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«REPORT “Protect, Prevent, Treat: African Regional Workshop on coordinated approaches to pneumonia and diarrhoea prevention and control Nairobi, ...»

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REPORT

“Protect, Prevent, Treat":

African Regional Workshop on coordinated approaches to

pneumonia and diarrhoea prevention and control

Nairobi, Kenya, 25-28 January 2011

CONTENTS

List of Abbreviations

Acknowledgements

Executive summary

Introduction

Background

Purpose

Participants

Objectives

Expected outcomes

Opening Session

Session 1: “Protect, Prevent, Treat: an overview”: An integrated framework for the prevention and control of pneumonia and diarrhoea

Presentation 1: Understanding the concept and principles of GAPP

Presentation 2: Updates on integrated Community Case Management (iCCM) including the tool kit

Presentation 3: Creating behavioural change and demand: Integrated framework for pneumonia/diarrhoea communication activities

Presentation 4: Strengthening supply chain

Session 2: Increasing awareness and building capacity for communication & advocacy16 Presentation 1: Kenya’s experience with communication and advocacy

Presentation 2: Advocacy and communication for World Pneumonia Day and for diarrhoea prevention and control

Presentation3: Communication and advocacy capacity building

Session 3: Monitoring progress, research priorities and funding opportunities.............19 Presentation 1: Monitoring progress

Presentation 2: Operational research agenda to support GAPP and diarrhoea control strategies

Panel Discussion: Funding opportunities

Session 4: Sharing and learning from country experience

Session 5: Identifying coordinated actions

Conclusions

Annex 1: Agenda

Annex 2: List of Participants

Annex 3: Outcome of country team group work

List of Abbreviations

ACT Artemisinin-based Combination Therapy AMREF African Medical and Research Foundation CHWs Community Health Workers CAH WHO Department of Child and Adolescent Health and Development CHAI Clinton Health Access Initiative CHNRI Child Health Nutrition Research Initiative CIDA Canadian International Development Agency DHS Demographic and Health Surveys EPI Expanded Programme on Immunization ETAT Emergency Triage Assessment and Treatment GAPP Global Action Plan for the Prevention and Control of Pneumonia GAVI Global Alliance for Vaccine and Immunization GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria HMIS Health Management Information Systems iCCM Integrated Community Case Management IMCI Integrated Management of Childhood Illnesses IVB WHO Department of Immunization, Vaccines and Biologicals KPA Kenya Paediatric Association MCHIP Maternal and Child Health Integrated Programme MDG Millennium Development Goal MICS UNICEF's Multiple Indicator Cluster Survey MNCH Maternal, Newborn and Child Health MSH Management Sciences for Health ORS Oral Rehydration Salts solution PCV Pneumococcus Conjugate Vaccine RDT Rapid Diagnostic Test UNICEF United Nations Children's Fund USAID United States Agency for International Development WHO World Health Organization

Acknowledgements

The World Health Organization acknowledges the valuable contributions of the many people who assisted in the preparation/organization of this workshop, and in the development of this report, especially the Ministry of Health and government of Kenya for hosting the workshop and the Bill and Melinda Gates Foundation for funding it.

© World Health Organization 2011 The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

The views expressed in this report are those of the participants in the African Regional Workshop on coordinated approaches to pneumonia and diarrhoea prevention and control.

Executive summary To support and facilitate the implementation of activities for the control of pneumonia and diarrhoea in children under five years of age living in developing countries, a series of four regional workshops is being organized by the World Health Organization (WHO) in collaboration with ministries of health, the United Nations Children's Fund (UNICEF) and other partners. The workshops are intended to facilitate the introduction or scaling up of effective interventions through coordinated action at country level. This report describes the first workshop that was held in Nairobi, Kenya, 25-28 January 2011.

Jointly organized by WHO's Departments of Child and Adolescent Health and Development (CAH) and Immunization, Vaccines and Biologicals (IVB) at Headquarters and the WHO Regional Office for Africa and funded through a grant from the Bill & Melinda Gates Foundation (BMGF), this four-day workshop brought together approximately 100 participants from eight countries (Ethiopia, Ghana, Kenya, Malawi, Nigeria, Uganda, the United Republic of Tanzania and Zambia), as well as representatives of a wide range of international organizations, bilateral organizations, research institutions and non-governmentalorganizations (NGOs) active in the area of child health1. The country teams included focal points from ministries of health responsible for child health/the Integrated Management of Childhood Illness (IMCI), the Expanded Programme on Immunization (EPI), nutrition, malaria, and health systems/health policy.





The objectives of the workshop were:

I. To orient participants to the concepts and practical principles of the Global Action Plan for the prevention and control of Pneumonia (GAPP) 2 and the seven-point plan for

comprehensive diarrhoea control outlined in the WHO/UNICEF publication "Diarrhoea:

Why children are still dying and what can be done" 3, their relationships with existing programmes and the benefits of putting greater emphasis on these two illnesses; and provide technical updates on integrated community case management (iCCM).

II. To analyse opportunities and obstacles to implementation, share lessons learned/best practices, and identify solutions, including policy issues, to increase coverage of pneumonia and diarrhoea prevention, treatment and control interventions at all levels.

III. To foster collaboration and linkages across programmes by identifying and developing country-specific actions for practical application of the GAPP and diarrhoea control strategy to strengthen existing child survival and primary health care programmes.

IV. To define the resources and technical assistance needed to ensure that coordinated actions and processes are implemented, and agree upon a set of indicators for monitoring and reporting.

