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1. (((((((((((((((((((((((((((((( Dr Thiam Ismael Nutrition & Child Survival Officer WAHO Dakar May 21st 25th 2007

2. OUTLINE • PART ONE: The Rationale and Purpose to identify BP • PART TWO, Session 1: Process to Identify BP. • Definitions: Practice, BP • Definition of Criteria and their content • Pyramid of BP and PP • Collection of Practices • Submission Process • Review Process • Dissemination of BP • The Compendium of BB: objectives, purpose • The BPAG: Roles & Responsibilities

3. PART II Session 2 • Lessons from the BP on Anemia Workshop • Brief Presentation of the experience • Achievements: • Criteria identified by participants • Final review results • Follow up Actions undertaken • Constrains and challenges

4. PART II Session 3 A Case Study of a BP in Child Survival

5. Rationale: Documenting Success • Organizations implementing FP/RH projects have documented 3 decades successes commonly known as Best Practice but… • Occasionally information is available about them also… • Increasingly country leaders and donors want to ensure that successful program models and the lessons learned from their implementation are used in other situation when appropriate

6. Rationale • Lack of coherent information on what works and what does not work • Costly duplication efforts • Costly implementation of ineffective programs • Limited access to evidence-based tools • Limited opportunities to share knowledge with local and Intl colleagues (WHO, UNFPA, USAID: Implementing BP Initiative)

7. Purpose of the Compendium of BP (Advance Africa) • Enables program managers in the field to quickly find tested program models to meet specific program needs so that they can successfully implement evidence-based programs • · Recognizes and publicizes information about successful program models, including lessons learned • · Promotes higher standards and brings rigor to the evaluation process

8. Purpose of Implementing Best Practices Initiative (WHO, UNFPA, WHO) • Maximize the quality, the efficiency and effectiveness of RH services for women and men worldwide • Promote the use of the BP by helping diverse organizations in different regions to access, share and build upon this Knowledge

9. DEFINITIONS (AA) A Practice Is a specific action or set of actions within a program or activity consistently used in response to a problem identified

10. DEFINITION (AA) BEST PRACTICE (1) • «Gold Standard » of practices, tools or activities that can be implemented to support program OBJECTIVES • Evidence of success and impact drawn from multiple settings and objective data • Best Practice involve limited RISK: good track record, evidence of success, successfully REPLICATED • Program managers: more CONFIDENT that adapting and implementing a best practice to fulfill their program needs, will help to achieve desired program objectives.

11. Best Practice (IIBP) Initiative Implementation of BP (UNFPA, WHO, USAID » • Methods, Tools and Materials that have demonstrated as effective as innovative • Spectrum of evidence based: • Tools, materials, methods and practices including: guidelines, norms, protocols standards experiences and skills that proven their worth in RH

12. Promising Practice • A Specific action or set of Actions exhibiting inconclusive evidence of success or evidence of partial success. (lack of evidence of success and no evidence of replication or transferability)

13. Evidence of Success Adds value Evidence of Transferabilty Accepted by Communities Cost effective Practical Ethical Works with existing programs Promoted by outside organizations Others terminolgy Mesurable Impact Sustainable Replicable Partnerships and linkages Community based development Criteria of Best Practices (AA)

14. Summary • A BP must be: evidence based, shows transferabilityand provide a practical, efficient effective solution to the situation • An Unbiased multi Agency Review Board should be established to assess practice or program model submitted (to the Compendium). • Several criteria listed can be considered principles that program managers should strive to meet but that are not mandatory for consideration or assessment as a best practice.

15. PROCESS FOR IDENTIFYING BEST PRATCICES

16. COLLECTION of Best Practices • The Question « Has the program been replicated » not « if it is replicable » • Replicability criteria • Replicated in the same province • Replicated in the same country • Replicated in different countries • Replicated on different continents • If replication not documented: Review Board to assess it

17. Collection and Submission process of Best Practices 1) Research and solicitation 2) Submission from • BPAG, Review Board members, program managers • Publications 3) Process • Online submission form • Submission guidelines according the specific practice (standardization of Success) developed

18. REVIEW PROCESS (1) • Necessary to ensure a dynamic, non static compendium of current BP. • Review on a continual basis to capture ideas that have relevance for work in the field • New programs implemented and evaluated and gain evidence of success are able to move up the PYRAMID

19. REVIEW PROCESS • Review by AA Staff: Manager of the Compendium • Joint Process with various Experts/organizations • Review by the Advisory Board members

20. DISSEMINATION PROCESS • Initiated by the Manager of the Compendium (AA) Channels • Conferences, • Meetings • Workshops • Collaboration with organization at both headquarters and field offices • Information on the BPC distributed through • Concise summary document distribution (month/year) 2 pages • Web site links • Partnership • Presentation (EX: ARI at the 2005 AHM of WAHO by Aware)

21. Dissemination and Ownership of the BP Compendium • Done openly with multiple partners on a Continual basis • Leadership, and utilization of BP cannot be implemented without Strong CHAMPIONS • Stakeholders and COMMITTED individuals to COORDINTE and PROMOTE the BP • Example Partnership for Child Survival (Dakar-2005) • USAID, AED, BASICS (Washington) UNICEF, WAHO, WHO/Afro, WHO/Sn, Aware-Rh USAID Mission, BASICS/Sn, CCF, MOH, DHT

22. CRITICAL ISSUES: • Best Practice vs Promising Practice: THE PYRAMID • Roles of the Stakeholders: THE BPAG

23. Pyramid of Practices for Public Heath Interventions

25. DEFINITIONS (1) • Principles: Essential ideas and concepts for program success. Usually related to policy. • Confidence: Confidence replaces Risk and merges the level of evidence of replicability • To reduceriskthat a chosen practice will be ineffective or inappropriate: It is needed a standardized evaluation process to codify program model success • Lessons Learned: cross cutting observations and conclusions that apply to a specific practices. It is from the process of lessons learned that a practice moves up the pyramid or to another stage

26. DEFINITIONS (2) Transferabilty • BP:« Evidence of transferability or having been transferred » (BPAG) • Transferability: Successful application of a program in new settings; • The ability to successfully apply a procedure or program across cultures, sectors or geographic areas.

