Integrated Framework, Part 1: Integration Entry Points

Integrated Framework, Part 1: Response Cycle Stages and Integration Entry Points

Strategic Leadership and Coordination Planning Proposal Development and Project Design Program Implementation Monitoring, Evaluation, Accountability & Learning (MEAL)

Response Cycle Stage

Strategic Leadership and Coordination

Each section below explains an integration entry point applicable to this stage of the response cycle, offers practical tips for implementation, and describes examples of how this has worked in specific humanitarian settings.

1. Partnerships

1. Agree to apply a response-wide holistic approach to local partnerships to ensure community-led solutions, safe and hygienic environments, and access to basic services and social care during quarantine or isolation. This action might require a change in mindset and creative leadership to ensure success.

TIP: Build on pre-existing relationships to lobby national line ministries, UN agencies, and NGOs through the cluster system as well as country donors to establish COVID-19 Task Forces represented by various key sectors and technical areas. Diverse Task Forces demonstrate a collective voice in protecting communities from COVID-19 and advocate for their respective policies. Ensure task forces include RCCE and Protection (including child protection and gender-based violence) representatives and that a mechanism exists for closing community age- and gender-sensitive feedback loops across sectors.
TIP: If your NGO is a multi-sectoral agency, form a senior-level COVID-19 Task Force within your organization representing the various sectors and technical areas to determine a response strategy that considers protection and will move away from siloed programming. Determine measurable and achievable benchmarks for successful outcomes based on meeting the beneficiaries’ holistic needs rather than individual sector successes. Identify methods for assessing protection outcomes throughout all sectors.

2. Integrated Goal Setting

2. Commit to multi-sector collaboration by agencies and teams to secure integrated goal-setting. Ensure that priority cross-cutting issues (e.g., age, gender, RCCE) are represented at all stages.

TIP: Establish national and regional Quarantine Working Groups and enlist one representative from each sector to participate in these working groups. Ensure representation of protection staff, including general protection, child protection (CP), and gender-based violence (GBV).
- This suggestion is not to replace the cluster system or other national/regional coordination mechanisms but rather to enhance coordination by including a working group inclusive of all sectors and open to community representation.
- Lean on existing community-based structures to ensure continuous formal/informal community leaders’ and community representatives’ engagement from the planning stages throughout the quarantine and isolation measures. This approach allows the group to seek input, endorsement, and feedback, ensuring age and gender inclusivity and vulnerable groups’ considerations. Establish a mechanism for collecting community (including child-friendly mechanisms) perceptions (including other ideational factors related to quarantine and isolation) and community feedback.
TIP: Ensure active engagement of the non-health cluster/actors throughout all phases to identify and mitigate risks. For example, including protection actors ensures appropriate psychosocial support activities, capacity building of multi-sectoral staff on the Centrality of Protection, and establishing a referral mechanism for child protection case management services.

3. Organizational Leadership

3. Ensure that everyone is aware of why the organization, working group, or consortium has chosen an integrated approach. Understand that they contribute collectively to meeting its objective(s) – for example, via a briefing session, articulating the vision, benefits, and the operational realities to make this happen.

TIP: Use Community of Practice workshops as a platform to orient respective project teams and technical specialists on what integrated programming is, the proven benefits, and what it means for their thematic sector, including sharing best practices, opportunities, and challenges. Program staff needs to understand and feel they are part of a larger team versus one that is driven by a specific sector or project funds. This perspective includes support staff, such as drivers assigned to the COVID-19 response versus a sector-specific team.

Examples from country humanitarian responses

Save the Children Uganda developed a joint advocacy briefing at the start of the crisis. They worked in a consortium and across civil society to highlight school closures’ holistic impact on children’s learning and overall well-being, including protection risks.
Several countries (e.g., Bangladesh, Vietnam) have established national One Health coordination platforms and strategies with defined activities and emergency operations protocols. For example, Cameroon rapidly mobilized a multi-sectoral team for investigating a monkeypox outbreak in chimpanzees. The team comprised focal points from four ministries but required authorization from only one ministry.^[6]
Utilize existing coordination platforms established during a non-emergency period to serve the current humanitarian context. For example, the Scaling Up Nutrition (SUN) Movement and the Maximizing the Quality of Scaling Up Nutrition Plus (MQSUN+) projects have supported countries in spearheading task forces/workshops to plan, develop, and implement multi-sectoral nutrition action plans (MSNAPs). While geared towards nutrition, the forum brings together a broad range of sectors, including health, women’s affairs/gender, agriculture and food security, WASH, education, social protection, etc. MQSUN+/SUN supports countries in rolling out these integrated nutrition programs and can help bring the various actors together for the COVID-19 response.

