BL 11 Business Plan 2008-2013 Integrated community-based interventions Draft Business Plan for JCB May, 2007 Business plan: Business line 11 – Integrated community-based interventions TABLE OF CONTENTS EXECUTIVE SUMMARY .2 OBJECTIVE 1.1 OVERALL OBJECTIVE 1.2 SPECIFIC OBJECTIVES .5 NEEDS AND OPPORTUNITIES 2.1 NEEDS 2.2 OPPORTUNITIES: .7 COMPARATIVE ADVANTAGE 3.1 TDR COMPARATIVE ADVANTAGE 3.2 SYNERGIES WITH OTHER ORGANIZATIONS .9 ACTIVITIES AND END PRODUCTS 11 4.1 KEY ACTIVITIES .11 4.2 END-PRODUCTS 15 4.3 INTERIM IMPLEMENTATION MILESTONES 16 RESOURCE REQUIREMENTS .18 5.1 BUDGET REQUIREMENTS 18 RISKS 19 Page Business plan: Business line 11 – Integrated community-based interventions EXECUTIVE SUMMARY Needs and Opportunities Several effective and simple interventions are available to prevent or treat infectious diseases of poverty such as malaria and neglected tropical diseases (NTDs) However these interventions often not reach the affected populations that need them most, in particular, the poor and rural populations in Africa Innovative ways of getting effective interventions to affected poor people are urgently needed Community-based delivery strategies have been developed for different diseases, but vary in terms of community involvement, effectiveness and sustainability Different control programmes implement their community-based strategies independently, resulting in inefficiencies and conflicting practices at the community level There is an urgent need for effective strategies for co-implementation of community based interventions that build on effective models such as home management of malaria and community-directed treatment of onchocerciasis in which communities are empowered to manage the process themselves Recent studies have indicated that co-implementation using the community directed model can greatly increase access to health interventions among poor populations, in line with WHO goals to promote integrated approaches that strengthen health systems Overall Objective To develop innovative and efficient strategies for providing community based interventions to poor populations Specific Objectives • To determine how to scale up the Community Directed Intervention (CDI) strategy and how to efficiently introduce it into new areas • To develop and test other community-level intervention strategies, especially for urban and post-conflict areas, for nomadic populations and through collaboration with other sectors such as in school health programmes • To determine the costs, benefits and limits of co-implementation of community-based health interventions, and how co-implementation can be simplified • To develop innovative solutions to the problem of conflicting incentive policies for community volunteers, and to develop mechanisms through which communities can enforce their demand for intervention supplies Page Business plan: Business line 11 – Integrated community-based interventions Activities The business line will undertake large multi-disciplinary multi-country studies to explore and test new delivery strategies The studies will be undertaken in close collaboration with national, regional and global disease control programs, including APOC and the NTD and malaria programs of WHO As much as possible, the intervention strategies to be tested will be implemented through the regular health system The preparation of the studies will involve extensive consultation with disease control programmes and ministries of health to carefully define the research needs and research questions, and exploratory studies to identify potential solutions that take into account critical social factors such as gender and economic status The focus of the business line will be on Africa and the research will use the extensive network of African public health and social science researchers that has been established in the context of previous research by TDR End-Products • Strategy for upscaling CDI for co-implementation of interventions against NTDs and Malaria in areas where community directed treatment is already established for onchocerciasis control (2010) • Strategy for CDI in areas where there is no onchocerciasis (2010) • Delivery strategies for community based interventions in urban and post-conflict areas, and strategy for upscaling deworming through School Health Programmes (2011) • Framework for co-implementation, including evidence on the costs and benefits of different co-implementation strategies, and on the type of interventions that are appropriate for co-implementation (2009-2011) • Impact of conflicting policies for incentives to community volunteers documented and innovative solutions developed and tested (2011) • Mechanisms to strengthen communities' influence on implementation strategy and help them reinforce their demands for support and supplies for interventions (2010) Comparative Advantage TDR has over the years acquired unique experience in the design and implementation of multi-country studies on innovative community-based interventions against infectious diseases in neglected populations It has developed community based treatment strategies e.g the Community Directed treatment with ivermectin and Home Management of Malaria, and the CDI strategy as an effective model for co-implementation of interventions TDR has supported the training of a large network of scientists and researchers across a range of disciplines (including epidemiology, social sciences, economic research amongst others) thereby creating a unique network of researchers with expertise in the areas of community- Page Business plan: Business line 11 – Integrated community-based interventions based intervention approaches TDR is a leading agency in the application of advanced social sciences in the design and evaluation of health intervention strategies TDR has experience with involving disease control programmes and national health systems in the design and implementation of these studies, and in facilitating the effective transfer of research findings into