2Module 3 Objectives By the end of this module, learners will: Identify and define community structuresDefine community participationExplain the value and benefit of community participation and involvement in health programsIdentify the various volunteer community health agents and their rolesDescribe the community social and economic factors that affect healthList community resource people who can be involved in malaria control
3Home and Community Management Although this module uses malaria as an example, we can apply the principles to management of other health problems common in the home and communityPlease suggest other common problems that are amenable to home management
4Why Community Involvement? Health is produced at home and in the community. Health depends upon:What people do or fail to doIn many countries the National Malaria Control Program (NMCP) strategic plan is directed at improving case management of malaria at the home and community levelsHome management of malaria (HMM) is an important strategy because it provides access to pre-packed, quality, anti-malarial medicines within 24 hours of the onset of feverThis strategy is designed to use a network of community resource persons
5What Is a Community?A group of people living in the same defined area—sharing basic values, organization and interests (Rifkin et al. 1988)An informally organized social entity, which is characterized by a sense of identity (White 1982)A population, which is geographically focused, but which also exists as a discrete social entity, with a local collective identity and corporate purpose (Manderson et al. 1992)
6Why Is Community Valuable for Health Service Delivery? A community is:An operational area for delivering a minimum health care packageDesigned to mobilize political commitment to health service delivery as a requisite for social development
7Larger and Smaller Arrangements of Community Sometimes the health service may group smaller communities to make it easier to deliver servicesFor example, a ward or sub-district may be the catchment area of a health center and serve many communitiesCommunities themselves may be composed of smaller units (like blocks, neighborhoods and kindreds/clans)We need to learn from the communities how they are divided and subdivided, and use this information to foster maximum involvementHow are communities organized in your area?
8What Constitutes Participation? Active involvement of the local population in the decision-making for—and implementation of—development projects
9What Constitutes Participation? (continued) The community determines collective needs and priorities, and assumes responsibility for these decisions
10Role in Participation The community’s role includes: Formulating a health programEnabling its residents to understand and make informed choicesReconciling outside objectives with community priorities
11Why Participation? Participation (assumptions): Increases program acceptance and ownershipEnsures that programs meet local needsMay reduce costs using local resourcesUses local/familiar organizations and problem-solving mechanisms—and is more efficientSome examples follow
12Village Health Workers (VHWs) Promoting Filters Product, price, place and promotion organized by VHWs
13Effects of Participation Guinea worm filter sales are better where village-selected health workers take partCommunities select their VHWs and usually respect them
14Community Involvement in … Water Supply ImprovementsRaising moneyHelping digDedicating the wellSupervising use and maintenanceCommunity involvement
16Participation in Water Supply Project Multiplier effect on immunization participation
17Community-Managed Essential Drugs VHWs, selected by the community, buy and maintain village drug stocksIn the graph above, LGA = local government area.
18Community Problem-Solving Above: Community Action Cycle: Save the ChildrenDiscuss community involvement efforts you have seen
19Participatory Approach for Improving MCH Save the Children worked in Bolivia to help women’s groups plan their own programOn the slide above:MCH = maternal and child healthTT = tetanus toxoidANC – antenatal careBF = breastfeeding
20Rationale and Scientific Basis for HMM It is widely acknowledged that access to appropriate and effective treatment of malaria should be provided within 24 hours of onset of symptomsAny strategy to accomplish this should take into account:The rural populationInadequate coverage of the population by the health systemPoor terrain and road networks in malaria-endemic areas
21Community Involvement Addresses the Access Gap HMM is designed to address the access gap HMM:Is designed to enable communities and homes to serve as the first “hospital”Relies upon the community and the services offered by the formal and informal private health sectorsIs an integral part of malaria case management within the overall Roll Back Malaria (RBM) strategy
22Who Are Community Agents? Are volunteers selected by their own communities to perform basic health and educational dutiesMay be called by many names, but the concept is the sameCommunity-directed distributors (CDDs)Role model caregivers (RMCGs)Community-integrated managers of childhood illness (CIMCI)Community health workers (CHWs)/village health workers (VHWs)Community-oriented resource persons (CORPs)
23Community Management Community agents promote HMM The HMM strategy has the potential to ensure effective case management for non-immune people at risk of malaria (such as children under five years of age in high malaria transmission areas)HMM may also be applicable to adults in low and moderate malaria transmission areas. In this population, the disease could advance rapidly to severe malaria, especially during epidemics
24Malaria Is Often Managed in the Home and Community In many countries self-treatment is often the most common form of treatment, though it is often not appropriateIn communities, first-line malaria treatment medicines are bought from patent medicine vendorsUsually diagnosis and treatment of malaria is done at home by family membersSuch treatment is frequently done on a “wait and see” basis, which leads to delays in care and possible complications
25Factors That Affect Malaria Treatment Non-affordability of anti-malaria drugsInappropriate health-seeking behaviorInadequate health care infrastructuresUnapproved malaria drugs found in clinics and shopsNon-compliance with drug regimensPoor communication between clients and providersTrained community agents can address these factors
26Communities Can Also Prevent Trained community-based workers and community leaders can:Mobilize/sensitize the communities on the value of antenatal care (ANC), the risk of malaria in pregnancy, the concept and rationale for intermittent preventive treatment in pregnancy (IPTp)Promote other control measures, especially use of long-lasting insecticide-treated nets (LLINs)/insecticide-treated nets (ITNs)Refer pregnant women promptly to the appropriate level of careEncourage the community to accept and use IPTp
27Involving Local Resource People TBA in Nigeria volunteers as a CDD
28Local Resource PeopleLocal resource people understand the cultural, social and economic realities of their own communitiesThese people can serve as volunteers and opinion leaders to promote malaria control. They include:Traditional birth attendants (TBAs)Religious leadersTeachersLocal chiefsCan you name others?
29Community Resource People like TBAs Can Aid Malaria/Disease Prevention TBAs in in several Nigeria communities volunteer to distribute LLINs and provide IPTp
30With Community Participation, What Might Your Country Be Like without Malaria? Decreased morbidity, leading to fewer clinic visits and fewer hospital admissionsIncreased health resources for other diseasesDecreased infant, childhood and maternal mortality (deaths)Increased life expectancyReduced absenteeism from school and workIncreased work productivity and more food for everyoneImproved national economy
31Summary and Conclusions Community represents a vital missing link in malaria control effortsCommunities can mobilize members and resources for effective malaria control effortsCommunity involvement can strengthen facility and community linkagesCommunity agents can address and reduce the factors that impede malaria control effortsComments and Questions?