PLENARY
Review the Effectiveness of Community-based Primary Health Care in Improving Child and Maternal Health: Leveraging Results for Advocacy
Henry Perry, Johns Hopkins University; Paul Freeman, Independent; Enric Jané, Bill & Melinda Gates Foundation; Moderator: Sarah Shannon, Hesperian Health Guides
With funding from multiple donors, including the Gates Foundation, Henry Perry and colleagues are completing a 10-year, ground-breaking effort of the Working Group on Community-based Primary Health Care (PHC) of the International Health Section of the American Public Health Association to compile and review evidence about the effectiveness of community-based PHC in improving child and maternal health. The upcoming release of this study presents a unique opportunity to increase the visibility of, and to advocate for, community-based interventions. During this session, Henry Perry and Paul Freeman presented key findings, and Enric Jané commented on the findings and discussed current activities and future plans of the Gates Foundation regarding integrated community-oriented primary health care. Participants had the opportunity to strategize about how we might work together to publicize the results of the Review to advocate widely for our shared commitment to community engagement and community-based interventions.
By the end of this session, participants had:
• Identified how these key findings can support our advocacy for Community-based Primary Health Care.
• Identified specific ways to use the release of the Review to increase advocacy for community-based health programs as individual organizations and as CORE Group members.
CONCURRENT SESSIONS
Effectiveness of Community-based Primary Health Care: Participatory Discussion of Program Implications
Mary Carol Jennings, Johns Hopkins Bloomberg School of Public Health; Paul Freeman, Independent; Henry Perry, Johns Hopkins Bloomberg School of Public Health; Moderator: Sarah Shannon, Hesperian Health Guides
This session built on the plenary above. A 10-year study to compile and review evidence about the effectiveness of Community-based Primary Health Care in improving child and maternal health has just been concluded. This major effort of the Working Group on Community-based PHC of the International Health Section of the American Public Health Association provided extensive findings on maternal health, neonatal health, child health, equity, integration, and strategies for community engagement and intervention implementation that can inform and strengthen approaches to improve child and maternal health. Speakers shared a brief overview of key findings and then participants discussed how these findings can be used to inform and strengthen NGO programs.
By the end of this session, participants had:
• Learned about the results of the Review of Effectiveness of Community-based Primary Health Care regarding maternal health, neonatal health, child health, equity, integration, and strategies for community engagement.
• Discussed how these findings can inform and strengthen the implementation of NGO community-based programs.
Community-based Primary Health Care: Maternal Health_JENNINGS
Packaging Communications to Influence Longer-term Solutions
Tom Paulson, Humanosphere; Joy Portella, Minerva Strategies; Dara J. Royer, Mercy Corps
We’ve all seen (and maybe even created) the flashy communications targeting funders, policymakers, and media around “hot topics” in global health like Ebola and Zika. But how can we draw more attention to longer-term health interventions such as health systems strengthening? This session discussed how NGOs can be more purposeful in their communications to advocate for funding and policies that support more abstract health solutions. While they can have significant impact in the field, these solutions are more challenging to package neatly as communications sound bites. Panelists suggested ways communications and program staff can better work together internally to improve these communications, and how blogging and other media can be employed to orient people toward these longer-term investments.
By the end of this session, participants had:
• Engaged in meaningful discussions about how we develop different types of communications and messaging based on the topic and audience.
• Learned how communications staff and program staff at field and HQ levels can better complement each other and work together toward creating the most effective external messaging.
• Gained tips and tricks to communicate to external audiences that long-term health interventions are just as urgent and impactful as more targeted interventions.
Packaging Communications to Influence Longer-term Solution_PORTELLA
Packaging Communications to Influence Longer-term Solution_ROYER
The Complexities of M&E in a Multi-dimensional, SDG World
Dora Ward Curry, CARE; Claire Boswell, The TOPS Program, Food for the Hungry
Participants explored M&E issues raised by new directions for 21st century, post-child survival global health, as exemplified by the new SDGs. These changes imply a range of new needs for documenting and assessing the “how,” “how well” and “why (impact)” of our programming. The session used small group guided discussions, concluding in a plenary discussion. The themes of the three small groups included: 1) M&E options to better understand and document truly integrated programming (as contrasted to parallel vertical programming); 2) key elements of M&E for multi-dimensional SBC, such as practical methods for assessing social and gender norms and prioritizing issues within SBC M&E in this context; and 3) M&E implications for assessing health impact of work from other “sectors,” especially how the theory of change in multi-dimensional programming influences the choice of monitoring and evaluation indicators and design of M&E approach.
By the end of this session, participants had:
• Discussed three specific challenges related to monitoring and evaluation of programming with a multi-dimensional approach: integration in programming across systems or sectors; the M&E of social change; and improvement of our understanding and assessment of the causal pathways from interventions in other sectors to health outcomes.
