Presentation is loading. Please wait.

Presentation is loading. Please wait.

Community partnerships for health related MDG’s

Similar presentations


Presentation on theme: "Community partnerships for health related MDG’s"— Presentation transcript:

1 Community partnerships for health related MDG’s
Conclusions of The State of the World’s Children 2008 and Systematic Review of the Effectiveness of Community-Based Primary Health Care in Improving Child Health

2 the importance of communities for Health MDG’s
Micro-level: Households/ Communities Meso-level: Health system & other sectors Macro-Level: Policies and Financing MDG outcomes Family/ Community level Care MDG focused + Child friendly: MDGs : U5MR MMR Malnut. Malaria HIV/TB National Health- Nutrition Policy Efficacy Family behaviors Population oriented (outreach) services PRSP quality SWAP compliance Budget Support utilisation This slide shows a version of the “pathways” framework adapted from the HNP chapter for the PRSP Sourcebook. The blue panel on the left-hand side of the slide has a box for HNP outcomes. As we move through the module, specific examples of HNP outcomes for the poor will be discussed, along with the risk factors associated with them. The examples will focus on outcomes related to maternal and child health and nutrition, for example low birth weight and maternal mortality. The second (green) panel has boxes for household and community factors, including household behaviors and risk factors, household resources, and community factors. Solid lines link the main pathways through which these factors influence outcomes, and the dashed line adds some of the feedbacks and secondary linkages to be considered. The brown and orange panels hold the boxes for factors in the health system/other sectors and for government policies and actions. Community Support Protection of Household Revenue access Medium Term Expenditure Framework Individual (Clinical) Care availability

3 The Bamako Initiative Launched by African health Ministers in 1987
Built on 5 years operations research in Benin (Pahou) and Congo (Kasongo) Community movement: Community co-managed, cost shared and monitored revitalization of health centers with drug revolving funds Community Based National Health Systems in Benin, Guinea, Mali, DR Congo, Guinea Bissau Benin Immmization Coverage from 12% in 1986 to 75 % in 1990 and fully sustained since then Resiliance demonstrated during Togo, DR Congo, Guinea Bissau and other crisis Foundation for success of ACSD (10-20% U5MR reduction for $ 500/life saved)

4 Lessons Learned from a hundred years
Scaling-up will not be achieved through facility-based and outreach services alone: Community Partnerships are central to achieving coverage, creating demand and achieving sustainability. Ensuring a continuum of care by delivering integrated packages of health, nutrition, HIV, water and sanitation interventions will be critical to achieving maximal impact on maternal, newborn and child survival. Strengthening of ‘health-systems for outcomes’ combines the strength of selective/vertical approaches and comprehensive/horizontal approaches to scaling up evidence-based, high-impact intervention packages and practices, while removing system-wide bottlenecks to health care provision and usage.

5 A Continuum of Care in Time and Place
Source: PMNCH (www.who.int/pmnch/about/continuum_of_care/en/index.htm), accessed 30 September 2007

6 Community partnerships in PHC: Ways of enhancing success
Cohesive, inclusive participation; Support and incentives for workers; Adequate programme supervision and support; Effective referral systems to facility-based care; Intersectoral collaboration; Secure financing; and Integration of community partnerships with district and national health programmes and policies.

7 Scaling up community partnerships, a continuum of care, health systems for outcomes
Realign programmes from disease –specific interventions to evidence-based, high-impact, integrated packages to ensure a continuum of care Make MNCH a central tenet of integrated results based national planning processes for scaling up Improve the quality and consistency of financing for strengthening health systems Foster and sustain political commitments, national and international leadership an sustained financing to develop health systems Create conditions for greater harmonization of global health programmes and partnerships

8 Striking increases in exclusive breastfeeding in 16 Sub-Saharan African countries
Seven Sub-Saharan African countries have achieved increases of more than 20 percentage points over the past 15 years. Infants exclusively breastfed (< 6 mos.) Note: These are countries with the current rate of at least 10% and an average annual rate of change of > 1% (except Rwanda) Source: UNICEF global database, 2007

9 Ethiopia: scaling up ITN

10 Pourquoi accélérer pour l’ODM4
permet d’atteindre tous les ODMs relatifs à la santé

11 Full Minimum Package at scale: 30% U5MR, 15% MMR, NNMR reduction for $ 800 per life saved

12 The Human Resource Challenge in Africa: 1
The Human Resource Challenge in Africa: 1. On the job training of 300,000 community health promoters and health extension workers; 2. Pre-service training and (re) deployment of 300,000 additional health professionals; 3. Improved productivity of existing health staff resulting in over 700,000 additional Full Time Equivalents (FTE).