^[6] https://p2.predict.global/strengthening-health-security

Response Cycle Stage

Planning

The sections below explain integration entry points applicable to each stage of the response cycle, offer practical tips for implementation, and describe examples of how this has worked in specific humanitarian settings.

4. Integrated Assessments

4. Develop integrated assessments for different community groups’ needs, perceptions, concerns, and capacities. Community engagement in developing rapid assessment tools and carrying out rapid assessments are invaluable to this process.

Multi-sector initial rapid assessments already exist^[7], and agencies should tailor these to be further integrated in the context of COVID-19.

International Federation of Red Cross and Red Crescent Societies (IFRC) provides operational guidance on conducting integrated rapid assessments.^[8]

^[7] https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/mira_revised_2015_en_1.pdf
^[8] http://webviz.redcross.org/ctp/docs/en/3.%20resources/1.%20Guidance/2.%20Additional%20CTP%20guidance/2.%20Assessment/IFRC-operational_guidance_inital_rapid-en-lr_3.pdf

5. Data Collection

5. Given movement restrictions and limited access to communities, maximize the use of secondary data available across all sectors and agencies for needs analysis and beneficiary targeting.

Always critically consider the quality of secondary data; consider who, when, how, and where the data was collected, the data collector’s intent, and whether the data is consistent with other sources.

TIP: Consider alternatives to in-person interactions, such as telecommunications approaches or source data captured through other sectors or surveys such as DHIS data; KAP and perceptions surveys that may include health-seeking behaviors or protection policies; donor and/or NGO reports particularly on responses for prior outbreaks, e.g., Ebola or Cholera responses; data routinely collected by government line ministries, e.g., agricultural outputs, EWARS data, etc. Check with regional or national technical working groups to locate sector-specific data.
TIP: Consider using the Needs Identification and Analysis Framework for Child Protection Response Planning During COVID-19.⁹ The framework provides recommended indicators and maximizes data analysis use from other humanitarian sectors to produce a reliable Child Protection Analysis.

^[9]https://docs.wfp.org/api/documents/WFP-0000115227/download/

6. Operationalizing Integration

6. Ensure operations and programs colleagues plan how to operationalize integration and regularly discuss their challenges and the progress of the integrated delivery. This activity may be a prioritization exercise as some activities may not be integrated from the start. We recommend that you prioritize protection activities for integration to diminish harm at a later stage. Determine a process for deciding which activities will be prioritized and identify the criteria for a phased approach.

TIP: Review contingency plans for staff safety and review methods for team communication. Ensure that the age, gender, and social inclusion analysis outcomes inform staff and community safety and security plans. Ensure that work plans, procurement plans, budget review meetings, mid-term reviews, and end-of-project reviews are designed from the project’s start as collaborative efforts between operations and program staff.

7. Risk Communication and Community Engagement (RCCE)

7. Develop a joint RCCE plan that outlines priority behaviors and available services across all sectors. This plan can be developed into localized messaging based on community-level data. Typically, integrated SBC programming involves developing a single coherent strategy and groups behaviors that are:

practiced by the same audience or people accessing the same services;
influenced by the same social norms or individual level factors;
preceded by the same gateway behavior or pertain to co-occurring health or development conditions.

In an emergency context, it is also important for messages to include links to services related to the impacts of COVID-19 and public health measures.

As part of the emergency pillar, in collaboration with national RCCE working groups, share what you hear in communities with other teams—for example, rumors or concerns about COVID-19 or an increase in gender-based violence. Work together with the communities to address these issues (e.g., support for gender-based violence) and close the feedback loop.

Ensure all messages and activities specific to different audiences, are sensitized for age, gender, and inclusion, and are accessible for community members who are most in need and marginalized.

Prioritize and phase messages to avoid information overload and response fatigue.

TIP: Refer to READY’s COVID-19 RCCE Toolkit for guidance and tools that can be used to plan and integrate RCCE into every stage of the COVID-19 response.
TIP: Ensure messages are tested with relevant community groups before wider dissemination. For example, child-friendly messaging should be piloted with children to elicit their understanding of the message and make adaptations accordingly.
TIP: In coordination with the Accountability to Affected Populations (AAP) groups, consider preferred and adapted communication styles to reach those self-isolating.

