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RHO archives : Topics : Men and Reproductive Health

IGWG Men and Reproductive Health Subcommittee

Meeting Minutes: July 25, 2001

Attendance and logistics

The meeting was held at Georgetown University, from 10am to 5pm. Attending were: Erin Anastasi (Georgetown/IRH), Mark Austin (USAID), Michal Avni (USAID), Anna Benton, (CHANGE), Lucretia Brosey (consultant), Michèle Burger (Consultant), Sam Clark (PATH), Nick Danforth (Consultant), Anne Eckman (Consultant), Jill Gay (Consultant), Meg Greene (PAI), Jay Gribble (Georgetown/IRH), Ruth Goldstein (Wesleyan), Judith Helzner (IPPF), Victoria Jennings (Georgetown/IRH), Mihira Karra (USAID), Tabitha Keener (USAID), Ann Leonard (Consultant), Sara Martin (JSI), Minna Nikula (Georgetown/IRH), Emma Ottolenghi (PopCouncil), Diana Prieto (USAID), Julie Pulerwitz (Population Council), Karin Ringheim (PATH), Saira Saeed (Consultant), Diana Santillan (JSI), Jane Schueller (FHI), Myrna Seidman (Georgetown/IRH), Jeff Spieler (USAID), Kathy Taylor (PAHO), Mary Nell Wegner (EngenderHealth), Claudia Velasquez (Georgetown/IRH)

Victoria Jennings, new co-chair of the Men and Reproductive Health Subcommittee, hosted the meeting, held at Georgetown University. She welcomed participants with a brief history of the Warwick Evans room where the meeting took place. Sam Clark, co-chair, then distributed the "blue fact sheet" on the subcommittee and asked participants to introduce themselves. The two working teams, Communication & Dissemination and Research & Evaluation, then met for an hour and reported back to the subcommittee. New members were invited to attend one of the two working team meetings.

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Report of the working teams to the committee

Communications Working Team

Mary Nell reported for the Communication and Dissemination working team.

Speaker Series. Wayne Pawlowski will facilitate a day-long sexuality training workshop on August 15th at AED. The purpose of the workshop is to train members of the IGWG and interested USAID and CA staff on how to discuss issues of sexuality and incorporate sexuality in our programs. Sexuality training was a recommendation that came out of the Population Council's Power in Sexual Relationships meeting. Wayne Pawlowski is the current Director of Training at Planned Parenthood Federation of America. He is a nationally and internationally recognized reproductive health care/family planning trainer, educator and counselor. Mary Nell thanked the Population Leadership Program for financial and logistic assistance to the subcommittee in hosting the Sexuality Training session. She also thanked Michelle Burger, who has been handling this.

Mary Nell reported that Dean Peacock of the University of California at Berkley, Lori Heisi or Mary Ellsberg will present on Gender-based Violence with a focus on advocacy and policy issues. The date has yet to be determined. Lori Heisi has agreed to speak at the next Subcommittee meeting in November; participants agreed that the best date for a longer presentation would be better determined at that time.

Orientation Guide Update. The OG has now been pilot tested in 14 organizations in Boston, New York, Washington and North Carolina. Recipients evaluations and facilitators feedback were summarized by Michelle Burger with help from Meg Greene. An all day meeting was held on July 24th at Georgetown University with those who had facilitated the presentations as well as two representatives who hosted presentations, to determine next steps. The discussion was based on results from recipients evaluations and facilitators feedback, which were summarized by Michèle Burger, Meg Greene, and Diana Prieto. See Item VIII below re "Update on the OG" for recommendations and decisions made at the meeting.

Research and Evaluation Working Team

Meg Greene, reported for the Research and Evaluation Working Team

Status of Case Studies. Meg Greene updated the team on the status of the case studies and distributed a sheet on some decisions that needed to be made, some of which were discussed earlier in the morning by the reviewers. As background for new members, she described that the case studies were being developed in response to feedback from CAs that there were few models of behavior change and male involvement in the literature. The model for these case studies is the very reader-friendly "Qualite" publication put out periodically by the Population Council. The working team identified three innovative program strategies, which, although they lacked formal evaluation, were consistent with the subcommittees core values, useful in getting men and boys (and women) to question their assumptions regarding gender norms, and worthy of further replication and testing. The three NGOs selected were addressing issues related to the subcommittees three themes, violence (Salud y Genero, Mexico), Adolescents (Society for the Integrated Development of the Himalayas, India) and dual protection (Stepping-Stones, Africa and Asia). Jeff mentioned that there has been much discussion in Uganda about the contribution that the Stepping Stones program played in promoting behavior change that resulted in reductions in HIV incidence, delay of sexual initiation and decline in number of partners. Meg said the entire Stepping-Stones manual is quite impressive and one can see how participation in these exercises could permanently change ones views.

