Content

Proposals in 2012

These are the proposals that German-supported health and social protection programmes submitted for publication in 2012. 


All staff from German Development Cooperation working in health and/or social protection programmes in partner countries or at KfW or GIZ head offices were invited to help assess the proposals submitted to the GHPC in January 2012.

Three good practice approaches have been selected from all 2012 proposals and have been documented in the following publications:

Kyrgyz Republic: The Success Story of the Mandatory Health Insurance Fund a the Heart of the Health Sector Reform Program

The major approaches of the FC supported Health Sector Program in the Kyrgyz Republic are:

  1. Financing of Kyrgyz health reforms through budgetary support to the health sector;
  2. Strengthening government systems and procedures (planning, budgeting, procurement, accounting, auditing, M&E);
  3. Target agreement on health budget as incrementing shares of total state budget.

The core results are:

  1. Reduced financial burden on patients as a result of increased public funding and strengthening the single pooling and payer system within the mandatory health insurance fund;
  2. Enhanced efficiency of the health care system through increasing share of the state guaranteed benefit package funds allocated to the primary health care;
  3. Improved government led donor coordination and communication through joint review mechanisms established on the SWAp platform.

Why should this approach be documented in the German Health Practice Collection?

The Kyrgyz Health SWAp is seen as a worldwide best-practise example for government-donors’ alignment and joint (basket) financing in the health sector. According to an IEG evaluation of the World Bank in 2009 the Kyrgyz SWAp was found the best prepared out of six randomly selected SWAps worldwide and attested ‘substantial’ achievements in reducing people’s financial burden, improving their access to health services, reducing out-of-pocket health spending, and improving the transparency and efficiency of health services financing and delivery. The German DC, in particular Financial Cooperation is the biggest donor among the joint financiers in the basket, has respected weight in the policy dialogue and donor coordination and significantly contributed to the conceptual shape and implementation of the sector programme.

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner country’s population?

While the SWAp is based on a clear sector strategy since 2005, contractual arrangements between Government and Joint Financiers had explicitly included target budget rules and the implementation of fiduciary risk mitigation measures, which were regularly reviewed in bi-annual Health Summits convened by the Government and Development Partners. According to the budget rule #1 the share of public health expenditures of the state budget was to achieve 13% by 2010 and has currently even exceeded the target. A major concern of the Kyrgyz Health Sector Reform Program(s) was the strengthening and further development of the ‘Mandatory Health Insurance Fund’ being the single pooling and purchase system for health care deliveries in the country ensuring population coverage for a Guaranteed Basic Benefit Package. Over the period of the Health Sector Reform Program “Manas Taalimi” 2006-2011 implementation under the SWAp umbrella more than 100 dashboard indicators have been monitored providing evidence a.o. on improved access to health care, reduction of out-of-pocket payments, increased government expenditures on direct patients’ care and primary health care, but also on positive trends towards Millennium Development Goals. While the ‘Evaluation of the Kyrgyz Republic National Health Reform Program Manas Taalimi Implementation’ of April 2011 states good progress in health care delivery, quality of care and human resources remain issues of concern and receive particular attention in the ongoing consecutive Health Sector Reform Program “Den Sooluk” (2011-2016).

In what way does the approach conform with the following GHPC criteria: transferable to other contexts; participatory and empowering; gender-sensitive; cost-effective and sustainable?

The Sector Investment Program is based on the six principles for basket financing as defined by Harrold and others in 1995: (i) Sector-wide in scope, covering all current and capital expenditures, (ii) based on clear sector strategy and policy framework, (iii) Run by local stakeholder, including government, direct beneficiaries and representatives of the private sector, (iv) Adopted and financed by all main donors, (v) based in common implementation arrangement among all financiers, and (vi) Reliant on local capacity, rather than on technical assistance, for implementation. The implementation of Manas Taalimi under the SWAp arrangements was carried out by country led partnerships and had enhanced stewardship of Ministry of Health in close cooperation with Ministry of Finance. Through alignment with the budgetary and accountability systems of the country effectiveness of program implementation was enhanced, while administrative burden on the Kyrgyz Government and transaction cost were reduced. The program is to be seen an important contribution to improvement of health care for the entire population, in which relevant target groups such as the poor, children, mothers and women particularly benefit from improved access to health care at affordable prices.

Which existing documentation materials (studies, reports, photos, films or other documentation) could be used as background for the proposed publication?

(PPT) Presentation: PBA meeting Bonn 130111

(PPT) Presentation: SWAp Kirgistan BMZ 310311

(PPT) World Bank: Nov 2010 JAR

(PPT) World Bank: JAR Summit Presentation June 2011

(PPT) World Bank: Health Summit Joint DP Statement (Oct 2011)

(PPT) JAR May-June 2011 Presentation Minister

What itinerary and schedule would you recommend for the writer, when visiting your country to collect material for this GHPC report? Whom should he or she meet and interview? Which sites should he or she visit?

Since the review of the health sector is conducted bi-annually in form of ‘Joint Annual Reviews’ of the Government and the Development Partners, it is recommended for the writer to attend the next JAR scheduled for May 2012 and meet with representatives of MoH, MoF, the MHIF as well as Development partners (WHO, WB, SDC a.o.). For site visits the writer may want to visit eligible health facilities at primary and secondary level.

At which occasions, to which audiences and in which language (in addition to English) would your partner organisation and you like to distribute the resulting publication?

Distribution: German Health Practice Collection
Publication in German and possibly Russian

Applicants

KfW Entwicklungsbank / Division Health and Social Protection (Led5)

Dr. Joachim Schüürmann
Health Sector Coordinator Central Asia KfW Entwicklungsbank, KfW Office Central Asia
Phone: +996 312 90 90 87/ 88
e-mail: joachim.schuurmann@kfw.de

Ministry of Health of Kyrgyz Republic

Ms Paiza Syunbaeva
State Secretary
Phone: +996 312 66 26 14
e-mail: p_suiumbaeva@mz.med.kg

Employee Wellbeing Programmes for Health and Social Protection in Ghana

Our approach 'in action'

2. Three brief statements to describe the EWP approach

a. The Employee Wellbeing Programme (EWP) concept is a pace setter in the international trend of applying comprehensive operative health management and fully integrates the capacities and competencies of the private sector to strengthen national health systems and increase the wellbeing of societies in partner countries.

b. The EWP concept complements the implementation of the legal obligations regarding the occupational health and safety at the workplace and is adopted in the HR policies of the companies.

c. The EWP concept comprises two main components: (1) capacity development at the Ministry of Health to deliver comprehensive health programs through sustainable public-private collaboration and (2) the implementation of interventions at the workplace and beyond to improve the health status as well as the social and financial situation of the employees, their core families and members of the immediate communities of the private partners with a target group of approximately 140,000 people.

3. What we have achieved:

a. The integration of the EWP Concept into the HR structure of the Ghana Revenue Authority ensures a continuation of the concept after GIZ has phased out.

b. The EWP has been scaled-up by the end of 2011: A Strategic Employee Wellbeing Alliance of eight private partners from various sectors such as mining, banking, and IT across the country, the Ghana Ministry of Health and GIZ is implementing the EWP since then.

c. A comprehensive EWP-Package is developed containing an EWP Training Curriculum, an EWP-specific IT monitoring and data management system, a cost-benefit projection/analysis tool, and a sample EWP Policy.

Why should this approach be documented in the German Health Practice Collection?

The EWP concept is a pace setter in the international trend of applying comprehensive operative health management and fully integrates the capacities and competencies of the private sector to strengthen national health systems and increase the wellbeing of societies in partner countries. The concept is a naturally grown and comprehensive approach based on the increasing demand of a productive and efficient workforce on institutional, national and regional level. The effectiveness of the EWP concept has been acknowledged at international level (e.g. by the WHO International Consultation on Healthy Workplaces, 2011, India).

In Ghana, the Ministry of Health, the Ghana AIDS Commission as well as a number of public and private sector organisations started working with GIZ (former GTZ) to develop workplace programmes in 2006. It is against this Background that the Regional Cooperation Unit for HIV and Tuberculosis (GIZ-ReCHT) was founded to support the private and public sector in the implementation of HIV workplace programmes tailored to the particular needs and opportunities of the partner organisations. A “learning-by-doing”-approach has led to the expansion of HIV workplace programmes into comprehensive Employee Wellbeing Programmes (EWP) which combines traditional HIV mainstreaming with more elaborate health and social protection measures to improve the health status of the employees of private partners, their families and the immediate communities..

From the experience to date in Ghana four key lessons can be drawn:

1. The broader the focus, the more likely people are to participate:

In Ghana the HIV prevalence was down to 1.5% in 2010. Many Ghanaians deny that HIV threatens them personally and the fear of stigmatization and discrimination makes them reluctant to be seen participating in HIV-related events. At the same time they know that other health conditions threaten them and their families. So they are eager to obtain information and other assistance to prevent or reduce the harm done by those conditions. A Workplace Programme of the Ghanaian Revenue Authority showed a rising proportion of employees taking offers of voluntarily counselling and testing of HIV from 61% to 92% when the offer was extended to include counselling and testing for other health conditions in addition to HIV.

2. Workplace programmes provide opportunities to address a broad range of diseases and other health-related topics as well as social protection:

In Ghana, the leading causes of loss of healthy and productive days of life due to illness and premature death include communicable diseases such as malaria and hepatitis B and non-communicable diseases such as hypertension, diabetes and cancers for which there are known prevention, early diagnosis harm reduction measures. The major causes underlying the spread of these diseases are the lack of awareness of health determinants and disease prevention measures and healthy lifestyles, inadequacy of basic health care and social protection services, and limited access to adequate treatment facilities. In addition, poor financial management and the lack of social protection may have a negative impact on employees’ health and productivity level since it may result in psycho-social problems and ultimately in non-communicable diseases. This severely affects private companies which lose huge numbers of their skilled workforce to diseases, leading to high employee costs and therefore to lower profit margins. In order to overcome these constraints, private companies consider the implementation of Employee Wellbeing Programmes complementing the initiatives taken by the government a worthy investment.

