Projects often state that they are really interested in equity, but when you read the project descriptions, you don’t see exactly what they mean by equity or how they plan on addressing it – Jennifer Luna, MCHIP. Jennifer Luna authored a Health Equity Guidance Document with the input of CORE Group members and a Job Aide that outlines a systematic, six-step process for professionals who design and implement community-oriented projects to ensure equity is effectively integrated into their programs. She will present these tools on Thursday. - Presentation at Wilson Center 4/2011
While there has been some progress in reducing the rates of mortality for children under five (the UN’s Millennium Development Goal 4), Chopra said “there has to be a change” if they are going to be achieved completely. Most of the 30 percent decline in child mortality so far has been in Asian countries, while Africa as a whole remains stagnant. Further, two-thirds of the 35 countries that have made significant progress to meet MDG 4 show worsening inequalities between the highest and lowest income brackets of the population. In the majority of countries, the “rich are still capturing most of the benefits of new investments and interventions,” said Chopra. “The challenge at the program and policy levels is to understand why there is this gap between the richest and the poorest in terms of uptake of critical interventions.”“Shifting delivery of services within channels, appropriately shifting delivery to different channels, or improving the performance of an established delivery channel could help increase uptake of treatment and prevention among poor and marginalized communities, concluded Chopra. He stressed that progress need not come at the expense of the poor. According to a UNICEF report, Ghana, Eritrea, Nepal and Malawi have all reduced under-five mortality and inequality by prioritizing providing essential services to the most marginalized communities first. - Mickey Chopra, UNICEF – presentation at Wilson Center
The Countdown to 2015 is tracking equity. This slide shows several countries that have 50-60% coverage of key child survival indicators. Some such as Zambia, have small differences between the wealthy and the poor, while others, such as Madagascar and Guatemala have large differences between the wealthy and the poor.
Again, Countdown to 2015 data showing that equities also differ by intervention. In the case of ORT, overall coverage is amazingly low for an intervention shown to be effective since the 1980s, and it’s low for both the poor and the wealthy. On the other hand maternal health interventions such as postnatal visits and skilled birth attendants have the highest inequity by wealth quintile.
From Countdown to 2015:Based on selection of 9 preventive child survival interventions measured through DHS: water, antenatal care (>=4 visits), skilled delivery, TT (2 doses in pregnancy), BCG, DPT (3 doses), measles, vitamin A, bednets Calculated how many of these interventions were received by each child aged 1-4 yearsUsed DHS and MICS dataCalculated asset index to classify wealth quintilesDescribed patterns of inequities in co-coverage by socioeconomic groups
There are strategies that can be used to improve equity. According to a UNICEF report, Ghana, Eritrea, Nepal and Malawi have all reduced under-five mortality and inequality by prioritizing providing essential services to the most marginalized communities first. But you can’t change anything, unless you measure it.
In order to decrease inequities more work is needed to understand and improve those linkages within communities and between communities and the formal health system that contribute to health outcome. We are defining these linkages and relationships as social capital, the bonds between similar people and the bridges between diverse people, with norms of reciprocity. (Dekker and Uslaner 2001) CORE Group has developed a paper to explore this idea further that will presented later today and needs your field based input.
If we look over the past 10 years we can see major shifts in our membership. We’ve grown from 30 to 55 organizations. 32 organizations have joined us while only 7 have left, generally due to shifting missions or economic hardship. This year we have two member organizations up for vote – WCDO and Samaritans Purse. Voting concludes today and we need a majority of members to approve the vote. We have five organizations in the one year courting period. Please get to know these organizations and make them feel welcome.
We wanted to extend the benefits of belonging to CORE Group to those organizations who didn’t meet all of the criteria yet were passionate about community health, so we initiated a new “Associates” category in March of this year. We’re pleased to welcome our first three organizations – BU Center for Global health and development, Institute for Reproductive Health at Georgetown University, and American College of Nurse Midwives. We’re also please to welcome our new Individual Associates – our “early adopters”.
