The views expressed in this book are those of the authors and do not necessarily reflect the views and policies of the Asian Development Bank or its Board of Governors or the governments they represent.
ADB does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use.
Use of the term “country” does not imply any judgment by the authors or ADB as to the legal or other status of any territorial entity. Case studies have been edited from their original version.
Copyright This publication has no copyright. Translation, adaptation, and copying of materials used for non-commercial use is encouraged, provided that the original credits to Development Finance International, Inc. (DFI) and the event’s facilitators (Asian Development Bank, GlaxoSmithKline and Save the Children) are maintained.
Drafted and compiled by Ann Ewasechko Edited by Jennifer Petrela Designed by Creative 2.0, Inc.
Photos from the workshop were taken by Chris Peregrino. Photos from the field credited to Ann Ewasechko unless otherwise indicated.
Published 2009 by Development Finance International, Inc. Asia Representative Office Manila, Philippines
ISBN 978-971-93216-2-0
Printed in the Philippines
C Table of Contents
Abbreviations iv
Acknowledgments v
Executive Summary vii
INTRODUCTION 1
MATERNAL, NEWBORN AND CHILD HEALTH INTERVENTIONS 5
The State of Mothers and Children in Asia 6
The Investment Case for MNCH in Asia 8
Barriers and Bottlenecks: What Prevents Interventions From Working and What We Can Do 10
Broadening NGO Involvement in the Delivery of MNCH Services Through Contracting 12
Tackling Four Challenges Related to MNCH Interventions 14
Challenge 1: Mobilizing Resources 14
Challenge 2: Generating Political Will 16
Challenge 3: Delivering MNCH Programs 17 iii Challenge 4: Communicating Messages for MNCH Interventions 18
IMMUNIZATION 21
Access, Partnerships and Latest Developments in Vaccines for the Developing World 22
Innovative NGO Approaches to Immunization 24
NGO Solutions to Immunization Obstacles 29
Scenario 1: Low-Income Country, Weak Coverage 29
Scenario 2: Middle-Income Country Graduating From GAVI 31
Scenario 3: Making the Case for More Funds 33
Scenario 4: Innovation Pile-Up 35
MOVING FORWARD: WHAT’S NEXT? 37
Appendices 41
Appendix 1: Workshop Description and Agenda 42
Appendix 2: Participant Directory 46
Appendix 3: NGO Participants by Country of Affiliation 56
Appendix 4: Speaker / Panelist Bios 57 CAppendix 5: Workshop Evaluation 60 Abbreviations ADB Asian Development Bank ADRA Adventist Development and Relief Agency (ADRA) Basic Education for Awareness Reforms and Empowerment/ Basic BEFARe Education for Afghan Refugees BRAC Building Resources Across Communities CCF Christian Children’s Fund CIHP Consultation of Investment in Health Promotion CSO Civil society organization EPI Expanded Program on Immunization GAVI Global Alliance for Vaccines and Immunization GSK GlaxoSmithKline HU Health Unlimited IBI Indonesian Midwives Association Japanese Organization for International Cooperation in Family JOICFP Planning MAP Medical Assistance Program International International MDG Millennium Development Goal MIRA Mother And Infant Research Activities iv M&E Monitoring and evaluation MNCH Maternal, newborn and child health NGO Nongovernmental organization NUV New and under-utilized vaccines NORAD Norwegian Agency for Development Cooperation PATH Program for Appropriate Technology in Health Peoples’ Primary Healthcare Initiative/ PPHI/SRSO Sindh Rural Support Organization PFV Philippine Foundation for Vaccination PNGOC Philippine NGO Council on Population Health and Welfare, Inc. Q&A Question and answer RACHA Reproductive And Child Health Alliance RDRS Rangpur Dinajpur Rural Service UNICEF United Nations Children’s Fund WATCH Women Acting Together for Change AWHP World Health Partners C AACKNOWLEDGMENTS This publication would not have been possible without the dedication and enthusiasm of the workshop speakers, the workshop participants and the authors of the case studies featured here. We would like to thank them and the many individuals whose commitment to better health helped these projects to succeed. We would also like to thank Julia Cummins for her invaluable contribution as lead facilitator as well as the co-facilitators, Merla Aquino, Ester Isberto, and Chonchita Ragragio, for their support. C v A C EXECUTIVE SUMMARY Asia NGO workshop
EExecutive Summary
Introduction
Between February 24 and 26 60% of neonatal deaths occur in Asia NGOs are 2009, 27 international and national non- and stressed the invaluable role played governmental organizations (NGOs) by NGOs in the struggle to improve sometimes the only from across Asia convened in Manila, the health status of Asia’s mothers and the Philippines for a regional NGO children. The NGO participants then players to reach workshop on maternal, newborn and brought their collective experience disadvantaged and child health (MNCH). Hosted by the to bear on the questions of how to vii Asian Development Bank (ADB) and strengthen efforts to mobilize resources remote areas where Save the Children (STC) with the support for MNCH programs and interventions, of GlaxoSmithKIine (GSK), this landmark how to generate greater political maternal and child event provided for the first time a will for MNCH financing and creative mortality rates are unique and intimate forum for some of programming, how to play a larger the region’s most experienced NGOs to and more effective role in delivering highest. share their perspectives, experiences and MNCH services, and how to better approaches in implementing MNCH and communicate the importance of MNCH immunization programs in Asia. Official interventions at the community level. development agencies from Australia, There was consensus that each of these Canada, Norway and the United States, four challenges must be elevated as along with representatives from priority for NGOs moving forward. ADB, World Bank, the United Nations Children’s Fund (UNICEF), and the Global The second day discussed a proven Alliance for Vaccines and Immunization MNCH intervention: immunization. (GAVI), also participated in the Millions of Asia’s mothers and children workshop. The dialogue was considered are still not receiving even the most basic particularly timely in light of the current immunization services and healthcare global financial and economic crisis systems are ill-prepared to accommodate and the approaching deadline for the new and improved vaccines. Against the Millennium Development Goals. backdrop of varying immunization rates and different levels of development The first day of the workshop focused between and within Asia’s countries, on MNCH interventions in general. participants shared best practices and MNCH experts underscored that 41% of crafted strategies around how to improve Cglobal deaths of children under five and vaccine availability and uptake for both Asia NGO workshop EXECUTIVE SUMMARY
Expanded Program on Immunization helping to monitor, report, and forecast stronger incentives that lead to better (EPI) and new and under-utilized demand to reduce the incidence of health outcomes, and by entering into vaccines (NUV) through enhanced vaccine shortages. Capacity building, government health service contracting advocacy, innovative programming, and training, and collaborative efforts would arrangements that would leave creative partnerships. help NGOs make their mark in these governments free to focus on those areas. activities they do best. Substantive Outcomes However, participants recognized that Insofar as international donors are By the end of the two-day event, a for the region’s MNCH indicators to concerned, participants concurred that number of important themes had improve substantially, NGOs could the partnership between NGOs and emerged. These themes related to not tackle the challenges alone. the international donor community NGOs’ unique role in tackling MNCH in To reach their public health goals, could also be optimized for better general and immunization in particular NGOs would have to engage more health results. Of particular concern and to priority areas for future focus and effectively with national governments, is the fact that most donor funding for collaboration. international donors, the private sector, health is funnelled through government and community leaders and groups. entities. In addition, funding tends to be To begin with, workshop participants With regard to governments, workshop minimal, unpredictable and short-term confirmed that NGOs are particularly participants recognized the need to in nature. NGO participants expressed well-placed to both supply and advocate for greater, more effective, and a keen interest in becoming more stimulate demand for MNCH more equitable budget expenditures. engaged in in-country consultative interventions. NGOs are sometimes the This means systematic and strategic mechanisms in order to help inform only players to reach disadvantaged and targeting of ministries of finance and priority-setting processes and to better remote areas where maternal and child planning in order to ensure that MNCH understand donors’ plans. However, mortality rates are highest. They are often interventions including immunization some NGO participants noted NGOs’ singularly adept at mobilizing energies are valued and prioritized in health own responsibility to better demonstrate viii at the community level, at overcoming budgets and systems. program results. GAVI’s support to cultural, religious, and language issues, Civil Society Organizations (CSOs) is an and at developing innovative and It also means working with ministry of example of a program that assists NGOs tailored information and communication health officials through partnerships to engage more actively in this domain, tools. NGOs also contribute significantly in which the sharing of costs and risks for example through consultative to the strengthening of health systems encourages the parties to try new and mechanisms. by training community health providers, alternative interventions. NGOs can also filling gaps in services, and increasing support health systems by encouraging NGO collaboration with the private the uptake of EPI vaccines and other child survival interventions.
Nonetheless, NGOs recognized that their effectiveness could be enhanced by strengthening their capacities in several areas. These include reducing dependency on traditional donors for MNCH programming, playing a greater role in MNCH and immunization advocacy efforts, accelerating the demand for new vaccines, and providing interventions through alternative delivery channels. Many also felt that they could refine their expertise at scaling up activities, at using technology Ato bring services to remote areas, and at C EXECUTIVE SUMMARY Asia NGO workshop
areas. They have even less information to support the introduction or uptake of underutilized and new vaccines. For these reasons, workshop participants identified the generation of more and better data as a priority. NGOs also agreed that the greater use of analytical tools would improve the impact of their programming—tools such as barrier analysis that considers the root causes of why interventions are not achieving the desired results and how such barriers can be overcome.
Insufficient data is hurting MNCH in another way as well: it is crippling NGOs’ advocacy efforts and compromising RDRS Bangladesh their ability to evaluate the effectiveness of their programs. Without sound sector was seen as an area of strong religious leaders, teachers, mothers, analyses of the disease burden of potential that remains largely untapped. schoolchildren, and others to modify vaccine-preventable diseases and other Participants concurred that expanding their health practices and act as partners illnesses, and without adequate data on the role of the private sector (including in their own health. NGOs’ efforts in the results of their own initiatives, NGOs midwives and private practitioners) in the these areas have succeeded in doubling struggle to demonstrate to politicians, delivery of immunization services could or even tripling immunization coverage decision-makers, and key opinion ix help surmount significant absorptive rates and achieving other impressive leaders how MNCH programming and capacity constraints faced by NGOs and health indicators in some of the region’s preventive health practices such as governments. Pharmacies, which are on hardest to reach and most politically immunization can improve the health the front line with clients, could play a unstable areas. It is true that what works of women and children. They are also stronger role along the immunization in one community will not necessarily hampered in their dealings with anti- value chain and collaboration with work in another. Nonetheless, by sharing vaccine lobby groups and attitudes. professional associations could yield best practices, NGOs can learn from each results by helping to bring the medical other in order to leverage their success Workshop participants agreed that community on board. NGOs also have and reach even more people in need of making the investment case for much to learn from the private sector their services. MNCH, an approach advanced by the in terms of social entrepreneurship donor-driven Maternal Newborn and and a business-oriented approach to This said, NGOs emphasized that Child Health Network for Asia and the management and results. Corporate serious information gaps create Pacific (also known as the Coogee Beach social responsibility (CSR) funds could significant barriers to their work and Consultative Group), was essential also represent an important source of indeed to the work of all development to raising the public profile of MNCH financing for MNCH programming. partners. Accurate social, economic and efforts. They also concurred that more health-related data at the most basic robust monitoring and evaluation Finally, many NGOs have a rich history level is often insufficient to inform local activities were in order. Several NGOs of working closely with communities (including baseline statistics and by have achieved significant success in to educate them about the benefits of extension national indicators). Without these areas and their suggestions of how vaccination and other health practices this data, it is impossible for actors to to better target advocacy efforts and and to promote their ownership of grasp the extent and nature of needs secure champions for MNCH campaigns MNCH objectives. NGOs have used and plan an appropriate response. inspired new ideas in turn. innovative communication strategies In addition, actors still do not fully and behavior change techniques to understand all of the reasons why EPI Cpersuade healthcare workers, tribal and vaccine coverage is so poor in so many Asia NGO workshop EXECUTIVE SUMMARY
Outputs
A key output of the workshop was a ■■ Develop an advocacy toolkit on compilation of 25 case studies by the MNCH and immunization; and NGO participants. Describing NGOs’ health initiatives from conception to ■■ Broadly disseminate the case outcome and listing lessons learned as studies and the workshop NGOs can learn well as obstacles encountered, these proceedings. case studies showcased innovative NGO from each other in approaches to MNCH programming The partners also committed to with a particular focus on immunization. continuing their support for MNCH and order to leverage Together, they offer valuable insight and immunization initiatives in Asia and to x novel perspectives on how to implement working with NGOs to address some their success and successful programming, sometimes of the challenges identified during the reach even more under the most difficult conditions. workshop. Save the Children’s October Workshop participants agreed that the 5, 2009 global launch of the Newborn people in need of first-ever compilation of case studies Child Survival Campaign and the May on MNCH interventions in Asia is an 26-30, 2009 Global Health Council their services. invaluable resource in the effort to meeting (Washington, D.C.), at which improve program efficiency and reach GSK is invited to lead a session, offer two greater numbers of people still lacking such opportunities. basic health care. The workshop concluded with all Follow-up Action participants—NGOs, donors and hosting organizations alike—agreeing that the Before closing the workshop, the wealth of knowledge-sharing that had participants identified several actions taken place over the prior two days had that could build on the momentum exceeded their expectations in many generated in Manila: ways. Armed with new awareness of the as-yet-untapped expertise of many ■■ Establish a regional network NGOs and of the principal challenges of NGOs as a means to improve that face the MNCH community, they inter-NGO communications and agreed to capitalize on their strengths, collaboration; redress their weaknesses, and explore new ways to further improve the health ■■ Step up lobbying efforts in order and the lives of Asia’s mothers and to induce governments to better children. address MNCH, particularly for the Apoor; C PROCEEDINGS Asia NGO workshop
1 CIntroduction Asia NGO workshop PROCEEDINGS
IIntroduction
RDRS Bangladesh
In 2008, the Asian Development The workshop was designed to: This document is a record of the Bank (ADB), Save the Children and ■■ Provide a forum where NGOs workshop proceedings. It discusses the GlaxoSmithKline (GSK) discussed the from across Asia could share their plenary and the panel presentations, possibility of creating a forum that would experiences and best practices the issues that emerged during allow nongovernmental organizations in MNCH and immunization question and answer (Q&A) sessions, the (NGOs) to share their experiences, programming and advocacy; outcomes of small group discussions, successes, and best practices in Asia, ■■ Exchange views and experiences and ideas for carrying the momentum and in so doing, create momentum related to four key challenges in forward (taking next steps). It also for more effective responses to the launching and sustaining MNCH presents the case studies submitted 2 maternal, newborn and child health / immunization interventions: by NGO participants in advance of (MNCH) challenge. The response from (1) resource mobilization; (2) the the workshop as a complement to the NGOs was extremely positive. They generation of political will; (3) proceedings. These studies, most of confirmed that Asia lacked a forum of health service delivery; and (4) which focus on immunization, are rich this kind and were eager to learn about communications; with experience and ideas and offer the accomplishments of their fellow ■■ Consider practical ways to expand important insights into the challenges organizations. Several donors were NGOs’ positive impact in meeting and rewards of tackling MNCH across also interested to attend with a view to MNCH needs; and Asia. The lessons of these case studies sharing their MNCH program priorities ■■ Identify opportunities for concerted were woven into the workshop design and best practices with NGOs while advocacy efforts to strengthen and informed the ensuing discussions. learning about NGO initiatives. support for MNCH and immunization in particular.
