Malaria continues to be a major contributor to public health and economic burden in Cambodia with high rates of morbidity and mortality, hence malaria control is a priority for Cambodia. The National Strategic Plan for Elimination of Malaria (2011-2025) aims to ensure that no artemisinin-resistant malaria parasites are detected in Cambodia by 2015, to eliminate falciparum malaria as well as malaria deaths by 2020, and to eliminate of vivax malaria by 2025, in line with the global call for elimination and eradication of malaria.

Program implementation in Kampot, Koh Kong, Preah Sihanouk, Kampong Chhnang, Kampong Speu, Pursat, Kep and Takeo provinces. The program focuses on information, education and communication (IEC)/ Social Behavior Change Communication (SBCC) interventions, particularly through community mobilization: raising awareness of malaria among at-risk populations, increases use of bed nets (particularly for children) and other prevention measures, and promotes individual awareness and self-protective changes for the general population. PfD is building the capacity of community health workers in effective IEC/SBCC tools and skills to effectively identify Key Affected Population (KAP) in or near their villages and to mobilize their communities toward health goals to achieve long-term sustainability.

Key Activities:

• Train, inform, and educate key village members (e.g., maternal and child health and mobile/ migrant population (MMP) key persons) about malaria risk, prevention, diagnosis, and treatment.
• Mobilize communities through strengthening relationships between VMW/health facilities and key community members for prevention and referral to VMWs/health facilities including tracking of case referral from community to VMW/HC
• Conduct BCC Impact Assessment (KAP Survey) and develop BCC interventions, IEC/BCC toolkits, and training materials; build capacity of existing sub-national health systems and staff.

Result of the program is on-going, but as of July 2017:

• Trained 253 health center staff on ToT approach for participatory community mapping and group identification and BCC approach
• Trained 11 Village Malaria Workers (VMW) on participatory community mapping and group identification and BCC
• Conducted the World Malaria Day in seven target provinces with average of 300 participants in each event
• Co-organized two kick – off workshop for consortium members and government health partners and national consultation workshop on BCC message and approach.
• Carried out Knowledge, Attitude and Practice (KAP) survey in eight target provinces with the results:
  • Proportion of population that slept under an insecticide-treated net* the previous night in target districts (77%)
  • Proportion of children under five years old who slept under an insecticide-treated net* the previous night in target districts (76%)
  • Proportion of pregnant women who slept under an insecticide-treated net* the previous night in target districts (73%)
  • Percentage of population at risk of malaria living in the targeted VMW/VHSGs villages who go to a VMW/VHSGs/MMW when they have a fever (5%)
  • Percentage of population at risk of malaria living in the targeted villages who correctly identify symptoms of malaria (79%)
  • Percentage of population at risk of malaria living in the targeted villages who correctly identify cause of malaria (83%)
  • Percentage of forest goers living in targeted villages who slept under an ITN the last time they were in the forest (71%)

PfD is piloting an early warning system in Kratie province to improve tracking the emergence and spread of drug resistant parasites. The approach combines the experience of PfD in implementing interventions towards mobile migrant populations (MMP) and at community level, the expertise of the London School of Hygiene & Tropical medicine (LSHTM) in conducting operational research in Cambodia on MMPs and on drug resistance and the technical skills and expertise of Pasteur Institute in Cambodia (IPC) in molecular epidemiology. The project focuses on the Cambodia-Vietnam border where recent research results have documented the emergence of artemisinin resistant strains in Bin Phuoc province in Vietnam and delayed parasite clearance time in Snuol area in Kratie province (with the potential threat to spread to neighboring Kratie province in Cambodia).

Key Activities:

• Conduct research to inform surveillance of drug resistance and establish an “early warning system”
• Measure drug resistance focusing on K13 (a protein that is strongly linked to artemisinin resistance)
• Strengthen tracking and information systems for MMPs
• Implementation of Plasmodium Falciparum (Pf.) Day 28 follow up and admission of Pf. Day 28 positive patients by health facilities to track drug resistance (train health staff on early diagnosis and treatment (EDAT) and second line treatment based on national treatment guideline; train VMW on EDAT)

PfD is piloting an early warning system in Kratie province to improve tracking the emergence and spread of drug resistant parasites. The approach combines the experience of PfD in implementing interventions towards MMP and at community level, the expertise of LSHTM in conducting operational research in Cambodia on MMPs and on drug resistance and the technical skills and expertise of IPC in molecular epidemiology. The project focuses on the Cambodia-Vietnam border where recent research results have documented the emergence of artemisinin resistant strains in Bin Phuoc province in Vietnam and delayed parasite clearance time in Snuol area in Kratie province (with the potential threat to spread to neighboring Kratie province in Cambodia).

