The Salud Mesoamérica Initiative (SMI) is a public-private partnership between the Bill & Melinda Gates Foundation (BMGF), the Carlos Slim Foundation, the Government of Spain, the Inter-American Development Bank (IDB), the countries of Central America and the State of Chiapas in Mexico. SMI works to reduce maternal and health inequalities through a results-based financing model, aligned with priorities established by the governments of the region. Among the poor in Mesoamerica, only 5 out of every 10 pregnant women are attended during childbirth by skilled birth personnel and the mortality rate among children in poverty is twice that of the national average.
Setting a Path for Improved Health Outcomes RBFRBFHealth
Learning is a critical part of the HRITF RBF portfolio, with all programs benefiting from an embedded impact evaluation and in some cases, complemented by qualitative research components such as process evaluation studies. The presentation discusses the following topics:
1. Using RBF at the community-level to address demand side barriers
This presentation elaborates on the early evidence and the rationale for using RBF at the community level. It will share lessons learned from the implementation of community RBF at country level.
2. Using RBF to Strengthen Quality of Care: Early Lessons
This presentation discusses the broader policy implications of using RBF to strengthen the quality of care. It will explore how Measuring and Paying for the Quality of Care has been operationalized and will highlight the experience of Nigeria. Lastly, it will focus on measuring and Analyzing the Quality of Care from the Impact Evaluation perspective.
Make them count using the best data for maximum impactnewborn1
This document discusses indicators for measuring newborn health and mortality. It outlines progress made by various groups in establishing standardized indicators, including:
1. The Newborn Indicator Technical Working Group is working to establish core indicators for postnatal care, newborn behaviors, and newborn services in facilities.
2. The Countdown to 2015 initiative tracks coverage of interventions to reduce maternal and child mortality in 68 countries.
3. Core indicators are proposed for measuring kangaroo mother care in facilities, including the percentage of low birthweight babies receiving kangaroo mother care.
Day 2 - USING DATA FOR INFORMED ACTION - IDInsightPOSHAN
District administrators can use data to diagnose problems and improve socioeconomic wellbeing. IDinsight collects high-frequency district data through its Data on Demand platform to help measure performance and identify areas for improvement. The document discusses using administrative data, surveys, and comparisons over time to validate data and understand issues. It also provides an example of using different data sources to analyze low rates of antenatal care visits and determine potential causes and solutions.
1) The Salud Mesoamérica 2015 Initiative (SM2015) is a public-private partnership aimed at reducing maternal and child health inequalities in Central America and Chiapas, Mexico through a results-based financing model.
2) The results-based financing model provides initial funding to implement evidence-based maternal and child health interventions for the poorest 20% of populations, and provides additional incentive funds if countries meet at least 80% of agreed-upon targets.
3) Surveys found that coverage of important interventions and health outcomes remained low for the poorest populations, revealing inequalities hidden by national averages. However, countries made advances in increasing availability of supplies and equipment, and coverage of certain
Care Seeking for Newborn Illness a Changing Paradigm_Steve Wall_4.25.13CORE Group
The document discusses evidence from community health worker programs in multiple countries that care seeking for newborn illness from qualified providers outside the home is higher than originally assumed, as cultural taboos can be overcome through community education. It also examines the roles of community health workers in improving newborn care practices through home visits and facilitating care seeking, finding that while practices and care seeking increased, timely care seeking could still be improved. Overall, the key lessons highlighted are that demand for care can be generated through community programs, but treatment also needs to be accessible, and strengthening monitoring and follow up of referrals is important.
IFPRI_Alderman global evidence impact of cash 24_sep2019POSHAN
This document summarizes evidence on the relative impacts of cash transfers versus in-kind food assistance on child nutrition outcomes. It finds that on average, the impacts of cash and food transfers are similar, with cash being more effective in 48% of cases studied and food in 36%. However, neither approach consistently leads to improvements in nutrition metrics like height. While both increase food expenditures, additional barriers like quality of health services need to be addressed. The document also examines examples of mixed cash-food systems and notes no single approach is superior in all contexts.
Day 2 - PCI - Strengthening Nutrition-related ActionsPOSHAN
The document discusses strategies to strengthen nutrition actions in India. It outlines interventions implemented by JEEViKA in Bihar to improve complementary feeding practices, including behavior change communication sessions, feeding demonstrations, home visits, and community events. Evaluation found the interventions improved minimum dietary diversity and minimum acceptable diet indicators. Concurrent measurement confirmed scale-up was also effective. Additionally, an independent survey showed significant improvements in these complementary feeding indicators in blocks where JEEViKA implemented the package of interventions.
Cost-Effectiveness Analysis of RBF in Zimbabwe and ZambiaRBFHealth
Profs. Shepard and Zeng have been leading projects for the Bank to develop methods for performing a cost-effectiveness analysis of Results-Based Financing (RBF) programs and applying them to maternal-child health (MCH) services in Zambia and Zimbabwe. Both countries’ RBF programs proved highly cost-effective. Methods and results should be informative to other RBF and MCH programs.
Setting a Path for Improved Health Outcomes RBFRBFHealth
Learning is a critical part of the HRITF RBF portfolio, with all programs benefiting from an embedded impact evaluation and in some cases, complemented by qualitative research components such as process evaluation studies. The presentation discusses the following topics:
1. Using RBF at the community-level to address demand side barriers
This presentation elaborates on the early evidence and the rationale for using RBF at the community level. It will share lessons learned from the implementation of community RBF at country level.
2. Using RBF to Strengthen Quality of Care: Early Lessons
This presentation discusses the broader policy implications of using RBF to strengthen the quality of care. It will explore how Measuring and Paying for the Quality of Care has been operationalized and will highlight the experience of Nigeria. Lastly, it will focus on measuring and Analyzing the Quality of Care from the Impact Evaluation perspective.
