2006 Working Group Highlights

Worked closely with the planning team to organize the Pan American Health Organization (PAHO) Latin America and Caribbean neonatal conference, nominate NGO participants, and review the draft strategy. The meeting took place Feb. 21-23 with 102 participants from 15 countries. CORE Group members held a pre-meeting the night before the workshop began to discuss NGO positioning and how to best mobilize additional NGOs at the country levels to support neonatal health efforts.

Awarded a grant to Save the Children/Bolivia for a collaborative effort in partnership with CORE Group members, PROCOSI (a network of Bolivian health organizations), the BASICS Project, the Rational Pharmaceutical Management Plus Program, and the Bolivian Ministry of Health. The partnership will improve the political environment of community-case management through advocacy efforts to integrate the boticas (community pharmacies) into the local health insurance package, so that patients are able to get the medications prescribed for them. It will also improve training and support for the volunteers managing the boticas. Finally, it will conduct a situational analysis in the rural areas of the La Paz, Oruro, and Chuquisaca departments resulting in three case studies and document the Bolivian experience in the CCM Essentials Guide so that practitioners in other countries can learn from the experience.

Planned a user-friendly, how-to manual for programmers regarding treating serious infections among under-fives, including newborns, in communities remote from health facilities. This joint project with BASICS, Save the Children, UNICEF, WHO, Johns Hopkins University, USAID, SARA Project, and others will focus on practical application issues synthesizing state-of-the-art knowledge and experience and providing program managers with easy-to-use guidance and techniques. In 2007, the guide will be tested in the field and further refined.

2005 Working Group Highlights:

Facilitated several activities to increase PVO involvement in scaling-up high quality community case management (CCM) programs to improve treatment for common, potentially fatal infections among under-five children, by addressing regions that lack access to health facilities based on geographic, cultural or other barriers. Activities include:

• Initiated the development of a Community Case Management Essentials guide for NGO program managers and Ministries of Health to implement CCM programs for childhood pneumonia, malaria, and diarrheal diseases, in collaboration with the BASICS Project and Save the Children. The CCM approach places drugs for infections among under-fives (including newborns in some cases) in the hands of trained, supervised and supplied providers.

• Facilitated a consultative process between CORE member PVOs and other stakeholders to identify countries where private voluntary organizations (PVOs) can contribute to the scaling up of Community Case Management programs to reduce childhood mortality and morbidity from preventable childhood diseases.

Past Working Group Highlights

1. C-IMCI Country Workshops
   CORE completed the “Facilitator’s Guide for Conducting Country Meetings on HH/C IMCI” to enable country staff to design, conduct, and evaluate workshops that guide local planning of C-IMCI efforts. The guide includes pre-workshop planning, detailed session guides, supplemental workshop materials such as PowerPoint presentations, sample invitations, and speaker guides as well as all the necessary handouts and a participant guide. The objectives are that by the end of the workshop participants will have:
   • Increased their understanding of HH/C IMCI;
   • Developed a common perspective on HH/C IMCI in order to recognize the potential inputs by all partners;
   • Practiced using the framework as a tool for identifying and developing HH/C IMCI activities across partners and sectors; and
   • Increased cross-organizational and cross-sector collaboration with HH/C IMCI.

   Project Concern International was awarded a sub-grant to refine, implement, and follow-up on six workshops in Africa. The first workshop in Ghana was held on January 22-24, 2003. More than 35 participants representing PVOs, national and district level MOH, WHO, WHO/AFRO and UNICEF attended the meeting. Prior to the meeting the project manager conducted a series of meetings with key partners to build support and consensus around the workshop. The meeting also provided a good opportunity to work with WHO/AFRO to ensure synchronicity between the CORE meetings and the WHO/AFRO briefing package effort.

   Planning is in process for subsequent meetings in South Africa, Uganda, Ethiopia, Tanzania and Malawi. Publication of the Facilitator’s Guide will enable others to implement the meeting at country, district or organizational levels.

2. Child Survival Database
   The web-based database for PVO-created materials on child survival was completed. After initial delays due to software issues, the database was finalized and posted to the public section of the CORE website in March 2003. To date, more than 100 documents have been entered into the system. Users on the web page are able to search for documents by different parameters (author, country, topic area, etc.) and input their own documents to enhance the database. Documents include reports of PVO programs, training manuals, IEC materials, and research studies. CORE commissioned a consultant to continue to add more materials and to edit and check the quality of public entries.

