CSIH Projects

Country/Region:

Ukraine

Project Title:

Youth for Health II

Partners:

Canadian International Development Agency, Ukrainian Institute for Social Research

Contact:

Janet Hatcher Roberts, jroberts@csih.org

Key Objectives:

w         To create a national youth health promotion centre that can adapt and refine the YFH model through ongoing evaluation, and assist in the development of youth health promotion proposals

w         To adapt the YFH I model at the local level in two regions in Ukraine and focus on key health and lifestyle issues such as HIV/AIDS, smoking, drugs, alcohol, mental health, nutrition and physical activity, with emphasis on gender equality and youth involvement

Summary:

The goal of YFH II was to contribute to the development of effective public policies which would promote health among Ukrainian children and youth. The project staff worked with youth and adults in two regions, two cities and two villages, focusing on various health issues including: HIV/AIDS prevention, drug and alcohol harm reduction, smoking cessation, physical activity, healthy nutrition, gender equality, mental health and youth health promotion policy proposals. YFH II emphasized the use of positive messages, engaging youth in meaningful and important action, embracing and adapting to local needs, and unleashing the potential of youth and communities.

YFHII established the National Youth Health Promotion (NYHP) Centre in Kyiv to be a central youth health promotion policy and project development body, as well as regional and local Intersectoral Councils and Resource Centres as sites of training and other activities. A Youth Special Session brought together 700 Ukrainian participants to discuss project results and future policy development.

Lessons Learned:

w    Broad political support at all levels is essential.

w        The preparation and training of people in authority aids the decision-making and "buy-in" processes.

w        Equal participation of all partners, including youth, provides ownership and is essential for success.

w        Providing specific places for youth within each of the YFH II structures was essential in order for youth to have a voice in deliberations and decision making.

w        Funding from multiple revenue sources (i.e. local governments) is required in order to be sufficient.

w        The small grants program was a successful mechanism for encouraging local demand-driven youth health promotion activities.

w        Longer term commitment in funding from CIDA benefited from consistent and growing support from the national and other levels of government in Ukraine and allowed for a critical mass of organizational and government involvement and capacity to carry forth youth health promotion activities.

Country/Region:

Ukraine

Project Title:

Youth for Health I

Partners:

Ukrainian Institute for Social Research,  Canadian International Development Agency, Health Canada, Saskatchewan Education (Government of Saskatchewan), Toronto Healthy City Office, University of Saskatchewan, Centre for Health Promotion (University of Toronto), University of Victoria

Contact:

Janet Hatcher Roberts, jroberts@csih.org

Key Objectives:

w      The main objective of the YFH project was to facilitate the development of a multi-level, intersectoral health promotion for youth model which could be adapted to other parts of Ukraine. More specifically, the project sought to:

w        empower youth to promote healthy living and engage in behaviours focusing on AIDS prevention, smoking cessation, and reduction of drug and alcohol abuse.

w        increase the capacity of health promotion and youth delivery agents and the community to promote healthy living among youth.

Summary:

The health of the Ukrainian population, and of young people in particular, is a cause for concern. A large percentage of ordinary youth are smoking, drinking, using drugs, and practicing unsafe sex. YFH aimed to contribute to the development of a sustainable national health strategy in Ukraine by assisting in the development and implementation of health promoting policies and programs in support of youth.

Through its duration, YFH developed an integrated health education curriculum for Grades 1-11, developed a certificate course for public sector actors who are in a position to influence health promotion among youth, established a YFH resource centre aimed at youth outside the school environment, evaluated the health education curriculum and the resource centre, and conducted three research studies (a survey of the life styles of Kyiv and national youth, a review of legislation on youth health and a study of the influence of mass media on youth).

Country/Region:

Republic of the Philippines

Project Title:

Partnerships for Health Planning: Strengthening Local Capacity for Health Equity Reform in the Philippines (HER Project)

Partners:

Gerry Roxas Foundation (GRF)

Contact:

Lori Jones; ljones@csih.org

Key Objectives:

The overall goal of the HER project was “To contribute to strengthened capacity for resource allocation decision-making for equitable health care services planning and delivery in the Philippines.” The specific objectives of the project were to:
• Increase capacity of GRF to play a leadership training role related to resource allocation decision making;
• Increase resource allocation decision capacities within Filipino organizations (government, NGO, and educational);
• Facilitate the development of partnerships among local Filipino organizations (government, NGO, and educational) in their efforts to increase knowledge and influence resource allocation decisions; and
• Strengthen the capacity of CSIH project partners in project management.
 

