Building Community Orientated Primary Care in Mali Group One

Countries and their Context All countries had some health system infrastructure All countries had some health system infrastructure The developing countries had challenges obtaining robust technical information The developing countries had challenges obtaining robust technical information All except Macedonia, had a broad health policy All except Macedonia, had a broad health policy All except Eritrea had political stability All except Eritrea had political stability The developing countries had high levels of informal private funding The developing countries had high levels of informal private funding The developed countries had formal private sector arrangements Brugha & Zwi (2002) The developed countries had formal private sector arrangements Brugha & Zwi (2002)

Comparisons With Other Countries CountryChallenges GDP per capita Mali High infant and maternal mortality, high communicable disease workforce, focus on hospital care US$ 900 Malaysia High communicable disease, workforce, focus on hospital care US $8,800 Macedonia High non-communicable disease, workforce, focus on hospital care, ageing pop due to migration US $1800

Comparisons with Other Countries CountryChallenges GDP per capita Eritrea High infant and maternal mortality, high communicable disease workforce, focus on hospital care US $1053 England Inadequate human resources High incidence of non- communicable disease Focus on hospital care US $ 25,500 New Zealand Inadequate human resources High incidence of non- communicable disease Public focus on hospital care US $20,100

Key Problem for Mali High infant and maternal mortality High infant and maternal mortality Preventable infectious disease Preventable infectious disease Focus on hospital care Focus on hospital care Inadequate human resources Inadequate human resources Private out of pocket expenses Private out of pocket expenses

Vision Reduced neo-natal death rates Reduced neo-natal death rates Reduced maternal death rates Reduced maternal death rates Improved rates of immunisation Improved rates of immunisation Reduction of preventable, communicable disease Reduction of preventable, communicable disease Community engagement with in own health Community engagement with in own health

Solution Building community-orientated primary care to develop a network of community-based primary care centres to provide: Maternal and child health services Maternal and child health services Immunisations Immunisations Dietary advice Dietary advice Public health services Public health services

To do this we need The right type of services The right type of services The right number of staff to provide the services with the right skills The right number of staff to provide the services with the right skills Ensure that it can be paid for Ensure that it can be paid for To know the size of the problem and progress on addressing it To know the size of the problem and progress on addressing it

Implementation - Stages Engagement and communication Engagement and communication Gather information, surveys, analyse then needs assessment Gather information, surveys, analyse then needs assessment Plan (build in information, monitoring and evaluation, timeframes and planning) Plan (build in information, monitoring and evaluation, timeframes and planning) Resourcing (human and financial) Resourcing (human and financial) Implementation Implementation Review Review

Key Actions Engage the community in identifying local need, planning and development Engage the community in identifying local need, planning and development Train community and health professionals from the hospitals in community orientated primary care and public health care Train community and health professionals from the hospitals in community orientated primary care and public health care Seek aid money to build community infrastructure for Seek aid money to build community infrastructure for Set up information and data collection framework Set up information and data collection framework Begin satellite services in the community Begin satellite services in the community

Engaging communities Engage with community leaders to Engage with community leaders to - develop messages and approach - location of facilities - location of facilities - packages of care - roles of community and secondary care Media campaign using: Media campaign using: –Radio –Clinical staff talking to groups of mothers -Develop social marketing

Training Staff and Community Train the trainers in primary and public health care Train the trainers in primary and public health care Integrated Management of Childhood Illness (WHO programme) for health workers, community health workers and communities Integrated Management of Childhood Illness (WHO programme) for health workers, community health workers and communities Immunisation training for health workers Immunisation training for health workers Training for community health workers (traditional birth attendants) in Child and Maternal Health Training for community health workers (traditional birth attendants) in Child and Maternal Health

Satellite Community Health Services Consult with community about their needs Consult with community about their needs (mix of services, locations) Identify potential workers and trainees Identify potential workers and trainees Identify what secondary services can be shifted into the community Identify what secondary services can be shifted into the community Develop mobile resources Develop mobile resources Training persons to develop basic recording and reporting system Training persons to develop basic recording and reporting system

Information Define minimum data set Define minimum data set (immunisation status, demographic information) Establish simple networks of reporting Establish simple networks of reporting Conduct census of mothers and children (run at community centre) to establish basic needs Conduct census of mothers and children (run at community centre) to establish basic needs Identify barriers to accessing services Identify barriers to accessing services

Funding Cost out primary care infrastructure needs Cost out primary care infrastructure needs Access international infrastructure funding Access international infrastructure funding(MTEF) Review secondary system resources and identify what can be directed into primary care Review secondary system resources and identify what can be directed into primary care Work with local co-operatives and committees to identify current out of pocket expenses Work with local co-operatives and committees to identify current out of pocket expenses

Potential Challenges Community engagement Community engagement Cultural and gender issues Cultural and gender issues Possible community resistance Possible community resistance Clinical professionals’ engagement and alignment Clinical professionals’ engagement and alignment Inadequate funding Inadequate funding Transportation Transportation Cold chain maintenance Cold chain maintenance

How we will know we’ve done it Annual numbers of community run primary and public health centers grow Annual numbers of community run primary and public health centers grow Rates of immunisation increases Rates of immunisation increases Services re-orientated from secondary to primary care Services re-orientated from secondary to primary care Public focus on primary care first Public focus on primary care first Number of people accessing primary care increases Number of people accessing primary care increases Reduction in morbidity and mortality rates of communicable diseases Reduction in morbidity and mortality rates of communicable diseases

Conclusions Review of the outcomes of the first stage Review of the outcomes of the first stage Identify any needs for further improvement Identify any needs for further improvement Ensure sustainability Ensure sustainability Provide opportunities for additional expansion and development Provide opportunities for additional expansion and development