“By working together, with complementary skills and experience, more benefits can be brought to communities Aacross Asia.” – Dr Jacques Jeugmans, ADB C PROCEEDINGS Asia NGO workshop
Workshop Participation
The workshop participants:
■■ Hailed from 12 countries across Asia, thus providing broad representation of the region’s diversity;
■■ Boasted considerable experience in MNCH advocacy or program delivery, in many cases with a strong emphasis on immunization;
■■ Included both international NGOs undertaking large-scale or widespread health services in Asia and community-based/national NGOs with local organizations and strong grassroots connections; and
■■ Featured expertise with innovative policy advocacy; service delivery; 3 the generation of community demand; and financing or resource mobilization techniques designed to ensure the sustainability and self-sufficiency of health programs.
Official development agencies from Australia, Canada, Japan and the United States joined the workshop. In addition, the Global Alliance on Vaccines and Immunization (GAVI) and the Norwegian Agency for Development Cooperation (NORAD) participated in one session by video conference. The three sponsor organizations were represented by local and international staff.
“Eighty percent of GSK’s vaccines are distributed in developing countries. NGOs prove central to ensuring that those vaccines are made accessible Cto those most in need.” - Ms. Elizabeth Hernandez, GSK Asia NGO workshop PROCEEDINGS
ABBREVIATED AGENDA
24 February Opening Reception and Dinner
Launch of Poster Session
25 February MNCH Session Themes
Introductions and objectives To consult the full workshop agenda, see Making the case for MNCH interventions in the Asia-Pacific region: Appendix 1. To consult the case studies Plenary presentations and Q & A and their abstracts, refer to the flip side Making the most of NGO-Implemented MNCH: of this publication. The directory of Panel discussion and Q&A 4 workshop participants is provided in Tackling MNCH challenges: Appendix 2. For a list of participating Break-out sessions and group presentations NGOs by country, consult Appendix 3. Video conference with NORAD and GAVI
26 February Vaccines and Immunization Session Themes
NGO-featured MNCH/immunization programs: Poster walkabout Latest developments in vaccine development and access: Plenary presentations and Q&A Innovative NGO approaches to immunization: Panel discussion and Q&A Conquering immunization scenarios: Break-out sessions and group presentations
“Save the Children is committed to working with a variety of stakeholders to deliver improved outcomes for children across the region. The value of sharing ideas and best practices between NGOs, governments and the private
sector cannot be understated.” - Ms. Latha Caleb, Save the AChildren Philippines C PROCEEDINGS Asia NGO workshop
5
Maternal, Newborn and Child Health CInterventions Asia NGO workshop PROCEEDINGS
The State of Mothers Tand Children in Asia Save the Children’s “State of Mothers and Children” report conveys a number of sobering findings:
■■ Countries in the region are failing to
provide the most basic health care RDRS Bangladesh that would save children’s lives;
■■ The poorest children are the least play a significant role in addressing child 3. Deliver a basic package of maternal, likely to receive lifesaving health survival rates. The lives of 3.9 million newborn and child healthcare care. Hence, child mortality rates children a year could be saved if each services that takes the realities of are highest in the poorest and most Asian country’s average child survival poor people in developing countries disadvantaged areas; rate matched the rate enjoyed by the into account; 6 most privileged 20% of that country’s ■■ Funding for child survival programs population. 4. Invest in community healthcare does not match needs; and workers who can reach the poorest Moving forward, Mr. Stoeckel drew out of the poor with essential lifesaving ■■ Closing healthcare coverage gaps the report’s key recommendations: care; and could save the lives of more than 6 million children each year. 1. Design healthcare programs to 5. Increase government support for better target the poorest and most proven solutions that save children’s This said, in his presentation, Mr. marginalized mothers and children; lives, including pneumonia care; John Stoeckel, Save the Children’s oral rehydration therapy for Asia Health Advisor, reinforced 2. Strengthen basic health systems with diarrhea; malaria prevention and that immunization and other life- a view on the entire continuum of treatment; measles immunization; saving interventions such as skilled care – from the household to the and breastfeeding and Vitamin A birth attendance and treatment for hospital; from the healthcare worker supplementation. pneumonia, diarrhea, and malaria can to the parent; from prevention to Atreatment; C PROCEEDINGS Asia NGO workshop
Mr. John Stoeckel, Save the Children’s Asia Health Advisor Mr. Stoeckel’s bio is provided in Appendix 4 7
What Struck Home: Highlights of the Q&A Discussion The State of Mothers and Children in Asia
Mr. Stoeckel’s presentation stimulated poignant questions from the donor community to NGO participants:
■■ How do NGOs recommend identifying the best interventions for health system strengthening? ■■ How do NGOs stimulate political will? ■■ What role can NGOs play in improving and reporting on data collection? ■■ What are NGO’s role in monitoring and evaluation (M&E)?
In regards to identifying best interventions, numerous NGOs encouraged, tailoring national or community-level solutions to MNCH problems to the extent possible. As to generating political will, Mr. Stoeckel pointed out that each project needed a dedicated advocacy component to help generate political participation without which the advocacy effort would not receive the attention it deserved. Another NGO participant agreed, and added, that NGOs often serve as particularly strong advocates at the local level.
The presentation also opened a discussion of the lack of accurate local data, particularly baseline data, and of problems associated with the usability and reliability of national-level data (including immunization rates) when data is not disaggregated. Participants acknowledged that many countries could theoretically achieve Millennium Development Goals (MDGs) without reaching their poorest citizens. Dr. Atwood suggested that NGOs can serve an important role in M&E to help ensure accurate measurements. Mr. Stoeckel agreed, and added that many NGOs already have a focus on M&E given the need to demonstrate returns on donor Cinvestments. Asia NGO workshop PROCEEDINGS
The Investment Case for TMNCH in Asia
MNCH does not receive sufficient overall needs. What is high, in contrast, attention. Yet the poor health status are individual out-of-pocket health of mothers and children in the region expenditures that often contribute to “The child-friendly village makes “business as usual” unacceptable. impoverishment. The presentation made by Mr. Ian approach… motivates Anderson, Advisor and Principal Concerns about health expenditures individuals … to coordinate Economist, Health Services Delivery, are not limited to quantity alone. local health activities, solve ADB summarized the value of the Expenditures tend to be inadequate, inefficient, and inequitable. They also local health problems and investment case for MNCH in Asia based tend to lack links to outcomes (with 8 on a recently initiated donor effort. cooperate with the local health clearly articulated incentives) and to center with a view to achieving The Maternal Newborn and Child fail to ensure the full implementation seven village-wide indicators Health Network for Asia and the Pacific, of programs. The Coogee Beach Group informally called the “Coogee Beach plans to capitalize on the diversity of its that cover a wide spectrum of Group”, is seeking to improve the level - membership to develop an international aspects of MNCH. […] Once and quality - of public expenditure so as advocacy program that highlights targets are achieved, a village to help improve health outcomes for the deficiencies in the quantity and quality poor and vulnerable. The group’s goal of national expenditures and to work health day takes place during is to secure more and better allocated with NGOs and the private sector to work which the village is formally funding at the national level. The Coogee for increased expenditures and better declared a “child-friendly Beach Group includes individuals from targeted MNCH interventions. A key village” and a monument is a number of multilateral and bilateral component of this advocacy effort will development organizations.1 focus on building an investment case for erected to that effect.” MNCH in Asia that draws on compelling - the case study from Adventist The argument for the need to shift focus economic arguments for MNCH back to Asia and the Pacific is based on investments (focused on productivity, Development and Relief Agency statistics: the region accounts for 43% of competitiveness and economic returns) (ADRA): The Child-Friendly Village maternal deaths and 41% of child deaths and on helping countries identify “best Initiative in Kampong Thom worldwide and 15% of the world’s buys”—namely, proven, cost-effective newborn deaths occur in three states of Province, Cambodia. interventions that have the most impact India alone. Yet, as Mr. Anderson pointed on maternal and child mortality. These out, some governments fund a mere country-level investments or bankable fraction of actual health expenditures plans can in turn help inform the and funds from external donors are investment decisions of finance and in most instances small compared to health ministries.
1 ADB, the Australian Agency for International Development (AusAID), the Bill & Melinda Gates Foundation, the Canadian International Development Agency (CIDA), the Japan International Cooperation Agency (JICA), the Partnership for Maternal, Newborn and Child Health (PMNCH), the United Kingdom’s Department for International Development (DFID), UNICEF, the United Nations Population Fund (UNFPA), the United States Agency for AInternational Development (USAID), the World Bank, and the World Health Organization (WHO). C PROCEEDINGS Asia NGO workshop
Mr. Ian Anderson, Advisor and Principal Economist, Health Services Delivery, ADB 9 The bio of Mr. Ian Anderson is provided in Appendix 4.
What Struck Home: Highlights of the Q&A Discussion The Investment Case for MNCH in Asia
One of the themes that emerged from Mr. Anderson’s presentation was the frequent mismatch between funding allocations and the national disease burden. As articulated by one NGO, NGOs are often forced to operate where the donors wish to invest, without having the opportunity to express what they think would work better. In turn, donors explained that they tried to align their funds to government priorities. So what can be done as a group, Mr. Anderson asked? Together, donors, NGOs, health experts and academics can help provide evidence that will help identify the most cost-effective interventions and help make the investment case at the country-level. This will inform government decisions and improve the quality and quantity of expenditures.
Another factor perceived to contribute to the mismatch between funding and disease burden is the extent to which donors extend funding directly to governments who are responsible for budget allocations. In India, for example, NGOs contribute only 1% of healthcare delivery: most delivery actually occurs through private channels. With this in mind, how can private sector delivery be improved? Mr. Anderson pointed to the need for a greater focus on health system strengthening and acknowledged that donors needed to focus on supporting local private sector. ADB, for example, aims to increase broad private sector support to 50% of its Coverall portfolio under its new Strategy 2020. Asia NGO workshop PROCEEDINGS
Barriers and Bottlenecks: What Prevents Interventions From BWorking and What We Can Do
By defining barriers to MNCH significant to low breastfeeding program implementation and analyzing rates than were hospital policies the root causes of those barriers, it that separated the mother from her is possible to identify strategies to newborn for the first hour after birth overcome obstacles and achieve better and nursery care practices that kept program results. This was the message the baby in a separate room from the of Dr. Stephen Atwood, Director of mother. Public Health Solutions, Ltd, and formerly Asia Regional Advisor for ■■ Family and community care, UNICEF.2 population-oriented scheduled 10 outreach, and individual-oriented According to Dr. Atwood, barrier analysis clinical care in seven East Asia and has demonstrated its value in multiple Pacific countries3: This UNICEF-led MNCH interventions: barrier analysis project considered multiple interventions. For each ■■ Early initiation of breastfeeding intervention, barriers were identified in the Philippines: The presence of and an analysis of their causes skilled attendants at birth had been ensued. identified as a factor that facilitates the early initiation of breastfeeding. ■■ Skilled attendants’ failure to attend Barrier analysis took place to births: Initial analysis suggested that determine barriers to attendants’ the absence of skilled attendants at presence at births. Surprisingly, births was caused by unpredictable the analysis revealed that barriers demand (women can go into labor to attendants’ presence were less at any time of the day or week) and
“We save lives but we do not solve problems. We need to
stop treating and start solving.” - Dr Stephen Atwood, Director
of Public Health Solutions, Ltd
2 Public Health Solutions, Ltd., is a Hong Kong- based international consultancy firm focused on health and nutrition in Asia and the Pacific. A3 Cambodia, the Lao People’s Democratic Republic, Mongolia, Myanmar, the Philippines, Timor-Leste and Viet Nam. C PROCEEDINGS Asia NGO workshop
an insufficient number of skilled society in improving health outcomes: attendants in remote areas. But in one region, deeper analysis showed ■■ Ameliorating the quality of that the behaviors and attitudes of data used for local decision- birth attendants themselves was making through community-based affecting women’s choice to give monitoring systems, community birth at home rather than at a birthing wealth mappings, etc; facility. This realization prompted different interventions, as it seemed ■■ Acting as a source of unbiased likely that the region would benefit information and education for the less from better transport and higher community; staff numbers than from better performance monitoring of health ■■ Guiding the analysis of problems staff. and probing deeper into causality using qualitative and quantitative Throughout his presentation, Dr. Atwood methods; cautioned that barrier analysis was complex, that analysis must be based ■■ Working with communities on multi-stakeholder input, and that the to introduce standards, make Dr. Stephen Atwood, Director of Public Health use of good quality data was essential. interventions more effective and Solutions, Ltd, and formerly Asia Regional He also stressed that barrier analysis improve implementation; and Advisor for UNICEF The bio of Dr. Stephen Atwood is provided in Appendix 4. tended to stop too soon, before real and persistent problems were unearthed. ■■ Informing and promoting the community’s interests, thereby acting Dr. Atwood concluded by highlighting as a “third sector” that balances the several critical roles played by civil roles of the State and the market. 11
What Struck Home: Highlights of the Q&A Discussion Barriers and Bottlenecks: What Prevents Interventions from Working and What We Can Do
The discussion around barrier analysis stimulated questions from NGO participants around barriers they face in their particular programs.
■■ “The impact of gender and economic issues is often a barrier” (PNGOC): dr. Atwood agreed that gender and economic issues are often the root of a given problem. For example, one analysis revealed that patients were reluctant to seek treatment at a health center because of degrading and insulting treatment. It was discovered that doctors treated midwives poorly and that some midwives then copied that behaviour in their dealings with patients. This deeply rooted gender attitude was difficult to change on an individual level. For that reason, it was deemed more effective to address it through an institutional performance incentive. That way, it became the collective responsibility of all health workers to ensure everyone was treating women with more respect.
■■ “Scaling-up is a major challenge for my program” (Plan International): Noting the pervasiveness of difficulties in scaling up programs, Dr. Atwood noted that barrier analysis could also help in this regard. One approach is to start with a province-wide baseline study, proceed with barrier analysis, identify bottlenecks, and take remedial measures immediately. This allows scaling up to occur within the first year—not likely when actors do not fully understand and address the core barriers.
■■ “Ensuring accurate performance measurements to introduce incentive systems is a real challenge” (ADRA): barrier analysis can also be used to identify and introduce effective incentives, according to Dr. Atwood. The analysis can identify gaps, identify appropriate indicators downstream, and link incentives to key measurements. C Asia NGO workshop PROCEEDINGS
Broadening NGO Involvement in the Delivery of MNCH Services Through BContracting How many believe that NGOs can deliver health services at scale? Be more cost-efficient than governments? Deliver better quality interventions than governments? Amidst widespread skepticism, Dr. Benjamin Loevinsohn, Health Nutrition and Population Cluster Leader at the World Bank, assessed. Results demonstrated how From an NGO perspective, these presented several case studies that NGOs can both serve to scale and examples revealed that contracted highlighted how NGOs could deliver play a significant role in improving services can lead to increased access to services on behalf of governments more the quality of care, ameliorating government funding, more predictable effectively and at scale. healthcare outcomes, increasing government funding, and funding that immunization rates and reducing the covers the overhead costs of other NGO ■■ In Cambodia, two approaches to mortality rate of children under the activities. In addition, contracting offers contracting government health age of 5. greater possibilities for large-scale service service delivery to NGOs (the delivery, allowing NGOs to increase their “Contracting In” approach and ■■ In Bangladesh, a project that now impact on the lives of the poor. 12 the “Contracting Out” approach) covers over 15 million people quickly were compared to two models demonstrated that NGOs could But additional challenges may also arise. of government service delivery. provide better quality of care at As in any partnership arrangement, Results showed that the contracting lower cost than could government tensions between parties are inevitable. models giving NGOs a major role service providers. Depending on the services involved, outperformed the government NGOs may also feel pressure to focus models with respect to four major ■■ In Pakistan, a study comparing on priorities other than their own. In indicators: percentage of pregnant NGO-contracted versus non-NGO- some cases, NGOs’ implementation of women receiving antenatal care, contracted districts found that services on behalf of the government health center utilization rates, contracting led to a more than 50% can erode their role as advocates. percentage of health facility increase in out-patient visits and These challenges notwithstanding, Dr deliveries, and a concentration much better efficiency. Contracting Loevinsohn concluded his presentation (equity) index. has now been expanded to more by noting that contracting represents an than 40 districts in Pakistan and more exciting opportunity to leverage existing ■■ In Afghanistan, performance- than 40 million Pakistanis are now resources but that improved advocacy based contracting with NGOs was covered by NGO-managed services.4 with governments and more rigorous evaluation remained necessary.
