- Support implementation of national plans
- Fill gaps in service delivery
- Support social mobilization
Partner:
- Participate in planning and review
- Joint problem solving
- Share resources
Watchdog:
- Advocate for equity and quality
- Monitor progress and challenges
- Hold government and partners accountable
Innovator:
- Pilot new approaches
- Generate evidence
- Share learning
Convener:
- Bridge sectors and levels
- Foster multi-stakeholder coordination
- Build consensus
The key is finding the right balance
The document summarizes a seminar held by FARA on mycotoxins management in Africa. It discusses the large health and economic impacts of aflatoxins contamination across Sub-Saharan Africa, including an estimated 1 million additional HIV infections annually from fumonisin in maize alone. Aflatoxins are found to suppress immune function and exacerbate diseases like malaria and tuberculosis. They also impact nutrition and pregnancy outcomes. Agricultural technologies, post-harvest processing methods, and policy approaches are recommended to minimize exposure and enforced food quality standards. FARA's role in advocacy and awareness creation on the health and food security implications was discussed.
The Power of Vaccines: ‘getting to zero’ for HIV and TB was an event hosted by the TB/HIV and Prevention Working Groups of the UK Consortium on AIDS and International Development. The meeting was sponsored by Pamela Nash MP and held on Friday, 18th May 2012, in Portcullis House, Westminster. Read more at http://storify.com/PamojaUK/the-power-of-vaccines
http://www.pamoja.uk.com
First batch of covid 19 vaccines arrives in latin americaDany Goldraij
The first batch of COVID-19 vaccines has arrived in Latin America, with Mexico receiving the first shipment. Mexico plans to vaccinate 750,000 healthcare workers and those over 90 years old using 1.4 million doses of the Pfizer vaccine. Brazil expects to have 150 million vaccine doses in the first half of 2021 from Sinovac and AstraZeneca. Argentina has begun vaccinations using 300,000 doses of the Russian Sputnik V vaccine. Colombia has secured deals for 9 million doses of the Johnson & Johnson vaccine. Chile began vaccinations using an initial 10,000 Pfizer doses. Uruguay has kept cases low through efficient testing.
Being chosen as one of the best practices of VSMMC to be presented during the 2nd DOH National Staff Meeting, the Program for Young Parents is a collaborative project to address the health needs of pregnant adolescents and provide comprehensive "one-stop shop" care for the pregnant adolescent, her partner and her infant.
Department of Health Program Directions and Priorities Towards MDGs 4 and 5Michelle Avelino
The document outlines the Department of Health's (DOH) current efforts, status, and directions regarding achieving Millennium Development Goals 4 and 5 in the Philippines. It discusses programs established to improve maternal and child health, including emergency obstetric care facilities, integrated service packages, training programs, and monitoring systems. It notes accomplishments, ongoing challenges, and a proposed approach to scaling up family planning and maternal, newborn and child health programs through collaboration with partners.
The document summarizes the history and implementation of primary health care (PHC) in the Philippines. It discusses the definition of PHC according to the WHO and how it was adopted in the Philippines. It then outlines the different periods of PHC implementation: pre-devolution, institutionalization, and devolution. Under each period, it describes the various approaches, innovations, and mechanisms used to promote PHC in the country. It concludes by noting some of the challenges faced in fully implementing PHC.
This document summarizes the WHO's position on vaccination recommendations for children. It includes:
1) A table outlining the recommended ages, doses, and intervals for various routine childhood vaccines.
2) Footnotes providing details on booster considerations, co-administration, and catch-up schedules.
3) Clarification that national immunization schedules should be based on local epidemiological factors in addition to these guidelines. The document is intended to help countries develop appropriate vaccination schedules.
The document summarizes a seminar held by FARA on mycotoxins management in Africa. It discusses the large health and economic impacts of aflatoxins contamination across Sub-Saharan Africa, including an estimated 1 million additional HIV infections annually from fumonisin in maize alone. Aflatoxins are found to suppress immune function and exacerbate diseases like malaria and tuberculosis. They also impact nutrition and pregnancy outcomes. Agricultural technologies, post-harvest processing methods, and policy approaches are recommended to minimize exposure and enforced food quality standards. FARA's role in advocacy and awareness creation on the health and food security implications was discussed.
The Power of Vaccines: ‘getting to zero’ for HIV and TB was an event hosted by the TB/HIV and Prevention Working Groups of the UK Consortium on AIDS and International Development. The meeting was sponsored by Pamela Nash MP and held on Friday, 18th May 2012, in Portcullis House, Westminster. Read more at http://storify.com/PamojaUK/the-power-of-vaccines
http://www.pamoja.uk.com
First batch of covid 19 vaccines arrives in latin americaDany Goldraij
The first batch of COVID-19 vaccines has arrived in Latin America, with Mexico receiving the first shipment. Mexico plans to vaccinate 750,000 healthcare workers and those over 90 years old using 1.4 million doses of the Pfizer vaccine. Brazil expects to have 150 million vaccine doses in the first half of 2021 from Sinovac and AstraZeneca. Argentina has begun vaccinations using 300,000 doses of the Russian Sputnik V vaccine. Colombia has secured deals for 9 million doses of the Johnson & Johnson vaccine. Chile began vaccinations using an initial 10,000 Pfizer doses. Uruguay has kept cases low through efficient testing.
Being chosen as one of the best practices of VSMMC to be presented during the 2nd DOH National Staff Meeting, the Program for Young Parents is a collaborative project to address the health needs of pregnant adolescents and provide comprehensive "one-stop shop" care for the pregnant adolescent, her partner and her infant.
Department of Health Program Directions and Priorities Towards MDGs 4 and 5Michelle Avelino
The document outlines the Department of Health's (DOH) current efforts, status, and directions regarding achieving Millennium Development Goals 4 and 5 in the Philippines. It discusses programs established to improve maternal and child health, including emergency obstetric care facilities, integrated service packages, training programs, and monitoring systems. It notes accomplishments, ongoing challenges, and a proposed approach to scaling up family planning and maternal, newborn and child health programs through collaboration with partners.
The document summarizes the history and implementation of primary health care (PHC) in the Philippines. It discusses the definition of PHC according to the WHO and how it was adopted in the Philippines. It then outlines the different periods of PHC implementation: pre-devolution, institutionalization, and devolution. Under each period, it describes the various approaches, innovations, and mechanisms used to promote PHC in the country. It concludes by noting some of the challenges faced in fully implementing PHC.
