PLENARY
Listen to a recording of the plenary session.
Child Health Policy and Programming Transitions
Malia Boggs, Bureau for Global Health, USAID; Mariam Claeson, Global Financing Facility for Every Women Every Child, World Bank; Sarah Dalglish, Independent; Rasa Izadnegahdar, Bill & Melinda Gates Foundation; Stefan Peterson, UNICEF; Mary E. Taylor, Independent; Wilson Were, WHO; David Oot, Save the Children (Moderator)
- The Mapping of Global Leadership in Child Health conducted by USAID’s Maternal and Child Survival Program.
- The strategic review of Integrated Management of Childhood Illness (IMCI) by WHO and UNICEF.
The panel started with two presentations of key finding of the reviews, followed by discussion involving questions from the audience and targeted questions by the session moderator to the panelists.
By the end of this session, participants had:
• Shared results of the child health global leadership mapping and the strategic review of IMCI.
• Discussed implications of the findings and recommendations from the two reports.
• Contributed to discussion of global agenda on (a) how to elevate, coordinate, and collaborate on child health; (b) how to advocate for better funding for child health.
NEW INFORMATION CIRCUITS
TABLE 1 | Innovative SBC Method for Community Health Worker Training and Mothers’ Empowerment for Behavior Change
Hosted by: Laura C. Altobelli, Future Generations
A Community Health Worker (CHW) training method innovation based on sharing memories of personal experiences from the first 1000 days, called “Sharing Histories,” engages, transforms, and empowers CHWs to take ownership of cultural practices and build a new collective understanding. Participants discussed corroborating psychological research on the functions of memory, and evidence of attributable effects on child stunting reduction in rural Peru.
TABLE 2 | Drone Technology for Advancing Community Health
Hosted by: Paul Robinson, International Medical Corps
Drones, or unmanned aerial vehicles (UAVs), are rapidly making an appearance in our community health skyline. From mapping and surveillance of stricken communities in the aftermath of a disaster to supplying CHWs with drugs for integrated community case management programming, the UAVs are poised to become the next generation tools—in both the humanitarian and development settings. At this table, participants learned about the potentials of this innovative technology, and the initial efforts already underway to use them widely. They were inspired to undertake community health programming in their own organizations and projects using the UAV technology. There were video clips, slides, handouts, and contact information shared.
TABLE 3 | The Intentional Photo
Hosted by: Richard Lord, Richard Lord Studio
The Intentional Photo provided pointers on how you and your program staff can take pictures that communicate a message. It was aimed at the amateur photographer whose images have important meaning to convey.
TABLE 4 | Data Can Help Us: Analysis of Participation in Multi-sectoral Programs that Reduce Stunting
Hosted by: Joan Jennings, The TOPS Program, Save the Children
Participants reviewed and discussed three examples of data analysis of participation at final evaluation of multi-sectoral food security programs that achieve reductions in stunting and discussed what this information contributed to future program design. Examples included regression analysis in Honduras FY2000 and Bangladesh FY2010, along with an example of stratification of severity of stunting and cross-tabulation in Mozambique FY2001.
TABLE 5 | Understanding the Association Between Referrals and Vulnerability and Food Security in Lesotho
Hosted by: Claire Gillum, Clinton Sears; Zach Andersson, FHI 360
The goal of the Livelihoods and Food Security Technical Assistance II (LIFT) project is to build the continuum of care for people living with HIV and other vulnerable households. We do this by developing referral systems to connect clients accessing clinical HIV and nutrition services to a range of care and support, focusing on links to economic strengthening, livelihoods, and food security (ES/L/FS) opportunities that can improve their overall health and social outcomes. In March 2016, the LIFT project began collection of outcomes data from clients in Lesotho who had received a referral as part of LIFTsupported referral networks in Mohale’s Hoek and Thaba-Tseka Districts. We presented on preliminary activity results, particularly exploring shifts in household-level vulnerability and food security in light of the ongoing El Niño drought, and engaged participants in discussion around how the findings may contribute to our broader understanding of how referrals may enhance resilience of vulnerable populations.