“One enabling factor of this project was its holistic approach: more specifically, the fact that entire health facilities and their budgets were transferred to PPHI authority. […] The immunization coverage of mothers and children rose considerably, health professionals’ attendance of deliveries improved, and antenatal
care visits increased.” – the case study of The Peoples’ Primary Healthcare Initiative (PPHI) of Sindh Province, Pakistan: Revitalizing the
primary healthcare delivery system for maternal, newborn and child health (MCHN) and other health areas in rural regions.
4 For further information on this project see the workshop case study: People’s Primary Healthcare Initiative of Sindh Province (PPHI) / Sindh Rural ASupport Organization (SRSO) Pakistan - Revitalizing the Primary Healthcare Delivery System for MNCH and Other Health Areas in Rural Regions. C PROCEEDINGS Asia NGO workshop
Why contracting to NGOs works
■■ Contractors have a strong focus on measurable results;
■■ The private sector tends to be more flexible in accommodating changes in scope;
■■ Morale tends to be higher within NGOs than within government entities;
■■ NGOs tend to have more managerial autonomy than do government entities. This leads to more innovation; Dr. Benjamin Loevinsohn, Health Nutrition and Population Cluster Leader at the World ■■ NGOs can be rewarded with Bank performance bonuses or can be The bio of Dr. Benjamin Loevinsohn is provided in Appendix 4. sanctioned if they under-perform;
■■ Contracting makes use of competition to increase effectiveness and efficiency; and 13
■■ Contracting allows governments to focus their resources on their comparative strengths.
What Struck Home: Highlights of the Q&A Discussion Contracting MNCH Services for NGOs
How do we encourage our governments to contract out health services to NGOs and how can we ensure optimal performance and quality control from such an arrangement? These were the key issues raised by NGO participants in this session:
■■ Dr. Loevinsohn recommended that NGOs increase political advocacy to call for more resources for NGOs but that advocacy efforts should consider the source of funds—whether donor agencies, foundations, tax revenues, or out-of- pocket payments— in order to target and design advocacy efforts for best results.
■■ He cautioned that while the contracting model can produce significant benefits, quality standards and performance measures need to be clearly specified in the contracting arrangements between the NGO and the government.
Additional insight on whether to contract and how to contract is detailed in the World Bank Toolkit entitled, Performance- Based Contracting for Health Services in Developing Countries authored by Dr. Loevinsohn in 1998. The World Bank offers additional materials on its website, including a contracting plan, a draft contract, terms of reference and checklist. See Cwww.worldbank.org/hnp/contracting. Asia NGO workshop PROCEEDINGS
Tackling Four Challenges TRelated to MNCH Interventions Jhpiego
While NGO-driven MNCH programs Challenge 1: vary greatly in their objectives, their Mobilizing Resources components, and their size, most NGOs “Political commitment, participants agreed that the challenges Most NGO participants characterized continuous financial were common in nature. Key challenges mobilizing sufficient resources to launch were as follows: and sustain MNCH initiatives as a key support, the mobilization challenge, particularly in an era of limited of funds, skilled manpower, 1. mobilizing resources, resources and competing priorities. cold chain maintenance, 2. generating political will, Options to address this challenge 3. delivering services and include public and government rural electrification and 4. communicating. resources, external donor grants and the involvement of NGOs contributions, out-of-pocket payments, through grassroots workers These issues were considered separately social entrepreneurship schemes, 14 were all necessary for this in four break-out sessions where resource pooling, and community-based participants considered: resource mobilization programs. project to be sustained.” – the case study of BRAC: ■■ The issues faced in addressing one of NGO participants narrowed in on a few Achieving Immunization the four challenges; of these options, namely donor funding, in Bangladesh with the social entrepreneurship, and better data Help of Nongovernmental ■■ The options available to address this and evidenced-based analysis. Organizations. challenge; and Options to address resource mobilization ■■ Key success factors. challenges focused most notably on building better partnerships and dialogues with donors, governments and other stakeholders, on using better monitoring and evaluation systems to Atrack NGO results, and on pursuing moreC PROCEEDINGS Asia NGO workshop
“Project sustainability will be accomplished by... charging a fee, however small, for almost all services in order to reduce dependence on donors; and using financial instruments like risk pooling,
government contracting arrangements. 4. Develop adequate and reliable insurance and vouchers to More specifically, the ideas circulated at data and analysis to enable NGOs to safeguard the interests of the workshop were as follows: prove their case for investments and the poorest communities generate better results; and 1. Institute a regular partnership without compromising the dialogue among NGOs, donors, 5. To manage as social entrepreneurs, quality of care.” governments, and other stakeholders strengthen NGO capacity to develop – the case study of World or create a regular forum between self-sustaining operations. funding agencies and NGOs to help Health Partners: Developing a ensure that NGOs’ voices are heard, Model to Deliver Sustainable
that funds are earmarked for NGOs, Health Care on Scale and that funding restrictions such Anywhere. as the obligation to match funds are used judiciously; 15
2. Invite donors to encourage NGOs to improve their monitoring and evaluation systems. This would allow NGOs to showcase their What Helps Civil Society Organizations Succeed: accomplishments and their capacity A NORAD Perspective to deliver results. It would also highlight the areas in which NGOs ■■ The accessibility of funding, which is likely to become more difficult as the global need strengthening, what capacity- financial crisis begins to impact government and donor resources; building activities NGOs require, and ■ Increasing the quality and the quantity of national expenditures on health. Aid is how much funding is necessary; ■ only one part of the solution; 3. Encourage governments to ■■ Opportunities to scale up innovative approaches as with contracting and results- subcontract program and service based financing; delivery to NGOs; ■■ Community involvement in all stages of an intervention;
■■ Adequate data for lobbying and program evaluation purposes; and
■■ CSO forums that facilitate dialogue with donors and governments, collect and disseminate information, advocate through the media, and share best practices.
--Based on the background note and videoconference presentation by Paul Fife, Helga Fogstad and Grønseth Lars, Global Health and AIDS Department of Cthe Norwegian Agency for Development Cooperation (NORAD). Asia NGO workshop PROCEEDINGS
Challenge 2: 2. Compete head-on against other Generating Political Will interest groups by improving data collection, conducting effectiveness While linked to resource mobilization, analysis and putting forward clear generating adequate political support and feasible solutions to government for MNCH programs extends well officials and politicians who, for the beyond financial support. Successful most part, do not consider health MNCH programming often depends on a priority. Only through thought the political support of governments, analysis and messaging will NGOs thought-leaders, medical and be able to persuade politicians of “As a result of this project, professional associations, the private the benefits of MNCH programs, the residents of this remote sector, village heads, and other parties including immunization programs, who must either be brought on board and highlight that the benefits island, characterized by to endorse programming or must of disease prevention through poor access to services, be managed so as not to become an immunization can be realized within poor infrastructure and obstacle. their terms of office; little capacity, now have Participants explored four priority issues 3. Improve awareness and information greater confidence in faced by NGOs wishing to address of the health status of communities taking responsibility for the challenge of generating political and in particular of the role and their own health… and are will. The issues raise questions about importance of immunization in disease who, when and how to stimulate the prevention by improving marketing now demanding that the support needed for successful MNCH efforts and using messages tailored to government healthcare interventions and programs. The the target audience; sector give them their solutions identified by the NGOs placed 16 rights.” heavy emphasis on the need for reliable 4. Overcome health ministry and robust data: apprehensions about new, - the case study of MAP alternative interventions and International: Tello Integrated 1. Target the right people beyond collaborate with other sectors of the Community Health Education. health departments and health community by spearheading creative providers by undertaking a mapping partnerships with government exercise to determine which entities at both the national and stakeholders are most relevant with the local levels that ensure that regards to MNCH and which are in governments and NGOs share the a position of power and influence. costs as well as the risks; and Expanding advocacy efforts to target finance ministries, among 5. Do not underestimate the role others, could help to demonstrate of communities and ensure their the long-term financial benefits of early and ongoing involvement and immunization for a country’s financial participation in the entire advocacy and social well-being; research, planning, implementation, and monitoring and evaluation process. For this to unfold, MNCH resources, knowledge and skills must be made available at the community level and influential local or national champions must sponsor initiatives. Champions such as prominent religious figures, tribal leaders and elders, are critical catalysts to a successful advocacy strategy. A C PROCEEDINGS Asia NGO workshop
Challenge 3: 2. Coverage and accessibility issues delivery; and by addressing the lack of Delivering MNCH Programs arise particularly in rural areas where verifiable performance indicators in the infrastructure (especially the cold public sector. However, the difficulty NGOs play a key role in MNCH service chain) is weak and media coverage of securing financial sustainable delivery in many jurisdictions and for is limited. Coverage could be programs or services in areas that that reason are amply familiar with the improved by ensuring that NGOs or are particularly poor or remote will challenges associated with delivering implementing agencies build upon continue to be a challenge. MNCH interventions to mothers and their knowledge of the local context so children. These challenges relate to that programs are better designed to the supply of goods and commodities; meet local circumstances; by making delivery logistics; the condition of physical better use of technology in order to facilities and infrastructure; and the quality bring services to remote areas (e.g., “Another remarkable and availability of health providers. by using solar technology to power observation… is that rural batteries for cold chain); by structuring clients are not intimidated Participant’s discussion of key actions incentives to encourage coverage required for better MNCH delivery converged in underserved areas; and by using by the use of technology; around capacity, reach, and financing innovative demand-side financing rather they are quite at to create a demand for services in constraints: ease to be diagnosed in hinterland areas; and front of a computer.” 1. Human resource availability and capacity to deliver services could 3. Sustainability could be improved – the case study of World be partly overcome by persuading by encouraging longer-term funding Health Partners: Developing a members of the community to serve cycles that allow NGOs to build more the community. In addition, actors efficient models and reduce the Model to Deliver Sustainable could introduce creative solutions such subsidy burden; by using vertical Health Care on Scale 17 as expanding the role of pharmacies as funding to develop a backbone Anywhere. an entry point into the health system that enables the delivery of broader and making pharmacies clients’ first interventions; by focusing on building port of call; partnerships with governments to ensure the sustainability of service
Best Practices in Political Will Generation for Vaccines: Philippine Foundation for Vaccination
“The first and only vaccine advocacy organization in Asia”, the Philippine Foundation for Vaccination (PFV) was established in 2000 with the aim of reducing childhood mortality through vaccination and developing strategies to improve vaccine coverage. Focusing first on improving coverage of vaccines, such as the measles vaccine, under the National Immunization Program, it later expanded to promoting new and underutilized (NUV) vaccines including Haemophilus influenzae type b (HIB), rotavirus, and the pneumococcal conjugate vaccine.
Dr Lulu Bravo, Professor of Pediatric PFV’s continued success can be attributed to a holistic approach that includes political advocacy, public Infectious and Tropical Diseases at the College of Medicine, University of awareness and mobilization techniques, and vaccine education through a concerted public media the Philippines Manila campaign that targets parents, healthcare workers, policy-makers and key opinion leaders. Her bio is provided in Appendix 4.
The PFV approach also utilizes effective advocacy techniques such as personal testimonies, celebrity endorsements, and opinion leaders’ participation in mobilizing interest in vaccination. C-- Based on the presentation of Dr Lulu Bravo, Executive Director of the Philippine Foundation for Vaccination (PFV) Asia NGO workshop PROCEEDINGS
Challenge 4: What data is available is not packaged Communicating Messages for in such a way as to create specific, MNCH Interventions targeted and accurate messages that reach different client segments. While it is critical that the MNCH Evidence-based health data is community overcome higher-level needed to ensure that local officials “Involving and gaining constraints to the supply of MNCH are responsive to preventive health the confidence of interventions, generating demand for issues; peaceful religious leaders; and communicating messages about widely disseminating MNCH interventions at the community 3. MNCH-trained health personnel level is equally important. must be able to explain the program objectives; and advantages of immunization and creating independent In considering messages, media, vaccines to the public. There is a monitoring and evaluation conveyers of information, and target dearth of good teaching materials at audiences, workshop participants were the local level; mechanism, have played principally concerned with the critical role a vital role in the project’s of appropriate data and information tools 4. Cultural, religious and language success.” and the need for the early and effective barriers that affect communities’ involvement of local stakeholders: understanding of the importance – the case study abstract of MNCH should be factored into of BEFARe: Improving Child 1. Communication plans require a communications efforts; and Health in FATA, Pakistan, strategic approach that stimulates 5. Where targeting is concerned, a 18 Through Behaviour Change community participation and involvement so as to establish balance must be struck. To be cost- Communication Interventions. community ownership of MNCH effective, messages must often be interventions throughout the life communicated at scale. But to have cycle of the intervention; real impact, most messages need to developed through local participatory 2. The MNCH community requires processes and must be tailored to the data to support its communications. community. This process is highly Aresource-intensive and can be costly. C PROCEEDINGS Asia NGO workshop
Support for Civil Society Organizations: “Local government now The GAVI Example pays greater attention to the improvement of
To build on CSOs’ numerous strengths—working in remote communities, stimulating midwifery education as it public demand, strengthening health system vaccine delivery, providing technical has realized that improving assistance, advocating and sharing their expertise at the policy level—GAVI offers the quality of midwives CSOs two types of support: who graduate from
■■ A-type support to strengthen the coordination and representation of CSOs at the [Takengon Midwife] country and regional levels and in GAVI governance structures; academy will ultimately lead to decreasing ■■ B-type support available in ten pilot countries to involve CSOs in comprehensive, multi-year plans for immunization and/or GAVI health systems strengthening. maternal mortality. The local government began A global civil society constituency could also provide increased CSO representation to increase budget at regional and global levels, including within GAVI. It could consist of a new entity or be a link to an existing network, and its level of institutionalization is flexible. It allocations for midwifery 19 would ideally include CSO representation from both GAVI and non-GAVI countries, education last year.” and could be applied at the regional level (Asia). – the case study of Jhpiego:
- Based on the presentation of Dr Craig Burgess and Ms. Nilgun Aydogan, Global Health Improving Access and Quality
Partnership, GAVI, by videoconference. for Maternal and Newborn
Care Services in Aceh Tengah
District.