This document summarizes the WHO's position on vaccination recommendations for children. It includes:
1) A table outlining the recommended ages, doses, and intervals for various routine childhood vaccines.
2) Footnotes providing details on booster considerations, co-administration, and catch-up schedules.
3) Clarification that national immunization schedules should be based on local epidemiological factors in addition to these guidelines. The document is intended to help countries develop appropriate vaccination schedules.
Childhood pneumonia is the leading cause of death in children under 5 years old globally. Pneumonia kills more children than AIDS, malaria and measles combined. In the Philippines, pneumonia accounts for 34% of deaths in children under 5. The main pathogens causing pneumonia are Streptococcus pneumoniae and Haemophilus influenzae. Studies conducted by the ARI study group from the 1980s-2012 helped develop pneumonia control programs through investigating etiology, risk factors, treatments, diagnostics and conducting vaccine trials. Pneumococcal conjugate vaccines were found to be highly effective against invasive pneumococcal disease and radiographic pneumonia. Future studies aim to further understand etiology, monitor antibiotic resistance and investigate the pediatric microbiome.
This presentation discusses implementing an antimicrobial stewardship program in hospitals. It recommends starting with formulary restriction, preauthorization, and prospective audits with feedback. Additional strategies include education, clinical guidelines based on local data, and streamlining antibiotic therapy. The presentation emphasizes developing customized treatment protocols based on the hospital's own microbiology data to promote evidence-based antibiotic usage. It provides a framework for compiling local infection and antibiotic sensitivity data, risk stratifying patients, and suggesting empiric therapies with options for de-escalation.
Friday 2.15 Pm Adolfo Valadez Prevention And Preparedness DivisionNathan Bunker
The document discusses immunization programs in Texas, including:
- The top 10 public health achievements of the 20th century, including vaccinations.
- How immunizations have led to declines in disease incidence and saved lives and costs.
- Vaccine coverage levels in Texas, which are close to national goals.
- Disease incidence trends being lowered by immunizations in Texas.
- The Texas Vaccines for Children Program and ImmTrac immunization registry.
This document discusses strategies for improving adult vaccination rates in rural Indiana by empowering healthcare providers. It describes an educational initiative developed by the Indiana Immunization Coalition and Indiana Faculty to provide providers with information on communicating vaccine benefits to patients, identifying patient barriers to vaccination, and applying system changes to address provider barriers. The goal is to help integrate adult vaccination screening and administration into clinical practice.
This presentation discusses the importance of infection control and the role of information technology. It was presented at the Apollo International Forum on Infection Control in 2013. The presentation outlines how healthcare-associated infections impact patients and the healthcare system. It also identifies challenges in infection control programs, including the need for leadership, focus on prevention and surveillance, education, and leveraging clinical information technology. The presentation provides an example of Apollo Hospital's focused infection control program that incorporates hand hygiene, isolation procedures, training, and surveillance.
This document discusses influenza in humans and pigs, comparing their epidemiology and control. It covers topics like antigenic drift vs shift, annual impacts of seasonal influenza, goals for influenza vaccination, recommendations for vaccine strain changes, and the human-animal interface of influenza. Sanofi Pasteur is highlighted as a global leader in human vaccines with a vision of protecting health worldwide through superior vaccines.
A dangerous trend is emerging in the USA where some parents are deliberately exposing their children to chickenpox (varicella) by mailing infected clothing or saliva in an attempt to contract the disease naturally. Before the varicella vaccine was introduced in 1995, chickenpox affected around 4 million Americans each year, resulting in over 10,000 hospitalizations and 100-150 deaths annually, mostly among healthy children. While the vaccine has dramatically reduced cases and complications in the USA, some parents now seek to infect their children at home rather than vaccinate, despite the health risks. Public health officials warn that these do-it-yourself infection attempts could spread the virus and endanger others.
The document contains information about vaccination rates in adolescents from 2006-2008. It shows that rates of HPV vaccination and meningitis vaccination increased over this period but rates of whooping cough and tetanus vaccination were still below the Healthy People 2010 goal of 80% in 2008. Free and low-cost vaccines are available through programs like the Vaccines for Children program.
This document discusses several topics related to improving healthcare quality and financing:
1) Pay-for-performance programs aim to incentivize quality care over quantity by tying provider payments to performance measures rather than just services provided. However, designing effective payment models remains challenging.
2) Medical errors are a major problem, costing billions annually in the US due to injuries, deaths and unnecessary costs. Reducing errors could significantly cut healthcare spending.
3) Patients armed with information about treatment options and costs may choose less aggressive care, reducing overtreatment. However, some argue the system also needs reforms to truly reward high-value care.
4) Adverse events during hospital care remain common globally despite efforts to
The document discusses several studies related to vaccines:
1. A study of 176 infant pertussis cases found most were vaccinated and exposed in households, suggesting promoting Tdap vaccination of household contacts.
2. A study found 15 children allergic to DT vaccine spontaneously resolved their allergy, with 3 still allergic on reevaluation.
3. A study of 1.8 million children found no increased risk of ITP after vaccines except MMR and possibly hepatitis A, varicella and Tdap vaccines in older children.
4. Residual casein was found in DTaP vaccines, possibly linking to reports of anaphylaxis in children with cow's milk allergy.
The document discusses the patient centered medical home model which aims to address issues with the declining value of primary care. It notes the aging population, rising chronic conditions, and skyrocketing healthcare costs. The medical home model emphasizes comprehensive and coordinated care through accessible primary care providers with long-term patient relationships.
Presentation by Sheila Richmeier, MS, RN, FACMPE, President & Founder of Remedy Healthcare Consulting
"Think Clinical: Running a More Efficient Practice through Optimal Clinical Operations"
Presentation given at Lawrence Medical Managers meeting June 8th 2011
This document summarizes key points from a health financing summit:
1. Quality healthcare is essential to the success of any health financing initiative. Pay-for-performance programs aim to improve quality by linking payments to achievement of targets but can have unintended consequences if not designed carefully.
2. International studies show adverse event rates in hospitals have increased significantly over time, costing billions annually. Only a small percentage of errors are reported highlighting the need for improved reporting systems.
3. Proper design of pay-for-performance programs is important to avoid pitfalls like focus on targets over quality, undermining intrinsic motivation, and gaming of the system. Stakeholder input and clear, achievable goals are necessary
Modeling the Consequence of Multi Intervention Campaigns for the Spread of Ma...ijtsrd
This document summarizes a research paper that developed a mathematical model called SPITR to study the transmission dynamics of malaria and the impact of multiple intervention strategies. The SPITR model divides the human population into 5 groups - susceptible, protected, infected, treatment, and recovered. It also includes 2 mosquito groups - susceptible and infected. The model aims to assess how interventions like insecticide-treated bed nets and indoor residual spraying can increase mosquito mortality and help control the spread of malaria. Simulation results suggest combining these interventions with prompt treatment and vaccination can more effectively reduce malaria cases and transmission.