3. The workplace enables efficient extension of interventions to the community by the rapid entry in the community, the organized structure for the multiplication of information hence facilitates the adoption of healthy behaviours and utilization of preventive and curative health services by the population.

4. The EWP concept complements the implementation of the legal obligations regarding the occupational health and safety at the workplace and is adopted in the HR policies of the companies.

The EWP concept lives up to the German Coalition Contract stipulating the cooperation with the private sector as strategy for the attainment of the Millennium Development Goals and the BMZ Strategy Paper 3 (2011) in the following dimensions:

  • The creation of a healthier and better socially protected population will increase the productivity of national economies in Sub-Saharan Africa and pave the way for sustainable development, better investment climate and stronger economic relationships.
  • The direct dialogue and cooperation with the private sector will be intensified.
  • In-country innovation systems will be strengthened.
  • Private partners’ businesses (potentially German) are better protected against high employee related costs which might impede their competitiveness.

Additionally the Programme is connecting health policy with other policy areas (Developing Partnerships with the Private sector and Social protection) and covers focus areas of both the BMZ Sector Concept for Health (the development and strengthening of national health systems, the fight against HIV, Malaria and Tuberculosis, prevention of sexually transmitted diseases) and the BMZ Sector Concept for Social Protection (Extension of coverage to the poor and the development of more inclusive systems, improvement of social justice of SP systems).

What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner country’s population?

The EWP has been piloted with the Ghana Revenue Authority and Ghana Community Network Services Ltd. in a development partnership with GIZ. In this project the EWP has been sustainably integrated into the human resource structures since the beginning of 2010. By the end of 2011, the EWP has been scaled-up with the initiation of a Strategic Employee Wellbeing Alliance of seven private partners from various sectors such as mining, banking, and IT across the country, the Ghana Ministry of Health and GIZ.

For all Projects baseline studies in form of KAP surveys as well as comprehensive monitoring data are available; regular status reports and picture reports can be shared. Monitoring data is collected, processed and analysed with an EWP-specific data management system:

  • A significant increase of the acceptance rate of preventive interventions and HIV counselling and testing (CT) ocurred after the inclusion of CT of other diseases such as high blood pressure and sugar levels. In the Revenue Agencies/GCNet project, the proportion of employees taking up offers of voluntary counseling and testing rose from 61% in 2006 (HTC only) to 91.5% in 2009 (comprehensive testing) when the offer included counseling and testing for other health conditions, in addition to HIV.
  • Enhanced knowledge of workers is indicated under the assumption that the baseline sample population (KAP 2008 among CEPS workers) is comparable to the follow up KAP survey in 2011 among GRA workers which fully include CEPS workers (selected results):

Compared to the 2008 baseline survey, the survey in 2011 indicated a knowledge increase by the following percentages:

  • traditional healers cannot cure AIDS: knowledge increase from 46.5% to 64.7%
  • treatment for HIV/AIDS exists: knowledge increase from 54.2% to 70%
  • unsterilized instruments can lead to HIV infections: knowledge increase from 84% to 95.5%

An EWP-specific monitoring tool is in the development process; currently data is in the final stages of analysis. This process is very work-intensive as the system is being transferred from manual to electronic (EWP and HIV WPP Programmes together sum up to a total number of ca. 120.000 persons with 20 entries per person). Preliminary data on rates for reactive testing in 2011 in a few thousand screened are: HIV (approx. 2.5%), high blood sugar levels (approx. 2%), high blood pressure (approx. 10%), Hepatitis B (approx. 10%).

Indication for the monetary benefit of the programme is given through a Cost-Benefit Projection Tool and study. The model projects a reduction of personnel costs over time (based on Ghana’s epidemiological profile, inclusion of absenteeism and presenteism, choice of various interventions at the workplace). Furthermore, direct medical costs - could be used for more in-depth analysis when released from the respective institutions. In 2010, a staff motivation study was carried out for the VAT department of the GRA. A GRA Employee Engagement Study following up on absenteeism, presenteism and staff motivation is planned for 2012.

External sources also indicate a general monetary benefit through preventive measures at the workplace; e.g. a best practice cost-benefit comparison “Vorteil Vorsorge-Die Rolle der betrieblichen Gesundheitsvorsorge für die Zukunftsfähigkeit des Wirtschaftsstandortes Deutschland” (booz&co) of preventive measures at the workplace shows an economic minimum benefit of 1:5 for each Euro invested. Although based on German data, the study is interesting as chronic diseases are also very relevant in the Ghanaian context, and so for GRA. One concrete example from Ghana for a reduction of personnel-related costs through a preventive measure at the workplace is the Indoor Residual Spraying Programme of AngloGold Ashanti here in Ghana (material can be provided).

In what way does the approach conform with the following GHPC criteria: transferable to other contexts; participatory and empowering; gender-sensitive; cost-effective and sustainable?

The EWP provides both a sufficiently defined and flexible framework to be transferrable to other country and industry contexts. This has been proven through the scale-up in Ghana and the interest of other African countries to adapt the concept. One private partner, UT Holdings, for example is in the process of expanding the collaboration to their offices in Nigeria to implement an EWP and assure a more targeted community outreach.

The concept foresees the coordination of the EWP by the partner organisation in form of active participation in the steering process (working groups) as well as through coordinators while GIZ is playing an advisory role. Thus, the partner is empowered to fully integrated both in the decision-making and the implementation of the EWP. In the case of the Ghana Revenue Authority, this has led to a complete integration of the EWP into their HR structure.

The EWP is cost-effective, both for the employer and the development partner. Starting as a development partnership, the intervention shares costs and responsibilities and allows for in-kind contributions. Employers reduce personnel and health related costs over time as their staffs become more healthy, motivated and productive.

Which existing documentation materials (studies, reports, photos, films (or other documentation) could be used as background for the proposed publication?

  • Status reports
  • Pictures (IEC sessions, health screening, Health Walk, Work Shops etc.)
  • E-Waste Study
  • KAP survey reports

At which occasions, to which audiences and in which language (in addition to English) would your partner organisation and you like to distribute the resulting publication?

  • WHO International Consultation on Healthy Workplaces
  • Bi-annual International AIDS Conference
  • National AIDS Conference (Ghana)
  • Sector Network Meeting
  • Partner Institutions’ Channels

Applicants

GIZ Regional Coordination Unit for HIV & TB (GIZ-ReCHT)

Dr. Holger Till, Team Leader, GIZ-ReCHT
Phone +233-24-4335516
Email: holger.till@giz.de

Ghana Revenue Authority

Mr. A. E. Minlah, Commissioner Support Service Division
Phone: +233-02-06855714
Email: aeminlah@hotmail.com

Strategic Alliance for the Fortification of Oil and Other Staple Foods (SAFO)

How it works:

  • Food fortification works with evidence-based politics that translate malnutrition studies into a political and legal framework:

    “In the name of the Ministry of Health and Sports of the Plurinational State of Bolivia I would like to pay recognition to the SAFO project, especially for its contributions in the area of laboratory analysis and bio markers. The results of these contributions will be part of the public census for the mid-term evaluation of the programme “Desnutritión Cero”/“Zero Mal- and Undernutrition” and the evaluation “Juana Azurduy” (integrated public census).” Dr Nila Heredia, Former Minister, February 2011

    • Food fortification works within multi-sectoral networks and political as well as legal containers:

      “There is a need to work in partnership with the private sector. The local milling industry needs support with better quality processing to add valuable micronutrients. We need to work with other development partners and with civil society to educate the public on the value of fortified foods. Food fortification is a whole industry, but alegislative and regulatory framework is crucial to impose (…) standards.” Ronald Sibanda, WFP Tanzania Country Director and Representative

      • Local enterprises are keen to take part:

        "Fortification with Vitamin A is for the good of our customers, and they will value it. In addition, fortified oil may prove to be an advantage in neighboring markets, such as Zambia or Rwanda, where producers are not yet supplying fortified oil. We are currently in the process of quadrupling our production capacity to 45.000 litres per months and intend to expand our market to neighbouring countries, so fortification has strategic importance for East Coast Oils and Fats." Vijay Raghavan, CEO of East Coast Oils and Fats Ltd.

        What we have achieved:

        “Thanks to the SAFO project we could strengthen the network of micronutrient laboratories in the area of food fortification quality control. This is especially true for those laboratories, which did not count with sophisticated equipment (HPLC) for determining thevitamin A content in edible oils.” Dr Virginia Martínez, District Health Administration of Santa Cruz

        “SAFO offers us and the local network the support we need to give the poor and severely malnourished sections of the population access to fortified food products.” Prof. em. Soekirman, Bogor Agriculture University and director of the Indonesian Fortification Initiative (KFI)

        “SAFO shows that partnerships can achieve a lot with little. It’s time to scale up the excellent and efficient work with GIZ in nutrition.” Dr Andreas Bluethner, BASF Food Fortification/Base of the Pyramid (BoP)

        Working title for the proposed publication

        The "Strategic Alliance for the Fortification of Oil and Other Staple Foods (SAFO)" - A Sample Business Case and Capacity Development Solution to Malnutrition Alike

        Why should this approach be documented in the German Health Practice Collection?

