1. The document describes a study that evaluated the sustainability of impacts from food aid programs after they ended in four countries.
2. The study examined whether program activities, outcomes and impacts were maintained after the programs closed, and which program characteristics helped sustain effects.
3. The study used qualitative and quantitative methods including interviews, surveys, and comparing data to agency evaluations to associate exit strategies with sustainability of impacts.
The Colorado Coalition for the Homeless implemented a project to address health disparities among homeless Native Americans in the Denver metro area through talking circles and patient navigation services. Over three years, the project served 515 individuals, conducted 497 talking circles, and made 284 referrals for health services. Evaluations found the culturally-specific talking circles and navigation services improved access to healthcare and housing for participants.
Tele-monitoring continuity of adolescents and women’s nutrition services in e...POSHAN
This document discusses a study that used tele-monitoring to understand how a multi-sectoral maternal and adolescent nutrition program in India called Swabhimaan was impacted by COVID-19 lockdowns and adapted its services. Community health workers under the program continued providing home visits and nutrition services for at-risk groups, though group meetings and counseling sessions were halted during lockdowns. The study collected data over two rounds from 158 village organizations across 4 states to understand continuity of community actions and government nutrition services. Key findings showed adaptations made by women's groups to continue delivering services, and that tele-monitoring provided insights on continuity of the community-led program and capacity building needs.
Models for Strengthening the Community-based Management of Acute Malnutrition...CORE Group
The document discusses the CMAM (Community-based Management of Acute Malnutrition) Forum, a multi-stakeholder initiative to improve health outcomes through improved information sharing about managing acute malnutrition interventions worldwide. The CMAM Forum aims to provide easy access to technical guidance, evidence, and learning from nutrition and health actors through an open access interactive website. It also seeks to develop technical materials to address information gaps and assess the effectiveness of the CMAM Forum through case studies in 4 countries. The overall goal is to support quality improvement, integration and scale-up of acute malnutrition management.
Lessons in the Integration of CMAM & IMCI Activities_Diene_5.12.11CORE Group
This document summarizes a presentation on integrating community-based management of acute malnutrition (CMAM) into national health systems in Burkina Faso, Mali, Mauritania, and Niger. It discusses the background, analytical framework, country experiences and challenges, key lessons learned, and recommendations. The main lessons are the need for high-level commitment, strengthened community outreach, improved training, sustainable access to services and supplies, and standardized quality of care guidelines. The way forward is to improve service delivery and access through integrated approaches while strengthening pre-service and in-service training linkages.
Considerations For Incorporating Health Equity in Project Design_Gall_5.12.11CORE Group
This document discusses a project in Cotopaxi, Ecuador that aims to improve health equity. [1] The provincial health system is fragmented with inequitable access and poor quality of care. [2] The CHS-Ecuador Child Survival Project aims to reduce maternal and newborn mortality by improving access to and quality of maternal newborn services. [3] A baseline assessment found that indigenous women have lower coverage of services than non-indigenous women. The project will prioritize parishes with over 50% poverty or indigenous populations to focus on disadvantaged groups.
Equity and Nutrition Through Agriculture_Quisumbing_5.10.11CORE Group
This document summarizes a study evaluating the long-term impacts of agricultural technologies in Bangladesh. It finds:
1. Agricultural technologies like vegetable and fish farming can improve nutrition by increasing micronutrient supplies and incomes, but impacts depend on implementation.
2. A 10-year follow up found individual fishpond technologies significantly increased household consumption and assets, while group technologies had smaller impacts.
3. Nutrition improved most where technologies engaged women's groups, indicating the importance of intrahousehold dynamics.
4. A new project will evaluate gender gaps in asset control from agricultural projects to identify best practices for benefiting both women and men.
Health partners elluminate ppt_final_9.13.10CChangeProgram
C-Change (Communication for Change) is a USAID-fundd program to improve the effectiveness and sustainability of social and behavior change communication (SBCC) as an integral part of development efforts in malaria, HIV and AIDS, and family planning/reproductive health.
C-Change works with USAID and the President's Malaria Initiative (PMI) to prevent and control malaria in several PMI target countries, including Ethiopia, Kenya, Mozambique, Sao Tome and Principe, as well as others.
On September 13, 2010, C-Change and MCHIP facilitated a narrated presentation of the work of two PMI grantees, Concern Universal and HealthPartners, via a webinar. Participants included Save the Children, USAID, CDC, IFPH, and others.
For more information, please visit: http://www.c-changeprogram.org/
The document summarizes several HIV/AIDS programs implemented by World Vision across multiple countries in Africa. It discusses key strategies used such as community mobilization, capacity building, and task shifting. Specific interventions discussed include PMTCT, pediatric HIV care, male circumcision, and programs to support orphans and vulnerable children. Results showed improved access to services, increased testing and treatment adherence, and reduced loss to follow up. Lessons highlighted the importance of integrated service delivery, community ownership, and long-term commitment to sustain programs.
The Colorado Coalition for the Homeless implemented a project to address health disparities among homeless Native Americans in the Denver metro area through talking circles and patient navigation services. Over three years, the project served 515 individuals, conducted 497 talking circles, and made 284 referrals for health services. Evaluations found the culturally-specific talking circles and navigation services improved access to healthcare and housing for participants.
Tele-monitoring continuity of adolescents and women’s nutrition services in e...POSHAN
This document discusses a study that used tele-monitoring to understand how a multi-sectoral maternal and adolescent nutrition program in India called Swabhimaan was impacted by COVID-19 lockdowns and adapted its services. Community health workers under the program continued providing home visits and nutrition services for at-risk groups, though group meetings and counseling sessions were halted during lockdowns. The study collected data over two rounds from 158 village organizations across 4 states to understand continuity of community actions and government nutrition services. Key findings showed adaptations made by women's groups to continue delivering services, and that tele-monitoring provided insights on continuity of the community-led program and capacity building needs.
Models for Strengthening the Community-based Management of Acute Malnutrition...CORE Group
The document discusses the CMAM (Community-based Management of Acute Malnutrition) Forum, a multi-stakeholder initiative to improve health outcomes through improved information sharing about managing acute malnutrition interventions worldwide. The CMAM Forum aims to provide easy access to technical guidance, evidence, and learning from nutrition and health actors through an open access interactive website. It also seeks to develop technical materials to address information gaps and assess the effectiveness of the CMAM Forum through case studies in 4 countries. The overall goal is to support quality improvement, integration and scale-up of acute malnutrition management.
Lessons in the Integration of CMAM & IMCI Activities_Diene_5.12.11CORE Group
This document summarizes a presentation on integrating community-based management of acute malnutrition (CMAM) into national health systems in Burkina Faso, Mali, Mauritania, and Niger. It discusses the background, analytical framework, country experiences and challenges, key lessons learned, and recommendations. The main lessons are the need for high-level commitment, strengthened community outreach, improved training, sustainable access to services and supplies, and standardized quality of care guidelines. The way forward is to improve service delivery and access through integrated approaches while strengthening pre-service and in-service training linkages.
Considerations For Incorporating Health Equity in Project Design_Gall_5.12.11CORE Group
This document discusses a project in Cotopaxi, Ecuador that aims to improve health equity. [1] The provincial health system is fragmented with inequitable access and poor quality of care. [2] The CHS-Ecuador Child Survival Project aims to reduce maternal and newborn mortality by improving access to and quality of maternal newborn services. [3] A baseline assessment found that indigenous women have lower coverage of services than non-indigenous women. The project will prioritize parishes with over 50% poverty or indigenous populations to focus on disadvantaged groups.
Equity and Nutrition Through Agriculture_Quisumbing_5.10.11CORE Group
This document summarizes a study evaluating the long-term impacts of agricultural technologies in Bangladesh. It finds:
1. Agricultural technologies like vegetable and fish farming can improve nutrition by increasing micronutrient supplies and incomes, but impacts depend on implementation.
2. A 10-year follow up found individual fishpond technologies significantly increased household consumption and assets, while group technologies had smaller impacts.
3. Nutrition improved most where technologies engaged women's groups, indicating the importance of intrahousehold dynamics.
4. A new project will evaluate gender gaps in asset control from agricultural projects to identify best practices for benefiting both women and men.
Health partners elluminate ppt_final_9.13.10CChangeProgram
C-Change (Communication for Change) is a USAID-fundd program to improve the effectiveness and sustainability of social and behavior change communication (SBCC) as an integral part of development efforts in malaria, HIV and AIDS, and family planning/reproductive health.
C-Change works with USAID and the President's Malaria Initiative (PMI) to prevent and control malaria in several PMI target countries, including Ethiopia, Kenya, Mozambique, Sao Tome and Principe, as well as others.
On September 13, 2010, C-Change and MCHIP facilitated a narrated presentation of the work of two PMI grantees, Concern Universal and HealthPartners, via a webinar. Participants included Save the Children, USAID, CDC, IFPH, and others.
For more information, please visit: http://www.c-changeprogram.org/
The document summarizes several HIV/AIDS programs implemented by World Vision across multiple countries in Africa. It discusses key strategies used such as community mobilization, capacity building, and task shifting. Specific interventions discussed include PMTCT, pediatric HIV care, male circumcision, and programs to support orphans and vulnerable children. Results showed improved access to services, increased testing and treatment adherence, and reduced loss to follow up. Lessons highlighted the importance of integrated service delivery, community ownership, and long-term commitment to sustain programs.
This document is the 2014 annual report on Nigeria's health sector response to HIV/AIDS. It summarizes progress on key interventions including HIV counseling and testing (HCT), prevention of mother-to-child transmission of HIV (PMTCT), and anti-retroviral therapy (ART). Nigeria has made progress in scaling up these services but still faces challenges in reducing new HIV infections, especially among children. The report analyzes data on service coverage and identifies gaps to help stakeholders better target their responses and work towards eliminating mother-to-child transmission of HIV by 2015.
This document summarizes the findings of a study on the quality of family planning services and integration with prevention of vertical transmission (PVT) programs in Cameroon, Nigeria, and Zambia. Key informant interviews and focus groups were conducted with women living with HIV and service providers. The findings highlight critical areas that need improvement, such as increasing the range of family planning methods, improving counseling on reproductive rights, and ensuring confidentiality. Recommendations include developing national strategies to boost access to and quality of family planning counseling, education initiatives targeting young women's reproductive rights, and requiring confidentiality procedures for service providers.
ABA Program and Services - Cycle 2 Evaluation ReportTangül Alten
This document provides a summary of the Cycle 2 evaluation report for the Applied Behaviour Analysis (ABA) program in the Central West Region of Ontario from April 2014 to March 2015. Key findings from the evaluation include:
1. The ABA program is generally well-implemented, though waitlists remain long and staff burnout is an issue due to high caseloads. Both individual and group sessions are offered with most families choosing individual.
2. Most children achieved or exceeded their goals as seen in evaluation tools like the Goal Attainment Scale. Parents also reported increased confidence and coping skills. System coordination between agencies improved.
3. Recommendations focus on increasing resources to reduce waitlists and caselo
The document summarizes the Urban Health Equity Assessment and Response Tool (Urban HEART). It describes Urban HEART as a guide to help identify health inequities between groups in cities and determine effective strategies to reduce inequities. The tool involves assessing data on health and social determinants, engaging multiple sectors, and involving communities. It comprises four phases: assessment, response, policy, and program implementation with ongoing monitoring and evaluation. A case study application in Gezirat El Warak Giza, Egypt is presented which found gaps between the community's health and social determinants compared to national standards.
The document summarizes the National Kidney Foundation's Food and Fun after school program being implemented in the Hikone public housing community. It discusses conducting assessments of the community to understand how to best engage residents. These included a rich map of relationships, a SWOT analysis, and a force field analysis. It recommends forming partnerships within the community and making organizational changes to ensure long-term access to healthy foods and physical activity opportunities. The goal is to work with the community to establish sustainable environmental and behavioral changes through community engagement and input.
The document outlines a proposed HIV strategy for Hennepin County. It includes a vision of eliminating new HIV infections and ensuring all people living with HIV have access to care. The strategy aims to coordinate efforts across multiple partners to reduce disparities and integrate services. Goals include decreasing new infections through increased testing and prevention programs, ensuring access to care for those living with HIV, and engaging communities disproportionately affected by HIV. Key tactics involve improving access to testing, PrEP, housing, care coordination and developing culturally appropriate education campaigns.
The document discusses Virginia's health and human services programs and delivery system. It provides an overview map of the various state agencies and programs involved, including Medicaid, social services, behavioral health, public health, and more. It emphasizes moving from a program-focused model to a more coordinated, customer-centric model to better serve individuals and families. Key challenges discussed include demographic changes, technological shifts, workforce issues, balancing specialization and integration, and coordinating complex federal, state and private systems and requirements.
This document summarizes a study examining the availability of evidence-based disease self-management programs and promising practices for older adults in Orange County, California. The study found that while 16 of the 21 organizations surveyed provide such programs, 15% are unable to meet demand. Barriers to implementation included lack of funding and trained leaders. The document concludes that efforts to provide these programs are currently segmented and that future research should explore ways to improve coordination and fill service gaps.
Community healthcare financing the Zambia experience byDr Dally Menda, CHAZachapkenya
This document summarizes different models of community-based health financing in Zambia, including community managed user fees, performance-based financing (PBF), provider-based health insurance, and a care and prevention model (CPT). It describes features of each model, such as how communities are involved in setting fees, allocating funds, and managing resources. The document also discusses some successes and challenges of these models, such as increased resources for health and community ownership, but also potential conflicts between health facilities and communities.