The document discusses Swine Flu, its symptoms, spread, impact and status in India. It notes that while Swine Flu has spread globally and seriously impacted some countries, it is not the biggest health threat in India where other diseases like TB, Hepatitis and Malaria infect and kill many more people annually. The document advises basic precautions like hand washing and visiting a doctor for treatment. It emphasizes that most people recover from Swine Flu with basic medical care and there is no need to panic.
The Extended Program on Immunization (EPI) aims to reduce illness, disability, and mortality from 8 childhood diseases through immunization: polio, neonatal tetanus, measles, diphtheria, pertussis, hepatitis B, Hib pneumonia/meningitis, and tuberculosis. EPI provides safe and effective vaccines for these diseases, which currently cause millions of cases and deaths annually. The program's goals are to immunize over 95% of infants and pregnant women, eliminating diseases like neonatal tetanus and reducing mortality from vaccine-preventable diseases by 2/3 compared to 2000. EPI has been implemented in Pakistan since 1978 through routine immunization, supplemental immunization activities, disease surveillance, and
Presentation_Behar - Private Public Partnerships and CKDuCORE Group
The document summarizes statistics and information about the sugarcane agribusiness in Mexico, including:
- It produced over 6 million tons of sugar in 2017/2018 and generated nearly 500,000 direct jobs.
- It has a complex supply chain involving sugarcane suppliers, mills, transportation, and the food industry.
- It has a legal framework including laws governing sustainable development of sugarcane and labor relations in mills.
- The government has a National Sugarcane Agribusiness Program to increase productivity and competitiveness.
Presentation_World Vision - Private Public Partnerships and CKDuCORE Group
The Fields of Hope project by World Vision Mexico seeks to prevent and reduce child labor in the sugarcane and coffee sectors in the states of Veracruz and Oaxaca. It aims to benefit 1,520 children at risk of or engaged in child labor across 24 communities and 4 municipalities. The project takes an integral approach through advocacy, collaboration with the private sector, and sensitizing communities and workers, while also promoting access to education.
Childhood pneumonia is the leading cause of death in children under 5 years old globally. Pneumonia kills more children than AIDS, malaria and measles combined. In the Philippines, pneumonia accounts for 34% of deaths in children under 5. The main pathogens causing pneumonia are Streptococcus pneumoniae and Haemophilus influenzae. Studies conducted by the ARI study group from the 1980s-2012 helped develop pneumonia control programs through investigating etiology, risk factors, treatments, diagnostics and conducting vaccine trials. Pneumococcal conjugate vaccines were found to be highly effective against invasive pneumococcal disease and radiographic pneumonia. Future studies aim to further understand etiology, monitor antibiotic resistance and investigate the pediatric microbiome.
This presentation discusses implementing an antimicrobial stewardship program in hospitals. It recommends starting with formulary restriction, preauthorization, and prospective audits with feedback. Additional strategies include education, clinical guidelines based on local data, and streamlining antibiotic therapy. The presentation emphasizes developing customized treatment protocols based on the hospital's own microbiology data to promote evidence-based antibiotic usage. It provides a framework for compiling local infection and antibiotic sensitivity data, risk stratifying patients, and suggesting empiric therapies with options for de-escalation.
Friday 2.15 Pm Adolfo Valadez Prevention And Preparedness DivisionNathan Bunker
The document discusses immunization programs in Texas, including:
- The top 10 public health achievements of the 20th century, including vaccinations.
- How immunizations have led to declines in disease incidence and saved lives and costs.
- Vaccine coverage levels in Texas, which are close to national goals.
- Disease incidence trends being lowered by immunizations in Texas.
- The Texas Vaccines for Children Program and ImmTrac immunization registry.
This document discusses strategies for improving adult vaccination rates in rural Indiana by empowering healthcare providers. It describes an educational initiative developed by the Indiana Immunization Coalition and Indiana Faculty to provide providers with information on communicating vaccine benefits to patients, identifying patient barriers to vaccination, and applying system changes to address provider barriers. The goal is to help integrate adult vaccination screening and administration into clinical practice.
This presentation discusses the importance of infection control and the role of information technology. It was presented at the Apollo International Forum on Infection Control in 2013. The presentation outlines how healthcare-associated infections impact patients and the healthcare system. It also identifies challenges in infection control programs, including the need for leadership, focus on prevention and surveillance, education, and leveraging clinical information technology. The presentation provides an example of Apollo Hospital's focused infection control program that incorporates hand hygiene, isolation procedures, training, and surveillance.
This document discusses influenza in humans and pigs, comparing their epidemiology and control. It covers topics like antigenic drift vs shift, annual impacts of seasonal influenza, goals for influenza vaccination, recommendations for vaccine strain changes, and the human-animal interface of influenza. Sanofi Pasteur is highlighted as a global leader in human vaccines with a vision of protecting health worldwide through superior vaccines.
A dangerous trend is emerging in the USA where some parents are deliberately exposing their children to chickenpox (varicella) by mailing infected clothing or saliva in an attempt to contract the disease naturally. Before the varicella vaccine was introduced in 1995, chickenpox affected around 4 million Americans each year, resulting in over 10,000 hospitalizations and 100-150 deaths annually, mostly among healthy children. While the vaccine has dramatically reduced cases and complications in the USA, some parents now seek to infect their children at home rather than vaccinate, despite the health risks. Public health officials warn that these do-it-yourself infection attempts could spread the virus and endanger others.
The document contains information about vaccination rates in adolescents from 2006-2008. It shows that rates of HPV vaccination and meningitis vaccination increased over this period but rates of whooping cough and tetanus vaccination were still below the Healthy People 2010 goal of 80% in 2008. Free and low-cost vaccines are available through programs like the Vaccines for Children program.
This document discusses several topics related to improving healthcare quality and financing:
1) Pay-for-performance programs aim to incentivize quality care over quantity by tying provider payments to performance measures rather than just services provided. However, designing effective payment models remains challenging.
2) Medical errors are a major problem, costing billions annually in the US due to injuries, deaths and unnecessary costs. Reducing errors could significantly cut healthcare spending.
3) Patients armed with information about treatment options and costs may choose less aggressive care, reducing overtreatment. However, some argue the system also needs reforms to truly reward high-value care.