Make them count using the best data for maximum impactnewborn1
This document discusses indicators for measuring newborn health and mortality. It outlines progress made by various groups in establishing standardized indicators, including:
1. The Newborn Indicator Technical Working Group is working to establish core indicators for postnatal care, newborn behaviors, and newborn services in facilities.
2. The Countdown to 2015 initiative tracks coverage of interventions to reduce maternal and child mortality in 68 countries.
3. Core indicators are proposed for measuring kangaroo mother care in facilities, including the percentage of low birthweight babies receiving kangaroo mother care.
Day 2 - USING DATA FOR INFORMED ACTION - IDInsightPOSHAN
District administrators can use data to diagnose problems and improve socioeconomic wellbeing. IDinsight collects high-frequency district data through its Data on Demand platform to help measure performance and identify areas for improvement. The document discusses using administrative data, surveys, and comparisons over time to validate data and understand issues. It also provides an example of using different data sources to analyze low rates of antenatal care visits and determine potential causes and solutions.
1) The Salud Mesoamérica 2015 Initiative (SM2015) is a public-private partnership aimed at reducing maternal and child health inequalities in Central America and Chiapas, Mexico through a results-based financing model.
2) The results-based financing model provides initial funding to implement evidence-based maternal and child health interventions for the poorest 20% of populations, and provides additional incentive funds if countries meet at least 80% of agreed-upon targets.
3) Surveys found that coverage of important interventions and health outcomes remained low for the poorest populations, revealing inequalities hidden by national averages. However, countries made advances in increasing availability of supplies and equipment, and coverage of certain
Care Seeking for Newborn Illness a Changing Paradigm_Steve Wall_4.25.13CORE Group
The document discusses evidence from community health worker programs in multiple countries that care seeking for newborn illness from qualified providers outside the home is higher than originally assumed, as cultural taboos can be overcome through community education. It also examines the roles of community health workers in improving newborn care practices through home visits and facilitating care seeking, finding that while practices and care seeking increased, timely care seeking could still be improved. Overall, the key lessons highlighted are that demand for care can be generated through community programs, but treatment also needs to be accessible, and strengthening monitoring and follow up of referrals is important.
IFPRI_Alderman global evidence impact of cash 24_sep2019POSHAN
This document summarizes evidence on the relative impacts of cash transfers versus in-kind food assistance on child nutrition outcomes. It finds that on average, the impacts of cash and food transfers are similar, with cash being more effective in 48% of cases studied and food in 36%. However, neither approach consistently leads to improvements in nutrition metrics like height. While both increase food expenditures, additional barriers like quality of health services need to be addressed. The document also examines examples of mixed cash-food systems and notes no single approach is superior in all contexts.
Day 2 - PCI - Strengthening Nutrition-related ActionsPOSHAN
The document discusses strategies to strengthen nutrition actions in India. It outlines interventions implemented by JEEViKA in Bihar to improve complementary feeding practices, including behavior change communication sessions, feeding demonstrations, home visits, and community events. Evaluation found the interventions improved minimum dietary diversity and minimum acceptable diet indicators. Concurrent measurement confirmed scale-up was also effective. Additionally, an independent survey showed significant improvements in these complementary feeding indicators in blocks where JEEViKA implemented the package of interventions.
Cost-Effectiveness Analysis of RBF in Zimbabwe and ZambiaRBFHealth
Profs. Shepard and Zeng have been leading projects for the Bank to develop methods for performing a cost-effectiveness analysis of Results-Based Financing (RBF) programs and applying them to maternal-child health (MCH) services in Zambia and Zimbabwe. Both countries’ RBF programs proved highly cost-effective. Methods and results should be informative to other RBF and MCH programs.
Integrating Family Planning Into CSHGP and MCH Programsjehill3
The document discusses integrating family planning into maternal and child health programs. It provides historical context and examples of how flexible funds have supported family planning integration. Specific strategies discussed include community-based distribution of contraceptives, increasing postpartum family planning access, mobile family planning services, birth spacing messaging, and integrating abortion prevention and post-abortion care.
Providing Health in Difficult Contexts: Pre-Pilot Performance-Based Financing...RBFHealth
The Adamawa Primary Health Care System in Nigeria has implemented performance-based financing (PBF) to address underlying issues plaguing the health system. After two years of pre-pilot implementation, results have been encouraging with improvements in key indicators like institutional deliveries and vaccination rates. Success stories like Mayo-Ine health center demonstrate how community engagement and strengthened management can boost coverage. However, some indicators still show room for growth, and deeper analysis finds issues like staffing shortages and infrastructure problems influencing performance. Moving forward, continued scale-up and addressing broader health system challenges will be important to sustain gains under PBF in Adamawa State.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
The Philadelphia Department of Public Health's Kathleen Brady presented on Philadelphia's Fetal Infant Mortality Rate (FIMR) process at the January 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
GH_16_Adopting Healthy CSPs_PPT_Mohammed_ Presentation at USAID_Crystal City ...Mohammed Ali
This document summarizes a health program in rural Ghana that aimed to improve maternal and child survival practices. Key points:
- The program was a partnership between CRS Ghana and the Ghana Health Service to encourage positive maternal/newborn health practices in East Mamprusi District.
- Baseline data showed high rates of maternal mortality, infant mortality, and low uptake of health services. The program deployed strategies like model mothers, community education sessions, and transportation improvements to increase access to and quality of care.
- Outcomes included significant reductions in mortality rates, increased usage of antenatal care, skilled birth attendance and postnatal care. Nutrition and malaria indicators also improved.
