Presentation_Lamstein - Breaking Barriers to Improve Health and Nutrition
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CORE Group Global Health Practitioner Conference 2019
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Presentation_Lamstein - Breaking Barriers to Improve Health and Nutrition
- 1. Breaking Barriers to Improve Health and Nutrition Working at the DISTRICT level to strengthen nutrition services delivered through the health system Global Health Practitioner Conference (GHPC) May 8, 2019 Sascha Lamstein, PhD Senior Technical Advisor, USAID Advancing Nutrition
- 2. Districts can help strengthen the nutrition services delivered by the health systems, by… Building capacity for providers, supervisors, and managers through a continuous process of trainings and support Determining who is and should be delivering nutrition services Instituting systems for supportive supervision and for providing timely feedback to service providers.
- 3. And by… Ensuring the availability of the necessary infrastructure, resources, and supplies as well as a supportive environment Coordinating actors and actions across sectors.
- 4. Conducting formative research to strengthen nutrition services in the DRC — The Maternal and Child Survival Program (MCSP)
- 5. Coordinating nutrition activities across sectors in Uganda ─ The FANTA III Project
- 6. Increasing awareness of and commitment to nutrition among government leaders in Tanzania — The Pamoja Tuwalee project
- 7. Harmonizing district and community efforts in Ghana — The USAID Resiliency in Northern Ghana (RING) Project
- 8. — Kenya iCCM Research Project Building buy-in and ownership of country officials in Kenya
- 9. Resources and References • Food and Nutrition Technical Assistance II Project (FANTA-2) Bridge. Year of publication varies. Multi-Sectoral Nutrition Toolkit: A Resource Repository for Nutrition Coordination Committees in Uganda • Global Communities. 2016. Governance Fact Sheet. • Kavle, J. et al. Strengthening nutrition services within integrated community case management (iCCM) of childhood illnesses in the Democratic Republic of Congo: Evidence to guide implementation Maternal and Child Nutrition 15:S1. • SPRING. 2014. Nutrition Workforce Mapping Toolkit. Arlington, VA: USAID/Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. • SPRING. 2018. Building a Shared Vision for Good Nutrition, Growth, and Development in the Community: A Recipe for Policymakers, Planners, and Program Managers. Arlington, VA: Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project. • Various. Series: Strategic review of child health. BMJ 2018; 362: bmj.k3013.
- 10. This document was produced for the U. S. Agency for International Development. It was prepared under the terms of contract 7200AA18C00070 awarded to JSI Research & Training Institute, Inc. The contents are the responsibility of JSI and do not necessarily reflect the views of USAID or the U.S. Government. Thank you! For more info, please contact: Sascha Lamstein at sascha_lamstein@jsi.com
Editor's Notes
- District can provide this, by: Working together with key stakeholders to determine who is and should be delivering which nutrition services. Under the USAID SPRING project, a tool was developed to map nutrition services – who is trained to provide them, who is expected to provide them, and who actually provides them. Though many projects and programs invest in training, trainings are not always aligned with national policies or job descriptions. Furthermore, programs often stop short with trainings that improve knowledge and sometimes skills. In order for training to improve the quality of nutrition services, it must be designed and implemented as a continuous process including refresher trainings, additional trainings for new staff, and follow-up to address identified knowledge and skill gaps and provide support at the site of service delivery. Instituting systems for providing feedback to service providers by guiding, monitoring, and coaching workers to continue to build competence by reinforcing, clarifying, and correcting lessons learned during trainings, to motivate health workers, and, ultimately, to promote compliance with standards of practice and assure the delivery of quality care service.” Supportive supervision is the most common type of system used. Through supportive supervision visits, supervisors can provide feedback to workers, improve their understanding of expectations, motivate them, and reinforce their knowledge and skill, ensuring that service providers have and know what they need to perform their tasks. This might also or instead include peer or team-based approaches like the quality improvement approach and performance improvement that engage and empower teams, focus on clients, analyze processes, and use data.
- District can provide this, by: Ensuring the availability of adequate infrastructure, resource, and supplies. For nutrition, this could mean job aides, nutritional supplements, tools to measure nutritional status, etc. A study conducted in five countries by the Prime Project, a significant association was found between the performance of workers and conditions in the workers’ environment. Further, to be successful, governments, managers, and supervisor need to be supportive of health workers carrying out nutrition services. Their work will benefit from multi-sectoral committees to (a) manage complex inter-governmental processes and governance systems; (b) coordinate across sectors; and (c) hold members accountable for completing agreed-upon actions and ultimately improving nutrition outcomes. SPRING also developed a tool to define roles and responsibilities across sectors … to reinforce nutrition messages and behaviors and provide services that can complement those nutrition services delivered through the health system.