13 Systematic Review of the Effectiveness of Community-Based Primary Health Care in Improving Child Health Key Questions How strong is the evidence that CBPHC can improve child health? What conditions/program elements must be in place for CBPHC to be effective? How important are partnerships between communities and health systems? Does CBPHC promote equity and is it cost-effective? 13

14 Definition of CBPHC Activities, interventions, programs that take place in the community outside of health facilities Includes selective and comprehensive approaches Includes non-health interventions (e.g., micro-credit, education, women’s empowerment, societal factors) 14

15 Process Review of available documentation
Peer-reviewed journal articles Books Program evaluations Unpublished reports Data extraction-2 independent reviewers Special focus on community context and community partnerships 15

16 Community-Based Primary Health Care
Contextual Analysis and Implementation Framework Contextual factors: (external resources and support, political factors, social capital, functionality of health system, country laws, cultural issues, intracountry inequities, mortality setting, disease epidemiology, opportunities for education, women’s status, strength of medical professional lobby, etc.) Delivery System Health Outcomes Technical Interventions Community Empowerment

17 Technical Interventions Criteria for defining priority effective interventions
Safety demonstrated Shown to have mortality or nutrition improvement efficacy Programmatic experience exists Feasibility of or experience with reaching high coverage

18 Technical Interventions Priority child survival interventions for scale up
Immunizations for mothers and children Vitamin A supplementation Iodine fortification and supplementation when necessary Home-based neonatal care including neonatal sepsis management Clean delivery Hand-washing Household water treatment and safe storage Sanitation ORT and zinc for diarrhea treatment Childhood pneumonia treatment Prevention of mother-to-child transmission of HIV Cotrimoxazole prophylaxis for HIV-infected children

19 Technical Interventions Priority child survival interventions for scale up
Insecticide-treated materials and/or indoor residual spraying for malaria Malaria treatment Intermittent preventive therapy for malaria for pregnant women Exclusive breastfeeding promotion for first 6 months Continued breastfeeding promotion until at least 24 months Ready to use therapeutic foods for severely malnourished children Promotion of complementary feeding for children focused on 6 to 23 months Supplementary feeding for food-insecure families focused on 6 to 23 months

20 Technical Interventions Interventions with more evidence needed for effectiveness, safety or feasibility of scale up Congenital syphilis prevention Prophylactic supplemental zinc Prenatal calcium Detection and treatment of asymptomatic bacteriuria Umbilical cord topical antiseptic Newborn antiseptic skin cleansing Neonatal resuscitation and airway management Household smoke reduction with improved cooking stoves

21 Technical Interventions Interventions with indirect effects on child survival
Family planning Adult HIV treatment Maternal mortality reduction

22 Technical Interventions Messages regarding effective interventions
Effectiveness and scale up depend on delivery systems, community involvement and local context Although community engagement is ideal, interventions’ dependence on this is variable Community engagement promotes scale up and sustainability Integrated packages not investigated as well as single interventions

23 Community-Based Primary Health Care
Contextual Analysis and Implementation Framework Contextual factors: (external resources and support, political factors, social capital, functionality of health system, country laws, cultural issues, intracountry inequities, mortality setting, disease epidemiology, opportunities for education, women’s status, strength of medical professional lobby, etc.) Delivery System Health Outcomes Technical Interventions Community Empowerment

24 Delivery System Elements
Integration of services at community level Foundation of values and power shifting Peer neighborhood volunteer Multi-purpose community health worker Incentives: monetary, material, other Facility outreach vs. community-based Community-based organization for health Community generation and use of health data Bi-directional linkage to national health system Accountability of health system Bi-directional information and communication Respectful, collaborative delivery system culture Equitable service delivery

25 Delivery System Elements
Coordination of formal and traditional health sectors Appropriate service provision intensity Workload of community health workers Number of tasks, number of and distance to homes Processes to shift power locus to communities Work with women, microcredit, conditional cash transfer Communication technology – e.g., mobile phones Training of community health workers Supportive supervision of CHWs linked to PHC level Supplies for service delivery Adequate global and national financing Monitoring of CBPHC program Authority for lay persons to perform health tasks

26 Community-Based Primary Health Care
Contextual Analysis and Implementation Framework Contextual factors: (external resources and support, political factors, social capital, functionality of health system, country laws, cultural issues, intracountry inequities, mortality setting, disease epidemiology, opportunities for education, women’s status, strength of medical professional lobby, etc.) Delivery System Health Outcomes Technical Interventions Community Empowerment