“It will be important to consolidate and document the various intervention models with respect to IEC activities, nutrition education, and IEC materials... to share with program partners and others working in the same field.” – the case study from Consultation of Investment in Health Promotion: The Cordaid-Supported Common Health Program in Viet Nam: 2004- C2006. C PROCEEDINGS Asia NGO workshop
21 CIMMUNIZATION Asia NGO workshop PROCEEDINGS
Access, Partnerships and Latest Developments in Vaccines for the Developing World
A
Many development experts distribution. A successful partnership According to Dr. Taylor, critical roles for have recognized the threat of an approach exists where: civil society in Asia and beyond lie in the “innovation pile-up”—a strain on health following areas: infrastructure, health systems, and ■■ Vaccines are valued and prioritized health financing caused by increasing in health budgets and healthcare Advocacy – stimulating community technology (including vaccine) systems as an investment, rather than support and use of vaccines and innovations that could, if available, as a cost; positioning MNCH in order to generate prevent millions of deaths. ■■ New vaccines are rapidly introduced political will and sustain financing; and accepted/demanded by the As underscored by Dr. Kate Taylor, Vice public; Programming - working on distribution President of Global Vaccine Policy ■■ New generation vaccines are supported and delivery programs, building 22 and Public Health Partnerships, GSK and vaccine coverage is expanded into capacity by training health workers, and Biologicals, for vaccines’ full potential new population segments; improving data through operational to be realized, many stakeholders need ■■ Sustainable financing and reasonable research and M&E; to be involved. This entails a partnership pricing is in place; and approach that would stretch across ■■ Innovative models to promote The creation of innovative the supply chain from development to availability are developed. approaches - reaching underserved
Vaccines for the Developing World: The GSK Approach
As the leading supplier to UNICEF and GAVI, almost 80% of the 1.1 billion doses of vaccines produced by GSK in 2008 went to the developing world where they reached some of the world’s most disadvantaged populations. GSK’s tiered pricing system, pioneered 20 years ago, has accelerated this widespread uptake by encouraging prices to be set according to the vaccine’s value, the country’s ability to pay, the volumes purchased and the duration of the purchasing commitment. Tiered pricing applies both across and within countries where distribution channels can remain separate.
GSK’s current vaccine pipeline is recognized as the deepest in the industry with 24 vaccines presently somewhere between Development Phase I and approval. Many of the new vaccines target diseases common in the developing world, such as malaria, dengue, HIV, cervical cancer, and rotavirus. GSK’s vaccines are based on an adjuvant system that activates different arms of the immune system. These vaccines can provide a stronger or broader immune response and help to provide longer-term protection. A-- Based on the presentation by Dr Kate Taylor, GSK C PROCEEDINGS Asia NGO workshop
populations by developing new delivery channels and innovative financing models; and
Policy development - conducting gap and barrier analysis and helping to Dr. Kate Taylor, Vice President of Global Vaccine translate findings into informed policy. Policy and Public Health Partnerships, GSK Biologicals The bio of Dr. Kate Taylor is provided in Appendix 4.
23
What Struck Home: Highlights of the Q&A Discussion Developments in Vaccines for the Developing World
The subject of vaccine financing dominated the discussion following Dr Taylor’s presentation.
The previous day, GAVI had shared via teleconference that its board of directors was currently reviewing conditions for country eligibility. What was the likelihood of the Philippines becoming eligible for GAVI support? Dr Taylor pointed out that while GAVI is indeed considering extension to new countries and vaccines, the alliance must also raise $3 billion to cover it current country portfolio. Resources are increasingly limited and GAVI already faces challenges to funding eligible countries from now to 2015.
Dr Taylor believes that these challenging times call for new evidence and new thinking on innovative financing mechanisms for vaccines. She suggested pooled procurement for Asia’s middle income countries as a possible solution.
Dr Taylor was then asked to consider vaccine financing challenges from a government perspective. Dr Loevinsohn pointed out that governments are the largest financier of vaccines and therefore need to understand their liability. Dr Taylor replied that countries with a fixed line item for vaccines in their national budgets will be able to negotiate better prices. Long-term pricing benefits both countries and manufacturers. GSK has committed to long-term pricing for various vaccines, e.g., pneumococcal vaccine, from now to 2023. Advocacy efforts such as those already discussed that aimed to inform ministries of finance of the value of vaccines and the economic returns on the investment in Cpreventative health serve to support that long-term pricing benefit. AsiAsiaa NGONGO wwoorkshrkshoopp PROCEEDINGS
Innovative NGO IApproaches to Immunization
What predominant challenges do NGOs face in the delivery of MNCH services and what have NGOs done to overcome them? Moderated by Mr Bart W. Édes, Head of ADB’s NGO and Civil Society Center, this panel discussion considered NGO responses to a number of common challenges.
Programs Featured by the Panelists
The Well Baby Bakuna Program - Dr. The project reversed low demand for immunization by applying Eden Divinagracia, Executive multiple communication strategies, targeting local leaders, and Director, Philippine NGO Council pursuing behavior change techniques. on Population, Health and Welfare, Inc., Philippines Revitalizing the Primary Healthcare Delivery System for MNCH and Other Health Areas in 24 Designed to ensure that children, particularly those born in low Rural Regions immunization coverage areas, receive a full set of EPI vaccines - Dr. Riaz Ahmed Memon, Program Director, before their first birthday, Well Baby Bakuna partnered with private People’s Primary Healthcare initiative of practitioners to target and serve members of low and middle-earning Sindh Province income brackets who were willing to pay for improved vaccines or private health services. The project delegated the management of government health facilities and their budgets to PPHI authority to upgrade health Immunization Rates Improve with facilities, introduce incentivized salary systems, develop community Timed and Targeted Counseling of Birth ownership and awareness, and diversify medical/health deliverers in Cohorts in Uttar Pradesh, India order to deliver better health services to nearly 30 million people. - Dr. Sri Chander, Regional Health Multi-Sectoral Approaches to Increasing Advisor, World Vision, India Immunization Rates: Saving Lives Through Improved Quality of Care in Nagan Rayah, Aceh Designed to increase immunization rates by timing counseling to Province life cycle events rather than scheduling health services according - Dr. Nasaruddin Sheldon, Country Director, to doctors’ availability, this project uses a pregnancy register and Project Hope Indonesia targeted education to ensure that counseling is “neither too early, lest it be forgotten, nor too late for the behavior to be practiced”. Designed to revitalize integrated health posts and strengthen maternal and neonatal health initiatives, this program trained village Revitalization of Community Based Demand midwives, nurses and community health volunteers and engaged Generation for Immunization in Lao PDR fifth grade students in the promotion of immunization among - Ms. Che Katz, International mothers in their communities. Communications Officer / Lead Project Consultant AMr Bart W. Édes’ and the panelists’ bios are provided in Appendix 4. C PROCEEDINGS Asia NGO workshop
Theme 1: The Role of Government: Governments in most countries are firm in their commitment to ensure that at least the basic EPI vaccines are delivered to their populations; in general, they play an active role in this regard. But to what extent do governments enable NGO- led projects? How do NGOs generate the political will for specific initiatives or draw attention to immunization more generally?
Panelist Insights: Panelists agreed that successful interventions depend on building political will at multiple levels of However, securing political will is not government. Dr. Memon outlined a always left solely to NGOs. According to two-pronged approach in Pakistan – an Ms. Katz, generating political will in Lao evidenced-based presentation to the PDR was undertaken more by project President and his Cabinet, and district donors than by NGOs, except at the level advocacy to municipality officials. district and local level where program facilitators had more direct contact with Several panelists also stressed the need officials. for evidence-based analysis to convince decisions-makers on the value of Although it is key to bring governments 25 programming. For example, Dr. Sheldon on board, governments are not the only noted that Project Hope secured support stakeholders whose support is required. from local government officials only after In the Philippines, Dr. Divinagracia convincing them with baseline research noted the project’s success was more on the health situation in the district. dependent on the buy-in of the pediatric The program was scaled up after project society than that of the government. leaders were able to demonstrate good The ministry of health was however results. kept abreast of program developments and results. “The key strategy of the program is to supplement and complement government health services and help attain the health-related “These [pregnancy and infant] registers were thus used not only to Millennium Development plan for and provide timely counselling to households but also to help community workers plan for and inform and/or escort beneficiaries Goals (MDGs).” to immunization sessions at health outposts. Local-level problem – the case study of RDRS solving and close coordination with peripheral health providers were critical skills used by workers to ensure that all beneficiaries availed Bangladesh: A Community themselves of immunization services in a timely manner.” – the case Health Program in Northwest
study of World Vision: Immunization Rates Improve with Timed and Targeted Counseling Bangladesh. Cof Birth Cohorts in Uttar Pradesh, India Asia NGO workshop PROCEEDINGS
Theme 2 – Health Service Delivery: However, another participant cautioned While some NGO projects seek to that alternative or private channels improve the efficiency and the reach of may require different management and government health services, others work regulatory processes. Governments “Early identification to develop alternative or private channels play an important oversight role in this to deliver immunization services. How regard. Moreover, efficiencies may be of target children, important is it to have both public and gained by involving existing institutions the mobilization and private entities involved in the supply (e.g. private midwives) instead of reminding of mothers and delivery of immunization services? creating new institutions or channels of delivery. 26 to avail themselves of Panelist Insights: services through regular Dr. Divinagracia was most keen to Theme 3 – Focus on Supply and community rounds, share PNGOC’s experience in nurturing Demand for Immunization: Successful and the follow-up of alternative health channels as a immunization programs often depend supplement to government systems, on concerted attention to factors that children who did not avail noting that private delivery channels affect both the supply of and the demand themselves of services, are already play a major role in some for immunization. Yet some projects are ways that village health countries and can be very effective at by scope or financial limitation forced workers (VHWs) have delivering health services, particularly to focus more on one or the other. How to have-less / middle-class populations. easy is it to isolate demand factors increased coverage.” She added that “willingness to pay” from supply factors when developing – the case study of Plan studies can determine the identity of the immunization programs? target population and how much that Philippines: Practical and population can pay for health services. Coordinated Approaches to
Child Health.
“As many nongovernmental organizations (NGOs) operating in the area provide salaries for services and per diems for training and travel, the [local women’s groups] also started demanding salaries and per diems. [… ] WATCH explained its philosophy about making the community self-
reliant and able to stand on its own feet. “ – the case study of Women Acting ATogether for Change (WATCH): Barefoot Women Health Volunteers. C PROCEEDINGS Asia NGO workshop
Panelist Insights: Theme 4 – Cost-Effective Panelists agreed that planning that Communications: Generally, messages addresses both demand and supply is are more effective (i) the more tailored critical. While concerted effort is often they are to the individual or community, required to ensure that both sides of (ii) the more frequently they are the equation are in place, in other cases, reinforced, and (ii) the more inclusive “Janani has shown that work on supply and demand issues the target audience is. When we resources available beyond flows quite naturally. For example, weigh messages’ impact against cost- the public sector can be narrowing in on local circumstances— effectiveness and scalability, what kinds leveraged and brought within and considering the challenges of a of trade-offs should be considered? community or village in its entirety— an operational framework to forces a more tailored and integrated Panelist Insights: deliver services to the poorer response. This also reinforces the view The answer to these questions is not and rural communities on a that the solution for one village may not straightforward and appears to depend be appropriate for the next. on the circumstances and needs of large scale at very high levels the target communities. Effective of cost efficiency. Even in Some project components impact both communication strategies recognize areas where the public sector is supply and demand. For example, and utilize a variety of communication efficient, such a strategy can be incentives can incite doctors and channels and target a variety of actors healthcare workers to work in remote and influencers. used as a force multiplier”
locations, which can improve both the – the case study of Janini: supply of and increase demand for On one hand, Dr. Sheldon stressed Expanding Intrauterine Device and health services by their mere presence. that targeting different influencers of Similarly, as Dr. Sheldon pointed out, behavior, such as teachers and school Medical Abortion Services in Two the timed and targeted approaches children, can maximize message States of India: Bihar and Jharkhand. 27 employed in Aceh Province helped dissemination and uptake. Similarly, Dr. address both supply of and demand for Divinagracia underscored the value of immunization services. one-on-one communication between health workers or between volunteers However, Ms. Katz suggested caution and mothers. regarding the structure of incentive systems. For example, in one case, health Ms. Katz suggested however that workers were incentivized to reach a combining tailored and general messages certain number of villages as opposed to achieves greater cost-effectiveness. a certain number of people. As a result, In addition, both Dr. Memon and Dr. very few of the target group—in this Divinagracia advised that the formation case seasonal workers—were actually of community support groups can be a immunized: they were not in the villages very cost-effective way to disseminate at the time of the visit. Yet health workers information, locate clients, and generate Cwere still given their credit. demand for MNCH services. Asia NGO workshop PROCEEDINGS
Theme 5 – The Importance of Introducing an element of peer pressure Dr. Diviagracia pointed to social Community Ownership: The importance can also be effective in ensuring enterprises that are structured as of community ownership has been local ownership and compliance (e.g. profitable business models and that a recurring theme in the vaccine developing links to community support integrate cost-sharing and profit-sharing initiatives presented at the workshop. groups (Dr. Memon) and posting records to ensure sustainability and growth; Ownership seems to come in many on community message boards (Ms. forms: ownership by local public health Katz). Ms Katz underscored the value of deliverers; ownership by community institutional memory. This manifests in and religious leaders; ownership by Theme 6 – Sustainability: Financing the development of tool kits comprised families. What strategies have led to immunization is a challenge faced by of best practices and sample materials genuine community ownership, not all countries. Increasingly, governments so that planning and development costs only of projects, but also of the need to and development practitioners are are minimized; and
28 ensure access to vaccines over the long looking at creative ways to ensure not term? only that EPI vaccines are financed, but Models based on government also that resources for NUV vaccines contracting can help sustain NGO Panelist Insights: are mobilized and that adequate operations, assuming that performance Panelists agreed that local communities investments in the health systems that requirements are met and that the must be involved in programs from their support immunization services are government is commited to contracting design through to their monitoring made available. What are successful NGOs for service delivery, as was and evaluation. It is also necessary that ways in which the issue of financial experienced by Dr. Memon in Pakistan. programs include local healthcare and sustainability has been addressed? community workers from the outset in the design and particularly in the Panelist Insights: implementation of programs delivered Panelists saw the question of financial at the local level. However, as Dr. sustainability as both important and Sheldon and Dr. Divinagracia pointed difficult to address. There was strong out, appropriate training of healthcare recognition that donor funding can be workers is also critical. Dr. Chander an effective means of launching new shared that fully 20% of his organization’s pilots or introducing new approaches program budget is allocated to behavior but should not be viewed as a source change communication. of long-term operational funding. Nonetheless, panelists had some specific As reinforced by Dr. Sheldon and Dr. recommendations: Chander, the involvement of local religious community leaders and the Dr. Chander stressed that some programs extended family is often an important achieved sustainability by supporting component of an MNCH program. income-generating activities for local ANGOs; C PROCEEDINGS Asia NGO workshop
NGO Solutions to NImmunization Obstacles
Many of the challenges that Scenario 1: emerge in launching and sustaining Low-Income Country, Weak MNCH programs in general also Coverage materialize in efforts to extend immunization services more specifically. This scenario was related to a low- “One of the project’s most Again, these challenges relate to income country where innovative strategies consisted mobilizing sustainable resources, ■■ The country is not on target to generating political will, ensuring achieve MDGs 4 and 5; of child-to-child health quality delivery, and communicating ■■ At 60%, EPI coverage lags behind the education methods whereby 29 messaging to ensure the demand regional average; fifth grade elementary school for services is strong. Depending on ■■ Urban and rural pockets are not students reached out to the the context, however, the challenges availing of immunization services; manifest in different ways. and mothers of children under the ■■ The country is GAVI-eligible. age of three to promote the Workshop participants considered these importance and benefits of challenges within the context of four NGO Response to Key Bottlenecks immunization and other IHP scenarios representing real challenges facing the immunization systems of Demand generation, weak health services… the local ministry of many Asian countries: systems, weak management of the education [later] adopted the 1. a low-income country with weak supply chain and a poor policy and subject as an official part of immunization coverage; regulation environment were the 2. a middle-income country graduating dominant bottlenecks in this scenario: the local curriculum, meaning from GAVI support; that students will be formally 1. Poor community demand for 3. a country in the midst of making evaluated in the subject as part critical budgetary decisions, where vaccines. Most low-income countries of their scholastic report.” making the case for immunization is have poor community demand of utmost importance; and for immunization. This stems from – the case study of Project Hope: commonly held traditional beliefs 4. a country trying to avoid an Saving Lives Through Improved innovation (new vaccine) “pile-up”. and/or negative experiences with immunization. It also stems from a Quality of Care in Nagan Raya, Specifically, discussion focused on key lack of awareness of the benefits of Aceh Province, Indonesia. issues, the role of the NGO community, immunization. As with many health and what was required for NGOs to conditions, poor families do not pay succeed. much attention to disease prevention, Conly facing the consequences of Asia NGO workshop PROCEEDINGS
disease when it strikes. Furthermore, 4. Conflict between policy and communities often experience regulation. In many low-income vaccine shortages and cannot always countries, health policies do not afford vaccines. focus on immunization. In addition, it is common for policies that NGO ACTION: To address poor community support immunization to conflict demand for vaccines, NGOs need to with healthcare delivery regulations. step up actions to raise awareness For example, while midwives in a about immunization and to mobilize country are being encouraged to play “This private sector partnership communities. a stronger role in vaccine delivery, has paved the way for the regulations may be prohibiting Government of Bangladesh 2. Weak health infrastructure. Many them from actually administering health systems in the region lack vaccines. to achieve Millennium adequate infrastructure. This is Development Goals 4 and 5 particularly the case in communities NGO ACTION: To address conflicts between without significant investments.” outside large population centers policies and regulations, NGOs could work where frequent power outages together in a consortium, initiate dialogue – the case study of Pathfinder: affect the cold chain. The lack of well- with government, and conduct advocacy Sponsoring community-level service maintained refrigeration equipment efforts at all levels. providers for safe motherhood and results in the wastage and shortage
infant care services. of vaccines. 5. Poor supply chain management. Common to low-income countries NGO ACTION: To address weak health are weak links in the vaccine supply infrastructure, NGOs could engage chain. These arise in part from more health workers; and foster greater inadequate demand forecasting 30 cooperation with community-based of supplies at national and district organizations (CBOs) in order to cover levels, under-developed logistics and hard-to-reach areas. information management systems, and weak coordination among health 3. Under-performing health workers: deliverers and officials. In addition, health workers in many low-income countries are underpaid NGO ACTION: To address poor supply and lack training. This results in chain management, NGOs could undergo workers feeling unmotivated to serve training in supply chain management their clients, especially in remote and and step up monitoring, reporting and inaccessible areas. advocacy activities in order to reduce the incidence of vaccine shortages. NGO ACTION: strengthen networks of NGOs, CBOs and government entities; and build health workers’ capacity.