- Integrated Community Case Management (iCCM) is an equity-focused intervention aiming to improve access to quality essential health care for children under-five. The standard model employs Community Health Workers/ Volunteers (CHWs) to provide primary health care services beyond the health facility, diagnosing and treating for uncomplicated cases of malaria, pneumonia and diarrhea in the community. In the DRC, USAID’s Maternal and Child Survival Program (MCSP) conducted formative research on how to strengthen preventative and curative nutrition services within the iCCM platform. They explored: 1. cultural beliefs and perceptions of IYCF, child illness, and care-seeking behavior for sick children. 2. perspectives of health providers who provide counseling on nutrition and iCCM. 3. roles of key influential family/community members. 4. gaps and opportunities to strengthen nutrition counseling for caretakers of children under five years of age at the health facility and community Based on findings, they developed an integrated approach that included supportive supervision and revised national IYCF counseling cards This then was rolled out in Tshopo district through a series of trainings of health providers
- Effectively working with multi-sectoral stakeholders requires aligned objectives, coordinated implementation, collaborative operations research, common metrics, the use of real-time data for monitoring, evaluation, and learning, and commitment to systematic shared learning and adaptation. In Uganda, District Nutrition Coordination Committees (DNCCs) coordinate nutrition policies and activities at the district level. Recognizing this, the Office of the Prime Minister Nutrition Secretariat, the Ministry of Local Government, FANTA, and Wageningen University and Research Centre for Development Innovation supported and strengthened DNCCs’ capacity to plan, budget, leverage existing resources for, advocate for, and monitor nutrition activities. To do this, they… Defined DNCC roles, responsibilities, and performance benchmarks through stakeholder consensus building. Reviewed and revised the nutrition planning process Developed monitoring and reporting tools, including monitoring and supervision checklists and quarterly reporting templates. Conducted joint support supervision visits with government and partners. Developed guidelines and materials. DNCCs used a multi-stakeholder partnerships process to bring together key stakeholders. This multi-stakeholder partnerships process involved: 1. Consensus building to agree on a common vision, objectives, and expectations 2. Capacity strengthening to improve systems for governance and service delivery 3. Advocacy to encourage prioritization of nutrition and mobilization of resources 4. Monitoring and reporting to promote increased accountability and adaptation 5. Experience sharing to document and share best practices to inform programming 6. Effective communication, which influences all aspects of the approach and is critical to maintaining stakeholder coordination and promoting learning. 7. Continuous implementation of nutrition programs, by working through and strengthening existing systems, helps avoid the creation of parallel structures.
- Under the USAID-funded Pamoja Tuwalee project, World Education increased awareness of and commitment to nutrition among government leaders by first familiarizing them with the government’s nutrition plan then training facility-based nutrition focal persons to oversee, coordinate, and integrate basic nutrition services into existing services.
- The USAID-funded RING Project in Northern Ghana has worked at the community, district, and regional level. At the district level, they have focused on building capacity of key staff who then built capacity of their supervisees and worked to ensure continuous supportive supervision and monitoring. In addition, local governments (District Assemblies) were supported in convening agriculture, health, WASH, and governance admin and technical staff to develop annual work plans. The project used Global Communities’ Participatory Approach to Governance Excellence (PAGE) to help local governments to plan and manage multi-sectoral activities in a transparent and accountable manner.
- iCCM+Nut utilizes this existing platform by integrating the screening and treatment of uncomplicated acute malnutrition into regular iCCM activities thus increasing the coverage of treatment and bypassing traditional barriers often associated with the treatment acute malnutrition. In the Kenya, Action Against Hunger USA is carrying out a research project currently in Isiolo County, with support from the Children’s Investment Fund Foundation. Through this work, they are building new evidence on the potential impact and effectiveness (including cost-efficiency) of integrating the treatment of acute malnutrition by Community Health Workers as part of the iCCM package. A key success factor of this project to-date has been the buy-in and ownership of officials at the county level. This entailed: - engaging key stakeholders at the formative stages of the research project and participation in the Technical Advisory Group. A ICCM Technical Working Group at county level was formed to address any implementation issues promptly. Further ownership has been facilitated by the inclusion of iCCM activities into the Community Health Management Teams (CHMT) workplan. Quantification, forecasting and ordering of commodities is done through MOH system., and supplies are delivered to health facilities within the county. Reporting tools have also been integrated into existing MOH tools and feed into MOH community and facility health information systems.