        • The Strategic Alliance for the Fortification of Oil and Other Staple Foods (SAFO):

        SAFO is a develoPPP.de partnership between BASF and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), running between 2008 and 2012. SAFO has already made an impact: More than 100 million malnourished people from poor population groups in Bolivia, Brazil, Indonesia, and Tanzania use edible oils fortified with vitamin A. SAFO triggers a win-win situation: On the one side, BASF, a major global supplier of high-quality vitamin A, accessed new markets and transferred business and technical know-how to local oil mills. On the other side, GIZ successfully supported political processes in partner countries that specified food fortification in evidence-based industry standards, enabling their monitoring, and rendering programmes sustainable. As a result, SAFO realizes business profits and seeks to reduce malnutrition as a global health challenge alike.

        • The SAFO Approach:

        Malnutrition (i.e. the insufficient intake of vitamins and minerals as micronutrients) is a challenge that affects the health status and productivity of more than two billion people worldwide according to the UN. Malnutrition increases the mortality rate especially of children and (future) mothers by affecting their immune systems, making them vulnerable to diseases, and not allowing children to grow and develop to their full potential. Consequently, malnutrition clearly links with the UN Millennium Development Goals (MDGs) 1 (to end poverty and hunger), 4, and 5 (child and maternal health). SAFO forms a development partnership in line with MDG 8 in this respect. For GIZ, food fortification is an effective, cost-efficient, and business based intervention; and a medium-term malnutrition intervention that complements short-term supplementation and long-term diversification nutrition programmes.

        SAFO supports food fortification programmes in its partner countries, which are usually alliances between the public sector tackling malnutrition as a public health challenge, local food producers later fortifying a specified food vehicle, and social stakeholders such as non-governmental organizations (NGOs) advocating food fortification or consumer organizations. SAFO works in two areas supporting national food fortification programmes, namely standardization and implementation. Standardization covers policy advice and advocacy, especially the moderation of multi-stakeholder dialogues, as well as industrial norm-setting. With regard to the latter, SAFO primarily supports evidence-based studies collecting data on the state of malnutrition in order to set minimum and maximum levels of fortification. Implementation covers business and technical capacity development with BASF advising local food producers on business plan development and food fortification hardware equipment. Additionally, GIZ supports national food and drug authorities in designing food fortification monitoring and evaluation (M&E) processes.

        • SAFO is innovative:

        Food fortification as such is an approved type of intervention, just considering e.g. iodized salt, a fortification also necessary and common in Europe. A concise circle of donors advocates food fortification as an intervention in developing and transitional countries in order to reduce malnutrition. The main donor financing national food fortification programmes is the Geneva-based Global Alliance for Improved Nutrition (GAIN), receiving funds from the Bill & Melinda Gates Foundation. On a smaller scale SAFO provides a concept for capacity development in the area of food fortification, and acts rather as a catalyst for locally owned processes. In Indonesia for instance, SAFO successfully strengthens a local NGO as driver of food fortification, which at the same time won a large GAIN grant. In this respect SAFO is innovative because it developed a model for food fortification capacity development.

        • SAFO contributes to raising the profile of the GDC (including references):

        SAFO reactivated links between nutrition and health for GIZ on behalf of the BMZ. This was possible precisely because SAFO is not only a nutrition project but also a development partnership. These two perspectives combined make SAFO appealing and are its unique selling point: SAFO gained attraction especially within the UN system. UNDP’s Growing Inclusive Markets is currently listing SAFO in its actors database. The UN and World Bank Scaling up Nutrition (SUN) initiative focuses on the first 1,000 days of life as an essential window of opportunity for nutrition interventions, and advocates multi-stakeholder partnerships for maternal and child health. SAFO receives recognition as one of the SUN public-private partnerships (the Annex to the 2010 SUN framework for action lists SAFO). Beyond such concrete UN appreciation, re-introducing the links between health and nutrition is relevant for the upcoming debate on non-communicable diseases (NCDs) with nutrition being a major risk factor.

        As concerns international references, SAFO has implications for MDGs 1, 4, 5, and 8 as described above. More operationally, SAFO policy and technical advice is strictly based on FAO/WHO Codex Alimentarius Commission (CAC) standards, especially the General Principles for the Addition of Essential Nutrients to Foods (CAC/GL 09-1987, as amended in 1989 and 1991) and related CAC guidelines on nutrition claims and labelling. Also, SAFO considers food fortification as an intervention contributing to the progressive realization of the right to adequate food as provided in Article 11 of the UN International Covenant on Economic, Social, and Cultural Rights. More precisely, SAFO advises according to the FAO Voluntary Guidelines on the right to adequate food in the context of national food security, especially Guideline 9 on food safety and consumer protection and Guideline 10 on nutrition (with 10.3 referring to micronutrient interventions such as food fortification).

        With regard to national references, the 2009 BMZ sector concept on health mentions nutrition at several points to illustrate inter-sectoral links. The BMZ position paper “Kooperation mit dem Privatsektor im Kontext der Entwicklungszusammenarbeit – Kooperationsformen – Ein Positionspapier des BMZ (2011)“ does not mention SAFO especially, yet several concepts naturally have a fit with SAFO: SAFO is already by its name a strategic alliance, BASF applies a Base/Bottom of the Pyramid (BoP) approach, advises local food producers on Corporate Social Responsibility (CSR) issues, and SAFO in general uses multi-stakeholder dialogues. The „GIZ Arbeitspapier Ernährungssicherung“ pays reference to SAFO from a GDC nutrition perspective.

        What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner country’s population?

        SAFO counts with annual progress reports since 2008 as well as one final report 2010 for its first term (from 2008 to 2010, with the second and final term running from 2010 until end of 2012). Additionally, in 2009 two external GIZ consultants reported for a SAFO project progress review. Currently, another external GIZ consultant has been contracted to carry out a plausibility check on existing output and outcome data, and collect new relevant data. Food fortification as such has been a proven intervention: The 2006 WHO-FAO Guidelines on food fortification with micronutrients (edited by Lindsay Allen, Bruno de Benoist, Omar Dary, and Richard Hurrell) provide excellent in-depth information on all aspects of operating national food fortification programmes, and structure the amplitude of information available. SAFO initiated several studies: BASF on the one hand counts with a technical team constantly collecting and analyzing own data. The BASF SAFO team also has agreements with several universities in the region providing students working for the team for a period of time, and submitting their final papers or thesis on SAFO. However, these studies are partially confidential. The GIZ SAFO team has an agreement with the Giessen University chair of nutrition, which has constantly supported SAFO with several studies and evaluations (e. g. an evaluation of a BASF qualitative testing method) on the global level and in the partner countries, especially in Bolivia and Indonesia. SAFO also continues to support local partners (from the public and social sector) in Bolivia and Indonesia to collect and analyze vitamin A malnutrition data. In 2011, two authors for the Harvard Kennedy School CSR Initiative committed to write a SAFO case study, mainly focusing on SAFO in Tanzania, and analyzed SAFO from a business perspective. A draft version of this study is currently available. SAFO has at country level already been scaled up in Uzbekistan, with other countries in discussion.

        In what way does the approach conform with the following GHPC criteria: transferable to other contexts; participatory and empowering; gender-sensitive; cost-effective and sustainable?

        • Transferable to other contexts: SAFO has processed information for national food fortification programmes, which allow for a scale-up of the approach in other countries. SAFO can also exemplify how to link nutrition data with health policies; and from another angle SAFO provides a model for public-private cooperation in the nutrition and health sector.
        • Participatory and empowering: Participatory multi-stakeholder processes are a key success factor for SAFO in the partner countries bridging the public health oriented public, the fortifying private, the advocating social, and evidence-oriented academic sector. In several countries, actors institutionalized these processes. Although from a technical point of view food fortification works already with a distribution chain only, SAFO supports social marketing components, including empowering consumer information and education, and advocates according nutrition labels and claims on the products. In Tanzania, SAFO supported a local food fortification logo tender, and in Indonesia, the local NGO and SAFO partner KFI runs a large social marketing media campaign.
        • Gender-sensitive: Food fortification as an intervention as such targets everyone and is not gender-sensitive. However, (future) mothers and children face special micronutrient needs, and food fortification can contribute to them if combined with supplementation programmes. Unlike other nutrition interventions food fortification uses an existing distribution chain, and does not require behavioural changes. Consequently, it does not run the risk of addressing or enforcing gender stereotypes associated with nutrition, e.g. concerning food preparation.
        • Cost-effective and sustainable: Food fortification is one of the most cost-effective development interventions according to the last Copenhagen Consensus in 2008 with an expert panel of leading world economists ranking the most promising solutions to pressing global challenges. SAFO advocates evidence-based mandatory food fortification standards in combination with M&E programmes in order to sustainably anchor processes in partner countries, and has successfully advised partners in Bolivia, Indonesia, and Tanzania so far. SAFO also commits to strengthen partner organizations institutionally. Additionally, fortification raises the food price by maximum 0.3% for the consumer.

        Which existing documentation materials (studies, reports, photos, films (or other documentation) could be used as background for the proposed publication?

        • Studies: 2009 process recommendations for multi-stakeholder dialogues; stakeholder analysis; BASF studies; Studies by SAFO partners
        • Reports: SAFO country workshop reports, SAFO team member and consultant reports
        • Photos: The BASF and GIZ SAFO teams as well as consultants and partners have constantly taken a lot of pictures.
        • Films: BASF produced several movies on food fortification (one jointly with UNICEF) and has further material available. The Indonesian SAFO partner KFI has recently made available several TV interviews for its vitamin A cooking oil fortification social marketing campaign.
        • Other Documentation: Press releases and articles

        At which occasions, to which audiences and in which language (in addition to English) would your partner organisation and you like to distribute the resulting publication?

