BL 11 Business Plan 2008-2013: Integrated community-based interventions ppt

There is an urgent need for effective strategies for co-implementation of community based interventions that build on effective models such as home management of malaria and community-di

BL 11 Business Plan 2008-2013

Integrated community-based interventions

Draft Business Plan for JCB

May, 2007

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TABLE OF CONTENTS

EXECUTIVE SUMMARY 2

1 OBJECTIVE 5

1.1.OVERALLOBJECTIVE 5

1.2.SPECIFICOBJECTIVES 5

2 NEEDS AND OPPORTUNITIES 6

2.1.NEEDS 6

2.2.OPPORTUNITIES: 7

3 COMPARATIVE ADVANTAGE 8

3.1TDRCOMPARATIVEADVANTAGE 8

3.2SYNERGIESWITHOTHERORGANIZATIONS 9

4 ACTIVITIES AND END PRODUCTS 11

4.1KEYACTIVITIES 11

4.2.END-PRODUCTS 15

4.3.INTERIMIMPLEMENTATIONMILESTONES 16

5 RESOURCE REQUIREMENTS 18

5.1BUDGETREQUIREMENTS 18

6 RISKS 19

EXECUTIVE SUMMARY

Needs and Opportunities

Several effective and simple interventions are available to prevent or treat infectious diseases

of poverty such as malaria and neglected tropical diseases (NTDs) However these interventions often do not reach the affected populations that need them most, in particular, the poor and rural populations in Africa Innovative ways of getting effective interventions to affected poor people are urgently needed Community-based delivery strategies have been developed for different diseases, but vary in terms of community involvement, effectiveness and sustainability Different control programmes implement their community-based strategies independently, resulting in inefficiencies and conflicting practices at the community level There is an urgent need for effective strategies for co-implementation of community based interventions that build on effective models such as home management of malaria and community-directed treatment of onchocerciasis in which communities are empowered to manage the process themselves Recent studies have indicated that co-implementation using the community directed model can greatly increase access to health interventions among poor populations, in line with WHO goals to promote integrated approaches that strengthen health systems

• To determine the costs, benefits and limits of co-implementation of community-based health interventions, and how co-implementation can be simplified

• To develop innovative solutions to the problem of conflicting incentive policies for community volunteers, and to develop mechanisms through which communities can

enforce their demand for intervention supplies

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Activities

The business line will undertake large multi-disciplinary multi-country studies to explore and test new delivery strategies The studies will be undertaken in close collaboration with national, regional and global disease control programs, including APOC and the NTD and malaria programs of WHO As much as possible, the intervention strategies to be tested will

be implemented through the regular health system The preparation of the studies will involve extensive consultation with disease control programmes and ministries of health to carefully define the research needs and research questions, and exploratory studies to identify potential solutions that take into account critical social factors such as gender and economic status The focus of the business line will be on Africa and the research will use the extensive network of African public health and social science researchers that has been established in the context of previous research by TDR

End-Products

• Strategy for upscaling CDI for co-implementation of interventions against NTDs and Malaria in areas where community directed treatment is already established for onchocerciasis control (2010)

• Strategy for CDI in areas where there is no onchocerciasis (2010)

• Delivery strategies for community based interventions in urban and post-conflict areas, and strategy for upscaling deworming through School Health Programmes (2011)

• Framework for co-implementation, including evidence on the costs and benefits of different co-implementation strategies, and on the type of interventions that are appropriate for co-implementation (2009-2011)

• Impact of conflicting policies for incentives to community volunteers documented and innovative solutions developed and tested (2011)

• Mechanisms to strengthen communities' influence on implementation strategy and help them reinforce their demands for support and supplies for interventions (2010)

Comparative Advantage

TDR has over the years acquired unique experience in the design and implementation of multi-country studies on innovative community-based interventions against infectious diseases in neglected populations It has developed community based treatment strategies e.g the Community Directed treatment with ivermectin and Home Management of Malaria, and the CDI strategy as an effective model for co-implementation of interventions TDR has supported the training of a large network of scientists and researchers across a range of disciplines (including epidemiology, social sciences, economic research amongst others) thereby creating a unique network of researchers with expertise in the areas of community-

based intervention approaches TDR is a leading agency in the application of advanced social sciences in the design and evaluation of health intervention strategies TDR has experience with involving disease control programmes and national health systems in the design and implementation of these studies, and in facilitating the effective transfer of research findings into policy and practice As a WHO programme, TDR has close links with the relevant technical programs of WHO, such as the African Programme for Onchocerciasis Control, Neglected Tropical Diseases and Global Malaria Programme, and effective access to ministries of health through the regional and country offices of the organization