A draft has now been received from the authors of two of the three case studies, Stepping-Stones and SIDH. Draft three of the SIDH case study has just been received and will be sent out to reviewers. Hopefully, it is now close to being ready to send to PRB for copy editing and layout. Pictures have been received and the text is an appropriate length. The Salud y Genero case study was due in May and Meg has drafted an urgent appeal to the organization to complete this. PRB has already received funds from the Subcommittee, which will be used to produce and distribute the case studies. In addition to the comprehensive PRB mailing list, we discussed other potential recipients. Tabitha will send the case studies to missions through the internal mail. Other suggestions should be sent to Meg.

Thematic Position Statements. The working team drafted position statements on the three priority areas of Subcommittee work for the benefit of those who wanted to know about the work or submit proposals that were consistent with the Subcommittees three thematic goals. The statements had to be reviewed by numerous people and vetted through a long process. The dual protection statement is now on the www.rho.org Men and Reproductive Health website (supported by the Subcommittee). The Gender Based Violence (GBV) statement is close to being finalized. The adolescent statement may take some additional work because it is framed in terms of meeting the needs of adolescent boys rather than as a statement about gender norms and socialization as originally envisioned.

Indicators. The Men and RH indicators were drafted by Nancy Yinger and Elaine Murphy and also posted on the RHO website. Previously, there had been discussion around having Tim Williams of JSI develop some additional programmatic indicators for illustrative purposes so that CAs could more readily see how to operationalize male involvement in their programs. Tim was not at the meeting but Julie Pulerwitz of the Population Council suggested there might be still time to have input into the indicators used in the gender study underway through Frontiers in Bolivia. She will follow up with the Frontiers staff.

Positive Deviance Study. The Subcommittee is providing support to replicate, in the Dominican Republic, an exciting new protocol that was developed for use in Mexico to study positive deviance with support from the Moriah Fund. Sandy Garcia is the PI. Those interested in receiving a copy should send an email to Tabitha at: [email protected]. The focus of the study is on factors contributing to successful condom use.

Evaluation of products. The committee is supporting the development of a version of the PATH game for young men entitled Safari of Life Game—A Young Mans Journey. Jeff asked if we had also funded evaluation of the game. Karin said that the proposal included pre-testing but no field-testing. The original Safari of Life was recently field tested in Kenya. Sam has discussed with Sam Taylor the possibility of testing the game in the United States. Jeff suggested that it would be worth investing additional funds for field testing in 1-2 countries.

The working team has previously recommended that all proposals have an evaluation component built in. When the CD-ROM HIM was issued, Meg Greene and Megan Drennan developed an evaluation form, which was included with the CD-ROM but the Subcommittee has not been informed of the response to this form (there was not a JHU representative at the meeting). JHU/CCP submitted a proposal to evaluate the CD-ROM HIM; the proposal was approved with a request that JHU revise the evaluation instrument. Jeff said there were a variety of activities that could be evaluated. For example, Margaret Sanger has produced a teaching tool for working with men.

Meg said that she would like to step down as chair of the R and E working team once the case studies are completed, by the end of the year. She asked team members to be thinking about her replacement. Jeff suggested that the restructuring of the IGWG and Subcommittee might mean that the R and E team would be replaced by another type of team.