- The partnership strengthened
Mona Sinha, UNICEF - A social movement to end child marriage and dowry in Bih...POSHAN
Presentation made at an IFPRI event on "What Lies Beneath:
Women’s and Girls’ Wellbeing as a Critical Underpinning of India’s Nutritional Challenge" on December 10, 2018, in New Delhi
Towards a Grand Convergence for Child Survival and HealthCORE Group
This document summarizes the findings of a strategic review of the Integrated Management of Childhood Illness (IMNCI) approach. Some key findings include:
- IMNCI has been widely adopted and transformed global approaches to child health, but implementation has been uneven and challenges remain.
- Fragmentation of global child health strategies and lack of sustained funding and leadership have undermined full implementation and impact.
- Evidence is not systematically used to inform policies and programs.
The review provides 5 recommendations to address these problems, including consolidating global leadership, developing innovative strategies to reach marginalized populations, establishing mechanisms for shared learning and evidence use, tailoring strategies to country contexts, and strengthening monitoring and accountability. The overall
The Paradigm Shift from Healthcare to Population HealthPractical Playbook
This document discusses the need to shift from a healthcare system focused on treatment of illness to a population health system focused on preventative care. It notes rising healthcare costs in the US and projections that Medicare and Medicaid will consume all tax revenue by 2050 without reforms. The document outlines Trinity Health's vision of building a "people-centered health system" through initiatives in population health management, care management, and addressing social determinants of health. It provides examples of Trinity Health's work in accountable care organizations, bundled payments, and community engagement initiatives.
Strategic Review: Towards a Grand Convergence for Child Survival and HealthCORE Group
This document summarizes a strategic review of options for improving integrated management of newborn and childhood illness (IMNCI) going forward. The review draws on data from over 90 countries and hundreds of experts. Key findings are: 1) While IMNCI has helped transform child health services, interest and funding have declined and scale-up was rarely achieved; 2) To achieve ambitious new child mortality targets, health systems must be strengthened and universal health coverage ensured; 3) The review proposes renewing focus and action on IMNCI through a "Grand Convergence" to end preventable child deaths, supported by domestic and international financing. The goal is high quality care across home, community and health facilities as part of reproductive, maternal
Why nutrition matters and what is this the perfect systems issuePOSHAN
The document discusses malnutrition in India. It provides statistics from various reports that find high levels of undernutrition and anemia in India. The Global Hunger Index 2017 ranks India 100th out of 119 countries. The Global Nutrition Report 2017 notes that India carries a serious burden of malnutrition and must integrate actions to meet nutrition goals for 2030. The document discusses underlying factors for malnutrition like breastfeeding practices, access to nutrition-rich foods, disease burden, food security, and access to healthcare and sanitation. It outlines nutrition-specific and nutrition-sensitive interventions that can help, including maternal supplementation, breastfeeding support, treating severe acute malnutrition, food fortification, social safety nets, women's empowerment and education programs.
Early interpretations of trends in nutrition outcomes, determinants and inter...POSHAN
This slide deck is an evolving work in progress, with updates being made frequently. If you want to use or cite this, please email us at IFPRI-POSHAN@cgiar.org to receive the most updated version.
Divya Nair - Training of district officials on using data for decision-makingPOSHAN
Presentation by Divya Nair on "Training of district officials on using data for decision-making" at Developing a nutrition training roadmap to support India’s nutrition progress (17-18 Dec 2019)
Common vision mn def march 29 2019 sam scottPOSHAN
This document summarizes a meeting on tackling micronutrient malnutrition in India. It outlines key takeaways, current policies and programs, known challenges, surveys that collect micronutrient data, and potential actions. The main points are that a multi-pronged approach is needed to address micronutrient deficiencies, standardized national mapping of micronutrient status and diets is important, and assessing current program operations could help create more effective solutions.
This document provides key performance and quality indicators for monitoring high impact interventions under India's Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy. It begins with introductions by senior officials at the Ministry of Health and Family Welfare emphasizing the importance of these indicators for measuring progress and improving service delivery quality. The document then lists the indicators under each of the 5 areas of the strategy: reproductive health, maternal health, newborn health, child health, and adolescent health. It aims to help program managers at all levels accelerate progress, especially in India's 184 high priority districts.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
ICOLC 2016: Boosting visibility and impact of published researchKudos
A tour of Kudos to show the content in which it was developed (competition for funding, growing impact agenda, huge growth in output, fight for visibility and usage , “off-grid” sharing), our vision (more impact for research, more recognition for researchers), the platform through which we do this (a central system for explaining publications in plain language, managing sharing across multiple channels, and measuring effect across multiple metrics), the extent to which it works (use of the Kudos toolkit correlated to 23% higher downloads of full text on publisher websites) and how this data is made available to institutions (libraries, research offices and communications teams).
Integrating Family Planning Into CSHGP and MCH Programsjehill3
The document discusses integrating family planning into maternal and child health programs. It provides historical context and examples of how flexible funds have supported family planning integration. Specific strategies discussed include community-based distribution of contraceptives, increasing postpartum family planning access, mobile family planning services, birth spacing messaging, and integrating abortion prevention and post-abortion care.
Providing Health in Difficult Contexts: Pre-Pilot Performance-Based Financing...RBFHealth
The Adamawa Primary Health Care System in Nigeria has implemented performance-based financing (PBF) to address underlying issues plaguing the health system. After two years of pre-pilot implementation, results have been encouraging with improvements in key indicators like institutional deliveries and vaccination rates. Success stories like Mayo-Ine health center demonstrate how community engagement and strengthened management can boost coverage. However, some indicators still show room for growth, and deeper analysis finds issues like staffing shortages and infrastructure problems influencing performance. Moving forward, continued scale-up and addressing broader health system challenges will be important to sustain gains under PBF in Adamawa State.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
The Philadelphia Department of Public Health's Kathleen Brady presented on Philadelphia's Fetal Infant Mortality Rate (FIMR) process at the January 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
GH_16_Adopting Healthy CSPs_PPT_Mohammed_ Presentation at USAID_Crystal City ...Mohammed Ali
This document summarizes a health program in rural Ghana that aimed to improve maternal and child survival practices. Key points:
- The program was a partnership between CRS Ghana and the Ghana Health Service to encourage positive maternal/newborn health practices in East Mamprusi District.