policy and practice As a WHO programme, TDR has close links with the relevant technical programs of WHO, such as the African Programme for Onchocerciasis Control, Neglected Tropical Diseases and Global Malaria Programme, and effective access to ministries of health through the regional and country offices of the organization Page Business plan: Business line 11 – Integrated community-based interventions OBJECTIVE 1.1 OVERALL OBJECTIVE This business line will develop innovative and efficient strategies for providing community based interventions to poor populations 1.2 SPECIFIC OBJECTIVES The specific objectives of this business line are: • to determine how to scale up the Community Directed Intervention (CDI) strategy and how to efficiently introduce it into new areas • to develop and test other community-level intervention strategies, especially for urban and post-conflict areas, for nomadic populations and through collaboration with other sectors such as in school health programs • to determine the costs, benefits and limits of co-implementation of community-based health interventions, and how co-implementation can be simplified • to develop innovative solutions to the problem of conflicting incentive policies for community volunteers, and to develop mechanisms through which communities can enforce their demand for intervention supplies Page Business plan: Business line 11 – Integrated community-based interventions NEEDS AND OPPORTUNITIES 2.1 NEEDS Access Infectious diseases remain a major cause of morbidity and mortality in developing countries, especially in Africa where they are responsible for 60% of all deaths Effective interventions exist to prevent or treat infectious diseases such as malaria and neglected tropical diseases that disproportionately affect the poor However, it has proven very difficult for the weak public health systems in many developing countries, especially in Africa, to deliver these interventions to the affected populations who need them most Many promising new interventions have only limited impact and millions continue to suffer or die because of the failure to have interventions delivered in an efficient and sustainable manner to poor populations It is increasingly recognized that research should not stop after the development and evaluation of new control tools, but that it has an additional critical role to play in helping to solve major implementation problems and improve access to health interventions by poor populations Research is needed to provide objective evidence on the main obstacles to health care delivery in poor communities and develop more effective and sustainable delivery strategies that are appropriate for the environment in which they are needed Many interventions against infectious diseases of the poor are simple and not require trained health professionals They can be administered at the community level by community members who have received basic training in their use Disease control programs are therefore increasingly opting for community-based delivery strategies for these interventions However, the approaches used vary significantly in terms of community involvement, effectiveness and sustainability, and there has been very little research to evaluate and compare these strategies and to determine how they could be optimized Recent years have seen a significant increase in global support for the control of infectious diseases that affect poor populations New control initiatives have been launched for individual diseases, and although this is a very welcome development for the fight against diseases that have been so long neglected, there is increasing concern about the fragmentation, inefficiency and potential negative impact on the health system of these different initiatives Hence there is an urgent need for research to develop more coherent and efficient strategies for the co-implementation of multiple community-based interventions that can ensure sustained high coverage of the target population and that are effectively integrated into, and strengthen, the public health system Page Business plan: Business line 11 – Integrated community-based interventions 2.2 OPPORTUNITIES: Research has shown that community-based delivery strategies can greatly increase access to interventions, especially when communities are empowered to manage the process themselves, and that these strategies can strengthen the health care system TDR research on home management of malaria has shown how interventions and IEC materials can be optimized for use at the community level, and how different community members, from mothers to shopkeepers, can be trained to effectively diagnose and treat uncomplicated malaria The home management strategy has been adopted by Roll Back Malaria and malaria endemic African countries, and the challenge is now to bring it to scale Community directed treatment with ivermectin (CDTi) has been a new model of community empowerment in health, in which the community is fully in charge of the planning, execution and monitoring of the intervention delivery Developed by TDR in the 1990s, CDTi has been implemented at scale by the African Program for Onchocerciasis Control (APOC) Over 40 million people are treated annually with ivermectin by communities themselves, and a high treatment coverage continues to be sustained Because of the success with this approach, there is increasing interest to use the community directed model also for other interventions The communities themselves are keen to use it for their priority health problems such as malaria The board of APOC, with among its members the Ministers of Health of 19 African countries, has also expressed interest but wants decisions on the wider use of CDTi to be evidence based The board has therefore requested TDR to investigate to what extent the community directed approach can be used for other interventions A major multicountry study of community directed interventions (CDI) is under way to answer that question and preliminary