“ A motivating factor for families and communities was the presence of local nongovernmental organizations that acted as watchdogs, supporters and co-lobbyists with parents, health teams and rural health unit staff in their demands for greater health allocations on the part of the municipality.” – the case study from Christian Children’s Fund Philippines: Mobilizing the Community to Increase Immunization in Lamitan, the APhilippines C PROCEEDINGS Asia NGO workshop
What Is Required for NGOs to Succeed build their capacity to mobilize local, national and international resources, To succeed, it was suggested that NGOs improve their access to information strengthen their internal capacities and and obtain training in resource build on one another’s comparative generation. advantages as they coalesced and expanded their networks to include Scenario 2: other partners. Specific actions include: Middle-Income Country Graduating From GAVI “The process of becoming a 1. Strengthening capacity for advocacy. NGOs’ advocacy skills This scenario reflects what many [certified] bidan delima allows need to be strengthened to enable countries might experience once they midwives to evaluate the extent them to conduct advocacy activities move from being a low-income country of their skills and remedy any at various policy-making levels; to being a middle-income country and weaknesses before applying thus graduate from GAVI eligibility. 2. Forming a network or coalition This scenario relates to a middle- for validation. This program is of NGOs. Believing in the strength income country with the following unique in that it allows midwives of numbers, NGOs active in public characteristics: to decide when to be tested.” health concerns should form a network or a coalition dedicated to ■■ Recently graduated from GAVI - the case study of the Indonesian better lobbying policy-makers; eligibility; Midwifery Association (IBI): Bidan
Delima: a Branding Program to 3. Involving the private sector. NGOs ■■ Health budget and health capacities Improve the Quality of Midwife need to tap private health providers are stretched; and practitioners, the business sector Services 31 (for example through corporate ■■ Private and public channels for social responsibility programs) and immunization co-exist, although other private sector stakeholders; most residents rely on public systems; and and
4. Expanding capacity for resource ■■ Citizens are not accustomed to paying generation. As NGOs usually have for vaccines and the government limited financial, technical and is not accustomed to charging for Chuman resources, they need to them. Asia NGO workshop PROCEEDINGS
NGO Response to Key Bottlenecks 2. Inadequate data and data more efficient and accessible. In this systems on the burden of disease context, it is important to work with The group identified several likely and inadequate analysis of the professional associations that could be bottlenecks in the supply and demand immunization problem. This is affected by the introduction of alternative of vaccines in this middle-income particularly challenging for middle- vaccine delivery systems (e.g. transferring country scenario: income countries with decentralized doctors’ duties to midwives). health systems. Community demand 1. Limited vaccination funding for vaccines and vaccine-related 4. No official market segmentation sources coupled with inconsistent information is also likely to be low, to show what segments of the NGO capacity in budgeting and causing a lack of appreciation for the population are willing to pay for procurement. It is also likely that value of immunization. services and what segments cannot the global economic crisis would afford them; increase the competition for funding NGO ACTION: Develop and disseminate between immunization advocates health education and promotion NGO ACTION: Conduct market and the proponents of other health materials that underscore the importance segmentation research to provide options interventions and activities. and benefits of vaccination; advocate for to inform policy decisions. reliable and accessible databases of local, NGO ACTION: Identify priority areas for national and regional data reporting and 5. Ineffective incentives to stimulate funding and explore alternative sources analysis; and anticipate and engage anti- the supply and demand of of financing at the local, national and vaccine lobby groups. immunization services. Well- international levels; build NGO capacity in designed incentives which are linked regards to budgeting and procurement. 3. The lack of public-private to concrete measurements can have a collaboration in most countries and demonstrable impact on community communities. This has hampered demand for immunization services effective MNCH programming, and can also improve health care 32 with parties often duplicating delivery, particularly in remote areas; efforts or working at cross purposes “Among the reasons why [some without due respect for each other’s NGO ACTION: Programs which aim to low-middle income] clients comparative advantages. strengthen alternative and/or private prefer to pay for vaccines from delivery channels offer good potential to NGO ACTION: Strong public-private introduce incentives for the community, private practitioners are the collaboration could provide a venue or healthcare workers, and so on. NGOs types of vaccines available to share and discuss ways to improve can ensure that incentives are linked to (monovalent versus multivalent immunization rates, for example, ways concrete measurements that impact vaccines); the better quality to make under-utilized private channels program objectives directly. of private health facilities; the sometimes difficult attitudes of certain public health deliverers; shortages in vaccine stocks at public facilities; and the limited range of vaccines provided.”
– the case study of the Philippine
NGO Council on Population Health
and Welfare, Inc.: Well Baby Bakuna AProgram. C PROCEEDINGS Asia NGO workshop
What Is Required for NGOs to Succeed Scenario 3: Making the Case for More Funds For NGOs to succeed in these tasks, the group believed that changes in their In countries throughout Asia, activities and approaches would be immunization against vaccine- required. Specifically they believed that preventable diseases competes for “Health issues are largely there was a need for NGOs to funding with other health priorities. In overshadowed as compared this scenario, 1. Become more business-oriented and to many other development create sustainable operating models; ■■ The national government has needs. More concerted NGO 33 budgeted for greater support of advocacy at international and 2. Be more committed to advocating health sector challenges; for immunization; regional organizations and ■■ Millions of children, teens, and adults with governments could help 3. Identify strong collaboration with are dying from vaccine-preventable donors; diseases; strengthen this much needed
voice.” 4. Secure strong leadership, especially ■■ Elections are coming; local and national champions; - Mr Bart W. Édes, ADB ■■ Other health advocates have already 5. Improve access to media and obtain begun to lobby for increased funding media relations training; and of their causes; and
6. Ensure the provision of incentives/ ■■ To date, no one has made a enablers to incite health providers to case to allocate more funds for work in remote areas. immunization.
“Incentives must be considered carefully. A well was necessary for many villages, but it was probably not right
to make the well a reward. A well is a necessity.” – the case study of RACHA: Changing Health Behaviors Using Community CPerformance Contracts. Asia NGO workshop PROCEEDINGS
NGO Response to Key Bottlenecks budgets; advocacy efforts are What Is Required for NGOs to Succeed fragmented; opportunities for public The issues identified by this group participation are not realized; vaccine The group felt that enabling NGOs to reflected the fact that governments advocates have not developed play these roles would require them to frequently fail to prioritize immunization, strategies to press for more funding; do the following: that there is little data to convince and advocacy for other health government that immunization should issues is much more developed. 1. Step up lobbying activities. be a priority and that few advocates This places immunization advocacy Lobby groups and champions can brought immunization to governments’ at a disadvantage, especially as EPI successfully promote immunization attention. practices are not often linked to as a health priority, generate media other health practices. exposure and influence the political 1. Preventive health care does not tend agenda; to be a political priority. The decision- NGO ACTION: Network and advocate makers who control public funds do more effectively to make the case for 2. Bolster their advocacy capabilities. not perceive vaccines as a priority; immunization by (i) raising public NGOs need to formulate clearer candidates for public office do not awareness so that communities demand and more consistent messages to see vaccination as a vote-getting immunization services; (ii) using data improve awareness and generate issue and have little awareness of the gathered at the community level to make demand and to sustain advocacy immunization needs of newborns; the case for immunization to politicians efforts. They must also make better and health issues are used principally and stakeholders; (iii) seeking the support use of the data; as a technique to win votes. of stakeholders such as the media, the private sector, sectoral leaders, and 3. Improve their access to and use NGO ACTION: Promote health care others; and (iv) building NGO coalitions of information. Decision-makers as a priority by performing strengths, for immunization. need better local, regional and weaknesses, opportunities and threats national data, some of which can 34 (SWOT) and risk analyses of immunization 3. No data or analysis supports the be generated by communities that issues; identifying immunization case for immunization. There is share information and best practices champions within the government; neither a cost-benefit analysis of the in immunization approaches. organizing and mobilizing lobby groups health burden of low immunization of parents, industry actors, civil society, coverage nor hard data or analysis and/or health workers to support the to explain why the country has such immunization cause; tapping the media; low immunization rates; no one has and conducting political advocacy argued for more budget allocations activities using evidence-based data. for immunization.
2. Immunization advocates are often NGO ACTION: Build databanks and lacking. The community lacks develop analytical capabilities. More awareness about disease prevention; specifically, train communities to collect nobody from the public sector, the and analyze data; prepare tools and private sector or civil society takes guides for community data collection and the lead in increasing immunization analysis; and generate testimonials at the local level.
“When a donor is rushed to obtain outcomes and places too much focus on efficiency, activities become donor-
driven and counterparts’ sense of ownership suffers.” – the case
study by the Japanese Organization for International Cooperation in Family APlanning (JOICFP): Viet Nam Reproductive Health Project in Nghe An Province C PROCEEDINGS Asia NGO workshop
Scenario 4: 1. Inadequate awareness about and To address these challenges, workshop Innovation Pile-Up insufficient demand for new vaccines participants recommended that NGOs among potential clients and health step up their role with respect to Participants were also asked to sector workers; advocacy and the delivery of services: consider the pressing challenge of 2. Lack of a solid evidence base that “innovation pile-up”, a phrase coined enables organizations to lobby NGO ACTION: Play a much more significant by Chris Elias, Chief Executive Officer relevant government organizations role in advocating for universal access to of PATH, to indicate a situation where and individuals for the inclusion of the new vaccines. This role would surface new vaccines are coming or will come the new vaccines; with advocacy efforts targeted at many on line faster than immunization levels: government (asking it to develop systems and infrastructure can handle 3. A dearth of trained service providers the required policies and regulations and their communication, storage, and for the dissemination of the new to manifest political will), health workers distribution. In this scenario, vaccines, particularly if the vaccines (building their awareness), clients (creating require new delivery methods; demand and encouraging the view that ■■ National EPI coverage is over 90%; vaccination is an investment, not a cost), 4. Logistical problems particularly donors (soliciting financial as well as ■■ New vaccines for children, as regards cold chain facilities in technical assistance but also, importantly, adolescents, and adults have been areas where resources are already encouraging the development of a solid endorsed by the World Health stretched; region-wide research base), and NGOs Organization and the country’s (seeking to apply more innovative supply, medical community but have not yet 5. A lack of new funding models given delivery and funding models). been added to the country’s list of that government health resources in approved vaccines; most countries are already strained NGO ACTION: Play a crucial role in the and that clients are not often given delivery of new vaccines by (i) piloting ■■ No sources of funds have been the opportunity to pay for certain new service delivery and funding models; 35 identified outside of sources that services or vaccines; (ii) using NGO clinics and outreach fund traditional EPI vaccines; and services; (iii) partnering with private sector 6. The lack of political will to provide organizations; (iv) piggy-backing on ■■ The health system’s capacity and access to vaccines that were government-run systems and helping to infrastructure are already stretched. previously unavailable and the lack of improve those systems in the process; (iv) policies and regulations that enable training health service workers at different NGO Response to Key Bottlenecks dissemination of the vaccines; levels as appropriate; and (v) developing tiered pricing models and new payment Providing access to vaccines that can 7. Low levels of NGO involvement in mechanisms where willingness to pay is prevent illness should be a priority for immunization even though NGOs ascertained. all governments but the impending generally play a significant role in the “innovation pile up” is likely to amplify provision of health services; and existing resource, capacity and infrastructure constraints. NGOs found 8. A lack of new business and the key bottlenecks to address in this operating models to develop new scenario to be as follows: vaccine delivery systems, particularly among NGOs.
