline Johnson, FFD Manager, Africare
This session provided examples of tools PVOs have developed to measure community capacity.
The Role of Community Capacity in Reducing Global Malnutrition among Children within a Food Security Program in Chinandega, Nicaragua
David Marsh, Save the Children USA
Save the Children USA, like many CORE member organizations, invests much effort in strengthening community capacity (CC), an important element of "Intermediate Result - 4" (IR4), the Enabling Environment. In fact, this is a likely engine of sustainability. Investments in IR4 could even be the most cost-effective strategy to increase use of life-saving interventions over time, but we do not know because we do not measure CC. In 2006, supported by the Health Communications Partnership, Save held a global conference in Lusaka to share experiences and map out next steps. A literature search was conducted to develop a theory-based approach to characterizing and measuring CC and Save commissioned four small studies to describe and measure CC and its associations with other socially desirable outcomes within existing programs in Vietnam, Nicaragua, Zambia and Uganda. All studies are in various stages of analysis and documentation. Highlights were shared.
Community Capacity: What is it? How do we measure it? How important is it?
Thebisa Chaava, The Salvation Army World Services Office (SAWSO)
SAWSO’s "Community Competency" tool was first developed in Zambia to help communities identify their competencies in dealing with the many facets of the HIV/AIDS Pandemic. The tool is built on the premise that community do have strengths and capacities to deal with issues that affect their communities and that the best way to support a community is to explore and build on these strengths an capacities. Since the development of the tool, SAWSO has expanded the use of the tool from HIV/AIDS to a wide variety of issues that affect communities.
Food Security Community Capacity Index:
Jacqueline Johnson, FFD Manager, Africare
Jacqueline Johnson presented Africare’s Food Security Community Capacity Index (FSCCI). The FSCCI was developed over twelve years ago to measure the beneficiary community's technical ability and knowledge (capacity) needed to deal successfully with issues related to food security in their community. In the most recent revisions of the tool in 2004 and 2007, the FSCCI was revised to better take into account the special capacities needed to cope with cyclical risks and shocks, specifically including HIV/AIDS. Programs have also used the basic principles of the FSCCI to develop a revised index to target the more specialized capacities needed to implement effective growth monitoring promotion and nutritional rehabilitation programs within food security programs.
By the end of the session, participants learned a more systematic approach to defining, measuring, and valuing community capacity.
3. Promoting use of insecticide-treated nets for malaria prevention
Bill Yaggy, Director, Institutional Giving, AMREF USA, Moderator
David M. Gittelman, Public Health Advisor and Deputy Team Leader, Program Implementation Unit/President’s Malaria Initiative, Malaria Branch, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention
James Pimundu, Director, Programs and Capacity Building, CCF Uganda
International interest in supporting the rapid scale up of national malaria programs has resulted in significant increases in ownership of insecticide-treated bednets in many countries. However, national surveys and local assessments have demonstrated a clear discrepancy between ownership and actual use of nets by those at greatest risk of morbidity and mortality due to malaria. This session focused on the practical aspects of promoting ITN use at the national and community levels. David Gittleman reviewed recent data on the gap between ownership and use, and identify many logistic, cultural, economic and other factors that lead to low use among individuals. These include: net preferences (size, shape, color), communication approaches, household promotion, sleeping arrangements, use patterns by malaria transmission period, timing of promotional activities (in mass campaign and routine service settings), and net durability. He discussed related efforts by RBM, multinational organizations, and civil society, along with specific country examples of current approaches and key operational research issues. James Pimundu discussed CCF Uganda’s approach to community-based programming in the prevention, diagnosis, and treatment of malaria. He highlighted how CCFU is working to increase usage of ITNs through strategies including participatory communication, community organizing, child and youth agency, and community malaria control plans. He also outlined some of the issues faced around availability, demand, accessibility, affordability, and sustainability of ITN initiatives. At the conclusion, the speakers facilitated an open discussion to identify additional concerns and successful approaches to boost bednet use.
Promoting use of insecticide-treated bednets for malaria prevention
David M. Gittelman, Public Health Advisor and Deputy Team Lead, Program Implementation Unit/President’s Malaria Initiative, Malaria Branch, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention
International interest in supporting the rapid scale up of national malaria programs has resulted in significant increases in ownership of insecticide-treatment bednets in many countries. However, national surveys and local assessments have demonstrated a clear discrepancy between ownership and actual use of nets by those at greatest risk of morbidity and mortality due to malaria. Some African programs have quantified a 25% gap between bednet ownership and use. There is little published to date that shows effective models for both delivering nets and ensuring their use, though there are good country-specific examples.
This session focused on the practical aspects of promoting ITN use at the national and community levels. Following a review of recent data on the gap between ownership and use, the speaker identified many of the logistic, cultural, economic, and other factors that lead to low use among individuals. Some of the issues considered included net preferences (size, shape, color), communication approaches, household promotion, sleeping arrangements, use patterns by malaria transmission period, timing of promotional activities (in mass campaign and routine service settings), and net durability.