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Workplan discussion and budget update

Sam reported that the Subcommittee is close to having all present funds committed. The need to plan ahead and submit viable proposals by November was stressed. The Subcommittee should define what it wants to accomplish and CAs will propose to take the lead on particular projects. The IGWG TAG will review these. The budget group meets in February and funds will become available to the recipients in June. Tabitha said that in the meantime, between $10,000-$15,000 remained available for innovative ideas. Michal said that interest in male involvement is very high, but stressed the need for concrete ideas and implementation plans. Jeff said the subcommittee/IGWG budget cycle is the same as for the CAs. As USAID learns what its budget will be, it will ask the Subcommittee to prioritize its proposals. Under the new administration, USAID is being restructured and the Center for Population, Health and Nutrition will now become a Bureau. It is unknown how much money will be allocated in FY02. Five million dollars were set aside for special initiatives, including the IGWG, in FY 01. Proposals from the Men and RH Subcommittee will compete with all other proposals for available funds. Because there will not be another meeting before proposals are due, the discussion of workplans and development of proposals will need to be conducted through additional meetings and conference calls. Members are encouraged to think of ideas related to the three thematic areas.

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Other announcements

Introduction of PAHO representative

Jeff introduced Kathy Taylor, a new Michigan fellow working in the womens health and development division at PAHO. She will be working on the male involvement in RH study that Martine de Schutter, former PAHO representative to the Subcommittee, reported on last year. With funding from GTZ, PAHO will conduct a 4-year study in 7 countries. Programs will be implemented in Belize, Panama, Costa Rica, Guatemala, El Salvador, Nicaragua and Honduras. Formal evaluations will be conducted in the last four countries.

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Presentations

"Masculinities and Reproductive Health": a presentation, interactive exercise, and discussion with Michael S. Kimmel

Judith Helzner introduced Michael Kimmel, Professor of Sociology at SUNY at Stony Brook, NY, and Editor of the Journal, "Men and Masculinities". This journal is available from Sage Publications and is on their website.

Kimmel started by assessing the gender composition in the room. The majority of the participants of the M & RH Subcommittee meeting were women. This is what is faced when we talk about men. Gender has been under discussion only in the past 30-40 years and mostly by women. Only recently has it been considered a fundamental experience of social life. The problem remains that gender is invisible to men. We need to look at the points of entry for men in the gender discussion and make masculinity visible. "Privilege keeps the terms of your privilege invisible". It is important to start the discussion at privilege instead of at men's experience of powerlessness.

When we speak of making gender visible to men, we do not speak to a singular identity. We have to start with an understanding of difference. Kimmel recommended a UNDP document on masculinities that is available at: www.undp.org/gender.

Kimmel then discussed what he terms as the "Rules of Manhood". If manhood is a construction, what does it mean? He acknowledged that this is U.S.-centric. 1. "No sissy stuff"—don't do anything that hints at the feminine. 2. "Be a big wheel"—wealth, power, status. 3. "Be a sturdy oak"—reliable in a crisis. 4. "Give 'em hell"—take risks, go for it.

The definitions of what it means to be a woman has changed dramatically over the past 30 years. However, when boys are asked now what it means to be a man, they generally give the same answers as were given in the 1950s.

The rules can be used as tools to condense themes for discussion.

Rule 1—No Sissy Stuff: Highlights how our work with adolescents is so important. Boys want to be seen as "manly" by other boys. When boys are 8-9 years old, they start to find their voice, through posing, false bravado, etc. There is a constant fear of losing control, being over-powered.

There was a question raised as to how universal this is. Michael said he could not speak globally, but gave an example of boys in South Africa and harassment of women, which is done as posturing in front of other boys.

Rule 2—Be a Big Wheel: The entry of women in the workplace has been seen (by some) as an invasion. Men feel gender equality is a loss to men. Threatens the sense of entitlement. She took "my job."

Rule 3—Be a Sturdy Oak: This has implications for health-seeking behavior. Masculinity prescribes being out of touch with ones body, not concerned for personal safety. Masculinity is a fundamental risk factor for men and women. Example: HIV and dual protection. "Safe" and "sex" is an oxymoron. It is asking men to stop having sex like "men". The word "safe" is coded as feminine. The response of the gay male community addressed this by making "safe sex" sexy. Need to emphasize the pleasure aspect in dual protection messages.

Rule 4—Give 'em Hell: Direct implications on violence. Regarding gender-based violence, we know from research on domestic violence that men (generally) do not hit their wives when things are going well. It tends to happen when she doesn't do something, when his entitlement has been challenged. The violence occurs to restore power. To raise issues of gender-based violence, we must raise the issue of entitlement.