TABLE 6 | The Role of Knowledge Management in Preventing Zika
Hosted by: Lisa Mwaikambo, Johns Hopkins Center for Communication Programs
To fight Zika, coordinating agencies must prioritize effective knowledge management (KM). KM can: Provide the systems and processes for quickly updating health and emergency guidelines; Disseminate the updated guidelines effectively by leveraging appropriate technologies; Facilitate the coordination of activities among agencies; Help ensure the harmonization of SBCC messages; and Identify knowledge needs and gaps of providers and frontline responders. KM can strengthen the abilities of health program staff at all levels to do their jobs effectively. We applied the lessons we learned from the Ebola outbreak and quickly adapted the Ebola Communication Network for the Zika response. During this session, we demonstrated the usefulness of the Zika Communication Network for its various target audiences as well as shared how it is being leveraged as a broader coordination vehicle among USAID-funded and non-USAID-funded partners.
TABLE 7 | Supporting Local Partners Through Lean Evaluation Strategies and Tools
Hosted by: Jennifer Headley, Duke Global Health Institute
Looking to help local partners with lean strategies to gather stronger impact data? In this session, we learned about a new suite of evaluation tools developed by the Duke Global Health Institute Evidence Lab. The tools provide lean strategies for estimating out-of-pocket health expenditure, a decision tree to help determine appropriate types of economic analyses and questions, low-resource strategies for strengthening patient-level data, guidelines in leveraging existing data sources prior to expansion, and monitoring organizational reach and influence. The suite of tools may be used to help support a range of local partners—NGOs, social enterprises, CSOs, FBOs, and M&E staff.
TABLE 8 | ePartogram: Designing a Mobile Decision Support Tool to Improve Labor Management
Hosted by: Lindsay Litwin, Jhpiego
Despite being a global standard for the management of labor, use of the paper partogram in developing countries is low and inconsistent. Challenges to consistent use are related to learning and remembering how to fill it in appropriately, and—once filled in—knowing how to interpret the clinical implications of the observations. Birth attendants may find it cumbersome, time-consuming, and simply fail to see its clinical value. To address the key challenges in partogram use and appropriate management of labor and delivery, Jhpiego, in collaboration with D-tree International, has developed an electronic, tablet-based tool which aims to be easier to use and provides the decision-support missing from the paper version, through reminders and alarms. The tool stores data both locally and on a server, which allows supervisors, referral facilities, and experts real-time access to patient care information. In this session, we demonstrated the application, showing the features and functionality of the electronic partogram, as well as discussed lessons learned and potential challenges around practical implementation of an electronic tool during labor and delivery.
TABLE 9 | Microfinance, Community Health Workers and Insurance Agents, Oh My!
Hosted by: Cassie Chandler, Freedom from Hunger
How do you encourage those who most need it to access appropriate pre- and post-natal care? And how can you reach large numbers of women, both efficiently and cost effectively? Well, follow this yellow brick road… Through the Healthy Mothers, Healthy Babies (HMHB) initiative, Freedom from Hunger worked with Philippine Microfinance Institution CARD and their vast platform of micro-loan groups—in which millions of women attend weekly meetings—to deliver maternal health education via trained CARD staff. Financial services institutions such as CARD are often trusted actors that live and work in the community. Why not use the scale and structure of a microfinance institution to reach more women and their families with health interventions? At this table we discussed different players, partners, and opportunities to improve and scale community health.
