Personal Update

Due to time constraints, I will not likely be blogging here frequently in the future. I will, however, continue blogging at this health systems strengthening blog.

Presentation on Global Health Motives and Myths

I will be give a brief 30 min presentation on Global Health for the BYU Public Health Club tomorrow at 7pm in room 271 of the Richards Building.

Health Systems get-together, and HSIA sign-on activated

2 brief announcements:

1. The call to action for Health Systems Impact Assessments was published today in the Lancet. -Consider Signing onto the call here.

2. On July 8, at 5pm, we will have an informal meeting at my house to discuss “Transforming Health Systems.” All are invited. Drs. Henry Mosley (Johns Hopkins), and Kirk Dearden (Boston University) will be joining us. Respond to this email for directions and questions: ghsias@gmail.com.

Research Assistant and Volunteer Opportunities

See here for details.

Name Change

You’ll notice that I’ve changed the name of the blog.  While I’ve always liked “Unacceptable,” I think that “Utah Valley Global Health Group” better explains the current activity of the blog.  Let me know what you think.

BYU’s 2nd Annual Global Maternal and Child Health Conference

I went to this conference last year and was glad I did.  See here for details.

The Global Maternal and Child Health Conference at BYU is a one-day symposium addressing various mother, newborn, and child health issues with emphasis on a family perspective. The 2009 conference highlights various epidemiological data and scientific information gleaned from the studies conducted of the best researchers and practitioners in the field presented in a series of maternal, neonatal, and child survival articles published in The Lancet.

The conference will emphasize the need to act together on this knowledge and to work collaboratively to achieve the Millennium Development Goals by 2015. Plenary speakers and panelists will discuss family-based solutions, research findings, partnerships models, best practices and methods from the field that have been found to be effective in promoting, achieving, and sustaining the health of mothers, newborns, and children.

The symposium brings together the university community, medical and health sector, government and non-government agencies in an event that brings to the fore the major health needs and issues that compromise the health, future, and life of mothers and children worldwide. The conference is structured as follows:

1. Morning Plenary Session – features guest speakers with expertise in global health issues
2. Afternoon Panel Discussions – features presenters sharing research findings as well as best practices and lessons in the field.

Call for Papers

2nd Annual Global Maternal and Child Health Conference

March 20, 2009

Abstracts Due: February 1, 2009

The purpose of the Global Maternal and Child Health Conference at BYU is to provide students, faculty, professionals, and volunteers with an outstanding opportunity to understand successful evidence-based interventions for improving global health. This year the conference will specifically focus on family-based solutions to health challenges, and feature key officials from the Pan American Health Organization.
Paper/Poster Topics:

• The impact of culture and lifestyle on health outcomes of women and children
• Family health history as a prevention tool
• Infectious disease impact on mother, newborn, or child health
• The role of NGOs in meeting global maternal and child health challenges
• The impact of primary health care on maternal, newborn, and child health
• Health outcomes in resource-constrained areas
• Global health and diversity: maternal/newborn/child issues

Submission Deadline:
Materials must be received by 5:00 p.m. on February 1, 2009. Acknowledgement that materials arrived on time will be sent via e-mail.

Submission Format
All abstracts, not to exceed 300 words (one page), are to be submitted via e-mail to mnch.call.forpapers@gmail.com. Please follow the abstract guidelines listed below according to whether the abstract discusses a research project or an interventional or educational project.

Research: Purposes/Aims; Rationale/Conceptual Basis/Background; Methods; Results; Implications

Project Papers: Purposes/Aims; Rationale/Background; brief description of the undertaking, including the approach, methods, or process used; Outcomes achieved/documented; Conclusions, emphasizing implications for clinical or educational practices; and recommendations for research or future undertakings

Abstract Selection and Notification: The Abstract Selection Committee will meet in February to review and select abstracts and to finalize the conference program and schedule. (The Committee will assign the time of presentation for each podium or poster abstract on the conference schedule. The Abstract Selection Committee reserves the right to accept abstracts as a podium or poster presentation.) If your abstract is accepted for presentation, the first author will be notified around February 20, 2009 by e-mail regarding the presentation time. If there is more than one author, the first author will need to share the information with the other authors.

Conference Registration
Presenter registration fees will be waived, but all presenters must register by phone (801) 422-8925 in order to be counted for name badges and lunches.