PfD’s malaria prevention and control program, funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria, and in partnership with the Ministry of Health’s National Center for Malaria and Dengue, worked at a community level to prevent and control malaria. Engaging village volunteers, primary school students, teachers, village authorities, commune councils and local elected officials, PfD worked to encourage behavior change focused on prevention and treatment among rural populations. PfD  trained 1,345 teachers, benefiting 57,132 primary school students in health education. In 2014 alone, PfD trained 267 primary school teachers, reached over 57,000 individuals through community based malaria health education, and provided training for 500 new and existing Village Health Volunteers. Over the eight years that PfD has partnered with the Global Fund, PfD provided over 65,000 people with bed nets. This program improved access to early malaria diagnosis and treatment services, with an emphasis on detecting all new malaria cases (including among mobile/migrant populations) and ensuring effective treatment and P. falciparum gametocyte clearance. Also, PfD combated drug-resistant malaria parasites by improving access to appropriate treatment and educating the public against using sub-standard drugs and therapies. This was part of a larger strategy to promote awareness of malaria and change community understandings of how best to treat this endemic parasitic disease. PfD worked closely with local governments and health facilities to improve local capacity to fight malaria.

Improve and Expand Water and Sanitation Services in Nigeria: The Water and Development Alliance (WADA) III project in Nigeria will improve and expand access to safe, affordable, sustainable and reliable water and sanitation services in Abia and Cross River States, Nigeria. WADA is a unique partnership between Coca-Cola and the U.S. Agency for International Development (USAID) that addresses community water needs in developing countries around the world and is managed by the Global Environment and Technology Foundation (GETF)

Access to clean water and improved sanitation facilities is a daily challenge for many Nigerians. The program is designed to strengthen the capacity of local institutions; construct and rehabilitate WASH facilities; and promote hygiene education in schools, health centers and communities in Abia and Cross River states. Working with the Tulsi Chanrai Foundation (TCF), PfD will collaborate with government and private entities including the state Rural Water Supply and Sanitation Agency (RUWASSA) and Local Government Areas (LGA) to: increase access to and utilization of improved water sources; improve sanitation; and promote appropriate hygiene education in rural communities, schools and health facilities within the selected communities.

PfD will collaborate with the State Governments of Abia and Cross River to improve and expand access to safe, affordable, sustainable and reliable water and sanitation services in rural communities. More specifically, through the WADA Project, PfD will:
• Establish (where not available) and/or strengthen the capacity of the community institutions including WASHCOMs and Environmental Health Clubs (EHC) in schools to drive the implementation of WASH services in their respective communities
• Train and mentor established community institutions - WASHCOMs, VLOMs, EHC, etc. - WASH facility maintenance/repairs and management of facilities/services to ensure sustainability of project interventions
• Rehabilitate and/or construct water and sanitation facilities, including boreholes, latrines, and hand-washing stations in schools and healthcare facilities in 20 rural communities each in Abia and Cross River states
• The project will directly benefit 80,000 men, women and children in the target rural communities: Of these 80,000 beneficiaries:
 56,000 will have improved water access (at the household level)
 440 economically empowered women
 80,000 will have improved sanitation access
 220 economically empowered youth

The four focal areas of PfD’s community development work for the Allen Foundation in Stung Treng and subsequently Kratie province were: 1) economic development, particularly supporting rural livelihoods; 2) public health and sanitation; 3) public education and local capacity building, particularly improving community knowledge of health, nutrition, and agricultural practices; and 4) assessing and addressing problems in community infrastructure. A silk weaving training program was added to the project in 2001 with help from Veterans International. The World Food Program contributed rice to rice banks PfD built in Stueng Treng as part of its agricultural development support activities.

The project goal was to facilitate community development and quality of life within the eight communities. More specifically, through working with local structures such as Village Development Committees (VDCs), the project aimed to support community-initiated activities in: (a) economic development; (b) public health and sanitation; (c) public education and local capacity building; and (d) community infrastructure and communications.

The project completed “rice banks” in five villages across Stung Treng and Kratie. The banks have improved food security for poor farming households that are at risk of going in to debt or losing their land during periodic food shortages. Working through PfD, World Food Programme provided the rice stock for the banks to these community-constructed facilities. Members of the bank may then borrow from this stock during seasonal shortages; after harvest, borrowers then repay the bank with rice plus an extra 10% “interest” payment in rice. PfD also convinced local banks to provide credit for fertilizer and other key agricultural inputs.

With additional funding from the Allen Foundation, PfD also completed 100 latrines benefitting 567 community members, and provided sanitation education to families throughout the community.

The Agricultural Development Program exceeded its original objectives and close coordination with both the Provincial governments and Departments of Agriculture ensured successful implementation of the field programs. The four objectives of this program, improving agricultural productivity, enhancing household nutrition, supporting the Provincial Agricultural Extension Service, and improving access to markets, are interlinked and many of the activities completed by PfD spanned across more than one objective.