“In regions where maintaining the cold chain is difficult, the coverage of birth doses given within 24 hours could be significantly increased by using outside-the-cold-chain (OCC) vaccines. This strategy would help reach the goal of reducing hepatitis B infections in children aged 5 to below C2% by 2012.” – the case study of Path: Evaluating the use of outside-the-cold-chain hepatitis B vaccination in Viet Nam. Asia NGO workshop PROCEEDINGS
What is required for NGOs to succeed An Integrated Approach to Increasing Vaccine Uptake Enabling NGOs to fulfill this role would An Example from Mexico require them to focus on building networks and partnerships across the stakeholder spectrum and come up Under the direction of Dr Roberto Tapia Conyer, the Mexican Ministry of Health with creative and innovative solutions. introduced a “stepwise implementation” approach to achieving universal 36 Examples of activities in this direction immunization coverage, starting with the most socially vulnerable. The first stage are: covered 58 counties, the second stage an additional 432 counties, and the third stage 104 more counties. The program succeeded by addressing the 1. Consultations, particularly at the key elements of a comprehensive immunization program: enhancing existing community level; infrastructure, implementing effective monitoring and supervision, engaging in political advocacy and networking, mobilizing communities, and introducing 2. Collaborations between and among strategic social marketing. As a result, Mexico has benefited from the addition NGOs, between NGOs and the of six new vaccines (Hepatitis B, Haemophilus influenzae type b, influenza, donor community, and between pneumococcus 7-valent, rotavirus, and HPV) to its national immunization program intervention teams and their over the past decade, bringing the total number of antigens to 14. communities; and
-- Based on the Presentation by Dr Lulu Bravo, Executive Director of the Philippine Foundation 3. Creativity by all parties in coming up for Vaccination (PFV). with new and innovative solutions, particularly solutions to the dilemma of finding new sources of funding for new vaccines as they come on line, the challenge of communicating effectively with diverse communities and the goal of delivering vaccines in rural and remote locations and to the “Health staff is paid in rice and salt and earns no more than US $6 poorest communities. per month, which causes them to feel de-motivated and to lack
commitment” – the case study of Health Unlimited: Kachin People’s Health ADevelopment Initiative (2006 - 2010) C PROCEEDINGS Asia NGO workshop
37
Moving forward: Cwhat’s next? Asia NGO workshop PROCEEDINGS
MOVING FORWARD: MWHAT’S NEXT? Jhpiego
At the end of the workshop, Enhanced Advocacy - Imperatives: participants considered next steps to build on the information shared during ■■ Disseminate the case studies to “Synergy will be created the workshop and to capitalize on the government counterparts, to the networks established over the prior two United Nations, to global public when different MNCH days. health schools and libraries and programs interact and to other NGOs; Investigate best adapt their respective Improved NGO Networking - Options: advocacy practices and develop a practices... This interaction “how to advocate” tool kit; ■■ Establish a regional network of NGOs will improve the as a means to improve inter-NGO ■■ Appeal to donors for financial performance of individual 38 communication; support for regional and country- programs and help reduce level NGO networks that will (1) ■■ Improve in-country networking and advocate for an increased policy neonatal and maternal discuss issues at the country level; focus on MNCH/immunization and morbidity and mortality.” (2) increase the role of NGOs in
– the case study from Mother ■■ Establish a sustainable and current MNCH interventions; list server (e.g. yahoo groups) for and Infant Research Activities, information sharing; ■■ Commit to lobbying governments to “Facilitating Synergies to Scale pressure for an increase in the quality
Up Maternal, Newborn and Child ■■ Enable regular face-to-face meetings and quantity of health expenditures in order to strategize, showcase best and to better address immunization Health (MNCH) Intervention: practices and flag activities and and MNCH issues; Immunization practices; ■■ Contribute to better local and ■■ Hold workshops on other MNCH national data collection and interventions such as nutrition and dissemination to inform the design reproductive health. of better incentives and monitoring and evaluation efforts;
■■ Lobby for NGO inclusion in country- level investment plans where “Successful delivery of MNCH programs MNCH intervention “best buys” are depends on dedicated individuals like those determined; and
in this room.” -Dr Mike Singh, Save the Children ■■ Leverage Save the Children’s “Newborn Child Survival Campaign” Ato be launched on 5 October 2009. C PROCEEDINGS Asia NGO workshop
39
It was recognized that these next steps, in particular establishing and coordinating a network, would require funds that the current environment might make difficult to source but that the value of Csuch an effort would be worthwhile. Asia NGO Workshop Appendices A40 C Appendices Asia NGO WOrkshop
41 Cappendices Asia NGO Workshop Appendices APPENDIX 1 - WORKSHOP DESCRIPTION AND Agenda
Designed to encourage knowledge-sharing and stimulate discussions on innovative solutions to the key challenges facing NGOs engaged in MNCH programming in Asia, the workshop agenda integrated plenary presentations, panel presentations, panel discussions, and breakout groups. International organizations and NGOs delivered presentations about the state of MNCH in Asia, about current challenges and responses to MNCH, about innovative NGO initiatives, and about the latest developments in vaccines and immunization programs. In two facilitated breakout sessions, participants (1) considered key challenges to effective MNCH programs and evaluated options to address these challenges and (2) considered four immunization scenarios, the issues evident in the scenarios and what NGOs could do to address those issues.
Day One addressed broad aspects of MNCH. Keynote and panel speakers devoted attention to the great health needs of mothers and children across the region and the many significant barriers to their access to services. They discussed why building an investment case for MNCH is so important in an era of limited resources and increased attention to programming results, and why MNCH advocates must step back and assess core barriers and bottlenecks. Participants formed small groups to consider the question of how to overcome obstacles relating to four core components of MNCH programming: (1) mobilizing resources/ financing; (2) generating political will; (3) delivering MNCH programming; and (4) communicating at the local level.
Day Two was designed to apply participants’ experience and their learnings from Day One to a specific MNCH innovation: immunization. In the morning, participants had the opportunity to view their colleagues’ poster exhibits and interview them about their projects. This session was followed by small group discussions on the lessons learned from the case studies. Following this event, two plenary presentations were made. These presentations addressed the latest developments in vaccines for the developing world and best practices in vaccine advocacy.
In the afternoon, participants were invited to consider ways to overcome concrete challenges relating to vaccine uptake under 42 various scenarios. These scenarios differed by the income level of the country in question, by the role and capacity of public and private sector participants, by health challenge, by target beneficiaries and by other factors.
What follows is the full agenda of the NGO Workshop on MNCH and Immunization.
TUESDAY, 24 FEBRUARY: CONSULTATION LAUNCH
12H00 Arrival and Registration of Participants
14H00 – 17H00 Poster Exhibit Set-up
17H30 – 19H00 Cocktails / NGO Participant Poster Exhibit
Welcoming Format: brief remarks by Dr. Jacques Jeugmans (ADB), Ms. Elizabeth Hernandez (GSK), and Ms. Latha Caleb (Save The Children)
19H00 Dinner
WEDNESDAY, 25 FEBRUARY: MATERNAL, NEWBORN & CHILD HEALTH INTERVENTIONS
Morning
08H30 –10H15 Consultation Opening Objectives and Program Flow Introduction of Participants / Expectations for Consultation AFormat: facilitator-led discussion C Appendices Asia NGO WOrkshop
10H15 – 10H30 Coffee Break
10H30 – 11H15 “State of Mothers and Children in Asia” Plenary Presentation and Discussion Mr. John Stoeckel, Asia Health Advisor, Save The Children Format: 20 min presentation / 25 min Q&A
11H15 -12H00 “Challenges and Responses to MNCH in Asia and the Pacific” Plenary Presentation and Discussion Mr. Ian Anderson, Advisor, Principal Economist, Health Services Delivery, ADB Representative to the Coogee Beach Consultative Group Format: 20 min presentation / 25 min Q&A
12H00 – 13H30 Lunch Break
AFTERNOON
13H30 – 15H00 “Making the Most of NGO-Implemented MNCH Programs” Panel Discussion Format: Invited Panelists and Plenary Discussion 45 min of panelist presentations / 45 min Q & A
“Barriers and Bottlenecks: What Prevents Interventions from Working and What We Can Do” Dr. Stephen Atwood, Director, Public Health Solutions, Ltd., formerly UNICEF Asia Regional Health Adviser, current member of Coogee Beach Consultative Group 43 “Expanding the Demand for NGO Services – Contracting Out and Other Modalities” Dr. Benjamin Loevinsohn MD, Health, Nutrition, & Population Cluster Leader, World Bank and author of “Performance-Based Contracting for Health Services in Developing Countries: A Tool Kit”, WB 2008 and “Financing Immunization”, ADB
15H00 – 15H15 Coffee Break
15H15 – 16H45 “Tackling the Challenges” Breakout Session: Format: Each facilitated break-out group to consider the issues and solutions relating to one of the following challenges: Group 1: Financing MNCH interventions Group 2: Generating political will for MNCH activities Group 3: Delivering MNCH programs Group 4: Communicating messages / educating on MNCH interventions
16H45 – 17H30 “Presenting the Solutions” Plenary Presentation Breakout Session Results and Plenary Discussion including inputs from donor community and private sector Format: facilitated process for group reporting
“Norwegian Engagement in Global Health and MNCH” International Donor Video Link Paul Richard Fife, Director, Global Health and AIDS Department, Norwegian Agency for Development Cooperation (NORAD), Norway CFormat: 5 Minute Overview Asia NGO Workshop Appendices
17H30 – 17H40 “What does it all mean?” Closing Remarks Dr. Mike Singh, Deputy Director, Save the Children, Philippines
17H45 – 18H05 “Grant Funding for Increased CSO Involvement in Immunization / HSS” International Donor Video Link Craig Burgess, Global Lead for Health System Strengthening (HSS), GAVI Alliance, Geneva Format: 10 Minute Overview / 10 Minute Q&A
19H00 Dinner
THURSDAY, 26 FEBRUARY: VACCINES AND IMMUNIZATION SERVICES
MORNING
08H30 – 10H15 “NGO Experiences with Immunization in Asia” Participant Poster Walkabout Session Format: Poster walkabout and interviews (I hour) followed by a facilitated group discussion (45 min)
10H15 – 10H30 Coffee Break
10H30 – 11H15 “Access, Partnerships and Latest Developments in Vaccines for the Developing World: An Industry Perspective” Plenary Presentation and Discussion 44 Dr. Kate Taylor, Vice President, Global Vaccine Policy and Public Health Partnerships, GSK Biologicals
11H15 – 12H00 “Ensuring Vaccine Availability and Access: Lessons and Best Practices in Financing, Policy Support, Service Delivery and Communications for Immunization” Plenary Presentation and Discussion Dr. Lulu Bravo, Executive Director, Philippine Foundation for Vaccination Format: 20 min presentation / 25 min Q&A) A12H00 – 13H30 Lunch C Appendices Asia NGO WOrkshop
AFTERNOON
13H30 – 15H00 “Innovative NGO Approaches to Immunization” Panel Discussion: Format: Invited Panelists and Plenary Discussion 5 min panelist presentations; 60 min TV Talk Show style Q & A
Moderator: Mr. Bart W. Édes, Head, NGO & Civil Society Center, ADB
Ms. Che Katz, International Communications Officer / Lead Consultant. Revitalizing Community Demand Generation for Immunization (RCDI) in Laos.
Dr. Eden Divinagracia, Executive Director, PNGOC Philippines. Well Baby Bakuna Program: Increasing Middle Class Access to Privately Administered Vaccines.
Dr. Riaz Ahmed Memon, Program Director, PPHI/SRSO Pakistan. The Peoples’ Primary Healthcare Initiative (PPHI) of Sindh Province, Pakistan: Revitalizing the Delivery of MNCH Services in Rural Areas.
Dr. Sri Chander, Regional Health Advisor, World Vision. Improving Immunization Rates with Timed and Targeted Counseling in Uttar Pradesh, India.
Dr. Nasaruddin Sheldon, MD, Country Director, Project Hope Indonesia. Multisectoral Approaches to Increasing Immunization Rates: Saving Lives by Promoting Health and Improving Quality of Care in Aceh Province, Indonesia.
15H00 – 15H15 Coffee Break
RY: MATERNAL NEWBORN & CHILD HEALTH INTERVENTIONS 45 15H15 – 16H15 “Divide and Conquer an Immunization Challenge” Breakout Session Format: Each facilitated break-out group to consider the challenges, solutions, and success factors relating to one of the following scenarios: Group 1: LIC, weak immunization coverage Group 2: MIC, graduating from GAVI Group 3: Country in pre-election mode; making the case for immunization Group 4: Country facing innovation (new vaccine) pile-up
16H15 – 17H00 “Regroup and Synthesize” Plenary Presentation and Discussion Breakout Session Results and Plenary Discussion including inputs from donor community and private sector Format: facilitated process for group reporting
17H00 – 17H30 Consultation Outcomes and Next Steps Format: Participatory/facilitated process to generate input on concrete next steps, follow-up, and consultation outcomes
17H30 – 17H45 Closing Remarks Format: brief remarks by Bart Édes (ADB), Ms. Elizabeth Hernandez (GSK), and Ms. CLatha Caleb (Save the Children) Asia NGO Workshop Appendices APPENDIX 2 - PARTICIPANT DIRECTORY I. CO-HOSTS
Asian Development Bank (ADB) John Stoeckel * 6 ADB Avenue, Mandaluyong City Asia Area Health Advisor 1550 Metro Manila, Philippines 15th Floor Maneeya Center Building 518/5 Plenchlt Rd., Bangkok, Thailand 10330 Ian Anderson * Tel: 662 652 0732 3/662 684 1670 Advisor and Principal Economist, Health Services Delivery Fax: 662 652 0810 Regional and Sustainable Development Department Email: [email protected] Tel: (632) 632-6463 Email: [email protected] GlaxoSmithKline Pte Ltd (GSK) Bart W. Édes * 150 Beach Road Head, NGO and Civil Society Center #22-00 Gateway West Public Management, Governance and Participation Division Singapore 189720 Regional and Sustainable Development Department Website: www.gsk.com Tel: (632) 632-6643 Email: [email protected] Anne Belcher Director, Vaccines Business Development and Commercial Jacques Jeugmans * Strategy, Asia Pacific Practice Leader (Health) Tel: +65 6232 8338/6232 8107 Poverty Reduction, Gender, and Social Development Division Fax: +65 6291 5538 Regional and Sustainable Development Department Mobile: +65 9722 8107 46 Tel: +632 632 6392/6329 Email: [email protected] Fax: +632 636 2444/2409 Email: [email protected] Elizabeth Hernandez * Director, External and Government Affairs, Asia Pacific Tel: +65 6232 8134 Save the Children (STC) Mobile: +65 9170 1270 #1 Encarnacion St., Email: [email protected] cor. Lapu-Lapu Avenue Magallanes Village Dr. Kate Taylor * Makati City, Philippines VP, Global Vaccine Policy and Public Health Partnerships Tel: (632)852-5408 Rue de l’institut 89 Fax: (632)853-0215 1330 Rixensart Belgium Website: www.savechildren.org Tel: +32 2 656 8111 Fax: +32 2 656 8000 Latha Caleb * Email: [email protected] Country Director Email: [email protected] Dr. Sally Gatchalian Vaccine Medical Director Dr. Mike Singh * 2266 Chino Roces Avenue Deputy Country Director Makati City 1231 Philippines Email: [email protected] Tel: +632-892-0761 Fax: +632-893-8019 Dr. Edwin Ylagan Website: www.gsk.com.ph Health Manager Email: [email protected] A* Speaker / Panelist C Appendices Asia NGO WOrkshop
II. NON-GOVERNMENTAL ORGANIZATIONS
Adventist Development and Relief Agency (ADRA) Philippines
Mr. Göran Hansen About Us: Country Director A leading non-governmental relief organization, ADRA was PO Box 25, Silang 4118, Cavite, Philippines granted general consultative status by the United Nations in 1997 JP Rizal, Sabutan, Silang, Cavite, Philippines and has since enjoyed added voice in the international community. Tel: +63 46 414 2464/414 0146 In 2004, ADRA assisted nearly 24 million people with more than Fax: +63 46 414 1492 US$159 million in aid. More than 4,000 ADRA staff members Email: [email protected]; [email protected]; currently work in 125 countries. As new challenges and needs arise, [email protected] ADRA continues to strive to realize its mission of reflecting God’s Website: www.adra.ph love through compassionate acts of humanitarian service.
Afghan Refugees (BEFARe)
Mr. Fayyaz Ali Khan 1 About Us: Manager, Programming and Implementation BEFARe strives to empower underprivileged communities and 8-Tatara Road, Rahatabad Colony assist state actors in Pakistan through innovative and multi- Peshawar, NWFP, Pakistan pronged strategies in education, health, livelihoods, democratic Tel/fax: +92-91-5702955, 5854475, 584063 norms and human rights. Fax: +92-91-5841047 Email: [email protected] Website: www.befare.org
Building Resources Across Communities (BRAC) 47
Dr. Monowaul Aziz About Us: Senior Medical Officer The world’s largest southern non-governmental organization with BRAC Centre, 75 Mohakhali over 100,000 staff, BRAC works in Bangladesh and beyond with Dhaka 1212 Bangladesh the twin objectives of alleviating poverty and empowering the Tel/Fax: 880-2-9881265, poor. BRAC’s vision is of just, enlightened, healthy and democratic 880-2-8824180-7 societies free from hunger, poverty, environmental degradation Fax : 880-2-8823542 and all forms of exploitation based on age, sex, religion and Email: [email protected] ethnicity. In addition to health, BRAC runs programs for economic Website: www.brac.net development, education, social development and human rights. BRAC has worked in Bangladesh since 1972 and covers a population of 110 million throughout the country. BRAC employs about 60,000 staff and has an annual budget of US$485 million.