- Baseline data showed high rates of maternal mortality, infant mortality, and low uptake of health services. The program deployed strategies like model mothers, community education sessions, and transportation improvements to increase access to and quality of care.
- Outcomes included significant reductions in mortality rates, increased usage of antenatal care, skilled birth attendance and postnatal care. Nutrition and malaria indicators also improved.
- The partnership strengthened
Mona Sinha, UNICEF - A social movement to end child marriage and dowry in Bih...POSHAN
Presentation made at an IFPRI event on "What Lies Beneath:
Women’s and Girls’ Wellbeing as a Critical Underpinning of India’s Nutritional Challenge" on December 10, 2018, in New Delhi
Towards a Grand Convergence for Child Survival and HealthCORE Group
This document summarizes the findings of a strategic review of the Integrated Management of Childhood Illness (IMNCI) approach. Some key findings include:
- IMNCI has been widely adopted and transformed global approaches to child health, but implementation has been uneven and challenges remain.
- Fragmentation of global child health strategies and lack of sustained funding and leadership have undermined full implementation and impact.
- Evidence is not systematically used to inform policies and programs.
The review provides 5 recommendations to address these problems, including consolidating global leadership, developing innovative strategies to reach marginalized populations, establishing mechanisms for shared learning and evidence use, tailoring strategies to country contexts, and strengthening monitoring and accountability. The overall
The Paradigm Shift from Healthcare to Population HealthPractical Playbook
This document discusses the need to shift from a healthcare system focused on treatment of illness to a population health system focused on preventative care. It notes rising healthcare costs in the US and projections that Medicare and Medicaid will consume all tax revenue by 2050 without reforms. The document outlines Trinity Health's vision of building a "people-centered health system" through initiatives in population health management, care management, and addressing social determinants of health. It provides examples of Trinity Health's work in accountable care organizations, bundled payments, and community engagement initiatives.
Strategic Review: Towards a Grand Convergence for Child Survival and HealthCORE Group
This document summarizes a strategic review of options for improving integrated management of newborn and childhood illness (IMNCI) going forward. The review draws on data from over 90 countries and hundreds of experts. Key findings are: 1) While IMNCI has helped transform child health services, interest and funding have declined and scale-up was rarely achieved; 2) To achieve ambitious new child mortality targets, health systems must be strengthened and universal health coverage ensured; 3) The review proposes renewing focus and action on IMNCI through a "Grand Convergence" to end preventable child deaths, supported by domestic and international financing. The goal is high quality care across home, community and health facilities as part of reproductive, maternal
Why nutrition matters and what is this the perfect systems issuePOSHAN
The document discusses malnutrition in India. It provides statistics from various reports that find high levels of undernutrition and anemia in India. The Global Hunger Index 2017 ranks India 100th out of 119 countries. The Global Nutrition Report 2017 notes that India carries a serious burden of malnutrition and must integrate actions to meet nutrition goals for 2030. The document discusses underlying factors for malnutrition like breastfeeding practices, access to nutrition-rich foods, disease burden, food security, and access to healthcare and sanitation. It outlines nutrition-specific and nutrition-sensitive interventions that can help, including maternal supplementation, breastfeeding support, treating severe acute malnutrition, food fortification, social safety nets, women's empowerment and education programs.
Early interpretations of trends in nutrition outcomes, determinants and inter...POSHAN
This slide deck is an evolving work in progress, with updates being made frequently. If you want to use or cite this, please email us at IFPRI-POSHAN@cgiar.org to receive the most updated version.
Divya Nair - Training of district officials on using data for decision-makingPOSHAN
Presentation by Divya Nair on "Training of district officials on using data for decision-making" at Developing a nutrition training roadmap to support India’s nutrition progress (17-18 Dec 2019)
Common vision mn def march 29 2019 sam scottPOSHAN
This document summarizes a meeting on tackling micronutrient malnutrition in India. It outlines key takeaways, current policies and programs, known challenges, surveys that collect micronutrient data, and potential actions. The main points are that a multi-pronged approach is needed to address micronutrient deficiencies, standardized national mapping of micronutrient status and diets is important, and assessing current program operations could help create more effective solutions.
This document provides key performance and quality indicators for monitoring high impact interventions under India's Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy. It begins with introductions by senior officials at the Ministry of Health and Family Welfare emphasizing the importance of these indicators for measuring progress and improving service delivery quality. The document then lists the indicators under each of the 5 areas of the strategy: reproductive health, maternal health, newborn health, child health, and adolescent health. It aims to help program managers at all levels accelerate progress, especially in India's 184 high priority districts.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
ICOLC 2016: Boosting visibility and impact of published researchKudos
A tour of Kudos to show the content in which it was developed (competition for funding, growing impact agenda, huge growth in output, fight for visibility and usage , “off-grid” sharing), our vision (more impact for research, more recognition for researchers), the platform through which we do this (a central system for explaining publications in plain language, managing sharing across multiple channels, and measuring effect across multiple metrics), the extent to which it works (use of the Kudos toolkit correlated to 23% higher downloads of full text on publisher websites) and how this data is made available to institutions (libraries, research offices and communications teams).
Este documento describe una situación de aprendizaje basada en la Didáctica Crítica para estudiantes de quinto grado. Los estudiantes formarán equipos para investigar cómo la biodiversidad se usa en actividades humanas como la alimentación. Realizarán entrevistas, investigación documental y de campo para estudiar cinco especies usadas localmente. Presentarán sus hallazgos y se evaluará el proceso mediante autoevaluación y coevaluación.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illness and boost overall mental well-being.