This document presents a BDI logic model to reduce obesity within a community using community participatory principles and multiple intervention levels and strategies. The model includes interventions at the community, interpersonal, individual, organizational, and policy levels. At the community level, the model proposes recruiting partners from academic institutions, organizations, and political leaders to conduct cultural assessments and support program implementation. Regular meetings would ensure feedback and accountability. Access to healthy foods would be improved and community garden and fitness programs established. At the interpersonal level, community helpers would conduct interviews and outreach, and family participation in programs would be encouraged. Peer support components and small group discussions are also proposed. At the individual level, assessments, accommodations for needs, and incentives are
Community diagnosis of nakasongola district summaryOriba Dan Langoya
The study aimed to conduct a community diagnosis of Nakasongola subcounty in Nakasongola district. Key findings included: most households were female-headed and engaged in subsistence farming, leading to low incomes. The community's diet lacked protein and vitamins. Access to tap water was good, though water sources were far. Common diseases were respiratory infections and malaria. Overall, the community demonstrated good hygiene practices and health-seeking behavior by utilizing local health facilities. However, improvements could be made in nutrition, economic opportunities, and promoting routine medical checks.
AWA Experts 2015 Meeting_eMTCT Best Bractices Presentation NigeriaAIDS Watch Africa
The document summarizes Nigeria's efforts to integrate HIV counseling and testing (HCT) services into its Maternal Newborn & Child Health (MNCH) Week program. Key points include:
- Over 200,000 pregnant women received integrated HCT and MNCH services in six states, exceeding targets. The program identified over 1,400 HIV-positive women.
- The initiative leveraged existing MNCH structures at health facilities and engaged communities to increase access to HCT, especially for hard-to-reach groups.
- Successes included improved testing coverage, linkages to care, and health-seeking behaviors. Challenges included late test kit arrivals and staffing issues.
-
CSHGP Operations Research Findings_David Shankin_5.8.14CORE Group
The project aimed to improve maternal and child health in rural Honduras by establishing community-based health units (UCOS) staffed by volunteers. An evaluation found that the UCOS model significantly improved six coverage indicators, such as the proportion of the target population served. It also improved some outcomes, like the number of women receiving prenatal care. Costs to clients were much lower than using existing facilities. The Ministry of Health recognized benefits but recommended further testing the model. ChildFund continues supporting some initial UCOS sites and expanding the approach.
This document appears to be a resume and portfolio for Brian C. Robinson detailing his experience and qualifications in public health and disease control. Over 20 years of experience is highlighted, including positions as a disease intervention supervisor and public health consultant specializing in HIV and infectious syphilis prevention. Various certificates, letters of recommendation, and published works are referenced demonstrating his expertise in developing and implementing disease control methodologies and programs.
Reach, Benefit, Empower: Indicators for measuring impacts of programs and pol...IFPRI-PIM
This presentation was given by Agnes Quinsumbing (IFPRI), as part of the Annual Scientific Conference hosted by the CGIAR Collaborative Platform for Gender Research. The event took place on 5-6 December 2017 in Amsterdam, the Netherlands, where the Platform is hosted (by KIT Royal Tropical Institute).
Read more: http://gender.cgiar.org/gender_events/annual-scientific-conference-capacity-development-workshop-cgiar-collaborative-platform-gender-research/
Nutrition Advocacy Process: Using PROFILES and Nutrition CostingCORE Group
This document outlines the nutrition advocacy process using PROFILES and nutrition costing tools. It begins with defining key terms like nutrition advocacy and describing PROFILES and nutrition costing. PROFILES is an evidence-based tool that calculates the consequences of malnutrition and benefits of improved nutrition. Nutrition costing estimates the costs of implementing nutrition programs. The document then discusses how the results of these tools are used in multi-stakeholder workshops to develop advocacy plans and materials. Examples of results from various country applications are provided, showing estimated lives saved and economic impacts. New PROFILES models are described that examine relationships between breastfeeding, stunting, and outcomes.
CORE Group Fall Meeting 2010. Using Collaborative Improvement to Achieve Quality Care for Vulnerable Children in Ethiopia. - Nicole Richardson, Save the Children USA
Community Health Worker Models: A Focus on Sustainability MOLLY CHRISTIANSENCORE Group
Living Goods supports networks of Community Health Promoters who educate families on health and deliver life-saving products door-to-door. They reduce child mortality by 25% annually for under $2 per person. CHPs earn income through sales commissions and performance-based incentives to motivate them while improving health outcomes. Living Goods uses an integrated platform and always-in-stock system along with mobile tools and performance analytics to manage a large network of CHPs and achieve significant impact in improving community health.
Integrating Care Groups into Government Structures: Learning from an Operatio...CORE Group
The document summarizes an operations research study conducted in Burundi comparing a traditional Care Group model led by NGOs to an "Integrated" Care Group model led by the Ministry of Health. The study found that:
1) The Integrated model achieved similar improvements in knowledge and health practices as the traditional model.
2) The Integrated model functioned as well as the traditional model in terms of volunteer attendance and household visits.
3) The Integrated model showed potential for sustainability similar to the traditional model during the initial post-project period.
The Integrated model integrated Care Groups into the Ministry of Health structure using community health workers and showed promise for increasing scale and sustainability while building local capacity.
Evidence of Social Accountability_Kamden Hoffmann_5.7.14CORE Group
The document discusses social accountability and its role in improving health outcomes. It analyzes selected social accountability models used by international NGOs, including Citizen Voice and Action (World Vision), Partnership Defined Quality (Save the Children), Community Score Card (CARE), and various approaches used by White Ribbon Alliance. Common themes across the models include preparation and planning, involvement of marginalized groups, identifying barriers, interface meetings between communities and government, and using score cards to measure services. The document recommends expanding the evidence base on effectiveness, clarifying financial and human resource needs, identifying barriers to scale up, and exploring promising practices across models.
This document is the 2014 annual report on Nigeria's health sector response to HIV/AIDS. It summarizes progress on key interventions including HIV counseling and testing (HCT), prevention of mother-to-child transmission of HIV (PMTCT), and anti-retroviral therapy (ART). Nigeria has made progress in scaling up these services but still faces challenges in reducing new HIV infections, especially among children. The report analyzes data on service coverage and identifies gaps to help stakeholders better target their responses and work towards eliminating mother-to-child transmission of HIV by 2015.
This document summarizes the findings of a study on the quality of family planning services and integration with prevention of vertical transmission (PVT) programs in Cameroon, Nigeria, and Zambia. Key informant interviews and focus groups were conducted with women living with HIV and service providers. The findings highlight critical areas that need improvement, such as increasing the range of family planning methods, improving counseling on reproductive rights, and ensuring confidentiality. Recommendations include developing national strategies to boost access to and quality of family planning counseling, education initiatives targeting young women's reproductive rights, and requiring confidentiality procedures for service providers.
ABA Program and Services - Cycle 2 Evaluation ReportTangül Alten
This document provides a summary of the Cycle 2 evaluation report for the Applied Behaviour Analysis (ABA) program in the Central West Region of Ontario from April 2014 to March 2015. Key findings from the evaluation include:
1. The ABA program is generally well-implemented, though waitlists remain long and staff burnout is an issue due to high caseloads. Both individual and group sessions are offered with most families choosing individual.
2. Most children achieved or exceeded their goals as seen in evaluation tools like the Goal Attainment Scale. Parents also reported increased confidence and coping skills. System coordination between agencies improved.
3. Recommendations focus on increasing resources to reduce waitlists and caselo
The document summarizes the Urban Health Equity Assessment and Response Tool (Urban HEART). It describes Urban HEART as a guide to help identify health inequities between groups in cities and determine effective strategies to reduce inequities. The tool involves assessing data on health and social determinants, engaging multiple sectors, and involving communities. It comprises four phases: assessment, response, policy, and program implementation with ongoing monitoring and evaluation. A case study application in Gezirat El Warak Giza, Egypt is presented which found gaps between the community's health and social determinants compared to national standards.
The document summarizes the National Kidney Foundation's Food and Fun after school program being implemented in the Hikone public housing community. It discusses conducting assessments of the community to understand how to best engage residents. These included a rich map of relationships, a SWOT analysis, and a force field analysis. It recommends forming partnerships within the community and making organizational changes to ensure long-term access to healthy foods and physical activity opportunities. The goal is to work with the community to establish sustainable environmental and behavioral changes through community engagement and input.
The document outlines a proposed HIV strategy for Hennepin County. It includes a vision of eliminating new HIV infections and ensuring all people living with HIV have access to care. The strategy aims to coordinate efforts across multiple partners to reduce disparities and integrate services. Goals include decreasing new infections through increased testing and prevention programs, ensuring access to care for those living with HIV, and engaging communities disproportionately affected by HIV. Key tactics involve improving access to testing, PrEP, housing, care coordination and developing culturally appropriate education campaigns.
The document discusses Virginia's health and human services programs and delivery system. It provides an overview map of the various state agencies and programs involved, including Medicaid, social services, behavioral health, public health, and more. It emphasizes moving from a program-focused model to a more coordinated, customer-centric model to better serve individuals and families. Key challenges discussed include demographic changes, technological shifts, workforce issues, balancing specialization and integration, and coordinating complex federal, state and private systems and requirements.
This document summarizes a study examining the availability of evidence-based disease self-management programs and promising practices for older adults in Orange County, California. The study found that while 16 of the 21 organizations surveyed provide such programs, 15% are unable to meet demand. Barriers to implementation included lack of funding and trained leaders. The document concludes that efforts to provide these programs are currently segmented and that future research should explore ways to improve coordination and fill service gaps.
Community healthcare financing the Zambia experience byDr Dally Menda, CHAZachapkenya
This document summarizes different models of community-based health financing in Zambia, including community managed user fees, performance-based financing (PBF), provider-based health insurance, and a care and prevention model (CPT). It describes features of each model, such as how communities are involved in setting fees, allocating funds, and managing resources. The document also discusses some successes and challenges of these models, such as increased resources for health and community ownership, but also potential conflicts between health facilities and communities.
This document presents a BDI logic model to reduce obesity within a community using community participatory principles and multiple intervention levels and strategies. The model includes interventions at the community, interpersonal, individual, organizational, and policy levels. At the community level, the model proposes recruiting partners from academic institutions, organizations, and political leaders to conduct cultural assessments and support program implementation. Regular meetings would ensure feedback and accountability. Access to healthy foods would be improved and community garden and fitness programs established. At the interpersonal level, community helpers would conduct interviews and outreach, and family participation in programs would be encouraged. Peer support components and small group discussions are also proposed. At the individual level, assessments, accommodations for needs, and incentives are
Community diagnosis of nakasongola district summaryOriba Dan Langoya
The study aimed to conduct a community diagnosis of Nakasongola subcounty in Nakasongola district. Key findings included: most households were female-headed and engaged in subsistence farming, leading to low incomes. The community's diet lacked protein and vitamins. Access to tap water was good, though water sources were far. Common diseases were respiratory infections and malaria. Overall, the community demonstrated good hygiene practices and health-seeking behavior by utilizing local health facilities. However, improvements could be made in nutrition, economic opportunities, and promoting routine medical checks.
AWA Experts 2015 Meeting_eMTCT Best Bractices Presentation NigeriaAIDS Watch Africa
The document summarizes Nigeria's efforts to integrate HIV counseling and testing (HCT) services into its Maternal Newborn & Child Health (MNCH) Week program. Key points include:
- Over 200,000 pregnant women received integrated HCT and MNCH services in six states, exceeding targets. The program identified over 1,400 HIV-positive women.
- The initiative leveraged existing MNCH structures at health facilities and engaged communities to increase access to HCT, especially for hard-to-reach groups.
- Successes included improved testing coverage, linkages to care, and health-seeking behaviors. Challenges included late test kit arrivals and staffing issues.
-
CSHGP Operations Research Findings_David Shankin_5.8.14CORE Group
The project aimed to improve maternal and child health in rural Honduras by establishing community-based health units (UCOS) staffed by volunteers. An evaluation found that the UCOS model significantly improved six coverage indicators, such as the proportion of the target population served. It also improved some outcomes, like the number of women receiving prenatal care. Costs to clients were much lower than using existing facilities. The Ministry of Health recognized benefits but recommended further testing the model. ChildFund continues supporting some initial UCOS sites and expanding the approach.
This document appears to be a resume and portfolio for Brian C. Robinson detailing his experience and qualifications in public health and disease control. Over 20 years of experience is highlighted, including positions as a disease intervention supervisor and public health consultant specializing in HIV and infectious syphilis prevention. Various certificates, letters of recommendation, and published works are referenced demonstrating his expertise in developing and implementing disease control methodologies and programs.
Reach, Benefit, Empower: Indicators for measuring impacts of programs and pol...IFPRI-PIM
This presentation was given by Agnes Quinsumbing (IFPRI), as part of the Annual Scientific Conference hosted by the CGIAR Collaborative Platform for Gender Research. The event took place on 5-6 December 2017 in Amsterdam, the Netherlands, where the Platform is hosted (by KIT Royal Tropical Institute).
Read more: http://gender.cgiar.org/gender_events/annual-scientific-conference-capacity-development-workshop-cgiar-collaborative-platform-gender-research/
Nutrition Advocacy Process: Using PROFILES and Nutrition CostingCORE Group
This document outlines the nutrition advocacy process using PROFILES and nutrition costing tools. It begins with defining key terms like nutrition advocacy and describing PROFILES and nutrition costing. PROFILES is an evidence-based tool that calculates the consequences of malnutrition and benefits of improved nutrition. Nutrition costing estimates the costs of implementing nutrition programs. The document then discusses how the results of these tools are used in multi-stakeholder workshops to develop advocacy plans and materials. Examples of results from various country applications are provided, showing estimated lives saved and economic impacts. New PROFILES models are described that examine relationships between breastfeeding, stunting, and outcomes.
