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.
WASH 2011 conference: Ivo Guterres, Environmental Health Department Head
Heather Moran, Behaviour Change Communication Advisor, BESIK
Ministry of Health, Timor-Leste
Foundational Learning in Social Determinants of Health for Health Professionals by Dr. Haydee Encarnacion Garcia. Presented at the Emerging Trends in Nursing Conference at Indiana Wesleyan University on June 1, 2017.
Mulamba Diese, MD, Chief of Monitoring and Evaluation and Head of Research, SANRU on Active Involvement of Community Health Development and Mobilization Committees as Champions Increases Demand and Coverage of Immunization Services at the CCIH 2018 conference.
Importance of Community Health Strategy (CHS) in attaining health goals (MNCH...REACHOUTCONSORTIUMSLIDES
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by S. N. Njoroge on behalf of the Kenyan Ministry of Health. http://usaidsqale.reachoutconsortium.org/
WASH 2011 conference: Ivo Guterres, Environmental Health Department Head
Heather Moran, Behaviour Change Communication Advisor, BESIK
Ministry of Health, Timor-Leste
Foundational Learning in Social Determinants of Health for Health Professionals by Dr. Haydee Encarnacion Garcia. Presented at the Emerging Trends in Nursing Conference at Indiana Wesleyan University on June 1, 2017.
Mulamba Diese, MD, Chief of Monitoring and Evaluation and Head of Research, SANRU on Active Involvement of Community Health Development and Mobilization Committees as Champions Increases Demand and Coverage of Immunization Services at the CCIH 2018 conference.
Importance of Community Health Strategy (CHS) in attaining health goals (MNCH...REACHOUTCONSORTIUMSLIDES
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by S. N. Njoroge on behalf of the Kenyan Ministry of Health. http://usaidsqale.reachoutconsortium.org/
Primary Health Care Strategy:
Key Directions for the Information Environment. Case study report and composite success model.
Steve Creed & Philip Gander
Reproductive Health Lecture Note !
The Nairobi Summit on ICPD25 provides an opportunity to complete the unfinished business
of the ICPD programme of action and also a chance to commit to a forward-looking sexual
and reproductive health and rights (SRHR) agenda to meet the Sustainable Development
Goals (SDGs) and its targets. It is an opportunity for the global community to build on the
ICPD framework and fully commit to realizing a visionary agenda for SRHR and to reaching
those who have been left behind. This agenda must pay attention to population dynamics and
migration patterns, recognize the diverse challenges faced by different countries at various
stages of development, and ground policies and programmes in respect for, and fulfilment of,
human rights and the dignity of the individual (United Nations Population Fund, 2019).
Since 1994, the world has developed through responding to the Millennium Development
Goals (MDGs), which focused on the achievement of a few, specific health targets, to commit
to the comprehensive 2030 Agenda for Sustainable Development. The aspirational targets
of the health SDG (SDG 3 – Good Health and Well-being) are not merely ambitious in
themselves, but cover nearly every important aspect of human well-being, both physical and
relational. Unlike the MDGs, the SDGs explicitly recognize sexual and reproductive health as
essential to health, development and women’s empowerment. Sexual and reproductive health
is referenced under both SDG 3, including met family planning needs, maternal health-care
access and fertility rates in adolescence, and SDG 5 (gender equality), which additionally refers
to sexual health and reproductive rights.
With the SDGs, the world has also committed to achieving UHC, including financial risk
protection, access to high-quality essential health-care services and access to safe, effective,
high-quality and affordable essential medicines and vaccines for all. In connection with the
74th session of the United Nations General Assembly (2019), world leaders made a political
declaration1
recommitting to achieving UHC by 2030. The declaration further re-emphasizes
the right to health for all and a commitment to achieving universal access to sexual and
reproductive health services and reproductive rights as stated in the SDGs. As such, UHC
and SRHR are intimately linked. Without taking into account a population’s SRHR needs,
UHC is impossible to achieve, as many of the basic health needs are linked to people’s sexual
and reproductive health. Similarly, universal access to SRHR cannot be achieved without
countries defining a pathway towards UHC, which includes prioritizing resources according to health needs.
