1. Integrating Community-Based
Strategies Into Existing Health
Systems: The Unique Role Of INGOs
CORE Group Global Health Practitioner Conference
Silver Spring, MD
May 6, 2014

2. Why Community-Based Strategies?
• Significant progress towards reaching the MDGs for
maternal and child health
• Disproportionate number of maternal and child
deaths between and within LMICs
• Due to ineffective programs that lack community
involvement and participation
• Strategies to promote community participation have
the potential to enhance sustainability, improve
efficiency and effectiveness, and lead to greater
agency for the poor

3. The Changing Role of INGOs
• INGOs have traditionally served as implementing
organizations (boots on the ground) for community-
based health programs in LMICs
• Despite programmatic success, the model of using
INGOs as direct service providers or capacity
builders for direct service delivery has been criticized
• INGOs are being urged to shift to a model that
leverages their strengths and experiences to
influence systems, thereby having impact at scale
• Scale: Integration of community-based strategies into
existing structures and systems at the
district, national, or global level

4. A New Framework
• Dearth of literature on INGO contributions to scaling-
up community-based health strategies
• This paper will present:
• A new conceptual framework that shows how INGOs
can catalyze the integration of community-based
strategies into existing systems
• Six case studies that illustrate the application of the
framework
• The practical implications and limitations of the
framework

5. The Process
• Examined findings from 82 Child Survival and Health
Grant Program projects from the last 10 years
• Sent questionnaires to 10 INGOs representing
different sizes, different countries of operation, and
different community-based interventions
• Combined INGO responses with evidence from
literature review on scale-up, implementation
science, and evidence-informed policy making
• Six case studies were selected to represent the three
pathways described in the framework

6. Integration of community-based maternal, newborn, and
child health (MNCH) service delivery, prevention and
promotion strategies into existing public or private structures
and systems at the district, national, or global level.
Change institutional norms and provide a
platform for effective collective action
“Thought
leadership” through
training, information
sharing, and
learning
“Joint venturing”
through like-minded
partnerships
Key Factors for
Success:
Participation of
policy-makers/
stakeholders, po
licy community
cohesion, influe
ncing systems
change, etc.
Guiding institutions: INGOs
“Learning for
leverage” by
demonstrating
program
effectiveness
Policy-enabling environment:
Created by prior advocacy or timely “policy windows”
Conceptual Framework

7. Case Studies
1) Learning for Leverage
• Future Generations (Peru)
• CARE (Bangladesh)
2) Thought Leadership
• Haitian Health Foundation (Haiti)
• Helen Keller International (Nepal)
3) Joint Venturing
• Concern Worldwide, International Rescue
Committee, and World Relief (Rwanda)
• ChildFund International, Plan International, Catholic
Relief Services, Africare, Counterpart International and
World Vision (Senegal)

8. Small Group Discussion
• What are your suggestions for ways to better depict
the integration process? What is missing from the
framework?
• What are other key factors that help the three
mechanisms succeed?
• What are some of the other important characteristics
of a policy-enabling environment?
• How can this framework be used to inform policy and
practice regarding the future role of INGOs?
• What are the limitations of this framework?

9. Next Steps
• Finalize the case studies
• Revise the conceptual framework based on feedback
from today
• Develop the discussion around the implications and
limitations of this type of a framework
• Develop draft manuscript by the end of the month
• Send manuscript for review by all case study authors
• Submit manuscript for publication in peer-reviewed
journal by July 2014

10. Thank you!
• Please send additional feedback and inquiries to:
Will Story, PhD, MPH
Carolina Population Center
University of North Carolina at Chapel Hill
wstory@unc.edu