results have been very promising: communities could easily manage several interventions, the coverage of added interventions more than doubled and even the coverage of ivermectin increased Based on these findings the board of APOC has recommended the use of CDI for integrated delivery of multiple interventions, including against malaria Directors of Disease Control and Program Managers from the Ministries of Health of 10 African countries met in February 2007 in Brazzaville to discuss issues of integration and coimplementation Based on results of the CDI and other studies, they recommended that countries explore innovative ways to empower communities in health care delivery as a way to significantly improve coverage, that the CDI approach be used for co-implementation where already established for onchocerciasis control, and that other proven community level interventions, e.g School Health Programmes, be pursued where appropriate The current interest in CDI, and in community based interventions in general, together with the momentum in global support for infectious disease control in developing countries, provide a significant opportunity to develop efficient strategies for the integrated delivery of multiple community-based interventions that respond to priority needs and that are likely to be rapidly taken up for large scale implementation Page Business plan: Business line 11 – Integrated community-based interventions COMPARATIVE ADVANTAGE 3.1 TDR COMPARATIVE ADVANTAGE TDR is the global leader in innovative implementation research on access and community based delivery strategies for interventions against malaria, neglected tropical diseases and other infectious diseases of poverty 3.1.1 Proven Technical and field experience TDR has unique experience in the design and implementation of complex multi-country studies and in the development and evaluation of community-based interventions; in bringing the social and public health sciences together to evaluate planning, decision and implementation processes at the health system and community levels; in assessing the feasibility, effectiveness and efficiency of different intervention strategies; and in helping to translate research findings into practical public health policies e.g for malaria, onchocerciasis and lymphatic filariasis 3.1.2 Demonstrated stewardship Through its close interaction with disease control programs and their expert advisory committees, and with ministries of health through WHO, TDR has facilitated needs analysis and priority setting for implementation research on the critical issue of access to interventions Based on a continuing analysis and improved understanding of research needs, TDR has helped to shape the research agenda and has identified promising opportunities for innovative, high-impact research Because of its location within WHO, its extensive network of public health and social scientists in disease endemic countries, and its links with the scientific world from basic research to product R&D and implementation research, TDR has been able to combine field needs and scientific opportunities into effective targeted research programs that have had significant impact on disease control 3.1.3 Capacity building capabilities in developing countries TDR has trained many scientists in disease endemic countries in the research disciplines of implementation research, i.e public health, epidemiology, sociology, anthropology, biostatistics and health economics It has also supported and guided many researchers in the execution of implementation research projects, and this has resulted in an extensive network of disease endemic countries scientists with hands-on experience in large scale implementation research The business line will collaborate with the TDR business line on empowerment to help it identify priorities and opportunities for professional training of scientists in developing countries The business line itself will organize focused skills Page Business plan: Business line 11 – Integrated community-based interventions training activities that are required for the effective implementation of the research activities, especially within the context of multicountry studies 3.2 SYNERGIES WITH OTHER ORGANIZATIONS There are many partners involved in the development and implementation of strategies for co-implementation of different health interventions, and partnerships will be central to the activities of the business line Operational partners Ministries of Health, national disease control programs and district health management teams will be key partners in defining research needs and obstacles to control, and in postulating and testing possible solutions Scientists from research institutions in developing countries will undertake the research in collaboration with the Ministries of Health NGOs that support different disease control initiatives will also be actively involved in defining needs and undertaking the research Leading international scientists in the relevant research disciplines will be engaged to help ensure that the research is of high standard and capitalizes on the latest scientific advances Key partners at the international level will be the various global or regional disease control initiatives, including formal partnership arrangements where these exists, such as Roll Back Malaria, Global Alliance for the Elimination of Lymphatic Filariasis, International Trachoma Initiative, etc The business line will seek to interact on a regular basis with the technical advisory bodies of those programs WHO is the executing agency of TDR, and the organization will be actively involved at all levels in the activities of the business line WHO country offices will facilitate effective interaction with ministries of health, and especially with respect to needs analysis and translation of research findings into national policy As the main focus of this business line is on Africa, the WHO Regional Office for Africa will be actively involved in all activities