4) Adverse events during hospital care remain common globally despite efforts to
The document discusses several studies related to vaccines:
1. A study of 176 infant pertussis cases found most were vaccinated and exposed in households, suggesting promoting Tdap vaccination of household contacts.
2. A study found 15 children allergic to DT vaccine spontaneously resolved their allergy, with 3 still allergic on reevaluation.
3. A study of 1.8 million children found no increased risk of ITP after vaccines except MMR and possibly hepatitis A, varicella and Tdap vaccines in older children.
4. Residual casein was found in DTaP vaccines, possibly linking to reports of anaphylaxis in children with cow's milk allergy.
The document discusses the patient centered medical home model which aims to address issues with the declining value of primary care. It notes the aging population, rising chronic conditions, and skyrocketing healthcare costs. The medical home model emphasizes comprehensive and coordinated care through accessible primary care providers with long-term patient relationships.
Presentation by Sheila Richmeier, MS, RN, FACMPE, President & Founder of Remedy Healthcare Consulting
"Think Clinical: Running a More Efficient Practice through Optimal Clinical Operations"
Presentation given at Lawrence Medical Managers meeting June 8th 2011
This document summarizes key points from a health financing summit:
1. Quality healthcare is essential to the success of any health financing initiative. Pay-for-performance programs aim to improve quality by linking payments to achievement of targets but can have unintended consequences if not designed carefully.
2. International studies show adverse event rates in hospitals have increased significantly over time, costing billions annually. Only a small percentage of errors are reported highlighting the need for improved reporting systems.
3. Proper design of pay-for-performance programs is important to avoid pitfalls like focus on targets over quality, undermining intrinsic motivation, and gaming of the system. Stakeholder input and clear, achievable goals are necessary
Modeling the Consequence of Multi Intervention Campaigns for the Spread of Ma...ijtsrd
This document summarizes a research paper that developed a mathematical model called SPITR to study the transmission dynamics of malaria and the impact of multiple intervention strategies. The SPITR model divides the human population into 5 groups - susceptible, protected, infected, treatment, and recovered. It also includes 2 mosquito groups - susceptible and infected. The model aims to assess how interventions like insecticide-treated bed nets and indoor residual spraying can increase mosquito mortality and help control the spread of malaria. Simulation results suggest combining these interventions with prompt treatment and vaccination can more effectively reduce malaria cases and transmission.
The document discusses Swine Flu, its symptoms, spread, impact and status in India. It notes that while Swine Flu has spread globally and seriously impacted some countries, it is not the biggest health threat in India where other diseases like TB, Hepatitis and Malaria infect and kill many more people annually. The document advises basic precautions like hand washing and visiting a doctor for treatment. It emphasizes that most people recover from Swine Flu with basic medical care and there is no need to panic.
The Extended Program on Immunization (EPI) aims to reduce illness, disability, and mortality from 8 childhood diseases through immunization: polio, neonatal tetanus, measles, diphtheria, pertussis, hepatitis B, Hib pneumonia/meningitis, and tuberculosis. EPI provides safe and effective vaccines for these diseases, which currently cause millions of cases and deaths annually. The program's goals are to immunize over 95% of infants and pregnant women, eliminating diseases like neonatal tetanus and reducing mortality from vaccine-preventable diseases by 2/3 compared to 2000. EPI has been implemented in Pakistan since 1978 through routine immunization, supplemental immunization activities, disease surveillance, and
Presentation_Behar - Private Public Partnerships and CKDuCORE Group
The document summarizes statistics and information about the sugarcane agribusiness in Mexico, including:
- It produced over 6 million tons of sugar in 2017/2018 and generated nearly 500,000 direct jobs.
- It has a complex supply chain involving sugarcane suppliers, mills, transportation, and the food industry.
- It has a legal framework including laws governing sustainable development of sugarcane and labor relations in mills.
- The government has a National Sugarcane Agribusiness Program to increase productivity and competitiveness.
Presentation_World Vision - Private Public Partnerships and CKDuCORE Group
The Fields of Hope project by World Vision Mexico seeks to prevent and reduce child labor in the sugarcane and coffee sectors in the states of Veracruz and Oaxaca. It aims to benefit 1,520 children at risk of or engaged in child labor across 24 communities and 4 municipalities. The project takes an integral approach through advocacy, collaboration with the private sector, and sensitizing communities and workers, while also promoting access to education.
Presentation_Wesseling - Private Public Partnerships and CKDuCORE Group
This document discusses the epidemic of chronic kidney disease of unknown etiology (CKDu) affecting agricultural workers along the Pacific coast of Central America. It provides evidence that the disease has an occupational etiology related to heat stress and dehydration experienced by sugarcane and other field workers. Studies show physiological changes in workers consistent with heat stress and dehydration across work shifts. Longitudinal studies find declines in kidney function over harvest seasons among heat-exposed occupations. Intervention studies reducing heat stress through water, rest, and shade have shown reduced declines in kidney function. While some non-occupational factors may also contribute, the evidence strongly suggests that prolonged occupational heat stress is a primary driver of the CKDu epidemic.
Presentation_NCDs - Private Public Partnerships and CKDuCORE Group
Non-communicable diseases like cardiovascular disease, cancer, chronic respiratory disease, and diabetes are leading causes of death and disability globally but receive little focus from global health initiatives. While communicable diseases have declined in recent decades, deaths from non-communicable diseases have increased and pose growing health and economic challenges as treatments remain limited. Experts call for greater prioritization and resources for non-communicable diseases on the global health agenda.
Presentation_HRH2030 - Opportunities to optimize and integrate CHWCORE Group
This document summarizes a conference session on integrating and optimizing community health workers (CHWs) in health systems from global and local perspectives. The session included a fishbowl-style debate where attendees were invited to discuss questions about implementing the WHO CHW Guideline recommendations, important partnerships for training CHWs, priorities for managing and supporting newly recognized CHWs, considerations for optimizing the role of CHWs, and innovations needed to shape and sustain CHWs' roles by 2030.
Presentation_Save the Children - Building Partnerships to Provide Nurturing CareCORE Group
This document discusses the experiences of a mother giving birth to a preemie baby named Becky at 30 weeks gestation. Some key points include:
- Becky spent time in the NICU and the mother felt her discharge was rushed, leaving her unprepared to deal with feeding and breathing issues at home.
- Becky faced various developmental issues over time, including low muscle tone, sensory processing disorder, autism, ADHD, and scoliosis.