V. To increase awareness of and build capacity for communications and advocacy at country level to improve implementation of pneumonia and diarrhoea prevention, control and treatment interventions within the context of child survival programmes.

WHO, UNICEF, BMGF, the United States Agency for International Development (USAID), the Global Alliance for Vaccine and Immunization (GAVI), USAID’s Maternal and Child Health Integrated Program (MCHIP), Program for Appropriate Technology in Health (PATH), Management Sciences for Health (MSH), Save the Children, the Clinton Health Access Initiative (CHAI), Sabin Institute, World Vision International, the African Medical and Research Foundation (AMREF) and the Kenya Paediatric Association. See Annex 2 for full list of participants.

www.who.int/child_adolescent_health/documents/fch_cah_nch_09_04 www.who.int/child_adolescent_health/documents/9789241598415 Prior to the workshop, a template was developed and distributed to country teams to support the preparation of situation analyses. This covered organizational structures, coordination mechanisms, programme budget and funding, training and supervision, Health Management Information Systems (HMIS), community structures and personnel, performance of programmes, gaps, opportunities and challenges. This helped to ensure that all country presentations were of high quality, and facilitated cross country comparison and sharing of experiences.

After brief statements by representatives of USAID, BMGF, and the WHO Representative for Kenya, Dr S.K. Sharif, Director of Public Health and Sanitation, Ministry of Public Health and Sanitation, Republic of Kenya, officially opened the workshop. Dr Sharif stressed that effective, high-impact interventions for pneumonia and diarrhoea control exist and are affordable, and called for strong coordination of implementation at country level.

Introductory sessions at the workshop included presentations on: the strategies and framework to "Protect, Prevent, Treat" pneumonia and diarrhoea; iCCM and a tool kit for its implementation; creating behaviour change and demand and an integrated framework for pneumonia/diarrhoea communication activities; and strengthening the supply chain.

During the workshop, intensive country team group work focused on national

policies/strategies and strategic plans:

(i) to find out if key pneumonia and diarrhoea prevention and control interventions have been included;

(ii) to identify the main problems hindering implementation of proven intervention packages;

(iii) to propose realistic solutions; and (iv) to identify opportunities for scaling up key pneumonia and diarrhoea interventions.

The country team group work was assisted by facilitators (WHO/UNICEF/USAID/Save the Children) who used a Facilitators’ Guide specifically developed for the workshop. During the country team group work, coordinated actions were identified with an emphasis on fostering linkages between programmes.

Coordinated plans of action produced by the country teams during the workshop, focused mainly on coordination, capacity building, advocacy and communication, strengthening private sector involvement, monitoring and evaluation/data management, and supply chain logistics. In all countries, the key interventions for pneumonia and diarrhoea prevention and control were included in existing national policies and strategies, including community case management. However, coordination was identified as a challenge by most countries, and participants expressed a strong willingness to work together across programmes. In many cases, however, the authority to make the necessary changes to facilitate this was largely beyond the control of the workshop participants. Nevertheless, with the current momentum among governments, donors and partners towards more coordinated and integrated efforts for pneumonia and diarrhoea control, the process started at the workshop will likely find traction in countries.

At the close of the workshop, applying selection criteria (introduction of new vaccines within the next year; implementation of iCCM; and a supportive environment of government, donors and partners), workshop facilitators selected two countries -- Kenya and Zambia -- for more intensive follow-up and additional technical support within the scope of this initiative.

In order to maximize the benefit of this initiative, and to improve advocacy and communication for child health, pneumonia and diarrhoea prevention and control, the workshop included a half-day capacity building session on advocacy and communication.

Communication specialists from the WHO Regional Offices for Africa and South-East Asia, UNICEF HQ/Regional Office, and PATH co-facilitated this interactive session. The session included a refresher on communication basics, the process for identifying a single, overarching communication objective, performing a stakeholder analysis, and developing targeted key messages. In addition, case studies were presented, including the innovative advocacy and communication activities undertaken by the Kenya Paediatric Association (KPA) in a presentation by KPA President, Dr Fred Were.

The workshop also provided an opportunity for:

(i) A briefing on mechanisms and indicators for monitoring and reporting, including the Millennium Development Goals (MDGs), the Countdown to 2015: Tracking progress in maternal, newborn and child health, Demographic and Health Surveys (DHS)/Multiple Indicator Cluster Surveys (MICS), CCM Global Benchmark indicators, and the Canadian International Development Agency (CIDA)/UNICEF Catalytic Initiative.

(ii) An update on the operational research agenda to support the GAPP/diarrhoea control strategy.

(iii) An overview of possible funding opportunities: GAVI highlighted the opportunity for using health systems strengthening (HSS) funds to support coordinated action plans with a joint GAVI-Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) tranche of HSS funding becoming available in August 2011, as well as funding for new vaccines; the BMGF representative highlighted its support for research that complements country efforts; the Sabin Institute representative explained its advocacy support with parliamentarians; USAID and UNICEF highlighted linkages with their ongoing country support, with particular emphasis on support to iCCM through the President’s Malaria Initiative.

In summary, the workshop successfully achieved its objectives. The collaboration between programmes was strengthened, and the participation of colleagues from the WHO Regional Office for South-East Asia enabled forward planning for the regional workshop to be held in Dhaka, Bangladesh.

Recommendations

WHO staff from headquarters and the Regional Office for Africa and partners will follow up on the implementation of coordinated actions identified by country teams. WHO will send a letter to WHO and UNICEF country representatives of the eight participating countries providing a short briefing on the workshop and requesting their support to ensure the implementation of coordinated action plans.



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