Working Groups provide the technical direction to move CORE forward as a group. As you can see, as usual, all working groups have been active. Elluminates, especially, have been a very popular way to update everyone on state-of-the-art information and also on new products being produced by our members and partners. The Community Child Health and Nutrition Working Groups have been particularly active the past six months, hosting technical advisory group meetings on CARE Groups (there will be a roundtable later today), CHW Performance at Scale TAG with MCHIP, and a Community Health Systems paper which will be presented later today. The Nutrition WG partnered with the FSN network to host a NPDA training, participated in the Scaling-Up Nutrition and Thousand Days Initiative, and developed a new product on Essential Nutrition Actions.These activities are in addition to all of the work the Working Group do to plan and present at our spring and fall meetings, and open up new networking opportunities for us.
We build our consensus and get our technical directions through working group discussions. We’re proud of our co-chairs and very luck to have them provide their expert skills to our network. I’d like to have each WG Co-Chair stand up for the recognition they deserve. As recognition for their work each WG Co-Chair will receive a copy of this year’s bestseller: The Checklist Manifesto: How to Get Things Right by Atul Gawande. We thought they’d especially appreciate the “Checklist of Checklists”.
We are in the initial development stage for several products that have been prioritized by the working groups. Please join for any of these sessions where you might be able to better define the tool or provide expertise and guidance on its development. This is what makes our meeting so special – it’s a working meeting that sets into motion products directly responsive to member needs. I’d like to introduce Rebecca Nermina who is a fellow working with the CORE Group this year through a one year fellowship through Atlas Corps. You can find out more about this opportunity at one of the sponsor tables.
Thanks to Helen Keller Int. and JSI Research and Training and long hours of work, we were able to finalize English copies of the Essential Nutrition Actions Framework. We have copies of the messages booklet available by the registration table and sample copies of the training guides. We expect a French version to be ready sometime in June.
In addition to Working Groups, CORE Staff stay very busy, planning these meetings, facilitating communications and coordination around he Working Groups technical visions. I’d like to highlight a few of the activities we’ve launched in the last six months.we’re upgrading our website based on the desires you expressed in the survey and we’re hoping to produce a video on equity based on interviews at this meeting. Please see Pinky Patel if you have a story on equity you want to share.* Ann continues to lead our m-health interest group.Shannon is managing our relationship with MCHIP and we’re linking CORE ideas and actions to the program learning agenda of the USAID CSHGP.Joan Whelan has launched our food security and nutrition network and they had an amazing meeting yesterday. We’ll here more from Mark Fritzler.We continue to support the Polio Partners communication efforts. Frank Conlon will tell us more about their successes.We are on the civil society task team of the scaling-up nutrition and thousand days initiaitive and will participate in Concern Worldwide and Bread for the World’s civil society gathering on hunger and nutrition June 13 and 14.We are providing technical input into the UN document being written by the Earth Institute calling for a scale-up of CHWs.
This slide is just to remind all of us that we continue to work on our four program initiatives and encourage working groups to think how they can contribute to them. The fourth one, assuring integrated prevention and care for infectious diseases, is the least developed at this time.
As a network, our budget is reduced this year from previous years, but it is more diversified. We have a budget of approximately $1.5 million through MCHIP, the TOPS project, World Vision Polio, World Learning for Family Planning, and we are growing our foundation, membership and gifts through the combined federal campaign. We need to be proactive in selection of funding opportunities that match working group directions and encourage you to contact us when you see an RFA or opportunity where our diffusion and knowledge management niche will not compete with our members but instead provide that neutral safe environment for joint product development, ownership and use.
I want to thank all of you for your contributions to this meeting. This meeting is by you and about you. I also want to thank Shannon Downey for coordinating this meeting this year – her first time, and it’s never an easy task even when you do it many times.
I’d like to ask Frank Conlon and then Mark Fritzler to give us brief updates on the Polio Project and TOPS / FSN followed by Judy Lewis who will present your Board directions and Mary Hennigan to present the Board slate of candidates for 2011. Thanks to you all.