The first objective of the program was to improve agricultural productivity. PfD undertook a number of activities to accomplish this objective, including the introduction of new plant varieties, planting demo plots for farmer education, working with village veterinary workers and other volunteers to improve pig and poultry rearing, and introducing fish farming to households. Activities undertaken to achieve the second objective, to improve household nutrition, included introducing alternative farming techniques to combat cultivation difficulties during the dry season, incorporating fish farmed by the household into their diet, and the distribution of clay water filters. The third objective, to support provincial departments of agriculture was achieved through engaging associate staff to conduct field activities, conducting study tours to expose field personnel to developments abroad, training and providing support for field operations, and developing extension and training materials designed specifically for ADP activities. For the final objective, to improve access to markets, PfD designed, modified, and tested farm equipment for local manufacturing and commercialization and also collected information on market prices for a wide range of agricultural commodities.

In Cambodia, malaria is a health risk for an estimated 2.13 million people who live or work in close proximity to the tropical forests; and malaria remains one of the leading causes of death in Cambodia. Results from a 2007 large-scale survey indicate that mosquito net coverage (people sleeping under a net) was 80% in most high risk areas, but Insecticide-Treated Nets (ITN) coverage remained low (25%) despite re-treatment efforts. Due to poor health care coverage in endemic provinces, especially in remote locations, access to and use of quality malaria diagnosis and recommended treatment remains a challenge. This issue is inappropriately addressed by the informal and unregulated private sector currently used by 60-70% of Cambodian patients with fever cases. The program aimed to strengthen and scale up the most successful control activities.

In Phase 1 (GF-RCC Round 9), PfD conducted community-based interventions focusing on geographical and strategic areas where gaps have been identified and where government or other organizations have difficulty reaching. PfD focused on reaching out to mobile and migrant population (MMPs) by developing a strategy to work with MMPs, private companies, land development companies, owners of plantations and relevant local authorities at all levels including communities. PfD piloted the design and development of a forest package containing prevention, diagnosis and treatment products to be distributed through various channels to mobile and migrant population and local forest goers. In phase 1, PfD implemented programs in Stung Treng, Kratie, Koh Kong and Kampot provinces. In addition, PfD managed one international NGO sub sub-recipient (SSR) (Equal Access, now localized to Media One), and managed four Provincial Health Department (PHD) SSR in the four provinces. In Phase 2 (GF-SSF), PfD expanded these community-based interventions within Kratie and Koh Kong provinces.

Key Activities for GF-RCC/R9 (phase 1) and GF-SSF (phase 2):

• Case management: trained health staff, Village Malaria Workers (VMW), Mobile Malaria Workers (MMW), and Plantation Malaria Workers (PMW) on early diagnosis and treatment (EDAT), focused on MMPs
• Vector control: supported PHD/OD development of a mass distribution plan and mapped MMP; supported net distribution; designed and piloted forest package distribution for forest goers
• Surveillance: Performed Day 3 follow up of malaria cases to combat drug resistance by ensuring proper treatment
• Behavior Change Communication: created radio programming and community based malaria education; trained school teachers on malaria health education

Key Results:

• Trained 182 MMW and PMW on malaria diagnosis, treatment and health education; 888 Village Health Volunteers (VHV) on malaria health education; 441 School Teachers on malaria school health education using Child–To–Child methodology.
• Tested 4,285 patients suspected of malaria and treated 939 patients diagnosed with malaria; reached 121,354 individuals and 17,218 school children with community – based malaria health education;
• Distributed forest packages which could prevent malaria to 389 forest goers who were at risk malaria.

Final result: PfD achieved 91.4% of company/plantation workers who slept under an insecticide-treated net the previous night; 97.73% of school children who disseminated malaria prevention messages to their friends, families and other community members through various activities; and the forest package helped reduced malaria cases by 64% among forest goers.

In February 2012, PfD has partnered with John Snow Inc. (JSI) to implement the USAID-funded Targeted States High Impact Program (TSHIP) to reduce maternal and infant mortality in northern Nigeria. Together, PfD & JSI achieved this through capacity building exercises designed to:

1. Improve community engagement;
2. Improve the quality of local health care services; and
3. Improve health systems effectiveness.

JSI implements TSHIP in 43 local government areas across Bauchi and Sokoto States. PfD supervised the implementation of TSHIP across three areas in Bauchi State: Bauchi, Toro, and Tafewa Balewa. Nigeria has among the highest rates of maternal and child mortality in the world, and these predominantly rural states in northern Nigeria are among the most severely affected: in Bauchi State, under 5 child mortality remains at 260 deaths per 1,000 children, and the maternal mortality rate remains at a staggering 1,549 deaths per 100,000 births.
Partners for Development has improved community uptake of modern family planning, reproductive health, and MNCH services through a combination of capacity building exercises designed to improve the overall efficacy of local health systems in Bauchi, Toro, and Tafewa Balewa. These interventions, carried out with the consultation and full cooperation of local community leaders, included training-of-trainers activities; health education activities for health practitioners and community members on diverse topics such as children’s nutrition, family planning, prenatal care, and malaria prevention and treatment; and connecting community members to services through improving community-based health volunteers’ knowledge of the services available to families.

