Geneva Health Forum Archive

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GHF2014 – PS28 – Patient-Centric Technology: Innovation for Health

PS28 THURSDAY, 17 APRIL 2014 ROOM: 15 ICON_Fishbowl
Patient-Centric Technology: Innovation for Health
Mr. Hani Eskandar
ICT Applications Coordinator, ICT Applications and Cybersecurity Division,  Telecommunication Development Bureau of ITU, Switzerland
SPEAKERS (tentative):
Dr. Oliver Harrison
Senior Vice President, Healthways International; Consultant to WHO on mHealth for tackling Non-Communicable Diseases, Switzerland
Mr. Andrés Martin
Head of Digital Strategic Planning, BUPA
Mr. Sameer Pujari
mHEALTH secretariat for WHO and ITU joint program on mHealth for Non-Communicable Diseases, WHO, Switzerland
Mr. Simão Ferraz de Campos Neto
Counsellor for ITU-T Study Group 16, Secretariat of the ITU Standardization Sector, Switzerland
With the fast pace of technology development and the demand of improved service accessibility and quality, disruptive innovation has been having the perfect environment and opportunity to show its potential. Within healthcare, this mainly took form as the now very well-known field of personalized medicine, which allowed information and services to be more accessible to patients, healthcare professionals as well as the overall public and private sectors. Due to higher interaction between stakeholders, health services accessibility and quality will improve and to meet everyone’s expectations and needs. These technology advances allowed patient’s empowerment as well as the emergence of new services and trends. Special focus has been put on wearable technologies, which with time have been widening its use and purpose besides decreasing in size. Such technologies enabled the self-management of patients with chronic diseases, the improvement of quality of life of elderly and the promotion of healthier behaviors concerning physical activity and nutrition. Smart watches or bracelets track now users’ activities, wireless sensors correct a person’s posture, ingestible sensors are used for drugs’ compliance, biosensing clothing monitor heart rate and activity among many others. Innovation within healthcare has therefore been focused more and more on each person’s unique conditions and needs.The objective of the session is to facilitate a dialog between all stakeholders involved, namely government regarding policy-making and standardization requirements, private sector regarding future technology advances and trends, healthcare providers regarding new opportunities and international organizations regarding required global actions to unlock possible bottlenecks and to address challenges that will accelerate large scale uptake of these new technologies for improved health outcomes.

Hani_EskandarMr. Hani Eskandar

Mr. Hani Eskandar is the ICT Applications Coordinator at the ICT Applications and Cybersecurity Division of the Telecommunication Development Bureau of ITU. Mr. Eskandar is currently involved in providing assistance to several developing countries by advising on eApplications strategies and policies, assisting in implementing technical co-operation projects and developing guidelines and best-practices on eApplications.

Previously, Mr. Eskandar had extensive experience in the field of ICT for Development where he, through his work with the International Federation of Red Cross and Red Crescent in Switzerland and, UNDP and other NGOs in Egypt, was involved in several development projects in the fields of Health, Education, Illiteracy Eradication, Community Development, SME development and Micro Credits. This included, among others, introducing Telemedicine services in rural areas, introducing ICT in Schools, creating Community Development Portals, Community Learning Centres, developing e-Learning and training programs for Youth.

Mr. Eskandar has an educational background in Electrical Engineering (Telecommunications) and has completed an MBA from McGill University, Canada and a Master Degree in Social and Economic Development Studies from University of Paris I, France.

Oliver_Harrison_squareDr. Oliver Harrison

Dr. Oliver Harrison is a Senior Vice President with Healthways International, a global health and wellbeing company specializing in population health management based on more than 30 years of experience.  He is also a Consultant to the WHO for their joint initiative on mHealth for tackling Non-Communicable Diseases, and Co-Founder of Platform Health (, a non-profit Standards Development Organisation and ITU Sector Member.  Platform was created to help close the remaining gaps to enable secure “plug and play” health data system interoperability, including mobile.

Until 2013, as Director of Strategy at the Health Authority – Abu Dhabi, Dr. Harrison helped drive a comprehensive health system reform.  Progress was driven and tracked using data from pioneering IT systems designed/implemented by the Health Authority team (; these systems have become the blueprint for several additional countries (  Dr. Harrison established the Abu Dhabi Public Health Department, which used these data systems as the foundation to design and implement “Weqaya” – an award-winning population health management programme targeting diabetes, hypertension, and other risk factors for cardiovascular disease (

Before Abu Dhabi, Dr. Harrison spent five years with McKinsey working worldwide with the healthcare practice.  He is a UK physician with US National Board Certification in Public Health, and Masters’ degrees in Public Health from Johns Hopkins and Neuroscience from Cambridge University, a Non-Executive Director of Guy’s and St. Thomas’s NHS Trust, and a member of the World Economic Forum Global Agenda Council on Behaviour and Cognitive Science.

Andres_Martin_squareMr. Andrés Martin

Andrés Martin Diana was born in Seville, Spain, has academic background in Media and holds a MBA by the IE Business School (Madrid). He has been working in the digital arena since 1997, when he co-founded and managed a pioneering online content start-up. Passionate about healthcare disruption by innovative online services and technologies, he led the digital marketing, sales and services for Sanitas, a leading healthcare company in Spain, until 2008. After that, he was responsible for Bupa’s global digital strategy until 2013. He now leads the partnership between Bupa and the WHO and ITU for mHealth, supporting the initiative Be Healthy Be Mobile to tackle non communicable diseases globally. He has been invited as speaker in several international conferences on strategy, digital transformation and eHealth/mHealth

Sameer_PujariMr. Sameer Pujari

Currently with WHO, Sameer Pujari is part of the mHEALTH secretariat for the flagship WHO and ITU joint program on mHealth for Non-Communicable Diseases; Be He@lthy Be Mobile. With WHO, he has also provided technical advise and support to over 30 countries in the development of surveillance and management information systems. He is also a core member of the Health Data Forum at WHO and the co-chair of the WHO mHEALTH working group. Before coming to WHO, Sameer worked with the US Governments health agency helping various countries build informatics systems for immunization and vaccination programs in Asia Europe and Africa. He started his career working with WHO's National Polio Surveillance Project in India for 7 years, where he led the development and implementation of various information management systems for surveillance across the country.

Campos NetoMr. Simão Ferraz de Campos Neto

Simão Ferraz de Campos Neto joined the secretariat of the ITU Standardization Sector in 2002, and is the Counsellor for ITU-T Study Group 16 (for standardization work on multimedia services, protocols, systems, terminals and media coding, including accessibility, IoT, IPTV and Digital Signage). He organized several workshops (e.g. Multimedia in NGN, Telecoms for Disaster Relief, RFID, E-health standards; SIIT2005) and was the editor of the first version of the ITU-T Security Manual.

Prior to joining ITU in 2002, Mr Campos worked for 8 years as a scientist in COMSAT Laboratories performing standards representation and quality assessment for digital voice coding systems, and before that he was a researcher at Telebras’s R&D Center (CPqD).

A Senior Member of the IEEE, Mr Campos authored several academic papers and position papers, served in the review committee of several IEEE-sponsored conferences, and organized the first ITU Kaleidoscope Conference.