        • SAFO conference on May 10, 2012 in Berlin – Possibly the GIZ regional conference on ‘Engaging with the Private Sector in Health in Africa’
        • Learning from Experience, 14-16 May 2012, Dar es Salaam, Tanzania
        • Upcoming food fortification, health, nutrition, and private-public cooperation conferences and events
        • Internal and external SAFO workshops
        • Distribution by standard mail

        Applicants

        "Strategic Alliance for the Fortification of Oil and Other Staple Foods (SAFO)”, a develoPPP.de development partnership between BASF and GIZ on behalf of the BMZ

        Leonie Vierck, Junior Expert, GIZ
        Phone: +49 (0)6196 79-2624
        Email: leonie.vierck@giz.de

        BASF Food Fortification/BoP

        Andreas Bluethner, Senior Global Manager
        Phone: +49 (0)621 60-28715
        Email: andreas.bluethner@basf.com

        Using the public health system to improve adolescents’ sexual and reproductive health and rights in Nepal

        How it works:

        Ensuring management support and an enabling environment for the provision of adolescent-friendly services

        The National Adolescent Sexual and Reproductive Health Programme (ASRH) programme includes orientations on how to deliver adolescent-friendly services (AFSs) for both health managers (at central, district and health facility level) and health care workers. This allows the managerial level to supervise health care workers, to record and report their performance and to design the health facility adolescent-friendly along basic criteria.Health workers on the other hand are operating in a ‘sanctioned’ space where being adolescent-friendly, non-discriminatory and non-judgmental is approved by their managers. In addition, to create an enabling environment, district as well as community level stakeholders (teachers, journalists, NGOs) are oriented on the programme and their possible roles to ensure utilisation of AFSs.

        Working through the public health system to promote sustainability

        Compared to using non-governmental organizations to deliver quality adolescent-friendly services, a model preferred by many donors and international NGOs, this approach uses the existing network of public health services whose availability and sustainability is guaranteed and through national health systems strengthening efforts by the government and development partners continuously and gradually improved in terms of quality and accessibility. Equally, the introduction of a quality improvement measure such as converting a public health facility into an adolescent-friendly facility can have spin-offs on the quality of the health care provision in a patient-friendly manner in more generic terms.

        ASF can piggy-back on existing structures and processes

        The introduction of AFSs through the public health system can be a cost-effective option as it uses procedures that are part of the health system. This includes human resources, physical infrastructure, recording and reporting formats with the opportunity of data being integrated in the existing Health Management Information System (HMIS), monitoring and supervision of facilities and health workers and the integration into regional and national health performance reviews.

        What is has achieved:

        • The scaling-up process of the programme is currently including 455 health facilities (out of approx. 4000health facilities in Nepal) and the aim is to introduce AFSs in 1000 health facilities by 2015, under the leadership of the Family Health Division. The funding sources stem from both government budget and external development partner funding.
        • Strong leadership by relevant government entities in the MoHP to address adolescents’ needs and rights and an increase in financial investment into adolescent health, both from governmental and non-governmental partners
        • Improved capacity of district and health facility managers and coordinating committees to respond to adolescents’ needs; improved capacity of health workers to provide confidential SRH services to adolescents through using specific counselling tools and IEC materials provided to them; improved recording and reporting on service utilisation by adolescents and hence the possibility to monitor trends and progress


        Why should this approach be documented in the German Health Practice Collection?

        The Government of Nepal and more specifically the Ministry of Health and Population together with external development partners including GDC has committed itself to improving the access to quality health services especially of disadvantaged population groups. Despite of being on track with regard to reaching the MDG 5 goal to reduce maternal mortality, the objective to achieve universal access to reproductive health services in Nepal is challenged by inherent gender inequality, poverty, social exclusion based on caste or ethnicity and social and cultural norms and taboos surrounding sexuality and reproduction.

        Adolescents have traditionally not been specifically served or targeted by the public health system, and the adolescent fertility rate although slightly declining remains high (98 births among 1000 women aged 15-19, NDHS 2006) and the contraceptive prevalence rate extremely low (13.8% among married women aged 15-19, NDHS 2006). Self-reported STI prevalence lies at round 3.6% for male and 5.5% for female adolescents (NDHS 2006), however there is no data on HIV prevalence in this specific age group. In the absence of a culturally accepting attitude towards young people’s sexuality, the lack of adolescent-friendly information, access to confidential health services and contraception are the main reasons for putting adolescents at risk of unwanted pregnancies, infections with STIs incl. HIV and unsafe abortions.

        In 2007, the Family Health Division of the Department of Health Services and GIZ therefore decided to introduce adolescent-friendly services (AFSs) into the existing network of public health facilities in line with a rights-based approach to health. Through different steps taken throughout the past 3 years by FHD with the technical cooperation of GIZ – initiation, piloting, process evaluation, finalisation – in 2011 a national adolescent sexual and reproductive health (ASRH) programme was launched and is now being-scaled up throughout Nepal with the aim to provide AFSs in all 75 districts by 2015. GIZ through GFA Consulting Group is currently conducting operational research at three intervals to determine the effectiveness in terms of service utilisation, satisfaction and sexual and reproductive health of adolescents, the baseline has been completed in 2011.

        In the context of Nepal, before this programme was introduced interventions targeting adolescents were limited only to non-governmental organisations (NGOs), whilst being subsidiary to the government health system creating a parallel network of health facilities. The major drawbacks of this were the difficulty to ensure sustainability in service provision and the fact that government health facilities had been systematically excluded from those that had invested in ASRH interventions. Guidelines for AFSs and toolkits that had been developed with the support of external development partners were also not used by the government health facilities, and knowledge management of who was providing what services was weak.

        The national ASRH programme focuses both on the demand and supply side. On the supply side, it enhances the capacity of government staffs at different management and health care delivery levels through specific orientations so that they can manage and deliver integrated and high quality sexual and reproductive health services (family planning counselling and products, maternal health care services, HIV counselling, testing and treatment, safe abortion services) from local health facilities in an adolescent-friendly manner. The core of the programme is to change the attitude and behaviour of health workers towards adolescents’ and their specific needs. Youth participation in the coordination and management of AFSs is stipulated. Similarly, district health managers and NGOs are encouraged during orientations on the programme to invest in demand creation interventions to increase community awareness and acceptance of the importance of and rights to ASRH services and to motivate adolescents to visit the health facilities.

        GIZ has been the driver behind this process and has brought other external development partners on board to invest in tools that complement the programme (i.e. the adaptation of the WHO Job Aid on adolescents for primary level health workers and an ASRH counselling flipchart for health workers), hence acting as a catalyst and advocator. GIZ is also investing in demand creation through the provision of IEC materials and the implementation of the Join-in-Circuit on AIDS, Love and Sexuality (both tools are mentioned in previous GHPC publications).

        What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner country’s population?

        The scaling-up process of the programme is currently including 455 health facilities (out of approx. 4000 health facilities in Nepal) and the aim is to introduce AFSs in 1000 health facilities by 2015, under the leadership of the Family Health Division. The funding sources stem from both government budget and external development partner funding. Till date, the major EDPs supporting are GIZ/GFA, UNICEF, WHO, and Save the Children International.

        The introduction of the ASRH programme has led to the following changes at output level:

        • Strong leadership by relevant government entities in the MoHP to address adolescents’ needs and rights
        • An increase in financial investment into adolescent health, both from governmental and non-governmental partners
        • Improved capacity of district and health facility managers and coordinating committees to respond to adolescents’ needs when seeking SRH care services
        • Improved capacity of health workers to provide confidential SRH services to adolescents through using specific counselling tools and IEC materials provided to them
        • Improved recording and reporting on service utilisation by adolescents and hence the possibility to monitor trends and progress (currently complementary to HMIS system, but it is planned to integrate relevant service statistics into HMIS)

        The operational research mentioned above is investigating to what extent service utilisation and satisfaction with health services has increased among adolescents in those areas where AFSs have been introduced and to what extent those have affected their SRH knowledge, attitude and behaviour. These ‘hard facts’ will be available after the mid-term review in 2013 and the final evaluation in 2015. However, evidence from the registration documents at health facility level shows an increase in service utilisation after the introduction of the programme.

        In what way does the approach conform with the following GHPC criteria: transferable to other contexts; participatory and empowering; gender-sensitive; cost-effective and sustainable?

        This approach can be easily replicated in other contexts to introduce a sustainable and low-cost health sector response to adolescents SRH needs. Given that the health system – even if weak and fragmented – is already available in terms of infrastructure and human resources, the intervention can be easily integrated. In fact, the burden of an additional programme is outweighed by the benefits to health workers in terms of being more equipped to interact with the specific target group of adolescents. The intervention includes and stipulates youth participation at health facility management level and in decentralised coordinating mechanisms and therefore conforms to the principles of an effective youth-oriented programme. Given that health managers are included in the orientation trainings as well as health workers, it motivates and empowers both groups to act in line with the programme guidelines. The intervention is sustainable as the existing network of public health facilities is being used and as the intervention can be operated at low cost, which ensures that the MoHP is in a position to allocate government budget.

        Which existing documentation materials (studies, reports, photos, films (or other documentation) could be used as background for the proposed publication?

        • National ASRH Programme Orientation Guide (2011) (in English)
        • Process evaluation 2010
        • National ASRH Programme Orientation Guideline 2007 (in English)
        • National Adolescent Health and Development Strategy 2000 (in English)
        • National expert seminar 2008 factsheets on ASRH interventions in Nepal
        • Photographs
        • Set of 8 IEC booklets (Question and Answer booklets) in Nepali
        • ASRH Counselling Flipchart (in Nepali)

        At which occasions, to which audiences and in which language (in addition to English) would your partner organisation and you like to distribute the resulting publication?

        • ASRH Sub-Committee (Family Health Division) consisting of representatives from government line agencies, NGOs, EDPs and youth organisations
        • Annual national health review (MoHP)
        • Annual regional health review (MoHP) in 5 regions
        • WHO Regional Review on ASRH, 2013
        • Asia Pacific Conference on SRHR, Philippines in 2013
        • Other conferences

        Applicants

        MoHP/GIZ Health Sector Support Programme
        Component 3: Promoting sexual and reproductive health and rights for young people in Nepal (GFA Consulting Group)

        Eva Schildbach, Component Team Leader
        Phone: 977-9851034850
        Email: eva.schildbach@gfa-group.de.