Examples from Country Humanitarian Responses

United Nations World Food Programme (WFP), United Nations Children Fund (UNICEF), and the United Nations High Commissioner for Refugees (UNCHR) conducted a joint multi-sectoral rapid needs assessment for COVID-19 in Jordan.^[4]
Examples of country-specific multi-sector assessments are available through the REACH Initiative.^[5]
Save the Children Bangladesh, Save the Children Philippines, and Save the Children Lebanon conducted remote consultations with children to find out how COVID-19 has affected their lives. These consultations were holistic and did not have a single sector focus.
Save the Children’s Ethiopia EFSP COVID-19 award has a work plan integrated across food security (cash transfers), WASH, and health. Integration happens at the individual, household, and community levels. At the individual and household level, cash transfer beneficiaries are also being enrolled in community health insurance schemes to help them access health services. WASH activities like water trucking, building hand-washing facilities, and hygiene promotion are conducted at community health centers near targeted households.

⁴ MULTI-SECTORAL RAPID NEEDS ASSESSMENT: COVID19 -JORDAN (https://docs.wfp.org/api/documents/WFP-0000115227/download/), 27 अक्टूबर, 2020 को एक्सेस किया गया।
⁵ Multi-sector assessments (www.reachresourcecentre.info/theme/multi-sector-assessments/), accessed on October 27, 2020

Response Cycle Stage

Proposal Development and Project Design

8. Integrated Funding Proposals

8. Review proposals and projects to position the agency or consortium of agencies for integrated funding that promotes holistic programming and explicitly works to advance a community-centered approach that is age and gender-sensitive. Lobby donors on the integrated response framework to encourage more funding for integrated programming.

TIP: In proposals, present the NPIs of household quarantine/isolation or quarantine centers/CICs as a model that will require cohesive, multi-sectoral interventions for it to be well-received within the community and thereby successful in mitigating the impact of COVID-19 among individuals, households, and the community.
TIP: Prioritize protection activities since early detection, referral, and mitigation mechanisms can significantly reduce harm further down the line. For example, new frontline workers should be trained to identify protection needs, handle disclosure, and conduct safe referrals.

9. Community Groups

9. Based on multi-sectoral assessment data, sectors should determine the integrated targeting of community groups. This approach helps to build rapport and trust between community members and an agency while reducing community fatigue from various NGOs, repeatedly asking the same questions in the same community while saving time and using funds more efficiently.

An inclusive multi-sector approach will meet the specific needs and concerns of these different beneficiaries—women, unaccompanied children, adolescent girls, migrants, persons with disabilities, residents of urban slums, and so on.

TIP: Joint targeting of individuals in quarantine/isolation or quarantine centers/CICs will involve different sectors proposing interventions to meet or support their needs to ensure adherence to NPIs. For example, individuals in quarantine should have health, food and nutrition, water, sanitation and hygiene, and psychosocial needs fulfilled daily during their quarantine period. Needs will differ depending on the context.
During their quarantine/isolation period, individuals can also receive health education on COVID-19 or other health topics. They discuss their concerns and questions and be referred to services they may need during or immediately after their quarantine (e.g., protection services or cash voucher assistance). If individuals feel reassured that they are receiving the care and services they need while in quarantine, then they are more likely to adhere to the quarantine measures.

Examples from Country Humanitarian Responses

In Sierra Leone, the Social Mobilization Action Consortium (SMAC) was established during the Ebola outbreak in 2014. The consortium was led by GOAL and included BBC Media Action, US Center for Disease Control and Prevention, FOCUS 1000, and Restless Development. SMAC delivered evidence-based social mobilization activities that involved communities at every stage of the process and resulted in behavior change around safe burials, early detection and treatment, and social acceptance of Ebola survivors.
In Bangladesh, the Child Protection Sub Sector advocated having Child Protection Volunteers visit the quarantine centers daily to provide psychosocial support, run basic activities with children, and check on unaccompanied children’s well-being.

Response Cycle Stage

Program Implementation

10. Human Resources

10. Recruit and train for integrated positions that serve multiple sectors (e.g., Health, Nutrition and WASH Officers, or Nutrition and MHPSS counselors) or combine technical and operational roles (e.g., Health Manager & Medical Logistician). Recruit an SBC/RCCE specialist to serve as a generalist across all sectors to ensure an integrated community-centered approach at all levels.

TIP: Recruit technical leadership positions with clear mandates across sectors, for example, the position of Public Health Lead, who has the role of bringing protection, health, nutrition, and WASH programs together to design program approaches and activities jointly. This position also clearly articulates the expectations for a Program Director or Program Manager position to actively promote and support cross-sectoral collaboration on the key platforms (assessments, joint targeting of beneficiaries, community mobilization, etc.).
TIP: Ensure all staff receive training on Child Safeguarding (CSG) and Preventing Sexual and Exploitation Abuse (PSEA). Incorporate role-plays of handling disclosure, including signing a code of conduct and understanding reporting mechanisms and whistleblowing policies.