PfD surpassed the majority of its targets. In particular, PfD reached:

• 51,207 people through family planning counseling;
• 44,763 pregnant women who are receiving/have received IPT for malaria in prenatal care;
• 31,087 mothers & babies, who were assisted by TSHIP-trained skilled birth attendants.

The success stories PfD has collected from the HALE project illustrate the impact TSHIP’s health education programs have had on community health-seeking behaviors throughout conservative Bauchi and Sokoto States, reducing the number of women who give birth without skilled attendants, and dramatically increasing the number of women who access family planning and antenatal care services.

In 2007-2008, with support from the UN Family Planning Agency, PfD adapted its youth-focused behavior change curriculum to address issues of sexual and reproductive health in Cambodia. As in the United States, youth sex education is a difficult topic in Cambodia, and many teenagers are unaware of safe sex practices and HIV/AIDS prevention.

Working together with the Provincial AIDS Office, the Department of Women’s Afairs, and local health clinics, PfD organized a variety of community activities to educate young people in Kratie on safe sex practices. Activities included a sports tournament, community theater, parent education sessions, and teacher training workshops, and were designed to reach members of the community at all stages of life to promote a culture of responsible and healthy sexual behavior. PfD also hosted a youth forum on sexual and reproductive health, allowing young leaders the opportunity to educate their peers on safe behaviors and HIV/AIDS prevention. These young leaders were also invited to create community education dramas themselves. At the end of the project, the majority of youths surveyed expressed feeling confident in their awareness of safe sex practices and how to prevent HIV/AIDS, thanks in large part to PfD’s peer education initiatives.

From 2007 to 2011, with support from USAID and in collaboration with University Research Corporation (URC) and Cambodia’s MOH, PfD designed and implemented activities in: capacity-building; information, education and behavior change communication (IEC/BCC); formative and operational research; malaria case management and vector control in the northwest provinces of Battambang, Pailin, Banteay Meanchey and Oddar Meanchey.

PfD developed various innovative IEC/BCC strategies and materials, including the “taxi drivers” pilot project targeting mobile and migrant populations (MMP), based on PfD’s initial research and assessment of MMP travel tendencies. On this premise, PfD recruited and trained local taxi drivers on malaria prevention and treatment, and gave them IEC materials to distribute to their customers. Over 20,000 migrant workers received health education and IEC materials. Due to the success of the pilot, the Battambang provincial health department adopted it as one of its community-based malaria interventions.

Working in collaboration with the Provincial Education Offices in Kratie and Koh Kong, PfD designed a curriculum for educating children on malaria transmission and prevention for its School Health Education programs. Based on the Child-to-Child Methodology, this program enables school children to become peer educators and disseminate key messages to siblings, parents and the community through games, songs, activities and community theater productions. Over 55,700 children have been trained as peer educators in Malaria Health Education. PfD leveraged its expertise in school health education and child-to-child methodologies to work with the Ministry of Education, Youth and Sports (MoEYS) to develop a standardized national curriculum for malaria education in primary schools. The MoEYS approved the curriculum and integrated it into primary school classrooms. PfD trained 32 trainers from provincial and district education offices on how to work with teachers to disseminate and integrate the curriculum into school programs.

PfD, in partnership with the Pasteur Institute of Cambodia, the Institute of Research for Development and with support from the National Malaria Control Program, designed and conducted the “Malaria, Mobile Population and Migrants in the Context of Drug Resistance in Cambodia” study which shed light on the relationship between population movement, land development, malaria and the issue of drug resistance. As a result of this study, PfD developed a conceptual and operational framework using proxy indicators to define areas of concern for potentially imported malaria; emergence; and spread of drug resistance. By using this framework and geographical information systems (GIS), PfD was able to identify geographical areas of concern and to estimate the number of people in each of the three categories. PfD continues to refine this framework and develop it as an operational tool.

PfD played a critical role in building capacity among health professionals and community health workers. It designed and facilitated training workshops for health center and hospital staff in malaria prevention and health education; diagnosis and treatment, including severe case clinical management; logistics/drugs management; proposal writing and project cycle management, and selected and trained over 1,500 community members as Village Malaria Workers and Village Health Workers. PfD’s innovative interventions and research contributed to the development of strategies to address multi-drug resistant malaria in Cambodia, and the underlying challenge of mobile and migrant populations in this context.

In 2011, with a $250,000, 2-year seed grant from USAID, Partners for Development (PfD) implemented its “Providing Rural Communities Equal Care through Commercial Transport” (PROTECT) initiative in Kratie province. PROTECT was funded and implemented as part of USAID’s Saving Lives at Birth partnership to test an innovative approach to overcoming transportation barriers to maternal and newborn services in rural Cambodia.

The PROTECT project aimed to develop a replicable and financially sustainable model to ensure access to ante/postnatal care, and delivery and emergency obstetric care in remote, rural villages of Kratie province, in northeastern Cambodia. With local government guidance and management, PfD tested a model designed to leverage the strong local demand for reliable motor transportation to benefit the area’s pregnant women and new mothers. In addition to ensuring low trip costs, PfD negotiated 24-hour emergency transport service for these women by establishing fixed rates for emergency transport, guaranteeing the availability of transport providers, and creating a revolving village loan fund to provide immediate micro-credit to pay for the emergency travel.