CCF Uganda Community Based Malaria Programming and ITN Distribution
James Pimundu, Director, Programs and Capacity Building, CCF Uganda
This presentation provided information on CCF Uganda’s approach to community based programming in the prevention, diagnosis, and treatment of malaria. It highlights how CCFU is working to increase usage of ITNs through strategies including participatory communication, community organizing, child and youth agency, and community malaria control plans. Some of the issues faced around availability, demand, accessibility, affordability, and sustainability of ITN initiatives were outlined.
CCF Uganda currently supports over 33,000 families through 49 affiliate community based organizations in 28 districts, facilitating family engagement in child-focused development activities. Current programming includes water and sanitation, health, HIV/AIDS, OVC, livelihoods, education, and ECD.
Lunchtime Roundtable: Sustainability
Jim Ricca, Capacity Development Advisor, CSTS+/Macro International
Will Story, Child Survival and Health Technical Advisor, Christian Reformed World Relief Committee
We all think that sustainability is important but many organizations don’t systematically use the Sustainability Framework developed by CORE Group and CSTS+. Why? Too complicated, data doesn’t seem usable, not enough time, competing priorities? Will Story presented the results of his own "Child Survival Investigation," the data from the doer / non-doer analysis for use of the Sustainability Framework. Discussion on peoples’ ideas for how to improve the framework to increase its uptake followed.
Lunchtime Roundtable: Hygiene
Elizabeth B. Younger, Behavior Change Specialist, USAID/HIP – Hygiene Improvement Project, AED/The Manoff Group
The HIP program is developing materials to serve as a global resource for hygiene programming. The set was directed at two separate audiences—program managers/NGO partners and community-level health workers. The module for each audience included a technical reference guide, training materials, and job aids. HIP staff are gathering existing materials to see what they can leverage and what they would need to create. They will then validate what is developed in the field and, once it is finalized, make it widely available to any interested parties. The Roundtable was an opportunity to discuss this endeavor and see what input/expertise can be solicited from CORE member organizations.
Working Group Planning Time
Working Groups used this time to review 2008 workplans, move key activities forward, develop FY09 workplans, and discuss technical issues.
Concurrent Technical Sessions
1. Innovations in water and sanitation interventions to prevent disease
John Scicchitano, Area Manager, Vestergaard Frandsen, Moderator
Thomas F. Clasen, Senior Lecturer, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine
Christine Moe, Eugene J. Gangarosa Professor of Safe Water and Sanitation and Director of the Center for Global Safe Water at Emory, Rollins School of Public Health, Emory University
Rick Rheingans, Associate Professor, Hubert Department of Global Health, Emory University
Nearly 2 million people die annually from diarrheal disease. Global investments have achieved only a small fraction of coverage for those who currently lack access to potable water. Historical efforts have focused on water sources (pumps, wells, boreholes), with less-than-expected impact on health. Recent efforts have looked towards Point-Of-Use (POU) treatment as having far greater potential impact, and appropriate technology innovations such as LifeStraw® are helping advance these efforts.
By the end of the session, participants understood recent scientific advances on the prevention of water-borne disease, and how these advances can be translated into programs for the reduction of diarrheal morbidity and mortality.
Household Water Treatment: Effectiveness, Cost Effectiveness and Scaling Up
Thomas F. Clasen, Senior Lecturer, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine
An estimated 1.1 billion people lack access to improved water supplies; hundreds of millions more rely on water that is unsafe for drinking due to microbial infiltration of wells, pipes and other “improved” sources. Contaminated water, along with poor sanitation and hygiene, contributes to an estimated 1.8 million deaths each year from diarrheal disease, representing 17% of the deaths of children under 5 years of age in developing countries.
This session presented the most recent research on the effectiveness and cost-effectiveness of household-based interventions to prevent diarrheal diseases. It summarized recent technological developments and distribution strategies for improving the coverage and uptake of these interventions. The challenges of implementing water quality interventions at the household level, both in development and emergency settings, were discussed. The role of household-based water quality interventions was placed in the context of an integrated water, sanitation and hygiene strategy.
Sanitation Approaches for Developing Countries: Challenges and New Ideas
Christine Moe, Eugene J. Gangarosa Professor of Safe Water and Sanitation and Director of the Center for Global Safe Water at Emory, Rollins School of Public Health, Emory University
The United Nations declared 2008 as the International Year of Sanitation to bring attention to the estimated 2.6 billion people that lack access to basic sanitation. This presentation explored the challenges in improving access to sanitation in developing countries and some new approaches that are being tested by various NGOs. What is the evidence that improved sanitation has a beneficial impact on health? What motivates demand for sanitation? What technological approaches are appropriate for sanitation? How successful are new approaches for promoting sanitation coverage such as market-based approaches, sanitation as a business, sanitation as a service, community-led total sanitation, ecological sanitation and micro-financing for sanitation?
