CSHGP and Grantees
The CSHGP strategic partnership model engaged and built the capacity of civil society with host country governments and the private sector – promoting healthy behaviors, improving quality and equitable access to services, and informing national policies and strategies. Through an annual grant-making process, direct cooperative agreements were made to support the work of international non-governmental organizations (iNGOs) and their local partners. These programs generated new knowledge to address major barriers to improving and scaling up the delivery and use of integrated packages of low-cost, high-impact interventions to improve the health of women, children and communities. The portfolio consisted of approximately 32 projects in 24 countries.
MCHIP & PVO/NGO Efforts
MCHIP’s PVO/NGO Support team provided technical assistance in program design, monitoring, implementation and evaluation to grantees supported through USAID’s Child Survival and Health Grants Program (CSHGP). The team offered expertise in monitoring and evaluation, maternal & child health, and infectious disease interventions, as well as organizational development and health information systems, with a focus on equity and sustainability.
MCHIP’s technical support to the CSHGP focused on ensuring a standard level of quality across the portfolio of active grantees to pilot and analyze new approaches for introducing and scaling up high-impact interventions in diverse communities; contribute solutions to key operational barriers to scaling up delivery of these interventions; and disseminate evidence and lessons of proven models for the delivery of high-impact, integrated interventions.
Key Contributions of Grantees
Every project made key contributions, which include:
- Building on local assets—bringing services closer to communities: In both Plan and CARE’s project areas in Nepal, village development committees (VDC) were allocating an increased amount of funding to support and staff birthing centers with skilled attendants when their projects ended. CARE, in particular, facilitated the upgrading and strengthening of 56 birthing centers through funds from private donors but also through mobilization of VDCs and Health Facility Management and Organization Committees to make financial and in-kind contribution (land/space) for establishing the birthing centers. Both projects helped to bring skilled birth attendance closer to communities, and both reported significant increases in skilled birth attendance at the end of their projects compared to baseline: 43 to 78% and 22 to 52% for Plan and CARE, respectively.
- Leveraging partnerships: GOAL, a New Partner, collaborated with other international NGOs with strong technical skills in specific intervention areas to strengthen their project. GOAL worked with PSI, who supplied technical assistance and supplies of Waterguard™, to introduce the product and the practice of routine point-of-use water treatment to their project area. (Previously, the FMOH only engaged in free distribution of Waterguard during diarrhea outbreaks.) As a result of the partnership and distribution approach, consistent and affordable supplies of WaterGuard™ rose from 5% at baseline to 74% by the end of the project. Experiences gained in the OR were designed to be used for the implementing organizations (GOAL, PSI and FMOH) as the basis for future decisions and replication of a (successful) strategy.
- Influencing national policy: In Malawi, Save the Children helped to develop and implement the CBMNC package, which was adopted as the primary national approach for community-based MNC. The package trains HSAs to identify pregnant women and visit them in the home, where they provide counseling on ANC and delivery, ensure that women deliver at a health facility, and make postnatal visits. HSAs use community registers to record and track pregnant women – summary forms are completed monthly and sent to HCs, as part of a community-based surveillance system. Save the Children focused implementation in three focus districts – Chitipa, Dowa, and Thyolo – and it was then rolled out in 17+ districts. Data suggest that project inputs contributed to improvements in availability, quality and demand for newborn interventions – and improved intervention coverage – in the three CBMNC project focus areas; and possibly nationally.
Global Leadership Role of PVO/NGO Team
- PVO/NGO Team member sits on Global CCM Task Force
- PVO/NGO Team organizes and facilitates technical sessions at CORE Group meetings
- PVO/NGO Team member invited to present work on equity at LAC Regional Newborn Meeting, June 2013
- PVO/NGO Team members present data in global fora: APHA annual meeting (2009), International AIDS conference (2012), Breastfeeding and Feminism Symposia (2010, 2012, 2013)
Program Learning Achievements
- Portfolio reviews of contributions to maternal and newborn health, community case management, and Operations Research
- “Reducing child global undernutrition at scale in Sofala Province, Mozambique, using Care Group Volunteers to communicate health messages to mothers” by Davis, et al. published in inaugural issue of Global Health Science and Practice
- “Comparison of Knowledge, Practice and Coverage (KPC) child health survey coverage estimates and Lives Saved Tool (LiST) mortality modeling, with estimates from the Rwanda Demographic and Health Survey (RDHS)” by Langston, et al. paper submitted for publication
- “Community-based intervention packages facilitated by NGOs demonstrate plausible evidence for child mortality impact” by Ricca, et al. published in Health Policy and Planning
How did grantees address equity?
MCHIP in coordination with CSHGP grantees and CORE Group members developed guidance for incorporating health equity into programs and measuring its improvement through a six-step process that leads to a shared understanding by project staff and stakeholders of how to address health inequities. In Ecuador, the Center for Human Services learned through its baseline household survey that indigenous populations have much lower rates of maternal health care utilization than mestizo (of mixed European dissent) populations. As a result, they focused project efforts where most needed, on indigenous groups. In Nicaragua, Catholic Relief Services realized that gender issues were preventing women from utilizing maternal and newborn care services, so they included a male involvement component to help men realize the positive role that they play in family health. In Bangladesh, World Renew (formally Christian Reformed World Relief Committee) used Participatory Rural Appraisal to work with community members in identifying the poorest villages, thus taking advantage of local knowledge and engagement for targeting activities to improve health equity.
How did grantees address scale?
Grantees worked at a local level to generate evidence that could then be used to support a policy change, or they helped to roll out/implement or strengthen a national policy that had not yet been implemented in a specific geographical area.
How did grantees address community?
Grantees implemented community-oriented projects that focused on making information and services more accessible and available to communities while also increasing demand for the information and services. These projects often had strong behavior change components meant to increase the adoption of and reinforce the practice of healthy behaviors and appropriate and timely care-seeking. The strategies used were numerous, but included care groups, mothers’ groups, pregnant women’s groups, other peer support groups, home visits, positive-deviance/hearth, dramas, demonstrations, and engagement of religious leaders.
How did grantees address quality?
Grantees addressed quality through training, supportive supervision, provision of job aids, and assistance in procurement of supplies.