TABLE 10 | CenteringPregnancy: Group Prenatal Care in the US and Around the World
Hosted by: Sarah Covington Kolb, Greenville Health System
CenteringPregnancy (CP) is a model of group prenatal care currently implemented in over 500 healthcare practices throughout the United States. The model bundles medical care with health education and social support to more effectively address the complex socio-economic determinants that impact women’s health during pregnancy and childbirth. In this New Information Circuit, we discussed CP international work to date and the potential for use of this group model to improve prenatal healthcare in an international context. We believe that the Essential Elements of the model offer flexibility that allows the model to fit in most national and cultural contexts. One successful adaptation of the model has been piloted in East Africa. Other proofs of concept have been conducted in Brazil and several developed countries. We further discussed this model with a focus on steps needed to expand our current experience.
TABLE 11 | Policy for the People: Translating Global Guidance Documents into Community Level Tools
Hosted by: Lauren Van Enk, Institute for Reproductive Health, Georgetown University
The World Health Organization is considered the foremost resource on family planning global guidance. Their evidence-based cornerstone documents are used by Ministries of Health, donors, and program managers around the world. However, this guidance often has a heavily clinical and academic perspective which is difficult to convey at the community level. The Institute for Reproductive Health (IRH) has successfully adapted several of these global guidance tools for practical use by community health workers in public and faith-based family planning programs. Experiences from Uganda and Rwanda were shared to provide concrete examples of how the cornerstone documents like the Family Planning Training Resource Package and the Decision Making Tool for family planning clients and providers have been applied in various settings. Participants had a chance for in-depth discussion about how to adapt and apply the tools to enable design and implementation of effective community-based family planning programs.
TABLE 12 | The Potential of Community-Based Primary Health Care to Save the Lives of Mothers and Children
Hosted by: Henry Perry, Johns Hopkins Bloomberg School of Public Health
A Lives Saved Tool (LiST) analysis has been completed that estimates how many maternal deaths, stillbirths, neonatal deaths, and deaths of children 1-59 months of age could be saved if currently available evidence-based interventions that can be delivered by community-level workers could be scaled up in priority countries. The table presentation described the study and the findings.
TABLE 13 | Advocacy and Action: Integrating Women’s Health and Non-Communicable Diseases
Hosted by: Nalini Saligram, Arogya World
The Task Force on NCDs and Women’s Health will present new tools that highlight the growing burden of non-communicable diseases, particularly for women living in low/middle income countries. Participants learned how the tools can facilitate program planning and can promote transition to an integrated approach for health services offered to women and girls.
TABLE 14 | New Safe Motherhood Resources from Hesperian
Hosted by: Sarah Shannon, Hesperian Health Guides
Hesperian Health Guides has released a collection of new resources for the promotion of safe pregnancy and childbirth: Working Together to Stop Obstetric Fistula is a free mini eBook. This resource will help health promoters discuss the risks for developing fistula, how to prevent obstetric emergencies, and find treatment. The Childbirth Picture Book is a simple and complete visual guide to the basics of conception, pregnancy, childbirth, and breastfeeding in English, Spanish, French and Arabic. Hesperian also just released a French edition of A Book for Midwives, a comprehensive resource for practicing midwives and midwifery training programs. Updated to reflect new WHO/UNICEF guidelines for mothers and newborns, this guide covers the essentials of care before, during, and after birth, and provides the information needed to reduce dangers in childbirth, useful in a rural village or urban clinic as a teaching tool and a reference guide. Together or on their own, these new resources provide accessible information to help health workers improve pregnancy and birth outcomes and to promote safe motherhood.
TABLE 15 | Panicked by Nutrition in Emergencies? A Guide to the IYCF-E and CMAM Toolkits
Hosted by: Jesse Hartness, Save the Children
There has been an expressed need for and interest in the development of easy-to-use emergency response toolkits by actors in the public health arena globally. In response to this demand, Save the Children developed and translated two Toolkits: the IYCF-E Toolkit and the CMAM Toolkit. Both Toolkits are publically available, ready resources for first responders to an emergency as well as for use in emergency preparedness and scale up of both IYCF and CMAM services and programs. Both are quick and easy-to-use starting points that consolidate IYCF-E and CMAM best practice and guidance with standardized operational tools that will allow Nutrition Advisors, Coordinators, and Program Managers to rapidly access needed inputs and begin implementation as soon as possible, without needing to spend a lot of time searching for certain tools. Both resources were developed using USAID OFDA and USAID Technical and Operational Performance Support (TOPS) program funding.