- The mother advocates for increased support for preemie babies and their families, including more parent education, counseling, early intervention services, and IEP supports over time.
Presentation_Video - Building Partnerships to provide nurturing careCORE Group
This 4 minute video provides an overview of the key events in the history of the United States from 1492 to the early 2000s. It touches on major milestones like the founding of colonies, the American Revolution, westward expansion, the Civil War, industrialization, both World Wars, the Cold War, and events of the early 21st century. The video presents a high-level chronological summary of major political, economic and social developments that shaped America over the past 500+ years.
Presentation_Perez - Building Partnerships to provide nurturing careCORE Group
This document provides information on empowering health workers and caregivers to deliver therapeutic early childhood development care at home. It discusses how 90% of brain development occurs before age 5 and the importance of nurturing care for young children. The document outlines capacity development for parents and caregivers, including guidance on conducting activities that integrate motor, social-emotional, and therapeutic skills into daily routines. It also stresses the importance of addressing caregiver stress and depression through psychosocial support groups to promote child development.
Presentation_Robb-McCord - Building Partnerships to provide nurturing careCORE Group
The document summarizes key points from a CORE Group meeting on nurturing care for preterm newborns. It discusses how nurturing care involves providing a stable, sensitive environment that meets children's health needs from birth to 3 years. The evidence review examines interventions like skin-to-skin contact, breastfeeding, managing pain and stress, sleep protection and stimulation. Country case studies from both high and low income nations are also being conducted to understand policies and guidelines supporting nurturing care concepts.
Presentation_Discussion - Norms Shifting InterventionsCORE Group
Participants in a small group discussed how to integrate norms-shifting interventions into current projects and programs. They considered what new partnerships would be needed when working to shift social norms and what evidence of the effectiveness of norms-shifting interventions should be collected, for whom, and how.
Presentation_Krieger - Norms Shifting InterventionsCORE Group
The document discusses the origins and theories of social norms. It notes that early theorists like Durkheim, Weber, and Ogburn contributed to understanding where norms come from and how they guide behavior. Parsons further explored how members of society are socialized to norms. Later, feminist anthropologists studied norms and social control, especially regarding gender. The document contrasts philosophical, psychological, and anthropological approaches to studying norms and culture. It argues that knowledge of cultural norms can help reduce unexpected outcomes in social science and shift narratives to achieve behavior change. The example of the Albania Family Planning Project shows how understanding local norms was key to successfully promoting contraceptive use.
Presentation_NSI - Norms Shifting InterventionsCORE Group
This document discusses the key attributes of norms-shifting interventions. It identifies several attributes that make an intervention effective at shifting social norms, including seeking community-level change, engaging people at multiple levels, correcting misperceptions around harmful behaviors, confronting power imbalances related to gender, creating safe spaces for critical reflection, rooting the issue within community values, accurately assessing norms, using organized diffusion, and creating positive new norms. The document provides examples and explanations for each of these attributes.
Presentation_Igras - Norms Shifting InterventionsCORE Group
This document discusses using theory to inform the work of a learning collaborative (LC) on norms-shifting interventions for adolescent reproductive health. It outlines several relevant theories, including social norm and behavior change theory and communication and behavior change theories. It also discusses the value of "bottom-up" program change theory developed from implementation experience. The LC aims to facilitate collaboration between organizations, build knowledge, and develop shared tools to guide effective social norm measurement and practice at scale. By working collaboratively, the LC can take a more experimental approach in this nascent field while still being informed by relevant theories.
Presentation_Petraglia - Norms Shifting InterventionsCORE Group
This document discusses a constructivist perspective on norms and normative change. Some key points of constructivism are that knowledge is constructed through social interaction and prior experiences, and meaning is negotiated through language. Constructivism acknowledges that individuals belong to multiple reference groups and can choose which norms to follow in a given situation. Normative change interventions cannot directly manage or control norms, but may be able to influence them by facilitating dialogue, clarifying language, and encouraging ethical persuasion rather than direct attribution. Norms and beliefs are also difficult to accurately measure.
Presentation_Sprinkel - Norms Shifting InterventionsCORE Group
This presentation provides an overview of CARE's Tipping Point initiative which aims to address child, early and forced marriage in Nepal and Bangladesh through community programming and evidence generation. In Phase 1 from 2013-2017, the project worked with adolescents, parents and leaders in 16 districts across the two countries. Norms influencing child marriage include excluding girls' voices, controlling girls' sexuality, and perceptions of risks/benefits of marriage timing. Phase 2 implements a randomized control trial to generate evidence on effective gender transformative programming and the value of social norms approaches. Challenges included discussing sexuality while successes included girls gaining greater freedom and mobility.
Presentation_Tura - Norms Shifting InterventionsCORE Group
This document discusses the Care Group approach used in an intervention in Nepal from 2005-2010. It aimed to shift social norms around maternal and child health issues through community groups. Formative research identified key norms and barriers. Community groups engaged women to reflect critically and root issues in community values. Evaluations found sustained impact on behaviors like breastfeeding years later. Challenges included focusing directly on norm drivers and unrealistic community health worker workloads. Further research on accurate norm assessment and evidence-based norm-shifting is still needed.
Presentation_Sacher - Norms Shifting InterventionsCORE Group
This document summarizes Cristina Bicchieri's theory of social norms, which is grounded in philosophy, game theory, and psychology. The key aspects of the theory include conditional preferences that depend on social expectations, personal normative beliefs about what should be done, and expectations about what others in one's reference network do and think should be done. The implications for practice highlighted in the document include providing a theory of change, identifying the nature of norms to design appropriate interventions, and using data and illustrative vignettes to measure norms and guide social change programs.
Innovative Financing Mechanisms and Effective Management of Risk for Partners...CORE Group
The document summarizes the Utkrisht Development Impact Bond in India, which aims to improve quality of care in private maternity facilities. It discusses how impact bonds can mobilize private capital for development by lowering investment risk. The Utkrisht bond provides funds for accrediting 360-440 private facilities over 3 years. Facilities receive quality improvement support and investors are repaid based on the number of facilities accredited. Early lessons show facilities are motivated to improve if it grows their business and they receive support meeting standards. The bond also provides a framework for continuously improving the project and managing risks between partners.
Presentation_Multisectoral Partnerships and Innovations for Early Childhood D...CORE Group
This document summarizes a discussion on multi-sectoral partnerships and innovation for early childhood development. It was presented by several experts, including Dr. Maureen Black from RTI International, Dr. Joy Noel Baumgartner from Duke University, Mohammed Ali from Catholic Relief Services, Dr. Chessa Lutter from RTI International, and Dr. Erin Milner from USAID. The discussion covered topics like the importance of early childhood development, the Nurturing Care Framework, metrics and measures for childhood development, partnerships for early childhood programs, and challenges and next steps.