of the business line, but especially in the interpretation of research findings and in assessing their relevance for regional health policy The African Program for Onchocerciasis Control will be a key partner because of its achievements and experiences with community directed treatment, and it's keen interest in the proposed activities of the business line to further improve its control strategy At the global level of WHO there will be close interaction with the technical units for different diseases, such as the Global Malaria Program and the WHO department for Neglected Tropical Diseases Page Business plan: Business line 11 – Integrated community-based interventions Funding agencies/partners The African program for Onchocerciasis Control and the Bill and Melinda Gates Foundation have provided funds for the ongoing multicountry study on community directed interventions, and USAID has supported TDR research on home management of malaria Now that these strategies have proven their effectiveness, it is hoped that the same organizations would be willing to support on scale up of these strategies and to further develop them into efficient strategies for co-implementation of multiple interventions The activities of this business line are also highly relevant to the Global Fund to Fight AIDS, TB and Malaria (GFATM), and discussions are ongoing between TDR and GFATM on possible mechanisms for TDR coordinated operational research within the context of GFATM funded programs Other potential funding partners are global initiatives for the delivery of community-based interventions against specific neglected tropical diseases, pharmaceutical companies that donate drugs for mass drug administration programs and that would like to see these drugs reach the people who need them, and possibly bilateral donors that can support research activities of the business line in specific countries where there is a need to improve the effectiveness and efficiency of community-based health programs As the activities of the business line evolve, and increasingly cover multiple diseases through integrated community-based strategies in which the community is empowered to play a greater role in its own health care, the research activities will become increasingly relevant for strengthening primary health care and that may make the business line attractive to a broader range of potential donors Page 10 Business plan: Business line 11 – Integrated community-based interventions ACTIVITIES AND END PRODUCTS 4.1 KEY ACTIVITIES In order to achieve the above objectives, the following activities will be carried out 4.1.1 Community directed interventions (CDI) The research on community directed interventions will focus on Africa and involve three main activities • Upscaling CDI The ongoing multicountry study has already demonstrated the effectiveness of CDI for co-implementation of up to three interventions (results for five interventions will be available by December 2007), and the significant contribution CDI can make to the delivery of malaria interventions at the community level Based on these results the board of APOC and the Brazzaville meeting of the national health decision-makers have recommended the use of CDI for multiple interventions, including ITNs and home management of malaria, in areas where community directed treatment is already established for onchocerciasis control However, moving from recommendation to large scale implementation is still a challenge, and implementation research will initially be needed to help identify major bottlenecks, find ways to overcome them, and scientifically document the lessons learned The business line will discuss with different partners their plans for upscaling CDI, and will build a research component in a selected number of programs to evaluate the planning and upscaling processes at different levels of the health system, assess the costs of different approaches and develop evidence-based solutions to critical implementation problems This research will use sociobehavioral science, health systems and health policy research methodologies • CDI in Areas without CDTi for onchocerciasis The ongoing CDI study is being undertaken in areas where the community directed approach has already been established for many years for onchocerciasis control Although it is likely that the method will be equally effective in onchocerciasis free but otherwise similar communities and health districts within the same countries, it is not known how the strategy can be most effectively introduced in such virgin areas for the co-implementation of multiple interventions, and at what cost From the APOC experience it is known that the establishment of a community directed strategy for a single intervention requires a significant investment in community/health system mobilization and partnership building, to ensure true community empowerment and sustainable systems The Brazzaville meeting identified as a top research priority the development of the optimal strategy for introducing integrated, multi-disease CDI in areas where it is not yet established for onchocerciasis control, and to determine the costs Page 11 Business plan: Business line 11 – Integrated community-based interventions and effort needed to establish such an integrated approach as a basis for policy recommendations on the use of CDI in non-oncho areas, and therefore in the country as a whole A multicountry study will be undertaken to address this question, partly in the same countries where the CDI studies are undertaken so that the results for areas with and without a history of community directed treatment can be compared • CDI for other interventions The ongoing CDI study will provide evidence on the type of community-based health interventions for which the CDI strategy is appropriate This evidence will be limited to health interventions that the national health system considers a priority and appropriate for community-based delivery The priorities of the community not influence the