GHF2014 – LS02 – Evidence Informed Decision Making in Achieving UHC: the Role of Macro HTA

Evidence Informed Decision Making in Achieving UHC:
the Role of Macro HTA

Dr. Nick Drager
Honorary Professor, Senior Fellow, Global Health Programme, The Graduate Institute, Geneva
Mr. Adrian Griffin
Vice President, HTA Policy, Johnson & Johnson
Dr. Franz Pichler
Director, Global Public Policy, Eli Lilly and Company
Dr. John-Arne Røttingen
Norwegian Knowledge Centre for the Health Services
Dr. Eva Maria Ruiz de Castilla
Executive Director, Esperantra (NPO, Peru)

As a number of countries aspire to implement universal health coverage frameworks, many are looking at methods to best structure their health system to ensure citizens obtain the health services they need. Given cost constrained environments, many low and middle income countries have increasingly focused efforts on prioritization and determining value for investments in health. As such, a significant focus has turned towards the use of research evidence as a tool to support decision making. However, historically, this type of evidence has rarely been applied to support overall health system decision making. In the context of developed countries, a narrow interpretation has placed a significant emphasis on decisions related to coverage and reimbursement of healthcare technologies, such as medicines and diagnostics. 1 Healthcare technologies are only one of several inputs in the overall health system. The organization and delivery of a health care system is a complex matter, which requires a number of decisions regarding the resources necessary to ensure access to services, the mix of interventions required and the means to achieve optimal results.2 Limiting evidence based decision making to coverage decisions tends to obscure the potential role to apply to the overall health system as a whole, such as interventions that facilitate access, service delivery, and aim to improve quality of care.

Therefore, as countries embark towards universal health coverage, it is important that decisions related to coverage of health products and benefits packages are only one part of the discussion. Many low and middle income countries have extensive inefficiencies in their health systems, including issues related to service delivery, quality of care and treatment standards that transcend the need to focus specifically on coverage of health technologies to determine value for investments in health.

This session will explore the role of evidence informed decision making in achieving universal health coverage, looking specifically at the role of "macro" HTA as it is applied to overall health system efficiency and quality of care. This unique session will provide the audience with a view of different perspectives from various sectors in the healthcare space - patient, industry, academic and payer/NGO. Through live interaction, the audience will be able to participate and provide thought provoking questions/answers amongst the group to explore this innovative topic.


Nick Drager M.D., Ph.D
Honorary Professor, Senior Fellow, Global Health Programme, The Graduate Institute, Geneva

Former Director of the Department of Ethics, Equity, Trade and Human Rights and Senior Adviser in the Strategy Unit, Office of the Director-General at the World Health Organization- now is Honorary Professor, Global Health Policy, London School of Hygiene & Tropical Medicine; Professor of Practice, Public Policy and Global Health Diplomacy, McGill University; Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa; Adjunct Research Professor, Norman Paterson School of International Affairs, Ottawa; and Senior Fellow, Global Health Programme, The Graduate Institute, Geneva.

  • Work focuses on current and emerging issues related to global health, in the areas of global health security/diplomacy/governance, foreign policy and international trade and health including intellectual property and health.
  • Extensive experience working with senior officials in over 100 countries and major multilateral and bilateral development agencies in health policy development, health sector analysis, strategic planning and resource mobilization and allocation decisions and in providing strategic advice on health development negotiations and in conflict resolution.
  • Deep experience in global health diplomacy and high-level negotiations on international health security and development issues.
  • Represented WHO, serves as chair, keynote speaker at major international events and conferences; lectures and teaches at Universities in Europe, North America and Asia.
  • Editor/author of books, papers and editorials in the area of global health; global health diplomacy; trade and health including IP; foreign policy and health. Has an M.D. from McGill University and a Ph.D. in Economics from Hautes Etudes Internationales, (the Graduate Institute) University of Geneva.


AdrianGriffinAdrian Griffin
Vice President, HTA Policy, Johnson & Johnson

Adrian Griffin is Vice President, HTA & Market Access Policy at Johnson & Johnson.  He has been involved in the fields of health economics, outcomes research, and reimbursement policy within the healthcare industry for 16 years, with experience across the pharmaceutical, medical device, and diagnostic sectors.

Mr Griffin graduated in Medicinal Chemistry from University College London, obtained a post-graduate teaching qualification from Oxford University, and spent several years teaching chemistry before joining the UK’s Medical Research Council.  He then received his MSc in Health Economics at City University, London, before joining the healthcare industry.  Mr Griffin has held positions at GlaxoSmithKline, Pharmacia, and most recently Johnson & Johnson, where he has been since 2003.

In addition to undertaking outcomes research from the industry perspective, Mr Griffin has also served as a ‘decision-maker’, on the NICE Technology Appraisal Committee, where he has been a committee member for 10 years.  Mr Griffin is also active in numerous multi-stakeholder forums where key issues of HTA and access policy are debated and shaped, such as the HTAi Policy Forum, and initiatives that have brought regulators and HTA agencies together with companies, thus improving transparency and appreciation of different stakeholder perspectives.

Mr Griffin has contributed to several UK industry-government task-force and working groups, aimed at developing policy and processes to improve equitable access and uptake for patients to new innovations.

Within Europe, Mr Griffin has engaged through Company and Industry Association activities with EUnetHTA, with the aim of ensuring that what comes out of HTA collaboration across Europe is fit for purpose, with the ultimate aim of improving healthcare for patients.

Mr Griffin is currently on the Board of Directors of ISPOR, (the International Society for Pharmacoeconomics and Outcomes Research), and continues in his position as a member of the NICE Technology Appraisals Committee


Franz_Pichler2Franz Pichler, PhD
Director, Global Public Policy, Eli Lilly and Company

Franz Pichler has been Director, Global Public Policy at Eli Lilly and Company since 2012. This role encompasses development of external policy positions; provision of strategic advice; and external engagement around policy-related issues. A key focus of the role relates to the European environment, in particular with regards to Health Technology Assessment (HTA) and market access. He represents Lilly on the EuropaBio HTA and Market Access Group and the EFPIA HTA Task Force Steering Committee. He participates in the EUnetHTA Stakeholder Advisory Groups related to relative effectiveness assessment and methodological guidelines development. He is co-chair of the Medicines Adaptive Pathways to Patients initiative and is a participant of the Innovative Medicines Initiative (IMI) project ‘Incorporating real-life clinical data into drug development’ (GetREAL). He was a founding member of the HTAi interest sub group on HTA-Regulatory Interactions which he currently chairs. Franz joined Lilly after serving as the manager of the HTA Programme at the Centre for Innovation in Regulatory Science (CIRS) – a non-profit, independent medicines policy and research think tank. Prior to joining CIRS, Franz worked for over 10 years in molecular biology with specialties in functional genomics, population genetics and bioinformatics. He obtained his BSC in biology and PhD in population genetics at the University of Auckland in 1997 and 2002 respectively.