        Ministry of Health and Population, Nepal

        Dr. Naresh Pratap KC, Director.
        Family Health Division, Department of Health Services
        Phone: +977-9851042824
        Email: npkc@hotmail.com

        Health promotion on Reproductive Health/Family planning with special attention to traditional and cultural aspects in Uzbekistan

        The three short statements describing the approach:

        • Gender awareness - Approaches to promoting reproductive health (RH) and improvement of RH services can only develop their full potential if the social environment of women at reproductive age and their family members (husband, elders in the family) are taken into account
        • Participatory – Health promotion activities, on RH services using “MAKHALLA” framework, that is society structure, village councils, official makhalla committees and unofficial active members, reach almost each family at the micro level. Moreover, it is strongly centralized and coordinated at both, middle and macro level. It functions also as a platform that defines and enforces social and cultural norms within the society. Active members of the community steer together and provide health information using culturally appropriate approach for the target population.
        • Empowering - The project uses the makhalla structure to better reach most of the target group. Based on the information gathered during the baseline study, a new approach focusing on two levels (family and makhala structures) was developed.

        Three short statements describing its results:

        • Gender sensitive - At the very beginning of the project's activities, the team recognized misgivings about the new approach, especially training of men and mothers-in-law on reproductive health issues and family planning. However, at an early stage of the process, both men and mothers-in-law overcame reservations and began to integrate their views, knowledge, which enabled them to actively get involved into family planning. Resulting into a positive the training-of-trainers (ToT) approach facilitated the training of 1,080 mothers-in-law and husbands, who are now working in their respective makhallas. These trainees contributed to improve maternal health as well as gender equality within families by establishing direct dialogue and building rapport with the medical staff.
        • Cost-effectiveness - The results of the project evaluation conducted in February/March 2010 and May 2011, reflect the success of the described activities above. Compared to the baseline study, an increase of 74% in health promotion activities was registered within the population of pilot regions. The knowledge and awareness of reproductive health issues among makhalla leaders (female and male) improved by 78% after attending the ToT. The knowledge and awareness of reproductive health issues among the target population, trained by makhalla leaders, men and mothers-in-law improved by 72% after dissemination of materials and participation in workshops.
        • Transferable - This working intervention can be integrated into other health areas. In this respect, men and mothers-in-law have a sound knowledge on the subject and are actively involved in the promotion of family planning issues; healthy living and maternal health can result in a long-term behavioral change within the whole family. Therefore, these changes may contribute positively on the gender roles of men and women, such as decision making on contraceptives choice, birth interval, partner deliveries, exclusive breastfeeding and health facility seeking behavior.
          Changing social and gender stereotypes regarding role perceptions of men and women into more balanced gender relations, may lead to an improvement of the status of women in society and have a positive impact to the reproductive behavior of women in reproductive age.

        Why should this approach be documented in the German Health Practice Collection?

        Reproductive Health is a priority for achievement of MDG as well as for national Development Plan of Uzbekistan. At the same time, it is a very sensitive topic for policy makers and population due to its connection with demographic issues (Government efforts to decrease the birth rate in Uzbekistan) as well as cultural and religious aspects. Since 2009 two Presidential Decrees on RH/FP are becoming the main focus for Ministry of Health and CBOs’ efforts.

        When Uzbekistan gained its independence in 1991, profound restructuring processes were needed in all sectors of society. The primary health care system, in particular, had to be reformed, in order to give population equitable access to primary and emergency health services. Thus the GIZ Health System Development Project has supported Ministry of Health since 2009, focusing on visiting nurses’ clinical protocols on Reproductive Health. “Nursing and midwifery are vital components of the health workforce and are acknowledged professionals who contribute significantly to the achievements of PHC and the MDGs.

        The GIZ/Health Program recognizes and addresses the needs of different groups by:

        • Targeting men and mothers-in-law as the decision makers in families, community formal and non-formal leaders, public “gate-keepers” and family nurses/midwifes who support introduction of new innovations among population;
        • Providing specific services for trainings and curriculum packages of the program which addresses gender roles and barriers in family and community; launching and conducting mass-media campaigns and outreach work involving both groups – men and women of different ages;
        • Sensitizing nurses, local authorities and CBOs’ leaders on RH, gender and related topics

        What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner country’s population?

        The regional Programme Health in Central Asia contributes to improvements in the areas of sexual reproductive health and rights and HIV and drug abuse prevention in the three partner countries, Kyrgyzstan, Tajikistan and Uzbekistan. National strategies play an integral role in implementing programmes. Local conditions, social structure, culture, religion in each country are taken into account. Within the 1st phase (2009 – 2011) the Programme developed a gender sensitive and locally adapted concept of health-promotion. Analysis of the situation in the field of maternal and child health in Uzbekistan and baseline assessment data showed that there is significant progress in some key social indicators, particularly in the health sector but there still remain problems of preservation of these indicators and further progress towards achieving the MDGs by 2015 (Report of the Working Group/GIZ " Analysis of the situation in the healthcare system of Uzbekistan "Tashkent, 2009 and Report of GIZ on baseline assessment among male population and mothers-in-law in pilot sites, 2009).

        Being in line with the Decree of the President of the Republic of Uzbekistan on Reproductive Health Strengthening, the capacity building of visiting nurses working on RH, through the implementation of evidence-based standards for quality care at PHC level and raising awareness campaigns were implemented.

        Approaches to promoting reproductive health and improvement of RH services can only deve­lop their full potential if the social environment of women at reproductive age and their family members are taken into account. Through a baseline study as a first step the project learned more about the current status of reproductive knowledge and behaviour of women and their social environment, families, husbands, parents-in-law.

        The mahalla is a form of institutionalized community-based governance structure in city districts and villa­ges. It functions also as a platform to define and to enforce social and cultural norms within the society. Active members of a community steer together the social life and provide information and cultural education for population. Mahalla structure, together with its instruments, village councils, official mahalla committees and unofficial active members, reaches almost each family at the micro level and is strongly centralized and coordinated on both, the middle and macro level.

        The project uses the mahalla structure to better reach most of the target group. Based on the information gathered during the baseline study, a new approach on the two levels (family structure and mahala structure) was deve­loped. In two Uzbek pilot regions most respected men and mothers-in-law who were interested in carrying out awareness raising measures in their villages and city districts were selected in 250 mahallas of 2 pilots out of 13 administrative units (Andijan and Karakalpakstan). Small casting sessi­ons were held, where applicants introduced themselves. Selection criteria included personal family practices (for example, the birth intervals, using of modern contraceptives, partner delivery), the candidates’ presentation skills and the liveliness of their manner. As this work is volun­tary and unpaid, statements about motivation were also important (Report on monitoring of CBOs in 2 pilot regions, 2010 and Reports of “Healthy Family Forming Centre” organized at the basis of CBOs).

        Integrating the measures into local structures ensures sustaina­bility. The involvement of mothers-in-law and men in health promotion activities was developed in close collaboration with and is coor­dinated by the governmental structures (regional health departments) and community based organizations like, mahalla and the women’s committee (GIZ/EPOS Result based monitoring reports, semi-annual and annual, 2010 and 2011).

        Actvities related to capacity building of visiting nurses of primary health care (at more than 4000 rural health points) on implementation of nurses protocols on RH at national level have covered all 13 administrative units in Uzbekistan. The promotion of nursing standards was achieved with development and dissemination of curriculum guide and didactic methods of teaching nurses to implement clinical protocols and TOT for nurse facilitators (443 through 22 workshops). Training manual “Teaching, Learning and Assessment in Family Nursing” with focus on antenatal and postpartum care’s protocols implementation was tested by WHO, approved by MoH and National Nurses Association and disseminated at the national level. It was recommended as an obligatory tool throughout the country’s facilities (primary health care units) as a frame/basis for further trainings on other visiting nursing standards (total 103 protocols). By the initiative of National Association of Nurses the nurses’ clinical standards were implemented in all 14 regions of the country (729 cascade training with 13 117 nurses trained) . This input has pointed the sustainability of the project and opportunities for further involvement. The module also assisted to set up to prepare more than 600 nurses on self-monitoring and mentoring in mentoring system (Report of monitoring and evaluation of visiting nurses, 2010 and 2011y).

        In what way does the approach conform with the following GHPC criteria: transferable to other contexts; participatory and empowering; gender-sensitive; cost-effective and sustainable?

        • Health Promotion activities on RH were integrated within other contexts such as STI/HIV prevention, Mother and Child health care, Gender equality, supporting low income families through family budget planning and quality improvement of health services.
        • Local branches of National Women Committee together with CBOs leaders actively participated in development of strategy and action plans on RH interventions in pilots. By their proposals, the target community were selected based on following criteria: poverty, insufficient reproductive and demographic indicators.
        • All posters, booklets, methodical aids and materials for distribution of the Program include key messages for men and women; In Uzbekistan for health promotion and services on Antenatal Care, Prenatal care and Postnatal Care, Family Planning issues only young women are involved, however, traditionally they are not decision-makers in families. Therefore, gender-sensitized key messages developed in the Program are disseminated among partners and service providers.
        • The Program encouraged integration of gender issues in staff management of CBOs and pilot facilities (maternal hospitals, rural medical points and policlinics);
        • The Program promoted an equal participation of men and women in TOTs, cascade trainings and health promotion activities;
        • The Program integrated gender issues and leadership in its training/methodical aids for health services providers (e.g. Visiting Nursing Manual, Clinical protocols, Curricula for health promoters) so that medical workers used corresponding skills in their services to population;
        • The program developed and disseminated video-clips, photo-discussions, “stories-without-ends”, TV and radio- broadcasts focusing on RH, gender and culturally connected specific messages;
        • Baseline surveys (KAP Studies) of the Program targeted on three groups: men, mothers-in-law and women at fertile ages; boys and girls in lyceums/colleges.
        • High commitment of local partners (National Nurses Association, National and Regional Women Committees, Local Governments’ staff, local CBOs) (we must provide examples: steering committee, reporting system in place, regular meetings, etc) contributed to ensure sustainability of the interventions.
        • Cost-effectiveness of the interventions is based on usage of cascade method of activities.
        • RH component is fully in line with the national strategy on mother and child health which has been implemented in the country for the last 15 years.