Summary:

This project was implemented over the period March 2003-October 2005. The HER Project was designed to strengthen local capacity for resource allocation decision-making to ensure equitable health services planning and delivery at decentralized levels. Concepts of equity were introduced to the planners and community members, and were used to identify the determinants of health (literacy, transportation, gender, etc.) as a basis for budget allocation and planning. Planners in the pilot sites of the HER Project are now able to critically analyze and use relevant data, which was collected in a timely fashion at the barangay level, to identify and determine priority health interventions that considered the community’s actual needs and preferences. “Negotiation” workshops for resource allocation were held in the HER pilot sites, allowing community leaders the opportunity to commit resources for specific interventions and lobby local chief executives for budget allocations responsive to these health-related concerns. Opportunities were also created by the HER Project for stakeholders to work together for improved quality of health services using appropriate resource allocation decision tools. The HER Project therefore promoted a “bottom up” approach to health planning, which offers a potential to interface local planning processes with those at the national, regional and provincial levels. The results achieved are significant and highly relevant to the current health sector reform initiatives planned by the Filipino Department of Health. Specifically, the project has demonstrated an acceptable, timely and adaptable planning innovation for local health governance in four municipalities in Capiz Province. The end of project internal evaluation indicated that the HER Project addressed a significant policy gap in terms of supporting local health planning especially at the barangay and municipal levels.

The main activities were divided into eight distinct yet complementary, inter-dependent and often concurrent components, each of which contributed to the achievement of the project’s objectives: A) Environmental Scan; B) Training in Equitable Health Planning; C) Health Information Collection and Management; D) Training in Advocacy and Networking; E) Networking and Linkages; F) Project Promotion; G) Replication and Adaptation; and H) Project Management. Project activities were focused in a pilot site within the province of Capiz. Each of the mayors in the pilot municipalities demonstrated a commitment health reform, great cooperation, and endorsed the replication of this project within the province and region. The provincial governor also demonstrated his commitment and support to the project by signing a Memorandum of Agreement.
During its implementation of each project component, CSIH utilized a “Training-of-Trainers” (TOT) approach, by which CSIH experts provided training to GRF trainers, who in turn developed the capacity to carry on and replicate the project with increasingly less Canadian technical assistance.
 

Lessons Learned:

w       Until the Project Team visited barangay (community) health stations, it did not know (nor did many of those involved in the municipal health planning process) that a wealth of very valuable data already existed at the community level that could inform the planning process, although it was not necessarily in useable form. This provided some opportunities to incorporate training related to the importance of good data design, collection, and analysis for appropriate program priority setting and planning. The project highlighted the role of information for policy, advocacy and empowerment in health planning. Evidence based planning did not only result in more informed health plans but it also provided local health staff with information by which to negotiate with political leaders on health resource allocation. While the process of data gathering had been a standard role of the community health workers and LGU health staff, acquiring skills by which to analyze data and input the same into local planning processes has allowed local health personnel to value health information and the local health planning process.

Country/Region:

Central and Eastern Europe (Armenia, Azerbaijan, Georgia)

Project Title:

South Caucasus Health Information Project (SCHIP), Phases 1 & 2

Partners:

Canadian International Development Agency (CIDA), Armenia Ministry of Health, Georgia Ministry of Health, Labour and Social Affairs, Azerbaijan Ministry of Health, University of Dalhousie and University of Ottawa.

Contact:

Eva Slawecki, eslawecki@csih.org

Key Objectives:

Summary:

The main project activities included:

• Stakeholder Consultation for the identification of national and regional priorities, and coordination with other donors to work on integrated design of HIS;

• Regional events to allow professionals from the three countries to share information and exchange ideas to address common needs and strategic issues;

• Health Information Systems Certificate Course, with a train-the-trainer component, to train specialists to develop and manage information systems across the health system;

• Undergraduate and Post-Graduate Curriculum development and teacher training in HIS;

• HIS and Population Health workshops to address relevant health issues (e.g., PRSP); and Implement of HIS demonstration projects that linked national and district-level facilities.