In the 13 month period August 2012 – August 2013, a total of 584 emergency loans were made out of the VLF in the 25 villages. 248 of these (42.5%) were for maternal/newborn care.The remaining 336 loans (57.5%) were for other illnesses or accidents, particularly malaria or diarrheal diseases.

Between September 2011 and September 2013, PfD implemented PROTECT in all villages within two Health Center catchment areas, Prek Prasob and Kanchor, with an estimated combined population of 33,115. The members of each area’s villages are subject to the annual floods that make travel by road arduous and hazardous during monsoon season every year. PfD purchased seven remorque motorbike taxis and two stronger koyun tractor-esque taxis to navigate the steep and muddy hills surrounding Prek Prasob and Kanchor’s villages, and established contracts with the local Commune Councils to ensure their continued functioning in each community.

In partnership with the University of North Carolina, PfD performed a 27-month pilot study in Bauchi State – the Alive & Thriveprogram -- aimed at integrating microfinance activities with health initiatives. In Nigeria, fewer than 15% of infants under six months old are exclusively breastfed. By using microfinance meetings as a platform to teach young and expectant mothers the benefits of exclusive breastfeeding – whose benefits greatly increase an infant’s chances of survival – these vital lessons began to catch on. Findings from this study were published in the Journal of Nutrition, describing the benefits of pairing communal programming with educational messaging to produce positive results in new and lactating mothers opting to exclusively breastfeed newborns in their first 6 months of life.

PfD has carried out a microcredit and reproductive health program in four states in Nigeria for the last decade. Building on this experience, from May 2011 through August 2013, PfD and UNC conducted a cluster-randomized controlled trial in Bauchi State to test the effectiveness of a multi-component behavior change strategy to improve breastfeeding practices among microcredit borrowers. The intervention consisted of seven breastfeeding learning sessions held during monthly microcredit meetings, 11 cell phone breastfeeding messages (sent weekly as both text and voice), and songs and dramas about the key messages created by the participants themselves and presented at monthly meetings. The leader of the group was asked to share the weekly behavior change messages with group members, and the group had to create one song or drama per month.

The authors of the study concluded that, over time, the gap between the number of women in the experimental group and the number of women in the control group who were exclusively breastfeeding their babies only widened: as the babies got older, more and more women in the control group switched them on to water and solid foods, while women receiving microcredit and behavior change messages were likely to continue breastfeeding. The researchers concluded that “there were significant differences in exclusive breastfeeding to 3 and 6 months by study arm, and that the difference between the arms widened during this period shows that the intervention was successful at keeping more women in the intervention arm on track when Nigerian women typically introduce other fluids and complementary food to their infants (Flax et al 2014).”

Capacity Building of Local Institutions on WASH: With a Program Cooperation Agreement (PCA) funding from UNICEF, the program is designed to strengthen the capacity of local institutions to drive community-centered WASH Service Delivery. The project specifically targets five Local Government Areas (LGA) in Bauchi State and two LGAs each in three other states - Delta, Edo and Ekiti. It is funded through UNICEF by 1) DFID-supported Sanitation, Hygiene and Water in Nigeria (SHAWN); and 2) EU-supported Niger Delta Support Program (NDSP) and Water Supply and Sanitation Sector Reform Program (WSSSRP). PfD's role includes building capacity of Water, Sanitation and Hygiene Committees (WASHCOM), WASHCOM Federations and other local institutions to implement and advance WASH activities in rural communities.

The project goal is to strengthen the capacity of local institutions for effective, accountable and sustainable delivery of community-driven WASH and other developments in Bauchi, Edo, Delta and Ekiti States. The specific objectives of the project are:
• To form and strengthen LGA WASHCOM Federations through their role in monitoring and mentoring of community WASHCOMs in the 11 project LGAs;
• To train and mentor 80 selected, active or functional WASHCOMs on expanded roles for community WASHCOMs;
• To support establishment and strengthening of LGA WASH Coordination Forum across 11 project LGAs;
• To generate knowledge management with the development of three case studies and three human interest stories in at least 3 states.

PfD works with the local government Department of Environment (in charge of water and sanitation) and community WASH committees (WASHCOM), focusing on strengthening the ability of communities to identify needs, plan and implement WASH projects. By engaging local leaders who are committed to their own development, PfD ensures the sustainability of the WASH project.

The project currently benefits 2,530 rural communities across the 5 states including formation of WASHCOMs. Also, 11 LGA Coordination Forums and 11 WASHCOM Federations been established and trained in all 11 project LGAs and are currently supporting WASH service delivery in rural communities within these LGAs.