• Identified key priorities for future work by CORE Group members related to these three issues.
Hot Topics in Social and Behavioral Change
Mary DeCoster, The TOPS Program, Food for the Hungry; Chelsea Cooper, USAID’s Maternal and Child Survival Program, Jhpiego; Debora Freitas López, Chemonics; Antony Duttine, Handicap International
This participatory session covered “hot topic” areas in social and behavior change (SBC): 1) Broadening and deepening our approaches, increasing our efficacy in SBC: Working in small groups, the session attendees discussed SBC methods used in participants’ interventions, how to effectively add more methods to the mix, and potential usefulness of a common taxonomy of methods for more effective program design, implementation, and assessment. 2) Existing linkages between SBC and quality of care interventions: They explored the use of SBC approaches to address health worker behavior and institutional norms, and how client-health worker interactions effect perceived quality of care and health outcomes. The presenters will provide an overview of global evidence and program approaches, tools, and resources, offered case examples, and discussed how to further strengthen work in this area. 3) Using SBC methods to address risky road user behaviors: Road crashes cause over 1.2 million deaths annually and many more injuries and permanent disabilities. They discussed how SBC was used to enhance road user behavior, providing an overview of current approaches, tools, and resources used, offering case examples on how risky behaviors were being addressed, and considering what more can be done to connect SBC and road safety in the community.
By the end of this session, participants had:
• Identified SBC methods that could be used for more effective program design, implementation, and assessment.
• Identified SBC approaches to address health worker behavior and norms, and improve perception in quality of care received.
• Identified SBC approaches and tools used to address risky road user behaviors.
Hot Topics in Social and Behavioral Change Introduction
Social and Behavior Change, Provider Behavior, and Quality of Care_COOPER
Road Safety: Paving the Way with SBC_DUTTINE
Embrace Life: Always Wear Your Seatbelt Video
Volkswagen Eyes on the Road Cinema Stunt: Shocking Danger of Texting and Driving Video
LUNCHTIME ROUNDTABLES AND SESSIONS
Roundtable: New Tools for Tracking Multi-Sectoral Nutrition Investments
Amanda Pomeroy, SPRING, John Snow Inc.
This session oriented participants to SPRING Project’s new nutrition budget analysis tool and user’s guide to track financing for nutrition activities at multiple levels within a country. This tool has been used successfully in Uganda and Nepal, and can be used in other country contexts as well. Participants of this lunctime roundatable heard more about the tool and user’s guide, get links to the resources, and walk through an example from the Nepal study via a data placemat.
Roundtable: Accelerating Change Through Nutrition-Sensitive Agriculture
Ashley Aakesson, SPRING, John Snow Inc.
At this lunchtime roundtable, participants worked together with sample project data to identify nutrition-sensitive agriculture practices which are likely to contribute to improved nutrition outcomes in a specific context. This exercise was part of a larger online training that SPRING Project is designing for agriculture project staff to build their knowledge and skills to design stronger nutrition-sensitive agriculture projects. A key aspect of the training is practicing the application of social and behavior change (SBC) principles to define practices and priority and influencing groups, and to use data from formative research to design SBC interventions to reduce barriers to and strengthen enablers for change. The training places nutrition-sensitive agriculture interventions into the broader context of inclusive value chain and agriculture market development, helping project designers and implementers to focus resources effectively to achieve project objectives through SBC.
Roundtable: Behavior Change in Urban WASH in Eastern DR Congo
Nicole Weber, Mercy Corps DRC
Mercy Corps is currently implementing a large-scale DFID-funded urban water, sanitation and hygiene (WASH) program, known as IMAGINE. IMAGINE aims to reduce diarrhea in children under five and to reach 1 million beneficiaries in urban centers in Eastern DR Congo by 2019. It seeks to simultaneously improve the availability of, access to, management of, and proper utilization of WASH resources to ensure sustained health impacts. As part of an integrated approach, a multifaceted behavior change strategy including radio campaigns, integrated care groups with the Ministry of Health, and participatory theater is underway. Behavior change is cross-cutting and not only targets key hygiene behaviors linked to child health, but also promotes behaviors related to the other components of IMAGINE including good governance, gender, service provision, and infrastructure. At the base of the BCC campaigns are formative research, ensuring that our messages, materials, lessons, and tools based on local research that identified attitudes, perceptions, and behavioral determinants. Participant feedback, peer review, and inputs were very much welcomed during this session.
By the end of this informal session, participants had:
• Identified strengths and challenges in implementing integrated care groups in an urban setting.
• Discussed the utilization of barrier analyses results in multiple behavior change channels in an urban WASH setting.