Children’s Christian Fund (CCF) Philippines
Miel Filomeno S. Nora About Us: Health Development Specialist About Us: CCF’s mission is to give deprived, excluded and 8th Flr. Strata 100 Bldg., vulnerable children the opportunity to improve their lives and F. Ortigas Jr. Avenue, Ortigas Center become young adults, parents and leaders who bring lasting and Pasig City, 1605 Philippines positive change to their community. It promotes societies whose Tel: (632) 631-1575 to 78 ext. 105 individuals and institutions value, protect and advance children’s Fax: (632) 631 2813 worth and rights. Email: [email protected]; [email protected] Website: www.christianchildrensfund.org C 1BEFARe submitted a case study to the Consultation but Mr. Khan was unable to attend. * Speaker / Panelist Asia NGO Workshop Appendices
Consultation of Investment in Health Promotion (CIHP)
Bui Thi Thanh Mai About Us: Founder/Vice Director The Consultation of Investment in Health Promotion (CIHP) No. 2, Alley 49/41, Huynh Thuc specializes in the management of health promotion programs. Its Khang Street Dong Da, Ha Noi, Viet Nam expertise in health promotion, research and training has served a Tel: 84 4 3 5770261 ext. 22 number of national and international organizations active in the Fax: 84 4 3 5770260 fields of public health and community development both in Viet Email: [email protected] Nam and the surrounding region. CIHP is dedicated to gender Website: www.cihp.org equality and enhanced rights and health for all.
EngenderHealth
Dr. Lemuel Marasigan M.D. About Us: Senior Technical Director EngenderHealth is a leading international reproductive health Unit 1501, 15th Flr. Robinsons Equitable Tower, organization that works to improve the quality of health care in the ADB Ave. Ortigas Center, Pasig City, world’s poorest communities. EngenderHealth empowers people 1605 Philippines to make informed choices about contraception, trains health Tel: +632 635 2397 local 116 providers to make motherhood safer, promotes gender equity, Fax: +632 637 5165 enhances the quality of HIV and AIDS services, and advocates Email: [email protected] for positive policy change. This non-profit organization works in Website: www.engenderhealth.org partnership with governments, institutions, communities, and healthcare professionals in more than 25 countries around the world. Over 65 years, Engender Health has reached more than 100 million people to help them realize a better life. 48
Health Unlimited
Seng Aung Sein Myint About Us: MCH Doctor Health Unlimited works with some of the poorest and most Health Unlimited Kachin Project marginalized communities in Africa, Asia and Latin America, Waija, Laiza, KachinState, Burma/Myanmar often in very difficult environments. It works to enable these Email: [email protected] communities to achieve both immediate and long-term Website: www.healthunlimited.org.cn improvements to their health, promoting this as one of their fundamental human rights. At the same time, Health Unlimited campaigns for the changes in policies and practices needed to create and sustain good health among the world’s poorest people.
The Indonesian Midwifery Association (IMA) / Ikatan Bidan Indonesia (IBI)
Yetty Irawan, M. Sc. About Us: Jl Johar Baru V / D13 The Indonesian Midwifery Association (IMA), also known as Jakarta Puasat 10560 Indonesia Ikatan Bidan Indonesia (IBI), was established in June 1951 and has Tel: (+ 62- 21) 4247789, 4226043 been a member of the International Confederation of Midwives Fax: (+62-21) 4244214 since 1956. It counts 87,338 members and has 32 chapters, 435 Email : [email protected] branches, and 1900 sub-branches. Website: www.bidanindonesia.org A* Speaker / Panelist C Appendices Asia NGO WOrkshop
Janani
Rudrank Dhari Sinha About Us: General Manager Janani is a non-profit Indian society that implements a large Administration and Logistics service delivery program in three of the poorest states of India. Reshmi Complex, P&T Colony The program is modeled on the premise that the only option Kidwaipuri, Patna 800 001, India Tel: (+612) 2537645 / 2525010/ 2525011 available to supplement the public sector in scale and impact Fax: (+612) 2537291 of service delivery is the private sector. The non-governmental Email: [email protected] organization sector accounts for barely 0.7% of health care in Website: www.janani.org India and by itself is not a viable option.
Japanese Organization for International Cooperation in Family Planning (JOICFP)
Ms. Mayumi Katsube About Us: Program Manager Founded in 1968, JOICFP is a tax-exempt, non-governmental, non- Program Development and Research profit organization. It conducts international cooperation programs Hoken Kaikan Shinkan in the fields of population, reproductive health, family planning, 1-10 Ichigaya Tamachi Shinjuku-ku, Tokyo 162-0843 and maternal and child health. It enjoys consultative status with Japan the United Nations Economic and Social Council. JOICFP works Tel: +81-3-3268-3450 closely with the Japanese government and the Japan International Fax: +81-3-3235-7090 Cooperation Agency, the United Nations Population Fund, and the Email: [email protected] International Planned Parenthood Federation. JOICFP received a Website: www.joicfp.or.jp United Nations Population Award in 2001.
Japan International Cooperation Agency (JICA) Maternal and Child Health Project, Ifugao 49 Province
Marcelyn M. Dulnuan About Us: Assistant Project Manager In 2006, Japan International Cooperation Agency (JICA) Philippines JICA-MCH Project implemented a maternal and child health project in the province 2nd Floor Administration Building of Ifugao, the Philippines. This project has greatly reduced Natuwolan, Lagawe, Ifugao The Philippines maternal and infant mortality through the work of a team of local Tel: 63-906-960-9428 female community workers trained by the Department of Health Email: [email protected] to promote newborn and infant care, assist with facility-based deliveries and provide additional health-related services.
Jhpiego Indonesia
Richard Embry About Us: Country Director Jhpiego is a nonprofit international health organization affiliated Jalan Brawijaya 1 A No. 10 with Johns Hopkins University of Baltimore, the United States. Jakarta Selatan, 12160 Indonesia Jhpiego works to improve the health of women and families in Tel: 6221-7503546 more than 50 countries. Jhpiego’s work spans a continuum of Fax: 6221-7260678 client-centered care ranging from prevention to treatment in the Email: [email protected] areas of reproductive health, family planning, HIV/AIDS, maternal Website: www.jhpiego.net and newborn health, and cervical cancer. C * Speaker / Panelist Asia NGO Workshop Appendices
MAP International
Rumi Sidabutar About Us: Heath Program Manager MAP International promotes the health of those who live in the Puri Sriwijaya. Jl. Sriwijaya Dalam world’s poorest communities. It does this by partnering initiatives No 88 C Medan 20153, Indonesia that facilitate the provision of essential medicines, prevent and Tel: +62 61 4551549 eradicate disease, and promote community health. Fax:+62 61 4552669 Email: [email protected] Website: www.map.org
Mother Infant Research Activities (MIRA)
Jyoti Raj Shrestha About Us: Coordinator Established in 1992, Mother Infant Research Activities (MIRA) 755 Prashuti Marga, Thapathali Kathmandu, Nepal is a non-governmental organization run by experienced and Tel: 977 01 4266208 committed Nepalese health and development professionals. Fax : 977 01 4265174 MIRA’s mission is to improve the health of mothers and newborns Email: [email protected] by reducing maternal and neonatal mortality and morbidity Website: www.mira.org.np through research, training, and advocacy.
PATH
Vu Minh Huong About Us: Senior Program Team Leader PATH is an international nonprofit organization that finds 50 2nd Floor, Hanoi Towers, 49 Hai Ba Trung, sustainable, culturally relevant solutions to health problems and Hoan Kiem District Hanoi,Vietnam enables communities around the world to break longstanding P.O. Box 252,IPO, Hanoi, Vietnam cycles of poor health. By collaborating with diverse public and Tel: 84-4-39362215 ext 118/ private sector partners, PATH helps provide appropriate health Fax: 84-4-39362216 technologies and creates vital strategies that change the way Email: [email protected] people think and act. PATH’s work improves global health and Website: www.path.org wellbeing.
Pathfinder International, Bangladesh
Dr. Shabnam Shahnaz, MD, About Us: MPH, FRSPH Pathfinder International works to improve access to quality Country Representative health care for poor and marginalized women, men and children House No. 9, Road No. 7, Apt. throughout the developing world. It has worked in Bangladesh since No. A-2, Baridhara Diplomatic Zone the 1950s. Since 1980, its projects, implemented in partnership with Baridhara, Dhaka 1212 Bangladesh Bangladeshi non-governmental organizations, have been worth Tel: 880-2-8853815 to 17 over US$120 million. Pathfinder has developed comprehensive Fax: 880-2-8854030 contracting, monitoring, institutional capacity-building and financial Email: [email protected] oversight systems. Pathfinder’s success in Bangladesh is based upon Website: www.pathfind.org its deep understanding of community-based health programs, especially in difficult-to-reach coastal areas; its globally renowned project management skills; and its strong background in institutional strengthening. All of Pathfinder’s work is geared to supplementing and complementing the Governement of Bangladesh’s efforts to respect its constitutional commitment to health. A* Speaker / Panelist C Appendices Asia NGO WOrkshop
People’s Primary Healthcare Initiative, Sindh (PPHI/SRSO)
Dr. Riaz Ahmed Memon * About Us: Program Director The Peoples’ Primary Healthcare Initiative (PPHI) is the umbrella of C-130 First Floor Block-2 Clifton, Karachi, Pakistan the Sindh Rural Support Organization, which works to eliminate Tel/fax: +92-21-5872241 poverty from rural areas of Sindh Province, Pakistan. The Sindh Email: [email protected] Rural Support Organization also deals in micro credit and other Website: www.srso.org.pk tools of poverty elimination.
Philippine Foundation for Vaccination (PFV)
Prof. Lulu C Bravo * About Us: Executive Director/Vice Chancellor A non-profit, non-stock organization established in April for Research and Executive Director 2000, the Philippine Foundation for Vaccination is composed National Institute of Health of professionals, academics, governmental employees, University of the Philippines Manila, Taft Avenue, nongovernmental workers and private individuals who have Ermita, Manila, Philippines joined together to promote vaccination as a means of preventing Tel no. 632-5269167 disease and contributing to better health for all both now and Fax No. 632-5672307 in future. The foundation accomplishes its objectives through Email: [email protected] seminars, workshops, research, service-oriented activities and Website: www.philvaccine.org.ph other means. It holds increasing partnerships and networks with various stakeholders
Philippine NGO Council on Population, Health and Welfare, Inc. (PNGOC)
Dr. Eden R. Divinagracia, Ph.D. * About Us: 51 Executive Director The Philippine NGO Council on Population, Health and Welfare, Inc. Unit 304, Diplomat Condominium (PNGOC) was founded in June 1987. PNGOC is a national umbrella Russel Ave., Roxas Blvd. Pasay City, 300Philippines organization of 95 non-governmental organizations. Its objective Tel/fax: (632) 832-3267 is to become the voice of population and development advocates Mobile: 0917-7916103 within non-governmental, government and funding circles. It also Email: [email protected] serves as a channel for the exchange of information, resources, and Website: www.pngoc.com technical assistance among non-governmental organizations.
Plan International
Ma. Loida Y. Sevilla About Us: Country Program Advisor for Health Plan Philippines was established and registered in the Philippines 7/F 104 Salustian D. Ty Tower in 1961 at the invitation of Carlos P. Romulo, then president of Paseo de Roxas, Makati City, The Philippines the 4th Session of the United Nations General Assembly. Plan Tel: (632) 817-31-87 Philippines’ goal is that children live and grow in a safe and Fax: 63(2)-840-39-40 nurturing child-friendly environment at the family, community Email: [email protected] and society level. Plan Philippines works in approximately 420 Website: www.plan-international.org poor barangays in 32 municipalities in eight of the country’s 79 provinces. C * Speaker / Panelist Asia NGO Workshop Appendices
Population Services International (PSI)
Brian Smith About Us: Regional Director, Asia and Eastern Europe PSI is a nonprofit organization based in Washington, D.C. that 1120 19th Street, NW, Suite 600 harnesses the vitality of the private sector to address the health Washington, DC 20036 problems of low-income and vulnerable populations in more than United States 60 developing countries. With programs in malaria, reproductive Tel: (202) 785-0072 health, child survival, HIV and tuberculosis, PSI promotes products, Fax: (202) 785-0120 services and healthy behavior that enable low-income and Email: [email protected] vulnerable people to lead healthier lives. Products and services Website: www.psi.org are sold at subsidized prices rather than given away in order to motivate commercial sector involvement.
Project HOPE
Dr. Nasaruddin Sheldon, MD * About Us: Country Director Founded in 1958, Project HOPE is an independent, international Jl. Candi Prambanan No. 8 non-profit health education organization whose mission is to Medan 20112 North Sumatra, Indonesia achieve sustainable advances in health care around the world Tel: 62-61-4513188 by implementing health education programs and providing Fax: 62-61-4516804 humanitarian assistance in areas of need. Project HOPE operates Email: [email protected] 80 programs in 38 countries and has a staff of 600 worldwide. Website: www.projecthope.org Project HOPE’s programs focus on infectious disease, women’s and children’s health, health professional education, health systems and facilities improvements, and humanitarian assistance. 52
Reproductive and Child Health Alliance (RACHA)
Dr. Sun Nasy About Us: Deputy Executive Director Reproductive And Child Health Alliance (RACHA) is a USAID- House #160, Street 71 Tonie funded Cambodian non-governmental organization that runs a Bassac Chamkar Mon broad-based program in reproductive and child health in rural P.O.Box 2471, Phnom Penh, Cambodia communities. As well as training midwives and working with the Tel: (023) 213724/726257 Cambodian Ministry of Health at the national policy-making level, Fax: (023) 213725 RACHA provides support and continuing education to village Email: [email protected] health support groups and traditional birth attendants. RACHA Website: http://rc.racha.org.kh/ also collaborates with traditional healers, village shopkeepers, nuns and wat grannies.
Revitalizing Community Demand for Immunization Project
Che Katz About Us: Social Development and Communication Sponsored by ADB, UNICEF, and GSK, the Revitalizing Community Specialist Demand for Immunization Project was implemented in Lao c/-139 Darley Road, Randwick People’s Democratic Republic from September 2006 to December NSW 2031 Sydney, Australia 2007. The project aimed to improve childhood immunization Tel: 612 9398 2696 coverage in Lao PDR by helping the Government conduct Current location: Phnom Penh, Cambodia operational research on various communication strategies Email: [email protected] designed to increase community demand for immunization using a participatory approach. A* Speaker / Panelist C Appendices Asia NGO WOrkshop
RDRS Bangladesh
Dr. Salima Rahman About Us: Director, Community Health RDRS Bangladesh is a leading integrated development House# 43, Road #10, Sector # 6, Uttara, Dhaka-1230 nongovernmental organization working in northern Bangladesh. G.P.O. Box # 618, Ramna, Dhaka-1000,Bangladesh Its vision is to see the rural poor achieve meaningful political, Tel: (88 0591)-61389 social and economic empowerment, peace and justice and, Fax: (88 0591)-61248 through individual and collective efforts, create a positive and Email:[email protected]; sustainable environment. [email protected] Website: www.rdrsbangla.net
Women Acting Together for Change (WATCH)
Ms. Sarmila Shrestha About Us: Executive Chairperson and Women Acting Together for Change (WATCH) is a women’s Program Facilitator non-governmental organization established in March 1992. 572/45 Ram Mandir Marga,Dhobikhola, WATCH advocates for self-reliant, rights-based and participatory Battisputali, Kathmandu, Nepal development rather than development that creates dependency. Tel: 977 1 4492644/ 977 1 4494653 WATCH believes that imposed and donated development is neither Fax: +977 1 4494653 sustainable nor desirable. Email: [email protected] [email protected] Website: www.watch.org.np
53 World Health Partners
Mr. Gopi Gopalakrishnan About Us: President World Health Partners (WHP), a registered Indian non-profit society, BB 11, Greater Kailash II, New Delhi-110048, India will set up a service delivery system in the private sector with the Tel/Fax: +91 11 40757116 goal of reducing unwanted pregnancies and improving health Email: [email protected] status on a large scale in the poor rural parts of three districts in Website: www.worldhealthpartners.org Uttar Pradesh, India.