package of interventions to be delivered through CDI as this is considered unpractical, on the assumption that different communities would propose different intervention packages, including interventions that are not of public health importance or for which affordable intervention materials are not available However, there is no evidence to support this assumption But greater responsiveness to community priorities is likely to result in greater sustainability of the intervention process The business line will therefore undertake studies to better understand community priorities for health related interventions, and experiment with modified CDI strategies in which the communities are also empowered to influence the intervention package This may result in the inclusion of interventions that go beyond those currently regarded as community based interventions by the national health systems (for instance, a recurrent community priority in previous TDR studies was emergency care for snake bites), and interventions that go beyond the health sector, e.g water provision and purification The outcome of these studies may be a set of multisectoral intervention kits that respond to community priorities and that are appropriate for delivery by the communities themselves through the CDI process 4.1.2 Other community-level delivery models The CDI process builds on established traditional structures and processes in rural African communities The same structures not exist in urban areas where infectious diseases are also endemic and where the health systems face equal challenges in delivering public health interventions to those who need them But other formal and informal structures exist in urban areas and in the rural/urban interface, and it has been postulated that these can be used for alternative intervention delivery models that are built on the principle of community empowerment Studies will be undertaken, therefore, of community structures and dynamics in urban areas, and their socio-economic and environmental dimensions, in order to determine their potential use in the delivery of community-based interventions Based on this research, novel delivery models will be developed and tested at scale for feasibility and costeffectiveness Stable community structures that allow for CDI may also be absent among nomadic populations and in post-conflict situations where the challenge of delivering interventions is particularly great However, experiences by APOC with community directed Page 12 Business plan: Business line 11 – Integrated community-based interventions treatment in post-conflict situations seem to indicate that community empowerment and CDI may be highly appropriate for such situations This hypothesis needs to be confirmed through proper scientific evaluations that the business line will undertake School-health programmes are attractive for the delivery of interventions in school-age children, e.g preventive chemotherapy against schistosomiasis and intestinal helminth, but their use for neglected diseases has been limited in Africa The business line will explore what the main obstacles are to enlarging the outreach of these programs, and once the reasons are better understood, experiment with possible solutions 4.1.3 Framework for co-implementation While the above activities aim at the development of practical models for intervention delivery at the community level, the business line will also undertake research and analytical activities at a higher level with the aim to better understand the basic factors that determine the strengths and limitations of models for co-implementation of community-based interventions, and how these can be further simplified This will include the development of a general framework for the costs, benefits and limits of co-implementation for different types of interventions through different delivery models As it evolves, this framework and the supporting evidence will be widely made available through the internet and communicated to health decision-makers, disease control programs and other partners at the country, regional and international level 4.1.4 Incentives and Empowerment An increasingly important problem in community based interventions is that different programs have different policies for financial incentives for community volunteers In the CDI strategy it is left to the communities themselves to decide what incentives, at their costs, are to be provided to volunteers and there are no external financial incentives made available This is a strategic decision aimed at strengthening the sustainability of CDI and limit its dependence on irregular external resources However, other community-based programs have different policies A study in Mali has found 14 different health programs that use community volunteers, all with different incentive policies ranging from no external financial incentives to payment per person covered A multicountry study is now being undertaken in several African countries, funded by APOC, with as first phase a situation analysis along the lines of the Mali study and a second intervention phase (that will be managed by the TDR business line) to develop and test possible solutions The business line will also undertake more fundamental social science research on financial and social incentives, and other motivating factors, for community volunteers in order to better understand the type of support they require to maintain their effectiveness over a prolonged period of time The business line will also support research on innovative approaches for enhancing community empowerment in health programs that can ensure that community priorities and needs have a greater influence on health policy and implementation Of particular importance Page 13 Business plan: Business line 11 – Integrated community-based interventions is the development of effective mechanisms through which communities can enforce their demands for intervention materials, such as drugs and ITNs, that are needed for the