PUBLIC HEALTH AND NUTRITION SECTOR OVERVIEW AND STRATEGIC APPROACH

PUBLIC HEALTH AND NUTRITION SECTOR OVERVIEW AND STRATEGIC APPROACH Niger Cassandra Nelson/Mercy Corps An Overview The current state of global health presents a unique challenge. While there are many advances in medical science, basic healthcare services and health and nutrition awareness still fail to reach the majority of people living in resource-poor countries. Thus, these communities struggle with high morbidity and mortality in mothers, newborns and children; widespread malnutrition; prevention and control of infectious diseases; and access to safe drinking water and sanitation. Our public health and nutrition programs focus on these demanding challenges. Through context-sensitive, high quality integrated public health programs that strengthen local health systems and promote healthy behaviors, we work for sustainable change. Mercy Corps programming also address social determinants of health such as gender, race, age, ethnicity, and social status, which all play a critical role in the imbalance of healthcare service distribution and utilization worldwide. Our health programs are grounded in the core principles of local ownership; accountability and transparency; and adherence to state-of-the-art best practices. Our programs focus on integrating health interventions with other development programs that bring us closer to our mission; strengthening local health systems and promoting community ownership; empowering communities; building strong partnerships with communities, United Nations and peer agencies and the private sector; and documenting the impact of our programs through rigorous monitoring, evaluation and research. Over the last five years Mercy Corps has implemented over 200 public health programs worth $210 million that are generating measureable results in 28 countries. TECHNICAL SUPPORT UNIT Public Health and Nutrition MERCY CORPS 1

Improved health and well-being of individuals and communities Impact Context-sensitive, high quality integrated public health programs Mission of MC s health programs Best practices Local/national ownership Accountability and transparency Core principles Building strong partnerships Integrating programming Empowering communities Strengthening local health systems and promoting community ownership Documenting impact through evidence-based research Responding to communities in crises Key strategies Women s empowerment Governance Innovations Youth and adolescents Cross-cutting themes Our Strategic Goals and Approach Mercy Corps implements context-sensitive, high quality integrated public health programs by strengthening local health systems and promoting healthy behaviors and practices for a sustainable impact on the lives of individuals and communities. Strategic Approach Mercy Corps is well positioned to implement high quality health and nutrition interventions among existing and new country programs. We have experience working in complex and difficult areas within Core principles 1. National (and local) ownership of programs 2. Accountability and transparency at all levels 3. Use of globally accepted best practices and state-of-the-art behavior change approaches changing political climates. Regardless of changes that take place, health is a universal need and concern to all; our public health and nutrition programs focus on the following strategies: Integrated Programming: Mercy Corps implements its community-led health and nutrition programming alongside agriculture, food security, civil society, governance, economic development, climate change, and youth programs. 2 MERCY CORPS TECHNICAL SUPPORT UNIT Public Health and Nutrition

Strengthening Local Health Systems and Promoting Community Ownership: Mercy Corps works closely with Ministries of Health (MoH) and disease-specific national and subnational public health programs to address national priorities and gaps in health and nutrition. Local health department partners jointly design, implement and monitor programs. Key interventions are evidence-based, follow best practices, and include strengthening of local health facilities through infrastructure repair and maintenance; training of health care providers and community health workers; provision of drugs, laboratory reagents and other essential supplies; and strengthening existing health information and logistic systems. Mercy Corps adds value by working with local implementing partners to build their capacity to effectively plan, monitor and implement health and nutrition interventions to boost the sustainability of outcomes. This approach, coupled with community involvement and empowerment, fosters stronger local health systems. It promotes country ownership, accountability and longer-term sustainability of Mercy Corps programs. In countries with weak public health systems, Mercy Corps implements public health programs in coordination with UN agencies and other national and international humanitarian organizations, with the goal of involving local leadership as soon as appropriate to build a foundation for local ownership. 3. Empowering Communities: Mercy Corps empowers individuals and communities by raising awareness on key public health and nutrition issues, and creating demand for the availability of quality services. To achieve this, we carefully design culturally acceptable Behavior Change Communication (BCC) campaigns focusing on advocacy, communication and community mobilization. 4. Strengthening Partnerships: Mercy Corps collaborates with governments, UN agencies, international and local relief and development organizations, donors, civil society, private and public sector partners and communities, in order to meet the most urgent health and nutrition needs of a country. Such partnerships are also essential for effective work across complex geographies, for tracking trends, and for our ongoing learning about best practices and innovative methods. 5. Responding to Emergencies and Communities in Crisis: Mercy Corps responds to the rapidly changing health and nutrition needs of communities in crisis, especially those resulting from natural disasters and conflict. Given that we may be one of the only actors present to monitor deteriorating situations and ensure early detection, it is vital that we assess and respond to these crises by integrating water and sanitation, health, nutrition and psychosocial interventions into established programs. In line with our mission, we engage in health, nutrition and WASH clusters as a means to contribute field knowledge to global conversations, advocate for the needs of affected populations and bring best practices, lessons learned and innovations directly to teams in the field, including local partners. 6. Research and Evidence-based Practices: Evidence-based approaches are the foundation of Mercy Corps health programs. By remaining up-to-date on global health strategies and proven methodologies, Mercy Corps applies knowledge, information and creativity towards new and improved programming. Mercy Corps actively pursues partnerships with national and international research institutions. Evidence from programs also informs public health policies and actions that improve health outcomes of individuals and communities with whom we work. TECHNICAL SUPPORT UNIT Public Health and Nutrition MERCY CORPS 3