27 Community Empowerment How community-driven is the strategy?
Community as a resource vs. target Community vs. external priority setting Degree of community involvement Ownership Decision-making power Management Consultation Influence Buy-in Passive recipient

28 Community Empowerment Areas requiring community involvement
Leadership Planning and management Women Community management of external resources Monitoring and evaluation _________________________ Local context Value system Delivery of services in community Bundle of delivery systems and technical interventions

29 Community-Based Primary Health Care
Contextual Analysis and Implementation Framework Contextual factors: (external resources and support, political factors, social capital, functionality of health system, country laws, cultural issues, intracountry inequities, mortality setting, disease epidemiology, opportunities for education, women’s status, strength of medical professional lobby, etc.) Delivery System Health Outcomes Technical Interventions Community Empowerment

30 Key Contextual Factors
Ecological Epidemiological Social/Cultural Political Economic Education International funding

31 Recommendations for Implementing CBPHC in Africa
1. “There is no universal solution, but there is a universal process to find appropriate local solutions.” Carl Taylor 2. Invest in promising CBPHC approaches and field sites, start small, and be willing to help them go to scale within a framework of rigorous evaluation and operations research that demonstrates effectiveness in reducing under-five mortality 3. Look for and support promising young leaders who have a passion for CBPHC or who have the potential for becoming passionate leaders of CBPHC 4. Support opportunities for program leaders to visit and learn from successful experiences – build on success 5. Plan at the outset for long-term sustainability and for the supportive “human” infrastructure required for CBPHC (supervision, training, M&E) 6. Make under-five mortality in defined geographic areas the key outcome indicator and build it into ongoing program operations 31

32 Next Steps Forceful statement SOON from the Expert Review Panel to the world (via Lancet?) – building on the review but moving beyond it Early completion of the review as originally envisioned Incorporation of suggestions and recommendation of the Expert Review Panel and others into final report Broad dissemination of findings 32

33 CHILD SURVIVAL AND DEVELOPMENT:- ACHIEVING MDG 4
Scaling up High Impact Population- Based Interventions Improving family and Community Care practices Feeding Practices, Sleeping under ITNs, ORT, Hygiene & Sanitation, Early care seeking ITNs, Immunisation, New ORS, Vitamin A, Antibiotics for Pneumonia, Deworming Community Capacity Development:- Social Change Communication, CIMCI, Outreach Support Health System Support:- Facility-Based IMCI, EPI+, ANC+, EmOC, PMTCT, Paediatric AIDS Access to Safe & Clean Water, Intersectoral Linkages (Education HIV/AIDS), Household Food Security Moving Upstream:- Evidence-Based Advocacy, Leverage of Resources, SWAPS/Govt. Budget/PRSPS, Policy Dialogue

34 Services à base communautaire et familiale Situation de base
Matrones formées dans la majorité des villages Insuffisant recours à la matrone - habitude socio-culturelle Indisponibilité de kits pour accouchement propre au niveau des villages Sous utilisation des matrones formées. Barrières culturelles, ignorance, qualité des prestations/accueil/ non connaissance des soins NNé Genevieve

35 Services à base communautaire et familiale Situation de base
Matrones formées dans la majorité des villages Insuffisant recours à la matrone - habitude socio-culturelle Indisponibilité de kits pour accouchement propre au niveau des villages Sous utilisation des matrones formées. Barrières culturelles, ignorance, qualité des prestations/accueil/ non connaissance des soins NNé Genevieve

36 Services à base communautaire et familiale Phase 1: 2008-2010
Approvisionnement en kits d’accouchements et distribution gratuite lors de la CPN Lever les barrières culturelles et d’ignorance : IEC/CCC, supervision des matrones pour améliorer la qualité/accueil des prestations à domicile 85,0% 63,9% 53,3% 29,8% 29,8% Genevieve

37 Services à base communautaire et familiale Phase 2: 2011-2012
IEC/CCC, améliorer la qualité accts à domicile, promouvoir la participation communautaire dans la gestion des services, promouvoir la référence pour acct assisté au CSI 85,0% 63,9% 53,3% 37,1% 37,1% Genevieve 29,8% 29,8%

38 Services à base communautaire et familiale Phase 3: 2013-2015
IEC/CCC, améliorer la qualité accts à domicile, promouvoir la participation communautaire dans la gestion des services, promouvoir la référence pour acct assisté au CSI 85,0% 63,9% 53,3% 44,4% 44,4% 37,1% 37,1% Genevieve