11. Shared Community Engagement

11. Age and gender-sensitive community engagement and community feedback loops at every stage of the project cycle are critical to acceptance, participation, implementation, and successful outcomes. Shared community engagement requires sectors to engage communities around community-led solutions to COVID-19 and public health measures and their impacts. This engagement might include locally contextualized messaging, activities, and shared program outcomes that address individual, household, and community needs’ rather than sector-specific objectives.

TIP: Train staff on how to engage with communities to ensure an integrated, community-owned, and led response. Trainings should include technical information on how to identify community leaders and groups to partner with and community-specific issues around health concerns, and then how to prioritize addressing these concerns.
TIP: Develop and execute a joint action plan with communities on how to monitor and share data with and by communities, including women and children.
TIP: A multi-sectoral community-led response may not always need agencies to address community concerns if a more sustainable approach means that the communities can address issues with their own capacities and resources. Agencies can support communities in facilitating these discussions and tapping into available resources using READY’s six-step process for community engagement during COVID-19.

12. Shared Resources

12. Share resources and identify collaborative opportunities for integrated entry points between teams and sectors within the same organization or multiple agencies to maximize access to affected communities.

TIP: Include multiple teams in distributions. Build the capacity of community health workers to provide referral information for multiple sector services. Use physical spaces such as quarantine facilities/CICs to raise awareness on COVID-19 as well as other issues such as gender child protection or gender-based violence or how to enroll in mobile money programs to increase access to contactless money transfers.
TIP: Include child protection case management staff in contact tracing activities to identify alternative caregivers if and where necessary. Utilize community mobilization teams to identify families at risk of separation.

13. Integrated Referral Systems

13. Develop and maintain an updated and effective integrated referral system to link services between and across the different sectors and ensure staff within each sector know: how, what, and where to refer beneficiaries for different services. Ensure messaging across sectors have links to various referral services.

TIP: Maintain a simple list of priority RCCE messages, services, contacts, and referral pathways and share this material with all sector teams. When any staff member or volunteer is in contact (by phone, SMS, online platform, or in person where that is possible) with affected individuals, they have all the information to provide referrals and the training to do so sensitively.
TIP: Update service mappings and referral pathways to reflect the new reality. Work with the Protection Cluster/partners to establish or adapt systems of identification and safe referral.

14. Coordination

14. Engage in existing coordination mechanisms to identify integration opportunities with other agencies, including government agencies and local NGOs. Multi-sectoral collaboration is essential at every stage of the project cycle.

TIP: Different agencies bring different strengths. A consortium model can enable an integrated multi-sectoral approach for providing high-quality services for individuals in quarantine/isolation. Regardless of whether a consortium model is formed or coordination is more informal, it is important to identify focal points for coordination, communication, and information-sharing. This approach promotes transparency and provides greater impetus for agencies to collaborate.
TIP: Where possible, utilize this opportunity to strengthen existing coordination mechanisms—advocate for local agencies to join coordination forums by identifying barriers such as translation.

Examples from Country Humanitarian Responses

In Bangladesh, the Health Sector and Child Protection Sub-Sector coordinated to ensure “Child Carers” were identified in each Isolation Treatment Center (ITC). Child Carers are health staff who received training on running basic PSS activities, helping children maintain contact with family members, identifying and referring child protection cases, and ensuring safe discharge of children.
In Venezuela, a BHA migrant response project run by Save the Children, which started amid COVID-19, utilizes a cross-sectoral Health and Nutrition Technical Advisor to ensure integrated humanitarian programming.
Distributions are a key entry point for integration. In Myanmar, Save the Children conducts physical cash distributions. During distributions, they share information on WASH, nutrition, proper feeding practices, and protection issues.
Additionally, Save the Children runs projects utilizing electronic transfers in Nigeria and Somalia. When messages are sent (usually via SMS) about the next transfer, health and protection messages are also shared.
Save the Children Myanmar combined MHPSS, Child Protection, and WASH messages in Home Learning Kits distributed to the most vulnerable communities during school closures.
In Bangladesh, joint guidelines¹⁰ were drafted between the Child Protection Sub Sector and the Health Sector to identify risks and address various child protection concerns and prepare for various scenarios in which children may be separated from their caregivers.
In Liberia, BHA funded a consortium of INGOs to support national and country Health Teams as part of post-Ebola recovery and preparedness efforts.

^[10] Child Protection & Health Care for Children in Health Facilities during COVID-19 (https://www.humanitarianresponse.info/en/operations/bangladesh/document/child-protection-health-care-children-health-facilities-during-covid), 27 अक्टूबर, 2020 को एक्सेस किया गया।

Response Cycle Stage

Monitoring, Evaluation, Accountability, and Learning (MEAL)

Each section below describes a relevant integration entry point, offers practical tips for implementation, and describes examples of how this has worked in specific humanitarian settings.