Este documento presenta una línea de tiempo del desarrollo del conocimiento desde el siglo 0 hasta el siglo XXI. Cubre hitos como la construcción de maquinarias de relojería en monasterios, el desarrollo de la tecnología durante la revolución industrial, y la introducción de la noción de sociedad del conocimiento por Peter Drucker. Finalmente, analiza la evolución del conocimiento humano a lo largo de la historia y la importancia de llevar la información y tecnología a todas las regiones.
The 114th Congress has featured a significant amount of legislative activity related to Abandoned Mine Lands (AML). The Gold King Mine Spill in August of 2015 brought AML to the forefront of national attention, invigorating consideration of the many-faceted dilemma posed by the AML sites. The state AML programs have long endeavored to educate lawmakers and inform debate on potential solutions, bringing their practical experience and technical expertise to bear on the search for policies that best address the wide range of effects felt by AML-impacted communities. The National Association of Abandoned Mine Lands Programs (NAAMLP) and Interstate Mining Compact Commission (IMCC) provide a forum for state AML program managers to discuss contemporary issues in AML policy and enables them to make concerted recommendations to policy-makers. This presentation will review and provide state regulatory perspectives on the AML-related topics under consideration during the 114th Congress, including: Hardrock AML, Reauthorization of the AML fee, Response to the Gold King Mine Spill, Good Samaritan Liability Protection, AML Appropriations, Economic Revitalization, and others. This presentation will also include a review of specific bills and legislative proposals put forward in the current Congress and provide an account of the positions and actions taken by state AML regulatory authorities through NAAMLP and IMCC.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the importance of setting in stories. It provides examples from three short stories: Battle Royal by Ralph Ellison, which takes place in a wealthy hotel ballroom in the South; Two Kinds by Amy Tan, set in San Francisco, California in 1949; and A Rose for Emily by William Faulkner, located in Jefferson, Mississippi in the late 1800s. The concluding paragraph emphasizes that setting creates mood, atmosphere, and shapes characters and plots. Descriptive settings allow readers to visualize the time period and place, and help form an emotional connection to the story. Setting is a crucial tool for authors to effectively engage their audience.
Este documento presenta los resultados de una evaluación de estilos de aprendizaje realizada a Valeria Orozco Ramírez. La evaluación consistió en una serie de preguntas donde Valeria tuvo que asignar valores de 1 a 4 a diferentes formas de aprendizaje, dependiendo de cuál describiera mejor su manera habitual de proceder. Luego, los resultados se graficaron en un plano de coordenadas para identificar su estilo de aprendizaje predominante, el cual resultó ser Divergente, caracterizado por preferir aprender de la experiencia y la observación reflexiva.
Computing Workflows for Biologists: An Overviewtracykteal
This document discusses best practices for organizing and conducting reproducible computational analyses for biological research. It recommends that biologists properly organize their data, take detailed notes on their analysis steps and software versions, and adopt iterative workflows. It also emphasizes the importance of collaboration and shared responsibility within research teams to ensure reproducibility through practices like code reviews, reproducibility checkpoints, and seeking help from outside resources. The overall goal is to facilitate comprehensive documentation and validation of computational analyses to increase confidence in results and reduce manuscript retractions.
Similar to Success beyond numbers: The Salud Mesoamerica Initiative’s results-based financing approach to improve health services for the poorest in Mesoamerica
The Carlos Slim Health Institute provides integrated health solutions through various programs. It aims to contribute sustained health initiatives that profoundly impact people. Its programs include Amanece for maternal and child health, Vive Sano for chronic disease prevention, and Casalud for innovation in health services. In 2009, these programs benefited over 350,000 people across Mexico and Latin America. The Institute also pursues global health solutions like the Health Observatory, Mesoamerican Health Initiative, and Slim Initiative in Genomic Medicine. It invests in human capital through Carlos Slim Scholarships and health awards, with the goal of benefiting over 3.5 million people in 2010.
This presentation is all about the epidemiology of stillbirths, in India. It talks about the different challenges in controlling the stillbirths and the strategies of controlling it. The INAP guideline of Government of India, which is a stepping stone for controlling stillbirths in India, is also discussed here.
This presentation covers the USAID Office of Maternal, Child Health and Nutrition; the Office of Health Systems; Office of Population and Reproductive Health; and the Center for Innovation and Impact.
As the financial and demographic landscape changes, our healthcare services need to provide something significantly different to meet the needs of the Scottish population. In this session Gerry Marr talks about how do we make best use of the resources we have and what are we already doing that is transforming healthcare.
Maternal Anemia within Child Survival Grants Program: Lessons Learned and a ...jehill3
The document reviews maternal anemia programs within the Child Survival Grants Program (CSGP) to identify effective components and barriers. It finds that while programs integrated recommended anemia interventions like iron supplementation and deworming, implementation challenges remained. Outcomes like anemia reduction were achieved in few projects. It recommends CSGP programs improve monitoring of iron tablet receipt and quality of antenatal care to better address maternal anemia.
The Care Group Model is a strategy that uses volunteers to promote behavior change at the household level. A Care Group consists of 10-15 volunteers who regularly meet with project staff for training and support. Each volunteer is responsible for regularly visiting 10-15 neighbors to share what they have learned and facilitate behavior change. The Care Group Model creates a multiplying effect to equitably reach every family with health education and referrals. Operations research was conducted in Burundi to test the effectiveness and sustainability of a lower-input Care Group Model compared to a traditional higher-input model. The research examined the impact on knowledge and practices as well as the functionality and sustainability of the Care Groups under each model.
Operations Research: Methods, Challenges, Emerging Lessons, and Opportunities...CORE Group
The Care Group Model is a strategy used to promote community health. It involves training community health volunteers who each visit 10-15 neighboring households on a regular basis to share health information and facilitate behavior change. Care Groups aim to equitably reach all women and children in a community with individualized behavior change messaging and social support. The document discusses an operations research study in Burundi that compares the effectiveness of an integrated Care Group model using fewer project resources to the traditional higher-input Care Group model. It aims to test whether the adapted model can achieve similar health knowledge, practices, and group functionality and sustainability. Challenges of the research and lessons learned around obtaining ethics approval and integrating data collection into routine monitoring are also outlined.