The purpose of this paper is to define and describe the key components of a comprehensive,
life course approach to SRHR. Furthermore, the ambition is to describe how countries can move towards universal access to SRHR as an essential part of UHC.
RH 4 GMPH Students
A project proposal for East Timor on improving health and nutrition for women...Kazuko Yoshizawa
The presentation outlines a project proposal aimed at capacity building in health and nutrition for Timor-Leste, developed through extensive consultation with the Ministry of Health, development partners, NGOs, and civil society. The primary objective of the project is to enhance the nutritional status of women and children who are particularly vulnerable to malnutrition. The project proposal comprises four key areas that address the capacity gaps identified through stakeholder consultations and documented in published reports and strategies. By providing additional support and interventions, as well as strengthening existing structures, the proposed interventions would help to improve the nutrition status of children and women. The proposal further suggests that the capacity of Integrated Community Health Services (Sisca) could be enhanced to improve rural health services. Such improvements would help to address the existing disparities in health outcomes between rural and urban areas in Timor-Leste. Through the proposed interventions, the project aims to support the overall development of the health and nutrition sector in Timor-Leste. By addressing the identified capacity gaps, the project would help to build sustainable systems that can deliver effective health and nutrition services to the population.
In conclusion, the presentation explains a comprehensive project proposal that aims to improve the nutritional status of vulnerable women and children in Timor-Leste. The proposal is based on extensive consultation with stakeholders and would address capacity gaps identified through published reports and strategies. Through this project, it would be possible to enhance rural health services by strengthening the capacity of Integrated Community Health Services (Sisca) and supporting existing structures. Ultimately, the proposed interventions would contribute to the development of sustainable health and nutrition systems in Timor-Leste.
Use of Plan-Do-Study-Act (PDSA) Cycles to Strengthen Routine Immunization in ...JSI
The Universal Immunization through Improving Family Health Services (UI-FHS) project works to improve the routine immunization system in Ethiopia. This project conducted qualitative research to understand the experience of QI Teams in using PDSA cycles to improve routine immunization service delivery. It was found that the RED Quality Improvement (QI) approach encouraged greater facility-community linkages through engagement in PDSA cycles.
This was presented at the IHI Africa Forum on Quality and Safety in Healthcare in Durban, South Africa.
Up the Ratios Bylaws - a Comprehensive Process of Our Organizationuptheratios
Up the Ratios is a non-profit organization dedicated to bridging the gap in STEM education for underprivileged students by providing free, high-quality learning opportunities in robotics and other STEM fields. Our mission is to empower the next generation of innovators, thinkers, and problem-solvers by offering a range of educational programs that foster curiosity, creativity, and critical thinking.
At Up the Ratios, we believe that every student, regardless of their socio-economic background, should have access to the tools and knowledge needed to succeed in today's technology-driven world. To achieve this, we host a variety of free classes, workshops, summer camps, and live lectures tailored to students from underserved communities. Our programs are designed to be engaging and hands-on, allowing students to explore the exciting world of robotics and STEM through practical, real-world applications.
Our free classes cover fundamental concepts in robotics, coding, and engineering, providing students with a strong foundation in these critical areas. Through our interactive workshops, students can dive deeper into specific topics, working on projects that challenge them to apply what they've learned and think creatively. Our summer camps offer an immersive experience where students can collaborate on larger projects, develop their teamwork skills, and gain confidence in their abilities.
In addition to our local programs, Up the Ratios is committed to making a global impact. We take donations of new and gently used robotics parts, which we then distribute to students and educational institutions in other countries. These donations help ensure that young learners worldwide have the resources they need to explore and excel in STEM fields. By supporting education in this way, we aim to nurture a global community of future leaders and innovators.
Our live lectures feature guest speakers from various STEM disciplines, including engineers, scientists, and industry professionals who share their knowledge and experiences with our students. These lectures provide valuable insights into potential career paths and inspire students to pursue their passions in STEM.
