The United Nations Solution Exchange platform

Based on an initiative by the United Nations, the Solution Exchange platform has garnered praise from around the world as an innovative way of harnessing global and in-country expertise, practice and institutional memory. By creating multi-stakeholder Communities of Practices (COPs) through a virtual network, this expertise and memory fosters learning and real-time “solutions” to a vast range of problems and challenges as identified by government, partners and others in each COP.  This process, in turn, accelerates the pace and quality of targeted advice, analysis and prescriptions that otherwise depend on physical committee meetings or field assessment missions.

SurfAid is an active particpant in the Health and Nutrition community. Below is a extract from one recent contibution from SurfAid throught Solution Exchange platform. It focuses on our integrated approach towards Dasa Wisma and Posyandu using the Care Group Model.

SurfAid have been implementing the Care Group Model in Nias for over two years. The program is entitled Community Base Health Program (CBHP) and is funded by NZAID. The Care Group Model is very similar to the Dasa Wisma structure under PKK. At the village level we integrate both with Dasa Wisma and Posyandu. WATSAN is also integrated with the CBHP.

Lessons Learnt

In the process of delivering the program SurfAid has absorbed some valuable lessons which can be informative to future program designs. Key lesson to caders and household visits include:

• Up to six months, before the beginning of the program, should be invested in the initial socialisation and community organizing processes to create a supportive environment that is embraced across the community by all stakeholders and households. This time frame can help to secure better active cadre participation and to overcome barriers that inhibit volunteers from confidently making household visits from the outset of the program. A community-wide approach is required, and should not be focused solely on the election of care group volunteers, but should include the identification of roles and responsibilities of other key stakeholders and of individual household members.

• The practice of household visits lies at the core of successful care group programs in other parts of the world. In Nias, making house visits is sometimes culturally difficult. Consequently it is necessary, to firstly understand the local culture with regard to household visits and secondly to find ways of making these visits easier. In CBHP the focus is on nutrition, and the introduction of PDI-Hearth has especially been successful in this regard and has helped build strong relationships between volunteers and the mothers who form the target group. Future project design should include PDI-Hearth as early in project activity as is feasible. Posyandu revitalization is critical prior to the implementation of PDI-Hearth to ensure other treatable illnesses do not inhibit rehabilitation of malnourished children.

·         Incentive systems are challenging generally, and in the Nias they have been particularly challenging. Most villagers receive handouts or payments for the work they do from government reconstruction projects, and often from other NGOs. SurfAid does not promote incentives but focus on rewards for achievement of community goals. There is a need to agree upon types of rewards early in the project and ensure their agreement is in writing and with multiple levels within communities. Rewards should be for group achievement of community agreed targets, and not given out simply for being elected as a volunteer or for attending care group meetings.

For sustainability we focused on developing relationships with a wide range of key stakeholders. This has been achieved through:

·         Establishing a series of formal stakeholder meetings, including representatives from the Bupati’s office, health departments and other official groups;

·         Placing specific emphasis on developing relationships with the health departments;

·         Working with local health department staff at Puskesmas and community level, focusing on revitalization of Posyandu services and up-skilling of key staff and volunteers.

The sustainability of CBHP inputs relies on care groups continuing to be active, and also on support from their communities, particularly from key stakeholders. SurfAid has focused on Posyandu for the process of delivering sustainability, at the same time as community health services centres. Communities generally support Posyandu, as they can see the benefits to their children (and themselves, in the case of pregnant women or new mothers). The focus on nutrition has demonstrated that there remain problems of malnutrition in almost every community. And the implementation of the hearth rehabilitation program, together with the establishment of a database for individual children, provides an invaluable opportunity for communities to see the practical benefits of their commitment from participation in CBHP.

Delivering an improved, high quality Posyandu service has already had the effect of galvanising communities through shared health-related objectives. Increasing the commitment and participation of health department staff, and improving the level of support throughout targeted communities, will be key objectives for the remainder of the current CBHP, and for any future programs.