CORE Group Fall Meeting 2010. Using Collaborative Improvement to Achieve Quality Care for Vulnerable Children in Ethiopia. - Nicole Richardson, Save the Children USA
Community Health Worker Models: A Focus on Sustainability MOLLY CHRISTIANSENCORE Group
Living Goods supports networks of Community Health Promoters who educate families on health and deliver life-saving products door-to-door. They reduce child mortality by 25% annually for under $2 per person. CHPs earn income through sales commissions and performance-based incentives to motivate them while improving health outcomes. Living Goods uses an integrated platform and always-in-stock system along with mobile tools and performance analytics to manage a large network of CHPs and achieve significant impact in improving community health.
Integrating Care Groups into Government Structures: Learning from an Operatio...CORE Group
The document summarizes an operations research study conducted in Burundi comparing a traditional Care Group model led by NGOs to an "Integrated" Care Group model led by the Ministry of Health. The study found that:
1) The Integrated model achieved similar improvements in knowledge and health practices as the traditional model.
2) The Integrated model functioned as well as the traditional model in terms of volunteer attendance and household visits.
3) The Integrated model showed potential for sustainability similar to the traditional model during the initial post-project period.
The Integrated model integrated Care Groups into the Ministry of Health structure using community health workers and showed promise for increasing scale and sustainability while building local capacity.
Evidence of Social Accountability_Kamden Hoffmann_5.7.14CORE Group
The document discusses social accountability and its role in improving health outcomes. It analyzes selected social accountability models used by international NGOs, including Citizen Voice and Action (World Vision), Partnership Defined Quality (Save the Children), Community Score Card (CARE), and various approaches used by White Ribbon Alliance. Common themes across the models include preparation and planning, involvement of marginalized groups, identifying barriers, interface meetings between communities and government, and using score cards to measure services. The document recommends expanding the evidence base on effectiveness, clarifying financial and human resource needs, identifying barriers to scale up, and exploring promising practices across models.
Post Project Sustainability Study: Health, Wat/San and Agricultural Intervent...CORE Group
The document summarizes a post-project sustainability study conducted in Bolivia 6 years after completing a USAID-funded health, water, sanitation and agriculture project. The study found that communities who participated in the original project were still better off than control communities. Interventions related to maternal and child health, water systems, and agriculture showed strong sustainability over time, though some improvements were needed. Conducting post-project evaluations provides valuable lessons for improving future program design and measuring lasting impact. While challenging, these types of studies are important for assessing sustainability and improving strategic information for projects.
CORE Group Fall Meeting 2010. Findings and Reflections on the Food for the Hungry Care Group Child Survival Project in Sofala Province, Mozambique. - Henry Perry, Johns Hopkins
Global trends show increased focus on and endorsement of community health worker (CHW) programs to strengthen health systems and achieve health goals. Assessments of CHW programs find that factors like inadequate training, supervision, supplies and low status limit their quality and effectiveness. A global consultation identified key priorities for CHW programs including fully integrating CHWs into national health workforce plans, involving stakeholders, and ensuring adequate and ongoing support through training, supervision and incentives. Supporting CHWs as integral parts of health systems with clearly defined roles and career opportunities can help address current challenges and optimize their impact.
Designing CCT Programs to Improve Nutrition ImpactFAO
Presentación de James Garrett and Lucy Basset, International Food Policy Research Institute IFPRI, durante el Tercer Seminario de Transferencias Condicionadas de Ingresos, realizado en Santiago de Chile el 01 y 02 de Diciembre de 2008.
Speaking at the 2015 CCIH Annual Conference, Dr. Alfonso Rosales, Maternal and Child Senior Advisor, World Vision International, examines a study in South Sudan involving illiterate community health workers, suggesting that a process to measure and maintain clinical skills of community health workers is an important element of program design.
The National Diabetes Prevention Program aims to prevent type 2 diabetes through lifestyle change programs. It is based on evidence from the Diabetes Prevention Program research study showing that modest weight loss and increased physical activity through a structured lifestyle intervention can reduce risk of developing diabetes by 58%. The National DPP coordinates efforts across sectors to recognize and support diabetes prevention programs delivering this evidence-based approach. Quality assurance and a growing network of over 500 recognized sites nationwide are key to achieving the large-scale implementation needed to effectively address the diabetes epidemic in the United States.
The PSNP in Ethiopia aims to address food insecurity and malnutrition through multi-sectoral collaboration. While PSNP-4 integrated nutrition objectives throughout its design, challenges remain in implementation due to limited capacities at local levels and service availability. Lessons indicate a need to better define implementation modalities across sectors and build frontline worker skills. Ongoing data collection and advocacy can help address bottlenecks and guide the transition from design to effective nutrition-sensitive implementation.
Nutrition element portfolio review usaid_ Roshelle Payes & Rebecca Egan_10.14.11CORE Group
The document discusses USAID's nutrition approach, outlining its principles, components, target areas, and role of operating units. It provides context on the global burden of undernutrition and its causes. It then describes the recent shift in global and USAID nutrition strategies from vertical to integrated approaches, from under-fives targeting to the 1000-day window, from nutrient-specific to diet quality measures, from recuperative to preventive focus, and from health platforms to multi-sectoral delivery. It poses questions about reaching the 30% undernutrition reduction goal and delivering comprehensive nutrition interventions at scale through integrated frameworks.
Learn more about how the Regional Municipality of York explored and implemented a bylaw in their region mandating food handler certification for food premises.
Healthy People 2020Healthy People was a call to action and an.docxpooleavelina
Healthy People 2020
Healthy People was a call to action and an attempt to set health goals for the United States for the next 10 years.
Healthy People 2000 established 3 general goals:
Increase the span of healthy life.
Reduce health disparities.
Create access to preventive services for all.
Healthy People 2010 introduced 2 general goals:
Increase quality and years of healthy life.
Eliminate health disparities.
Practical Policy for Preventive Services
The U.S. health care system faces significant challenges that clearly indicate the urgent need for reform.
There is broad evidence that Americans often do not get the care they need even though the United States spends more money per person on health care than any other nation in the world.
Preventive care is underutilized, resulting in higher spending on complex, advanced diseases.
Practical Policy for Preventive Services
Patients with chronic diseases too often do not receive proven and effective treatments such as drug therapies or self management services to help them more effectively manage their conditions.
These problems are exacerbated by a lack of coordination of care for patients with chronic diseases.
Reforming our health care delivery system to improve the quality and value of care is essential to address escalating costs, poor quality, and increasing numbers of Americans without health insurance coverage.
Why policies need to be developed?
Basic needs are not being met (e.g., People are not receiving the health care they need)
People are not being treated fairly (e.g., People with disabilities do not have access to public places)
Resources are distributed unfairly (e.g., Educational services are more limited in neighborhoods of concentrated poverty)
Why policies need to be developed?
Current policies or laws are not enforced or effective (e.g., The current laws on clean water are neither enforced nor effective)
Proposed changes in policies or laws would be harmful (e.g., A plan to eliminate flextime in a large business would reduce parents' ability to be with their children)
Existing or emerging conditions pose a threat to public health, safety, education, or well-being (e.g., New threats from terrorist activity)
Marjory Gordon’s Functional Health Patterns
Marjory Gordon was a nursing theorist and professor who created a nursing assessment theory known as Gordon's functional health patterns.
It is a method to be used by nurses in the nursing process to provide a more comprehensive nursing evaluation of the patient.
Gordon's functional health pattern includes 11 categories which is a systematic and standardized approach to data collection.
List of Functional Health Patterns
1. Health Perception – Health Management Pattern
describes client’s perceived pattern of health and well being and how health is managed.
2. Nutritional – Metabolic Pattern
describes pattern of food and fluid consumption relative to metabolic need and pattern indicators of loca ...
State of Michigan HIE Update (without Tina Scott)mihinpr
This document summarizes health information technology (HIT) and health information exchange (HIE) efforts in the state of Michigan. It discusses the state's strategic priorities around improving population health, care delivery systems, and health care reform through initiatives like the State Innovation Model. It provides an overview of HIT programs and incentives like the Medicaid EHR Incentive Program. Key organizations involved include the Health Information Technology Commission and stakeholders working to advance HIT and HIE. The goal is to use health data and technology to improve care, outcomes and costs.
This document discusses sustainability in global grant projects focused on maternal and child health. It provides examples of sustainable single interventions like providing mosquito nets or vitamin supplements. It also describes a more comprehensive sustainable approach that includes introducing quality assurance in obstetrics along with satellite projects to provide things like water/solar power, delivery kits, and family planning education. This comprehensive approach measures outcomes like reduced maternal and infant mortality rates and aims to ultimately include project services into the local health system to ensure long-term sustainability.
The document provides information on resources and feedback processes for wellbeing services provided to government departments by GEMS. It outlines that the Healthi Choices Wellbeing Intelligence team will provide daily and weekly COVID-19 symptom dashboards and assessment reports to departments. It also discusses completing HRAs, customer satisfaction feedback, and training. The document provides details on centralizing event coordination and submitting requests, and answers common questions about the roles of GEMS CLOs, Departmental EHWPs, and the GEMS CLO helpdesk in optimizing wellbeing services.
Presentation is about the uniqueness of Implementation Research and Role of the Government, specially in Indian context of health programme implementation.
This document outlines a health system development programme in Myanmar from 2006-2011. It had three main objectives: 1) Promote health systems research to improve performance; 2) Explore sustainable health financing mechanisms; 3) Expand international cooperation. The programme included three projects: 1) Health systems research; 2) Developing alternative financing; 3) International health cooperation. It identified strengths like disseminating research and developing tools, but also weaknesses like lack of funding and dissemination of findings. The programme aimed to address gaps in service delivery, coordination, and human resources to improve access to essential health services.
1. The document outlines various deliverables, responsibilities, and feedback mechanisms for GEMS' health and wellness screening services (HWSS) events and COVID-19 screening programs. It includes daily and weekly COVID-19 reports, health risk assessments, customer satisfaction surveys, and training events.
2. Departments must ensure employees complete daily and weekly COVID-19 assessments and the online health risk assessment. GEMS will provide referral support and feedback on customer experience.
3. The document provides information on centralizing event coordination through a request form and selecting from HRA, COVID-19 screening, or wellbeing training options. Events can be scheduled by Regional CLOs or Government EHWPs.
Tackling Post-Ebola Health Recovery: Strengthening health system capacity to ...JSI
The document describes a program to support Ebola virus disease (EVD) survivors in Sierra Leone. It found that 10% more survivors were able to lead healthy lives due to the program's interventions. Stigma against survivors from healthcare workers decreased by 12%. The program helped reduce stigma through peer support from Survivor Advocates. However, advocates were terminated without the planned transition to community health workers. The document recommends ensuring transitions between short and long-term support mechanisms are properly planned and communicated. It also discusses improving survivors' access to services and drugs long-term through strengthened health systems.
Similar to But We Will Always be Here! Assuring Sustainable Benefits After Food Aid Programs_Beatrice Rogers_4.25.13 (20)
Presentation_Behar - Private Public Partnerships and CKDuCORE Group
The document summarizes statistics and information about the sugarcane agribusiness in Mexico, including:
- It produced over 6 million tons of sugar in 2017/2018 and generated nearly 500,000 direct jobs.
- It has a complex supply chain involving sugarcane suppliers, mills, transportation, and the food industry.
- It has a legal framework including laws governing sustainable development of sugarcane and labor relations in mills.
- The government has a National Sugarcane Agribusiness Program to increase productivity and competitiveness.
Presentation_World Vision - Private Public Partnerships and CKDuCORE Group
The Fields of Hope project by World Vision Mexico seeks to prevent and reduce child labor in the sugarcane and coffee sectors in the states of Veracruz and Oaxaca. It aims to benefit 1,520 children at risk of or engaged in child labor across 24 communities and 4 municipalities. The project takes an integral approach through advocacy, collaboration with the private sector, and sensitizing communities and workers, while also promoting access to education.
Presentation_Wesseling - Private Public Partnerships and CKDuCORE Group
This document discusses the epidemic of chronic kidney disease of unknown etiology (CKDu) affecting agricultural workers along the Pacific coast of Central America. It provides evidence that the disease has an occupational etiology related to heat stress and dehydration experienced by sugarcane and other field workers. Studies show physiological changes in workers consistent with heat stress and dehydration across work shifts. Longitudinal studies find declines in kidney function over harvest seasons among heat-exposed occupations. Intervention studies reducing heat stress through water, rest, and shade have shown reduced declines in kidney function. While some non-occupational factors may also contribute, the evidence strongly suggests that prolonged occupational heat stress is a primary driver of the CKDu epidemic.
Presentation_NCDs - Private Public Partnerships and CKDuCORE Group
Non-communicable diseases like cardiovascular disease, cancer, chronic respiratory disease, and diabetes are leading causes of death and disability globally but receive little focus from global health initiatives. While communicable diseases have declined in recent decades, deaths from non-communicable diseases have increased and pose growing health and economic challenges as treatments remain limited. Experts call for greater prioritization and resources for non-communicable diseases on the global health agenda.
Presentation_HRH2030 - Opportunities to optimize and integrate CHWCORE Group
This document summarizes a conference session on integrating and optimizing community health workers (CHWs) in health systems from global and local perspectives. The session included a fishbowl-style debate where attendees were invited to discuss questions about implementing the WHO CHW Guideline recommendations, important partnerships for training CHWs, priorities for managing and supporting newly recognized CHWs, considerations for optimizing the role of CHWs, and innovations needed to shape and sustain CHWs' roles by 2030.