Points of entry for future conversations with men. To get men over 25 years old to talk about gender, you must focus on the positive parts of masculinity. For example, fatherhood and the idea of protecting your family are good introductions. It is valuable to get men to think that discussing gender is not just "male bashing" or a negative critique of men. Fatherhood is a unifying factor for a large number of men and men tend to respond to this. (See the website, www.dadsanddaughters.org)

It is important to recognize the significance of age and generation differences. The new generation of feminists (3rd wave) takes the previous struggle of feminism for granted. This new generation is much more interested in individual efficacy and power. What they have to offer to the previous generation (2nd wave) is cross-gender friendship and coalition-building skills with people with whom they may not always agree.

Kimmel then engaged the participants with an activity of what it means to be in the box of "masculine" and what words we use for individuals that are outside of the box (fag, wimp, pussy, etc). Responses to being identified as being outside of the box can be extreme: suicide, depression, overcompensation with violence etc. It is not safe to stay in the box, with traditional masculine behaviors (of the sturdy oak, etc) and, at the same time, it is not safe outside of the box.

We must take homophobia very seriously. Homophobia is the fear that someone will label you as gay. The need to avoid being seen as a "gay" by other men/boys is very strong. Posing and not showing weakness starts very early.

It was suggested that it is much easier today to raise a girl that is strong and confident than it is to raise a boy who is sensitive and caring.

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Presentation on "Baseline Findings from the India Men in Maternity Project," by Emma Ottolenghi, FRONTIERS/Population Council

Emma Ottolenghi of FRONTIERS spoke about the Global Agenda "Men in Maternity Services or MiM" study being conducted in Delhi, India and Durban, South Africa. She described the study, its research design, site characteristics, components of the intervention, goals, objectives and research questions.

The second portion of the presentation consisted of a series of preliminary results (not for quotation) obtained from 486 interviews with pregnant women in 3 control clinics in Delhi. (Men will only be interviewed pre-intervention in the intervention clinics). The results presented included: 1) a socio-demographic description of the women and their husbands (as reported by the women); 2) family planning knowledge, past use and intentions to use after this pregnancy; 3) general RH knowledge including danger signs in pregnancy, fertility awareness, breastfeeding and LAM; and 4) STI and HIV-AIDS knowledge and reported risk behaviors of either the woman or her husband. Finally, there were data on male involvement, including supportive behaviors, financial support, decision-making in the couple, and desires of the women to have their husband involved in clinical services. The study is also collecting data on gender-based violence but these data were not ready for this preliminary discussion.

The India study is now interviewing women and husbands in the intervention clinics. In South Africa, they have not completed the control clinic women's interviews. When sets of data from couples interviewed become available, Emma said they would be glad to present both a comparison of what women and men say as well as concordance within couples. Both women and men will be interviewed separately again at six months postpartum (or six months after the index pregnancy was due to be at term, in cases when there was a pregnancy loss) in their home.

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Update and discussion on IGWG M&RH Subcommittee restructuring plan

Sam Clark quickly reviewed the reorganization plan that Michal presented at the May meeting and then reviewed the presentation he made to the IGWG last month that outlines the Subcommittees core values, accomplishments and proposed changes. Sam underlined the importance of finding more efficient ways to make decisions, monitor and evaluate the proposals funded by the Subcommittee, and develop state of the art field-oriented products. The recommended structural changes for the Subcommittee include adopting working groups that focus on the three themes and being more inclusive of the IGWG community at-large.

Victoria Jennings facilitated the discussion with a focus on how to work more closely with other members of the IGWG. Everyone acknowledged the volume of products developed by the Subcommittee. With regard to the Subcommittee being a think tank, several members considered the value/outcome of such an excellent presentation as the one that Michael Kimmel provided in the morning. How can members act on todays presentation? What can we do with it? Victoria suggested adding homophobia to the Subcommittees theme statement.

Jeff Spieler talked about creating a task force around re-defining masculinity, hiring Michael Kimmel as a consultant and developing a masculinity project in Botswana, for instance. In response to concerns about funding being controlled by one agency, Jeff and Diana suggested that CAs might get together as a team and work on a given project.

Several members raised concerns about funding issues and differed with the perception that most of the work is done by outside paid consultants. Karin Ringheim, Meg Green and Mary Nell Wegner provided examples of the extensive time and work they have contributed in-kind to the Subcommittee. They indicated that higher levels of productivity are unrealistic when some people are being funded and others are not.

