Community Interventions

In 1996, the REWARD Project identified a need for effective interventions to increase women’s communication about reproductive health among themselves and with their husbands. Project staff formed women’s groups, called Communication Action Groups (CAGs), in three rural districts. The project provides group leaders with training on communication, leadership, group dynamics, condom use, condom negotiating skills, and HIV/AIDS and sexually transmitted infections (STIs).

The main objections to the use of [antiretroviral therapies] in less-developed countries have been their high cost and the lack of health infrastructure necessary to use them. We have shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, the poorest country in the western hemisphere.

Guidance for integrated postpartum care at the community/household level that reduces maternal and newborn mortality and encourages health in the immediate postpartum period is lacking. This report identifies and summarizes descriptive and research studies of existing community-based postpartum programs which provide counseling and services along with education on self-care. The literature review identified three models of community-base postpartum care: home visits by professional health care providers, home visits by community workers and home visits by community workers with referral or health facility support.

The AIDS Support Organization (TASO) administers a home-based program in Uganda that gives people in poor and rural settings access to antiretroviral therapy (ART) and services. The program’s innovation lies in shifting delivery of most clients’ follow-up activities at home to field officers, a new cadre of degree and diploma holders from the social sciences and education. Field officers ensure adherence to ART, refill clients’ medications and perform various activities, from voluntary counseling and testing to education to promoting family and community support. [from executive summary]

This document brings together the promising practices identified by the PVO community. Our definition of promising is purposefully broad to include the many ideas and experiences of different organizations that seem likely to combat HIV/AIDS successfully. [from foreword]

Recent efforts to improve maternal health have focused on skilled attendants and emergency care at health facilities. Skilled birth attendants and access to emergency obstetric care are essential to saving mothers lives. In developing countries, 60 million women give birth at home without skilled care and with high maternal and neonatal mortality. Nearly all essential newborn care can be provided safely, effectively, and at a low cost at the household level. The same is true for care of the mother, and many effective interventions can be implemented at the household and community level that will save mothers’ lives.

Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. [from abstract]

The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

Sustaining healthy populations and creating a context that facilitates health may require a broader perspective, such as that embodied in community participation. But some health specialists think that community participation is time-consuming and does not really improve health outcomes. Participatory processes can be protracted and progress toward health goals delayed, requiring heavy time and resource investments that may not be matched by the achievement of desired results.

Over the past 25 years, Pathfinder has learned many lessons about what makes community-based programs thrive. Outlined in this report are some of the lessons learned and examples of how these programmatic concepts are integrated into our work. [from introduction]

This report discusses issues such as compensation for community health workers, building partnerships, and alternate service delivery options.

This strategy paper takes stock of “best practice” experiences in supporting communities in their response to HIV/AIDS in several countries in Africa. It draws lessons from Burkina Faso, Côte d’Ivoire, Guinea, Malawi, Nigeria, and Tanzania and sheds light on methods that a growing number of organizations and individuals use to foster behavior change among people living in rural areas. The success stories presented in this paper prove that it is both possible and promising to implement HIV/AIDS programs that include several components and multiple sectors at the community level. [from forwa

Achieving significant reductions in maternal and newborn morbidity and mortality will be facilitated by developing a comprehensive approach to address the social and health system issues in the community, and at both peripheral and district-level facilities. This integrated approach to community and facility based maternal and newborn programming and implementation is called the Household-to-Hospital Continuum of Care. [from author]

Palliative care aims to maximise quality of life and relieve the suffering of patients with life-limiting incurable disease, and to support their families and carers. It is provided through specialist services such as hospices and palliative care teams and in general settings. The HIV/AIDS pandemic and rising cancer rates in Africa have increased the need for well-developed and integrated palliative care services. In sub-Saharan Africa, the concept of palliative care is not well developed and palliative care is largely confined to isolated specialist centres. Services have developed, but in very varied ways. In order to inform future developments, this review aimed to identify and appraise activities, opportunities and evidence of the status of palliative care in Africa.