Presentation_Save the Children - Building Partnerships to Provide Nurturing CareCORE Group
This document discusses the experiences of a mother giving birth to a preemie baby named Becky at 30 weeks gestation. Some key points include:
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- Becky faced various developmental issues over time, including low muscle tone, sensory processing disorder, autism, ADHD, and scoliosis.
- The mother advocates for increased support for preemie babies and their families, including more parent education, counseling, early intervention services, and IEP supports over time.
Presentation_Video - Building Partnerships to provide nurturing careCORE Group
This 4 minute video provides an overview of the key events in the history of the United States from 1492 to the early 2000s. It touches on major milestones like the founding of colonies, the American Revolution, westward expansion, the Civil War, industrialization, both World Wars, the Cold War, and events of the early 21st century. The video presents a high-level chronological summary of major political, economic and social developments that shaped America over the past 500+ years.
Presentation_Perez - Building Partnerships to provide nurturing careCORE Group
This document provides information on empowering health workers and caregivers to deliver therapeutic early childhood development care at home. It discusses how 90% of brain development occurs before age 5 and the importance of nurturing care for young children. The document outlines capacity development for parents and caregivers, including guidance on conducting activities that integrate motor, social-emotional, and therapeutic skills into daily routines. It also stresses the importance of addressing caregiver stress and depression through psychosocial support groups to promote child development.
Presentation_Robb-McCord - Building Partnerships to provide nurturing careCORE Group
The document summarizes key points from a CORE Group meeting on nurturing care for preterm newborns. It discusses how nurturing care involves providing a stable, sensitive environment that meets children's health needs from birth to 3 years. The evidence review examines interventions like skin-to-skin contact, breastfeeding, managing pain and stress, sleep protection and stimulation. Country case studies from both high and low income nations are also being conducted to understand policies and guidelines supporting nurturing care concepts.
Presentation_Discussion - Norms Shifting InterventionsCORE Group
Participants in a small group discussed how to integrate norms-shifting interventions into current projects and programs. They considered what new partnerships would be needed when working to shift social norms and what evidence of the effectiveness of norms-shifting interventions should be collected, for whom, and how.
Presentation_Krieger - Norms Shifting InterventionsCORE Group
The document discusses the origins and theories of social norms. It notes that early theorists like Durkheim, Weber, and Ogburn contributed to understanding where norms come from and how they guide behavior. Parsons further explored how members of society are socialized to norms. Later, feminist anthropologists studied norms and social control, especially regarding gender. The document contrasts philosophical, psychological, and anthropological approaches to studying norms and culture. It argues that knowledge of cultural norms can help reduce unexpected outcomes in social science and shift narratives to achieve behavior change. The example of the Albania Family Planning Project shows how understanding local norms was key to successfully promoting contraceptive use.
Presentation_NSI - Norms Shifting InterventionsCORE Group
This document discusses the key attributes of norms-shifting interventions. It identifies several attributes that make an intervention effective at shifting social norms, including seeking community-level change, engaging people at multiple levels, correcting misperceptions around harmful behaviors, confronting power imbalances related to gender, creating safe spaces for critical reflection, rooting the issue within community values, accurately assessing norms, using organized diffusion, and creating positive new norms. The document provides examples and explanations for each of these attributes.
Presentation_Igras - Norms Shifting InterventionsCORE Group
This document discusses using theory to inform the work of a learning collaborative (LC) on norms-shifting interventions for adolescent reproductive health. It outlines several relevant theories, including social norm and behavior change theory and communication and behavior change theories. It also discusses the value of "bottom-up" program change theory developed from implementation experience. The LC aims to facilitate collaboration between organizations, build knowledge, and develop shared tools to guide effective social norm measurement and practice at scale. By working collaboratively, the LC can take a more experimental approach in this nascent field while still being informed by relevant theories.
Presentation_Petraglia - Norms Shifting InterventionsCORE Group
This document discusses a constructivist perspective on norms and normative change. Some key points of constructivism are that knowledge is constructed through social interaction and prior experiences, and meaning is negotiated through language. Constructivism acknowledges that individuals belong to multiple reference groups and can choose which norms to follow in a given situation. Normative change interventions cannot directly manage or control norms, but may be able to influence them by facilitating dialogue, clarifying language, and encouraging ethical persuasion rather than direct attribution. Norms and beliefs are also difficult to accurately measure.
Presentation_Sprinkel - Norms Shifting InterventionsCORE Group
This presentation provides an overview of CARE's Tipping Point initiative which aims to address child, early and forced marriage in Nepal and Bangladesh through community programming and evidence generation. In Phase 1 from 2013-2017, the project worked with adolescents, parents and leaders in 16 districts across the two countries. Norms influencing child marriage include excluding girls' voices, controlling girls' sexuality, and perceptions of risks/benefits of marriage timing. Phase 2 implements a randomized control trial to generate evidence on effective gender transformative programming and the value of social norms approaches. Challenges included discussing sexuality while successes included girls gaining greater freedom and mobility.
Presentation_Tura - Norms Shifting InterventionsCORE Group
This document discusses the Care Group approach used in an intervention in Nepal from 2005-2010. It aimed to shift social norms around maternal and child health issues through community groups. Formative research identified key norms and barriers. Community groups engaged women to reflect critically and root issues in community values. Evaluations found sustained impact on behaviors like breastfeeding years later. Challenges included focusing directly on norm drivers and unrealistic community health worker workloads. Further research on accurate norm assessment and evidence-based norm-shifting is still needed.
Presentation_Sacher - Norms Shifting InterventionsCORE Group
This document summarizes Cristina Bicchieri's theory of social norms, which is grounded in philosophy, game theory, and psychology. The key aspects of the theory include conditional preferences that depend on social expectations, personal normative beliefs about what should be done, and expectations about what others in one's reference network do and think should be done. The implications for practice highlighted in the document include providing a theory of change, identifying the nature of norms to design appropriate interventions, and using data and illustrative vignettes to measure norms and guide social change programs.
Innovative Financing Mechanisms and Effective Management of Risk for Partners...CORE Group
The document summarizes the Utkrisht Development Impact Bond in India, which aims to improve quality of care in private maternity facilities. It discusses how impact bonds can mobilize private capital for development by lowering investment risk. The Utkrisht bond provides funds for accrediting 360-440 private facilities over 3 years. Facilities receive quality improvement support and investors are repaid based on the number of facilities accredited. Early lessons show facilities are motivated to improve if it grows their business and they receive support meeting standards. The bond also provides a framework for continuously improving the project and managing risks between partners.
Presentation_Multisectoral Partnerships and Innovations for Early Childhood D...CORE Group
This document summarizes a discussion on multi-sectoral partnerships and innovation for early childhood development. It was presented by several experts, including Dr. Maureen Black from RTI International, Dr. Joy Noel Baumgartner from Duke University, Mohammed Ali from Catholic Relief Services, Dr. Chessa Lutter from RTI International, and Dr. Erin Milner from USAID. The discussion covered topics like the importance of early childhood development, the Nurturing Care Framework, metrics and measures for childhood development, partnerships for early childhood programs, and challenges and next steps.
Presentation_Jurczynska - Catalyzing Investments in RMNCAH at the Community L...CORE Group
The document describes an evidence-based advocacy model called the Family Planning – Sustainable Development Goals (FP-SDGs) model. The model allows users to quantify the impacts of different family planning scenarios on 13 Sustainable Development Goal indicators out to 2030 or 2050. Users input baseline data and create three future scenarios capturing various levels of ambition for family planning and other socioeconomic factors. The model then projects population figures and calculates outcomes for the SDG indicators. Results can support advocacy efforts to increase funding and prioritization of family planning programs and policies. Examples of the model's use in Malawi, Tanzania, and West Africa demonstrate its ability to quantify potential development impacts of expanding access to voluntary family planning.
Generating privacy-protected synthetic data using Secludy and MilvusZilliz
During this demo, the founders of Secludy will demonstrate how their system utilizes Milvus to store and manipulate embeddings for generating privacy-protected synthetic data. Their approach not only maintains the confidentiality of the original data but also enhances the utility and scalability of LLMs under privacy constraints. Attendees, including machine learning engineers, data scientists, and data managers, will witness first-hand how Secludy's integration with Milvus empowers organizations to harness the power of LLMs securely and efficiently.
TrustArc Webinar - 2024 Global Privacy SurveyTrustArc
How does your privacy program stack up against your peers? What challenges are privacy teams tackling and prioritizing in 2024?
In the fifth annual Global Privacy Benchmarks Survey, we asked over 1,800 global privacy professionals and business executives to share their perspectives on the current state of privacy inside and outside of their organizations. This year’s report focused on emerging areas of importance for privacy and compliance professionals, including considerations and implications of Artificial Intelligence (AI) technologies, building brand trust, and different approaches for achieving higher privacy competence scores.
See how organizational priorities and strategic approaches to data security and privacy are evolving around the globe.
This webinar will review:
- The top 10 privacy insights from the fifth annual Global Privacy Benchmarks Survey
- The top challenges for privacy leaders, practitioners, and organizations in 2024
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Let's Integrate MuleSoft RPA, COMPOSER, APM with AWS IDP along with Slackshyamraj55
Discover the seamless integration of RPA (Robotic Process Automation), COMPOSER, and APM with AWS IDP enhanced with Slack notifications. Explore how these technologies converge to streamline workflows, optimize performance, and ensure secure access, all while leveraging the power of AWS IDP and real-time communication via Slack notifications.
Driving Business Innovation: Latest Generative AI Advancements & Success StorySafe Software
Are you ready to revolutionize how you handle data? Join us for a webinar where we’ll bring you up to speed with the latest advancements in Generative AI technology and discover how leveraging FME with tools from giants like Google Gemini, Amazon, and Microsoft OpenAI can supercharge your workflow efficiency.
During the hour, we’ll take you through:
Guest Speaker Segment with Hannah Barrington: Dive into the world of dynamic real estate marketing with Hannah, the Marketing Manager at Workspace Group. Hear firsthand how their team generates engaging descriptions for thousands of office units by integrating diverse data sources—from PDF floorplans to web pages—using FME transformers, like OpenAIVisionConnector and AnthropicVisionConnector. This use case will show you how GenAI can streamline content creation for marketing across the board.
Ollama Use Case: Learn how Scenario Specialist Dmitri Bagh has utilized Ollama within FME to input data, create custom models, and enhance security protocols. This segment will include demos to illustrate the full capabilities of FME in AI-driven processes.
Custom AI Models: Discover how to leverage FME to build personalized AI models using your data. Whether it’s populating a model with local data for added security or integrating public AI tools, find out how FME facilitates a versatile and secure approach to AI.
We’ll wrap up with a live Q&A session where you can engage with our experts on your specific use cases, and learn more about optimizing your data workflows with AI.
This webinar is ideal for professionals seeking to harness the power of AI within their data management systems while ensuring high levels of customization and security. Whether you're a novice or an expert, gain actionable insights and strategies to elevate your data processes. Join us to see how FME and AI can revolutionize how you work with data!
Nunit vs XUnit vs MSTest Differences Between These Unit Testing Frameworks.pdfflufftailshop
When it comes to unit testing in the .NET ecosystem, developers have a wide range of options available. Among the most popular choices are NUnit, XUnit, and MSTest. These unit testing frameworks provide essential tools and features to help ensure the quality and reliability of code. However, understanding the differences between these frameworks is crucial for selecting the most suitable one for your projects.
Best 20 SEO Techniques To Improve Website Visibility In SERPPixlogix Infotech
Boost your website's visibility with proven SEO techniques! Our latest blog dives into essential strategies to enhance your online presence, increase traffic, and rank higher on search engines. From keyword optimization to quality content creation, learn how to make your site stand out in the crowded digital landscape. Discover actionable tips and expert insights to elevate your SEO game.
A Comprehensive Guide to DeFi Development Services in 2024Intelisync
DeFi represents a paradigm shift in the financial industry. Instead of relying on traditional, centralized institutions like banks, DeFi leverages blockchain technology to create a decentralized network of financial services. This means that financial transactions can occur directly between parties, without intermediaries, using smart contracts on platforms like Ethereum.
In 2024, we are witnessing an explosion of new DeFi projects and protocols, each pushing the boundaries of what’s possible in finance.
In summary, DeFi in 2024 is not just a trend; it’s a revolution that democratizes finance, enhances security and transparency, and fosters continuous innovation. As we proceed through this presentation, we'll explore the various components and services of DeFi in detail, shedding light on how they are transforming the financial landscape.
At Intelisync, we specialize in providing comprehensive DeFi development services tailored to meet the unique needs of our clients. From smart contract development to dApp creation and security audits, we ensure that your DeFi project is built with innovation, security, and scalability in mind. Trust Intelisync to guide you through the intricate landscape of decentralized finance and unlock the full potential of blockchain technology.
Ready to take your DeFi project to the next level? Partner with Intelisync for expert DeFi development services today!
Introduction of Cybersecurity with OSS at Code Europe 2024Hiroshi SHIBATA
I develop the Ruby programming language, RubyGems, and Bundler, which are package managers for Ruby. Today, I will introduce how to enhance the security of your application using open-source software (OSS) examples from Ruby and RubyGems.