John_Arne_Rottingen_squareDr. John-Arne Røttingen
Norwegian Knowledge Centre for the Health Services

John-Arne Røttingen is Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health; Professor of Health Policy at the Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo; Visiting Professor at the Department of Global Health and Population, Harvard School of Public Health; and Institute Visiting Scholar at the Harvard Global Health Institute.

He is Associate Fellow at the Centre on Global Health Security, Chatham House; research associate of the European Observatory on Health Systems and Policies; Chair of the Board of the Alliance for Health Policy and Systems Research; member of the Scientific Oversight Group of the Institute for Health Metrics and Evaluation, University of Washington, Seattle; and member of the International Advisory Committee for the Global Burden of Disease study.

He has been Director General of the Norwegian Knowledge Centre for the Health Services; Oxford Scholar at Wadham College; and Fulbright Fellow at Harvard Kennedy School.

He received his MD and PhD from the University of Oslo, an MSc from Oxford University and an MPA from Harvard University.


EvaMaria_Ruiz_de_CastillaEva Maria Ruiz de Castilla, PhD
Executive Director, Esperantra (NPO, Peru)

Dr. Eva Maria Ruiz de Castilla is a co-founder and since 2006 Executive Director of ESPERANTRA, a not-for-profit cancer and chronic disease patient advocacy organization in Lima, Peru. Her work at Esperantra is to improve the quality of life of patients with chronic conditions, health promotion, and to advance the recognition of the rights of patients to achieve access to timely diagnosis, treatment, and follow-up care. She has been instrumental in a number of national initiatives focused on cancer, including the government’s Plan Esperanza launched in 2012 to provide basic cancer care coverage for the poorest and most vulnerable Peruvians.

In addition to her work with Esperantra, Dr Ruiz de Castilla consults part-time for various Peruvian ministries, including Health, Social Development, Housing, Women, and Water-Sanitation to help design and coordinate the country’s public-sector social assistance programs. From 2011 to 2012, Dr Ruiz de Castilla was Director General of the Peruvian Ministry of Health’s (MINSA) International Coordination office and before that served as MINSA’s Director General of Health Prevention and Promotion. She has in-depth experience working with donor country agencies and multilateral organizations such as the World Bank.

As a Board Member of the International Alliance of Patients’ Organizations (IAPO) since 2010, Dr Ruiz de Castilla has been a global leader in patient-based organizational capacity building and has led various workshops on patient empowerment and networking. Her experience and involvement with building the capacity of civil society organizations focused on cancer in Peru earned her the American Cancer Society’s “Excelencia Latina 2009” Award. In 2011, Dr Ruiz de Castilla was named a Global Cancer Ambassador by the American Cancer Society, and was invited by the World Health Organization to participate as a civil society representative during the UN High-Level Meeting on non-communicable diseases (NCDs).

Dr Ruiz de Castilla’s academic credentials include degrees in Industrial Engineering and a PhD in Economic Development at the EHESS in Paris, France, and in Political Science at the Sorbonne University Paris 1. In Europe, she consulted for the United Nations on food and agriculture issues for the southern common market (MERCOSUR). Dr Ruiz de Castilla has authored a number of publications and papers on social development, health, and citizen engagement, and has been invited to speak at more than 200 national and international congresses.

GHF2014 – PS23 – Inclusive Decision Making and Local Health Policy Development

Inclusive Decision Making and Local Health Policy Development
Ms. Monika Christofori-Khadka, Health Advisor, Swiss Red Cross, Switzerland
Equity and Local Government: Sao Paulo, Brazil
Dr. Vera Coelho, Coordinator, Citizenship, Health and Development Group, Brazilian Centre of Analysis and Planning, Brazil
Inclusive Decision-Making and Community Empowerment for Health and Well-being: The Health Promotion and System Strengthening Project in Tanzania
Dr. Kate Molesworth, Senior Public Health Specialist and Reproductive Health and Social Development Adviser, Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Switzerland
Strengthening Health Systems and Democracy Through the Empowerment of Rural Indigenous People for Rights Claiming in Guatemala
Dr. Walter Flores, Executive Director, Center for the Study of Equity and Governance in Health Systems, Guatemala

Khadka Profile PhotoMs. Monika Christofori-Khadka

Trained physiotherapist, working in several institutions in Germany.

1993-1996   Physiotherapist tutor in Tansen, Nepal

1999             Masters in Community Health, Liverpool School of Tropical Medicine, UK

2000-2005   Health Delegate in Bangladesh re-establishing and managing a MNCH programme of the Bangladesh Red Crescent  Society

2006-2012   Programme Coordinator for Kyrgystan, Nepal and China/Tibet with Swiss Red Cross, Switzerland

2010-2012   Masters in Health Economics, Policy and Management, London School of Economics, UK

Since 2013   Health Adviser of the Swiss Red Cross

VeraCoelhofoto (2)Dr. Vera Coelho

I have a PhD in social sciences in the area of “State and Public Policies” and I work at CEBRAP, an independent and interdisciplinary research center located in São Paulo, Brazil. I work with both qualitative and quantitative research methods, evaluating policies and coordinating comparative research projects in the areas of health systems, citizen involvement and pension reform. During the last twenty years I had some nice opportunities to combine professional responsibilities and personal interests as, for example, in 2008 when I went to the State of Gujarat in India to research the social justice committees at the panchayat, the local governance institutions. During my stay, I attended yoga classes, it was a great experience.

walter flores at IDRC-Beijing receptionDr. Walter Flores

Dr. Flores, a national from Guatemala, is a social scientist with over 20 years of professional experience. He holds a PhD and a Masters of Community Health from the Liverpool School of Tropical Medicine, UK.  His professional work has been carried-out in more than 20 countries from Latin America, Africa, Asia and Europe. His areas of expertise are:  health policy analysis, health equity, right to health, democratic governance of  public policies and community participation in public policies. Currently, Dr. Flores is the director of  Center for the Study of Equity and Governance in Health Systems), a civil society organization in Guatemala specialized in research, capacity building and advocacy around issues affecting indigenous and other marginalized populations (

GHF2014 – PS20 – Harnessing ICTs to Improve Tuberculosis Control

PS20 WEDNESDAY, 16 APRIL 2014 ROOM: 16 ICON_Fishbowl
Harnessing ICTs to Improve Tuberculosis Control
Dr. Lucicia Ditiu
Executive Secretary, Stop TB Partnership, World Health Organization, Switzerland
Communications Platform for Tuberculosos to Supplement Mainstream Media: India
Ms. Barathi Ghanashyam
Founder Editor, Journalists against TB, India
mTB by Front Line Workers in a Tribal District in India: A Pilot Study
Dr. Archana Trivedi
Union South-East Asia, The Union, India
Using Technology and Community Empowerment to Treat Tuberculosis
Dr. Shelly Batra
President and Co-Founder, Operation ASHA, India
Dr. Alberto Colorado
Patient Advocate, International Public Health Consultant, Advocates for Health International, United States
Mr. Andrew Codlin
Stop TB Partnership, World Health Organization, Switzerland

Ghanashyam Profile PhotoMs. Barathi Ghanashyam

Unconventional choices have shaped my personal and professional life.  Having chosen to eschew formal academics, I pursued the path of learning – learning what I wanted to, in the way I chose to – by reading, absorbing and applying what I learnt to real life situations.  I have also been deeply influenced by the intensive field trips I have undertaken into rural India in the course of my career as a development writer.  Living and interacting with rural communities have taught me to respect their traditional wisdom, the way they cope with lack of choices, the simplicity with which they find solutions to their complex problems and I have often been humbled into emulating their way of life – which is devoid of artifice of any sort.  My writing, because it resonates with field realities, is credible and important for development processes.

