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Building Consensus and Capturing Lessons Learned Learning from the Zika Response for Future Success | April 1 - 3, 2019 | Santo Domingo, Dominican Republic

The United States Agency for International Development (USAID) and the Knowledge for Health Project (K4Health) organized the share fair "Building Consensus and Capturing Lessons Learned: Learning from the Zika Response for Future Success," April 1 to 3, 2019 in Santo Domingo, Dominican Republic.

The event brought together 75 participants representing 18 partner organizations/projects from 14 countries in Latin America and the Caribbean. Partners from all four lines of effort— social and behavior change, service delivery, community engagement, and vector control—participated in the event. The objective of the meeting was to generate consensus around the design, implementation, and utility of effective and documented cross-cutting practices of the USAID Zika response, to inform future outbreaks.

At the share fair, partners identified effective cross-cutting practices, discussed the contextual factors that facilitated or hindered their success, explored how effective practices could be integrated into current systems, and created national action plans to communicate technical results and lessons learned during close-out processes.

Arthur Brown, Director of USAID’s Mission in the Dominican Republic and Christina Chappell, Deputy Director of Infectious Diseases at USAID Washington, opened the event with welcome remarks. Both highlighted the importance of sharing challenges and achievements to learn from each other. They spoke about the impact of improvements in access to health, maternal care, community surveillance, capacity building, collaborations between partners, and with ministries of health and UNICEF—citing the regional platforms that have been created under the USAID Zika response as examples.

Opening Panel: Lessons Learned and Recommendations for the Future

During this panel, four speakers (Paula Wood, Zika AIRS Project [ZAP]; José David Laínez Kafati, UNICEF; Jorge Hermida, ASSIST; Ariel Habed, Save the Children) and the moderator (Elizabeth Conklin, USAID) shared the most important lessons learned from their projects in the USAID Zika response.

The experiences shared by the ZAP Project included the importance of being flexible from the beginning; working with national and local authorities; and focusing on supervision and training for the success of workers in the field. When talking about communication for social and behavior change, UNICEF noted the importance of including the participation of different actors in the community and working at inter-institutional and intersectoral levels. ASSIST highlighted the importance of improving the quality of care; creating fast response mechanisms; leveraging existing mechanisms instead of creating new ones; and linking health services with communities. Likewise, Save the Children highlighted the importance of the social capital of the community; school programs; communication strategies and behavior change; and the inclusion of governmental and local authorities.

Learning and adapting: Monitoring, evaluation, and learning during a rapid response setting and knowledge management

During this panel, four participants (Martha Silva, Breakthrough RESEARCH; Erin Law, International Federation of Red Cross and Red Crescent Societies [IFRC]; Arturo Sánchez López, Medical Care Development International [MCDI] / Guatemala; Anne Ballard Sara, K4Health) and the moderator (Harold Suazo Laguna, Sustainable Sciences Institute [SSI]) shared their effective practices and lessons learned related to the topics.

Breakthrough RESEARCH presented a qualitative evaluation composed of interviews with key stakeholders from the Ministries of Health, USAID, and partners, to analyze points of intersection. The general recommendations included: 1) developing a standardized measurement framework, 2) providing technical monitoring and evaluation assistance for implementing partners, 3) facilitating learning and rapid use of data for decision-making, 4) ensuring consistency in instruments and data collection, 5) including a coordinating partner for the design of a monitoring and evaluation model for the response, 6) advocating for and ensuring formative research at the beginning of a response, and 7) incorporating technical assistance to improve programs throughout the response.

Additionally, IFRC noted the importance of focusing on what motivates people to make changes when interacting with communities (e.g., incorporating dengue and chikungunya). MCDI spoke about experiences controlling larvae in households and the importance of placing a sticker indicating what had been discussed with the household. MCDI also pointed out the importance of conducting quarterly mini-KAPs (knowledge, attitude, and practice surveys) to analyze the impact of the messages and using ARCGIS to allow real-time results. K4Health shared effective practices in knowledge management, including the importance of creating opportunities for partners and providers to: search and share information in one place, talk to each other, search and share internal information in a closed page, and integrate knowledge management at each level from the beginning.