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HCL Notes und Domino Lizenzkostenreduzierung in der Welt von DLAUpanagenda
Webinar Recording: https://www.panagenda.com/webinars/hcl-notes-und-domino-lizenzkostenreduzierung-in-der-welt-von-dlau/
DLAU und die Lizenzen nach dem CCB- und CCX-Modell sind für viele in der HCL-Community seit letztem Jahr ein heißes Thema. Als Notes- oder Domino-Kunde haben Sie vielleicht mit unerwartet hohen Benutzerzahlen und Lizenzgebühren zu kämpfen. Sie fragen sich vielleicht, wie diese neue Art der Lizenzierung funktioniert und welchen Nutzen sie Ihnen bringt. Vor allem wollen Sie sicherlich Ihr Budget einhalten und Kosten sparen, wo immer möglich. Das verstehen wir und wir möchten Ihnen dabei helfen!
Wir erklären Ihnen, wie Sie häufige Konfigurationsprobleme lösen können, die dazu führen können, dass mehr Benutzer gezählt werden als nötig, und wie Sie überflüssige oder ungenutzte Konten identifizieren und entfernen können, um Geld zu sparen. Es gibt auch einige Ansätze, die zu unnötigen Ausgaben führen können, z. B. wenn ein Personendokument anstelle eines Mail-Ins für geteilte Mailboxen verwendet wird. Wir zeigen Ihnen solche Fälle und deren Lösungen. Und natürlich erklären wir Ihnen das neue Lizenzmodell.
Nehmen Sie an diesem Webinar teil, bei dem HCL-Ambassador Marc Thomas und Gastredner Franz Walder Ihnen diese neue Welt näherbringen. Es vermittelt Ihnen die Tools und das Know-how, um den Überblick zu bewahren. Sie werden in der Lage sein, Ihre Kosten durch eine optimierte Domino-Konfiguration zu reduzieren und auch in Zukunft gering zu halten.
Diese Themen werden behandelt
- Reduzierung der Lizenzkosten durch Auffinden und Beheben von Fehlkonfigurationen und überflüssigen Konten
- Wie funktionieren CCB- und CCX-Lizenzen wirklich?
- Verstehen des DLAU-Tools und wie man es am besten nutzt
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- Praxisbeispiele und Best Practices zum sofortigen Umsetzen
How to Interpret Trends in the Kalyan Rajdhani Mix Chart.pdfChart Kalyan
A Mix Chart displays historical data of numbers in a graphical or tabular form. The Kalyan Rajdhani Mix Chart specifically shows the results of a sequence of numbers over different periods.
Main news related to the CCS TSI 2023 (2023/1695)Jakub Marek
An English 🇬🇧 translation of a presentation to the speech I gave about the main changes brought by CCS TSI 2023 at the biggest Czech conference on Communications and signalling systems on Railways, which was held in Clarion Hotel Olomouc from 7th to 9th November 2023 (konferenceszt.cz). Attended by around 500 participants and 200 on-line followers.
The original Czech 🇨🇿 version of the presentation can be found here: https://www.slideshare.net/slideshow/hlavni-novinky-souvisejici-s-ccs-tsi-2023-2023-1695/269688092 .
The videorecording (in Czech) from the presentation is available here: https://youtu.be/WzjJWm4IyPk?si=SImb06tuXGb30BEH .
Skybuffer AI: Advanced Conversational and Generative AI Solution on SAP Busin...Tatiana Kojar
Skybuffer AI, built on the robust SAP Business Technology Platform (SAP BTP), is the latest and most advanced version of our AI development, reaffirming our commitment to delivering top-tier AI solutions. Skybuffer AI harnesses all the innovative capabilities of the SAP BTP in the AI domain, from Conversational AI to cutting-edge Generative AI and Retrieval-Augmented Generation (RAG). It also helps SAP customers safeguard their investments into SAP Conversational AI and ensure a seamless, one-click transition to SAP Business AI.
With Skybuffer AI, various AI models can be integrated into a single communication channel such as Microsoft Teams. This integration empowers business users with insights drawn from SAP backend systems, enterprise documents, and the expansive knowledge of Generative AI. And the best part of it is that it is all managed through our intuitive no-code Action Server interface, requiring no extensive coding knowledge and making the advanced AI accessible to more users.
leewayhertz.com-AI in predictive maintenance Use cases technologies benefits ...alexjohnson7307
Predictive maintenance is a proactive approach that anticipates equipment failures before they happen. At the forefront of this innovative strategy is Artificial Intelligence (AI), which brings unprecedented precision and efficiency. AI in predictive maintenance is transforming industries by reducing downtime, minimizing costs, and enhancing productivity.
Energy Efficient Video Encoding for Cloud and Edge Computing Instances
But We Will Always be Here! Assuring Sustainable Benefits After Food Aid Programs_Beatrice Rogers_4.25.13
1. Beatrice Rogers and JenniferCoates
with:
Johanna Andrews, Alexander Blau, Ameya Bondre,
Jamie Fierstein, Kathryn Houk, Tina Galante, Carisa
Klemeyer, Elizabeth Kegode, Leslie Sanchez
“BUT WE WILL ALWAYS BE HERE!”
ASSURING SUSTAINABLE BENEFITS
AFTER FOOD AID PROGRAMS
3. Study Rationale
3
Title II programs closing in non-priority
countries
Little systematic knowledge of whether
program impacts are maintained and how to
maintain them
Effectiveness of Title II programs depends on
both short-term impact and long-term
sustainability
4. Study Objectives
4
1. Determine the extent to which
activities, outcomes, and impacts
of Title II programs were
sustained.
2. Identify program characteristics
that make it possible to sustain
program activities and effects
after the program shuts down.
3. Assess how the process of
“exiting” affects sustainability.
4. Provide guidance to future
programs on how to exit while
ensuring sustainability.
5. Key Concepts
5
Sustainability
Sustainability of
impacts among
program
participants
Diffusion of impacts
to new populations
Sustainability/
expansion of
activities
Exit
From specific
activities
6. Key Concepts: Exit Strategy/
Sustainability Plan6
Explicit plan for transition from program
support to exit
Often called “sustainability plan” in agency
documents
Specifies approach to exit: phase over (to
whom), phase out (of resources)
Should include timeline and allocation of
responsibility for ensuring progress
7. Study Methods Overview
7
1. Qualitative picture of exit strategy implementation
around time of agency exit
2. Qualitative inquiry one year after exit: to explore the
success of exit strategy in leading to sustainable
service provision (where applicable) and beneficiary
uptake
3. Qualitative and quantitative data two years after exit
to assess sustainability of impacts and outcomes
4. Compare quantitative follow-on data to agency
endline survey data to determine sustainability and
link to exit strategies
8. Analytic Strategy: Associating Exit
Strategy with Sustainability of Impacts
8
Agency evaluations did not include control
groups for attribution of impact
Associations based on:
Testing Implementation Pathways
Sustainability of desired behaviors and impacts
Continuation of service provision and utilization
Implementation of an exit strategy
Use of Secondary Data
To serve as a point of comparison for survey results
9. Study Locations
• Kenya
• Bolivia
• Honduras
• India
Selection Criteria
• Programs achieved key
impacts on food security and
malnutrition
• Programs implemented exit
strategies
• Close-out coincided with study
time frame
9
10. Conceptualizing
Sustainability and Exit10
Sustained Impact
Sustained Behaviors and/or
Service Utilization
SUSTAINE
D
SERVICE
DELIVERY
SUSTAIN
ED
ACCESS
SUSTAINE
D
DEMAND
SUSTAINE
D
RESOURC
ES
SUSTAINE
D
CAPACITY
SUSTAINED
MOTIVATIO
N
SUSTAIN
ED
LINKAGE
S
Program Exit StrategiesProgram Exit Strategies
EXTERNALFACTORS
11. 11
Critical combination of resources, motivation, and
technical and managerial/administrative capacity
Programs should be designed with exit in mind
Gradual transition to independence with a period of
independent operation before exit
Importance of linkages - variable
Impact at exit is not the same as sustained benefit later
on
Provision of free resources poses challenges for
sustainability
Depending on government linkages is risky, and
depending on newly entering NGOs poses questions
Different technical sectors face different challenges
applying these principles
Emerging Conclusions
15. 15
1. Maternal and Children Health
and Nutrition (MCHN)
2. Water and Sanitation (WatSan)
3. Agriculture/Rural Income
Generation (RIG) (after mid-
term evaluation change in focus
from production to
commercialization)
4. Natural Resource Management
(NRM)
Program Technical Sectors
16. 16
Motivate CHWs to continue providing GMP, health
promotion and home visits through social prestige and
respect; credentialing.
Link CHWs to decentralized health services to assure
supervision, training, resources
Teach mothers to substitute local foods for Title II
provided foods
MCHN Exit StrategyMCHN Exit Strategy
17. 17
Prevalence of stunting declined
substantially during Title II and
generally remained low after exit:
ADRA, CARE, SC: No significant
change in stunting since exit
FH: Stunting continued to decline
significantly after exit
While overall stunting in the
Departments declined during the
period of Title II implementation, the
Awardee declines were larger than
regional declines and Awardees
worked in areas with much higher
MCHN Results: Stunting
19. 19
GMP participation and prenatal care visits remained high
Success of linkages to national government programs:
Zero Malnutrition (ZM): nutritional
supplements for children under 2; Comprehensive
Nutrition Units (UNIs) at healthcare centers
Bono Juana Azurduy (BJA) conditional cash transfers
for completing prenatal/postpartum care and
growth monitoring visits
Awardees with both a significant increase in GMP and the
strongest malnutrition impacts, CARE and FH, continue to
operate after exit
GMP participation declined in SC communities, where fewer
governmental and NGO resources may be available
MCHN Results: Demand for Services
Growth Monitoring and Prenatal Care
22. 22
Percentage of mothers reporting prenatal care in first 5 months during last
pregnancy
Prenatal Care (< 5mo)
23. 23
Presence of a community health
worker remains high
Coherent governmental and NGO
initiatives likely sustaining CHW
presence:
Intercultural Family and Community
Health Program (SAFCI)
Tarija’s “Health Guards”
NGOs (Esperanza Bolivia, Plan
International) adapt CHWs for their
own program activities
MCHN Results: Service Delivery
24. 24
FH collaborates with UNICEF in
some former Title II communities in
malnutrition prevention and GMP,
with funding from Spain and USAID
(Proyecto Integrado de Seguridad
Alimentaria, PISA)
In some cases local incentives may
sustain CHWs
Incorporation into water committee;
profit-generating women’s groups
MCHN Results: Service Delivery
26. 26
EBF increased during the program and has
been sustained
No cost; reinforced bygov’tprograms
(BJA, ZM)
All other practices have declined since exit
Proper treatment of diarrhea, hygiene
Importance of reinforcing behavior change
messages:
Behaviors not reinforced through home
visits/trainings since exit
Not prioritized since health system targets
services like prenatal visits/GMP
Results: MCHN Practices
27. 27
Title II Communities National Statistics
Percentage of mothers reporting exclusive breastfeeding for child < 6mo
Exclusive Breastfeeding
28. 28
Diarrhea Treatment (food and
liquid)
Percentage of
mothers offering
same/more food to
child during
diarrhea
Percentage of
mothers offering
same/more liquids
to child during
diarrhea
29. 29
Percentage of mothers offering same/more food , liquid, orORT to child
during last diarrhea episode
Diarrhea Treatment (food, liquid, and
ORT)
30. 30
Percentage of children 12–23 months of age receiving the third dose of DPT or
pentavalente vaccine
Note: No data available for ADRA in 2002 and 2004
Vaccinations
31. 31
Sustainability of impacts and CHW service use due to
alignment with government health programs and
presence of NGOs for continued support
ANC and GMP remain high since exit
Behavior change harder to sustain once food rations
removed
Rations had been provided children < 35 months and
pregnant women participating in GMP/health talks
Use of health services remains high since exit, but the
lack of resources for community training and CHW
supervision appears to limit the quality of information
provided or the incentive to continue household-level
behaviors requiring time/resources
MCHN Summary
32. 32
Piped waterand latrines
Awardee provided inputs for construction of piped water
and latrines
Elected water committees trained in system maintenance
and repair, and in financial management and
administration.