PS20_Archana_TrivediDr. Archana Trivedi

Medical Doctor married with two sons, served in Indian Army (Medical Branch) with 21 years of rich and dynamic work experience in the medical field with 7 years of hands on technical experience working in National Health Program on Tuberculosis. Have background of working for 7 years in Global Fund Projects with International Union Against Tuberculosis and Lung Disease, Catholic Bishop Conference of India, Catholic Relief Services and Indian Medical Association.

Have ability to work and liaise effectively with government agencies, civil society organizations, private sector, people affected with diseases and synergize with other stake holders.  Also have persuasive and innovative skills supported by thorough research, to achieve best accruals for health projects. Have ability to conceptualize and lead health projects from front in strict disciplined environment. Adept in program management to include planning, coordination, execution and monitoring & evaluation of project.

At present position in Union South-East Asia The union, implementing project to involve qualified and non-qualified private practioners to promote TB care and control. Developed mobile application to track and trace TB patients. Currently scaling up mobile application under World Bank IDM project and Grand Challenges-TB Care along with Dimagi (USAID funded project).

Batra PhotoDr. Shelly Batra

I started my professional journey as a young surgeon, of which I was dazzled by the glamour, fame and money that was part of being a doctor. Very soon I came to a cross road and decided to take the road not taken. So, on one side there were the dazzling lights, the success and the glamour but the other route was an uphill path; rocky and thorny and all around was the stench of disease and death and all I could hear were the sighs of the sick and dying; that is the road I have chosen.

Mr. Andrew Codlin

I worked along the Texas-Mexico border studying the interaction of diabetes and pulmonary infections (influenza and tuberculosis) for two years.  I then moved to Karachi, Pakistan, where I spent 3 years implementing TB case finding initiatives focused on the private healthcare sector. All of  my programs had a significant mHealth component and I worked with other TB REACH grantees to adapt our successful strategies for other country contexts.

GHF2014 – PS18 – Improving Health Information Systems for Better Decision Making

Improving Health Information Systems for Better Decision Making
Mr. Hazim Timimi
Data Manager, Tuberculosis Monitoring and Evaluation, World Health OrganizationSwitzerland
Best Practices for Building an Integrated National Health Information System: Rwanda
Dr. Caricia Catalani
Senior Researcher, Innovative Support to Emergency, Disease, & Disaster (InSTEDD) & University of California, Berkeley, School of Public Health, United States
Prof. Don De Savigny
Head, Health Systems Interventions Research Unit, Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Switzerland

PS18_Catalani_squareDr. Caricia Catalani

I am a researcher, focusing on digital innovations for health.  I started working in the health field at age 16, as a physician’s assistant in our family-run urgent care clinic in the rainy Pacific Northwest of the United States. Since then, I’ve worked in an emergency room in a tough neighborhood in New York City, a sex workers’ union in the Dominican Republic, devastated neighborhoods in New Orleans after hurricane Katrina, US government health departments across the coasts, a cigar factory in Cuba, one of the world’s biggest private health insurance companies, a women’s health advocacy powerhouse in Washington, DC, a milky-eyed shamanic healer’s hut on the border of Cameroon, a teen health and empowerment center in San Francisco low-income housing, and clinics with mud floors and tin roofs throughout the African continent.  These days, I spend most of my time as a research consultant to eHealth, mHealth, and digital innovation projects at ministries of health, hospitals, and non-governmental organizations around the world (especially in Rwanda, Cambodia, Kenya, India, Canada, and the USA). I am faculty at the University of California, Berkeley, where I teach courses on digital innovations for health.  Awesome comedy improv and freestyle rap give me a lot of joy.  I spend countless hours learning from my four-month old and three-year old daughters, as we grow up together in the San Francisco Bay Area.

Don de Savigny_squareProf. Don de Savigny

Professor de Savigny is an epidemiologist and public health specialist and currently Head of the Health Systems Research Unit in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, University of Basel.  He has extensive experience in conducting and facilitating health research in developing countries and has lived and worked for many years in Africa.  He chairs or is a member of a number of WHO, RBM, Global Fund, and TDR advisory committees and networks such as COHRED, the Health Metrics Network and the INDEPTH Network.  His current research focuses on interventions to strengthen health systems in developing countries, and on the health system effects of Global Health Initiatives for scaling up access.

Strengthening the competencies and skills of nurses in mental health: Experiences from Bosnia and Herzegovina

Author(s) Selma Kukic1, Zvjezdana Stjepanovic2.
Affiliation(s) Mental health, Mental health Project in BH, Sarajevo, Bosnia and Herzegovina, Mental Health, Mental Health Project in BH, Banja Luka, Bosnia and Herzegovina.
Country - ies of focus Bosnia and Herzegovina
Relevant to the conference tracks Health Workforce
Summary The mental health reform in BiH was launched in 1996 focusing on community-based care and so far has made significant progress in the development of a large network of community mental health centers. In the centers multidisciplinary teams operate, however nurses are the largest and least skilled professional category of professionals and have the highest fluctuation rate within health system. The reform project in BiH (Mental Health Project in Bosnia and Herzegovina) is focused on the informal education of nursing staff with the objective of professional development, empowering and providing networking as a first steps toward a systematic re-profiling of nurses in mental health.
What challenges does your project address and why is it of importance? In 2008/09 the survey "Situation analysis and assessment of community-based mental health services in Bosnia-Herzegovina“ (Mental Health in SEE Project 2009) was undertaken. The findings of the 2008/09 survey were used as the baseline for the Mental Health Project in BiH to monitor changes and improvements made with the project's support. A self-assessment of the middle-level nursing staff in this survey revealed that the staff believed they were under-trained. 46% of nurses believed they had not received enough training to work in a mental health centre, and the MHC team members believed that the work of the nursing staff was not recognised by other health professionals and that there were prejudices caused by vaguely defined job descriptions for the nursing staff working in a MHC team. A new concept of nursing, as well as the empowerment of nurses within the system of community mental health, requires well trained nurses, whose knowledge is closely linked to psychological, sociological, philosophical, educational, medical and expert training. This would improve the ability of nurses to assume new tasks. This can be achieved through formal education, non-formal education, continuing professional education, as well as initiative and creativity in the field of nursing.
How have you addressed these challenges? Do you see a solution? The adequate re-profiling of nurses in mental health is optimally achieved through formal education. This project presented informal education as the first step to a systematic aproach. Education has garnered excellent results in terms of narrowing the gap of professional training, but the benefits of education are more reflected in the development of contacts, exchange of experiences and formal networking of these professional groups that did not previously exist in the form of professional associations. The results indicate that associated advocacy for the development of nursing legislation on education and employment in mental health is required.
How do you know whether you have made a difference? The results of the performance evaluation of the Conducted Educations suggested key improvements in the work of this professional group. 96 % of respondents felt that the education contributed to providing quality services to patients and their families through individual or team work. Particular emphasis was upon the acquisition and use of new knowledge, skills and techniques in work (88%), the rights and obligations of medical professionals and patients (66%) and combating the stigma of mentally ill patients in society (32%). 90 % of respondents observed changes in the area of respect for the professional attitudes of mental health nurses by other team members. Particular emphasis was on the experience exchanges among colleagues (65%), the level of self- confidence in the process of presenting opinions to their superiors (64%) and an additional level of competence to work within a multidisciplinary team (53%). With continous collaboration with mental health staff in MHCs there is greater viability for the initiatives taken by nurses to process their difficulties in work.
Have you or the project mobilized others and if so, who, why and how? The key project holders and implementers were the Ministries of Health, and their key responsibility was to make the entire process a success by ensuring the participation of nursing stuff and relevant experts and key stakeholders in the implementation of activities, as well as to provide further support to the continuing education of nursing staff.
When your donor funding runs out how will your idea continue to live? Sustainability is ensured through cooperation with other projects whose main goal is to work on legislation that would provide a legal framework for the employment of nurses in mental health, including formal education, by providing needed information and support.