One of the primary components of the South Caucasus Health Information Project (SCHIP) was the design, development, and delivery of a health informatics curriculum. CSIH worked closely with the medical universities and post-graduate training institutions in Armenia, Azerbaijan and Georgia to integrate key concepts of health information into existing educational programs. Integrating health information training into medical school curricula provided physicians and other health professionals with an understanding of the role of data and health information for clinical decision support as well as a general understanding of the role of health information for hospital governance, policy-making, and health planning.  The health informatics training also built the capacity of health planners and administrators, as well as physicians returning for additional training, to use information as the basis for managing facilities, designing programs, and developing policies focusing on management information systems. Following a comprehensive needs-assessment, a curriculum was designed that would fit with the academic institutions’ educational reform agendas, taking into consideration the direction of health reform in each country. Through partnership with the Faculty of Medicine, University of Ottawa, and the School of Health Services Administration, Dalhousie University, CSIH developed a modular curriculum incorporating undergraduate and post-graduate materials on the following topics:

• Computer Literacy

• Literature Searching

• Basic Biostatistics/Epidemiology

• Evidence-Based Medicine/Critical Appraisal

• Hospital/Practice-Based Applications of Medical Informatics

• Population Health Databases and Health Information and Database Management

Lessons Learned:

A number of lessons were learned. One key lesson is it is crucial to learn about the political environment during the planning stages so that relationships with decision-makers can be built and maintained throughout the implementation phases. Other lessons learned include: (1) the demonstration model and “train-the-trainer” components inspires confidence, motivation and cooperation, (2) it is important not to anticipate a country's policy development initiatives, (3) questioning gendered differences in data could lead to investigation and action in a manner that is culturally relevant, and thus more likely to be sustainable, and (4) it is important to plan for sustainability at an early stage as doing so may influence choice of personnel, training, and software.

Country/Region:

Selected organizations implemented projects in Brazil, Philippines, Mexico, Mauritania, Suriname, St. Kitts, Tanzania, South Africa, Bolivia, Swaziland, Gabon, China, India, Botswana, Belarus, and Guyana.

Project Title:

HIV/AIDS Small Grants Fund Phase I and II

Partners:

Interagency Coalition for AIDS and Development, as well as various small grant recipients and their local partners

Contact:

Lori Jones; ljones@csih.org

Key Objectives:

w    To encourage new partnerships in HIV/AIDS between Canadian organizations and those in developing countries and/or countries in transition.

w         To encourage cost-effective, innovative, inter-sectoral knowledge-based approaches to HIV/AIDS, particularly as they address the socio-economic determinants of health among vulnerable populations.

w         To encourage the use of Information and Communication Technologies (ICTs) in addressing HIV/AIDS issues.

Summary:

The goals of CIDA’s policies related to HIV/AIDS include increasing collaboration between Canada and developing countries or countries-in-transition: encouraging the development of innovative, cost-effective, knowledge-based approaches to address the pandemic and increasing the quantity and quality of HIV/AIDS programming. During the first phase of this Small Grants Fund, CIDA made funding available for twelve Small Grants (up to $50,000 for each grant for a 12 month project period) to encourage Canadian and developing country and/or countries-in-transition collaboration to work on HIV/AIDS priority issues. For the second phase, CIDA made available a new round of Small Grants for seventeen Small Grants (up to $75,000 each for up to an 18 month period) to further encourage new and emerging partnerships between Canadian organizations and organizations in developing countries and/or countries-in-transition.

The primary focus of SGFIII is HIV/AIDS and Gender. In support of CIDA’s HIV/AIDS priorities, SGFIII seeks to encourage cost-effective, innovative, inter-sectoral, knowledge-based approaches to HIV/AIDS that examine the gendered aspects of the HIV epidemic in developing countries and/or countries in transition and which reflect national activities and priorities. Twenty Small Grants have been awarded (up to $100,000 each for up to 24 months).
 