Presentation_Jurczynska - Catalyzing Investments in RMNCAH at the Community L...CORE Group
The document describes an evidence-based advocacy model called the Family Planning – Sustainable Development Goals (FP-SDGs) model. The model allows users to quantify the impacts of different family planning scenarios on 13 Sustainable Development Goal indicators out to 2030 or 2050. Users input baseline data and create three future scenarios capturing various levels of ambition for family planning and other socioeconomic factors. The model then projects population figures and calculates outcomes for the SDG indicators. Results can support advocacy efforts to increase funding and prioritization of family planning programs and policies. Examples of the model's use in Malawi, Tanzania, and West Africa demonstrate its ability to quantify potential development impacts of expanding access to voluntary family planning.
Presentation_Jurczynska - Catalyzing Investments in RMNCAH at the Community L...
What's New in Immunization_
1. What’s new in
immunization and where do
PVOs fit in?
Presented to CORE Group Meeting
by Rebecca Fields and Robert Steinglass, MCHIP
October 12, 2012
2. Outline of presentation
What is new in the field of immunization
Findings from ARISE with particular
relevance for PVOs
New vaccine introduction
3. Global U5 Mor tality: Role of
Vaccine Preventable Diseases
(2008 data)
8.8 million under five deaths
Pneumonia other 17% (1.5 million)
Pneumoccocal
12%
diseases* from vaccine
6% preventable diseases
Other Hib*
18% Pertussis
2%
2%
Tetanus
Measles 1%
1%
Perinatal
Rotavirus*
32%
5%
Diarrhoea other
HIV 10%
Malaria 2%
9%
Source: Black RE at all, Global, regional, and national causes of child mortality in 2008: a systematic analysis,
Lancet. 2010 Jun 5;375(9730):1969-87. Epub 2010 May 11.
* WHO/IVB estimates
4. The cause of 1 .5 million deaths globally
among children that are preventable by
routine vaccination, 2008
Tetanus Pneumoccocal
Measles 4% diseases*
8% 32%
Pertussis
13%
Hib*
13%
Rotavirus*
30%
Source: Black RE at all, Global, regional, and national causes of child mortality in 2008: a systematic analysis,
Lancet. 2010 Jun 5;375(9730):1969-87. Epub 2010 May 11.
* WHO/IVB estimates
5. What’s new in immunization?
Global Vaccine Action Plan (Decade of Vaccine)
Many new entrants into immunization arena
Need to move from RED to REC
Role for CSOs recognized (RED modules, MLM
module on partnering with communities)
Mechanisms to engage CSOs (e.g. GAVI constituency)
Inequity now recognized as key challenge
BMGF strategy for routine imm being designed
Polio erad. declared public health emergency
New vaccines exposing cracks in RI system
7. System requirements continue
to grow
Diseases
vaccinated 2.5x
against1
Vaccine doses per
child (#) [assuming receives ~3x
vx listed above] 2
Vaccine volume per Increased
fully immunized child 50 200
4x stress on the
(cm3)3
2010+
RI system
Immunization cost per $30+
2008
child ($) [including delivery $17 ~6x
costs] 4
1980
$5
Across
Age groups targeted for life
immunization course
1980s realities 2010 and beyond realities
1. Varies by nat'l schedule; represents maximum.1980: Diphtheria, pertussis, tetanus, measles, polio and tuberculosis; 2010 add'l vx: PCV, Rota, HepB, Hib, Yellow Fever, Rubella, JE, MenA. 2. Represents maximum;
1980: 1 BCG, 3 DTP, 3 OPV, 1 measles; 2010: based on 2012 WHO immun. position papers. 3. Based on projected vol. per immun. child for 20 countries according to introduction plans; compares 2001 vol. for tradt'l vx
with 2020 expected vol.; growth driven by penta, PCV, Rotavirus, HPV.
4. Based on 2008 projections. Source: WHO Bulletin, 62 (5):729 -736 (1984); Optimize Vaccine Supply Chains, Optimize (2009); State of the world’s vaccines and immunization, WHO (2009); Vaccine volume calculator, S.
Kone, WHO (2011); Immunization position papers, WHO (2012). Historical analysis of cMYPs in GAVI eligible countries, L. Brenzel and C. Politi (2012)
8. Me
Eli asles
min
ati
on
nus tion amily g
ta ina F
in
Te im P lann Polio
Eradi
El cation
Life Cycle
Support other NUVI Vaccination
health
interventions
Routine Immunization System
9. The five overlapping components of the
Reaching Ever y District (RED) approach
Planning and • RED is intended to be a
flexible approach
management
Monitoring of resources
• the idea is for
for action Reaching countries/districts to tailor it
the target to fit their situation
populations
Supportive • so the intensity of
supervision Linking implementing each
services with component will vary from
communities country to country
11. Africa Routine Immunization System
Essentials
(funded by BMGF)
Strengthen the evidence base to improve understanding of the
drivers of RI system performance and exploring investment
options.
What drives routine immunization performance in Africa?
Why did coverage improve in some countries?
Why did coverage improve in some districts and not others?
(within the same country: Ethiopia, Ghana, Cameroon)
Visit us at arise.jsi.com
12. ARISE Project : A pathway to improving
routine immunization coverage at district level in
Africa
13. Cadre of Community-centered
Health Workers
Take vaccination
into heart of the Mechanism
community
More workers,
build trust, Transformational
local support,
vaccine supply. step
Raised
awareness,
improved Effect
access,
increased
use
14. Partnership between the Health
System and the Community
Joint
planning, Mechanism
awareness-
raising,
Performanc
e review,
Resource
pooling
Transformational
Shared step
sense of
purpose &
accountabilit
y, credibility
Effect
Ensured
service
availability,
decreased
dropout
rates
15. Tailor Immunization Services to
Community Needs
Gather
information on
preferences; Mechanism
choose
appropriate
sites for
outreach, adapt
services
Personal links,
use appropriate Transformational
avenues, trust step
and credibility
of health
workers and
service
Increased
physical and
social access;
Effect
increased
acceptance,
improved
completion
of
vaccination
schedule
19. Role of
PVOs/NGOs
Engage on global immunization issues
Assure immunization is a core component of all
health programs
Play a role at national and sub-national levels (Inter-
agency Coordinating Committee, plans)
Staff need to stay technically up-to-date
Make sure immunization doesn’t get lost amid so
many other objectives/initiatives
20. Why does civil society (e.g., PVOs)
of ten NOT par ticipate in routine
immunization?