• Recommended new ideas and provide peer review on the current approach used by IMAGINE.
Kristie Urich, World Vision InternationalThere is increased focus on water, sanitation, and hygiene (WASH) as a key missing piece in health programming. Improved WASH conditions during pregnancy and childbirth can reduce maternal and newborn mortality and morbidity, and healthy WASH conditions and behaviors within a young child’s feeding and play areas can help to prevent environmental enteric dysfunction, leading to a reduction in stunting. Yet, the practice of systematic integration between WASH, maternal newborn and child health, nutrition, and early childhood development remains hindered on multiple levels, including policy, advocacy, financing, research and programmatic implementation. Acknowledging that the Sustainable Development Goals (SDGs) encourage more cross-sector collaboration, World Vision initiated the BabyWASH Coalition to provide guidance and focus on the lack of integration in the First 1000 Days. This session presented World Vision’s current work on BabyWASH, the purpose and work of the BabyWASH Coalition, and invited input and further involvement.
By the end of this session, participants had:
• Understood the research and rationale for an integrated approach to maternal and child health in the First 1000 Days.
• Learned the purpose and current work of the BabyWASH coalition.
• Had the opportunity to contribute to BabyWASH efforts through dialogue, discussion, and opportunities for further involvement.
Roundtable: Low-Burden M&E for Nutrition SBC: Brainstorm on Challenges and Methods Using Non-Technical Staff
Tom Davis, Independent; Jennifer Nielsen, Helen Keller International; Cheryl Combest, URC; Kristina Granger, SPRING, The Manoff Group
This session was an opportunity to brainstorm challenges and solutions for nutrition social and behavior change (SBC) monitoring that non-technical staff (volunteers and community-level agents) can conduct and use. It began with mini-presentations of programs using innovative solutions for dealing with existing challenges. Participants were then invited to break into groups and discuss their own challenges while collectively brainstorming solutions. Specific topics might include: issues of self-reporting of nutrition practices, trial vs. sustained behavior change, observational methods, difficulty with dietary recall for non-technical staff, and more. Program examples were presented by Tom Davis on using low quality assurance sampling (LQAS) as a mini-KPC in Mozambique, Jennifer Nielsen from Helen Keller International on modifications to dietary recall questions, Cheryl Combest from URC on monitoring plans for husband schools on nutrition under REGIS-ER in the Sahel, and Kristina Granger on routine monitoring of maternal, infant, and young child nutrition MIYCN behaviors presented through community videos using community volunteers, and MIYCN monitoring forms with illustrations for illiterate volunteers in Guatemala designed by The Manoff Group.
By the end of this session, participants had:
• Learned about specific program examples using low-burden techniques for monitoring and evaluating nutrition SBC.
• Identified specific challenges to using non-technical staff for M&E for nutrition SBC.
• Brainstormed potential solutions that programs can use for the identified challenges.
Working with Partners to Leverage Resources and Maximize Impact to Achieve Big Results: Lessons from the CORE Group Polio Project and the Gavi Civil Society Network
Lee Losey, CORE Group Polio Project, Catholic Relief Services; Janine Schooley, PCI; Brenda Hegarty, Catholic Relief Services; Moderators: Meg Lynch, CORE Group Polio Project, Catholic Relief Services; Frank Conlon, CORE Group Polio Project, World Vision
We have seen immense growth in the formation of global, multi-stakeholder coalitions to address large and increasingly complex development issues. The collaborative actions of these coalitions have the potential to extend the reach and multiply the impact of more isolated efforts multifold. The potential for bigger results cannot, however, be uncoupled from more complex challenges in the governance and management of such collaborative efforts. The CORE Group Polio Project and the Gavi Civil Society Network shared their experiences in convening coalitions of civil society organizations within larger global health partnerships – the Polio Eradication Initiative and the Gavi Vaccine Alliance, respectively. The group discussed the strategies, advantages, and challenges of working in coalitions as well as considered other global health issues that could benefit from similar structures and strategies.
By the end of this session, participants had:
• Understood the structures and strategies of two coalition projects, the CORE Group Polio Project and Gavi CSO Net- work.
• Discussed the advantages, in terms of resources and outcomes, of working in large coalitions.
• Discussed lessons-learned from a perspective of NGO coalition convener and global coalition partner.
• Considered other global health issues beyond polio eradication and routine immunization that could benefit from similar coalition approaches.
WORKING GROUP TIME
Child Health Working Group
This session built on the work conducted on Wednesday to identify critical child health technical or programmatic challenges, solicit targeted feedback from colleagues working in similar situations, and identify opportunities to work across organizations to solve common challenges time-bound task forces.