        Which existing documentation materials (studies, reports, photos, films (or other documentation) could be used as background for the proposed publication?

        1. Fact sheet on makhallas (CBOs), men and mothers-in-law
        2. Fact sheet on nurses and midwifes are key persons in health services
        3. KAP survey among male population, August 2009.
        4. KAP survey among mothers-in-law, February 2010.
        5. Report on monitoring of CBOs in pilot regions (Andijan and Karakalpakstan), 2010
        6. Report of monitoring and evaluation of visiting nurses, 2010 and 2011y.
        7. GIZ/EPOS Result based monitoring reports, semi-annual and annual, 2010 and 2011.
        8. Reports of “Healthy Family Forming Centre” organized at the basis of CBOs.
        9. Photos
        10. Videotapes, articles in news papers

        Applicants

        GIZ Health Programme in Central Asia/Uzbekistan

        Nigora Murotova, GIZ Health Programme in Central Asia/Uzbekistan
        Phone: +99871 1400489
        Email: nigora.muratova@giz.de

        Ernest Robello, Team Leader, GIZ Health Programme in Central Asia/Uzbekistan
        Phone: +99871 1400489
        Email: ernest.robello@giz.de

        National Women Committee of Uzbekistan

        Dilfuza Khasanova, PhD, Deputy of Chief of National Women Committee of Uzbekistan
        Phone: +998901788488
        Email: dilfuzaxasanova@mail.ru

        Ministry of Health, Uzbekistan

        Salihodjaeva Rikhsi, Main specialist of Ministry of Health of Uzbekistan on Nurses
        Phone: +99871 7374181
        Email: salikhodjaeva@mail.ru

        Dilrabo Urunova, Specialist of MoH on nurses capacity building,
        Phone: +99897 7061072
        Email: 0.k.dilrabo@mail.ru

        Improving the quality of Safe Motherhood services in Tajikistan

        About the approach:

        "The project brings together the people who can make a difference in the quality of services." Director maternal and child health, Health Department Soghd region.

        "Senior physicians from maternity houses have arranged mutual monitoring visits because they see the benefit of the external perspective of peers and they trust the monitoring card as an objective tool."Head of Obstetric Department in the Postgraduate Training Institute

        "With the monitoring tools doctors and midwifes have learned to take a team approach in emergency situations. They now work, think and act together to improve the services."Neonatologist from Khojent

        About the results:

        Rational drug use is much improved. We now order only the drugs included in the standards. We save a lot of money like this and we can order more of the essential drugs. In addition, a limited number of products are easier to manage. We experience less stock-outs and save money.

        There has been a significant reduction in the use of blood and blood products – the funds saved correspond to 10% of the national hospital budget.

        The accreditation process helps the hospital to ensure quality within, and to demonstrate it to the outside.

        Alternative working title for the proposed publication

        “Introduction of the External and internal monitoring of implementation of national MCH standards/clinical protocols, based on EBM, is an effective and sustainable tool to improve the quality of service provision"

        Why should this approach be documented in the German Health Practice Collection?

        Currently, in the health care system of the Republic of Tajikistan the work is going to ensure that people who need medical care receive high quality medical care from those who provide this care. The introduction of management standards and an external and internal monitoring can improve the quality of care and satisfaction of caregivers, thereby, improving the performance of the institution, which in turn can improve patient health and increase patient satisfaction. Improvement of the quality of medical services requires that many people and factors work together; these includes a manager, an employee, the team of workers, patient, family, community, existing health system policies. When these factors successfully work together, we can improve and maintain the level of performance within the health system. Thus, in order to improve the system, attention should be given to each factor of the system, which is done through:

        • receiving feedback (comments and wishes) of the patients and health providers;
        • provision managers with tools, standards and guidelines;
        • developing the capacity for monitoring performance in accordance with approved standards;
        • establishing teams and strengthening communication skills.

        The goal of the external and internal monitoring is to determine the differences between the desired parameters defined in the standard, and the real parameters of performance to search for the causes of these differences for their correction. The process used to identify differences between expected and actual performance and their causes, and to develop solutions to overcome such differences is defined as performance indicators improvement.

        What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner country’s population?

        1. Sogd Oblast TECHNICAL REPORT on the monitoring of the national standards implementation (Physiological birth, Antenatal care, Hypertensive disorders in pregnancy, delivery and the postpartum period, Obstetric hemorrhages) in Republic Tajikistan, , 6 pilot districts. 88 pages, 2009 year/ 2010
        2. Khatlon Oblast TECHNICAL REPORT on the monitoring of the national standards implementation (Physiological birth, Antenatal care, Hypertensive disorders in pregnancy, delivery and the postpartum period, Obstetric hemorrhages) in Republic Tajikistan, 12 pilot districts. 234 pages, 2009 / 2010
        3. Dushanbe city TECHNICAL REPORT on the monitoring of the national standards implementation (Physiological birth, Antenatal care, Hypertensive disorders in pregnancy, delivery and the postpartum period, Obstetric hemorrhages) in Republic Tajikistan, 15 pilot facilities. 234 pages, 2009 / 2010
        4. Khatlon Oblast Joint Technical report (GIZ and KfW) on the monitoring of the national standards implementation (Physiological birth, Antenatal care, Hypertensive disorders in pregnancy, delivery and the postpartum period, Obstetric hemorrhages) in Republic Tajikistan, 12 pilot districts. 2011

        How long this approach has been implemented and to what level/coverage it has been scaled up:

        GIZ “Healthcare system development Programme” was launched in 2008 in Tajikistan and provided technical support to the Ministry of health (MoH) experts working group to develop the national standards/clinical protocols on safe motherhood based on EBM and WHO recommendations. The standards were approved by the MoH Decree and implemented in the medical facilities at the hospital and primary care level over the country. In order to monitor the implementation of the standards/protocols in the medical facilities and assess the improvement in quality of service provision, in 2009 the Tools for assessment of the quality of management of physiological pregnancy, physiological birth, hypertensive complications in pregnancy and obstetric hemorrhages (Manual for external and internal monitoring) were developed by MoH experts, including the experts from State Agency over medical activity supervision, and MoH Decree was issued. The Tools have been tested in the pilot facilities and then widely discussed at the national and regional conferences with interested stakeholders and institutions (feedback/comments/recommendations) – Tools revised and updated.

        In 2010 the MoH has issued the Decree #336 on approval and implementation of the Tools for assessment of the quality of management of physiological pregnancy, physiological birth, and hypertensive complications in pregnancy and obstetric hemorrhages in health facilities. In the framework of this Decree, the Quality Committees should be established in each medical facility that would be responsible for implementation of protocols and regular provision of the internal monitoring on a monthly basis. According to the MoH Decree, the external monitoring should be conducted each 6 months by external observers (experts from State Agency over medical activity supervision, Heads of MCH departments-national/regional) in order to provide MoH with reports/feedback on the implementation of the standards/protocols and development of the further steps on the improvement of the quality of services.

        During 2010 and 2011 the Tools were printed and distributed over the country, and medical specialists conducted several rounds of internal and external monitoring and assessments within the facilities using the Tools, and identifying the obstacles/difficulties in implementation of the protocols, assessing the quality of service provision and developing recommendations for quality improvement.

        In what way does the approach conform with the following GHPC criteria: transferable to other contexts; participatory and empowering; gender-sensitive; cost-effective and sustainable?

        Participatory and empowering – with implementation of modern evidence-based safe motherhood practices women and their family members have opportunity to participate in making decision on their health issues. For example, women and their partners currently attend birth preparedness classes where they learn a lot about issues related to pregnancy such as nutrition, labour, non-medical pain relive in labour, partners’ support during labour and delivery, danger signs, visit maternities to learn about new conditions available for delivery, and etc. At labour, women have a chance to have partners support, choose positions which more comfortable and benefit foetus, stay with the newborn in the same room, immediately breastfeed newborn after birth – opportunities that woman was deprived before implementation of effective perinatal care technologies. Implementation of modern safe motherhood practices also contributes towards empowering women and their families to take responsibilities on issues related to pregnancy and birth. During antenatal visits, together with health provider they develop a detailed birth plan including issues on where to go for birth, what to take to maternity, and, the most important, preparedness in case of emergencies. Here it becomes the family responsibility to know the health provider to contact in emergency or health facility to go, arranging transportation and timely deliver women to health facility.

        Gender-sensitive – implementation of safe motherhood practices brings more attention to women needs particularly during pregnancy and labour. Working family members, particularly mothers-in –law and husbands who are making decisions on women’s health issues, the message is conveyed on specific needs of pregnant women on nutrition, time for rest and assistance with care for other children, with specific focuses on knowledge of danger signs and necessity to immediately seek for medical assistance in case of emergency.

        Cost-effective and sustainable – A significant reduction in the use of blood and blood products since the introduction and application of the national standards to ensure safe motherhood observed from the data of Health Departments reports. The amount saved was said in one Oblast to be 20,000 Tajik Somoni corresponding to 10% of the hospital budget. Substantial savings by limiting drug procurement to the drugs recommended in the national standards is observed from Maternity House 1 Dushanbe reports.