Feel unwelcome on ICC
Uneasy relationship with
Government/MOH
Increasing demand can
betray trust, if services
don’t follow
Community work not
valued
Immunization is too
vertical, broader objectives
Looking for financial
support
21. “New” vaccines – new opportunities
yellow fever
rubella
hepatitis B
HPV (human papillomavirus virus)
Hib (haemophilus influenzae type b)
pneumococcal (conjugate)
rotavirus
meningococcal A (conjugate)
typhoid
JE (Japanese encephalitis)
oral cholera
22. New vaccines bring new
challenges
Increase in number of vaccines (6 12 -15)
Difficult age restrictions (Rotavirus vaccine)
New target age groups (HPV)
New messages (disease syndromes, partial
protection)
Integrated approaches to disease control
Cold chain and logistics challenges (volume,
waste)
Cost of new vaccines
23. Framework: Protection, prevention and treatment
strategies for pneumonia & diarrhoea PREVENT
PROTECT Reduce
pneumonia
and
diarrhoea
morbidity
and
mortality
TREAT
24. Contribution of healthy actions for
pneumonia and diarrhea interventions -
examples
PROTECT PREVENT TREAT
Exclusive breastfeeding for Vaccines against measles, Home management of
6 months pertussis, Hib , rotavirus, dehydration (ORS and zinc)
and pneumococcus
Adequate nutrition Vitamin A supplementation Community Case
Management (CCM)
Hand-washing with soap Prevention of HIV in Case management in health
children facilities
Community-wide sanitation Cotrimoxazole prophylaxis Case management at
promotion for HIV exposed and hospitals
infected children
Treatment and safe storage Zinc supplementation for
of household water children with diarrhea
24
25. Example of BCC materials,
Kenya
PCV 10 Poster – Global Action Plan Against Pneumonia
Poster during “Malezi
Bora” child health
week (linked with
Africa Vaccination
Week)
26. oppor tunities with new
vaccines – role for PVOs?
Challenges Opportunities
Resource mobilization for Real opportunity to
new vaccine introduction achieve MDG 4
High demand for the Renewed government/
vaccine – real danger of partners interest in
stock outs immunization
Community perceptions Renewed community
on multiple antigen interest in immunization
vaccinations Training opportunity for
Communication about health workers
disease syndromes when Create momentum for
only some is vaccine- GAPP implementation
preventable
27. Oppor tunities for PVOs to engage
1) Policies and plans exist – need to strengthen communication
and community involvement for pneumo and DD prevention/
implementation; develop strategies for migrant and urban
populations
2) National and local media – develop partnerships for positive
messaging and supportive articles/programs
3) Technical Advisory Groups – integrate case management and
prevention with behavior change interventions
4) Link with initiatives (World Pneumonia Day, World
Handwashing Day, 2012 Year of RI Intensification)
5) Community mobilizers in place – improve/focus their support in
high risk areas (mapping, due lists, referral)
28. Immunization has a role to play
in your por tfolio:
MCH
IMCI/CCM
Nutrition
Safe Motherhood
Infectious Diseases
Child Health
Child Survival
PHC
29. Every child should be a
VIP…
Vaccinated,
Immunized &
Protected!
Thank You
32. Global Vaccine Action Plan’s strategic
objectives
• All countries commit to immunization as a priority
• Individuals and communities understand value of vaccines
and demand immunization as both their right and
responsibility
• Benefits of immunization are equitably extended to all
people
• Strong immunization systems are an integral part of a well-
functioning health system
• Immunization programs have sustainable access to
predictable funding, quality supply and innovative
technologies
• Country, regional and global research and development
innovations maximize the benefits of immunization
33. MCHIP immunization strategies
Increase capacity for sustainable immunization coverage
with all appropriate vaccines to reach unreached and
reduce child mortality
Support effective and sustainable introduction of safe,
high-quality, life-saving new vaccines
Engage in disease control priority programs with focus to
enhance positive effects on strengthening RI platform
Influence global and regional levels with program
learning from the field
34. Sustainable Routine Immunization System
Financing
Practices
Community
Action
Policies Supportive
Supervision Training
Supplies Monitoring
& &
Logistics
Advocacy Surveillance
&
Manageme
nt Communication
s
35. Introduction of new vaccines are
challenging the immunization system
• Good planning, partnership and adequate resources
• Effective commitment of Government, partners and
community
• Good coordination between MOH and ICC partners and
close follow-up for the introduction process
• Additional storage capacity to accommodate new vaccine
• Increased number of vaccines at the vaccination site level
• Increased immunization waste to manage and dispose
• More training for health workers and community volunteers
• Revised technical guidelines, recording and reporting tools,
IEC materials, etc.
• Good communication with parents to address concerns
• Good surveillance system prior to and after NV introduction
• Extra financial resources required to buy vaccines
36. Scale Up Map for New Vaccine Introduction
Program Implementation
National Global
Preparation
Actions Actions (3-6 months before Vaccine Launch Post-Introduction
Asses the magnitude of
the problem: morbidity launch)
and mortality due to the Advocate for vaccine
target disease with the introduction support
new vaccine
Upgrade cold chain
Initiate discussion and
reach consensus to
introduce a vaccine and Conduct registration of
the type of product the vaccine, review
vaccine supply
distribution system,
Initiate surveillance to upgrade as needed
establish baseline
Prepare and/or amend Country
application and submit re-/submits Make improvements Conduct post-
on time application to waste management introduction
system, as needed evaluation
Update/prepare cMYP PR events held assessment a Reduced
and costing tables to launch the year following morbidity
Ensure it is IRC makes a Develop learning vaccine
incorporated into the recommendation materials, conduct vaccine launch and
national health sector to the GAVI technical training mortality
plan Board Monitor and due to the
respond to any Conduct
Conduct nationwide Revise, print and
reported adverse impact targeted
cold Chain storage space distribute EPI
assessment GAVI management tools events assessment vaccine
Secretariat preventable
Develop an prioritizes Initiate AEFI disease
applications for surveillance for the NV Document
introduction plan
approval and strengthen AEFI lessons
reporting system learned
Solicit ICC endorsement
and commitment for Develop communications
implementation strategies and key
messages to address
caregiver/ provider
concern(s)
Obtain ministerial
signatures on the
application to GAVI IEC/demand creation
for new vaccine
M&E
Source: MCHIP 2011
37. What do some country
bilaterals say about ICC and
immunization?