As a part of the USAID-funded Northeast Cambodia Community Development Program, PfD took an integrated approach to community health and well-being to improve the quality of life throughout Stung Treng. Specific initiatives targeted local water supplies, community environmental sanitation (particularly human waste management), HIV/AIDS education (particularly for members of the military and sex workers), and improving local government structures.

PfD’s USAID-funded Child Survival Program in Cambodia improved the health of children in Chhlong through immunizations, treating and preventing diarrheal diseases, and improving families’ knowledge of the basics of good child nutrition. The overall goal of the Child Survival Program was to improve the health of children less than five years old in Chhlong OD through control of diarrheal disease, immunization, nutrition and micronutrients, and promotion of breastfeeding.

PfD cooperated with local health centers to promote child vaccination throughout Chhlong, focusing primarily on common childhood illnesses that may be fatal without treatment, but which are easily prevented through vaccination. PfD also sought to reduce child mortality by working with individual families in Chhlong to prevent and treat childhood diarrhea, providing them with education and flipchart reference guides on how and when to use oral rehydration salts, and when to seek professional medical help.

As part of PfD’s “Minimum Package for Nutrition” initiative, PfD Cambodia provided informational materials on child nutrition and breastfeeding for training purposes to village health volunteers to help them communicate about these issues to local families. Training materials focused on Vitamin A deficiency and the importance of exclusive breastfeeding from birth until 6 months, as well as on general nutrition and health. This was combined with a Village Model Gardens program, where local volunteers created model gardens to demonstrate the cultivation and intercropping of highly nutritious fruits and vegetables.

In addition to these community-oriented activities, PfD worked closely with local health centers to improve the quality of local health systems. In particular, PfD helped hospital staff review oversight and vaccine management practices, ensuring sufficient stocks of sensitive vaccines be properly refrigerated.

Beginning in 2001, with support from the USDA and the David and Lucile Packard Foundation, PfD leveraged microfinance to deliver a targeted behavior change campaign. This program provided microloans to over 90,000 women, addressing critical issues such as family planning, birth spacing, mater¬nity care, newborn care & feeding, and post-partum care. PfD engages with com¬munity leaders and key influential groups to help perpetuate the program’s core messages on reproductive health and practices, shifting the responsibility to the entire community rather than allowing the responsibility to continue to rest solely on the women residing within these communities.

In April 2009, The David & Lucile Packard Foundation and Partners for Development (PfD) granted PfD a $1.5 million Program-Related Investment. PfD used this loan capital to implement microfinance activities in several Nigerian states through nine Nigerian microfinance institutions (MFI); they, in turn, distributed small loans to local individuals and groups to support agricultural and petty trading initiatives. This approach allowed PfD to remain lean while engaging qualified Nigerian organizations, utilizing their local knowledge and networks and enhancing their skills in loan and organizational management.
Separately in Nigeria and from 2001-2011, PfD had secured from the Foundation five different reproductive health grants. Thus, from the PRI’s inception in 2009 PfD integrated the two programs: it disseminated RH and family planning information to women of reproductive age through borrower groups. With the PRI capital, PfD:

• Oversaw the issue of over 77,000 small loans of about $300 average size, mainly to women (93%).
• Multiplied overall lending to end-borrowers by more than 15 times: total loan volume in the five year period was $23,409,123.
• Integrate microfinance and reproductive health and family planning programming into its other programs, such as Alive & Thrive, TSHIP, and EASE, reaching over 42,000 microloan beneficiaries with important health information.

The Packard Foundation’s support was integral in PfD’s ability to participate in research on breastfeeding promotion with UNC-Chapel Hill. A study completed in 2014 by UNC researchers in partnership with PfD concluded in The Journal of Nutrition that women receiving training in microfinance are nearly 50% more likely to exclusively breast feed at six months (64% of respondents) versus those mothers not involved in microfinance (43% of respondents).

The Global Fund to Fight Aids, Tuberculosis, and Malaria (GFATM) began its work in 2002, with funding made competitively available through “rounds” of multiple years. Over the course of these funding rounds, Partners for Development (PfD) has aimed to strengthen and scale up the most successful malaria control and prevention activities throughout five provinces of Cambodia: Kratie, Stung Treng, Koh Kong, Kampot and Mondulkiri.

Over the course of GFATM funding, PfD’s approach has been a community-based one: seeking to build the capacity of community level partners so that those partners can themselves sustainably undertake malaria prevention programs. Over the years, PFD program beneficiaries have included students and teachers receiving School Health Education and villagers and other community members receiving training through Information, Education and Communication (IEC) / Behavior Change Communication (BCC) programs.

The PfD strategy focused on decentralized, community-based, and health system strengthening approaches. The overall approach used is based on partnership and collaboration with the main stakeholders; institutional support for program management and disease surveillance at the provincial and operational district level; and the combination of implementation of proven interventions, pilot of new interventions, and survey/research at community level.