Members then considered how IGWG members could have benefited from this mornings presentation. Members agreed that these meetings and the presentations should be open to the entire IGWG. The discussion moved toward considering the possibility of substituting the quarterly meetings with a speakers series and having annual business meetings. Time did not allow further discussion to consider this format nor to get a sense of whether it was acceptable to Subcommittee members.

There was consensus that the Subcommittee, which was created to influence USAID to support male involvement initiatives, succeeded in pushing the IGWG on men and RH issues. Before concluding the discussion, Victoria asked members to consider "who is not around the table." This elicited further discussion about funding issues, and how funds may drive who is and who is not active in the Subcommittee.

The session ended with members voicing concerns about transitioning from work teams into theme-based task forces. They agreed to merging the Men and RH Subcommittee mailing list with the IGWG mailing list and to end these parallel structures, but were not clear on who would do this and when.

Finally, members expressed serious concerns about developing proposals in time to meet the November deadline, since the Chairs had not seen the new format for the proposals and the Subcommittee will not meet again until November. A draft of the proposal was distributed at the Steering Committee meeting in June; Diana will re-send that draft (and any subsequent drafts).

Before the meeting ended, members agreed to meet at 8:30 am on August 15, when several members will be attending the Sexuality Training Workshop, to work on proposals.

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Updates on other selected CA activities

IPPF/WHR

Judith Helzner informed the Subcommittee of the Working Group Meeting on Men as Partners for Gender Equity that IPPF/WHR hosted with partial support from the Subcommittee.

Judith described how impressed she was with the youth that participated and the important contribution they made to this meeting. For instance, it was the first time the Adolescent module of the Orientation Guide was presented to youth and it was clear that the module was designed for adult providers rather than with peer leaders or youth promoters. However, the young men attending this meeting were eager to work with the Orientation Guide and adjust the language to make it youth-friendly. Judith also relayed the enthusiasm with which the Orientation Guide was received and the urgency to release it in its current version. The representative from Tunisia wants to use it at a meeting in October and regional representatives from Asia were eager to collaborate on a meeting where they would present the OG to their constituencies.

Judith then reported on the meeting that AGI hosted to bring together an advisory group as AGI begins to work on an "international chartbook" on mens RH. In her report, she underlined AGIs reliance on DHS surveys in contrast to advisory members urging of AGI to consider additional sources that also provide qualitative information.

Institute for Reroductive Health

Rebecca Lundgren (IRH, Georgetown University) provided an update on projects in India and El Salvador:

Introducing the Standard Days Method into the Reproductive Health Programs of CASP-PLAN and CARE, India. The objectives of these projects are to test the introduction of a new fertility awareness-based family planning method into community-based reproductive health programs. CASP (Community Aid and Sponsorship Program)-PLAN provides family planning services through Community Health Guides in urban slums of New Delhi, while CARE provides FP education and services through community volunteers in rural villages of Uttar Pradesh. Both projects use an experimental design to test whether involving husbands in method counseling and follow-up has any impact on the number of new users, method satisfaction, correct use and continuation. The project will be completed in about one year, and baseline and preliminary results could be shared by early 2002.

Incorporating the Standard Days Method into Water and Sanitation Projects in El Salvador. This project is being conducted by Project Concern International in El Salvador. In an effort to involve men in family planning, they are incorporating family planning outreach and referrals into water and sanitation projects. They are also training community volunteers to provide the Standard Days Method. This strategy was chosen because baseline research from the water projects suggested that men were interested in using a natural FP method, and indeed many already use some kind of periodic abstinence. This project also uses a quasi-experimental design to test the impact of male involvement on method uptake, correct use, continuation and satisfaction. (Same time frame as above, except baseline data has already been completed.)

Sexuality Training

Tabitha Keener announced that the Sexuality Training Workshop will take place on August 15.

Liaison

Sam informed the Subcommittee that the IGWG is looking for a person to be the liaison between the Men and RH Subcommittee and the Gender and HIV/AIDS Task Force. Anyone interested in volunteering for this position should contact Sam, who can provide a description for this position. [Mark Austin of USAID has since agreed to take this on.]