        Overall impressive improvement of practice and attitude from follow-up visits data is observed and effectiveness and efficiency of obstetric services (reduction of malpractice as a cause of maternal death, relative reduction of maternal deaths due to hemorrhage and hypertensive disorders, more rational and efficient drug procurement) improved as demonstrated by the existing indications.

        Which existing documentation materials (studies, reports, photos, films (or other documentation) could be used as background for the proposed publication?

        • Manual including monitoring tools
        • Photos
        • Film
        • Technical Reports

        Applicants

        “Healthcare System Development Programme” in Tajikistan, GIZ

        Evelina Toteva, Technical Advisor
        "Healthcare system development Programme in Tajikistan"
        Phone: +992 44 600 52 00
        Email: evelina.toteva@giz.de

        City Health Department, Tajikistan

        Khuseinova Dilbar,
        Chief Obstetrician Gynaecology
        Phone: +992 93 5060111
        Email: dilchik67@yandex.ru

        Triangular Cooperation for an improved knowledge transfer: applying Brazilian experiences in the strengthening of Uruguay’s health system

        How it works:

        1) The three partners (ABC, AISA Brazil; Ministry of Public Health Uruguay; GIZ/KfW/BMZ Germany) support Uruguay’s national health system reform, including the horizontal integration of responses to HIV and AIDS, with participation from civil society and user representatives, based on the Brazilian experience with the “Sistema Único de Saúde” (SUS).

        2) The partners are cooperating to structure health networks more coherently in localities with less than 5000 inhabitants in four pilot regions.

        3) According to the principles of South-South Cooperation, knowledge is exchanged in a horizontal way between the three partners, concerning Decentralization, Participation, Health Promotion, Prevention Programmes, including HIV.

        What we have achieved:

        1) New forms of collaboration between the Ministry of Public Health and the rural regions (departamentos) were developed and capacity-building in the area of integrated health systems and networks has begun and is in the process of being extended to the whole country.

        2) Strategic plans and monitoring systems were elaborated, contributing to the national process of health system strengthening.

        3) Integrated approaches for rural health were developed, increasing access of rural populations to improved primary health care.

        Why should this approach be documented in the German Health Practice Collection?

        This project focuses on Health System Strengthening (HSS), using a multisectoral and participatory approach in order to reduce inequalities in access to health care and respond to HIV/AIDS through the horizontal integration of formerly vertical health programs. It merits attention in terms of its innovative approach as well as its potential of filling the current gap in knowledge and practice of knowledge transfer through triangular cooperation. It thus operates not only in conformity with the guidelines and priorities of the BMZ and the GDC’s Sector Strategy Paper in Health but also with the goals and action plans outlined in the recent Rio Declaration on Social Determinants of Health, which highlighted the significance of strengthening international cooperation, participation, multisectoriality, and integrated health systems in order to achieve greater health equity.

        Background and Project Description

        The current, unprecedented process of HSS of the Uruguayan SNiS (Sistema Nacional Integrado de Salud) requires changes at the level of health care provision and management. This entails improved coordination between different levels of health care and care providers, and the establishment of integrated health care networks which will increase the involvement of all actors and promote decentralized, intersectoral and participatory interventions.

        The present triangular cooperation project, implemented in partnership with the Brazilian Ministry of Health (MS) and the Brazilian Cooperation Agency (ABC), the Uruguayan Ministry of Public Health (MSP), and the GIZ Regional HIV/AIDS Program on behalf of the BMZ, pursues the aim of strengthening the Uruguayan health system, emphasizing localities with less than 5000 inhabitants. Currently, the project is implemented in four prioritized departments (Artigas, Rivera, Cerro Largo, Rocha). The project stimulates a horizontal knowledge transfer using Brazilian experiences to inform practices in Uruguay in order to elaborate strategic plans, norms, and routines for the management of integrated health care networks with the participation of health system users and civil society. The knowledge transfer contributes to structuring health care networks within the SNiS by linking different subsystems, regulating information flows and processes of reference and counter-reference as well as stimulating the exchange of experiences in health care network management, and capacitating health professionals. As a result, the processes within the health network will become more coherent, thereby strengthening the overall health system. The technical assistance is complemented by financial cooperation provided from the German Government through KfW. With a total of EUR 5 million grant funds, funding is provided for the physical improvement of regional health centres in the regions and the improvement of their technical equipment.

        An innovative approach – triangular cooperation for knowledge transfer

        Based on Brazil’s long term  experience in the implementation of its own integrated health system (the SUS), through triangular cooperation Uruguay will integrate its HIV/AIDS response into the national health system and thereby promote synergies with related health services and achieve greater efficiency and amplify effects (Schwartlaender et al. 2011, Sidibé et al. 2010). The knowledge transfer from Brazil to Uruguay acknowledged in this initiative is delivered through triangular cooperation and thereby optimized by combining the knowledge of local contexts and needs (Uruguay) with technical expertise (Brazil) and experience in facilitating, and the monitoring and evaluation (M+E) of international cooperation processes (Germany). Underscored by excellent results already achieved in this and previous projects, knowledge transfer itself is a concept which bears great value and potential. Additionally, the recent international consensus of encouraging and supporting the South-South dialogue and the new agenda for aid effectiveness require a more inclusive dialogue between cooperation partners (see Paris Declaration 2005, Heiligendamm Process, Accra Plan of Action 2008, MDG 8), making this project a prime example for the value of triangulation as a new tool to combine the strengths of traditional donors and providers of South-South cooperation. It is very important to mention the positive aspect of the dissemination of public policies, through the official cooperation, as a factor of creating structured institutions with a view of capacity development.

        Visibility and Profile of the German Development Cooperation (GDC)

        Because triangular cooperation is still underutilized (UNDP 2009), this project represents an opportunity to raise the GDC’s profile and strengthen its visibility as one of the few traditional donors who take part in improving this innovative tool. The UNDP’s Special Unit for South-South Cooperation highlights the importance of triangular cooperation in the effort to promote and enhance the effectiveness of South-South cooperation (UNDP 2009). Germany possesses significant expertise in steering processes of international cooperation and in facilitating cooperation and innovation in health in the LAC region. By following the agenda set by Uruguay as well as taking in consideration the technical capacities Brazil brings to the table, this project contributes to raising the profile of the GDC. Under principles of the south-south cooperation and because it responds to local needs rather than imposing standards and practices which are detached from local realities, this triangular relationship is conducive to improved terms of international cooperation (TTSSC 2010). Given its role as emerging global player, Brazil is a natural partner in the region as well as in global cooperation projects (John de Souza 2010), and this type of cooperation fosters a climate conducive to future collaboration and Germany’s visibility as a valuable partner. Moreover, the innovative horizontal and multisectoral approach and the considerable successes it entails distinguish this project from others in the LAC region. As a virtually unique project, this cooperation serves as a model for future projects as well as raising the GDC’s profile across the region.

        What evidence on outputs and outcomes is available to show that this approach is effective and that it has been scaled up to cover a significant proportion of the partner country’s population?

        Outputs

        For the first time in Uruguay, planning for integrated health system networks exists in the departments. Based on the Brazilian SUS as a model of integrated health system management and with ample participation from local actors and health system users, a National Rural Health Plan has been created in order to provide a new framework for integrated health care in Uruguay. Furthermore, this “Plan Nacional de Salud Rural” extends the health networks from the four pilot departments to all rural areas of the country and thus serves as a first step to scaling up the results achieved during the project. Additionally, a decree will enter into force on Jan 1st, 2012 which will initiate the process of HSS in all remaining national departments and scale up the process to cover all of Uruguay by 2014. In this sense, the knowledge transfer has an impact beyond the scope of the project and demonstrably affects national planning processes. As such, the process instigated by the cooperation project strengthens the process of planning and implementing integrated health care delivery networks across the country.

        Moreover, not only was a dialogue initiated between national and regional/rural levels, it was also acted upon with the drawing up of concrete action plans. The cooperation project has triggered a model which provides a formal structure for the implementation of integrated health system networks, with the implementation of this structure well underway: Routes of reference and counter-reference for primary health care have been defined; as a vital part of strengthening the integrated delivery networks, this contributes to the consolidation of primary health care as the entry point into the health system for users, thereby improving and amplifying access to health care.

        The project has played a role in national processes in terms of a complete reorganization of the system towards the provision of services within integrated delivery networks and the elaboration of a steering structure for HSS has advanced considerably. This is underscored by the creation and implementation of strategic departmental rural health plans and four capacity development strategies which have been created according to the necessities of each department.

        To ensure sustainability and effectiveness, a departmental M+E plan has been elaborated and committees have been set up in order to ensure its implementation.

        Outcomes

        The project supports the drawing up and institutionalization of a new and innovative model of participative, locally based health management in Uruguay. The process of HSS currently takes place in four departments which cover an area of about 45.500 km² and have a total population of approximately 353.000. While rural areas with a population of less than 5000 inhabitants are emphasized, the integrated networks approach applied is expected to contribute to better health for the entire population: over the long term, the development and implementation of the integrated health care model will lead to increased access of the Uruguayan population (approx. 3.53 million) to integrated health services of higher quality, including improved access to HIV/AIDS diagnosis, and treatment, gender-sensitive sexual and reproductive health services, as well as stronger civil society participation in health policy definition and implementation.This expectation is coherent  with PAHO/WHO recommendations which consider integrated delivery networks important contributors to universal coverage and access to the system, comprehensive, integrated and continuous care, reduced costs, and an overall improved response to population health needs (PAHO 2008).