TABLE 16 | Using Mobile Phones to Create “Smart Clients”
Hosted by: Allison Mobley, Johns Hopkins Center for Communication Programs
To inform, empower, and promote smart clients to actively participate before, during, and after a family planning counseling visit, the Health Communication Capacity Collaborative (HC3) has developed the “Smart Client” innovative tool. While drama is a common approach used in behavior change communication, it is usually delivered via television, radio, or community theatre. The “Smart Client” tool delivers drama using interactive voice response (IVR) via mobile phones. The approach provides key information and decision triggers via a series of short dramatic episodes about a fictional couple making choices regarding family planning. The tool also delivers additional tips, discussion prompts, and information related to the core messages. Quizzes reinforce key messages and engage users. In this session, we learned how this social and behavior change communication tool has been developed in Nigeria and Cote d’Ivoire and how it can be adapted for other programs.
TABLE 17 | Testing Feasibility and Usefulness of New Routine Reproductive, Maternal, Newborn and Child Health Indicators
Hosted by: Vikas Dwivedi, USAID’s Maternal and Child Survival Program, John Snow Inc. (JSI)
Global efforts are needed to improve reproductive, maternal, newborn and child health (RMNCH) in low resource settings, including development and use of standardized indicators to measure quality and coverage of evidence-based interventions to reduce maternal, newborn, and child mortality. This includes measuring the quality of health facilitybased and community-based interventions through national health management information systems (HMIS) and other routine sources and population- based household surveys and health facility assessments. The Maternal and Child Survival Program (MCSP) plans to conduct small-scale testing of routine RMNCH indicators included in some of the new WHO global guidance documents, as well as a few others, in 3-4 countries embedded in ongoing quality improvement work. In this session we shared our current plans, including the assessment design and different measurement domains, and corresponding metrics and data collection tools. Lessons from these small-scale assessments are intended to help generate the evidence for inclusion of new indicators into appropriate information systems, including, national HMIS and complement information being generated from other indicator testing efforts.
TABLE 18 | Community Health Committees and Health Facility Management Committees: Roles and Responsibilities
Hosted by: Karen LeBan, Independent
What are the key roles and responsibilities of Community Health Management Committees? Do they differ from Health Facility Management Committees? Participants in this session shared their experience! A task force of CORE Group and World Vision assembled a draft Community Health Committee Functionality Tool called the “Assessment and Improvement Matrix.” World Vision tested the AIM Tool with Sub-county Health Officers, Community Health Assistants, and members of Community Health Committees and Health Facility Management Committees in August 2016 in one sub-county of Siaya County, Kenya. A checklist of the CHCs/HFCs roles was developed based on the literature and then assessed according to MOH guidance. Participants then validated the tool based on their experience and then discussed what worked well and what could be improved. The Roles Matrix along with the entire AIM tool was well received, stimulating interesting discussion. The tools are being edited based on the field test. Copies of the Roles Matrix were available and drafts of the AIM Tool on display. We are looking for organizations who are interested in validating the tool in other countries.
CONCURRENT SESSIONS
Urbanization and Health: Oxymoron or Opportunity?
Charles (Chuck) Setchell, OFDA, USAID; Janine Schooley, PCI; Megan Christensen, Concern Worldwide U.S.
This panel session featured three panelists’ presentations with time for Question & Answer. The three presentations featured: OFDA and the “Neighborhood Approach” to addressing urbanization risk; PCI’s experience with this approach (Clinton Global Initiative Commitment to Action, Barrio Mio in Guatemala and Barrio Mio coming to Tijuana, Mexico) and the link to health; Concern Worldwide’s toolkit for the replication for an effective urban health model. Participants then broke out into small group discussions to answer the following questions: What has been your experience with urban programming; what are the key challenges in terms of community mobilization and SBC for positive health outcomes; and what are the key opportunities in terms of program design, including community mobilization and SBC? The session concluded with reports from tables.