Beneficiaries provided labor for construction, pay a
connection fee and a monthly fee for water use; water cut
off for lack of payment;
User fees cover maintenance and repairs
Some water committees were operating prior to Title II but
received training
WatSan Exit Strategy
33. 33
Vertical linkages to municipal government and horizontal
linkages among water committees were part of
sustainability plan, not implemented
Waterquality testing
Water committees would take over water quality testing
once awardees left
Hand washing and latrine use
Hygiene behaviors promoted by community health
workers in home visits would continue
WatSan Exit Strategy
34. 34
Infrastructure continues to be available in Awardee areas
Percentage of communities reporting piped water and
latrine availability generally maintained
Immediate tangible benefit; responds to priority need;
successful water committee model; infrastructure coverage
is government priority
Sanitation and handwashing
practices were not sustained after exit
Water quality testing also not
maintained
Results: WatSan
41. 41
Percentage of households using any water treatment (boiling, chlorination, SODIS)
Note: No data available for FH
Water Treatment
42. 42
Water and sanitation infrastructure demonstrated greater
sustainability than hygiene behaviors and water
purification
Infrastructure: Tangible benefit, self-financing user
fees, community capacity to operate system and
maintain accountable administration; not dependent on
linkages
Behaviors: No immediate, tangible benefit, no financial
incentives to motivate implementation, no national
program focused on such behaviors, since national
priorities are more concerned with visible infrastructure
coverage
Water quality: no independent operation before exit
WatSan Summary
44. 44
Rural Income Generation (RIG) Exit
Strategy
Model farmers were given free agricultural inputs and
training in return for training other farmers
Model farmers would continue to serve as technical
resources
Focus on improved production and diversification shifted to
commercialization after MTE
Farmers associations formed, trained in production and in
management, contracting
Profits from increased sale would motivate sustained use of
practices taught in the program, and profits would cover
purchase of inputs
45. 45
Results Rural Income Generation
(RIG)
Agricultural income of farmers increased throughout the
program, but fell substantially at follow-up, though remaining
substantially higher than baseline
Inputs provided free during program now must be
purchased
Farmers who are members of producer associations (PA)
have maintained substantially higher incomes than those
who received training but are not PA members
National GDP per capita continues to rise
according to World Bank indicators
46. 46
Mean Annual Income from Agricultural Sales by Farmers Trained in the
Program
(adjusted for inflation, 2011=100)
Agricultural Income
48. 48
Percentage of trained farmers belonging to a producer association
Note: No endline data available for ADRA and FH
CARE participation data are only for farmers in promoted value chains
Producer Association Membership
50. 50
Percentage of farmers in producer associations
is declining
Members of producer associations have
substantially higher incomes than non-
members
Qualitative evidence indicates that farmers may
drop out of associations because they are
unable to meet quality standards
More successful farmers may be those able to
afford inputs through the profits from marketing
Commercialization model is successful for
those who can take advantage of it
RIG Results Summary
51. 51
Use of inputs and promoted practices declining
Inputs provided free during life of program now
must be purchased; farmers may have become
accustomed to receiving these inputs without charge
Practices sustained by trained farmers are those
returning noticeable benefit and low cost (organic
fertilizer, crop rotation)
Proportion of farmers adopting improved practices
similar among trained and un-trained farmers
Individual producers likely copying improved
production methods
RIG Results Summary
52. 52
Sales through an association more likely where
associations continue to receive support from external
sources (NGOs, foundations, government)
Government partners have high rates of turnover,
changing priorities, stretched budgets, and shortages
of technical staff; partnerships with buyers are more
reliable
Sustained operation of PAs is more likely when
responsibility of negotiating contracts is transitioned
gradually, with a period of independent operation
RIG Results Summary
53. 53
Practices have declined significantly since exit
Food for work and free inputs no longer available
Motivation is low if tangible benefit is not perceived
Continued practices are those that produce tangible
benefit and do not require purchased inputs
Municipal Natural Resource units are underfunded and
understaffed
Some activities produced lasting change during the
program, but were not continued (forestation, terracing)-
phase out
Results: Natural Resource
Management
55. 55
NRM activities largely not sustained after exit
Technical capacity was strong; resources and
motivation lacking
Municipal support was weak or lacking
Withdrawal of food and free inputs
jeopardized sustainability of activities
NRM Results Summary
57. Conclusions
57
Impact at exit does not consistently predict
sustained impact two years later.
There are specific ways to increase the
likelihood of sustainability.
Provision of free resources poses risks to
sustainability.
58. Impact Assessment at Exit Can
Be Misleading58
Impact assessment at exit does not
consistently predict impact two years later.
Many activities, practices, and impacts
across sectors declined over the two years
after exit.
These declines are related to inadequate
design and implementation of sustainability
strategies and exit processes.
59. Sustaining service provision and beneficiary
utilization of services and practices depends on three
critical factors:
1. Resources
2. Technical and Management Capacity
3. Motivation
There are often synergies among these three
elements.
Best practice models have emerged for each – and
they are often sector-specific.
The relevance of linkages is sector-specific.
Specific Ways to Increase the
Likelihood of Sustainability59
60. Provision of Free Resources
Poses Risks to Sustainability60
Withdrawal of food rations or any other free
input (as incentive) jeopardizes sustainability
without consideration of substitute incentives.
Provision of free food rations risks creating
unsustainable expectations.
Consideration of alternative incentive structure
must be incorporated into program design.
Beneficiaries receiving free inputs to support
program activities may not be willing or able to
replace them once project ends.
61. MCHN: Exit Strategy Models Lacked
Sustained Sources of Resources, Capacity,
and Motivation61
Motivation: Withdrawal of food was a
disincentive for participation in and provision of
growth monitoring.
In Kenya, withdrawal of food resulted in
reduced participation in growth monitoring.
NGO return also reinstated the incentive.
In Honduras, withdrawal of food reduced
demand participation in growth monitoring,
while in Bolivia, the government implemented
a cash incentive for growth monitoring and
promotion.
Overall community health worker (CHW) service
provision declined in Kenya, Bolivia, and
Honduras with decline in material incentives and
62. MCHN: At least four types of resources must
be considered in order to sustain CHW service
delivery62
1. Resources that helped CHWs do their job, such as
weighing scales, report forms, and bicycles, as well as
training and supervision from the health sector
2. Resources that they offered the community as an
incentive to participate in activities
3. Benefits accrued to the CHWs that incentivized their
service, such as access to goats distributed to women’s
goat groups
4. CHW time and its converse, the opportunity cost of time
spent on CHW activities rather than on other productive
labor
• No fee for service models were observed in the health sector.
63. MCHN: Success of linking to government
depended on government capacity and resources
63
Bolivia: Some CHWs continued linkages to health
system; public health system provided services.
In Honduras, linkages with health system worked
until government resources ran out.
In Kenya, government did not/could not take the
responsibility for supervision, training, or provision
of resources resulting in declines in CHW service
quality, motivation, and capacity when they were
not being reinforced.
64. Water system exit strategy demonstrated that
motivation, capacity, and resources are all critical
to sustainability64
Beneficiaries are motivated to pay for water
services that are reliable, convenient, and
abundant.
Technical and management capacity of
water committees permits system to
continue operation post-project.
Fees paid by consumers provide ensured
resources for system maintenance.
65. WatSan: Linkages to Government Not
Always Needed
65
Linkages were actively avoided by most water
committees; independence from government
entities that could be unreliable sources of
support
66. Sustainability of Water Quality Provides a
Counterexample….
66
Motivation for water quality testing is low because
benefits are not visible.
Therefore willingness to pay was low.
Capacity-building activities during the DAPs did
not emphasize water quality.
Water quality testing was not operating
independently at exit.
No linkages to support water quality testing were
in place at exit.
67. Agriculture Sector Exit Strategies
Yielded a Mixed Sustainability
Story67
Model farmers (extension farmers) lacked
motivation, resources, and reinforcement of
capacity to continue providing technical assistance
after incentives were withdrawn. Service provision
largely declined.
Producer associations participation rates were
variably low/declined. PAs provided concrete
benefits in some countries but not all.
Commercialization activities produced sustainable
68. Improved agricultural practices generally declined
when requiring resources provided during the
DAP68
Free inputs
were provided
during program
life
and
Use of these
inputs declined
when they
needed to be
purchased after
the program
69. Engagement in NRM activities and
practices declined dramatically after
program exit69
Food as pay (FFW) was withdrawn.
Resources in the form of inputs (seedlings, etc.)
was no longer provided free of charge.
Motivation was lacking unless costs were low and
direct benefits to farmers were high.
Linkages to local government environmental groups
were ineffective as those groups lack resources.
Positive changes (reforestation, terracing, etc.)
were maintained, though activities to expand these
changes were not.
70. COSAMO in Kenya Was a Model of
Sustainability
70
Sustained capacity, motivation, and resources.
Sustained beneficiary utilization and impact.
Self-financing: No outside seed money and no other
external resources needed.
Modular training program built solid technical and
managerial capacity.
There was a gradual withdrawal of NGO after a period
of COSAMO group independent operation
Linkages were not necessary – could pay for technical
assistance of trained resource persons.
72. Program Design
72
Sustainability should be built into the design of
programs from the beginning.
Plans must include: decision about approach
(phase out, phase over); explicit benchmarks for
progress; timeline; clear allocation of
responsibility, graduation criteria
Each element — capacity, motivation, and
resources — must be considered, with
redundancies and contingencies for external
shocks built into the plan.
74. Phased Program
Implementation74
Sustainable design and initial service delivery,
demand creation, and partnership formation
Strengthening capacity, developing ensured
resources, ensuring appropriate linkages,
promoting independent operation
Independent operation of program activities
and gradual agency withdrawal
75. Program Monitoring and
Evaluation75
Emphasis on assessment of impacts (e.g.,
reduction in stunting) can undermine focus on
sustainability.
Progress toward sustained capacity, motivation,
and resources should be measured as process
indicators during monitoring.
Evaluations should be done at each phase;
criteria for assessment will differ by the
76. Program Withdrawal (Exit)
76
Phase-over of responsibility must be gradual.
Groups should be operating independently (with agency
backstopping) before full withdrawal.
Community organizations and individuals should be aware of
their post-exit roles and responsibilities from the outset.
Philo so phy of sustainability should be embedded throughout
implementation to withdrawal.
Be aware that communities may not commit to independence,
in the expectation of new sources of external support.
77. This study is made possible by the generous support of the
American people through the support of the Office of Health,
Infectious Diseases, and Nutrition, Bureau for Global Health,
and the Office of Food for Peace, Bureau for Democracy,
Conflict and Humanitarian Assistance, U.S. Agency for
International Development (USAID), under terms of
Cooperative Agreements GHN-A-00-08-00001-00, AID-OAA-
A-11-00014, and AID-OAA-A-12-00005 through the Food and
Nutrition Technical Assistance III Project (FANTA), managed
by FHI 360.
The contents are the responsibility of Tufts University and do
not necessarily reflect the views of USAID or the United States
Government.
77
Acknowledgments and Disclaimer
Discuss and give examples of potential tradeoffs between impact and sustainability
Provide guidance to Food for Peace and to Cooperating Sponsors General approaches to planning for program exit Key elements of an exit strategy, including development and implementation How to build sustainability into program design from the beginning This study is a study of ‘delivery science’. GOAL IS TO PROVIDE USABLE GUIDANCE TO PROGRAM IMPLEMENTERS
Sustainability of QUESTION: IS IT SUSTAINABILITY IF THE COMMUNITY SIMPLY TRANSFERS DEPENDENCE TO A NEW NGO?
Exit strategy is the same as a sustainability plan. Should be developed early; ideally program design should include plans for exit. We don’t know whether it is important to have an explicit exit strategy with benchmarks and timelines etc. Includes timeline, benchmarks for progress, mechanisms for monitoring and allocation of responsibility for ensuring progress Phase out: program activities stop; benefits/effects are presumed to be lasting without further input Phase over: responsibility for program activities is transferred to another entity Community based organization Government (local to national) Key individuals Another NGO or donor Market based agreements : Phasing to private sector market incentives.
Also drew on baseline reports to present trends in indicators from start of project, through to endline, and on to the follow-up. We did not use baseline data, only figures from the reports, which created some limitations as we had to use only baseline indicators exactly as defined, and this wasn’t always clear. More flexibility in the endline to follow-on comparisons, since we had data sets for those two time points.
Point out that agency evaluations didn’t use a control group – mention difficulties of attribution (and what we would be “attributing” in such a study, even if there were a control group.
Don’t always need sustained participation in activities to get sustained behavior change and you don’t always need sustained behavior change to get sustained impact. Consult slide that was deleted for details.
Hereafter, Baseline = Awardees collect baseline data (2002) Midterm = primarily monitoring data (2004) Endline = awardee ’s final evaluation survey (2009) Follow-up = our two year later survey (2011)
MCHN strategies focused on growth monitoring, initially for recuperation of malnourished children and shifting toward prevention after the mid-term evaluation (MTE). Agencies trained community health workers, or teams of community health leaders in the case of STC, to conduct these and related health and hygiene trainings in coordination with municipal and health center partners. Water and sanitation strategies included construction of piped water system s to the household as well as latrine construction , along with technical and administrative training and the organization of community water committees to operate and maintain new constructions. RIG strategies targeted production practices with a focus on improved production of demand-driven products, market linkages, agricultural infrastructure, and the formation of producer associations for sharing information and for collective buying of inputs and marketing of products, both in their raw state and processed . While ADRA was noted for its market-driven orientation from the beginning of the DAP, all of the agencies shifted to a market-oriented value chain focus after the MTE. In addition, ADRA uniquely created Agricultural Service Centers (ASCs), or warehouses, in its four targeted municipalities where producers could consolidate and jointly sell their products more efficiently. The agencies also worked to initiate or strengthen related municipal offices and create partnerships with these offices and other NGOs working toward RIG objectives in their regions. NRM strategies focused on sustainable resource management including soil management, reforestation, and irrigation practices and infrastructure. As for other components, both community and municipal level actors were trained to promote and fund these activities
ADRA ’s stunting rates for children 3-35 mo declined 19.5 percentage points during Title II, with no significant change in stunting since exit; this compares with a decline of 8.4 percentage points in the department of Chuquisaca where its program was implemented. CARE ’s stunting rates declined 19.9 percentage points during the program, with no significant change in stunting since exit; this compares with much smaller regional declines in its area of intervention of: --8.4 percentage points in Chuquisaca --5 percentage points in Potosi --7.3 percentage points in Tarija FH ’s stunting rates declined 14.9 percentage points, with a further significant decline of 6.8 percentage points since exit; this compares with regional declines in its area of intervention of: --5 percentage points in Potosi --4.3 percentage points in Cochabamba STC ’s stunting rates declined 9.2 percentage points during the program, compared with the La Paz department’s decline of 4.6 percentage points over the same period. While stunting appeared to increase slightly since exit, this increase is not significant.