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Update on orientation guide and new products

Orientation Guide

Mary Nell presented the outcomes of a meeting held the previous day, July 24th, to agree on the next steps for the Orientation Guide. Detailed minutes from the July 24th meeting are available from Diana Prieto or Michele Burger.

Revisions. The guidelines for revisions include: no additional slides, and changes to the text under the slides will be limited based on the feedback from evaluations and facilitators. Cosmetic and some contextual changes can be made to the slides themselves, also based on the feedback received. Notes for facilitators will be integrated into the Orientation Guide. Revisions will also include bolding text that underlines the main idea of a given slide. However, in cases where it is difficult to discern one main idea over another, a team may decide not to bold any text.It was agreed that teams would work on individual modules and every effort would be made to include the original authors, whenever possible, into these teams. The deadline for submitting revisions to Michele is September 15.

Jane Schueller offered to have one of her trainers read the revised version for content and flow as well as for suggestions of where to insert interactive activities. The final version will be reviewed by Michèle and other key members of the Subcommittee (to be determined).

Audience. It was agreed that the Orientation Guide is relevant to a broad audience, given the agreement that users can adapt it to their needs. However, the facilitators notes will urge presenters to know their audience prior to presenting modules so they can adapt their presentation to their audiences knowledge, interests, culture, etc.

Proposed strategies for disseminating the O.G. in the field include: offering it to missions when staff goes on TDYs; presenting it at annual meeting of PHN teams (which tend to include local partners); encourage members of the Subcommittee to disseminate it to their field offices; look for opportunities to present it at meetings, distribute it to academic institutions, both in the United States and abroad.

The consensus, however, was that the Orientation Guide should be modeled by a facilitator and then released to participants who attend a given presentation rather than distributing it by mail or over the Internet.

It was also agreed that a limited number of the current version would be released immediately to selected individuals who have requested it. In exchange, these recipients will be asked to complete a newly revised evaluation form. The release of these copies is considered Phase II of the pilot test, by testing it in the field. Facilitators will let Michèle know the number of copies they need.

The committee will ask JHUCCP to make the additional copies and will get an estimate from them for the cost of producing a talking head version of the CD-ROM. Also, Michèle reported that UNFPA has offered to translate the guide.

Update on New Products

New products under consideration include a conference or workshop to share state of the art programming, and the production of monographs and a power point presentation based on the papers presented at the conference. Other suggestions were: a mechanism to track the use of the guide, a clearinghouse for programming information on men and reproductive health, and technical assistance to organizations.

The suggested audience for the conference includes: USAID, CAs, chiefs of party, the research community, donors, representatives from the "South", the RH and HIV/AIDS community, influential people within CAs, UNFPA, and IPPF (among others to be determined). No decision has been made regarding the number of participants. Mihira Karra urged organizers to make sure that the appropriate audience is targeted and that we reach beyond those already working with men as participants. Michèle Burger suggested inviting Ministers of Health and senior staff of bilateral donor organizations.

Two scenarios were considered in terms of the timing of the conference. If it is supported with USAID funds only, the conference could occur in the fall of 2002, given the funding cycle. For the conference to be held earlier (end of 2001) would require leveraging "seed" money from another source. These funds could be combined with Men and RH SC funds that have not been obligated. Tabitha reported this could be up to 15K, but the amount actually available is not certain.

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Next meeting/Plus-delta exercise

The next meeting of the Subcommittee will be on November 15 at AED. Lori Heisi will be presenting on Gender-based Violence.

Plus (to do again next meeting)

  • Co-chairs did a great job.
  • Michael Kimmel was an exceptional presenter.
  • Wonderful space. Participants had no trouble finding it & getting there.
  • Judith and Michals work on planning the OG debriefing meeting resulted in its being so productive.

Delta (to change)

  • Include time in the agenda to discuss actionable items immediately after a presentation.
  • Ordering lunch. People did not RSVP about ordering lunch, so it was difficult to estimate the lunch order.
  • Too much information in a short time.
  • Keep more focused on results.
  • Have to be conscious of avoiding becoming a talking box and think about how to relate the work of the Subcommittee to country programs. How to increase participation of CAs as well as developing country participants?
  • Dont revisit restructuring at the next meeting. Have a small group grapple with this issue.

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For more information

For more information, please review the minutes of other past Subcommittee meetings.

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