implementation of the community-based programs that they are responsible for As many health systems are weak, supplies are often irregular Communities are at the mercy of the supply chain and have no means to enforce their rights as implementers and clients This research will require advanced social science research to identify realistic and constructive opportunities for strengthening community rights within the context of the public health and political systems in the disease endemic countries Gender Gender is a critical factor in the delivery and uptake of interventions at the community level, and the research activities of this business line will systematically assess the role of gender in the planning and implementation process at the community level, and evaluate gender specific coverage of the interventions In community directed intervention approaches, the community is empowered to plan the implementation of the interventions itself In doing so, the community employs its traditional consultation and decision processes which are male dominated in most disease endemic societies Research on community directed approaches aims to determine how communities can best be empowered to take control of the delivery of multiple health interventions at the community level This research will include a detailed analysis of the role of gender in the decision process, and to what extent a reinforcement of the role of women within the context of the prevailing social cultural environment would strengthen intervention delivery and its sustainability Gender is also a major factor in the implementation of interventions, e.g women are the main care providers at the household level while men tend to be the deciders on related financial expenditures or on participation of household members in mass treatment campaigns Again, a proper understanding of the role of gender in implementation is critical for the development of more appropriate and effective intervention delivery strategies Both qualitative and quantitative research methods will be employed to document the role of gender and for identifying gender related opportunities to strengthen equitable delivery of interventions The scientific advisory committee of the business line will annually review the gender specific research activities and findings, synthesize the main findings for sharing with other business lines and reporting to STAC, and advise on the future direction of gender related research of the business line Research methodology development The research activities to be undertaken by this business line will be quite unique in international health research and involve the development and application of innovative research methodologies for large scale multidisciplinary, multicountry intervention studies covering health systems in disease endemic countries from the community up to the health district and national disease control program level Building on implementation research previously undertaken by TDR, the business line will further advance research Page 14 Business plan: Business line 11 – Integrated community-based interventions methodologies for complex multi-arm intervention studies, and document methodological innovations in the scientific literature Similarly, lessons learned on community participation, bottom-up processes in health system development and program implementation, and in translation of research findings into policy and practice, will also be systematically documented and shared with the scientific community 4.2 END-PRODUCTS The main end products will be evidence-based strategies for integrated delivery of multiple health interventions at the community level The specific end products are listed below under the four main objectives: Community directed interventions • Strategy for upscaling CDI for co-implementation of interventions against NTDs and Malaria in areas where community directed treatment is already established for onchocerciasis control (2009) • Strategy for CDI in areas where there is no onchocerciasis (2010) • Multisectoral intervention kits and community directed delivery strategies that address community priorities (2012) Other community-level delivery strategies • Delivery strategies for community based interventions in urban areas (2010-2012) • Delivery strategies for community based interventions in post-conflict areas (2012) • Strategy for upscaling deworming through School Health Programs in Africa (2011) Framework for co-implementation • Framework for co-implementation, with evidence on the costs and benefits of different co-implementation strategies, and on the type of interventions that are appropriate for co-implementation (2010-2012) Incentives and empowerment • Impact of conflicting policies for incentives to community volunteers documented and innovative solutions developed and tested (2010) • Mechanisms to strengthen communities' influence on implementation strategy and help them reinforce their demands for supply of intervention materials (2011-2012) Page 15 Business plan: Business line 11 – Integrated community-based interventions 4.3 INTERIM IMPLEMENTATION MILESTONES Community directed interventions (CDI) • Programs for upscaling CDI identified and agreement reached to include an implementation research component (2008) • Major obstacles to upscaling CDI identified, and studies launched to test possible solutions (2009) • Researchers selected through a competitive process for a multicountry study on CDI in areas where there is no onchocerciasis, research protocol finalized, research teams funded and studies started (2008) • Advanced socio-behavioural studies launched on community priorities and needs (2010) • Results of studies on community priorities used to define multisectoral intervention kits, and study started to develop and test appropriate delivery strategies (2011) Other community-level delivery strategies • Preliminary studies in urban areas completed, results analysed and used to develop protocol for testing alternative