• ICC agenda is too
narrow, confining
• Important ICC
decisions made
beforehand
• Their technical
assistance not valued
38. Potential country roles for NGOs in
routine immunization
• Directly immunize
• Support district MOH staff (capacity
building)
• Mobilize communities and create demand
• Use birth and service registers to reduce
left-outs and drop-outs
• Plan and monitor with communities
• Advocacy
39. So why does Civil Society
participate on campaigns?
• High-level request
• Clear role
• Credit/Recognition
• Funding
• Supply/services assured
“But they won’t participate for the long-run.”
40. So why do NGOs love to participate
in “Child Health”/CCM/c-IMCI?
• Credit/recognition
(appreciation from
communities)
• Supply assured
• Clear role
• Funding
41. Promotion of “Healthy
Actions”
•Motivate individuals,
households, and
communities to:
Adopt “healthy actions”
Engage in the fight against
leading child-killers
Increase demand for
health services
Identify danger signs and
seek treatment
• Improve knowledge,
attitudes, norms and
practices
42. Illustrative community linkages with immunization
• Motivate others to use immunization and other PHC services
• Arrange a clean outreach site (school, community meeting room, etc.)
• Transport vaccines and health workers, particularly for outreach sessions
• Inform other community members when a health worker/team arrives at the
outreach site
• Provide a meal to the health worker when they are on outreach visits
• Register patients, control crowds and make waiting areas more comfortable on
the day of a fixed or outreach session
• Deliver appropriate messages, including dispelling rumours about immunization
• Assist with newborn and defaulter tracking
• Arrange home visits when children are behind schedule, to explain
immunization and to motivate caregivers
• Provide equipment and even financial support
Understanding reasons for low coverage is easier when district and health facility
staff establish rapport with the community and involve community members in
planning, promoting, implementing and monitoring services
Editor's Notes
We want to do more than ever.
… and layered on top of these challenges, new ones will crop up over the next 5-10 years as we continue to add vaccines onto the RI platform
. Planning and management of resources Better manage human and financial resources 2. Reaching the target populations Improve access to and use of services through a mix of service delivery strategies (fixed, outreach, mobile, etc.) 3. Linking services with the community Engage with communities to ensure health services are meeting their needs 4. Supportive supervision Regular on-site teaching, feedback, and follow-up with health staff 5. Monitoring and use of data for action Promote use of data especially during review meetings, use data tools for self- monitoring (e.g. charting of doses), map population in each health facility Immunization programs have pioneered approaches that lend themselves to adaptation by other health programs. Many countries are implementing RED. It’s a package of common-sense elements relevant to most interventions, not just vax. Because vax sessions can be scheduled in advance, they can be better planned and supported. We identify the low-performing populations to be prioritized. RED consists of tools, approaches to monitoring and supervision, that can be customized for each country. And RED includes a module to better link health facilities with communities. Targets pockets of unimmunized children and mothers for better equity Focuses planning on low coverage and hard to reach areas Prioritizes the use of limited resources Decentralized approach, with focus on district level and below Some better practices: District prioritization, training, microplanning Mentoring and quality improvement through regular and supportive supervision Analysis and sharing of data with local partners on a monthly basis; visible display of monitoring charts in facilities & districts Newborn and defaulter tracking Catchment area maps displayed at facility and district levels Active community involvement in planning and implementation of activities
Nigeria Swaziland
When country findings were compared and synthesized, six drivers of routine immunization performance improvement emerged as conceptually common to the nine study districts where coverage improved – Direct drivers Enabling : Political and Social Commitment to Routine Immunization Actions of Development Partners Health System and Community Partnership Cadre of Community-centered Health Workers Regular Review of Program and Health Worker Performance Immunization Services Tailored to Community Needs These same drivers were absent or weaker in the three study districts where coverage remained steady. Although researchers began by tracing possible pathways from each driver to improved coverage, as they compared country and district experience, it became clear that no single driver could independently explain performance improvement. Rather, the cases revealed how the six common drivers were often connected, and in some instances, dependent on each other for achieving results. They worked in synergy using specific mechanisms to bring about conditions or actions that resulted in:
Not linear 1. Mechanism: How it worked: Bringing vaccination into the heart of the community; regular service provision that was planned with the community; Delivered vaccination through health posts, outreach services, and sometimes home visits; planned with community; educated and informed the community through local leaders and local channels; encouraged attendance; coordinated volunteers; worked with community to improve defaulter tracing; home visits; registering children; 2. Effect: raised awareness of the benefits of immunization ; increased physical and social/cultural access; increased demand for services; improved regular attendance (vaccination completion); 3. Pivotal – transformational step: Why it worked: more people; built trust, name recognition, supported by district and facility staff/supervisors, strong link to local government and volunteers/volunteer network; learned community needs and tailored services accordingly; engage community in running the program; clear expectations and accountability; gained community respect and support; health workers motivated; reliable vaccine supply.
Mechanisms: joint planning; joint awareness raising and motivation of community; joint performance review; health workers sits on local government cabinet (Ethiopia); resource pooling (human and material) Transformational steps: shared sense of purpose; shared system of accountability; community recognizes technical credibility of health workers and social and political authority of community members/leaders; Outcome: ensured service availability; increase use of vaccination service; decreased dropout rates, increase completion of vaccination schedules;
Mechanisms: Health workers together with local, political and administrative leaders and volunteers gather knowledge about the community and community needs/preferences; based on their knowledge health workers choose appropriate sites for outreach, adapt the service schedule to encourage maximum attendance, and take services into the home when needed; health workers provide services consistently and reliably to meet needs; health workers adapt communication message to community, district management teams empower health workers to determine their own clinic and outreach schedules based on community input, district management teams split the community into zones so that communities are more manageable for the health workers who feel ownership over their assigned populations, the district management team has fiscal autonomy to tailor service delivery in response to community demand. Transformative steps: Health workers formed personal links to the community to gain greater understanding of their needs and increase community trust in health messages; health workers u se of appropriate avenues by which to inform people about immunization and immunization services; improving community access to appropriate and reliable services builds trust and credibility in health worker and health system in community; health workers are held accountable by the community, the health system and the local and political leaders and feel responsible for delivering good quality service Outcome: Increased physical and social access to care; improved community acceptance of vaccination and attendance at clinics and outreach sites,; reduced vaccine dropout rates, improved completion of vaccination schedule
The first column requires primarily communication support. The second and third, a mix of communication and health services/supply.