The three-party agreement known as the “Strategic Alliance” between the Cambodian Ministry of Rural Development, the World Bank Water and Sanitation Programme, and Partners for Development was signed on 13 September, 2001. The purpose of the Strategic Alliance was to assist Cambodian communities to gain sustained access to safe water and sanitation services through reform efforts within the rural water and sanitation sector. Partners for Development acted as the World Bank’s Water and Sanitation Programme’s Cambodia liaison and program manager under the terms of the Strategic Alliance.
The Alliance project, as originally conceived, was intended to be a 14-month project designed to meet the following four specific objectives in Stung Treng and Kampong Cham:

1. PDRD and selected rural communities develop the capacity to assess the effectiveness, equity of service, and sustainability of community RWSS services using the MPA tool;
2. Selected rural communities become skilled in the selection, financing, implementation, and maintenance of community RWSS services;
3. MRD develops the capacity and identifies the resources needed to scale up implementation of the RWSS sector strategy; and
4. The Alliance Project is effectively and efficiently managed within agreed budgets and schedules, and liaison between WSP-EAP, MRD, and PfD is maintained.

As a part of PfD’s work with the Family Health Care Initiative (FAHCI) in Nasarawa State, Nigeria in 2004-2005, it became evident that almost 100 individuals supported by FAHCI were struggling with the social impacts of their HIV/AIDS-positive status: manual labor could severely jeopardize their health, but they lacked the skills to support themselves in jobs that didn’t require it. In 2006, with support from the Embassy of the Netherlands, PfD launched a vocational skills training program for people living with HIV/AIDS (PLWHA).

The goal of the project was to empower PLWHA with income generating skills to make them economically self-reliant, as well as to increase their self-esteem. The main mechanisms for creating this change were:

1. the establishment of a vocational skills training center for PLWHA;
2. training PLWHA on fashion design and interior decorating (the skills most requested in consultation);
3. the creation of a sustainable source of credit to support PLWHA in their business endeavors.

The project was an overwhelming success, creating the following outcomes:

1. Local expertise in design: Two PLWHA were sent for training of trainers’ course on fashion designing/interior decorations at Mashiah Foundation in Jos. They have been employed to manage the skills acquisition center and have provided same training to 46 PLWHA (far more than the 15 that were proposed).
2. Stronger local microfinance institutions: PfD helped FAHCI learn to manage a revolving loan fund to provide credit to 15 PLWHA targeted in the project proposal. Technical assistance was provided in the areas of pre-loan training to intended loan beneficiaries and management of the micro credit program (including loan recovery; supervision of loan officers; credit program reporting; delinquency; and default management).
3. Sustainable micro-credit: FAHCI conducted pre-loan training to 46 PLWHA during the project period and provided loans to establish various business ventures in their communities. This component of program has a loan portfolio of 150,000 Niara provided loans to 46 PLWHA, each receiving an average of 5,000 Naira.
4. Sustainable skills training opportunities: The established skills acquisition training center now provides skills training not only to PLWHA, but also to other vulnerable community members. Beyond fashion designing and interior decorations, trainings are also provided in other vocations like making of handicrafts (beads, mats, etc.); dying of local fabrics; etc. This has not only helped sustain the skills acquisition center, but also increased income generating skills for community members especially women and youth. FAHCI has also used the opportunity of these trainings to deliver health messages particularly those related to HIV/AIDS to trainees.

With a population of approximately 174.5 million people, Nigeria’s HIV prevalence rate is only 3.7%. Nevertheless, this percentage still yields the world’s sec¬ond highest number of HIV positive adults and children. Due to a lack of education on disease prevention, HIV continues to spread in Nigeria. In 2008, PfD won an award from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) to implement a 5-year project entitled “Counseling, Care and Antiretroviral Mentoring Project” (CAMP) initially in two states – Akwa Ibom and Delta – in Nigeria. This award, a Cooperative Agreement, was administered through the Centers for Disease Control and Prevention (CDC) that provided technical and administrative oversight. The primary goal of CAMP was to provide a comprehensive package of care for People Living with HIV/AIDS (PLWHA), including adult and pediatric care and treatment, antiretroviral treatment (ART), care for Orphans and Vulnerable Children (OVC), Prevention of Mother-to-Child Transmission (PMTCT), and HIV Counseling and Testing (HCT) in Akwa Ibom and Delta states. In 2009, CDC approved the expansion of some components of CAMP--Prevention, PMTCT, HTC and OVC--to Benue and Bauchi states to meet pressing need in those areas. Also following the program’s initial success, a 2012 grant from UNICEF allowed PfD to further expand CAMP into Ughelli state.

CAMP provided a compre¬hensive package of care and treatment to people living with HIV/AIDS, including assis¬tance for orphans and vulnerable children, prevention of mother-to-child transmission, sexual prevention, and adult and pediatric care and treatment services. CAMP com¬bined facility- and community-based sup¬port for HIV-infected people to support their ability to access quality treatment. CAMP also supported the improvement of laboratory testing centers to help meet the demand for quick, accurate test results.