delivery strategies for urban areas in Africa (2008) • Researchers selected through a competitive process for a multicountry study on delivery strategies in urban areas, research teams funded and studies started (2009) • Consultation and review of experiences with delivery in post-conflict areas (2010) • Researchers selected for a multicountry study on delivery strategies in post-conflict areas, research protocol finalized, research teams funded and studies started (2011) • Literature review and consultation on obstacles and challenges to upscaling deworming through school health programs in Africa (2009) • Researchers selected for research on upscaling deworming through school health programs, research protocols developed and studies started (2010) Framework for co-implementation • Systematic review of information on costs, benefits and limitations of coimplementation strategies in different regions of the world (2010) • First version of framework on co-implementation developed and made available online (2010) Page 16 Business plan: Business line 11 – Integrated community-based interventions Incentives and empowerment • Fundamental social science research started on financial and social incentives, and other motivating factors, for community volunteers (2008) • Multicountry study launched to test possible solutions to the problem of conflicting incentive policies for community volunteers by different health programs (2009) • Advanced social science research launched on opportunities for strengthening community rights within prevailing public health and political systems (2009) • Multicountry study launched to test possible mechanisms through which communities can enforce their demands for intervention materials needed for implementation of community-based interventions for which they are responsible (2010) Page 17 Business plan: Business line 11 – Integrated community-based interventions RESOURCE REQUIREMENTS 5.1 BUDGET REQUIREMENTS The budget requirements are given in the table below for each of the four main objectives of the business line The costs of the different activities have been estimated on the basis of similar research projects undertaken by TDR in the past, and include the costs for multidisciplinary research teams to implement the studies, supporting activities such as protocol development and analysis workshops, skills training and standardization activities in multicountry studies, and independent site monitoring activities Four professional staff members will coordinate and manage the different research activities They consist of one business line manager, one sociobehavioral scientist, and two research project managers They will be assisted by three general service staff US $ x 1000 Objective 1.1 1.2 1.3 2.1 2.2 2.3 3.1 4.1 4.2 4.3 Description Community Directed Interventions Upscaling CDI CDI in areas without oncho CDI for other interventions Other community-level delivery models Urban areas Post conflict areas School health programmes Framework for co-implementation Review and development Incentives and empowerment Social science research on incentives Innovative solutions Community rights Total activities Personnel costs Page 18 2009 1,200 300 900 - 2010 690 150 300 240 2011 500 500 2012 500 500 2013 120 120 500 500 340 340 - 600 500 100 704 404 300 1,130 300 240 290 150 150 800 400 400 710 100 160 150 150 150 320 320 650 240 110 150 150 - 300 60 240 - 2,190 2,504 2,770 1,680 1,300 420 1,180 Professional staff General service staff Total 2008 1,350 450 900 - 1,180 1,180 1,180 1,180 992 3,370 3,684 3,950 2,860 2,480 3 1,412 Business plan: Business line 11 – Integrated community-based interventions RISKS Speed The research issues that this business line will address are currently of high priority in international public health, and the results are urgently needed to improve health care delivery to poor populations Any delay in the implementation of the business plan, and therefore in the delivery of improved intervention strategies, will delay improved health care for millions of poor people Delays would also negatively affect the credibility of the research exercise and reduce the likelihood of research findings being taken up Furthermore, international health is evolving fast and what presently is an urgent research question may no longer be so relevant in a few years time Hence, speed of research implementation and rapid feedback of research findings to disease control programs and ministries of health is of critical importance Research capacity in disease endemic countries For reasons of relevance and credibility of the research, it is essential that study design and research implementation is undertaken by scientists from disease endemic countries Not all disease endemic countries have the necessary capacity for this type of multidisciplinary research, and there is a risk that the research teams will be predominantly selected from more advanced developing countries That would limit the relevance of the research findings, and special efforts will therefore be undertaken to include in the studies also countries with limited research capacity and experience The presence business line will collaborate with the TDR empowerment business line to provide additional capacity building support for those countries, and thus ensure that they can also fully and effectively participate in the research activities Page 19 ... established for onchocerciasis control, and to determine the costs Page 11 Business plan: Business line 11 – Integrated community-based interventions and effort needed to establish such an integrated. .. needed for implementation of community-based interventions for which they are responsible (2010) Page 17 Business plan: Business line 11 – Integrated community-based interventions RESOURCE REQUIREMENTS... intervention materials (2 011- 2012) Page 15 Business plan: Business line 11 – Integrated community-based interventions 4.3 INTERIM IMPLEMENTATION MILESTONES Community directed interventions (CDI) •