Maternal death Review- national perspective-wb-2011Prabir Chatterjee
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Success beyond numbers: The Salud Mesoamerica Initiative’s results-based financing approach to improve health services for the poorest in Mesoamerica
1. Success beyond numbers:
The Salud Mesoamerica Initiative’s results-
based financing approach to improve health
services for the poorest in Mesoamerica
World Bank BBL Presentation
Social Protection and Health Division- Inter American Development Bank
Emma Margarita Iriarte, Executive Secretary of SMI
2. What does SMI aim to change?
Only 1 of every 2 pregnant women in the poorest 20%
gives birth assisted by skilled personnel
Twice as many children <5 years of age in the poor
population die compared to the regional average
A 5-year-old child from the poorest 20% is
6cm shorter than a child from the wealthiest 20%
x2
3. What does SMI aim to change?
SMI areas: baseline situation (2012) – child health
Chiapas El Salvador Guatemala Honduras Nicaragua Panama
(%)
Population Health Metrics, 2015: Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings
4. What does SMI aim to change?
SMI areas: baseline coverage (2012) – women’s health
Modern contraceptive prevalence rate
Institutional births by skilled personnel
(%)
* Institutional births by skilled personnel not measured at baseline
Population Health Metrics, 2015: Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings
5. What does SMI aim to change?
SMI areas: baseline situation (2012) – quality of care
* Information on equipment and inputs is not available
Health facilities with continuous availability of equipment and
inputs for emergency neonatal and obstetric care
Neonates with complications (low birth weight, prematurity,
asphyxia, sepsis) treated according to the norms
Women with obstetric complications (pre-eclampsia,
eclampsia, sepsis, hemorrhage) treated according to the
norms
(%)
6. What does SMI aim to change?
SMI areas: Crude vs Effective Coverage of Measles Immunization in Mexico and Nicaragua
Chiapas, Mexico Nicaragua
Citation: Colson KE, Zúñiga-Brenes P, Ríos-Zertuche D, Conde-Glez CJ, Gagnier MC, Palmisano E, et al. (2015) Comparative
Estimates of Crude and Effective Coverage of Measles Immunization in Low-Resource Settings: Findings from Salud
Mesoamérica 2015. PLoS ONE 10(7): e0130697. doi:10.1371/journal.pone.0130697
7. What is SMI?
SMI: Public-Private Partnership – Collective Impact Initiative
•Bill & Melinda Gates Foundation
•Carlos Slim Foundation
•Government of Spain
•8 Mesoamerican Countries
•IDB
Grants: US$ 114m
Domestic Funding: US$ 55m
Objective: Reduce inequities in maternal, neonatal, child, and
adolescent health in 1.8 million women and children
8. What makes SMI different?
From… To…
• Beneficiaries and Donors
• Financing inputs: Buying
micronutrients
• Thinking about who and
what to support
• Risk intolerance and
resistance to change
• Assuming we made a
difference
• Partners and joint-investors
• Buying Results: Reducing
Anemia
• Focusing on leverage points
and removing bottlenecks
to reach targets
• Taking smart risks, learn
from failures and adapt
• Verifying we met our goal
9. SMI aims to create value for the entire field
Porter and Kramer, Philanthropist’s New Agenda: Creating Value.
How can we do
development
better?
How can we do
development
better?
10. Target the poorest 20% of the population
Results Based Financing (RBF) model – Incentive
at national level
SMI approach: critical features
11. Evidenced based interventions and systemic
approach
Supply and Demand side interventions
Context specific and action-oriented technical
assistance
Independent measurement of performance at
outcome level
Regional dimension and benchmarking
SMI approach: critical features
12. Based on the General Framework, countries built their
Performance Framework with 8-12 indicators per phase
On average, each Performance Framework has a total of
24 indicators
Results and Performance Frameworks
M&E Indicators
SMI Indicators
~50 indicators
Performance
Framework
Performance
Tranche
~24 indicators
Regional
Monitoring &
Benchmarking
Linked to
Performance
Incentive
13. Selection of performance indicators
90% of health
facilities with
permanent
availability of
family planning
methods
Unmet need
for
contraceptio
n decreases
5% PP
Unmet need
for
contraception
decreases
10% PP
permanent availability
of family planning
methods
unmet need for
contraception
Targets
set for all
indicators
Process
indicators
Coverage
& Quality
indicators
Coverage
& Quality
indicators
18m targets
36m targets
54m targets
18 months 36 months 54 months
Operation 1 Operation 2 Operation 3
100
50
0
0 months
14. What do countries commit to?
Key Performance Indicator Baseline
1st
Operation
Targets
2nd
& 3rd
Operation
Targets
Primary Health Centers with permanent
availability of medicines and inputs for
obstetric and neonatal emergencies
62.5% 80%
Primary Health Centers with permanent
availability of medicines and inputs for the
treatment of diarrhea and pneumonia in
children under 5
0% 80%
Institutional births by skilled personnel 63.9% +12 PP
Management of obstetric complications 11% + 40 PP
Children less than 5 years that received oral
rehydration salts and zinc during the last
episode of diarrhea
0% +25 PP
Anemia in children 6-23 months 35.3% - 15 PP
Example: Honduras (selected targets)
15. How did SMI set and negotiate targets?
Trend of national health indicators and evidence on
impact of interventions
Literature review, international experiences
Economic model based on cost-benefit analysis
Power calculations
Expert consultations and art
Set individually with each country
16. Target negotiation
• Ambitious but achievable
• Commitment and support from authorities
• No baseline?