Cutting through complexities to solve problems

I found this speech by Bill Gates on global health inequities insightful, optimistic, and even a little entertaining (there are 5 total portions, maybe 30 min total):

New Spreadsheet on Under Five Mortality Rates (with some thoughts on disease advocacy)

Here is an excellent spreadsheet made available through some listserve discussions through the CORE group. The spreadsheet is being used by the Child Health Epidemiology Reference Group (CHERG), Partnership for Maternal, Neonatal, and Child Health (PMNCH), and the Countdown to 2015 Group. Its modeling methods are explained in the 2003 Child Survival Lancet series (another excellent resource). The 2003 version was updated recently and this is the latest version (2007).

This data is objective and comes as a great resource in the midst of a heated discussion with regards to disease advocacy and funding wars currently raging in the global health realm. The battle really was set off after Roger England questioned HIV/AIDS funding. For example, this mortality data shows HIV/AIDS as the number cause of mortality in one country, South Africa. Some diseases (especially HIV/AIDS) get more social arousal than the very unflattering diarrhea. Should funding ever be disease-specific?

Welcome, Ryan and Kristen!

Ryan and Kristen Lindsay have joined us as a fellow bloggers.  Learn more about them here.   Welcome!

Care for Life’s Family Preservation Program

Joao Bueno from Care for Life sent me this summary of their Family Preservation Program:

What is Family Preservation Program?

Family Preservation is a family based development program implemented at community level. Its main objective is to overcome poverty by preserving and empowering families, whatever structure a family may be.

Children are the main victims of family failure; they will naturally be the main beneficiaries of healthier and happier families.

Sickness, hunger, ignorance, and dependency, are both the cause and consequence of family disintegration, describing a continued downward cycle. Family Preservation Program stops this cycle by creating a sustainable community environment that fosters behavior change, instills hope, brings ownership, and promotes self-reliance.

How Family Preservation Program achieves its objectives?

Family Preservation Program achieves its objectives by creating

5 powerful SYNERGIES that occur on multiple levels

Synergy 1 – By applying an integrated approach in 8 areas of emphasis in which families achieve specific objectives

Synergy 2 – By adopting the Horizontal Approach (involving the total community population, including every family in a selected area)

Detailed Selection Criteria facilitates choosing the optimal community to promote synergy among families. We look for a moderate-size community of about 200/250 homes, providing 20 to 25 families per Field Officer, maximizing the strategy of one visit/one day/one truck to keep program costs low. The population should be large enough to provide 30 community leaders who can commit to serve about five hours a week.

Synergy 3 – By developing activities and programs that target different family members

PROGRAMS

Proliteracy

ProLiteracy helps participants reach a functional level of literacy by using its unique Literacy for Social Change Methodology, which combines literacy with health, education, economic self-reliance, environmental sustainability, and human rights. Meetings are held at the Communities Learning Centers four times a week and are taught by community facilitators who are trained in learning participatory methods.

Children’s Club/Stay Alive

In weekly meetings led by respected members of each community, children ages 9 to 14 are taught important principles regarding their power and ability to choose, so that they are already able to think critically and make smart choices before reaching the age of sexual activity and thus avoid contracting HIV/AIDS. These lessons are drawn from the Stay Alive curriculum, designed by United Families International. Other lessons are also presented regarding important principles such as the need to seek an education and personal hygiene. Children are also involved in a number of cultural and recreational activities such as dancing, singing, playing, etc.

Family Garden

The purpose of the Family Garden Program is to create a simple, replicable approach to sustainable agriculture for individual families. Families work one on one with the garden promoter to create and maintain their own personal garden, growing a variety of simple crops to add nutritional balance to their meals. The family garden program strives to help families to 1) improve family daily meals, 2) use garden surplus as income generation activity, and 3) bring mothers close to their homes and children. The program provides technical assistance and follow-up, helping individual families to get the best results from their garden.

Home Improvement (Goals)

The pictures above show Luiza’s house, before and after last goals period

The best benefits for family health and wellbeing, usually comes from simple hygiene habits and small initiatives like start drinking safe water, keeping the house and backyard clean, taking children to health care for vaccination and consultation, using latrines regularly, repairing leaks in the roof, etc. The House Improvement Program helps families to achieve those objectives by motivating them to make and work hard to achieve reasonable goals. With the Field Officer assistance, each family establishes 10 simple goals of their own choice. Those goals will be evaluated by the community Zone and Group Leader and by the FPP’s Field Officer in their regular bi-monthly visits for a period of five months. Families that have achieved at least 80% of their goals will be rewarded and can chose an award from a number of construction materials, like few sacks of cement, zinc for the roof, a door, or a window, etc. Awards are given to recognize families for their hard work.