Cross-Cutting Themes Governance: We work with government counterparts and communities in program design, implementation and monitoring at the national, sub-national and community to help ensure accountability and transparency. Mercy Corps experience suggests greater impact when addressing both dimensions of good governance in health programs, which include 1) strengthening the capacity of public sector actors to be effective, efficient and responsive in their public service delivery functions; and 2) ensuring citizens, civil society organizations and private sector groups have the skills, information and opportunity to engage with government about health issues. Gender and Women s Empowerment: Countless studies show that women s empowerment plays a significant role in improving the economic and health status of a community. Mercy Corps recognizes that women, alongside men, should be active in program implementation, and in identifying communities with greatest health needs. We also understand the importance of including both genders in empowering women, raising awareness and participating in program activities to facilitate acceptance and understanding of the varied health needs of community members. Youth and Adolescent Girls: There are many reasons to emphasize the engagement of youth, especially adolescent girls, in our public health programs. While pregnancy-related complications are the leading cause of death among adolescent girls in the developing world, engaging youth in community mobilization programs translates into healthy practices, including birth spacing and nutrition, to decrease vulnerability and to improve their potential to make positive contributions to their communities. Innovations: Mercy Corps focuses on engaging in new, innovative health interventions through building upon previously successful programming, or working to apply new, thoughtful ideas where possible. Intervention Areas Driven by local needs, Mercy Corps focuses on the major public health challenges faced by the most vulnerable and marginalized communities. These include: Integrated Maternal, Newborn, and Child Health Programming: More than 300,000 women die of causes associated with pregnancy and childbirth each year, with resource-poor countries accounting for 99 percent of these deaths. 1 Mercy Corps is building on its maternal, newborn and child health (MNCH) programs by focusing on creative community-based interventions. Evidencebased approaches such as birth-preparedness and complication readiness; antenatal, intra-partum (natal) and postnatal care; immediate and exclusive breast-feeding; and appropriate complimentary feeding practices are built into all MNCH programs. Where possible, Mercy Corps uses low-cost technologies to improve the delivery of health care and empower women and families to practice healthy behaviors and utilize quality health services. We also emphasize capacity building in the local context; supporting the training of local implementing partners and communities including civil society, public and private sector groups to improve the quality of care and raise awareness. 1 http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/index.html 4 MERCY CORPS TECHNICAL SUPPORT UNIT Public Health and Nutrition

Nutrition: Under-nutrition is an underlying cause in nearly one-third of the 6.6 million deaths in children under age 5 each year. Further, stunted growth, the result of chronic under-nutrition, affects 195 million children under age 5 in resource-poor countries annually. Mercy Corps focuses on reducing chronic, acute and micronutrient malnutrition through a range of proven interventions that increase access to and demand for nutritious food, improve dietary diversity, and encourage appropriate infant and young child feeding practices. Moreover, nutritional interventions focus on adolescent girls and mothers, who are significant determinants of improving child nutrition. In addition, these interventions link closely with our food security and agriculture programs. Infectious diseases [HIV and AIDS, Tuberculosis (TB) and Malaria]: Mercy Corps HIV and AIDS programming focuses mainly on prevention through awareness-raising activities and health education to improve knowledge, attitudes and practices. There is strong potential to link with economic development and agriculture-related programs to address the continuum of care and support components for people living with HIV and AIDS. And with approximately 1.5 million people dying annually from TB and roughly 8 million infected 2, Mercy Corps is building on its successful TB programming and expanding it into additional high burden countries. We also focus on malaria control programs in the most underserved areas (275 million cases of malaria are reported annually, leading to over 1 million deaths) 3 and implement programs with a focus on prevention and control within local contexts. Water, Sanitation, and Hygiene (WASH): Improving access to clean drinking water is a key focus area as over 3.5 million people die annually from water-borne diseases 84 percent are children, and 98 percent of deaths occur in resource-poor countries. 4 Access to clean drinking water and sanitation is improved through developing or rehabilitating water systems, often in close collaboration with governments; water treatment at point of use; safely disposing of health facility and home waste by using low-cost technologies (such as incinerators, latrine construction and care, and bio-latrines); and raising awareness among communities. Psychosocial Programming: Mercy Corps builds community capacity to support the needs of children and youth who have experienced trauma by training professionals, paraprofessionals, parents, and community members to provide psychosocial support in homes, schools and other community settings. These psychosocial interventions are often an important foundation on which to build subsequent recovery and development programs. The Approach in Action Healthy Start Indonesia improved the health status of mothers and infants in urban North Jakarta, Indonesia, in 30 neighborhoods by supporting exclusive breastfeeding in infants from birth to 6 months of age through work in public and private health care facilities, the community and at the policy level. Over four years (October 2006 to September 2010), this USAID-funded project had a significant impact on immediate initiation of breastfeeding following birth increasing from 17.9to 64.9 percent, with pre-lactal feeding (giving of liquids or foods other than breast milk) reduced from 62.4 to 34.9 percent. The project was also successful in developing Mother Support Groups, training over 450 volunteers in collaboration with the MoH and developing technical materials for use in group discussions with lactation counselors and mentors. 2 http://www.who.int/infectious-disease-report/pages/ch2text.html 3 http://www.who.int/infectious-disease-report/pages/ch2text.html 4 http://water.org/learn-about-the-water-crisis/billion/ TECHNICAL SUPPORT UNIT Public Health and Nutrition MERCY CORPS 5