Inclusive decision-making and community empowerment for health and well-being: The Health Promotion and System Strengthening Project in Tanzania

Author(s) Kate Molesworth1, Ally-Kebby Abdallah2
Affiliation(s) 1Swiss Centre for International Health (SCIH), Swiss Tropical and Public Health Institute, Zürich, Switzerland, 2Health Promotion and System Strengthening Project (HPSS) Field Office, Swiss Tropical and Public Health Institute, Dodoma, Tanzania.
Country - ies of focus Tanzania
Relevant to the conference tracks Advocacy and Communication
Summary This presentation aims to show how participatory techniques can be effectively embedded within government health and community development structures to successfully support community action for health and well-being and at the same time contribute to broader positive social change and equitable access to health services.
By using participatory techniques and at the same time mainstreaming gender, HIV and social equity, within the project itself, as well as at the community and government levels, the Health Promotion and System Strengthening Project (HPSS) takes a broad human rights, equity and inclusive approach, to improve the health and well-being of all members of the community.
What challenges does your project address and why is it of importance? The HPSS Project aims to improve the health status and well-being of all members of a community through innovative approaches, with a particular emphasis on the support of vulnerable people, such as women, children, elderly and socially disadvantaged. A special focus is to ensure that all aspects of project implementation and information will maximize the potential to include all sectors of society in community health promotion and address existing inequalities. However, most often communities - and in particular vulnerable groups - do not have an arena in which to raise their voice and address their health concerns, while the possibility of involvement is low.
The project therefore aims to empower communities and their members to identify and express their health needs and demand equitable access to appropriate health care and social services. By addressing local needs and supporting community action for health, the projects aims to establish sustainable community mechanisms and strongly link them with government and non-government structures for sustainable results that contribute to improve health and well-being of all people in the region.
How have you addressed these challenges? Do you see a solution? This presentation will demonstrate how the project translates the Ottawa Charter onto the ground in the context of Dodoma Region and report on early operational research outcomes of the Regional pilot for health reform.
In adapting the health and community development systems to strengthen health promotion, the project has negotiated adapted terms of reference and trained-as-trainers Community Health and Development Officers (CHOs and CDOs) as well as School Health Coordinators (SHC) in community participatory techniques and cutting edge health promotion approaches. As master trainers, with support of HPSS District Coordinators, these government cadres have rolled out a tailored training packages to their assistants, Non-Governmental Organizations (NGOs), Faith Based Organisations (FBO), Community Based Organizations (CBOs) and communities themselves. Following consultative workshops, regional governments agreed to expanded health promotion roles of the Region’s 152 CDOs and their assistants. They work together with Health Officers to support communities, through participatory methods, to identify local health concerns, as well as resources and to plan solutions. In this process the trained government CHOs and CDOs and SHCs facilitate communities to identify their health concerns and solutions in a participatory meeting of peer groups - disaggregated by sex and age as well as by concern groups – such as the disabled. After initial community-led discussions, facilitators showed discussion groups how to quantify their priorities and the group subsequently voted for their primary health concerns. The results of the sub-groups were then presented by the facilitators to the whole community in a final meeting, emphasising the very different priorities of men and women, and different age groups in the same community. This usually resulted in a direct community discussion and debate concerning different perceptions on health and well-being issues within the community. Following this, the community as a whole, facilitated by their trained CDO, prepared a community health promotion plan for presentation to local councils for inclusion within and funding with the Council Comprehensive Health Plans.
How do you know whether you have made a difference? In the process Regional authorities have raised the importance and profile of inclusive, participatory approaches by adding these duties to government staff terms of reference. The strengthening of health promotion, gender and social inclusion approaches within community led-processes has not only improved grass-roots level dialogue and action on local health and social concerns but strengthened the capacity and networking of community-based organisations. This has also set in motion means by which communities can not only take action to address issues in the local context, but access existing funding lines for community health activities. The Participatory Rural Appraisal (PRA) process has been rolled-out to all communities in the 7 districts of Dodoma region. Even at this early stage of the project, PRA outcomes resulted in community health action plans, which have been inclusively developed in more than 200 villages. A total of 220 health promotion action plans have been developed by communities in this way, reflecting 16 priority health-related themes.
By taking an inclusive approach that sensitises government and non-government facilitators, the solidarity and empowerment of traditionally marginalised and stigmatised groups including women, the poor, people living with HIV and affected by AIDS and people living with disabilities has also been strengthened.
Have you or the project mobilized others and if so, who, why and how? Approaches chosen within the HPSS Project have mobilized people on several different levels. Primarily, government CHOs, CDOs and SHCs were trained-as-trainers in facilitating community participatory techniques and cutting edge health promotion approaches. This has led to their expanded health promotion roles in accordance with the regional governments. The master-trainers have rolled out these techniques to all government staff and community organisations in the region. Applying a bottom-up approach, government officers facilitate communities to identify their health concerns and solutions in a participatory manner.
When your donor funding runs out how will your idea continue to live? The HPSS Project, implemented by the Swiss Centre for International Health (SCIH)/Swiss Tropical and Public Health Institute (Swiss TPH) on behalf of the Swiss Development Cooperation Agency (SDC), is subdivided into three project phases, namely a pilot implementation phase from the year of 2011-2014, a consolidation and scaling-up phase between 2015 and 2017 and the completion of a nationwide scale-up in the years of 2018-2020.
By training a cadre of master trainers within government and non-government structures in the first phase of the project in Dodoma region, novel inclusive approaches have been rapidly cascaded to the communities for complete geographical coverage. The inclusive, participatory techniques used effectively advocate for the different health priorities of various groups within community’s debates, inclusive action planning and ensure that these actions are funded and realised.
As approaches have been embedded in the skills and responsibilities of government staff, this allows the direct involvement of community members, in particular giving voice to vulnerable groups. These inclusive, participatory techniques are likely to be sustained and replicated as a nationwide scaling-up of the HPSS approaches and activities in subsequent phases. Furthermore, the project has developed and launched a short course (in June 2012) on participatory techniques for inclusive community action for health promotion at the Zonal Training Centre. This will contribute to sustainability by providing focussed training of development and health staff in the coming years and act as regional resource centre for these activities.