– Absolute changes (gold standard): for example,
above 85%
– Relative changes: 20 percentage points above the
baseline
17. SMI Scoring system
‘All or nothing’ rule focuses efforts on all targets, but makes receiving the performance award
more challenging
18. SMI independent performance measurement
Final
Evaluation
Final
Evaluation
1st
Operation
(18-24 months)
2nd
Operation
(18-24 months)
3rd
Operation
(18-24 months)
First
verification
of targets
First
verification
of targets
Second
verification of
targets
Second
verification of
targets
Third
verification of
targets
Third
verification of
targets
*Health Facilities and Population Based Surveys
We are here. In
most countries,
the second
operation is in
progress.
19. Role of measurement in SMI
• Setting and verifying targets
– Monetary incentive (PT)
• Comparable data between countries
– Reputational Incentive
• Generate data for evidence-based policy dialogue
and program design
• Program monitoring and course correction
• Learning about effectiveness of the model
20. …but is just measurement enough?
• Need for technical assistance on how to implement
evidence-based interventions
– Especially in the hardest-to-reach areas: platforms, new
mechanisms to deliver services
– Systemically and at-scale
– Need to create evidence-based culture
– Management and organizational issues
• Funding to test new interventions/innovations
– Scarcity of non-earmarked funds
23. Performance indictors linked to changes in
national norms and protocols (1st
Operation)
Country Policy Dialogue Indicator – Updated Norm Status
Belize
• Quality of reproductive and child health services
• Establishment of a community platform of services
Completed
El
Salvador
• Micronutrient powders to reduce anemia and zinc for
treatment of diarrhea
Completed
Honduras
• Common childhood diseases
• Micronutrient powders approved
Completed
Nicaragua • Community platform and nutrition interventions Completed
Panama • Inclusion of zinc for diarrhea treatment Completed
25. SMI first round of results (18-24 months)
Very sizeable changes in the supply of essential health care in a short
period in all countries
69% of the 83 negotiated targets met in 8 countries
Costa Rica, El Salvador, Honduras, Nicaragua and Panama received
the performance tranche (PT)
Belize, Chiapas and Guatemala mastered an impressive progress but
fell short of the cut off to receive the PT
Chiapas, Guatemala implemented an improvement plan, with their
own resources, were re-measured and achieved all the targets
27. Chiapas: success stories
Child care Antenatal
and
postpartum
care
Emergency
obstetric and
neonatal
care
Delivery and
newborn
care
Family
Planning
*All percentages reflect the Performance Improvement Plan Measurement (PIPM) definitions with no stock-out
29. Taking stock of SMI: voices from the countries*
*In depth interviews with a sample of national and district level leaders of the Ministries of
Health (independent evaluation by Rena Eichler and Susan Gigli).
Positive Aspects
• Overall feedback is highly positive
• Management by results is new and
perceived as catalytic and creates
new partnerships
• SMI is enhancing Know-How
• New evidence based strategies and
results oriented interventions are
being introduced.
• Supply systems are being
strengthened
Challenging Aspects
• Short Timelines
• Some targets were too ambitious
• Construction of some indicators
could be improved
• Initial incomplete understanding
of what needed to happen to
achieve targets
• Frustration with the country’s
own systems and their capacity
to move quickly
30. Moving forward
Next set of targets are much harder: coverage and quality of
interventions and selected outcomes (population-based results)
Addressing funding gaps
Continue facilitating technical assistance and collective learning
and innovation.
Sustainability: how to maximize the likelihood that system
enhancing changes will be sustained?
We have evidence about what works to save lives in maternal and child, however, unnecessarily people are dying every day in one of the most unequal region of the world – Mesoamerica. Many of the inequalities seen here are hidden by improving national averages. The numbers here are a small sample of the inequalities faced by the poorest 20%.
In 2012-2013, SMI performed a baseline study in the poorest areas of each country, where the program would be working.
Everyone expected the poor to be worse off, but many were shocked by how much worse off these populations are.
Vaccination, something the region is very proud of and worked hard to achieve national averages over 85%, in the poorest regions, there is still a lot to go (see Panama 9.9% and Guatemala 12.5%).
Anemia – directly related to cogitative development and stunting – a risk factor for diminished survival, childhood and adult health, learning capacity and productivity – complete with levels found in some of the most impoverished areas of Africa (Ethiopia= 64%)
In Panama, one of the fastest growing economies and home of the Panama Canal, just 2 hours from the capital, 3 of 4 children are anemia and 1 of 2 are stunted. Similar trends are seen in Guatemala.
Women’s health shows how international aid efforts in the last 20 years (Mainly USAID) have made lasting impacts – even in the poorest populations –
However in Chiapas, Guatemala and Panama coverage of basic interventions like institutional birth and modern family planning rates are extremely low.
When women were asked why they didn’t give birth in the hospital in SMI barriers analysis, many listed the cost to travel to the health center and that they had no one to watch their children. Cultural issues were also a concern.
Both of these demand side barriers have been worked into SMI Operations.
As you could see in the slide beforehand, countries like Honduras, Nicaragua and El Salvador had intuitional birthrates over 80%. The data presented here focuses on the next frontier – quality of health care.
According to the SMI baseline survey, in the targeted areas, less than 15% of health centers had the basic equipment needed for a quality delivery – like oxytocin, a lifesaving uterotonic – and
less than 10% of all neonatal and obstetric emergencies were treated according to the norm.
If 100 women showed up for a birth, less than 10 of them received the quality of care they deserved.
Dry Blood Sample of Seroprevalence of measles vaccine allows us to see the difference in crude vs. effective coverage is alarming.
Due to problems in cold chains, some of the children vaccinated are not protected from these preventable diseases.
