Day 3, Tuesday, April 26, 2005

Objectives:

• Identify program and practice gaps and TA needs
• Refine, review Terms of Reference (TORs) for Network
• Determine Year One activities for Network through September 2006
• Discuss next steps for CA collaboration in CBIPPC Network.

Group Discussion

After a brief recap on previous days activities the groups presented their discussions in plenary.

Group 1

Technical issues

The group recommended thatCountry-specific foundations need to be built, based on a series of questions:

Primary questions:

1. Defining the Health System

a. What are the cadres of Health Workers / Care Providers?

i. Formal / Informal

ii. Internal / External to the Health System

iii. Existing qualifications

iv. Existing regulations restricting scope of practice

b. What is the supervisory framework?

c. What are the referral pathways?

d. What is the training / information dissemination framework?

e. What are existing opportunities for ANC/Delivery/ PPC/ NBC

interactions?

2. Qualitative / Descriptive Formative Research

a. Cultural Framework of Birthing / PPC

i. Defining existing Birth / Delivery / PPC practices

ii. Identifying harmful practices

· Reasons for poor decision making

· Reasons for delayed treatment seeking

· Referral Pathway (Traditional providers, etc)

iii. Identifying cultural norms which are contrary to Best Practice

     Guidelines

b. Who is present at birth?

i. What are their roles?

ii. Are there any blind spots?

c. Describe the economic profile of Birth / PPC / NBC

            Existing Birth Planning?

d. Defining the availability of drugs / regulations

e. Role of Community Leaders

f. Identify the Gatekeepers

Group 2

Support systems

The group recommended that support systems starting from family to facility are extremely crucial for success of the program. As postpartum care is not perceived as a felt need by the community and very little is offered by way of PPC by the health system and yet majority of maternal and neonatal mortality and morbidity happen in this period, technical issues and interventions that are suggested should bear in mind the existing support systems and what more needs to be developed for successful service delivery right where the women need it.

Group 3

Monitoring

Recommendations

• Indicators proposed as aggregate or combined at Indicator level and Program component level
• Standardization is required to ensure cross country comparison
• Customize to fit in specific need of the country or maturity level of the program concerned

Need for indicators of policy, guidelines/ protocols, appropriate and effective support systems, and the need to authorize health providers to provide appropriate care at designated levels

The group highlighted the need for identification of appropriate set of indicators based on program objectives, development of standard tools and methods, capacity building for monitoring indicators at program level and feed-back for program development and process documentation

Group 4

Scaling up

Recommendations:

Situation Analysis

·         Formative Research

·         Stakeholder Analysis

·         Who are they?

·         What are their stakes and interests?

·         What should they be used for?

Package / Content

·         Identification of priority items

·         Evidence based/ results focused

·         Considers effectiveness and feasibility

·         Explicit about start-up strategy

·         Design for scale

Context

§         Coverage/ Targeting

·         Vulnerable populations

o        How can we identity and reach those most in need?

·         Consideration of Equity

o        Tradeoffs associated with  reaching marginalized populations

o        Cost effectiveness

§         Appropriateness for local setting

§         Adapt to existing structures

·         Identify operational gaps

·         Avoid adding new cadres of staff

§         Resource Mapping

·         Government and private sector services

Advocacy and strategic planning for scaling up is required. Implementation requires

Implementing agency / vehicle

Consideration of private sector

Linkages with the formal health sector

NGOs/ PVOs, faith-based organizations

Inputs

At what point in the intervention cycle are we and when is scale-up feasible?

What are the resource needs?

Community Interests

Buy in / acceptability by:

Changing knowledge and practices

Bridging known to new

The main challenges to scaling up are financing / resources, sustained donor interest, linkages, addressing equity issues, maximizing existing tools and best practices, human resource development, indicators of progress, and quality assurance.

In the last session participants discussed the way forward and need for developing partnerships beyond USAID. A need was felt to ensure governments come on board to take the issue forward and move from project to program mode. It was shared that ICDDRB would act as secretariat to follow up on this initiative and would be supported by a program associate. Dr. Marge Koblinsky would put in 20% of her time for this work.

The meeting concluded with vote of thanks from the organizers.