        Documentation/Evidence: Informe de Fase 1: Etapas 2 y 3 – Principales Resultados de los Talleres, Informe del Primer Ciclo de Debates, Informe de trabajo - Desarrollo del plan departamental de Monitoreo y Evaluación del Proyecto de Cooperación Trilateral (Artigas, Rivera, Cerro Largo y Rocha); Planes estratégicos de cada uno de los cuatro departamentos (Artigas, Rivera, Cerro Largo y Rocha);

        In what way does the approach conform with the following GHPC criteria: transferable to other contexts; participatory and empowering; gender-sensitive; cost-effective and sustainable?

        Transferable to other contexts:

        This triangular cooperation project is led by Uruguay, the beneficiary country, and aligned with national policies, needs, and context. Germany provides support based on its comprehensive knowledge and understanding of the health systems of both Brazil and Uruguay necessary to facilitate the process of knowledge transfer as well as M+E. Brazil, Uruguay, and the GIZ/KfW work together at every stage of the project – planning, implementation, and M+E. The flexibility that comes with this demand-driven approach ensures that Uruguay’s needs are taken into account in the knowledge transfer. It is also an indication of the transferability of this tool to other contexts. Due to the similarity of experiences with other Southern countries, Brazil’s technical skills and knowledge are more relevant to the needs of Uruguay and can be more easily transferred than those of traditional donors. It thus becomes clear that triangular cooperation represents an extremely flexible tool with ample potential for the GDC which can be easily adapted and transferred.

        Gender-sensitive

        In line with the principles of the GDC, gender-sensitivity is implied in the present project which will contribute to the promotion of gender equality in several important ways. By enhancing education, prevention, and health care, the project will equitably serve men, women, and Most At Risk Populations such as LGBTTTI. Women, who represent a larger part than men of both the health workforce and the health care users, will benefit substantially from a strengthened health system. Female health professionals as well as health system users will gain access to important resources in terms of further education, job opportunities, and access to services. A regional GDC project which specifically targets men’s health and related issues, in which Uruguay is also taking part, will furthermore ensure that the question of men’s health is not neglected in the process. Nonetheless, the rationale behind strengthening the Uruguayan health system in an integrated manner is that men and women can gain equitably from the resulting outcomes, thus foregoing the need to explicitly target either of the two groups.

        Cost-effective and Sustainable

        The present project represents an example of achieving ample effects with comparatively little money. Triangular cooperation combines the comparative advantages of all three partners, making the knowledge transfer more cost-effective. Germany’s proficiency in facilitating knowledge transfer, Brazil’s technical knowledge regarding HSS and health networks implementation, alongside the local expertise of Uruguay are joined together, ensuring that time and resources are used efficiently, knowledge transfer is delivered where it is needed, and results are subsequently expanded to country-level and maintained over the long term.

        Moreover, a range of factors not only contributes to the sustainability of this particular project but also demonstrates the sustainable qualities of triangulation as a tool of technical cooperation: firstly, ownership on the side of Uruguay, including a share in financing the knowledge transfer; secondly, the strengthening of structures of knowledge transfer and international cooperation within Brazil; thirdly, the sharing of responsibilities of financial and technical support between partners. Fourthly, by helping to build legal frameworks and strategic plans for action, the project ensures the endurance of national processes over the long term. GDC resources used in this triangle cooperation thus achieve the highest possible leverage in terms of both sustainability and cost-effectiveness.

        Participatory and Empowering

        Participation and empowerment feature prominently in the program priorities. They are enhanced through this project on both a country and a population level. Triangulation encourages a process of knowledge transfer which is participatory and empowering for the beneficiary country. It is a horizontal partnership between equals, in which responsibility is shared and each partner’s voice is heard. The element of ownership and the demand-driven approach ensure the participation and empowerment of Uruguay within the cooperative relationship. In addition, in this project Uruguay, Brazil and Germany actively encourage the participation and empowerment of civil society as well as health system users in the process of designing and implementing health policy.

        Which existing documentation materials (studies, reports, photos, films (or other documentation) could be used as background for the proposed publication?

        Ample photographical documentation already exists and will be made available to the writer.

        The following documentation materials could, in addition to the references below, serve as background for the proposed publication as they have served as background for the project:

        • Objetivos de desarrollo del Milenio
        • Informe 2010; Seminário de Atenção Primária à Saúde- Perspectivas e desafios para o Século XXI
        • AMEP; Informe temático– Encuesta Nacional de Hogares Ampliada 2006
        • Los Uruguayos y la salud: situación percepciones y comportamiento; Perfil de los Sistemas de Salud
        • República Oriental del Uruguay Monitoreo y Análisis de los Procesos de Cambio y Reforma, Octubre, 2009; Base de Datos de Indicadores Básicos en Salud de la OPS; El sistema de salud en Uruguay, considerando también 1) los Objetivos del Desarrollo de Milenio y 2) la situación del VIH/SIDA; Law Nº 18.211 and  Nº 18.161
        • Sistema Nacional Integrado de Salud
        • Normativa Referente a su Creación, Funcionamiento y Financiación; Administración de los Servicios de Salud del Estado; Plan Nacional de Salud Rural (APROPYEN/DEPES/MSP 2010)
        • Literature exploring the SUS, such as: Paim, Jairnilson et al. (2011): O sistema de saúde brasileiro: historia, avanços, e desafios, Lancet, DOI: 10.1016/S0140-6736(11)60054-8

        On which occasions, to which audiences and in which language (in addition to English) would your partner organization and you like to distribute the resulting publication?

        In addition to English, we would like to distribute the resulting publication in Spanish. We aim to distribute the resulting publication at the following events (depending on date of publication):

        • Global Health and Innovation Conference, Yale University, April 2012
        • HIV Management 2012: the New York Course, New York, May 2012
        • International Symposium on HIV & Emerging Infectious Diseases, Marseille France, May 2012
        • AIDS 2012--XIX International AIDS Conference, Washington DC, July 2012
        • World Future Health Forum, Monaco, March 2013
        • 8th Global Conference on Health Promotion, Helsinki, Finland, June 2013
        • Foro Latinoamericano y del Caribe en VIH/SIDA y ITS, Brazil 2012
        • II Fórum Sul-americano de Cooperação Internacional em Saúde
        • World Health Summit, Berlin  2012

        The events indicated above are only a few of the opportunities to deliver the publication. The publication would be suitable for distribution at events reviewing integrated networks in health, HIV/AIDS responses, as well as triangular cooperation.

        References:

        • Abdenur, Adriana (2007): The Strategic Triad: Form and Content in Brazil’s Triangular Cooperation Practices, International Affairs Working Paper
        • Altenburg, Tilman, Weikert, Jochen (2006): Möglichkeiten und Grenzen entwicklungspolitischer Dreieckskooperationen mit Ankerländern, Discussion Paper, Deutsches Institut für Entwicklungspolitik
        • Atun, R A, Gurol-Urganci, I., McKee, M. (2009): Health systems and increased longevity in people with HIV and AIDS, Editorial, BMJ 338:b2165
        • Davies, P. (2010): South-South Cooperation: Moving Towards a New Aid Dynamic" in Poverty in Focus, South-South Cooperation - The Same Old Game or a New Paradigm?, International Policy Centre for Inclusive Growth, UNDP
        • Fordelone, TalitaYamashiro (2009): Triangular Cooperation and Aid Effectiveness - Can triangular co-operation make aid more effective?, Paper prepared for the Policy Dialogue on Development Co-operation, OECD Development Co-operation Directorate
        • John de Sousa, Sarah-Lea (2010): Brazil as an Emerging Actor in International Development Cooperation: A Good Partner for European Donors?, Briefing Paper 5, German Development Institute
        • PAHO/WHO (2008): Integrated Delivery Networks: Concepts, Policy Options, and Road Map for Implementation in the Americas, Series: Renewing Primary Health Care in the Americas
        • Pantoja, Edien, Elsner, Cristina (2009): Triangular Cooperation: New Paths to Development - Summary Report of the Discussions and Experiences presented in the 1st International Symposium on Triangular Cooperation, Triangular Cooperation Program, GTZ-Brazil
        • Schwartlaender et al. (2011): Towards an improved investment approach for an effective response to HIV/AIDS, The Lancet, Volume 377, Issue 9782
        • Sidibé, Michel, Tanaka, Sonja and Buse, Kent (2010): People, Passion & Politics: Looking Back and Moving Forward in the Governance of the AIDS Response, Global Health Governance, Vol. 4, No. 1
        • Task Team on South-South Cooperation (TTSSC) (2010): Boosting South-South Cooperation in the Context of Aid Effectiveness - Telling the Story of Partners Involved in more than 110 Cases of South-South and Triangular Cooperation
        • UNDP (2009): Enhancing South-South and Triangular Cooperation - Study of the Current Situation and Existing Good Practices in Policy,Institutions, and Operation of South-South and Triangular Cooperation, Study commissioned by the Special Unit for South-South Cooperation, UNDP
        • WHO (2008): The World Health Report 2008 - Primary Health Care (Now More Than Ever)

        Applicants

        GIZ Regional HIV/AIDS Programme, Brasilia, Brazil

        Dr. Claudia Herlt, GIZ Regional HIV/AIDS Program Director
        Phone: +556130454114
        Email: claudia.herlt@giz.de

        Werner Klinger, KfW Project Manager for Latin America and the Caribbean
        Phone: +496974314946
        Email: werner.klinger@kfw.de

        Ministerio de Salud Pública, Uruguay

        Dr. Jorge Venegas, Ministério de Salud Pública (MSP), Uruguayan Health Minister
        Phone: +59824001086
        ministro@msp.gub.uy

        Agencia Brasileira de Cooperação (ABC)/ Ministério das Relações Exteriores, Brazil

        Marco Farani, Minister
        Phone: +55(61)34119365-3411-9362
        marco.farani@itamaraty.gov.br

        Ministério da Saúde, Brazil

        Ambassador Eduardo Botelho Barbosa, Head of International Affairs Advisory
        Phone: +55(61)33153805
        eduardo.barbosa@saude.gov.br

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