3. LAC Regional Workshop
   The CORE Group conducted an expert consultation on C-IMCI February 11-13, 2003 in Nicaragua. In partnership with EHP and BASICS II, the three-day meeting brought together more than 73 participants from across the LAC region. Participants represented PVOs, USAID mission HPN officers, USAID/Washington, MOH, EHP, BASICS and PAHO.

   Workshop Objectives were to:

   • Increase understanding and application of lessons learned, best practices and approaches that can be used to accelerate C-IMCI programming, with a focus on how PVOs can scale-up C-IMCI;
   • Identify issues and challenges involved in taking C-IMCI programs “to scale,” and to discuss areas in which additional financial support, political space and/or relationships with other organizations could make a positive difference in taking C-IMCI programs to scale;
   • Build PVO capacity in integrating peri-natal and neonatal care and environmental health into C-IMCI; and
   • Foster increased communication and collaboration among partners working on C-IMCI in the region.

   Ten PVO country offices presented their efforts in C-IMCI and extensive small group discussion enabled participants to explore the workshop themes. There was an extensive marketplace set up that enabled participants to share materials and experiences across countries and organizations. Additionally, BASICS worked with four PVOs prior to the workshop to produce two to six page reports documenting their program efforts. BASICS will be producing final workshop proceedings detailing the presentations and recommendations developed.

4. Benin
   CORE provided a subgrant from May 1, 2002 to April 30, 2003 to Africare to support documentation of national and departmental planning around C-IMCI in Benin. Key project objectives are to:
   • Enhance C-IMCI implementation in Benin using C-IMCI framework to document existing efforts to guide program planning in Oueme and Borgou departments; and
   • Inform the global C-IMCI process through documenting and analyzing the process of C-IMCI implementation through the C-IMCI Framework at the national and departmental levels in Benin.

   In the preceding reporting period, Africare conducted a national workshop June 24-26, 2002 to inform all stakeholders about the framework and initiate planning efforts. Partners participated in a mapping of C-IMCI efforts, prioritized interventions to be documented, and agreed upon a protocol for data collection.

   In this reporting period, Africare completed and distributed a 53-page paper documenting the selected interventions to partners throughout Benin. The paper is currently in French and will be translated into English by the Africare office.

   Despite meeting with national and department-level officials to encourage C-IMCI planning efforts, priorities such as local elections, clinical IMCI trainings, vaccination campaigns, and the selection of a new national IMCI coordinator slowed departmental planning efforts in C-IMCI and delayed the subsequent documentation effort. Africare has therefore recommended changing the project objectives to capture experiences with the framework in community and zonal level planning efforts over which they have more direct control and accountability. Requested change of project end time is September 15, 2003.

5. Bolivia
   CORE supported PROCOSI, a network of NGOs in Bolivia, to support collaborative efforts of NGOs and partners focused on coordinating and improving C-IMCI efforts through a subgrant for the period of September 1, 2002 – August 31, 2002. Key project results and indicators are:
   • National Commission of C-IMCI, regional teams, and regional technical committees established and functioning – Indicator: National IMCI Commission (composed of MOH, NGOs, BASICS/USAID, PAHO, and UNICEF) and eight regional technical committees organized by month six and meeting at least once every two months by the end of FY03.
   • Documented models of partnerships between health facilities and the communities they serve – Indicator: A document highlighting strategies for improving partnerships between health facilities and the community that support the best quality of care to children zero to five developed, elaborated and disseminated.
   • Regulation of the functions and competencies for community-based health workers clarified – Indicator: MOH regulations clarifying payment, incentives, functions, and job competencies for community-based health workers available and understood by PROCOSI members.
   • IEC strategic plan developed and materials improved and disseminated that use best care practices for children zero to five in the household and community – Indicator: Document of the IEC Strategic Plan to promote key family practices available to NGOs; IEC materials validated and disseminated to NGOs.

   In this reporting period, PROCOSI hired a coordinator, formed a C-IMCI national-level commission of key partners, and conducted regional C-IMCI meetings in Oruro, Cochabamba, Santa Cruz, and Sucre. While a meeting was organized for Tarija, it was canceled due to a general strike in the department. The intent of the regional meetings was to strengthen Regional Committees, improve coordination between the clinical and community components of IMCI, and conduct an inventory of NGOs working with children under five. Accomplishments of the meetings include: consolidation and enlargement of the database on NGOs working with child health programs; development of working plans for each Regional Committee including training for committee members in clinical IMCI; and the addition of nine organizations outside of the PROCOSI network to the Regional Committees.