Welcome & Overview: State of CORE Group/Board Directions_LeBan_5.10.11
COMMUNITY HEALTH NETWORK<br />ANNUAL SPRING MEETING<br />May 10-13, 2011<br />
Welcome to Our Spring Meeting<br />EQUITY IN HEALTH<br />Ensuring Access, Increasing Use<br />State of CORE<br />Karen LeBan, Executive Director<br />
A Ten Year Retrospective<br />PAST SPRING MEETING THEMES<br />2001: Collaboration<br />2002: Opportunities<br />2003: Partnerships and Leadership<br />2004: Maternal and Child Health Impact at Country Level<br />2005: Scale and Scaling-Up<br />2006: Quality<br />2007: Innovations<br />2008: Research<br />2009: Health Systems Strengthening<br />2010: Community Health System Strengthening<br />2011: EQUITY<br />“of all forms of inequality, injustice in health care is the most shocking and inhumane” – Martin Luther King Jr.<br />
Health Equity Defined<br />“Health equity is both the improvement of a health outcome of a disadvantaged group as well as a narrowing of the difference of this health outcome between advantaged and disadvantaged groups – without losing the gains already achieved for the group with the highest coverage”<br />- MCHIP (with CORE Group)<br />
if coverage is low for everyone, target everyone
if coverage is low mostly for poor, target the poor</li></li></ul><li>Components of a Community Health System<br />Social Capital<br />Formal Health System<br />1. Health Services<br />2. Health Workforce<br />3. Health Information System<br />4 . Essential Products, Vaccines, Technologies<br />5. Health Financing<br />6. Leadership and Governance<br />Community Health System<br />Facility Outreach<br />Private Health Sector<br />Community Health Agents<br />Leadership & Governance Groups<br />Community Support Groups<br />Local communicators <br />Faith-based orgs. & Leaders<br />Other Sector Groups / Associations<br />Health Outcomes<br />Other factors, e.g. political, economic, environmental.<br />
55 Members<br />ACDI/VOCA<br />Adventist Development and Relief Agency<br />Africare<br />African Medical and Research Foundation<br />Aga Khan Foundation<br />American India Foundation <br />American Red Cross<br />American Refugee Committee<br />AME - SADA<br />CARE International<br />Catholic Medical Mission Board<br />Catholic Relief Services<br />ChildFund International<br />Christian Reformed World Relief Committee<br />Concern Worldwide<br />Counterpart International<br />Curamericas Global, Inc.<br />Episcopal Relief and Development<br />Food for the Hungry<br />Freedom from Hunger<br />Future Generations<br />Global Health Action<br />Haitian Health Foundation<br />Health Alliance International<br />HealthRight International<br />Helen Keller International<br />Hesperian Foundation <br />HOPE Worldwide<br />IMA World Health<br />Institute for OneWorld Health<br />International Relief and Development<br />International Medical Corps<br />International Relief and Development<br />International Rescue Committee<br />International Youth Foundation<br />La Leche League International<br />Medical Care Development International<br />Medical Teams International<br />Mercy Corps<br />Partners for Development<br />PATH<br />Pathfinder International<br />Physicians for Peace<br />PLAN International<br />Population Services International<br />Project Concern International<br />Project HOPE<br />Relief International<br />Salvation Army World Service<br />Save the Children<br />WellShare International<br />White Ribbon Alliance for Safe Motherhood<br />World Connect<br />World Lung Foundation<br />World Relief<br />World Vision<br />
Membership Changes2001 - 2010: 30 – 55 member organizations32 organizations joined, 7 organizations left<br />Members Up for Vote (5/11)<br /><ul><li>World Concern Development Organization
Samaritans Purse</li></ul>Applicants in “One Year Courting Period”<br />Project C.U.R.E.<br />Axios Foundation<br />Operation Smile<br />Partners in Health<br />Grandmothers Project<br />