Lessons Learned:

w          A number of administrative and programmatic lessons have been learned. A key lesson reiterated throughout the implementation of the Small Grants Fund has been that projects can be executed with relatively low cost, using existing HIV/AIDS organizations in Canada to twin with an existing organization in a developing country. This allows for sharing of personnel and resources and works on the principle of capacity building within an identified context. Twinning projects provide insight, exposure, vision, ideas, strategies and a wider view of the pandemic. Other lessons learned include: (i) the greater flexibility and responsiveness realized by implementing the Fund through CSIH than might have been possible by working through CIDA's internal requirements; (ii) sharing of lessons learned among grant recipients enabled many to learn “solutions” and “opportunities” from each other; the monitoring component of the Fund undertaken by CSIH and ICAD proved to be very valuable in contributing to the identification of success, effectiveness, and potential networking opportunities for the small grants projects; (iii) partnerships must be based on a “shared vision” - or at the very least, a common understanding of why each group is embarking on the project. Furthermore, the partnerships must respond to the perceived and significant needs of each organization. These needs must be clearly identified and understood – if the project is to be sustainable over the long term. At the same time, it was recognized that experiences of "new partnerships" are different than those of established partnerships – they face different timelines as well as expectations of funding and reporting requirements. This was particularly true in learning of and adapting to each other's cultures. In the end, not all of the twinning relationships were positive, but they can provide key lessons learned in the development and fostering of relationships between organizations.

Country/Region:

Croatia

Project Title:

Croatia Health System Project – Components related to (i) Categorisation of Hospital and Other Secondary Care Facilities; (ii) Human Resources for Health Information System Management, and (iii) Public Health Surveys and National Health Promotion

Partners:

Government of Croatia, World Bank

Contact:

Janet Hatcher Roberts, jroberts@csih.org

Key Objectives:

w     To undertake a national, region-wide public health survey covering both adults and children;

w      To develop a health promotion unit in the National Institute for Public Health;

w       To implement training workshops and courses for a variety of target groups;

w        To develop a reference library; and

w        To assess existing communications materials (electronic and print) and to develop a national healthy lifestyles campaign.

Summary:

The Government of the Republic of Croatia selected CSIH to implement three components of its IBRD-funded Health Systems Projects following a rigorous international competitive bidding process. The loans helped to finance the development of Croatia’s health sector. The Project’s objective was to support Croatia’s capacity to achieve a more effective, efficient, and financially sustainable health system. Key objectives of the loans were to:
• Introduce pilot delivery systems improvements and a national heart disease program;
• Strengthen public/primary health activities and policies;
• Develop policy options that would increase the sector’s financial sustainability;
• Improve and expand the health information systems; and
• Dispose of outdated and unusable pharmaceuticals.

Components (i) and (ii): Reforming the hospital sector involved adjustments in the mix, number, and scale of hospital and secondary care facilities and their clinical programs. These adjustments would, in turn, ensure that health services meet the needs of Croatia's population in clinically appropriate and economically sustainable ways. CSIH provided a team of experts (international and national) for categorisation and accreditation of hospital and other secondary care facilities and human resources for health information system management. Component (iii): The purpose of the Public Health Surveys and National Health Promotion component was to contribute to the reform and development of the health care system in Croatia by developing public health strategies to reduce the prevalence of heart disease. CSIH provided technical assistance and training to the Croatian Institute for Public Health and to selected local/regional institutes and partner institutions such as the Andrija Stampar School of Public Health, to enhance human and institutional capacity to (i) improve and expand the public health information system; (ii) lead national policy and activity efforts in health promotion with emphasis on cardiovascular disease prevention; (iii) plan and provide cardiovascular disease (CVD) risk reduction, clinical prevention, and emergency care; and (iv) promote healthier lifestyles among the general population with emphasis on smoking prevention and cessation. The design of the training and capacity building activities within the health care training institutions was based upon the preliminary results and analysis of the data collected by the national surveys. This enabled them to be appropriately targeted to the needs of women in particular.