15. Integrated MEAL Systems

15. An integrated MEAL system should capture and document good practices, learnings, and integrated programming outcomes. As much as possible, the system should be aligned with global response indicators (such as WHO or GHRP) or nationally agreed indicators by respective line ministries. These indicators can be used to measure the effectiveness of an integrated model, contribute to learning and improvement of integrated programming, and be used with new program design and implementation.

Include significant collaboration with response-level actors working on Accountability to Affected Populations/ Communication & Community Engagement that applies to the entire response. This collaboration may include collective feedback mechanisms, hotlines for seeking assistance for protection violations, and already established trusted networks and relationships with communities.

TIP: Where possible, conduct joint TA field visits for planning, monitoring, and ongoing support to projects. These visits are also valuable for identifying opportunities for increased integration. When in-person visits are not possible, data can be collected and monitored through digital data collection, by phone or text messaging, Interactive Voice Response (IVR) for short-response surveys, etc. MEAL teams should plan to consistently organize remote meetings to encourage teams to discuss gaps, challenges, and ways to strengthen the integrated approach.
TIP: Data collection systems should be aligned with the COVID-19 Global Humanitarian Response Plan (GHRP) and measure output and impact changes in population well-being at different levels (individual, household, community, institutional). Indicators should be disaggregated for gender, age, and disability when possible. Include indicators that measure changes to gender inequality and exclusion; community engagement; shifts in social and behavioral change; access to key services, and improving health equity.
TIP: Promote community-based data collection, particularly when community members have already been trained and participated in similar processes before COVID-19.
TIP: Conduct regular safety audits of all facilities and CICs taking into account the unique needs of men, women, boys, and girls. Ensure multiple methods of receiving feedback are in place (i.e., phones, in-person, complaint box, etc.).
TIP: Consult existing guidance such as the Inter-Agency Standing Committee MIRA (Multi-Sector Initial Rapid Assessment) manual and the IASC Needs Assessment Task Force Operational Guidance for Coordinated Assessments in Humanitarian Crisis when planning integrated MEAL systems to ensure accountability.

16. Inclusive Programming

16. Evaluate access to services of high-risk and marginalized groups and ensure appropriate age- and gender-sensitive and accessible listening, feedback, and reporting mechanisms are in place.

TIP: Establish or strengthen listening, feedback, and reporting channels that are remotely accessible, such as feedback boxes in camps or camp-like settings, hotlines, radio programming questions, feedback surveys over the phone, social media platforms, or email. Raise awareness about the remote feedback options available to communities. Let the communities know what they can expect in terms of staff conduct and the ability to handle and resolve feedback (e.g., time to respond will increase). Close the feedback loops by reporting back to communities on steps taken.
TIP: Engage with relevant actors (i.e., Child Protection Sub-Cluster or DPOs) to ensure child-friendly and inclusive feedback mechanisms.

17. Reporting

17. Produce program reports, mid-term reviews, and evaluations that highlight joint program outcomes, link technical areas, and sector interventions, and define lessons learned for future refinement and optimization. Ensure reports highlight priority cross-cutting issues, including safeguarding, gender equality, and inclusion.

TIP: In the program design and implementation plan, allocate time for multi-disciplinary writing workshops to enable collaborative writing and reporting rather than compiling single sector reports into one report.

Resource List for Part 1

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यह वेबसाइट यूनाइटेड स्टेट्स एजेंसी फॉर इंटरनेशनल डेवलपमेंट (यूएसएआईडी) के माध्यम से अमेरिकी लोगों के उदार समर्थन से संभव हुई है। सामग्री रेडी की ज़िम्मेदारी है और जरूरी नहीं कि यह यूएसएआईडी या संयुक्त राज्य सरकार के विचारों को प्रतिबिंबित करती हो। सेव द चिल्ड्रन के नेतृत्व में, रेडी पहल को जॉन्स हॉपकिन्स सेंटर फॉर ह्यूमैनिटेरियन हेल्थ, जॉन्स हॉपकिंस सेंटर फॉर कम्युनिकेशन प्रोग्राम्स, यूके-मेड और ह्यूमैनिटेरियन लीडरशिप अकादमी के साथ साझेदारी में कार्यान्वित किया गया है। रेडी बड़े पैमाने पर संक्रामक रोग के प्रकोप का जवाब देने के लिए गैर-सरकारी संगठनों के लिए वैश्विक क्षमता बढ़ा रहा है।