By the end of this session, participants had:
• Improved knowledge about urbanization, urban community health trends, opportunities, and challenges.
• Been exposed to key models that have been effective in addressing community health in urban environments.
• Discussed key programmatic challenges related to health and urbanization and explored positive and negative factors through a community mobilization and SBC lens.
Urbanization and Health: Oxymoron or Opportunity?_SCHOOLEY
Urbanization and Health: Oxymoron or Opportunity?_CHRISTENSEN
Gender Integration Approaches for Zika and Other Vector-borne Diseases
Niyati Shah, Bureau for Global Health, USAID; Norbert De Anda, Population Services International; Elana Landes Fiekowsky, USAID’s Maternal and Child Survival Program, Jhpiego; Debora B. Freitas López, Chemonics International (Moderator)
This interactive panel session focused on the importance of gender integration in addressing Zika and other vectorborne diseases. The panelists shared their experiences working at the nexus of gender and Zika and other vectorborne diseases, including key challenges and successes. In particular, panelists discussed how gender considerations can provide insight into transmission patterns and strategies for outbreak prevention and control, including how to address the disproportionate health burden increase on girls and women, promoting respectful care, and engaging men/fathers/ partners. Panelists also addressed the importance of considering gender to increase cooperation with public health interventions and the uptake of protection measures and other social and behavior changes.
By the end of this session, participants had:
• Understood the importance of addressing gender as it applies to Zika and other vector-borne diseases to help increase the adoption of disease prevention and control methods.
• Identified various ways to integrate gender throughout the program cycle, including assessment/analysis, design, implementation, monitoring, and evaluation, to ensure that social, cultural, and gender norms are addressed and the most marginalized are being reached.
The Triple Burden of Malnutrition and Inappropriate Feeding of Junk Foods to Children Under 2 Years of Age: What is Happening and What Can be Done about It?
Justine Kavle, USAID’s Maternal and Child Survival Program, PATH; Elizabeth Zehner, Helen Keller International; Inge Kauer, Access to Nutrition Foundation; Chessa Lutter, Pan American Health Organzation (Moderator)
Panelists shared research on the alarming prevalence of the consumption of nutrient-poor commercial foods by children 6-23 months of age, factors that contribute to these feeding practices, programmatic and policy implications for the triple burden (stunting, overweight, and micronutrient deficiencies) in low and middle income countries, and examples of effective regulations from Latin America.
By the end of this session, participants had:
• Learned about the findings of Helen Keller International’s Gates-funded Assessment and Research on Child Feeding (ARCH) project: cross-sectional, health facility-based surveys assessing consumption of commercial products (both nutritious complementary foods and unhealthy snack foods) by infants and young children and mothers’ exposure to promotions of these products in the most populous cities of Cambodia, Nepal, Senegal and Tanzania.
• Understood mothers’ perceptions and other factors influencing the feeding of inappropriate products to children.
• Discussed evidence of junk food consumption, policies, and programmatic considerations for infant and young child feeding programs in low and middle income countries as compiled by a multi-country research study by USAID’s Maternal and Child Survival Program (MCSP).
Access to Nutrition Index: Progress and Plans Fall 2016
Mental Health Integration into HIV, MCH, and Other Platforms
Joy Noel Baumgartner, Duke Global Health Institute; Melissa Sharer, John Snow, Inc (JSI); Regina Benevides, Pathfinder International
This session explored programmatic opportunities for integrating mental health services into HIV, Maternal & Child Health, and Adolescent Sexual & Reproductive Health platforms, among others. Panelists began with an overview of the burden of mental disorders in low- and middle-income countries, and existing global guidelines and evidence-based interventions for mental health care including WHO’s mhGAP Intervention Guide. We will also discuss how treating common mental disorders can potentially affect other health and well-being outcomes that are prioritized by a variety of health service platforms. Panelists will discuss examples of integrated programs in Tanzania, Zambia, Ethiopia, and Zimbabwe, highlighting the unique challenges of incorporating mental health into existing health platforms (e.g. donor funding, crosstraining, stigma). We also led a facilitated discussion on the global frameworks and trends in mental health needs and how organizations can strategically integrate mental health into other programs/platforms with a particular focus on adolescent/young adult populations (organizational policy/commitments; leveraging resources; making the case for investment as part of holistic care, etc.).
