MULTI-DIMENSIONAL PROGRAMMING:

The Rubik’s cube challenge to community health

The Rubik’s cube challenge to community health - plenary

• Brief Introduction to the session

• The World Café Rubik’s Cube Challenge: combination of World Café and speed dating

• Panel representing different perspectives and experience

Why the cube?

To try to grasp all the dimensions of community health, and understand what makes programs successful,

We have tried so many models….

And Frameworks….

The Community Health Framework WHY should we care about community health? Community health is foundational to attaining many of the SDGs.

WHERE can we find examples of effective models and innovations for community health? This framework includes a library of existing models across each component of community health as well as detailed case studies.

TOOLKIT

HOW can we take action to strengthen community health ecosystems? A five step process can help leaders bring the right data to bear for decision making, and set up sustainable community health programs with clear accountability.

WHAT is needed to create a strong community health ecosystem? An ecosystem of heath specific and health enabling actors and structures, both formal and informal, working together and supported by the agency, access, and resources needed to ensure the health of community members: • Agency, e.g., awareness of needs,

empowerment, and ability to act; • Access, e.g., access to care, access to

referral systems; and, • Resources, e.g., financial resources,

medical suppliers.

HOME

LOCAL COMMUNITY

DISTRICT / NATIONAL

HEALTH SPECIFIC

COMPONENTS DISTRICT & NATIONAL

CARE

COMMUNITY LEVEL CARE

COMMUNITY MEMBERS

FAMILY MEMBERS

LOCAL COMMUNITY

DISTRICT & NATIONAL

COMMUNITY

HOME LEVEL PROVIDERS

HEALTH ENABLING COMPONENTS

AGENCY

ACCESS

RESOURCES

ANALYZE BOTTLENECKS

DEVELOP OR STRENGTHEN

PROGRAMS

SET TARGET OUTCOMES

UNDERSTAND EXISTING

COMPONENTS

IMPLEMENT, MONITOR & EVALUATE

And more frameworks…..

Community health can be visualized as a series of components working together to serve community members (1/2)

DISTRICT & NATIONAL LEVEL CARE

COMMUNITY LEVEL CARE

COMMUNITY MEMBERS

FAMILY MEMBERS

LOCAL COMMUNITY

DISTRICT & NATIONAL

COMMUNITY

COMMUNITY HEALTH

HOME

LOCAL COMMUNITY

DISTRICT / NATIONAL

HOME LEVEL PROVIDERS Formal or informal actors

and structures focusing exclusively on health

Formal or informal actors and structures that play a

supporting role in health

HEALTH SPECIFIC

COMPONENTS

HEALTH ENABLING COMPONENTS

AGENCY, e.g., awareness of needs, empowerment and ability to act

ACCESS, e.g. access to care, access to referral systems

RESOURCES, e.g. financial resources, medical supplies

Source: Dalberg analysis

WHY WHAT HOW WHERE

Agency - the capacity for purposive action, the ability to make decisions and to pursue goals free from violence, retribution, and fear Kabeer, Naila. 1999. “Resources, Agency, Achievements: Reflections on the Measurement of Women’s Empowerment.” Development and

Wheels.... SHAPES

http://www.mtyhd.org/index.php/data-publications/public-health/social-determinants-of-health/health-in-all-policies/ Monterey County Health Department

Bubbles or flowers

Remember this? CORE’s attempt to represent the multisectoral platform and interaction of key CIMCI program elements

But these don’t capture the dynamics, relationships,

movement… they are too FLAT

Sectors: public, private, business, non-profit; or agriculture, employment, education, economy-poverty, environment, built environment, civil society, governance, energy…; or RMCHAN, FP, RH, WASH, NUT,HIV, TB, FS, EPI, HSS, SBC… Determinants: Individual, family, community, culture, society, poverty, beliefs, geography, climate, conflict, disasters, politics, justice, gender, sex, health system, …. Community, partnerships, stakeholders, assets, funding, donors, constituents, policy, advocacy, human resources, logistics, supplies, access, utilization, communications, management, data, research, ……………..

How have you solved/built it? What did you miss? What does it look like to you?

What are the facets of your cube?

The Rubik’s cube has 42 Quintillion possibilities but only one correct solution

World Café Built on the assumption that… People already have within them the wisdom and creativity to confront even the most difficult challenges; that the answers we need are available to us; and that we are wiser together than we are alone. Sounds like CORE Group!

Three progressive rounds of conversation ROUND ONE – 10 MINUTES!! • Think of a time you were involved in a

successful community health program. In addition to your hard work, what “dimensions” made that success possible?

• Draw a picture or map, write a note, and share with your table mates in 1 minute about that experience.

• One person remains

ROUND TWO – 10 MINUTES!! Think of a time you were involved in a program that did not meet the expectations of the community, organizations, partners or funders. Maybe it wasn’t a failure, but not a complete success. • What dimension was missing that you now

recognize? How can these factors improve future programs?

• Draw a picture or map, write a note, and tell your table mates in 1 minute about that experience.

• One person remains

ROUND THREE – 10 MINUTES!! Now, after thinking about your experiences, and hearing those of others, • How do you envision the multiple dimensions

involved in community health and development?

• Draw a picture or map, write a note, and tell your table mates in 1 minute about what you envision

Panel

• Video presentation from CRS Ghana’s partner District Health

• World Vision International regional and WV national perspective

• IRCO US CBO working cross-culturally, with many stakeholders and partners

Esther Indriani Regional Specialist for Maternal Child Health and Nutrition, World Vision South Asia and Pacific Ocean Region

Lee Po Cha Executive Director Immigrant & Refugee Community Organization (IRCO), Portland, Oregon