After the panel, participants worked in small groups to reach consensus on an effective practice or approach. These small group discussions included:

Monitoring and Evaluation

  • Develop tools and platforms that can be shared at the community level
  • Produce reports used for decision-making with the parties involved
  • Take into account the safety of staff in high-risk areas
  • Have a baseline with which interventions in countries can be adapted
  • Use real time data for decision-making
  • Measure the quality of clinical practice by defined standards and indicators
  • Conduct quarterly follow-up of risk perception

Knowledge Management

  • Motivate the community and promote timely action
  • Identify community platforms for capacity strengthening
  • Train all vector control technicians from the beginning, and continuously
  • Adapt communication materials with key messages and actors
  • Share information generated locally and in communities based on technical validity and effectiveness
  • Involve all actors (regional, district level, etc.)
  • Standardize best practices by documenting meetings in advance and dedicating time for collaborative discussions
  • Work with community managers to execute replica plans according to the needs of the community
  • Reflect and think about how knowledge management can be incorporated from the start
  • Implement programs in schools so children replicate information at home

Capacity Strengthening

During this panel, four speakers (Patricia Poppe, Breakthrough ACTION; Carlos Cardenas, ZAP; Charlene Corre Desai, ASSIST Jamaica; Dennis Navarro Costa, PAHO) and the moderator (Edgar Castillo Lora, Chemonics International, Procurement and Supply Management [PSM]) shared their effective practices and lessons learned related to the topic.

Breakthrough ACTION spoke about the implicit strengthening of national strategies to "learn by doing"; the prioritization of behaviors and messages from 30 to 7; and the importance of strengthening interpersonal communication skills based on trainings and support tools for facilitators and those who conduct home visits. ZAP highlighted the importance of home visits for vector control and entomological surveillance through basic training and "hands on" transferring of skills to directors of health ministries. ASSIST Jamaica shared its experiences with ECHO (Extension for Community Health Care Outcomes) to create knowledge networks through basic videoconferencing technology and case study-based learning. The Ministry of Health has embraced this idea and is analyzing how hosts can develop ECHO in other areas and continue to train health providers in Jamaica. PAHO highlighted the importance of developing national network plans and surveillance of insecticides and management of the surveillance network including: standardizing information; updating and strengthening capacities and policies of the countries; and creating sustainability by demonstrating that countries can use this new capacity.

Consensus

  • Strengthen the role of caregivers for child development through family-focused trainings
  • Use innovative techniques for capacity strengthening mechanisms, such as the use of technology in trainings and virtual methods
  • Develop simple and easy-to-replicate tools
  • Use KAP baseline data to build capacity and sensitize communities and health personnel
  • Offer a diploma through a local and structured university with a focus on capacity development that allows focused and flexible implementation
  • Have the flexibility to assess/recognize capacity at the start of the response: Identify strengthens and weaknesses and harmonize the approach
  • Institutionalize processes to ensure learning with relevant and validated proposals and be flexible and adaptable to the existing process
  • Offer practical trainings that allow participants to learn by doing

Coordination and Integration of Zika

During this panel, five participants (Mjrko Rennola, UNICEF Dominican Republic; Mark Hathaway, MCSP; María Espinosa, CARE/Peru; José Gómez, Global Communities; Alberto Vásquez, PSI/PASMO) and the moderator (Vivian Salomon, USAID) shared their effective practices and lessons learned related to the topics.

UNICEF began its presentation by showing a video regarding health services and support groups for affected families; the relevance of focusing on the first 1,000 days for clinical care, psychosocial support, information support, and social protection; and the importance of comprehensive care in nutrition, early stimulation, and the integration of clinical services. MCSP also spoke about the need for integration into existing systems and conducting workshops on how to analyze and use information. CARE highlighted the importance of coordination and integration with other implementing partners like UNICEF in the search for institutional and community practices, the systematization of regional experiences, and coordination with Save the Children for capacity strengthening. Global Communities shared its experience developing a dialogue platform where community networks communicate risks and take physical control measures for vector control and coordinate intersectoral community tables with local boards, community police, etc. PSI/PASMO shared their experiences working with adolescents by providing information and educational materials in schools, fairs, cleaning campaigns, etc.; using Facebook; and giving electronic vouchers to attend clinics.