Home-Based Care

Our HBC Field Officer assists a woman, who was taken to the health center in a bicycle ambulance that CFL made available for the community

Due to the AIDS epidemic it is necessary to consider how best to provide care for people with disease and their families. As more people become ill, many will not be able to stay in hospitals, or other institutions for care. The National Health System has limited health care resources. Situations will arise where, even if hospital or other institutional care may be the best response to an individual’s condition, it may not be available to him/her. Mozambican Ministry of Health has always defined its HBC target group broadly, as “People with AIDS and other Chronic Illnesses”. The Minister of Health has encouraged clearer definitions and further integration of services, and the training materials now have specific modules for HIV, TB, and other chronic illnesses and conditions such as: cancer, diabetes, hypertension, stroke, epilepsy, chronic pain, blindness, asthma, chronic arthritis, paralysis, paraplegia, burns etc. The FPP Field Officers have the primary objective to train family members to provide the actual care. They are certified by the Ministry of health, and assisted by a qualified nurse, that supervises the work.

Income Generation

The FPP director and the Income Generation Coordinator working together with local leaders, will invite interested families at FPP communities to attend a three-month course on starting and managing a small business. The teaching strategy will be based on case-study methodology of Steve Gibson’s “Academy for Creating Enterprise” and will focus on: client satisfaction, bookkeeping, quality control, savings, marketing, business plan, cooperatives, business skills, producing merchandise or providing services, inventory control, selling, buying, etc. Classes will be taught at the community.

As classes continue, students will participate in a selection process, bringing their business plans on agriculture, carpentry, fishing, bike repair, etc. for consideration. The partnership organization will select the best business plans of 30-50 students who distinguish themselves and will grant those students the necessary money (microcredit) to start or develop their own businesses.

The partner will offer consulting to the selected group, visiting their businesses regularly, on days that do not conflict with FPP scheduled visits, to follow up, train and monitor. When FPP leaves the community after its 39 months of involvement, the microcredit organization will remain, working with its clients in the community.

MAJOR ACTIVITIES

Bi-annual Family Assessment

Field Officers use a questionnaire to record families’ medical symptoms, literacy levels, health histories, etc. Focusing on behavior changing objectives, the assessment is used to evaluate family and community progress toward the 8 areas of emphasis.

Celebration Day

This informal event involves all community leaders and members, including children. Government officials are invited only for opening and closing ceremonies. Celebration days observe family achievements for the completed goal period by awarding prizes and motivate leaders and families to continue their completed goals and strive for new ones.

In addition, FPP presents codes on each goal period’s building blocks of Partnership, Trust, Choice & Consequences, Change, Ownership, Self-Reliance, and Freedom.

In the mornings, Field Officers present premiums to their zones, and Pro-literacy and Stay Alive facilitators receive certificates for their work.

The afternoon is given up to plays, recreation and other merriment. FPP shows slides of previous 6 months’ activities. Children’s Club presents singing and dancing; Literacy classes show their new-found skills; gardeners display their harvest when in season. American volunteers when in Beira participate, doing plays and games with children.

Field Officers Visits

To establish personal relations with each family and to encourage families to apply the FPP eight Areas of Emphasis in their daily lives, Field Officers visit each family individually with Zone and Group leaders bi-monthly from 9:30 to 1:30. FPP staff uses this time to help family members to establish and follow up on goals as well as to refer family members to Literacy, Children’s Club/Stay Alive, Home-Based Care, and Family Garden programs. During the second year, Zone and Group leaders take the lead on establishing and following up on goals.

Community Classes

The Community Class curriculum, composed of 32 lessons in the eight Areas of Emphasis, is taught every other week during regular visits. During the first two years those classes are taught by FPP coordinators, during the last year FPP community Zone Leaders take charge of these classes, and the coordinators helps community leaders to prepare and deliver the lessons. Each class involves a number of behavioral change objectives that are integrated with the goals of the Home Improvement Program and the core values of each Celebration Day.

These classes are given in both community centers, with two coordinators teaching in each center. Each coordinator will teach one of the classes for which he or she is responsible, based in his or her indicators. With each consecutive visit, the coordinators will alternate between teaching in one community center and teaching in the other—in this manner, each coordinator will teach each class in both centers before moving on to teach a new class. Following this schedule, it takes two visits, or one month, for a coordinator to teach a given class to the entire community. The techniques used to teach these classes and the content of these classes are contained in much greater detail in the General Curriculum. After Celebrating Ownership (the 5^th phase of community development) the community leaders start teaching the class. At this point the whole of the coordinator is helping the leader in his/her preparation and teaching.