Up the Ratios relies on the generosity of donors and volunteers to continue our work. Contributions of time, expertise, and financial support are crucial to sustaining our programs and expanding our reach. Whether you're an individual passionate about education, a professional in the STEM field, or a company looking to give back to the community, there are many ways to get involved and make a difference.
We are proud of the positive impact we've had on the lives of countless students, many of whom have gone on to pursue higher education and careers in STEM. By providing these young minds with the tools and opportunities they need to succeed, we are not only changing their futures but also contributing to the advancement of technology and innovation on a broader scale.
Russian anarchist and anti-war movement in the third year of full-scale warAntti Rautiainen
Anarchist group ANA Regensburg hosted my online-presentation on 16th of May 2024, in which I discussed tactics of anti-war activism in Russia, and reasons why the anti-war movement has not been able to make an impact to change the course of events yet. Cases of anarchists repressed for anti-war activities are presented, as well as strategies of support for political prisoners, and modest successes in supporting their struggles.
Thumbnail picture is by MediaZona, you may read their report on anti-war arson attacks in Russia here: https://en.zona.media/article/2022/10/13/burn-map
Links:
Autonomous Action
http://Avtonom.org
Anarchist Black Cross Moscow
http://Avtonom.org/abc
Solidarity Zone
https://t.me/solidarity_zone
Memorial
https://memopzk.org/, https://t.me/pzk_memorial
OVD-Info
https://en.ovdinfo.org/antiwar-ovd-info-guide
RosUznik
https://rosuznik.org/
Uznik Online
http://uznikonline.tilda.ws/
Russian Reader
https://therussianreader.com/
ABC Irkutsk
https://abc38.noblogs.org/
Send mail to prisoners from abroad:
http://Prisonmail.online
YouTube: https://youtu.be/c5nSOdU48O8
Spotify: https://podcasters.spotify.com/pod/show/libertarianlifecoach/episodes/Russian-anarchist-and-anti-war-movement-in-the-third-year-of-full-scale-war-e2k8ai4
Many ways to support street children.pptxSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
A process server is a authorized person for delivering legal documents, such as summons, complaints, subpoenas, and other court papers, to peoples involved in legal proceedings.
Canadian Immigration Tracker March 2024 - Key SlidesAndrew Griffith
Highlights
Permanent Residents decrease along with percentage of TR2PR decline to 52 percent of all Permanent Residents.
March asylum claim data not issued as of May 27 (unusually late). Irregular arrivals remain very small.
Study permit applications experiencing sharp decrease as a result of announced caps over 50 percent compared to February.
Citizenship numbers remain stable.
Slide 3 has the overall numbers and change.
Canadian Immigration Tracker March 2024 - Key Slides
Integrating Care Groups into Government Structures: Learning from an Operations Research Study in Burundi
1. Integrating Care
Groups into
Government Structures:
Learning from an
Operations Research
Study in Burundi
Jennifer Weiss; Health
Advisor, Concern US
Delphin Sula; Health
Program Manager,
Concern Burundi
Care Group Technical
Advisory Meeting
May 29-30 2014
2. Overview of Presentation
Description of Concern’s ‘Integrated’
Care Group Model
Overview of Operations Research Study
Results of Operations Research Study
Learning and Implications
3. Why Adapt the Model?
What We All Know:
Care Groups have been
implemented by more than 20
organizations in approximately 25
countries with excellent results
Evidence-based strategy that has
significantly contributed to improved
child health and nutrition outcomes.
Davis, T. et al (2013). Reducing child global undernutrition at
scale in Sofala Province, Mozambique using Care Group
Volunteers to communicate health messages to mothers.
Global Health Science and Practice.
Edward, A. Et al (2007). Examining the evidence of under-
five mortality reduction in a community-based programme in
Gaza, Mozambique. Transactions of the Royal Society of
Tropical Medicine and Hygiene.