Consensus

  • Highlight effective coordination among implementing partners, including joint planning, information exchange, and process feedback
  • Contextualize the referrals and counter-referrals
  • Promote the integration of structures that already exist in ministries. For example, PSI was added to a network of private doctors where they were able to integrate Zika into the conversation
  • Promote the sustainability of the response through the dissemination of education and awareness materials
  • Map interested partners beyond the Ministry of Health

Participants also discussed two topics in small groups: 1) collaboration across sectors and 2) designing for and anticipating youth and gender issues. The key points from the consensus include:

Collaboration Across Sectors

Ministry of Health

  • Align content with the prevention and control strategy
  • Work at all levels from national to the community level
  • Understand how the Ministry works and with whom programs should work
  • Improve the capacity of human resources and demonstrate how implementation aligns with the Ministry of Health strategy

Private Sector

  • Understand the diversity across countries
  • Offer certification programs that combine theoretical and practical approaches in the curriculum
  • Focus on social responsibility

Civil Society

  • Carry out work plans with communities
  • Develop participatory diagnostics first at the institutional level, and then integrate them into the community
  • Involve prominent community members and share results with them
  • Identify what interests communities and what people think is important for Zika prevention
  • Promote the presence of local civil society groups (women's organizations, etc.)

Local Governments

  • Avoid politicizing the response and effective practices
  • Motivate the health sector to lead interventions to ensure issues and processes are prioritized

Designing for and anticipating youth and gender issues

Youth

  • Use online tools (Facebook, WhatsApp, Zikario, etc.) to connect with young people about sexual and reproductive health issues (young people require rapid systems and expect answers within 24 hours); use attractive images
  • Implement quick, continuous, and fun interventions
  • Measure the effectiveness of knowledge transfer through school interventions
  • Measure the levels of infestation at schools every three months to assess which activities did or did not have impact
  • Use playful tools, such as puppets and characters, to talk to children about key behaviors at educational fairs
  • Develop the capacity of youth leaders and train trainers. Include topics such as sexuality, leadership, values, self-esteem, assertive communication, and decision-making

Gender

  • Consider gender issues from the beginning of the program design
  • Train health providers and promote non-traditional male roles in communities
  • Include exclusive messages for men
  • Focus on shared responsibility
  • Encourage male involvement beyond vector control within the home, including sexual transmission and elimination of breeding sites
  • Empower couples and families to share responsibility in prevention processes and behaviors
  • Conduct home visits as a couple (a man and a woman) to protect the health of the volunteers and avoid cases of sexual abuse and violence

Country Action Plans

In groups organized by country, participants discussed their action plans for close-out processes. The plans identified essential information, technical results, and lessons learned that they want their government to remember and prioritize after the USAID response to Zika has ended. Many countries highlighted their experiences with integration and intersectoral collaboration, the importance of technology and community-based surveillance, and capacity strengthening for vector control personnel and care and support services.

USAID Monitoring, Evaluation, and Learning Framework

During this session, the results of the monitoring and evaluation initiatives of the USAID Zika response were presented. Implementing partners have achieved a lot during the USAID Zika response, in the field of vector control and capacity strengthening with vector control workers. Partners have also achieved successes in relation to the provision of services, the development of protocols and standards, training health providers, strengthening and improving the quality and quantity of services, and creating linkages with communities. USAID noted initiatives aimed at: involving communities, creating social networks, and strengthening the capacity of school programs, with the participation of volunteers. Finally, throughout the Zika response partners have strengthened knowledge, achieved behavioral changes, and published key studies.

Looking to the Future

In the last session, Eric Baranick, Senior Zika Advisor of USAID Washington, interviewed Dr. Hans Salas Moronsky, Advisor on Disease Prevention and Control with PAHO/WHO Dominican Republic. Dr. Salas Moronsky spoke about USAID’s response and the future of outbreak response in Latin America. He highlighted that we have learned a great deal through USAID's response to Zika, including the importance of creating and/or updating entomological strategies directly with the national entomology program, improving health services, and making rapid plans to implement elimination programs.

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