Strengthening Health Systems and Democracy through the Empowerment of Rural Indigenous People in Guatemala

Author(s) Walter Flores1, Ismael Gomez2
Affiliation(s) 1Executive office, Center for the Study of Equity and Governance in Health Systems, Guatemala City, Guatemala, 2Field implementation, Center for the Study of Equity and Governance in Health Systems, Guatemala, Guatemala.
Country - ies of focus Guatemala
Relevant to the conference tracks Advocacy and Communication
Summary Based on both human rights and health systems frameworks, a coalition of CSOs have been implementing a participatory approach to empower rural indigenous citizens to monitor public policies and health care services, demand actions to improve equitable resource allocation and shift power relations at the municipal level. The premise of this work is that strengthening health systems must be part of a larger effort to redress historical discrimination of population groups. In addition, the political empowerment of indigenous populations is a key condition to an equitable and responsive health system. After 5 years the approach has shown important positive results.
What challenges does your project address and why is it of importance? Many health inequities are the expression of inequities of power in society. A history of discrimination, exploitation and 36 years of armed conflict in Guatemala has created unequal power relationships that place rural indigenous population at great disadvantage, suffering worse health outcomes than non-indigenous populations and facing many access barriers to existing services.
How have you addressed these challenges? Do you see a solution? Following a human rights framework, a coalition of civil society organizations led by Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud (CEGSS), have been implementing a participatory-action research approach aimed to empower rural indigenous citizens to monitor public policies and health care services, demand actions to improve equitable resource allocation and a shift power relations at the  municipal level. The premise of this work is the understanding that in a context such as Guatemala, strengthening health systems must be part of a larger effort to redress historical discrimination. In addition, the political empowerment of indigenous population is a key condition to an equitable and responsive health system. The process includes the monitoring of health polices and services by community based indigenous organizations. The key characteristics are the following:
• Based on both a human rights framework and health systems strengthening.
• Citizens’ health boards carry-out the following activities:
– Surveying existing services to assess compliance with national standards (drugs availability, medical equipment, human resources)
– Document cases of families suffering hardship due to unmet healthcare needs
– Studying barriers to access (transport, discrimination, resource allocation)
– Submit a report to authorities
– Implement strategic advocacy to demand changes
How do you know whether you have made a difference? Through ethnographic research and in-depth case studies, we have documented that our approach has had a positive impact in improving the availability of services at municipal level. It has also improved the level of trust between community based organizations and health authorities. Community leaders that have been part of this process also report “empowerment” and a motivation to expand their work. The health system is strengthened by improving resource allocation to benefit highly marginalized rural areas at the same time that health personnel develop skills to negotiate and respond to the user of services need. Overall, this approach is also strengthening democracy and promoting the social inclusion of indigenous populations.
Have you or the project mobilized others and if so, who, why and how? Skills and knowledge to implement the approach have been transferred to other NGOs that work in different regions of the country. In addition, due to the relevance of the approach, we have managed to raise funding to expand the approach to 20 new rural indigenous municipalities of Guatemala.
We are also participating actively in several international networks (COPASAH: in which we are transferring our skills, knowledge and tools and also learning from other colleagues that participate in the networks.
When your donor funding runs out how will your idea continue to live? A central component of our approach is the capacity-building of indigenous community leaders engaged in accountability and equity work. Up to June 2013, more than 400 community leaders from 15 different rural municipalities have been trained on community monitoring and social accountability of public polices and services. We are also transferring the skills to other civil society organizations present in these 15 municipalities. Since those organizations already have a presence in those municipalities and do not receive financial support from us, it is expected that they will continue to provide technical assistance to the community leaders once the skills and knowledge transfer process is completed. We are also active members of COPASAH ( and TALEARN ( In both networks we are contributing to field building, hence the skills and knowledge shared in these two networks will remain with all the other member organizations

