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What works… ?

What works… ? . What doesn’t ?. “NOUS SOMMES TOUS DANS LE MÊME BATEAU”. ‘BEST’ PRACTICES IN COMMUNITY ENGAGEMENT STRATEGIES. High Impact Behavioral Change at scale USAID funded ‘Linkages project’ 1996-2006:. Promotion of Exclusive Breastfeeding, Optimal Feeding Practices.

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What works… ?

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  1. What works… ? What doesn’t ?

  2. “NOUS SOMMES TOUS DANS LE MÊME BATEAU” ‘BEST’ PRACTICES IN COMMUNITY ENGAGEMENT STRATEGIES

  3. High Impact Behavioral Change at scaleUSAID funded ‘Linkages project’ 1996-2006: Promotion of Exclusive Breastfeeding, Optimal Feeding Practices. Exclusive breastfeeding rates (EBF) increased at significant levels in the five country programs; Madagascar 28 percent - in 5 yrs, Zambia 17 percent- in 4 yrs,Ghana and Bolivia 10 percent in 3 yrs, Ethiopia a 20 percent increase in 2 years. Spin-off programme BASICS in Benin showed a 26% increase in 4 years time. Project population; Ghana 3.5 million, Madagascar 6.3 million Limitation: sustainability , ownership

  4. Key strategies • multiple partners -coordinated strategies, collaborative plans, consensus building, scaling up • multiple entry points: - national: decision makers, academic staff,journalist - district; hospital staff and administrators, health facility supervisors - community; pregnant women, mothers of infants, fathers of infants, grandmothers, entire communities • community based strategies • behaviour change communication - targeted precise messages to promote do-able actions, peer group support , women’s groups other community groups, saturation of primary audience with messages (modern, traditional media) • capacity building -government workers, NGO staff, community health workers • monitoring and evaluation

  5. Community based approach • through intermediary of community based volunteers • A ‘jungle’ of volunteers…

  6. Bottle Necks “The problem is at the community level” • Quality of work /motivation • Sustainability • Ownership

  7. Quality of work at the community level

  8. Volunteer motivation • A ‘problem’ in every country, in every programme..but just a ‘challenge’ for some • True volunteers or selected • Should volunteers be paid or not ? • Spirit of volunteerism ? Alternatives; • Mother’s clubs Red Cross Ghana, Nigeria • Maman Visa – MCDI Benin

  9. What doesn’t work ? • Supervision by government staff • no time • no interest…? Going to scale without ensuring quality at community level

  10. “Projects directed at women are lasting” Income-generating activities Saving schemes Literacy programmes “Women's groups provide an especially powerful opportunity to share life-saving information and to increase demand for health care”. “If you want to reach mothers and children, you have to use mothers..” Sustainability

  11. Successful programmes including saving schemes, IGA for women - MMD programme CARE Niger - UNICEF Benin Community based Education Programme; adopted as a National Policy for the Promotion of Girls Education - Association Munyu BF - Groupement Naam BF

  12. CARE NIGER - Mata Masu Dubara MMD programme of saving’s and credit • CARE Niger developed in 1991 the MMD methodology of saving’s and credit which has been highly successful. • Today 7000 association’s in six of Niger’s seven departments • Benefiting more than 240.000 rural women • MMD methodology is unique; does not provide external credit. Methodology is derived from traditional savings method called “tontine”- very different from micro-finance • Sustainable because each group is autonomous. 95 % percent of groups formed continue their activities • Impact: social and economic but most importantly enhancing women’s self-esteem • They are often viewed as “having been educated”

  13. OWNERSHIP ?Passive recepients........? • ‘On chante le chanson que vous aime ecouter...’ • So..now we are breastfeeding what are you going to give us ? • ‘they told me I was appointed...’volunteer malaria, water..etc.’ • You have given us bicycles...but we need income generating activities to sustain our activities ? • We need to become better listeners, to the true needs of the community...

  14. Community-led development ? Good examples: - Groupement NAAM BF - WASH programmes - Faith based organizations Congo RDC, - Republic - Plan Mali (truly) participatory at all levels of the process; participatory diagnose community management of resources participatory analysis of results Time flexibility….. OWNERSHIP

  15. An example of sustainability and ownership… Guamina Implementing NGOOF KENEYA CIWARA HEALTH PROJECT

  16. KENEYA CIWARA HEALTH PROJECTFunded by USAID led by CARE Mali - consortium of partners ; JHCCP, Intrahealth, Action Against hunger and Groupe Pivot/ Sante Programme works with 4000 community health volunteers in 7 of Mali’s 8 regions reaches 30 % of the population. Integral part of the Malian Government Health Program. Decentralization process has given more of power of decision to the communities - project works directly in-line with this process A five year project (2003-208): Objective; to stimulate communities to demand for better quality health-services and to make them more responsible in solving their own health needs Some results; In 2006 97% children under age 1 vaccinated for DTP3 Children under 5 sleeping under ITN 9.7% in 2005 - 23.5% in 2006 76 % of women registered for antenatal care 50% of births attended by skilled personnel

  17. QUALITY INDICATORS FOR SUCCESSFULL COMMUNITY ENGAGEMENT PROGRAMMES • Presence and intensity of interaction between village volunteers and the supervising body (NGO, Government) • CBO endogenous to the region • Ownership; using truly participatory methods at all levels of the process • Inclusion/participation • Scale of the programme • The type of volunteers used and effectiveness in reaching the target population of mothers and children 0-5 years. • Using existing structures for communication (women’s groups, agricultural groups..) • Saving schemes or other IGA included in the programme • Sustainability after the programme has ended.

  18. Interpersonal Education, Peer education Exchange visits Community radio to re-enforce messages Traditional song, poems, theatre forum; more complicated issues: FGM, HIV/Aids Depending on the cultural context Communication channels used

  19. M & E Opportunities Behavior change impact information is available at community level and can be used… Observational data can be collected through community health workers

  20. The Challenge Ahead • Going to scale • Ensuring quality on the ground …a consortium of quality NGOs….

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