BL 11 Business Plan 2008-2013: Integrated community-based interventions ppt

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
1. OBJECTIVE ........................................................................................................................5
1.1. OVERALL OBJECTIVE................................................................................................5
1.2. SPECIFIC OBJECTIVES ...............................................................................................5
2. NEEDS AND OPPORTUNITIES ......................................................................................6
2.1. NEEDS............................................................................................................................6
2.2. OPPORTUNITIES:.........................................................................................................7
3. COMPARATIVE ADVANTAGE ......................................................................................8
3.1 TDR COMPARATIVE ADVANTAGE ..........................................................................8
3.2 SYNERGIES WITH OTHER ORGANIZATIONS.........................................................9
4. ACTIVITIES AND END PRODUCTS............................................................................11
4.1 KEY ACTIVITIES.........................................................................................................11
4.2. END-PRODUCTS ........................................................................................................15
4.3. INTERIM IMPLEMENTATION MILESTONES........................................................16

5. RESOURCE REQUIREMENTS .....................................................................................18
5.1 BUDGET REQUIREMENTS........................................................................................18
6. RISKS..................................................................................................................................19

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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 do 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

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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-

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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.

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Business plan: Business line 11 – Integrated community-based interventions

1. 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

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Business plan: Business line 11 – Integrated community-based interventions

2. 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 do 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.

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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.

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Business plan: Business line 11 – Integrated community-based interventions

3. 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

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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.

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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.

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Business plan: Business line 11 – Integrated community-based interventions

4. 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

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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 do 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 do 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 do 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

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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

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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

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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:
1. 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)

2. 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)

3. 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).

4. 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)

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Business plan: Business line 11 – Integrated community-based interventions

4.3. INTERIM IMPLEMENTATION MILESTONES
1. 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)

2. 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)

3. 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)

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4. 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)

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Business plan: Business line 11 – Integrated community-based interventions

5. 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
1.2
1.3
2
2.1

2.2
2.3
3
3.1
4
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

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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

4
3
3,370

4
3
3,684

4
3
3,950

4
3
2,860

4
3

2,480

3
3
1,412


Business plan: Business line 11 – Integrated community-based interventions

6. 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.

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