Silos should be used for storing grain, not delivering development programs

Originally published on the PPPHW blog.

Pwr-of-integrationBy Hanna Woodburn, The Global Public-Private Partnership for Handwashing (PPPHW)

On June 13, 2016 FHI 360 hosted Greater than the Sum of its Parts, a first-ever FHI 360 summit on integrated development. Over the past two years, FHI 360 has embarked on a journey to dig deep into both the “why” and the “how” of integrated development. At this event, speakers shared what they’ve learned about integration, both what has worked and what challenges remain.

The Global Public-Private Partnership for Handwashing has also started to explore integration through our work with the Clean, Fed & Nurtured community of practice. From my experience with the community of practice, and my own lens of working for a public-private partnership, there were a few key takeaways that emerged.

First, a challenge. Over lunch, I was discussing the definition of integration with my tablemates. For some, it was assumed that integration meant collaborating around implementing a project with a different sector. For instance, this could entail sharing family planning messages at childhood vaccination appointments. Others felt that integration could be much broader and include working with a range of actors, such as governments partnering with non-profits. I remarked that this reminded me of vertical and horizontal supply chain integration in the private sector. Integration, whether vertical or horizontal, seeks to maximize value and harness synergies, but in practice it is realized differently. Likewise, integrated development is a spectrum and actualized in a myriad of ways and contexts. Clarifying our language around integration will help ensure greater success in knowledge sharing and practice going forward.

Second, as Tricia Petruney with FHI 360 said, history shows that integration from the top-down simply has not worked. To be certain, integration champions at all levels of leadership are essential to fostering an integration-friendly environment, but, as Curtis Palmer, country director for PACT Nepal said, “People know better than I do what their real needs are.” The “meat” of integration should come from the local level. It should be driven by conversations with stakeholders about what they actually need and want.

This opportunity, to harness local knowledge and commitment, was reiterated in the comments made by Robert Mwadime from Uganda. In his storytelling session, he commented that integration requires fine-tuning, which means that failure, in some form, is inevitable. Through ongoing learning, flexibility, and leadership, the Community Connector project he runs was able to identify and reach excluded constituencies. Just like integration isn’t a “one-size-fits-all” approach, it also isn’t a “one and done” approach. Projects must be able to both measure their success as well as correct the course as needed.

The evidence shows that integration makes sense. There are a multitude of opportunities for integration; still there are also challenges which much be addressed. Not only does integration yield returns in efficiencies, but the new Sustainable Development Goals demand integration. It is only through common sense, cross-sectoral collaboration that we can hope to achieve these aspirational targets. People don’t live lives in silos, and our solutions should reflect that reality.




Heading West—an Expression of Multi-Dimensionalism within the CORE Group

By Renuka Bery, USAID WASHplus Project, and Nora Zenczak, ChildFund International

Change is in the air. It’s been many years since CORE Group has held its twice-annual meeting on the west coast—that is until this year’s Spring Practitioners Conference, which was held in Portland, and attracted new vigor and potential members into its fold. Additionally, the meeting provided an opportunity to introduce CORE’s new Executive Director, Lisa Hilmi. Lisa has worked in over a dozen countries and joins CORE most recently from MedStar Franklin Square Medical Center in Baltimore where she was both a clinical and research nurse.

The 2016 Spring Practitioners Conference theme, Achieving Health for All Through Multi-Dimensional Approaches, was both provocative and timely, as many organizations are exploring sectoral integration in their approaches and programming. Multi-dimensionalism was woven throughout the entire conference as participants grappled with how to recognize and address the extent to which health influences other aspects of development. The core hypothesis is that working at different levels and with a range of stakeholders to achieve more comprehensive change will lead to improved and sustained individual health and well-being within the global context and evolving landscape.

Shawn Baker, director of nutrition for the Bill and Melinda Gates Foundation, gave the keynote address that outlined the ways in which the Foundation is broadening nutrition efforts across dimensions within its structure and in its grant making. Participants noted that Shawn might be the most quoted keynote in CORE’s history! Later, Tim Frankenburger from Tango International discussed the components of resilience and the need to track changes in resilience over time because shocks and stressors can quickly change the landscape. Communities recovering from sequential shocks can lose resilience and households with higher self-efficacy were less likely to engage in negative coping strategies. This can lead to a vicious cycle where downstream effects impact people’s ability to protect themselves and thereby reduce resilience.

Circuit table discussions were particularly rich—this year there was an offering of 19 topics and a series of small group discussions of 20 minutes. Each table group brought out different dimensions of integrated health programming and sought to encourage thoughtful reflection to make the conversation different and meaningful.