FH works with NGOs like UNICEF to provide technical and administrative support to the UNIs to align local health priorities with malnutrition prevention and GMP. FH, in its former Title I communities, is helping to promote a decentralization that will result in establishing UNI-coms, or community based UNIs whose goal is early identification of cases of malnutrition. These outposts will require participation of community based workers such as the CHWs trained by the Title II program. CARE has maintained a presence in Tarija over the past few years to support the steady development of national health programs in the field, which may be the reason for the reductions in stunting and underweight (not significant). STC: the constant political turnover in many STC Altiplano municipalities may have prevented a stable municipal leadership from creating partnerships with external organizations to consolidate programs like ZM in their region. Since many municipal governments depend on external NGOs to assume responsibility for Title II activities, even where they align with explicit national health objectives, sustainability varies among communities with the availability of external funding. STC is the only one that implemented only ONE DAP.
ADRA: participation decreased by 4.1 percentage points from endline to follow-up (p<0.05) but remained high at 86% . The percentage of pregnant women in the target population with at least one prenatal visit in the past calendar year remained the same at 100% for both years, and the percentage of women with at least one prenatal visit before the fifth month of pregnancy was unchanged. The percentage of children under one year old that received the third dose of DPT or pentavalente vaccine did not change from endline to follow-up. Similarly, the DPT/pentavalente vaccines rates for children 12-23 months old remained high at 97.2% at follow-up. The values for all these services are substantially higher than the comparable figures at baseline, suggesting that improvements were maintained after exit. CARE: Participation significantly increased by 3.4 percentage points from endline to follow-up. The percentage of pregnant women in the target population with at least one prenatal visit in the past calendar year dropped slightly but significantly from almost 97% at endline to a still high level of 94% at follow-up. The percentage of women with at least one prenatal visit before the fifth month of pregnancy remained about the same in both years (90%). As was the case with ADRA, the proportion of women receiving any, and timely, prenatal care remained substantially higher at endline and follow-up than at baseline. The percentage of children under one year old that received the third dose of DPT or pentavalente vaccine significantly dropped from endline (61%) to follow-up (46%), but the DPT/pentavalente vaccines rates for children 12-23 months old remained high at 96%, despite a small but significant decrease of 3.1 percentage points. FH: Participation significantly increased by 6.6 percentage points from endline to follow-up (p<0.001); almost 100% of children attended growth monitoring two years after exit, compared with only 22% at baseline. The percentage of pregnant women in the target population with at least one prenatal visit in the past calendar year significantly increased from 84% to 91% (p<0.001). Similarly, the percentage of women with at least one prenatal visit before the fifth month of pregnancy increased from 68% to 75%. At baseline only 50% of women received prenatal care, and only 23% received it before the fifth month; this figure now stands at 75%, with 91% getting at least one prenatal visit in the previous year. DPT/pentavalente vaccines rates for children 12-23 months old significantly increased by 3.3 percentage points (p<0.05), and are now over 98%, compared with 15% at baseline. STC: Participation significantly decreased by 14.2 percentage points from endline to follow-up (p<0.001). Even though the participation rate of 79% is still higher than the 47% at baseline, it is a substantial decline. The percentage of pregnant women in the target population with at least one prenatal visit in the past calendar year remained about the same (84%), and much higher than baseline (56%). The percentage of women with at least one prenatal visit before the fifth month of pregnancy significantly increased from 47% to 59% (p<0.05), up from 31% at baseline. The DPT/pentavalente vaccines rates for children less than one year old and for children aged 12-23 months old remained the same, but the percent completing the DPT/pentavalente by 12-23 months (92%), and was substantially higher than the 41% at baseline.
Due to BONO BJA
(National) SAFCI:: encourages healthcare personnel to work alongside local community leaders and families for decentralized health interventions; CHWs become formal local health authorities (ALS) to collect data and prioritze activities (Tarija only) Guardianes de Salud: receive incentives like bicycles and first aid kits to coordinate with local health personnel to conduct GMP and promote prenatal care and vaccinations New organizations ’ shifting focus toward diseases such as Chagas and TB, along with the provision of new incentives like backpacks and flashlights, has in some cases attracted different people to fill these positions, creating some redundancy in the communities and discouraging previously trained CHWs from continuing their previous activities. Threats: tension between the desire to take advantage of local resources to decentralize basic health services and the medical profession ’s hesitancy to cede responsibility continues to limit the breadth and quality of work provided by CHWs who go without needed training and supervision. We observed many CHWs continue to coordinate with local health personnel to conduct GMP activities due to personal motivations (sense of community duty, hopes of professional advancement). However, the lack of supervision and refresher trainings has made it difficult to identify replacements for CHWs who retire or to sustain the quality of information and services provided.
(National) SAFCI:: encourages healthcare personnel to work alongside local community leaders and families for decentralized health interventions; CHWs become formal local health authorities (ALS) to collect data and prioritze activities (Tarija only) Guardianes de Salud: receive incentives like bicycles and first aid kits to coordinate with local health personnel to conduct GMP and promote prenatal care and vaccinations New organizations ’ shifting focus toward diseases such as Chagas and TB, along with the provision of new incentives like backpacks and flashlights, has in some cases attracted different people to fill these positions, creating some redundancy in the communities and discouraging previously trained CHWs from continuing their previous activities. Threats: tension between the desire to take advantage of local resources to decentralize basic health services and the medical profession ’s hesitancy to cede responsibility continues to limit the breadth and quality of work provided by CHWs who go without needed training and supervision. We observed many CHWs continue to coordinate with local health personnel to conduct GMP activities due to personal motivations (sense of community duty, hopes of professional advancement). However, the lack of supervision and refresher trainings has made it difficult to identify replacements for CHWs who retire or to sustain the quality of information and services provided.
ADRA: At follow-up, 61% of the ADRA communities sampled reported having a community health worker (CHW) CARE: At follow-up, according to the community survey, 75% of the CARE communities sampled reported having a community health worker (CHW) , compared to 100% at the time of exit. FH:At follow-up, 73% of the FH communities sampled reported having a community health worker (CHW). STC:Only 44% of sampled STC Title II communities reported having a community health worker two years after exit, compared with 61% for ADRA, 73% for FH, and 75% for CARE communities. While the other three agencies had previous experience implementing Title II programs, this last DAP was STC ’s first. STC narrowed its geographic area of intervention and program focus between the MTE and final exit, but this shorter period of operation may have limited their success in sustaining impact. Also, while CARE, ADRA, and FH still maintain some form of contact with former Title II communities conducting new projects since exit, STC no longer maintains a presence in any of its former Title II communities. Whether formal or informal, sustained contact provides a longer period of “exit” in which community actors have time to develop their skills while external support is only gradually withdrawn. STC’s lack of follow up for gradual alignment of MCHN activities with the health system may have limited their sustainability when compared with the other agencies.
National EBF stats from DHS; while EBF rates also increasing nationally during time of program, agencies achieved much higher rates that have generally sustained high levels: ADRA: Percentage of infants less than 6 months exclusively breastfed during the last 24 hours slightly decreased from endline to follow-up, and this decrease approached significance at alpha=0.0551. EBF did increase substantially from baseline, however, and remains high at 80%. CARE: Percentage of infants less than 6 months exclusively breastfed during the last 24 hours remained nearly the same from endline to follow-up, and a good deal higher than at baseline. FH: Percentage of infants less than 6 months exclusively breastfed during the last 24 hours significantly increased from endline to follow-up (p<0.001), reaching 100%, from a baseline value of 67%. STC: Percentage of infants less than 6 months exclusively breastfed during the last 24 hours was unchanged from endline to follow-up, but increased from the baseline. At baseline, the percent EBF was 75%, and was almost 90% at follow-up.
ADRA: The percentage of children less than 5 years old with diarrhea in the last two weeks who were treated with ORT or recommended fluids significantly decreased from endline to follow-up (88.6% in 2008 to 79.3% in 2011, p<0.05), but again, the use of ORT remained higher than at baseline. Proper treatment of diarrhea by maintaining or increasing solid food and liquids declined from baseline to follow-up. CARE: The percentage of children less than 5 years old with diarrhea in the last two weeks who were treated with ORT or recommended fluids remained about the same from endline to follow-up (95% in 2008 to 94% in 2011); both figures are substantially higher than the 60% who used ORT at baseline. However, the practice of maintaining or increasing solid food and fluid intake during diarrhea declined significantly. FH: Use of ORT to treat diarrhea declined between endline and follow-up but remained higher than at baseline. STC: there were significant declines in the use of all the practices related to treatment of diarrhea (use of ORT, maintaining solids and liquid intake during diarrhea) between end line and follow up, though not to near the levels that prevailed at baseline.
One likely cause of the sustained levels is a favorable health system environment that continues to motivate the use of services related to prenatal care and vaccinations. Where appropriate treatment for diarrhea decreased, households may not regard treatment with increased foods and fluids as important especially considered their continued use of appropriate ORT and improved health service access. STC: The increased level of stunting among children 0-24 months, along with the low presence of CHWs and poor behavior utilization numbers may reflect the short STC presence in Title II communities, as it was the only agency to begin Title II during this final round of DAPs, and it no longer maintains any agency presence in its former Title II communities. In addition, as mentioned repeatedly, the behavior utilization outcomes appear difficult to sustain after exit in general, without continued motivation and refresher training. However, the sustained levels of service use may result from both the positive national health environment that continues to provide related services as well as the STC exit strategies that focused on gradually improving municipal and health system capacity to continue technical and financial support for Title II activities after agency exit.
ADRA: Households would respond that they had ‘potable water’ if they had water in the home, even if they could not vouch for its microbiological quality. The percentage of households with piped water at follow-up was 92.3%, a small but significant decrease from the 99% reported at exit. CARE: The percentage of households reporting having piped water was 72.2% at follow-up, an increase from the 65.4% at endline FH: The percentage of households with potable water rose significantly from endline to follow-up (from 69% in 2008 to 84% in 2011, p<0.001). STC: We do not have data on household piped water systems, but the percentage of communities reporting having a potable water system was 86% at follow-up.
While sustained, lower coverage than piped water: Latrines do not match the criteria for sustainability of piped water: even if beneficiaries value them, individual beneficiaries must pay for maintenance; there is no fee for service model to provide the resources. ADRA: The percentage of households with latrines decreased from almost 96% at endline to 89% at follow-up (p<0.01). CARE: The percentage of households with latrines hardly changed, from almost 34% at endline to 35% at follow-up, suggesting that households maintained the latrines they had, but no new ones were added. If flush toilets are added to the definition of latrines, then the number of households with such facilities increased between end line and follow up. FH: The percentage of household that had a latrine increased by 42 percentage points, to 80% at follow-up (p<0.001). This suggests that another agency or the government may have intervened to expand these services after Title II program exit. In our qualitative visits, we noted that communities, governments, and NGOs prioritize funding for increased infrastructure coverage, while not always including adequate funding or training for behavior change (hygiene, water treatment etc). UNICEF/PLAN. STC: The percentage of households with latrines significantly increased from almost 32% at endline to 38% at follow-up (p<0.01), still a relatively low number.
ADRA: Latrine use (with signs of usage), decreased as well, with 29% using latrines at follow-up, compared to 75% at endline (p<0.001). This rate of use is comparable to the rate at baseline, before the intervention. Signs of usage were defined as: Respondent answers yes to question “Do you have a bathroom?”, and Respondent answers yes to question “Does the family use the bathroom?”, and Respondent answers yes to bathroom is completely clean or “does the bathroom have a waste bin”, and Interviewer confirms functionging water tank, the pipe to the toilet tank, the water connection to the tank and sink and the drain of the sink, and Interviewer confirmed signs of usage (soap/detergent, toilet papers, waste bin) Families reporting latrine use (whether or not the interviewer checked for signs of use) also significantly decreased, but the decline was not as extreme (dropped by 15 percentage points); 77% of households reported using their latrines at follow up. CARE: Latrine use (with signs of usage) even among those with latrines, decreased as well, with 85% at endline, compared to 70% at follow-up (p<0.001). FH: Latrine use (with signs of usage), decreased as well with 83% at endline, compared to 42% at follow-up (p<0.001), but the percentage of households reporting latrine use (without the interviewer observing the latrine to check) was maintained at 88.6%, not significantly below the 92.6% reported at endline. STC: Among those who had latrines, latrine use (with signs of usage), significantly increased by almost 6 percentage points (p<0.05) to 40%.
ADRA: ADRA ’s indicator, “Percentage of caregivers responsible for food preparation with proper hand washing practices” dropped by 43 percentage points from 89.9% to 46.9% at follow-up (p<0.001). With the exception of handwashing before eating, percentages for nearly all handwashing behavior s included in the survey significantly decreased, with the largest drops occurring in the percent handwashing after changing diapers (60% to 15%, p<0.001) and before breastfeeding (43% to 10%, p<0.001). CARE: CARE ’s indicator, “Percentage of caregivers responsible for food preparation with proper hand washing practices” dropped by almost 20 percentage points, from 85% to 65% (p<0.001). Adequate handwashing practices were defined as washing twice a day or more. With the exception of handwashing in the mornings, which actually increased, percentages for nearly all handwashing behaviors included in the survey significantly decreased. The only practices still maintained by more than half the households were washing in the morning, before food preparation, and after using the bathroom. FH: Handwashing was defined as using at least 8 hygiene practices (5 different occasions and 5 different conditions (such as uses clean water, uses some sort of cleaning product, both hands, rub 3 times, clean drying system)). FH ’s indicator, “Percentage of caregivers responsible for food preparation with proper hand washing practices” dropped by almost 64 percentage points from 93% to 29% at follow-up (p<0.001). Percentages for all handwashing behaviors included in the survey significantly decreased, with the largest drops occurring in the percent handwashing before feeding the children (dropped 60 percentage points, p<0.001) and handwashing after cleaning the child’s feces (dropped 47 percentage points, p<0.001). The handwashing practices that were best maintained were washing before food preparation (88%) and before eating (81%). STC: STC ’s indicator, “Percentage of caregivers responsible for food preparation with proper hand washing practices”, defined as at least 3 times a day with soap/detergent, dropped by 53 percentage points from 89% to 36% at follow-up (p<0.001). With the exception of handwashing in the mornings, percentages for nearly every handwashing behavior included in the survey significantly decreased, with the largest drop occurring in the percent handwashing before feeding the children (dropped 36 percentage points, p<0.001) and after using the bathroom (dropped 32 percentage points, p<0.001). The practices that were best maintained were washing before eating and before food preparation.