6. Documentation of PVO Experiences with AIN-C
   In a previous reporting period, CORE hired a consultant to conduct a review of existing literature on AIN-C in Honduras, interview key informants in the PVO community and carryout a meeting of NGOs to collect and analyze experiences with AIN-C. In this reporting period, CORE worked to edit the study document, receiving input and additional information from various partners. The final report is targeted for completion in the next quarter.

7. IAWG and other Global and Regional Efforts
   CORE participated in the Inter-Agency Working Group meeting held in Geneva in September 2002 in order to represent the community-based perspective and increase collaborative efforts with other global partners interested in C-IMCI. CORE members and staff participated as key informants in the interview process for the Analytic Review and provided feedback to WHO on the briefing package for C-IMCI consultants. The CORE Executive Director served as a key external reviewer to the WHO/WPR C-IMCI framework document.

8. CHW IMCI Case Management Review
   CORE worked with Peter Winch and his research team at Johns Hopkins University to assist in the development of a paper on community health worker programs and the management of sick children. CORE assisted in identifying PVO projects and key informants to include in the literature review and interview process and provided feedback at several points on paper development and classification of initiatives.

9. Positive Deviance/Hearth
   In order to enhance the development of tools to support elements of the C-IMCI Framework, the IMCI Coordinator reorganized and rewrote the final version of the PD/Hearth manual designed to assist field program managers interested in mobilizing communities to sustainably rehabilitate malnourished children. The resource guide explains in detail how to identify at-risk children, conduct a Positive Deviance Inquiry to identify positive practices, conduct Hearth sessions, and set up a monitoring and evaluation system. A number of specific field examples and useful tools are provided. The Coordinator also worked with the Nutrition working group to host a Technical Advisory Meeting for PD/Hearth experts and plan a training to equip headquarters staff to provide technical assistance to field programs in the design and evaluation of PD/Hearth interventions.

10. Coordination between IMCI and Malaria
    The first national Fresh Air Malaria workshop was held in Zambia. The workshop objectives were to: provide state-of-the-art information on malaria programming; apply the C-IMCI framework to community-based Roll Back Malaria efforts; educate participants on existing programs by both NGOs and government; and develop an action plan to enhance NGO coordination and collaboration to scale up community-based efforts to mitigate impact of malaria. Subsequent efforts initiated in this reporting period include the formalization of a secretariat in Zambia to guide collaborative efforts and the development of a Facilitator’s Guide to assist other countries in implementing similar meetings. This effort is being led by the CORE Malaria Working Group.

11. Advocacy for Child Health Workshop
    CORE co-sponsored a workshop on March 24, 2003 with the U.S. Coalition for Child Survival. The event emerged as a joint planning effort following the U.N. Special Session for Children. The goal was to provide PVO technical staff with an overview of global and congressional issues and an introduction to child advocacy in order to prepare them to be better child health advocates.

12. Promotion of the Framework
    An article entitled “An implementation framework for household and community integrated management of childhood illness” by Peter Winch, Karen LeBan, Larry Casazza, Lynette Walker, and Karla Pearcy was published in the December 2002 edition of the Journal of Health Policy and Planning. Remi Sogunro of BASICS gave a presentation on the C-IMCI framework at the APHA annual meeting and distributed numerous copies of the 9-page summary paper describing the framework.

13. Advancing PVO Use of the Framework
    CORE members are using the framework in a variety of ways to strengthen linkages and improve program planning. CRS used the framework and the planning tools developed for the country workshops to develop the Detailed Implementation Plan for their Child Survival project in the Philippines and their Title II project in Malawi. CARE used the framework to design a pilot C-IMCI project in the Obuasi West Ashanti Region of Ghana. PCI has used the framework at the international and country office levels in order to focus and plan their program efforts. Several PVOs also report using the framework for communication and advocacy efforts within their organizations. MIHV uses the framework with their Board of Directors to enable them to better understand and guide program efforts. Plan International uses the framework to build linkages across different sectors within Plan and facilitate discussion between departments related to cross-sector linkages. CARE reports that the framework enabled them to demonstrate to non-health departments within CARE how the health sector is integrated and not a medical model.