The projects focused on the development and implementation of capacity building activities that encompassed best practices around primary health care/health promotion activities, library science, the development of education plans, protocols curriculum, syllabuses and guidelines, and training and capacity building activities. CSIH collaborated with and built upon the primary care and health promotion work begun by WHO in Croatia. The project included (i) the development of an intensive Summer School in Health Promotion in combination with a study tour to train a core group of people in Croatia in the concepts and application of health promotion and disease prevention, particularly as it related to CVD. This core group returned to Croatia in order to train other key Croatians in this field. Trainees included key staff from the National Institutes for Public Health in Croatia; (ii) inter-sectoral seminars in health promotion and primary care disease prevention among key government and civil society leaders, including health providers, policymakers, health administrators, media, NGOs, and other interested parties; and (iii) in-service education for primary health care workers. The project also developed and implemented capacity building activities that encompassed best practices around cardiovascular care including emergencies and clinical protocols and guidelines. This involved the establishment of four regional emergency medicine training centres and the development of educational courses for emergency room physicians, nurses, PHC teams on call duty and ambulance staff/paramedical personnel from general and clinical hospitals and 4 regional EMS centers. A key outcome of these training programmes was the enhanced capacity of local health professionals to train others in public health and health promotion at the national and regional levels.

Another of the key objectives of this project was to support the development of a Department of Health Promotion and Disease within the National Institute of Public Health. This involved supporting the assessment of the process of establishing this department, as well supporting the development of its capacity. In short, CSIH was responsible for assessing it mission, objectives, roles and functions, organizational development, resources, finances, and governance. Given the weak capacity that existed in the Institute to create and sustain this department during the life of this project, CSIH focused instead on developing a collaborative framework that would build individual capacity in the field of health promotion, and on establishing a phased approach to the development of the department, including costing actions on selected priorities in terms of budget and human resources.
 

Lessons Learned:

Country/Region:

Bolivia

Project Title:

Building Capacity for Health Reform

Partners:

Canadian International Development Agency, Bolivian Ministry of Health

Contact:

Janet Hatcher Roberts, jroberts@csih.org

Key Objectives:

w         To support the Bolivian Ministry of Health in constructing a new health system based on community participation and decentralization by providing model projects in the municipalities of San Lorenzo-Tarija and Guayaramerin-Beni.

w         To implement the Strategic Health Plan (SHP) management model at the local/regional level.

Summary:

In an effort to fight poverty and increase community participation, the Bolivian government has chosen to reform numerous sectors. As part of this endeavor, Bolivia is implementing a new health system with universal access to primary health care in order to meet the immediate needs of vulnerable populations.

CSIH offered expertise through training and management consultation in key reform areas, including policy analysis and formulation, health administration, information management, and the development and management of integrated delivery systems. CSIH also helped the Bolivian government to develop institutional linkages with Canadian health organizations.

Lessons Learned:

Country/Region:

Armenia

Project Title:

Health Administration Training Program

Partners:

Contact:

Eva Slawecki, eslawecki@csih.org

Key Objectives:

w         To assist in capacity-development among local health care officials in Armenia.

w         To develop health reform initiatives in the Trans-Caucasus region through collaboration with donor agencies.

Summary:

Lessons Learned:

Country/Region:

Ukraine

Project Title:

Partners in Health

Partners:

Department of Foreign Affairs and International Trade (DFAIT), Canadian International Development Agency (CIDA)

Contact:

Janet Hatcher Roberts, jroberts@csih.org

Key Objectives:

w         To contribute to capacity development of health sector organizations ranging from the ministry level to NGOs in health sector reform.

Summary:

CSIH began its work in Ukraine in 1993 with the successful Partners in Health project. The Partners in Health project was originally funded by Canada's Department of Foreign Affairs and International Trade and later by the Canadian International Development Agency (CIDA).

The goal was to contribute to capacity development of health sector organizations, ranging from the ministry level to NGOs in health sector reform. The partnerships involved 19 groups in Canada and 20 in Ukraine. This project aroused interest in Azerbaijan, Georgia, Armenia, Russia and Croatia to work with CSIH and CIDA.

Lessons Learned: