Public event with CARE UK and GlaxoSmithKline

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1 Public event with CARE UK and GlaxoSmithKline Strengthening maternal and child health in Asia: innovative partnerships and approaches 18 September 2015

2 Chair and panellists Chair: Laurie Lee, Chief Executive Officer, CARE UK Panel: Daryl Burnaby, Global Community Partnerships Manage, GSK Fiona Samuels, Research Fellow, Social Development, ODI Dr Jahangir Hossain, Director of Health, CARE Bangladesh Kara Hanson, Professor of Health System Economics, London School of Hygiene and Tropical Medicine 1 Opening remarks Laurie Lee, Executive Director at CARE UK, opened the event by introducing CARE International s partnership with GlaxoSmithKline (GSK). To help respond to a shortage of 7 million health workers worldwide and a growing overall burden of disease, CARE is working with GSK as the implementing partner of GSK s 20% Reinvestment Initiative in Asia. This corporate community investment initiative aims to reinvest 20% of the company s profits into strengthening of community health systems in six of the least developed countries in which GSK operates. This partnership focuses on improving maternal and neonatal child health by improving the quantity and quality of frontline community health workers in the most remote and marginalised communities in Afghanistan, Bangladesh, Cambodia, Laos, Myanmar and Nepal. Examining this public private partnership in health, the event discussed the role the private sector can play in international development. 2 GSK presentation The first panellist was Daryl Burnaby, Global Community Partnerships Manager at GSK, who outlined GSK s 20% reinvestment programme. He highlighted the chronic shortage of trained frontline health workers in the world s least developed countries as one of the most fundamental constraints to improving access to healthcare. Whilst the figure is out-of-date and surely underestimated, the World Health Organisation estimated the global health worker shortage at around 7.2 million. This forms the basis of GSK s programme, which focuses on supporting the training of frontline health workers, including volunteers, community health workers, pharmacists and midwives, recognising that investing in frontline health workers is a high impact, cost-effective 2 ODI Report

3 means of improving access to healthcare. Daryl explained that to do this, the GSK programme uses a three-pronged approach. This includes: educating communities to recognise signs of disease and refer to health services, through working closely with community groups and leaders; building capacity by improving health facilities, equipping training centres and developing training courses; and working with governments on the benefits of increased investment and improved policies to strengthen local healthcare systems. Daryl emphasised the value placed on creating and adjusting programmes to fit the specific needs of local communities, based upon recommendations from NGO partners and from discussions with country governments on their key health priorities. As Daryl stressed, the aim of the programme is not to become another part of the health system, but to stimulate change and encourage self-sustaining health systems. The impact of the GSK programme in Asia was highlighted by Daryl, who showed the significant increase in the number of health workers trained and the number of people reached by the Asia programme since With 10m, over 20,000 health workers have been trained, reaching over 4.4 million people. To see GSK s presentation, click here. 2 ODI presentation Next to speak was Fiona Samuels, Research Fellow at the ODI, who was part of the review process of GSK s programmes in Asia. After outlining the programme s achievements at the end of phase 1, Fiona highlighted the different country contexts across the Asia programme. For example, the maternal mortality rate ranges from 327 in Afghanistan to 170 out of 100,000 live births in Cambodia and Bangladesh. Fiona emphasised that despite these differences, each country involved in the programme faces similar barriers to improving maternal and child health, categorised as on the supply (including the quantity and quality of health providers) or demand side (including geographical distance to healthcare facilities and the cost of transport to services). This meant that similar approaches were adopted across countries, including community involvement and mobilisation, strengthening health systems and partnerships. Fiona explained these in greater detail, with community involvement and mobilisation facilitated through basing projects on local priorities to ensure local ownership, sustainability and stakeholder and beneficiary empowerment. Community mobilisation approaches also included training and capacity building of existing community health groups within country, including peer educators in Nepal and male shura committees in Afghanistan, which are comprised of community opinion and religious leaders and provide maternal health awareness to other men in the community. Strengthening of health systems was facilitated through developing infrastructure and the distribution of supplies, such as in Laos and Nepal. Partnerships as part of the programme were deemed critical for scale-up and longer term impact and sustainability. This included partnerships at each level, including at the project design level and at implementation. Programmes were aligned and coordinated with government priorities, in order to generate government accountability and ownership. Source: CARE 2015 ODI/CARE/GSK Public event 18 September

4 Fiona also explained the importance of advocacy activities, including sharing key findings and best practice across countries. This was facilitated at the national level through government-led meetings and project documentation facilitation, and at the international level through regional and international conferences and events. The advocacy component of the programme led governments to adopt tools and approaches. One example of this was in Afghanistan, where the Ministry of Public Health adopted a specific data collection tool following dissemination of best practice from the programme. The country research briefs conducted by ODI and CARE outlined a set of conclusions and recommendations for strengthening community health systems with a focus on maternal and child health. Fiona highlighted the importance of continued commitment and buy-in from governments and other key stakeholders, and the continued sharing of learning and best practice both within country and across country programmes. To see ODI s presentation, click here. 3 Care Bangladesh presentation Next to speak was Dr Jahangir Hossain, Director of Health at CARE Bangladesh, who shared his experiences of the CARE-GSK initiative in the remote and underserved district of Sunamganj, Bangladesh. This area was selected as it has poor maternal, new born and child health indicators when compared to the national averages; it is a priority district for the Government of Bangladesh; and it was deemed to have the potential for collaboration and synergies with other development projects. The purpose of this specific country initiative was to ensure consistent, high quality and sustainable maternal and child health care services to over 1.4 million people in the region. Dr Jahangir outlined the project design phase, describing it as a participatory process through extensive situation analysis and discussions with the Ministry of Health and stakeholders including UNICEF, WHO and civil society organisations. The key focus of the programme was the development of community skilled birth attendants, with an emphasis on quality assurance. Dr Jahangir outlined the ways in which the CARE Bangladesh initiative facilitates this, through regular quality assurance Project beneficiary, Ekramunnesa with her family, Bangladesh CARE International, ODI Report

5 visits using checklists and bi-monthly refresher training for birth attendants at the sub-district hospital. Another programmatic approach in Bangladesh is community mobilisation, which involves promoting health services, identifying pregnant women and mobilising local funds to support the poorest households. Local government engagement and accountability is carried out through advocacy, capacity building and engaging with local government members to address health issues specific to their areas. Dr Jahangir also explained the emphasis on facilitating linkages between community skilled birth attendants and health facilities, and ensuring accountability by sharing community feedback on services. Accountability and lesson learning is also facilitated through a Technical Advisory Group, comprised of the Ministry of Health, WHO, UNICEF, UNFPA, Save the Children, DFID, CARE, GSK and other relevant stakeholders. This group focuses on reviewing programmatic progress, sharing lessons and best practices, and reviewing whether the programme is aligned with country needs. Dr Jahangir highlighted the success of the programme, with 34,745 pregnancies identified and registered, 9,652 deliveries attended, and 2,183 women referred to different health facilities since the start of the programme. Overall availability of consistent, affordable, accessible skilled maternal and child health services to underserved and poor communities has increased, providing potentially a sustainable alternative service delivery option for the remote community. However, Dr Jahangir was quick to stress the many challenges, including high attrition rates of health workers who had received training, often inadequate referral systems, and competition between programme and district level service providers and local traditional services. To see CARE Bangladesh s presentation, click here. 4 London School of Hygiene and Tropical Medicine presentation Our final speaker was Kara Hanson, Professor of Health System Economics at the London School of Hygiene and Tropical Medicine, who explored how this particular private public partnership lies within a broader landscape of partnership models. She did this first by exploring the various forms of partnerships that exist, and introducing the idea that these can often by fuzzy, making it difficult to establish just how important private public partnerships are. Kara stated that adequate public funding for health ultimately drives access to qualified health service providers, highlighting the importance of public, pooled funds for universal health coverage to ensure that the poor have access to good quality, affordable services to compete out the low quality private sector. Regulation is also paramount to ensure that low quality private providers are not responsible for services. 5 Q&A session Following presentations from the panel, the room was opened up for Q&A. The first question was directed at GSK, asking how community health workers are compensated for their time, and whether the programme has encouraged governments to invest in paying CHWs in the future to make the health gains sustainable. Daryl Barnaby (GSK) stated that some CHWs are paid, and other are not, which creates a huge challenge. As it stands, the lack of pay is one of the main reasons for attrition. However, many health workers are compensated in kind by the communities they work in. Daryl concluded by explaining that GSK deliberately do not pay health workers, and instead support training and NGO capacity building, as their goal is for a sustainable approach which builds the entrepreneurial skills of service providers. Dr Jahangir (CARE Bangladesh) added that community health workers need to be recognised by the Ministry of Health, so that uptake of their health services increases. The next question from the floor probed what doesn t work in private public partnerships. Fiona Samuels (ODI) responded by stating the value of involving a range of stakeholders in the design phase to ensure that everyone is involved and on the same page from the very start. Daryl Barnaby added that the attrition and turn-over of health workers trained by the programme remains a challenge. A thought-provoking question came from Options, who asked whether the initiative s focus on training health workers can really improve health care systems if health infrastructure remains weak. Daryl Barnaby (GSK) stated that when the programme started, training ODI/CARE/GSK Public event 18 September

6 was the main focus but at present, only 40-50% of funds are spent on training. One of the key priorities is to be flexible with local partners and governments, and adjust programmatic approaches and priorities in line with local recommendations. For example, in working with AMREF in Africa, GSK are spending a greater proportion of funding on strengthening health facilities as this is a local priority. One of the main questions from the floor focused on quality. Picking up on the statistics-heavy presentations, UCL asked how the quality of health services is monitored to ensure that the programme is resulting in higher quality health care. Drawing from a Bangladeshi context, Dr Jahangir (CARE Bangladesh) stated that the Ministry of Health is monitoring this, with CARE providing training on monitoring processes. Beneficiaries are also using a feedback system, and health care providers are offered refresher training at the sub-district level to ensure continued quality. Daryl Barnaby (GSK) specified that 10% of programme funds go into monitoring and evaluation, recognising the importance of holding to account the systems being built. This M&E is not designed for GSK, but for the services, systems and local staff themselves. The next question from the audience was how referral system quality, and the outcome of referrals, is monitored. Dr Jahangir (CARE Bangladesh) responded by saying that often facilities are not ready for referrals, which remains a significant challenge. In response, CARE Bangladesh are mapping all private and public facilities and giving people a choice over where they would like to be referred to. Svetlana Ancker, Senior Account Manager at CARE manging the corporate partnership with GSK and coauthor of the CARE-ODI research briefs, added that there is a strong focus on establishing strong referral systems by training staff at each level and in different areas. A final question from CARE UK focused on the emerging Sustainable Development Goals. The panel were asked about the impact of the SDGs, and whether these may act as motivating factors to drive further private public partnerships in health and general health system strengthening in developing countries. Kara Hanson (LSHTM) highlighted that the Universal Health Coverage target provides considerable incentive, and could help to drive public funding of a comprehensive package at national levels. To read the overview report, see here.

7 ODI is the UK s leading independent think tank on international development and humanitarian issues. Readers are encouraged to reproduce material from ODI Reports for their own publications, as long as they are not being sold commercially. As copyright holder, ODI requests due acknowledgement and a copy of the publication. For online use, we ask readers to link to the original resource on the ODI website. The views presented in this paper are those of the author(s) and do not necessarily represent the views of ODI. Overseas Development Institute This work is licensed under a Creative Commons Attribution- NonCommercial Licence (CC BY-NC 3.0). ISSN: All ODI Reports are available from Cover photo: Nepal Kate Holt/ CARE International, 2010 Overseas Development Institute 203 Blackfriars Road London SE1 8NJ Tel +44 (0) Fax +44 (0) odi.org

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