2. Sustainability: Lessons learned from recent post-project evaluations
Jim Ricca, Capacity Development Advisor, CSTS+/Macro International, Co-moderator
Rozalin Wise, Program Associate, Doctors of the World-USA (DOW), Co-Moderator
Indu Ahluwalia, Epidemiologist, Division of Adult and Community Health, Centers for Disease Control and Prevention
Michelle Kouletio, Health Advisor, Concern Worldwide, US Inc.
Will Story, Child Survival and Health Technical Advisor, Christian Reformed World Relief Committee
Jim Ricca and Rozalin Wise introduced the session and provided a brief overview of the Sustainability Framework and its practical uses. Michelle Kouletio discussed the post project evaluation of Concern Worldwide, US Inc.’s Saidpur and Parbatipur Child Survival Project in Bangladesh. The project sought to reduce maternal/child mortality by building the capacity of the Municipal Health Department to manage the health system and the capacity of the community to support the health system and build awareness and demand for quality maternal and child care through Community Health Committees. The Sustainability Framework was used as a management tool to monitor the progress of the Municipal Health Department and Community Health Committees, and the impact of their work on health outcomes and quality of services at facilities. Three years after the project ended, the Framework served as the basis of a post project evaluation to determine the sustainability of the projects key interventions. The post project evaluation results were shared along with the advantages and challenges/lessons learned of using the Framework from implementation to post-project evaluation.
3. Promising post-partum interventions for mothers and newborns
Susan Otchere, Advisor-Maternal and Newborn Health, Save the Children, Moderator
Marcos Arevalo, Medical Director, Biomedical Research/Assistant Professor, Georgetown, University/IRH
Robin Anthony Kouyaté, PhD; Behavior Change Communication Specialist, ACCESS-FP Program
Stephen Wall, Senior Research Advisor, Saving Newborn Lives, Save the Children
The revitalization of LAM
Marcos Arevalo, Medical Director, Biomedical Research/Assistant Professor, Georgetown, University/IRH
Robin Anthony Kouyaté, PhD; Behavior Change Communication Specialist, ACCESS-FP Program
LAM is a modern, reliable family planning method. It has been tested in clinical trials and shown to be at least 98% effective in protecting a woman from pregnancy, as long as she meets the three LAM criteria. Program use has confirmed its effectiveness. Despite LAM effectiveness and promotion efforts, findings from technical meetings and informal interviews with program managers and providers have indicated that LAM is underutilized and could be better integrated into family planning and MNCH services and programs. Recent efforts have focused on revitalizing LAM by: 1) repositioning LAM as a gateway method to other modern family planning methods; 2) developing strategies for integrating LAM into maternal, neonatal, and child health programs and services; 3) simplifying service delivery (training, counseling, messages to clients); and 4) emphasizing the timely transition to other modern FP methods. Lessons learned in the field provide information about revitalizing LAM through repositioning it as a gateway method and integrating LAM into FP and MNCH programs.
Community-Based Kangaroo Mother Care (KMC) for Low Birth Weight Newborns: Evidence and Experience
Stephen Wall, Senior Research Advisor, Saving Newborn Lives, Save the Children
Kangaroo Mother Care (KMC), involving skin-to-skin contact between mother and newborn, is known to provide a number of benefits for low-birth-weight newborns to help improve newborn survival. These benefits include reducing hypothermia, improving breastfeeding, stabilizing respiration, increasing weight gain, reducing length of hospitalization, and improving mother-infant bonding. Use of KMC methods to care for LBW newborns in community settings is a promising strategy to improve newborn survival in low-resource settings where facility-based care is not available or fully used by families. Recent studies have found home-based skin-to-skin contact to be acceptable to families, and to improve newborn survival, especially for small babies. Recent program learning and experiences from Asia and Africa also provide important new lessons on how community-based KMC can be successfully included in MNCH programs.
Dinner and Social Event at Agatha’s: A Taste of Mystery
Atlanta’s Original Comedy Murder Mystery Dinner Theatre.
Friday April 18, 2008
Opening Announcements
Day facilitator: Kathryn Bolles, CORE/Save the Children
Welcome:
Ronald Waldman, Avian and Pandemic Influenza Response Unit Team Leader, Pandemic Planning/Humanitarian Response, USAID
Interactive Simulation: Community Preparedness: Responding to a Pandemic in a UN-led Simulation
Michael Mosselmans, Interim Director, Pandemic Influenza Contingency (PIC), UN Office for the Coordination of Humanitarian Affairs (OCHA)
Maria del Pilar Gaspar Roses, Regional Planning Officer, Pandemic Influenza Contingency (PIC), UN Office for the Coordination of Humanitarian Affairs (OCHA)
Paul Handley, Field Manager, Pandemic Influenza Contingency (PIC), UN Office for the Coordination of Humanitarian Affairs (OCHA)
The Pandemic Influenza Simulation is a UN-developed package which uses a series of pandemic scenarios and injects to assist in the drafting of contingency plans and other specific preparedness measures. By exposing participants to a range of pandemic scenarios, the simulation also raises the level of awareness and understanding of the impact of a future influenza pandemic.
Child Survival Investigations (CSI): Atlanta Meeting Wrap-Up
Tom Davis, CORE Board Chair
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