27. DEFINITIONS (3) Replicability • Ability to reproduce the performance or an experiment or program more than once • The program may be repeated across cultures, sectors themes or geographic areas and can • Serve as model for generating policies and initiatives elsewhere with potential for replication (Ex: CCM of ARI in Senegal)

28. DEFINITIONS (4) Sustainability • Sustainability is the durability of project results after the termination of the technical cooperation/assistance channeled through that project (Positive Deviance). • Static sustainability: continuous flow of the same benefits, set in motion by the completed project, to the same target groups; • dynamic sustainability: is the use or adaptation of project results to a different context or changing environment by the original target groups and/or other groups.

29. The Best Practice Advisory Group (1) Advance Africa • Objectives 1) Establishing a The Review Board • Determine the criteria and process for member selection • Create a list of possible members • Agree upon list of technical area topics

30. The Best Practice Advisory Group (2) 2) Ensuring Rigor: The Review Process • Agree upon how the Review Board members will assess and report • Establish procedure for assessment 3) Sharing Ownership of the BP Compedium • Determine steps to ensure dissemination and ownership of the compedium

31. Members of The BPAG/AA • Advance Africa • Academy for Educational Development -SARA, • Family Health Intl • International training in Health (INTRAH) • Population Council • MSH • JHU/Center for Com. Program (CCP) • USAID • World bank • Global Health Council • Deloitte & Touch Tohmatsu

32. The Best Practice Compendium • Objectives • To facilitate the identification, documentation and dissemination of BP • To assist Program managers in identifying and selecting successful practices they can adapt for their own needs • To promote rigorous standards and evidence based practices within public health programs • To recognize and publicize PH practices and programs

33. The Best Practice Compendium(2) • Attempts to include BP and PP from experiences with RH, FP, Adolescent health,HIV/AIDS and Maternal & Child Health • The BP Up dates • Quarterly summaries of evidence based best practices, linked toAA Workplan

34. CASE STUDY ON ANEMIA: Coupling de-worming and vitamin A supplementation: National-level in Senegal

35. Principles and Context • WAHO workshop in 2004 • Pilot phase 2004 succesfull in terms of coverage the Ministry of Health piloted coupling of de-worming with other child survival interventions in 2 regions with support from UNICEF. • In 2005, DHS shown that 84% of children < 5 are anaemic. • Causes: inadequate feeding practices, infectious diseases (malaria, intestinal worms),poverty. • Intestinal worms represent a public health problem and anaemia is partly due to these intestinal worms

36. Outcomes • Tally sheets show 100% coverage for de-worming and VAS. Mebendazole was well accepted and tolerated by children. • High-level political advocacy has been an essential step in order to get commitments from all actors, • Administering de-worming 500 mg mebendazole tablet accepted and tolerated by children, • Rejection of worms (concrete and immediate effect), de-worming is mobilising • Integration of services (OPV+vitamin A+mebendazole) does not affect the overall coverage,

37. ESSENTIAL CRITERIA (1) • EVIDENCE BASED • FEASIBILITY - Process Indicators - Respond to population needs ( 96% of mothers accepted the combination of dworming and VAS) - Mebendazole accepted - Association with OPV • APPROPRIATION • WORKS WITH EXISTING SYSTEM • Integration approach through the implementation of the MinPack (National Strategy 1998) • Current M&E tools are adapted to the strategy of mass campaign

38. ESSENTIAL CRITERA (2) • EFFICIENCY • Cost analysis not available • SUSTAINABILITY • Not evaluated • Funding depends on DHS • QUANTITATIVE ASSESSMENT • Process Indicators: YES • Impact: No • ADAPTABLE • YES : Integration with existing intervention • REPLICABILITE • YES in others districts.

39. FLEXIBLE CRITERIA FUNCTIONING WITHIN EXISTING PROGRAMS • Integration with Immunization • Min Pack INNOVATION • Participatory Approach: facilitate Ownership • Community involvement: Facilitate sustainability • Partnership: Facilitate optimization use of resources & combination of 2 key C.S interventions

40. LESSONS LEARND • Seems a Promising Practice • Level of confidence Low • Impact Assessment not available • Not submitted for external review • Internal Review: Not completed only WAHO • Task Force established did not work However • The Initiative responds to a Regional and country level Needs (Consensus Statement of Bobo, multiple partnership) • Initiative created Awareness and strengthen Networking in Nutrition

41. FOLLOW UP ACTIONS • Review and respect of the process for identifying a BP • Conduct Impact assessment ? (Costs) CONSTRAINS • Criteria to select task force members • Workload of Key Resource persons • COORDINATION: Impact assessment??? • Clear definition of Roles and Responsibilities of the BPAG • LEADERSHIP & Timely Decision Taking

42. CONCLUSION • Over Decades in PH we know a lot : WHAT, WHERE, WHEN, WHY, WHO but less on HOW (Allan Berg, The WB in 80s) to solve problems • Identification and continuous documentation, information sharing and Knowledge management of BP can contribute significantly to achieving MDG • BP documentation and implementation IS paradigm for solving PH problems in the context of our countries with limited resources (Human, Financial, Material) • Combination of Technical Area in Health with IT support: BEHAVIOR CHANGE INITIATIVE

43. THANKS MERCI O’BRIGADO DIEUREDIEUF