The specific objectives of this business line are:

• to determine how to scale up the Community Directed Intervention (CDI) strategy and how to efficiently introduce it into new areas

• to develop and test other community-level intervention strategies, especially for urban and post-conflict areas, for nomadic populations and through collaboration with other sectors such as in school health programs

• to determine the costs, benefits and limits of co-implementation of community-based health interventions, and how co-implementation can be simplified

• to develop innovative solutions to the problem of conflicting incentive policies for community volunteers, and to develop mechanisms through which communities can enforce their demand for intervention supplies

2 NEEDS AND OPPORTUNITIES

2.1 NEEDS

Access

Infectious diseases remain a major cause of morbidity and mortality in developing countries, especially in Africa where they are responsible for 60% of all deaths Effective interventions exist to prevent or treat infectious diseases such as malaria and neglected tropical diseases that disproportionately affect the poor However, it has proven very difficult for the weak public health systems in many developing countries, especially in Africa, to deliver these interventions to the affected populations who need them most Many promising new interventions have only limited impact and millions continue to suffer or die because of the failure to have interventions delivered in an efficient and sustainable manner to poor populations It is increasingly recognized that research should not stop after the development and evaluation of new control tools, but that it has an additional critical role to play in helping to solve major implementation problems and improve access to health interventions

by poor populations Research is needed to provide objective evidence on the main obstacles

to health care delivery in poor communities and develop more effective and sustainable delivery strategies that are appropriate for the environment in which they are needed

Many interventions against infectious diseases of the poor are simple and do not require trained health professionals They can be administered at the community level by community members who have received basic training in their use Disease control programs are therefore increasingly opting for community-based delivery strategies for these interventions However, the approaches used vary significantly in terms of community involvement, effectiveness and sustainability, and there has been very little research to evaluate and compare these strategies and to determine how they could be optimized

Recent years have seen a significant increase in global support for the control of infectious diseases that affect poor populations New control initiatives have been launched for individual diseases, and although this is a very welcome development for the fight against diseases that have been so long neglected, there is increasing concern about the fragmentation, inefficiency and potential negative impact on the health system of these different initiatives Hence there is an urgent need for research to develop more coherent and efficient strategies for the co-implementation of multiple community-based interventions that can ensure sustained high coverage of the target population and that are effectively integrated into, and strengthen, the public health system

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2.2 OPPORTUNITIES:

Research has shown that community-based delivery strategies can greatly increase access to interventions, especially when communities are empowered to manage the process themselves, and that these strategies can strengthen the health care system

TDR research on home management of malaria has shown how interventions and IEC materials can be optimized for use at the community level, and how different community members, from mothers to shopkeepers, can be trained to effectively diagnose and treat uncomplicated malaria The home management strategy has been adopted by Roll Back Malaria and malaria endemic African countries, and the challenge is now to bring it to scale Community directed treatment with ivermectin (CDTi) has been a new model of community empowerment in health, in which the community is fully in charge of the planning, execution and monitoring of the intervention delivery Developed by TDR in the 1990s, CDTi has been implemented at scale by the African Program for Onchocerciasis Control (APOC) Over 40 million people are treated annually with ivermectin by communities themselves, and a high treatment coverage continues to be sustained Because of the success with this approach, there is increasing interest to use the community directed model also for other interventions The communities themselves are keen to use it for their priority health problems such as malaria

The board of APOC, with among its members the Ministers of Health of 19 African countries, has also expressed interest but wants decisions on the wider use of CDTi to be evidence based The board has therefore requested TDR to investigate to what extent the community directed approach can be used for other interventions A major multicountry study of community directed interventions (CDI) is under way to answer that question and preliminary results have been very promising: communities could easily manage several interventions, the coverage of added interventions more than doubled and even the coverage

of ivermectin increased Based on these findings the board of APOC has recommended the use of CDI for integrated delivery of multiple interventions, including against malaria