Abstract from paper: Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how survey based estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. We also collected dried blood spots (DBS) from children aged 12 to 23 months to compare crude and effective coverage of measles immunization. We used survey-weighted logistic regression to identify individual, maternal, household, community, and health facility characteristics that predict gaps between crude coverage and effective coverage. We found that crude coverage was significantly higher than effective coverage (83% versus 68% in Mexico; 85% versus 50% in Nicaragua). A large proportion of children (19% in Mexico; 43% in Nicaragua) had health card documentation of measles immunization but lacked antibodies. These discrepancies varied from 0% to 100% across municipalities in each country. In multivariate analyses, card-positive children in Mexico were more likely to lack antibodies if they resided in urban areas or the jurisdiction of De Los Llanos. In contrast, card-positive children in Nicaragua were more likely to lack antibodies if they resided in rural areas or the North Atlantic region, had low weight-for-age, or attended health facilities with a greater number of refrigerators. Findings highlight that reliance on child health cards to measure population protection against measles is unwise. We call for the evaluation of immunization programs using serological methods, especially in poor areas where the cold chain is likely to be compromised. Identification of within-country variation in effective coverage of measles immunization will allow researchers and public health professionals to address challenges in current immunization programs.
Based on the situation described in the slides above, SMI was created to health reduce the health equity gap.
SMI is a hybrid program, combining best practices and promising interventions, through a combination of
results-based funding;
a creation of a partnership with public- the government of Spain and -private donors – the two richest men in the world, countries, and the IDB;
evidence-based interventions balanced by innovations supported through learning through success and failures;
demand-based technical assistance; and
pro-poor focus – countries agree to only work in the 20% poorest part of the population.
This left us with the challenge of how to catalyze the uptake of health innovations for the poor within and between countries at scale to reduce the health equity gap. This was the question posed by this partnership, and it meant we couldn’t “do business as usual”
Based on our calculations – over the lifetime of the Initiative we have the opportunity to prevent over 15,000 maternal and child deaths in the areas we work (LiST Model) – the challenge we faced was how were we going to scale up these interventions quickly?
To make this change, this slide represents of the key transitions at work within the program – that make us different
Additionally, SMI seeks to create value for the entire field, not only studying if targets are met, but learning if the model allows for a new model with increased effectiveness and efficiency to meet targets – seeking to contribute to advancing the state of knowledge and practice in the field – according to HBR, this makes every dollar spent in the partnership more productive
Resource link: https://hbr.org/1999/11/philanthropys-new-agenda-creating-value
Pro-poor focus
3 sets of funding: IT, CP, PT
Note that the funding for country operations is less than 2% of the annual health budget. This type of funding is “catalytic” in that it sets of a series of changes to meet targets, but doesn’t necessarily finance them. The cost of reaching targets the countries commit to is much higher
SMI created a catalogue of indicators which would be measured in all countries – SMI General Results Framework
Based on the General Framework, countries built their Performance Framework with 8-12 indicators per phase
First Operation: Process Indicators
Second and Third Operation: Coverage and Quality of Care Indicators
On average, each Performance Framework has a total of 24 indicators
All countries are measured by the General Results Framework for monitoring purposes
Resource: Folder 2 and Folder 4
This slide is an example of the type of goals countries commit to at the outcome level.
SMI is implemented through 3 phases of country operations, each with 10-12 performance targets verified through external surveys.
Targets get harder with each phase. The first phase focused on necessary policy and operational guideline changes, supply and demand side inputs and processes.
The 2nd on coverage and quality and the 3rd on Effective Coverage – like reduction of anemia and seroconversion of the measles vaccine
NOTE: the last two targets area actually for the 3rd operation in Honduras
Target setting tools helped to set “ambitious but achievable” targets
Tools allowed for commitment and support from authorities to achieve targets
Tools contributed to removing motivational and aspirational aspects in target setting
Given that the majority of the countries did not have baseline data when they were establishing targets, targets were set two ways:
Absolute Changes (Gold Standard)
Above 85%
Relative Changes
Change in 20 Percentage points relative to baseline
Note- I added here a bar for where funding is needed for consideration…
SMI uses three main types of PD: fiscal, technical and operational.
IDB is a trusted partner in region with more then 50 years of PD experience
Some examples of Technical and Operational PD
In some countries, changes to national norms and protocols were necessary.
In 5 countries, changes were performance indicators, meaning they had to be completed in record time (usually this process takes 4-5 years) and the documents underwent external verification to ensure they met evidence-based criteria
“A System for Rapid Learning and Improvement” refers to a set of structures and processes that help providers of health care at every level of the system (national, regional and local) to:
Understand their current performance;
Set aims for improvement;
Build will for change;
Access the latest and best evidence-based knowledge; and
Test new innovations to rapidly enhance outcomes.
Importantly, a system of this kind seeks to avoid the pitfalls of typical learning activities which are often characterized by:
Vague aims;
Old data;
Static, underused knowledge repositories; and
Didactic training programs that put providers in a passive position.
1Baseline measured oxytocin or ergometrine, while 18-months measured these two or ergobasine
2Hydralazine, hydralazine hydrochloride, alphamethyl dopa, propanolol, nifedipine
3At baseline, only dexamethasone is measured; at follow up, betamethasone is also measured. Requirement for one of these two drugs only applies to follow-up
4Amoxicillin, ampicillin, amikacin sulfate, penicillin G, clindamycin, cephalexin, dicloxicillin, doxycycline, gentamicin, metronidazole
Here is should be noted that Chiapas did not pass the first round (green) although they made great progress from baseline (yellow).
They created a Performance Improvement Plan, and without additional funding, were measured 6 months later to revel that had met 100% of their targets
Here we should note that Belize did not pass and receive the prize, but still made vast improvements as illustrated here
4 key issues moving forward – key issue is finding funding for the 3rd operations, were we expect changes in effective coverage indicators and adequate time to see sustainable changes in the countries’ health systems