Limitations of Health Promotion Mechanisms: Pakistan

Author(s) Ayesha Aziz1.
Affiliation(s) Women's health, Rural Support Programmes Network, Islamabad, Pakistan.
Country - ies of focus Pakistan
Relevant to the conference tracks Advocacy and Communication
Summary To improve the maternal and child health indicators the government of Pakistan initiated the Lady Health Workers Programme in 1994. This study aims to investigate the role of the programme mechanisms in promoting health and empowering people. The research was conducted in purposively selected villages from the districts Thatta, Rajanpur and Ghizer. Qualitative methods were used to gather data for the study. Our findings highlight that the limited understanding and implementation of community mobilization, health promotion and empowerment strategies, exclusion of the lower socio-economic strata and the absence of in depth comprehension of indigenous spaces for dialogue limit the LHW programme’s success.
Background Pakistan has been struggling to improve the maternal, newborn and child health of its population for the last two decades. The government has initiated several maternal and child health (MNCH) programmes to address issues related to availability, affordability and access to MNCH services. Reduction in the country’s maternal and child mortality is still far from meeting the targets of the millennium development goals according to which the maternal mortality rate (MMR) of 380 per 100,000 live births was to be reduced by three-quarters and the infant mortality rate (IMR) of 76 per 1000 live births was to be reduced by two-thirds by 2015. However, the current MMR in 2010 was 260 per 100,000 live births and the IMR was 59 per 1000 live births. The National Programme for Family Planning and Primary Healthcare is one of the largest government health programmes. It was initiated in 1994 with the mandate of overcoming the financial and mobility barriers related to access and ensuring continuous availability of primary healthcare services at the doorsteps of rural communities. The most recent evaluation of this programme, conducted by the Oxford Policy Management in 2009, has revealed that despite all efforts of the programme there has been limited success in behavior change for health promotion.
Objectives Health promotion is considered a process of enabling people to increase control over and to improve their health. It is related to empowering people by developing skills of local leadership, strengthening community actions, creating supportive environment, reorienting health services and building healthy public policies. The National Programme for Family Planning and Primary Healthcare is widely known as the Lady Health Workers Programme as its prime workforce consists of community based Lady Health Workers (LHWs). The LHWs are responsible for advocacy, health education and creating awareness for promoting community health. Their work includes counseling, provision of family planning services, antenatal care and referrals, immunization, basic curative care and supporting community mobilization. There are a total of 90,000 LHWs employed in the programme across the country. Each LHW serves 1000 people living in the 100-200 households around her own house that is called the ‘health house’. For health promotion the LHWs are responsible for mobilizing the community into groups, particularly those of women. Over the years, the LHWs have gained a lot of respect and influence in their communities and their contribution in ensuring availability of affordable primary healthcare has been valuable.
This study aims to investigate the role of the LHW programme mechanisms and the LHWs in promoting health and empowering people, particularly the women and poor. The study will also explore the indigenous mechanisms and spaces for dialogue that exist in every community and endeavor to distinguish the impact of indigenous communication mechanisms and spaces on maternal and child health promotion from the programmatic ones.
Methodology The primary research question for this study was ‘in what ways do LHW programme mechanisms and spaces empower or inhibit women, poor persons and marginalized groups, particularly with respect to maternal and child health issues? The following refined research questions were defined from the primary research question.
1. What are the mechanisms and spaces formed by the LHW programme for promotion of MNCH?
2. How are the selected communities stratified? (ethnic groups, economic classes, castes, education status, gender and age)
3. What are the marginalized groups in the selected communities?
4. Who is included and who is excluded from the LHW programme mechanisms and spaces? And why?
5. What are the mechanisms of inclusion and/or exclusion in the LHW programme mechanisms and spaces?
6. What is the role of LHWs in engaging and empowering the women and poor?
7. What indigenous mechanisms and spaces for dialogue exist in the selected communities?
8. What is the impact of the indigenous and LHW programme mechanisms and spaces on raising awareness about health issues, availability of health services and entitlements of people for MNCH services?
9. What is the impact of the indigenous and LHW programme mechanisms and spaces on women’s mobilization and local accountability processes?
10. What lessons can be learned with respect to accountability and governance in the LHW programme and the identification, training and selection of the LHWs? To take into account the cross country geo-cultural differences, this research was conducted in a purposively selected LHW covered villages from the districts Thatta (delta), Rajanpur (plain) and Ghizer (mountainous). A comprehensive document review of relevant documents of the LHW programme was done and a total of 9 key- informant interviews (KIIs) were conducted with three LHW programme personnel in each village/district to gather information on the planned and implemented mechanisms for maternal and child health promotion. The community’s perspectives on the role of programmatic mechanisms and LHWs in health promotion was investigated by conducting 10 participatory reflection and analysis (PRA) based group discussions (5 with women’s group and 5 with men’s group) in each of the three selected villages. Indepth interviews with selected women were also conducted to distinguish the impact of indigenous communication mechanisms and spaces from the programmatic ones.
Results • Community mobilization mechanisms are utilized only for awareness raising
In all our study sites, LHWs were found to visit households on specific dates during the immunization campaigns, though they have a mandate to raise awareness and change attitudes by the formation of a women’s group and health committee in their catchment area. In each site, LHWs were found to conduct occasional awareness raising sessions on antenatal care and contraception. Communities in Thatta and Rajanpur did not know of any women’s group or health committee. In Ghizer some women informed us about a women’s group created by the LHW 2 years ago, but such group activities were no longer a part of the LHW’s routine work as she had a high work burden and was not held accountable for mobilization efforts.
• People from lower socio-economic strata were excluded and their women bore the highest burden of MNCH issues.
In villages of Thatta and Rajanpur Districts the community was stratified with respect to lineage that formed their caste identity, while in Ghizer it was stratified on the basis of religious sects. The men and women from the lower socio-economic strata were excluded from the awareness sessions as the LHWs were either relatives or friends of the better-off women and tended to complete their field activities with them without making much effort to ensure representation and participation of all strata. Due to lack of access to information and resources the poorest women in each site withstood the highest burden of MNCH issues. They related horrid stories of multiple young age pregnancies, miscarriages and even infant deaths. The most vulnerable women were those belonging to the poorest castes that led semi-nomadic lives in search of livelihoods. They were not even counted as women eligible for primary healthcare and family planning advice in LHWs’ registered catchment area population.
• Indigenous spaces for dialogue can serve as entry points for behavior change
In Ghizer, the place for congregational worship was used by women from the same religious sect to discuss and promote contraceptive usage. In Thatta and Rajanpur Districts, the agricultural activities and household gatherings were used to exchange information on contraceptive usage, but due to deeply ingrained patriarchal practices of the society, very few women could use this information for behavior change.
Conclusion Our findings highlight the limited understanding and implementation of community mobilization, health promotion and empowerment strategies in the LHW programme. This has restricted the focus of LHWs’ community mobilization activities to awareness raising, while their potential for promoting organized and sustainable community based collective efforts for building local partnerships and ensuring accountability of healthcare services remains unharnessed.
Social stratification determines people’s access to resources, livelihood, ownership of agricultural land and socio-economic status, therefore equitable access to information and health can be ensured by monitoring inclusion of the lower socio-economic strata and the semi-nomadic population groups in the community mobilization efforts.
The indigenous spaces for dialogue among women in all communities included communal places for washing clothes, collecting water and performing agricultural activities and the household gatherings for celebrating events. These spaces contribute to the construction of cultural norms and practices in a society. Therefore, in-depth comprehension of the indigenous spaces will allow the LHWs and their programme to capitalize upon existing opportunities for dialogue and behavior change for health promotion and empowerment.

Integrating health promotion to improve maternal and newborn health in El Salvador