Water Wells

The construction of wells is essential for agriculture and healthy families.

People often walk long distances to obtain water for drinking, washing, cooking, and gardening. In addition, the dry season each year creates great harm for vegetable gardens; most of the production is lost. Insufficient water quantity contributes to disease and malnutrition.

FPP will establish a partnership with another organization who will work with community members to install one well per zone per community, with work taking place on days other than FPP weekly visits.

Family Health Testing

Family Health Testing provides a site within the community where families can be evaluated for HIV, so that they may know their health status and receive essential care if necessary. Success of the testing process depends on the level of community preparedness, and especially the relationship of trust between CFL and community.

Testing is conducted at the matchessa every day for two weeks, and FPP’s Home-Based Care Field Officer attends daily. Government Health Agency makes available technicians, equipment, counselors, and antiretroviral medication if needed. Other needed services are provided, such as completing documentation forms by the Civil Registry; vaccinations for children by City Health Department, and free eye consultations by the NGO Light for the World.

Synergy 4 – By fostering support systems (safety nets)

Family

Neighbors

Community leadership (religious, traditional, political, educational)

FPP community Zone and Group leaders

“Programs should aim to increase the capacity of families to care for orphans and vulnerable children. This includes strengthening community safety nets, such as material and emotional support provided by neighbors; focusing welfare on communities and families rather than individuals; and supporting the economic capacity of families and communities.”

International HIV/AIDS Alliance, Building Blocks: Africa-Wide Briefing Notes, Overview, p. 7

“The best way to support the wellbeing of young children affected by HIV/AIDS is to strengthen and reinforce the circles of care that surround children. Children are best cared for by constant, committed and affectionate adults. When the care giving circle is broken for some reason, extended families normally plug the gap. When the circle of care provided by kin is broken, community initiatives need to stand in, and when the circle of care provided by community is broken, external agencies need to play a part. The optimal use of the resources of external program is to assist communities in supporting families. Families are best placed to provide for the psychosocial needs of young children.”

Where the heart is – Meeting the psychosocial needs of young children in the context of HIV/AIDS Linda Richter, Geoff Foster and Lorraine Sherr

Synergy 5 – By utilizing the socio-cultural approach

The socio-cultural approach utilized by The Family Preservation Program offers opportunity for a more participatory and supportive community environment, enhancing individuals and family’s capacity to understand and deal with poverty and its consequences within the context of their own socio-cultural references and resources. The socio-cultural approach gives to locals more control and ownership based on a deeper understanding of primary factors that shape behavior and brings more efficiency and sustainability on people efforts to alleviate poverty.

The synergy happens when people positively associate the concepts taught by CFL with values, behavior, or believes, that are in some extend part of their experience, tradition, or history. For instance the HIV/AIDS prevention message of abstinence taught to children as part of the Stay Alive curriculum is reinforced and strengthened by traditional values and cultural believes. Those traditional values are regarded as having disrupted as a result of modernization, lowering the moral standards of the population. The abstinence message is received as a welcome contribution to restore society traditional values.

FPP promotes a number of programs that are culturally appropriate, supporting positive community traditions and knowledge, respecting preexistent communication channels, and delivering messages using participatory strategies that foster families’ contribution and commitment.

Community Leaders in Casa Banana conducting the Celebration Day

Communities and even families differ one from another. The strategies utilized by CFL in the Family Preservation Program take in account and respect these individualities.

As part of its social-cultural approach, the Family Preservation Program adopts an Integrated Curriculum that considers for each lesson the cultural relevant aspects associated to that particular subject and also the stigma/discrimination related issues.

The synergy that emanate from the social-cultural approach that happens on every communication chance, becomes even more powerful when considering the teaching/learning strategy utilized by Care for Life called Teaching for Social Change or Empowering Education.

Some FPP key strategies are:

· Horizontal coverage attending and applying all programs to all families who live inside the community area

· Local control performed by community leadership organization with elected leaders

· Integrated approach addressing all the eight areas of emphasis

· Participatory methodology utilized in our teaching and programs

· Socio-cultural approach

· Every other week visits and classes

· Continuous emphases on “community participation, initiative, ownership, prevention, sustainability, long-term behavior change, and self-reliance.

· Limited time that CFL will be working with the community (39/40 months in Mozambique)