Directors of Disease Control and Program Managers from the Ministries of Health of 10 African countries met in February 2007 in Brazzaville to discuss issues of integration and co-implementation Based on results of the CDI and other studies, they recommended that countries explore innovative ways to empower communities in health care delivery as a way

to significantly improve coverage, that the CDI approach be used for co-implementation where already established for onchocerciasis control, and that other proven community level interventions, e.g School Health Programmes, be pursued where appropriate

The current interest in CDI, and in community based interventions in general, together with the momentum in global support for infectious disease control in developing countries, provide a significant opportunity to develop efficient strategies for the integrated delivery of multiple community-based interventions that respond to priority needs and that are likely to

be rapidly taken up for large scale implementation

3 COMPARATIVE ADVANTAGE

3.1 TDR COMPARAT IVE ADVANTAGE

TDR is the global leader in innovative implementation research on access and community based delivery strategies for interventions against malaria, neglected tropical diseases and other infectious diseases of poverty

3.1.1 Proven Technical and field experience

TDR has unique experience in the design and implementation of complex multi-country studies and in the development and evaluation of community-based interventions; in bringing the social and public health sciences together to evaluate planning, decision and implementation processes at the health system and community levels; in assessing the feasibility, effectiveness and efficiency of different intervention strategies; and in helping to translate research findings into practical public health policies e.g for malaria, onchocerciasis and lymphatic filariasis

3.1.2 Demonstrated stewardship

Through its close interaction with disease control programs and their expert advisory committees, and with ministries of health through WHO, TDR has facilitated needs analysis and priority setting for implementation research on the critical issue of access to interventions Based on a continuing analysis and improved understanding of research needs, TDR has helped to shape the research agenda and has identified promising opportunities for innovative, high-impact research Because of its location within WHO, its extensive network

of public health and social scientists in disease endemic countries, and its links with the scientific world from basic research to product R&D and implementation research, TDR has been able to combine field needs and scientific opportunities into effective targeted research programs that have had significant impact on disease control

3.1.3 Capacity building capabilities in developing countries

TDR has trained many scientists in disease endemic countries in the research disciplines of implementation research, i.e public health, epidemiology, sociology, anthropology, biostatistics and health economics It has also supported and guided many researchers in the execution of implementation research projects, and this has resulted in an extensive network

of disease endemic countries scientists with hands-on experience in large scale implementation research The business line will collaborate with the TDR business line on

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training activities that are required for the effective implementation of the research activities, especially within the context of multicountry studies

3.2 SYNERGIES WITH OTHER ORGANIZATIONS

There are many partners involved in the development and implementation of strategies for co-implementation of different health interventions, and partnerships will be central to the activities of the business line

Operational partners

Ministries of Health, national disease control programs and district health management teams will be key partners in defining research needs and obstacles to control, and in postulating and testing possible solutions Scientists from research institutions in developing countries will undertake the research in collaboration with the Ministries of Health NGOs that support different disease control initiatives will also be actively involved in defining needs and undertaking the research Leading international scientists in the relevant research disciplines will be engaged to help ensure that the research is of high standard and capitalizes on the latest scientific advances Key partners at the international level will be the various global or regional disease control initiatives, including formal partnership arrangements where these exists, such as Roll Back Malaria, Global Alliance for the Elimination of Lymphatic Filariasis, International Trachoma Initiative, etc The business line will seek to interact on a regular basis with the technical advisory bodies of those programs

WHO is the executing agency of TDR, and the organization will be actively involved at all levels in the activities of the business line WHO country offices will facilitate effective interaction with ministries of health, and especially with respect to needs analysis and translation of research findings into national policy As the main focus of this business line is

on Africa, the WHO Regional Office for Africa will be actively involved in all activities of the business line, but especially in the interpretation of research findings and in assessing their relevance for regional health policy The African Program for Onchocerciasis Control will be a key partner because of its achievements and experiences with community directed treatment, and it's keen interest in the proposed activities of the business line to further improve its control strategy At the global level of WHO there will be close interaction with the technical units for different diseases, such as the Global Malaria Program and the WHO department for Neglected Tropical Diseases