The recent UN Millennium Project (UNMP) report recommended as a ‘quick win’ a massive training of community-based workers. This review examines the evidence to support or reject the hypothesis that investment in community workers can only impact on health outcomes with parallel investments in trained health workers and health systems. [author’s description]

This issue of The Manager discusses the role of local resources in strengthening health services. It will help health managers at the local level to identify types of local resources that may be available to them, decide on strategies for mobilizing these resources, and assess the value of such resources to their organization or program. [author’s description]

This cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria to identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. The report discusses the effect of decentralization on health service providers and community involvement. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. [adapted from author]

The paper responds to a number of questions around what needs to be done to scale up towards universal access to essential health services, including comprehensive HIV services, in developing countries. The submission argues for an emphasis on the three health MDG’s - on HIV/AIDS, on child health and maternal health

This report focuses on HIV/AIDS home and community care projects and programs that have been able to scale up or reach out, and in doing so have brought an improved quality of life to people living with or affected by HIV/AIDS. The initiatives are widely spread geographically, with five from Africa, two from Asia, and one from Latin America. The final chapter of this report revisits some of the main lessons learned through the practices, and examines both commonalities and differences. [adapted from author]

[This case study evaluates the] Drug Resources Enhancement against AIDS and Malnutrition (DREAM) program, created by the Community of Sant’Egidio to fight AIDS in sub-Saharan Africa. The project takes a holistic approach, combining Highly Active Anti- Retroviral Therapy (HAART) with the treatment of malnutrition, tuberculosis, malaria, and sexually transmitted diseases. It also strongly emphasizes health education at all levels. DREAM aims to achieve its goals in line with the gold standard for HIV treatment and care. [author’s description]

This report of a two-day technical consultation summarizes challenges, lessons learned from promising projects, knowledge and practice gaps, and recommendations for future practice. It suggests guidelines for community involvement in youth reproductive health and HIV prevention at all stages of a project cycle. [publisher’s description]

A participatory assessment process is a valuable starting point for involving all community members, including young people, in YRH and HIV/AIDS program development. YRH and HIV/AIDS program workers need skills in facilitating participatory assessments, especially when youth involvement is a key component. Supporting facilitators to learn by doing is an effective strategy to build skills in using participatory learning and action (PLA) approaches and tools during participatory assessment and throughout the project cycle.

In recent years, a number of specific strategies for improving health services and strengthening health systems have been consistently advocated. In order to advise governments, WHO commissioned this exploratory study to examine more closely the track record of these strategies in twelve low-income countries. [author’s description]

Horizons, in collaboration with CARE International and Family Health Trust, conducted a quasiexperimental intervention study to determine which care and support needs of people living with HIV and AIDS and their families could be met by trained youth, and to establish whether youth engaged in formalized care and support activities would increase their adoption of protective behaviors or reduce the stigma faced by members of AIDS-affected households.

The study was conducted in semi-urban and rural communities in two provinces of northern Zambia located 700 to 1,000 kilometers from Lusaka.

The following guidelines have been developed by a working group of practitioners drawn from clinics, hospitals, congregations and communities. They are intended for use by practitioners from the congregation, community, clinic, and other partners in local responses which are incorporating ART. [Description from preface]

Evidence Update is a two-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle income-countries. This issue reviews whether lay health workers improve health care delivery and health care outcomes.

Most South Asian governments have concentrated on emulating a Western style of healthcare service, with the result that an elite few are overmedicalised whereas the majority are neglected. However, community participation in the development of local health services could provide a solution. [abstract]

An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. The Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources, and cultural institutions for supporting community-based primary health care.

This package includes Summary Document; Introduction to the Approach and Description of Facilitator Training; Facilitators’ Guide: Consultation I; and Facilitators’ Guide: Consultation II. The Community Problem Solving and Strategy Development (CPSSD) activities in Uganda have been designed to help health workers learn to work with communities, understand community perspectives about the services, and encourage community support and participation in the delivery of services, so that immunisation coverage is raised and sustained.

A number of ART projects are trying to tackle the HRH problematic by delegating certain tasks from medical doctors to other cadres. While this task-shifting is certainly an important step, we contend that it will not be enough for scaling up ART in the high HIV-prevalence countries with the most severe HRH shortages. In the present report we argue that an altogether different approach to HIV/AIDS care and treatment might be required for overcoming the HRH bottleneck. [from summary]