Author(s) Janet Perkins1, Nicole Répond2, Cecilia Capello3, Ana Ligia Molina Araniva4, Carlo Santarelli 5.
Affiliation(s) 1Health Department, Enfants du Monde, Geneva, Switzerland, 2Health Department, Enfants du Monde, Lausanne, Switzerland, 3Health Department, Enfants du Monde, Geneva, Switzerland, 4Health Deparment, Concertación de Educación of El Salvador , San Salvador,El Salvador, 5Enfants du Monde, Enfants du Monde, Geneva, Switzerland.
Country - ies of focus El Salvador
Relevant to the conference tracks Women and Children
Summary Women and newborns in El Salvador continue to face elevated risks related to pregnancy and birth. Historically, the Ministry of Health (MoH) has focused primarily on strengthening the health services while neglecting the critical role that women, men, families and communities play in improving maternal and newborn health (MNH). Our project integrates a Health Promotion component (Ottawa Charter) in the broader MNH strategy in order to empower women and communities to improve MNH, increase access to quality MNH services and incorporate community participation in the health system. As a result of our project, we have seen important changes at both the national and local level towards improving MNH.
What challenges does your project address and why is it of importance? Women and newborns living in El Salvador face among the greatest risks related to pregnancy and childbirth in Central America and the Caribbean. With a maternal mortality rate of 81/100,000, a woman living in El Salvador faces a 1 in 490 lifetime risk of death due to maternal causes, compared to the 1 in 3,900 risk of a woman living in a developed country. In addition, 15 out of every 1,000 infants fail to survive the first year of life, with a high proportion of these deaths occurring before the end of the first month. Risks related to pregnancy and birth are magnified in rural areas where the utilization of health services, and institutional birth in particular, remains low.
Achieving real improvement in MNH requires not only improving and expanding health services but also action with the community to improve care in the home of women and newborns as well as increase demand and utilization of health services. However, historically action aiming to improve MNH in El Salvador has been directed primarily at the health services, with only marginal emphasis accorded to the role of individuals, families and communities within the health system. Our efforts aim to address this gap by empowering women, men, families and communities to improve MNH.
How have you addressed these challenges? Do you see a solution? The World Health Organization’s framework for Working with Individuals, Families and Communities (IFC) to improve MNH is designed to facilitate the inclusion of Health Promotion in national MNH strategies. Its primary aims are to empower women, men, families and communities to improve MNH and increase access to MNH services. The IFC framework was integrated into the Pan-American Health Organization’s (PAHO) regional MNH strategy in 2004 and El Salvador was selected as one of four countries for pilot implementation.
Since 2005, Enfants du Monde (EdM), a Geneva-based NGO, in collaboration with the Concertación de Educación of El Salvador (CEES), a consortium of local NGOs, has been supporting Ministry of Health (MoH) to implement the IFC framework. Initially, a national IFC coordinating body was established to oversee IFC implementation in the country and assure that the framework is integrated in broader health initiatives. This IFC committee includes representatives from MoH and CEES, with technical support by EdM and the PAHO country office. This committee collaborates with and supervises IFC coordinating bodies at sub-national and local levels.
The national committee selected eight municipalities, covering approximately 100,000 women of reproductive age, for initial implementation of the framework at the local level for validation. Participatory community assessments (PCAs) were conducted in each municipality at the outset in order to guide planning. These PCAs consist of a series of roundtable discussions with community members and leaders where they discuss priority MNH needs and participate in designing interventions to tackle identified challenges. Results of these discussions were used to develop IFC action plans which were integrated into broader district action plans and implemented. Interventions vary by municipality, but include in general: birth preparedness; strengthening interpersonal skills of health providers; community oversight of health services; sensitizing men to MNH needs and their roles; and promoting rights to health.
At the national level, efforts have focused on institutionalizing health promotion and community participation in the national health strategy. Notably, due to the success of the program, the IFC committee has been invited to participate in elaborating a number of policies related to reproductive health. In addition, actors at the municipal level were consulted by MoH in the revision of the national birth preparedness strategy.
How do you know whether you have made a difference? The actions undertaken at both national and local levels have been successful at reaching their objectives. At the national level, the IFC committee participated in drafting the Strategic Plan for Reducing Maternal and Neonatal Mortality 2011-2015, the Sexual and Reproductive Health Policy, and the Technical Operational Guidelines for the Birth Preparedness Strategy. Largely as a result of their participation, each of these documents contains lessons from the implementation of the IFC framework, thereby highlighting Health Promotion and community participation in each one. These documents have now been finalized and endorsed by MoH. Furthermore, the IFC committee is now participating in drafting the Technical Guidelines for Promoting the Right to Health.
The PCA has elicited a great deal of enthusiasm by MoH at national and local level. Stakeholders have witnessed the benefit of working with communities using this tool and as a result MoH has adopted it for use beyond MNH for analyzing and planning health action more broadly. A range of actors at national, sub-national and local level are being trained to use it, contributing its institutionalization.
At the local level, IFC action plans have been implemented in the eight selected municipalities. Trust has been built between women and families and healthcare providers. Women have been empowered to demand quality health services which have been defined as their right. For example, women mobilized to obtain the right to be accompanied by a companion of choice when receiving MNH services at health facilities, notably during birth, and were successful in this goal. In addition, MoH responded to the community when they demanded that certain positions which had been vacant (i.e., gynecologist, pediatricians) be filled in rural health facilities.
Women and families report seeking health services to a greater extent and high satisfaction with services received. Women take action to prepare for birth and potential obstetrical and neonatal complications. However, challenges still exist in terms of women following through on their plan. Utilization of both routine and emergency MNH services is increasing. Men are increasingly participating in MNH by accompanying women to health facilities, though not to the extent anticipated. Promisingly, in each of the implementation municipalities maternal, perinatal and neonatal death has decreased and no maternal death has been reported in 7 of 8 municipalities for 3 years.
Have you or the project mobilized others and if so, who, why and how? We recognized from the outset of our project that long term success and real integration of the project in national policies and programs can only occur when a variety of actors across different sectors are mobilized. Notably, each year a team of 10 actors from national and local MoH, NGO’s and members of the IFC committee participate in the PAHO/EdM diploma awarding course on the IFC framework at the University of Antioquia in Colombia. This course helps actors from Latin-American understand the critical nature of working with and empowering individuals, families and communities and how to institutionalize mechanisms allowing them to participate to reach the goals laid out in the national MNH strategy. Following the training, these actors support implementation of the framework at national, sub-national and local level.
The national IFC committee’s participation in the Alliance for Sexual and Reproductive health has also served to mobilize others. This intersectoral alliance operates under MoH and includes a number of organizations such as PAHO, UNFPA, Save the Children, Plan International, and World Vision. This alliance has helped to increase visibility of the IFC component and encourage the interest of other members. For example, as a result of this alliance, Save the Children has become financially engaged to support the implementation of certain interventions of the IFC program.
Moreover, efforts have been undertaken to strengthen the system of community health teams at the national and local levels. At the local level these teams include community health workers as well as trained doctors and nurses. They visit under-served communities providing services. Within our program we are training them to integrate health promotion and community participation into their work and conduct PCAs. As a result, their capacities are reinforced to work with and empower communities.
In addition, community members, leaders and groups have been mobilized to participate in MNH action. Links have been created between communities and health facilities allowing for meaningful community participation to be institutionalized in the health system. Mayors and religious groups have become involved in funding the implementation of local interventions. Perhaps most importantly, the community, notably women, their partners and mothers-in-law, have mobilized to improve the care of women and newborns and increase access to health services, for example in facilitating transport.
When your donor funding runs out how will your idea continue to live? Sustainability of the program has been a priority since its inception and has therefore been implemented with a long term vision and the constant search for alliances. To begin with, a central priority of implementation process has been to institutionalize the IFC framework and community participatory processes into the national MNH strategy as well as in other policies at various levels. As highlighted earlier, we have made a great deal of progress in this domain, as components of the IFC framework have been integrated into some of the most important sexual and reproductive health documents and policies recently elaborated.
In addition, the IFC framework is being implemented by MoH, with the support of outside actors, including NGOs and PAHO. As a result MoH is directly responsible and accountable for its implementation. It has been institutionalized within the MNH program at all levels, ensuring that participatory processes themselves are integrated as well. MoH is now planning a strategy for scaling up to new municipalities.
In addition, at its core, our project focuses on building the capacities of in-country actors. Notably EdM has no expatriate staff on the ground. Rather, locals are staffed as coordinators in existing offices (of PAHO and MOH). Likewise, CEES is composed of a consortium of local NGOs, based and operating in El Salvador. Moreover, at every phase of IFC implementation, the focus remains on building the capacities of State and other local actors to implement the framework and assume primary responsibility for interventions. This focus on capacity building of in-country stakeholders prevents an over reliance on outsiders and ensures local ownership of initiatives, thereby promoting sustainability.
Finally, the program has also launched processes of empowering women, men, families and communities. This empowerment is considered not only a means to an end, but also an end in and of itself. These exercises of working together have built the capacities of community members to collaborate to identify their needs and design methods of addressing these needs. The capacities of the health services have simultaneously been reinforced to include the participation of community members in health planning and services action. This bodes well for the sustainability of the idea as local actors have the capacity to participate and the health sector is better equipped with the capacity to integrate and promote community participation.