With Opportunity for Improvement…
NGO-lead model: what happens
when the project ends?
Integration with Ministry of Health
systems: increases opportunities for
scale and sustainability
4. Background to Child Survival Project
• USAID CSHGP-funded project in
Mabayi District, Cibitoke Province,
Burundi
• October 2008 – September 2013
• “Innovation” grant with OR component
• Technical interventions: malaria,
diarrhea, pneumonia, IYCF
5. The ‘Integrated’ Care Group Model
National
level MOH
Cibitoke
Province
Mabayi District
Health Team
Mabayi District Health
Facilities (25)
Community Health Workers
(152, approximately 4 per
health facility)
Household level
(estimated 107,000 WRA and CU5)
Project Objectives:
1. Improved household maternal
and child health care and
nutrition practices
2. Improved access to quality
child health care services with
a balance of provision at the
health center and community
levels
3. Strengthened community
leadership in health
6. The ‘Integrated’ Care Group Model
CHWs instead of
Promoters
Key difference: CHW only
supervises 2 CGs
DHT is trained by NGO
staff to serve in
‘Supervisor’ role
7. Operations Research Study: Methods
Cluster randomized, pre-post study
Traditional
Area
Integrated
Area
# Care Groups 51 45
# Care Group Volunteers 503 478
# Children Under 5 and
Pregnant Women 7,758 6,630
8. Operations Research Study: Questions
1. Does the Integrated Care Group model achieve at least the same
improvements in key knowledge and practices as the traditional
model?
2. Does the Integrated Care Group model function as well as the
traditional model?
3. Is the Integrated Care Group model as sustainable as the traditional
model?
9. Care Group Activities
Care Group Activities in Both Study Areas
• Care Group Meetings 2x month
• Facilitated by Promoter in Traditional
• Facilitated by CHW in Integrated
• Home visits to Neighbor Women at least 1x per
month
• Collection of household data (illness, death)
MODULE TOPICS
Nutrition
Definition and consequences of malnutrition
and screening for malnutrition
Recognition of complications and danger signs
of malnutrition
Nutrition and micronutrient supplementation
during pregnancy
Immediate and exclusive breastfeeding for
children 0-5 months
Complementary feeding for children 6-8
months and 9-23 months
Food groups (strength, energy, micro-nutrient)
Micronutrient supplementation for children
Malaria
Malaria transmission, symptoms, and danger
signs
Malaria in pregnant women: consequences
and complications
Care-seeking for malaria
Diarrhea
Diarrhea symptoms and danger signs
Home-based management of diarrhea
Hand-washing practices; how to build a tippy-
tap
Water treatment and food hygiene
Pneumonia
Definition, danger signs, and care-seeking
Home practices to prevent pneumonia
Key Difference: Cascade Training in Integrated
Area
• Concern trains DHMT on modules
• DHMT trains HF staff (quarterly)
• HF staff train CHWs (monthly)
10. Operations Research Results:
Knowledge and Practices
Indicator Type Example of Indicators Collected Total # % ‘non-
inferior’
Knowledge
Danger signs in sick children
Critical times for hand-washing
Breastfeeding and complementary feeding practices
Food groups and components of balanced diet
13 85%
Preventive
Practices
Iron supplementation during pregnancy
Immediate and exclusive breastfeeding
Complementary feeding practices
Hand-washing
ITN use
13 100%
Sick Child
Practices
Diarrhea: care-seeking, use of ORS, increased fluids and food
Malaria: care-seeking within 24 hours, treatment with ACT
Pneumonia: care-seeking and treatment with antibiotic
10 90%
Contact Intensity
Contact with trained health information provider
Attendance at community meetings where health of child was
discussed
4 100%
OVERALL 40 90%
13. Summary of Results
1. The Integrated Care Group model achieved at least the same improvements
in key knowledge and practices as the traditional model
2. The Integrated Care Group model functions as well as the traditional model
3. The Integrated Care Group model is as sustainable as the traditional model
In at least the six month period following end of project support to CG
activities, project staff still active in area supporting other (non-Care
Group) project activities such as CCM
Post-project sustainability study required
14. Learning
• CHWs are able to serve as Care
Group Promoters through a modified
model:
• No more than 2 CGs per CHW
• Monthly support (training and
supervision) from health facility
• Head nurses do not have time for Care
Group / CHW supervision – delegate to
a more junior nurse “focal point”
• Integrated Model allows for community
health data to be directly incorporated
into Ministry HIS
15. The ‘Value-Add’ of Integrated Care Groups
In addition to increasing potential for scale-up and sustainability,
Integrating Care Groups into the MOH structure:
Capacity building of MOH staff at all levels
Increase demand for CCM work by CHWs (identification and referral
of sick children during home visits)
Reduction of workload of CHWs regarding the home visits
Improved link between the health facility and the community
16. Policy Implications for Burundi MoH
Some issues to take in consideration:
The start-up cost of Care Groups (Organization of CGV elections,
basic and refresher training of MOH staff, CHWs and CGVs)
When national MOH should take the lead in training districts vs.