New Associates Launched March 2011! <br />Associate Organizations<br />For those organizations not eligible to be members (because of 501c3, citizen support requirements) but committed to community health<br />Boston University Center for Global Health and Development<br />Institute for Reproductive Health – Georgetown University<br />American College of Nurse Midwives<br />Individual Associates<br />For community health professionals<br />Kyung Endres<br />Paul Freeman<br />Bonnie Kittle<br />Grace Kreulen<br />Judiann McNulty<br />
FY11 Working Group Highlights<br />Community Child Health: Care Group Technical Advisory Group Meeting; MCHIP’s CHW at Scale TAG Meeting; CCM Essentials Promotion; Community Health Systems Paper; Elluminates: WHO CHW Training Materials, WV Timed and Targeted Counseling Curriculum for CHWs<br />HIV/AIDS: Integration <br />Malaria: Elluminates: CRS community based malaria treatment and prevention project in Benin; MCHIP Malaria Communities Program Project Results and Highlights; MCHIP Best Practices in Communication for Community-Based Malaria Programs <br />M&E: Equity Guidance (with MCHIP)<br />Nutrition: Nutrition Program Design Assistant Training (with TOPS); Essential Nutrition Action Framework; Scaling-Up Nutrition<br />SBC: PDQ, Institutional Memory, Volunteerism <br />SMRH: IRH Faith and Family Planning Symposium; Helping Babies Breathe Facilitators Guide; Elluminate: Disrespect and Abuse in Childbirth<br />TB: Booth at IUATLD Meeting ; Support to TBCAP, Stop TB Representation; Elluminate: New Diagnostics<br />
Thank you WG Co-Chairs!<br />Community Child Health<br />Alan Talens, Alfonso Rosales, Jeanne Koepsell, Fe Garcia<br />HIV/AIDS<br />Janine Schooley, Shannon Senefeld<br />Malaria<br />Eric Swedberg<br />M&E<br />Todd Nitkin<br />Nutrition<br />Bethann Cottrell, Jennifer Nielsen, Kathryn Reider<br />SMRH<br />Judy Lewis, Abdelhadi Eltahir, Sadia Parveen<br />SBC<br />Mitzi Hanold, Marilyn Patton<br />TB<br />Kayt Erdahl, Charlotte Colvin<br />
New CORE Activities – Spring Meeting Dialogue<br /><ul><li>Nutrition CHN / FSN -- Tuesday</li></ul>-Kathryn Reider / Joan Jennings<br /><ul><li>Community Health Systems - Tuesday</li></ul>-Fe Garcia / Karen LeBan<br /><ul><li>Family Planning SBC Guide -- Wednesday</li></ul>-Ann Hendrix-Jenkins / Leah Elliot (ICF)<br /><ul><li>Sustainability Initiative – Eric Sarriot – Wednesday
Scaling-Up Nutrition Civil Society Task Team / Thousand Days Initiative
UN / Earth Institute 1 million CHW Campaign </li></ul>Leadership of a Neutral Space that Promotes <br />Coordination and Partnership Development<br />Facilitation of Working Group Technical Vision<br />
Our Program Initiatives<br />Strengthening Community Mother-Child Care<br />Scale-Up of Community Case Management <br />Nutrition in the Community Context<br />Assuring Integrated Prevention and Care for Infectious Diseases<br />
Resources<br />Knowledge Diffusion, CSHGP Program Learning, CCM, Equity, CHWs, Anemia, Nutrition, TB, Helping Babies Breathe<br />Food Security and Nutrition Network<br />Supporting CORE Polio Partners Project Communication Efforts<br />Flexible Fund (Family Planning)<br />Foundation Funding / Membership / Registration / Combined Federal Campaign<br />World Learning<br />Grants Solicitation and Management <br />In search of FUNDING OPPORTUNITIES (RFAs) where CORE’s Network Niche and Community Focus would be an ASSET<br />
Thank you to our Spring Meeting Supporters<br />CORE Group Members, Associates and <br />Working Groups<br />Presentors, Partners and Guests<br />Table Sponsors <br />Thanks to Shannon Downey for coordinating this meeting this year. <br />
Coming Next<br />Polio Partners Project Update, Frank Conlon<br />TOPS and FSN Update, Mark Fritzler<br />Board Directions, Judy Lewis<br />Board Nominations, Mary Hennigan<br />