As usual, CORE offered a wide variety of concurrent sessions with a large dose of participatory engagement. One of our favorites was Integrated Childhood Development: The Whole-Child Perspective—organized and facilitated by Clean, Fed & Nurtured—that featured Dr. Lia Fernald from the University of California-Berkeley School of Public Health, who infected the room with her enthusiasm in sharing new and fascinating findings on multi-sector early childhood development (ECD). An interesting take-away was her finding in one study that while integration was not detrimental, it did not improve results either. Participants engaged with Dr. Fernald and with practitioners in water, sanitation, and hygiene (WASH), ECD, and nutrition to dig deep into the “who, what, how, and why” of undertaking quality programming for young children. The working group meetings were efficient, productive, and focused on work planning and activities to undertake between now, the CORE Fall meeting, and beyond.

It is fun to see some of the same, familiar faces at the CORE meeting engaging in interesting work, but also connecting with new enthusiasts eager to learn and bring new ideas to old problems. Portland brought a new energy and laid back undercurrent to the meeting—a nice change from the intensity of Washington, D.C.

“What Gets Measured, Gets Done: Identifying Integrated Indicators that Count”

By Bijan D. Manavizadeh

Imagine a two-year old child is sitting on a three-legged stool. If one or two legs are stronger than the other, the stool would not be stable and the child would be at risk of harm. Yet, if the stool has been properly constructed, with resources to ensure all three legs are strong and secure, then the stool would be durable and the child would be at a reduced risk of harm. The same principle is applicable to key factors of growth and development in early childhood—such as water, sanitation, and hygiene (WASH), nutrition, and early childhood development (ECD).

This metaphor was the crux of the Clean, Fed & Nurtured (CF&N) side session at the George Washington University Global Health Mini-University on March 4. Presentations by CF&N members Merri Weinger (USAID), Monica Woldt (FANTA III), and Julia Rosenbaum (USAID WASHplus) outlined the “why” and the “how” of developing and measuring indicators for integrated global health programs to better promote essential multi-sector collaboration of WASH, nutrition, and ECD.

In the first part of the session, the speakers shared evidence supporting the link between the three sectors of WASH, nutrition, and ECD and promoted cross-sectoral collaboration. In the second part, they addressed integral questions, such as:  Which indicators need to be defined? How do we evaluate them? What kind of research is needed to develop more appropriate indicators for successful integration?

As a program officer for the Global Public-Private Partnership for Handwashing, I know the implications that WASH interventions can have on health and development, but I did not know the full extent to which poor WASH practices can inhibit nutrition and ECD. This what I learned and what needs to be done.

What we do know? The first 1,000 days of life—from conception to age two—is the most critical period of cognitive and motor function development in a person’s life. Evidence shows that WASH interventions can prevent diarrhea, which if left untreated can lead to undernutrition and poor physical and cognitive growth. Frequent bouts of diarrhea tend to lead to a reduced appetite and poor absorption of nutrients from the food children do consume. This leads to a vicious cycle. Undernourished children are more susceptible to contracting parasites, viruses, and bacteria that lead to diarrhea. This cycle of diarrhea and undernutrition leads to stunting, which can have lifelong implications as it prevents children from reaching their full potential, both physically and mentally. In the long term, this can lead to negative outcomes in school, in professional settings, and in society.


Why cross-sectoral collaboration? Growing evidence indicates that through integration we can harness synergies. Multifaceted problems need multifaceted solutions. Integration provides the opportunity for streamlining messages and greater efficiency in program delivery. However, there are challenges. Funding, staff motivation and workload, coordination among agencies and organizations are some of the many hurdles that must be overcome. Another hurdle is the lack of common indicators, which inhibit the measurement of program effectiveness.

Why focus on integrated indicators? Properly defined indicators for integration mean that we can learn which interventions worked and which failed to meet expectations. Each of the three sectors represented in CF&N have their own indicators with varying degrees of strength. Indicators that correspond with integrated programs will allow us to better know if our hypothesis—that integrating WASH, nutrition, and ECD will have a greater impact—is correct. We know that indicators developed and utilized must be SMART: specific, measurable, achievable, reliable, and time bound. But, we also know that there is more work to be done. The evidence base for three-way integration is growing, and the development of indicators is a crucial step as we move forward.

How do we move forward? During the second segment of the session at the Mini-University, the audience engaged in a discussion of what is needed to move forward by sharing ideas on ways to identify and develop indicators for integration, as well as methods for overcoming gaps and challenges of delivering integrated interventions.

Increased advocacy with donors is needed, integration must be incorporated at the service delivery level to not overburden families, and a broader range of partners, stakeholders, and implementers must be brought into the conversation. Simply put, more dialogue and a greater emphasis on developing frameworks with indicators that function along a continuum are both needed.

Robust, comprehensive, measurable, and integrated indicators will generate more evidence that will allow us to better hone our work. Ultimately, as the WASH, nutrition, and ECD sectors further collaborate and forge stronger bonds, a broad set of health, nutrition, and child development indicators will be essential to demonstrating impact. Certainly, the challenge is great, but we believe that through our joint efforts we can make a greater impact than we could alone.

 Find a list of proposed CF&N indicators here. To view the presentation for “What Gets Measured, Gets Done,” please click here.