39 Services orientés vers les populations Soins curatifs et préventifs de l’enfant Situation de base
Faible disponibilité et inégale répartition des RH, refus à la décentralisation Rupture de stock de vaccins Barrières géographiques financières et culturelles. Insuffisance de la mobilité sociale, qualité des prestations/accueil Genevieve

40 Service orienté vers les populations Soins curatifs et préventifs de l’enfant Échéance 2015
Formation initiale, Recrutement, Redéploiement, Prime / motivation Plan d’approvisionnement et gestion des stocks Atteindre chaque enfant, Améliorer la qualité des prestations/accueil, IEC/CCC, engagement communautés 96,0% 96,0% 94,7% 90,1% 90,1% 68,0% Genevieve

41 Soins cliniques individuels Soins curatifs au niveau des CSI 2
Situation de base Barrières financières, physiques, ignorance Insuffisance et pb répartition RH, Manque de personnels formés Coûts élevés prestations, faible qualité des services/ accueil Genevieve

42 Soins cliniques individuels Soins curatifs au niveau des CSI 2
Échéance 2015 Formation recyclage Redéploiement des agents Supervision/ formation PCIME → Qualité accueil/prestation 95% Case santé → CSI 1 CSI 1 → CSI 2 Dévpt PCIME ds cursus de formation 79% 78% 71% 69% 59% Genevieve

43 2006: A regional JUMP START: Scaling up of key health nutrition and WASH evidence based effective interventions World Press Photo 2005

44 Exclusive BF and BF+ water only in WCAR
< to to to to to to to to 23

45 Allaitement maternel exclusif ou Allaitement maternel avec eau (Source: dernières EDS –MICS)

46 Nutrition suggested activities for CS Jump Start
Exclusive breastfeeding for 6 months Early initiation of breastfeeding (<1 hour after birth) No prelactal foods, No water +++ Saves children’s lives per year Vitamin A and Deworming Management of acute severe undernutrition in children 6-59 mo Treatment and prevention Through facility-based and community-based programs For the same communities and at the same time (including urban) → Support countries in the development of national protocols → Support regional & national training workshops for capacity building → Ensure pipeline of uninterrupted supplies (therapeutic and supplementary foods and non food items)

47 Why water and sanitation matter to the jump start
Improved household water quality helps prevent endemic diarrhoea: cholera Latrine ownership potentially reduces diarrhea disease by an average of 36% Handwashing with soap can Significantly reduce the risk of diarrhea > 46% Can save 0.5 – 1.4 million deaths a year Impacts on helminth and eye infections, especially trachoma Key in the fight against avian flu References for slide: Handwashing with soap: Curtis & Cairncross, 2003; Fewtrell et al, 2005 Effectiveness of house-hold based water quality interventions to prevent endemic diarrhea: Clasen, T., Schmidt, W. (forthcoming 2006) – London School of Hygiene and Tropical Medicine Effect of sanitation against diarrhea and latrine ownership: Esrey SA, Potash JB, Roberts L & Shiff C(1991) Effect of handwashing on helminth and tracoma infections: Ensink, J., (forthcoming 2006) London School of Hygiene and Tropical Medicine

48 What we need to do BUT At the same time make sure WASH in the CO programme is looking at water point and sanitation (latrine) coverage – MGD 7, target 10 Doing one without the other makes no long term sense: read the WASH strategy Include hand washing for mothers in the jump start This requires ‘at scale’ communication programmes Should not necessarily be WASH sector driven but integrated in to our health and nutrition entry points Work with academic institutions/NGOs to assist with rapid baseline behaviour assessments and conduct surveys for compliance (behaviour change) RO is working on guidelines for communication strategies

49 Integrated Immunization: EPI-VitA-ITNs
Increase routine immunization coverage for all antigens (including TT 2+) in all districts by 10 points Ensure the second dose of measles vaccine for all children (routine and SIA) Integrate vitamin A supplementation within routine immunization Integrate ITNs distribution and promotion of its utilization within routine immunization Introduction in EPI of new and underused vaccines in all countries ( YF , HepB , Hib)

50 Quelle meilleure contribution de l’UNICEF?
Renforcer les politiques, la législation, plans & budgets + espace budgétaire Analyse de situation basée sur l’évidence Couverture effective des interventions à haut impact Atteindre l’ODM 4 et contribuer aux autres ODMs relatifs à la santé Analyse de la situation, monitoring & Micro-planification Facilitation de l’approche MBB Action au niveau communautaire et stratégie avancée


Download ppt "Community partnerships for health related MDG’s"

Similar presentations


Ads by Google