One hygiene behavior that continues to be implemented in Title II communities, though at decreasing levels since agency exit, is handwashing with soap or detergent. Women in Bolivia often wash their laundry in the handwashing sinks constructed outside the bathrooms, so they may be keeping detergent at the sink for both purposes. The continuation of home visits in some areas (either by CHWs, water committees, or healthcare personnel) may provide continued reinforcement for this practice since soap is more easily observed during a brief household visit than behaviors such as appropriate diarrheal treatment. ADRA: The percentage of caretakers using soap to wash hands also significantly declined (from 96% at endline to 87% at follow-up, p<0.01), but washing with soap was the best-maintained of all the practices, despite the fact that soap costs money, and the other practices do not. FH: The population using soap to wash their hands also significantly declined (p<0.001), but was still practiced by 87% at follow-up. STC: Although the percentage using soap/detergent when washing their hands significantly decreased, the use of soap/detergent remained high at 85%.
The microbiological quality of the piped water was not a focus of most agencies ’ SPs, so responsibility for water quality testing was not gradually transitioned as was responsibility for delivering piped water. ADRA is the only agency that referred to the importance of transferring responsibility for continued water quality maintenance to an appropriate local actor. Most water committees have not assumed responsibility for water quality testing since the end of the Title II intervention, when the agencies funded and organized this service , largely without involving the water committees . The lack of independent experience in negotiating and prioritizing this activity without external assistance appears to be a factor in its lack of sustainability. Water purification significantly decreased at the household level since exit as well: across ADRA, CARE, and STC communities (FH did not include this topic in its survey), water purification among caregivers significantly decreased. Just as we did not observe any motivation on the part of water committees to maintain water quality analysis activities, so water/sanitation beneficiaries do not seem to prioritize purifying their drinking water. Municipal governments are not providing any further training or support for water quality testing or water purification activities, since they target their own limited funding toward improving water system coverage in their region above ensuring potability of existing water systems. ADRA: Water purification practices among mothers of children under 5 also significantly declined, as the percent of caretakers reporting they do not do anything to the water before use increased by 34.3 percentage points to 50% (p<0.001). The decline in water treatment may be attributable to the cost (in time and resources) of boiling, chlorination, and even solar disinfection. Treating piped water that appears clean may not be a high priority for famili. CARE: Water purification practices among mothers of children under 5 also significantly declined. The percentage of caretakers reporting they do not do anything to the water before use increased by almost 28 percentage points (p<0.001) to 58%. STC: Water purification practices among mothers of children under 5 significantly declined. The percent of caretakers reporting they drink directly from the water source increased by 33 percentage points (p<0.001). Even though the percentage of caretakers that boil the water before use significantly decreased from endline to follow-up, it is important to note that 44% of caretakers still continued to boil the water before use, and just over half used some form of water treatment.
A Mesa Directiva for a potable water system in Bolivia…. Couldn’t resist putting this one in!!
Background ADRA: While all of the agencies shifted to a more market-focused RIG program after the MTE, ADRA ’s program had implemented a market approach to production activities since the beginning of the DAP. CARE: For its sustainability plan, CARE opted to focus on three of its six value chains: cheese in Chuquisaca, dried peaches in Potosi, and textiles in Tarija. This targeted approach to exit allowed the agencies to focus technical and financial resources on those value chains they judged to be most likely to be sustainable after exit. STC ’s main sustainability strategy was to strengthen the prioritized value chains and build strategic alliances between producer associations and strategic partners, especially municipal institutions. STC also promoted the establishment of stable long term contracts with buyers, such as the contract between the milk producers and Pil Andino, a dairy company, as a way of ensuring the producers would have both an assured market and access to technical support after the exit of the agency. FH: FH ’s sustainability plan was unique in its graduation of communities where unfavorable conditions made sustainable value chains seem unlikely. At the same time, FH received funding from both USDA and the Interamerican Development Bank (IDB) to continue RIG activities in some of its, as well as CARE’s, former Title II communities. This added funding may contribute to a longer period of time during which associations can develop and practices can continue to be adopted and replicated.
Background ADRA: While all of the agencies shifted to a more market-focused RIG program after the MTE, ADRA ’s program had implemented a market approach to production activities since the beginning of the DAP. CARE: For its sustainability plan, CARE opted to focus on three of its six value chains: cheese in Chuquisaca, dried peaches in Potosi, and textiles in Tarija. This targeted approach to exit allowed the agencies to focus technical and financial resources on those value chains they judged to be most likely to be sustainable after exit. STC ’s main sustainability strategy was to strengthen the prioritized value chains and build strategic alliances between producer associations and strategic partners, especially municipal institutions. STC also promoted the establishment of stable long term contracts with buyers, such as the contract between the milk producers and Pil Andino, a dairy company, as a way of ensuring the producers would have both an assured market and access to technical support after the exit of the agency. FH: FH ’s sustainability plan was unique in its graduation of communities where unfavorable conditions made sustainable value chains seem unlikely. At the same time, FH received funding from both USDA and the Interamerican Development Bank (IDB) to continue RIG activities in some of its, as well as CARE’s, former Title II communities. This added funding may contribute to a longer period of time during which associations can develop and practices can continue to be adopted and replicated.
ADRA: The mean income from this production declined from $3,400 at endline to $2,207 at follow-up (p<0.001) in constant 2011 dollars. Although there was a significant decline in the agriculture/livestock income of ADRA project participants, this mean income of $2,207 remains much higher than the starting agricultural/livestock income of $1,610 in 2002. The mean agricultural income of all producers (participants and non-participants) in 2011 was $2,094, still much higher than at baseline. The average agricultural income of all farmers in the communities served by Title II (not only program participants) was lower than that of program participants, but still much higher than at baseline, suggesting that the benefits of the RIG activities extended to those not directly involved in the program. In 2011, 79.8% (n=812) of the farmers had been program participants. CARE: The mean income from this production declined from $2,998 at endline to $1,701 at follow-up (p<0.001) in constant 2011 dollars. Although there was a significant decline in the agriculture/livestock income of CARE participants, the mean follow-up agriculture/livestock income of $1,701 remains higher than the starting agricultural/livestock income of $1,258 in 2002. FH: Of the 659 farmers surveyed in 2011, 467 (70.9%) farmers had participated in some of the Title II program trainings for farmers. The mean agriculture/livestock income for program participants declined from $2,871 at endline to $1,872 at follow-up (p<0.05) (constant 2011 dollars). Although there was a significant decline in the agriculture/livestock income of FH participants, this mean income of $1,872 remains much higher than the starting agricultural/livestock income of $717 in 2002 and more than the $1,305 at the midpoint. Furthermore, the figure in 2008 appears to have been affected by a skewed distribution; the change in the median farm income between 2008 and 2011, while still a decline, is considerably smaller. In 2011, total n = 659; 467 had been Title II program participants. STC: In 2011, 68.2% (n = 438) of the farmers interviewed had been program participants . Among participant farmers, income from agriculture/livestock production declined from $2,684 at endline to $2,104 at follow-up (p<0.001) (constant 2011 dollars). Although there was a significant decline in the agriculture/livestock income of STC participants, this mean income of $2,104 remains much higher than the starting agricultural/livestock income of $922 in 2002 and $1,050 at the midpoint. Among all farmers (participants and non-participants), agriculture income at follow-up was $1,976, compared with the baseline value of $922, demonstrating that non-participants benefited from the dissemination of improved practices and, possibly, marketing opportunities created by value chain development.
all farmers PA farmers 2008 2011 ADRA 2998 to 3634 CARE 3400 to 3508 FH 2871 to 3232 STC 2684 to 3866 This is ag income only. IF PA members ’higher activity generates employment in other sectors we wouldn’t know.
ADRA: 29% all of farmers were members of a producer association at follow up, and 15% of those who were not members had previously been members. CARE: The proportion of farmers participating in a farmers association dropped by close to half between endline and follow-up. FH: The percentage of farmers currently in a farmers association remained about the same between endline and follow-up (14.6% and 13.5% respectively). STC: At endline, 23% of participant farmers reported being in a farmers association, while in 2011 20% of participant farmers reported being in a farmers association. Of those farmers who were not in a farmers association in 2011, 5% had been in one before.
ADRA: Adopting improved practices was defined as: participating farmers having adopted at least 73% of the practices, meaning 11 or more of the 15 practices promoted during the project. Using the definition applied by the agency, the proportion of participating farmers who adopted improved agricultural technologies and practices decreased by almost 43 percentage points from endline to follow-up (p<0.001). Individual practices, however, were sustained in some cases. At endline , about 47% of participants were using fourteen of fifteen practices, and at follow-up the number of practices being used by almost half of participants remained at about 9-11 practices, suggesting that farmers were in fact choosing to use those practices they found cost-effective. FH: In 2011, 21.7% (n=143) of the farmers surveyed had participated in the Rural Income Generation component of the program. The proportion of participating farmers who met this criterion for using improved agricultural technologies and practices did not change between 2008 and 2011 (the small increase was not significant); the proportion using these practices increased substantially from the first measurement at mid-term, 51% compared with 76.2% at follow-up. STC: The proportion of participant farmers who adopted improved agricultural technologies and practices decreased by almost 17 percentage points from endline to follow-up (65% to 48%, p<0.001). With the exception of improved potato practices, the use of each crop ’s improved agricultural practices promoted by the STC project decreased from endline to follow-up.
While participation in producer associations has declined for all agencies, ADRA and CARE have the highest percentage of producers selling in associations. ADRA was the only agency to focus on value chains from the beginning of its DAP, while the others shifted from production to value-chain and market oriented focus after the MTE. ADRA also targeted a fewer number of associations that were organized around regional Agricultural Service Centers (ASC) instead of around a single product, which may motivate continued association participation for access to facilities and coordinated storage and sales for several different crops. CARE showed the highest participation in associations (at 41%). According to the Final Evaluation, while all of the agencies decided to form strategic partnerships with other organizations in the short time remaining after shifting toward a market-orientation after the MTE, CARE opted to provide a limited technical support for value chains already in a nascent stage of development , using their existing resources . Building upon existing value chains allowed a longer period of time for associations to develop skills while receiving external support and may have contributed to sustained high rates of membership in association s . For farmers to commercialize, credit is often a key resource. In the case of the producer associations, a ccess to credit was rarely sustained after the initial contacts were established between producer associations and banks during implementation; however, this has not proved critical for the sustainability of activities. Some associations continue to receive financial support from the government and from other NGOs after exit, and a few associations with formal contracts may be able to access future lines of credit through their buyers. However, some of the declines in association membership may be attributed to the lack of available credit for those producers unable to meet certain qualifying standards to participate once agency support is withdrawn, especially where municipal or NGO funding is not available.
While producers may not yet coordinate sale through associations or maintain formal contracts with secure buyers, they may continue to adopt those agricultural practices that appear likely to contribute to increased production, and therefore potential profit .
Examples of skills needed by associations: accounting, marketing, negotiating contracts/credit
NRM projects were financed during the life of the program through the provision of Title II food for work to undertake conservation, land improvement, and reforestation activities. Title II also provided inputs (seedlings) and equipment for these projects. The sustainability strategies for the continuation of these activities after exit were based on the expectation (or hope) that communities and individuals would recognize the benefits of these activities, and would continue to implement them without the remuneration represented by food for work. There are some municipal government entities whose responsibilities include NRM, but only a small percentage of communities reported having a natural resources committee (ranging from 25% in ADRA sites to 11% in FH and STC areas), and in general these are under-resourced and do not have technical nor financial capacity to pay for these activities or inputs. NRM activities align well with national and NGO priorities to mitigate the impact of climate change and support rural livelihood; FH, CARE, and ADRA maintain a presence in some former Title II municipalities with new funding that may support certain NRM activities through sustained pressure on municipal governments and NGO partners present in the region
Difficult to sustain because without mechanisms for self-financing, incentives for participation, or linkages to external support with coherent vision and the resources to back it up, activities lack the combination of factors critical for sustainability While Title II agencies succeeded in sustaining regular coordination with municipal partners throughout their interventions, information sharing and institutional strengthening w ere not sustained once those partners left office and new leaders entered with alternate priorities.
There are synergies between the 3
Food incentive was replaced by cash transfer in Bolivia, so not possible to gauge. Food not withdrawn in India;
The success of sustaining resources through gov’t linkages varied by country depending on gov’t’s capacity, motivation, resources to absorb trained CHWs We did not observe any system in which fee for service generated resources to support service provision.
alternative sources of care were available to beneficiaries in Bolivia
Gradual withdrawal and independent operation of water committees contributed to enhanced sustainability
Ag practices declined if commercial sales did not provide resources for purchase after the program ended (double-check this statement w/Bea)
Longer duration of operation in a community prior to exit (when agencies also manage expectations of permanence).
Can require more than one project cycle, or a longer project cycle than is typical for Title II, before reaching transfer and phase-out point. These benchmarks shouldn’t only be triggered by artificial project end-dates but rather by evidence of having achieved capacity, resources, motivation.