World Vision Asia Pacific Region
Dr. Sri Chander * About Us: Regional Health Advisor World Vision is a Christian relief, development and advocacy 10 Anson Road #13-08, International Plaza organization dedicated to working with children, families and Singapore 079903 communities to overcome poverty and injustice. World Vision Tel: (65) 6221-1040 serves all people regardless of religion, race, ethnicity or gender Fax: (65) 6221-1390 and is active in more than 97 countries worldwide, including 23 Email: [email protected] in the Asia-Pacific region. Website: www.wvi.org C * Speaker / Panelist Asia NGO Workshop Appendices
III. INTERNATIONAL DONORS / EXPERTS
Australian Agency for International Norwegian Agency for Development Development (AusAID) Cooperation (Norad) (via video conference)
Jimmy Loro Global Health and AIDS Department/ Avdeling for helse Program Officer og Aids Development Cooperation P.O.Box 8034 Dep Australian Embassy N-0030 Oslo NORWAY Level 23 Tower 2 RCBC Plaza Visitors’ address: Ruseløkkveien 26 6819 Ayala Avenue, Makati City Website: www.norad.no/motherchildhealth Philippines 1200 Tel: +632 757 8271 Lars Grønseth Fax: +632 757 8265 Senior Advocacy and Communication Adviser Email: [email protected] Tel: +47 22 24 0574 Website: www.philippines.embassy.gov.au Fax: +47 22 24 20 31 Email: [email protected] Canadian Intenational Development Agency (CIDA) Paul Richard Fife Director Dr. Sudeep Kishore Bhattarai Tel: +47 22 24 04 20 Senior Health Advisor, Science and Technology Group Fax: +47 22 24 20 31 Strategic Planning and Operations Asia Email: [email protected] 200 Promenade du Portage Gatineau, Quebec CANADA K1A 0G4 Helga Fogstad Tel: 819-994-5416 Coordinator, Maternal and Child Health Fax: 819-997-0945 Tel: 00 47 22 24 22 39 Email: [email protected] Fax: 00 47 22 24 20 31 Website: www.acdi-cida.gc.ca Email: [email protected] 54 Global Alliance for Vaccines and Immunization Public Health Solutions, Ltd. (via video conference) Dr. Stephen J. Atwood, M.D., F.A.A.P. GAVI Alliance Secretariat Director 2 Chemin Des Mines 822 Senanikom 1, Soi 18 CH-1202 Geneva 10 Switzerland Chatuchak, Bangkok 10900 Website: www.gavialliance.org Thailand Tel/Fax: +662 9418439 Mr. Craig Burgess Mobile: +668 19239077 Global Lead for Health System Strengthening (HSS) Email: [email protected] Tel: +41 22 909 6500 Fax: +41 22 909 6550 ited Nations Children’s Fund (UNICEF) Email: [email protected] Dr. Marinus Gotink Nilgun Aydogan Chief, Health and Nutrition Section Programme Officer - Country Support, Civil Society Philippine Country Office Tel: +41 22 909 7160 31st Floor, Yuchengco Tower, RCBC Plaza Fax: +41 22 909 6550 6819 Ayala Avenue, 1200 Makati City, Philippines Email: [email protected] Tel: 632 901 0150 Fax: 632 729 4525 Email: [email protected] Website: www.unicef.org/philippines A* Speaker / Panelist C Appendices Asia NGO WOrkshop
United States Agency for International Development (USAID)
Marietou Satin Deputy Director of the Public Health Office GPF Towers, Tower A 93/1 Wireless Road Bangkok, 10330 Thailand Tel: (66-2) 263-7400 Fax: (66-2) 263-7499
World Bank (WB)
Dr. Benjamin Loevinsohn * Lead Public Helath Specialist Human Development 3, Africa Regiom 1818 H Street, NW, Washington DC 20433 USA Tel: 202 463 7948 Fax: 202 473 8107 Email: [email protected] Website: www.worldbank.org
IV. CONSULTATION ORGANIZERS
Development Finance International, Inc. Unit 11-1, 11/F Net One Center 55 Bonifacio Global City, 1634 Taguig, Metro Manila, Philippines Tel: +63 (2) 818-1156 Website: www.dfintl.com
Christine Albee Purka Vice President and Head of Asian Regional Office Email: [email protected]
Ann Ewasechko Senior Manager (DFI Africa) Email: [email protected]
Estela del Rosario Manager Email: [email protected]
Dak Escay Office Manager Email: [email protected] C * Speaker / Panelist Asia NGO Workshop Appendices APPENDIX 3 - NGO Participants by Country of Affiliation
Country of Affiliation Total
Bangladesh 3
Cambodia 2
The People’s Republic of China 1
India 2
Indonesia 4
Japan 1
Nepal 2 56
Pakistan 1
Philippines 9
Singapore 1
Thailand 1
United States 1
Vietnam 2
Total 30 A* Includes representatives from the co-host, Save the ChildrenC Appendices Asia NGO WOrkshop APPENDIX 4 - SPEAKER / PANELIST BIOs
Mr. Ian ANDERSON is an advisor Professor Lulu BRAVO is Professor and principal economist in health of Pediatric Infectious and Tropical services delivery with the Asian Diseases at the College of Medicine, Development Bank (ADB) in University of the Philippines Manila. His focus is the economics Manila, where she is also Vice and financing of maternal, Chancellor for Research. Dr Bravo newborn and child health in Asia serves in various capacities for and the Pacific. At ADB, Mr other health-related associations Anderson has been responsible and societies. She is Executive for costing and cost-effectiveness Director of the National Institutes studies for the prevention of HIV of Health, University of the and AIDS. Prior to joining ADB, Mr. Anderson was Principal Philippines Manila; a member of the World Health Organization’s Advisor for the Australian Agency for International Technical Steering Committee of the Child and Adolescent Development (AusAID) where he addressed a range of Health Department; President of the International Society of development issues in Asia and the Pacific. Mr. Anderson has Tropical Pediatrics; Chair of the Asian Strategic Alliance for worked as a senior economist with the World Bank and was Pneumococcal Disease Prevention; a member of the head of Australia’s aid program to the Philippines. He is an Pneumococcal Awareness Council of Experts; and on the board economist by training. of counselors of the Pediatric Dengue Vaccine Initiative. Previously, she served as a World Health Organization temporary Dr Stephen ATWOOD is Director adviser. Professor Bravo helped establish the Philippine
of Public Health Solutions, Ltd. Dr Foundation for Vaccination whose mission to control and 57 Atwood formerly worked as a prevent diseases through vaccination. regional advisor in health and nutrition for UNICEF’s East Asia Dr Sri CHANDLER is Asia-Pacific and Pacific Regional Office (2000- Regional Health Advisor of World 2008) and as chief of health of Vision. In this capacity, he leads a UNICEF’s India Country Office regional team in providing (1994-2000). Prior to UNICEF, Dr technical support to World Vision Atwood worked as the director of offices in 17 countries in the Asia- the primary health care unit of Pacific region from his home base CARE International in India (1987-1994). Dr Atwood also served in Singapore. Dr Chander has a as associate professor of clinical pediatrics and as the director of medical degree from the National the Education Department of Pediatrics of the College of University of Singapore and a Physicians and Surgeons of Columbia University, the United master’s of public health from the States (1978-1986). He was also an assistant professor of Johns Hopkins University Bloomberg School of Public Health. pediatrics at the Albert Einstein College of Medicine (1976- He has extensive experience in the design, monitoring and 1978). evaluation of large-scale maternal and child health and nutrition, immunization, tuberculosis and HIV/AIDS programs. He is also an adjunct associate professor in public health at the CNational University of Singapore. Asia NGO Workshop Appendices
Dr Eden DIVINAGRACIA is Ms. Che KATZ is an independent Executive Director of the public health and communication Philippine NGO Council on consultant who has been working Population Health & Welfare, Inc. on issues relating to immunization, (PNGOC), a national network of sexual and reproductive health, 95 NGOs involved in population HIV/AIDS, gender, tobacco, and and development, reproductive environment in the Asia Pacific health care, maternal and child region for over 15 years. She has health, women’s empowerment, worked for various multilateral functional literacy and social and bilateral agencies including enterprise in the Philippines. As the Asian Development Bank executive director, Dr Divinagracia is responsible for (ADB), the United Nations Children’s Fund, the United Nations fundraising, forming collaborative partnerships with local and Population Fund, the Australian Agency for International foreign agencies, and providing technical assistance to Development (AusAID), the European Commission, and PNGOC’s partners. Dr Divinagracia is an organization various other international NGOs in the region. Her areas of development and human resources specialist and a seasoned interest are communication for social change, participatory trainer. She has represented the Philippines and the NGO processes, social marketing, and demand creation. community at various local and international conferences as a resource person, a delegate and a member of organizing Dr Benjamin LOEVINSOHN is committees. She is also a management consultant in three Health, Nutrition, and Population corporations that provide executive coaching. Cluster Leader at the World Bank. A public health specialist with 25 Mr. Bart W. ÉDES is Head of the years’ experience achieving NGO & Civil Society Center at the measurable results in challenging Asian Development Bank (ADB) circumstances, he has led initiatives 58 where he manages ADB’s relations in the areas of strategic with civil society organizations. development (e.g., the Among his responsibilities are reconstruction of Afghanistan’s implementing technical healthcare system and the assistance projects, facilitating development of the Asian Development Bank’s health sector public consultations, conducting policy); the introduction of innovations (e.g. performance- training in participatory methods, based contracting and conditional transfers); monitoring and and nurturing NGO-business evaluation (e.g. seven randomized or controlled studies and partnerships for sustainable development. In a previous other operational research). He has also collaborated with a position with ADB’s Office of External Relations, Mr Édes wide variety of stakeholders in multicultural settings. Dr drafted ADB’s public communications policy, widely Loevinsohn is the author of Performance-Based Contracting for recognized for setting a new standard for information Health Services in Developing Countries: A Tool Kit (World Bank disclosure among international financial institutions. Between 2008) and Financing Immunization (Asian Development Bank). 1996 and 2000, Mr. Édes oversaw communications for SIGMA, Dr Loevinsohn is a leader who inspires with his practical vision, a joint initiative of the European Union and the Organization his evident enthusiasm, his effective communication, and his for Economic Cooperation and Development to assist Central adept mentoring. and Eastern European countries with governance reform. While with SIGMA, Mr Édes advised governments on improving their public information activities and contributed to the launch and management of a regional anticorruption network. He has also worked as a newspaper editor, a policy analyst, an investment treaty negotiator, and a grassroots campaigner. Mr. Édes has a bachelor’s degree in government studies from Georgetown University, the United States, and a master’s degree in public policy from the University of Michigan, the AUnited States. C Appendices Asia NGO WOrkshop
Dr Riaz Ahmed MEMON is Bangladesh, Dhaka. He is the author of Intervention Research Programme Director and Chief on Child Survival (McGraw Hill, New York and Singapore, 1992) Operating Officer at the People’s and co-author of five other books including Designing HIV/ Primary Healthcare Initiative, AIDS Intervention Studies: An Operations Research Handbook Sindh. Initiated by Dr Memon just (2002), and Handbook for Family Planning Operations two years ago, this program has Research (1990), both published by The Population Council, since expanded to 17 districts and New York. some 886 rural health facilities and commands a budget of 1.2 Dr Kate TAYLOR is Vice President billion Pakistan rupees. Dr Memon of Global Vaccine Policy and has 17 years of government Public Health Partnerships at service to his credit and has had the honor to serve in various GlaxoSmithKline (GSK) Biologicals, positions such as deputy commissioner-head of the district as where she works to promote the well as additional secretary finance of the Government of widespread use and rapid uptake Sindh. Dr Memon has a master’s degree in social policy and of GSK’s vaccine portfolio in both planning in developing countries from the London School of the developed and the developing Economics in the United Kingdom; a bachelor’s degree in world. Dr Taylor is an Australian medicine; a master’s degree in economics; and a master’s medical doctor with a master’s degree in business administration (general management). degree in public health from Johns Hopkins University. After several years of clinical Dr Nasaruddin SHELDON, MD is practice, she joined McKinsey & Company as a business currently Country Director of strategy consultant. She then joined the World Economic Project HOPE for Indonesia. Prior Forum to start the Global Health Initiative, a program designed to this position, Dr Sheldon served to foster a global business response to HIV, TB and malaria. In as Program Director of Project this role, she coordinated private sector participation on the 59 HOPE (2005-2007). Before joining boards of directors of the Global Fund and other public-private Project HOPE, he was Executive partnerships. Before joining GSK, Dr Taylor was Senior Director Director of Community OutReach for Policy and Advocacy at the International AIDS Vaccine Initiatives (2000-2004). He has Initiative. She currently serves on the board of directors of the also worked as a consultant for Roll Back Malaria Partnership. several organizations including the Nature Conservancy, the World Wildlife Fund, Unocal Indonesia Co., and Total Indonesia. Dr Sheldon graduated from Manila Central University College of Medicine in 1990 and worked for several years at Indonesia’s ministry of health.
Mr. John STOECKEL, PhD, has worked in Asia for more than 40 years on population and reproductive health programs. He has held long-term posts in Bangladesh, East Pakistan, Nepal and Thailand. He is currently based in Bangkok where he is Asia Area Health Advisor for Save the Children/US. Mr Stoeckel’s former positions include that of scientist in Operations Research, the Global AIDS Program, World Health Organization, Geneva; senior associate at The Population Council, New York; and research demographer at Cthe International Centre for Diarrhoeal Disease Research, Asia NGO Workshop Appendices APPENDIX 5 - Workshop Evaluation
Before leaving, the participants completed a brief evaluation of the program. The evaluation results and anecdotal comments made by participants during and after the workshop indicated that participants found the workshop to be a very useful and unique venue for NGOs to share their experiences.
Over 90% of participants who completed evaluation forms rated the plenary presentations and panel sessions as either “very relevant” or “relevant”. Similarly, over 90% of respondents rated the breakout discussions as “very relevant” or “relevant”. Everyone who evaluated the workshop found that the preliminary documentation, which included the case studies and the abstracts, were “very relevant” or “relevant”. Some participants noted that the paucity of case studies on MNCH in Asia made the preliminary documentation an invaluable resource.
Participants named people and organizations with whom and with which they planned to share the information and knowledge they had gained at the workshop, including partner organizations and colleagues in their organizational networks. Finally, participants named key inspriations from the workshop. These included
■■ A sense of renewed possibility of working in partnership with other NGOs, the private sector and government;
■■ An understanding of the power of an evidence base and the usefulness of barrier analysis;
■■ Awareness of opportunities for new funding and service provision models such as contracting in/ contracting out;
■■ The realization that programs could be highly successful without the use of donor funds;
60 ■■ The power of various communications materials and mediums, including the media;
■■ The need to advocate more strongly at the government level; and A■■ The importance of broad and deep community support for programs. C