NGO staff
The development and replication of the BCC modules, reporting
tools (during scale-up – when the MOH has not yet taken up the
approach fully)
Integration of other community health activities in CG???
17. The Role of NGOs (medium term)
Key role of the NGO in the Integrated CG model:
Support the district team for the start-up phase
Capacity building of the district team
Technical support to the district for the development of the
BCC modules and registers
Financial support to the district team for the production of the
BCC modules and registers
Advocacy at national level for the inclusion of the CG
approach in the national community health policy
18. What is Happening Now in Burundi?
Integrated Care Groups from original program still
reporting to MOH and we are monitoring this data
Concern has funding to scale-up Integrated Care Groups
in two additional districts (Ronald McDonald House
Charities and UNICEF)
Extensive advocacy with MOH at national level to involve
them from the beginning in establishing Integrated Care
Groups (along with other Care Group implementers in
Burundi – World Relief, FH, IMC, CRS)
19. Conclusions
• Traditional Care Groups have been proven
to be effective in achieving coverage of key
health and nutrition behaviors in numerous
settings
• CHWs are a growing part of Ministry of
Health systems, however often difficult for
CHWs alone to attain complete household
coverage
• Integrated Care Group model holds
promise as a way to scale-up proven
practices at the household level while
leveraging existing structures, building local
capacity
Janvier Niandwi- Community Health Worker
20. Thank you!
For additional information:
Jennifer Weiss
Health Advisor
Concern Worldwide, US
Jennifer.weiss@concern.net
Delphin Sula
Health and Nutrition Program Manager
Concern Worldwide Burundi
delphin.sula@concern.net
www.concernusa.org
Editor's Notes
Since their initial design and implementation by World Relief in Mozambique in 1995, have been implemented in more than 25 countries by over 20 organizations
Due to the intensive management and supervision requirements of Care Group activities satisfied through full-time paid staff, it may be difficult for communities and the MOH to sustain Care Groups following the conclusion of the program. The sustainability strategy for some Care Group projects may plan for CHWs or other community actors to take over the facilitation of the Care Groups after project completion, but this is understandably difficult if such actors have not received the proper training to facilitate the Care Groups and are not provided with a system for ongoing supervision and support.
With these project objectives in mind, we knew we’d be doing some kind of household level behavior change. We had done Care Groups in Rwanda and had visited WR’s CGs in Burundi.
But we wanted to know whether there was a way for them to be integrated into the existing MOH system?
Existing gov’t system looks like this
Integrated model was designed to reduce the dependence of Care Group implementation on full-time, paid NGO staff, while increasing integration with the local MOH structure. This is accomplished through task shifting of Care Group facilitation and supervision duties from project staff to appropriate MOH staff and CHWs, while still satisfying the established Care Group Criteria
Still contained all the key activities of CG meetings, household visits, supervision, data collection as described earlier
Target = 80% based on global CG standards
Looking for difference of 15% between two models