Community-centered Health Systems Strengthening Working Group
Co-Chairs: Megan Christensen, Concern Worldwide; Alfonso Rosales, World Vision
The Community-centered Health System Strengthening (CCHSS) Working Group welcomed those who were interested in the topic or guest speakers, anyone looking to join a new Working Group, and individuals who were passionate and have had experience with health systems strengthening. The group hosted two guest speakers, one during each session. A guest from USAID presented the new community health framework and led a discussion. In addition, the group had a guest from USAID’s Maternal and Child Survival Program present a working document that is a joint effort with WHO on design and implementation principles for community-oriented health interventions. They approached the CCHSS Working Group and were seeking feedback from the perspective of practitioners. A portion of the time was also used to share the workplan and solicit input from members.
Monitoring and Evaluation; Nutrition; and Social and Behavior Change Working Groups
Co-Chairs: Monitoring and Evaluation – Claire Boswell, The TOPS Program, Food for the Hungry; Dora Curry, CARE; Nutrition – Jennifer Burns, International Medical Corps; Maureen Gallagher, Action Against Hunger; Justine Kavle, USAID’s Maternal and Child Survival Program, PATH; Social and Behavior Change – Lenette Golding, Alive & Thrive, FHI 360; Debora Freitas, Chemonics International; Joseph Petraglia, Pathfinder International
This time was devoted to a theme of integration and collaboration among the Nutrition, SBC and M&E working groups. During the first 40 minutes, Sally Abbott, USAID Bureau for Food Security Nutrition Advisor, presented to the Nutrition, M&E, and SBC working groups on the new USAID nutrition indicators. These indicators will be used with all nutrition programs overseas funded by the US Government. This includes Feed the Future, Food for Peace, Global Health and others. This small group of new indicators is part of a drive to focus measurement on the end goal: improved nutrition. USAID would be very pleased to have implementer discussion on these indicators as they roll out. Given that the USG Multi-sectoral Nutrition Strategy is multi-faceted, participation from Nutrition, M&E, and SBC would be very useful in the discussion. Following the presentation, there was 20 minutes for providing feedback to Sally on implementing partners’ perspective of these indicators in programming. During the last 30 minutes of the working group time, an exercise took place to brainstorm ways to enhance collaboration among our working groups. The outcome was a list of activities that feed into work plans on ways to strengthen integration – both across technical sectors and of M&E and SBC into integrated programming.
Reproductive, Maternal, Newborn and Adolescent Health Working Group
Co-Chairs: Corinne Mazzeo, USAID’s Maternal and Child Survival Program, Save the Children; Cindy Uttley, Samaritan’s Purse; Mychelle Farmer, Jhpiego; Regina Benevides, E2A Project, Pathfinder International
The RMNAH Working Group focuses on a broad range of health concerns related to sexual and reproductive health, maternal and newborn health, and adolescent health. Within the RMNAH Working Group, there are two task forces: Maternal and Newborn Health (MNH), and Sexual and Reproductive Health and Adolescents (SRH+A). This session included a joint Hot Topics session that provided members with the opportunity to discuss emerging health crises and policy developments affecting RMNAH.
PLENARY
Sustainable Health – A New Vision for Programming
Debora B. Freitas Lopez, Chemonics; Charlene McGee, Multnomah County Health Department Health Equity Initiative; Jonathan Fink, Portland State University; Moderator: Beth Outterson, Medical Teams International
This session focused on what sustainable health means, and how multi-dimensional approaches can catalyze our efforts to improve and sustain health. As the world’s population continues to grow and merges into urban centers, and as global warming looms, we need to find collaborative solutions both locally and globally in order to be more efficient and more resilient. The session started with a global example in the developing world, and then moved toward local examples that promote social and behavior change and sustainable living.
Debora B. Freitas López, shared how a multifaceted coastal city adaptation project in Mozambique is integrating urban planning, governance, climate change adaptation, and social and behavior change approaches to help coastal cities become climate-smart, resilient, and healthier. Charlene McGee shared the Multnomah County Department of Health’s Equity Initiative ecological model for social and behavior change. And Jonathan Fink from Portand State University discussed how a series of unique partnerships has turned Portland from one of the most polluted cities in the US to one of the most livable “smart cities.”
By the end of this session, participants had:
• Understood how multi-dimensional programming can promote sustainable health.
• Gained insight how an ecological model can help increase access and promote positive behaviors for disadvantaged populations.
• Recognized local and global examples of ways that multi-dimensional programs and partnerships can improve and sustain health.
Listen to a recording of the plenary session.
Urban-serving Universities’ Role in Building Green, Healthy, Equitable Cities_FINK
Becoming Climate-smart, Resilient, and Healthier through Integration_FREITASLOPEZ
Equity into Action: A Local Public Health Approach_MCGEE
Video | Portland: We Build Green Cities