By the end of this session, participants had:
• Understood how addressing the mental health needs of populations can not only improve mental health outcomes but also other health outcomes (e.g. ART adherence, adolescent well-being, etc.).
• Gained insight into ways to include mental health in more holistic health programming.
• Learned specific challenges of integrated strategies, especially in contexts where there is not dedicated funding for global mental health activities.
Mental Health & HIV Integration: Action and Organizational Buy-In_SHARER_DUFFY
HALF-DAY WORKSHOPS
Risky Business: Risk Management in Philanthropy
Maya Winkelstein and Laurie Michaels, Open Road Alliance; James Joseph, Arnold & Porter
Funders are often described—and describe themselves—as being able to take risks that neither the private sector nor the government can, will, or should take. However, no industry standard currently exists for defining, assessing, and managing risk in philanthropy. Few grantmakers assess risk during the application process and even fewer have processes in place to manage risk after a grant is made. This poses a significant challenge because if you can’t define and manage risk, then you can never actually take it. To address this gap in practice, Open Road Alliance convened a national taskforce over a six month period to create a toolkit to help funders—and nonprofits—better define risk, identify their appetite for risk, and implement sound risk management policies and procedures. In this session, Open Road Alliance shared a draft version of the toolkit for feedback, testing, and discussion.
By the end of this workshop, participants had:
• Answered what parts of these tools would be a blessing or a burden for nonprofits to implement and comply with.
• Adapted the toolkit for nonprofit, funder, or other use.
• Tested several of these tools and provided feedback on what tools are useful, how they could be more useful, and what additional tools would be necessary for non-profit use.
Risk Management in Philanthropy
Social Analysis and Action: An Approach for Social Norm Change
Bethann Witcher Cottrell and Feven (Tassew) Mekuria, CARE
During the Social Analysis and Action (SAA) session, we conducted two participatory activities from the manual to familiarize participants with the approach, allowing for reflection and questions after the activity. The presenters also covered the framework for SAA, SAA minimum standards, and the theories which undergird the approach. We examined different methods used for measuring impact. Finally, we concluded with an in-depth discussion on the challenges we encounter with the sensitive work of addressing social norms, power, and gender.
By the end of this workshop, participants had:
• Learned the SAA approach to social norms, gender, and power that impact individuals, households, and communities.
• Applied specific tools from the SAA manual.
• Understood potential ways of incorporating the SAA model in their own work.
Social Analysis and Action M&E Graphic
Link Nutrition Causal Analysis (NCA) Tool
Joy Noel Baumgartner, Duke Global Health Institute; Melissa Sharer, John Snow, Inc (JSI); Regina Benevides, Pathfinder International
The Link NCA tool uses mixed methods (combining qualitative and a descriptive quantitative component) to understand the mechanisms leading to under-nutrition in a given area. This tool is designed to improve nutrition security programming by providing operational recommendations for nutrition specific and sensitive interventions. This session gave an overview of the methodology and helped to understand the key factors to determine if a Link NCA is relevant or not, and how to use the result for programming. After a short presentation, the participants went through practical exercises.
By the end of this session, participants had:
• Received an overview of the Link NCA methodology and added-value of this tool.
• Discovered the importance of the preparatory phase to be conducted to decide if a Link NCA is relevant and feasible, or not in a specific context.
• Learned how to link findings from the Link NCA to nutrition security programming