During the five years of implementation, PfD/CAMP worked with 7 local community-based organizations, 40 secondary health facilities and 67 primary health centers (public and private) to deliver services to people in need. PfD worked closely with staff and volunteers at local community based-organizations to build their capacity to deliver important information on HIV/AIDS. With this training, community-based organizations have been able to conduct numerous sensitization campaigns, prevention messaging, testing and counseling, home‐based care and facilitated activities for OVC within target populations. Ultimately, CAMP reached over 105,000 members of its key target groups with important information about preventing and treating HIV/AIDS, and helped 51,000 pregnant women learn their HIV status for the first time.

With support from United Nations Children’s Fund (UNICEF), Partners for Development (PfD) implemented a 13-month program to increase the prevalence of HIV/AIDS prevention services for pregnant women, to prevent them to passing the virus on to their children in the womb. The project helped reduce mother-to-child transmission of HIV in the Ughelli North area of Nigeria by improving the availability of, access to and use of quality of HIV testing and counseling services, the provision of antiretroviral drugs, and strengthening the state’s health system response to HIV by building the capacity of 26 health facilities in area.

Through this support and with leveraged funds from Centers for Disease Control and Prevention (CDC), PfD renovated, upgraded and equipped (with modern automated equipment), the laboratory of Central Hospital Ughelli to be able to perform HIV diagnostic services; trained over 150 health care workers (doctors and nurses) to provide HIV/AIDS management services in these facilities; and worked with its partners to identify key weaknesses, and subsequently improve the way the hospitals acquired and handled sensitive testing equipment and life-saving medications. PfD also established referral linkages between the primary health facilities and the secondary facilities, as well as between skilled/traditional birth attendants and health facilities.

As a result of PfD’s UNICEF-funded interventions:

• 8,475 women received counseling and testing for HIV/AIDS
• 168 HIV+ pregnant women receiving complete course of ARV prophylaxis
• 168 women/HIV+ women received counseling and support to help them feed their infants and retain HIV- status in their children
• 157 children received ARV prophylaxis

The projects target beneficiaries included Sex Workers - infected with HIV/AIDS, as well as focusing on Awareness and Counseling.

PfD’s USDA-funded JANI (Jatropha Agriculture and Nutrition Initiative) provided a wide range of agricultural skills trainings and opportunities for rural communities during its five-year run, which ended in 2013. Through this $7 million Food For Progress initiative, PfD expanded the cultivation and processing of Jatropha curcus in 18 districts of eight regions in the North, Central and Lake Zones of Tanzania. Jatropha is a renewable energy source that can be processed into cooking oil and into pellet fuel for new, locally manufactured, clean-burning cookstoves, known as Jiko Bomba stoves, which PfD developed and marketed in cooperation with local manufacturers. Improving the availability of clean-burning fuel and stoves not only reduces the need for families to cut wood from Tanzania’s depleted forests: cleaner burning fuels also improve indoor air quality, the leading cause of respiratory illness in women and children in sub-Saharan Africa. Jatropha also serves as a valuable hedgerow for family enclosures, and jatropha-oil can be made into soap.

Through PfD’s signature integrated programming approach—involving agricultural extension, nutrition education, livestock vaccinations, enterprise development, and creating market linkages—JANI improved vulnerable agricultural communities’ food security by achieving the following core objectives in Tanzania:

• Diversifying and increasing household income with jatropha cultivation through training in the cultivation and processing of jatropha and by creating market linkages between farmers and buyers of jatropha seed and oil.
• Strengthening local capacity to promote jatropha by strengthening capacities of local extension agents, implementing entities and local outreach organisations working with PfD to promote cultivation, processing and sale of jatropha oil with smallholder farmers.
• Improving food security and nutrition for jatropha farming households through community nutrition education campaigns and technical assistance in household food production.

Through collaboration with 13 local partners, PfD trained over 42,000 farmers in Jatropha cultivation and processing, distributed over 1 million jatropha seedlings, and sold no less than 59 tons of jatropha seed. Demand for jatropha pellets for improved cookstoves now exceeds supply.

With support from the McKnight Foundation, PfD partnered with the Kratie-based Cambodian Rural Development Team (CDRT) to implement a wide range of community development activities to improve food security and the overall health of four communities within Damrei Phong. Highlights from the program include:

• The installation of a cement biodigester, used to capture methane gas from decaying waste for use as a household cooking fuel. This simple, sustainable technology can reduce deforestation, reduce women’s time spent gathering fuel, and substantially reduce the rate of respiratory illnesses in women and children.
• The creation of four new fish aquaculture ponds and the rehabilitation of three existing ponds, enhancing the livelihoods of fish-farming families and improving the availability of affordable sources of protein within Damrei Phong;
• The construction of 42 household rain water collectors and three pagoda rain water collectors. Damrei Phong experiences serious water security issues, and the construction of rainwater collectors allows villagers to easily store water at their homes for household consumption and facilitates agricultural production. The project also distributed 376 water filters to families in the four target communities.
• The Project Team assisted 74 families with the construction of household latrines, effectively increasing latrine access from one in 100 families to approximately one in eight families over the course of a year.