PROCOMIDA (Programa Comunitario Materno Infantil de Diversificación Alimentaria) is in its second year of a five year USAID/Food for Peace funded program in Guatemala. The goal is to improve the nutritional status of 189,000 vulnerable residents of 400 communities in northern Guatemala by improving the health and nutritional status of pregnant and lactating women and children under age 2 and strengthening the quality and delivery of healthcare services. The program involves three interrelated components: distribution of food rations; BCC strategies focused on improving health and nutrition-related behaviors; and preventative health services for pregnant and lactating women and children under age 2. Mercy Corps Pakistan has had a measureable impact on reducing the incidence and treatment of TB in collaboration with the Government of Pakistan, the Provincial Departments of Health and community health workers. Mercy Corps began to address the high incidence of TB in Pakistan in 2005 with its first program Increasing TB Case Detection in Balochistan and Sindh, funded by the European Commission (EC); subsequent Pakistan TB control programs have been funded by the Global Fund. The initial program reduced the prevalence of TB in 232 remote rural communities across 13 districts by implementing 65 diagnostic centers and improving the government s capacity to provide quality TB Direct Observational Therapy Services and local health care provider s ability to identify, diagnose, treat and monitor TB patients. TB case-detection rates improved from 8.5 to 70 percent, and treatment completion rates improved from a baseline of 82 to 88 percent. The School Environment and Education Development for Somalia Program is a three year USAIDfunded program designed to improve the overall educational environment and access to safe drinking water and improved sanitation in at least 250 communities in Somalia. The program increased access to drinking water for nearly 63,000 people and improved access for nearly 36,000 people through a variety of new construction and infrastructure improvements, including digging of borehole wells, rainwater catchment tanks and piped water systems, and latrines and hand-washing stations at schools. During the first year of the project, 449 latrines were rehabilitated/constructed in 88 schools, and 96 water points were rehabilitated or constructed. This project is increasing overall access to water and sanitation to the targeted communities, greatly needed in Somalia where only 29 percent of the population has access to safe water and only 26 percent have access to adequate sanitation. The Community Health and Livelihoods (CH/L) program in Niger focuses on 132 communities (536 villages; 10,000 households; 400,000 people) throughout the departments of Filingué and Loga, and the peri-urban communities of Niamey. The program works to build the capacity of local community health teams and the operational capacity of the health districts, leading to improved maternal health and reduced malnutrition in children under age five. In the first two years of the program, trained community health teams screened over 100,000 children for malnutrition. Children suspected of being malnourished are referred to local health centers for treatment and participation in associated therapeutic feeding programs. By the end of third year, the program increased the percentage of children under age 5 receiving vaccinations from 68 to 100 percent. Home deliveries decreased from 47 to 37 percent, resulting in better maternal and child outcomes. Breastfeeding immediately after birth increased from 25 to 66 percent. 6 MERCY CORPS TECHNICAL SUPPORT UNIT Public Health and Nutrition

Key Partnerships CORE Group is a community of practice of more than 50 member organizations and networks of partner health professionals whose mission is to generate collaborative action and learning to improve and expand community-focused public health practices for underserved populations around the world. CORE Group provides particular emphasis to women of reproductive age and children under age 5, as they are the most vulnerable to death and illness from poverty and disease. 1,000 Days is an advocacy hub that champions new investment and partnerships to improve nutrition during the critical 1,000 days between a woman s pregnancy and a child s second birthday. Proper nutrition during this 1,000 day window can have a profound impact on a child s ability to grow, learn and rise out of poverty. It can also shape a society s long-term health, stability and prosperity. 1,000 Days engages the private sector, civil society, and government in the U.S. in efforts to improve maternal and young child nutrition throughout the world. Contact Penelope Anderson Director, Food, Health and Nutrition TSU panderson@dc.mercycorps.org Arif Noor MD, MPH Director, Public Health anoor@hq.mercycorps.org TECHNICAL SUPPORT UNIT Public Health and Nutrition MERCY CORPS 7