Community Interventions

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 manual is a collection of adaptable tools and guidelines designed to help clinic supervisors and clinic managers achieve objective improvements in the quality of health care. The manual is especially useful for managers supervising integrated health services, who, on any given day, may be called on to support the provision of a full range of primary health services. The manual is designed to complement more detailed standard operating procedures that may be in use for specific services, for example, antiretroviral therapy.

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.

This report identifies innovative approaches countries are using to address the shortages of health care workers and describes efforts to achieve long-term sustainability. [author’s description]

The township health system in Myanmar is regarded as means to achieve the end of an equitable, efficient and effective health system based on the principles of primary health care approach. A township hospital caters medical care at the second referral level. Under the leadership and management of a Township Medical Officer in each township, para-professionals deployed at Rural Health Centers (RHCs) and Sub-centers under each RHC’s jurisdiction play key roles for providing primary health care services for rural population.

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.

The objective of this study was to describe the profile of community health workers - health promoters, traditional birth attendants and traditional healers - in rural Quechua communities from Ayacucho, Peru.

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]

A Village Development Committee Orientation organized to allow representatives of different organizations to discuss and identify causes of low coverage and high drop-out in their community. Special emphasis was placed on monitoring the immunization drop-out rate of each health facility. Indicators for VDCs have improved in 2003, and Parsa District is now regarded as one of the highest performing districts in the region.

Current safer motherhood and newborn care programmes emphasize interventions that do not reach the poorest households. Community based interventions have been neglected and undervalued. In this article, we argue that large scale community effectiveness trials are both necessary and feasible if we are to make further progress with reducing maternal and child mortality. [author’s description]

This study estimates the personnel cost implications of implementing the newly proposed Integrated Management of Childhood Illness (IMCI) algorithm in the first level health care facilities in rural Bangladesh. Policy makers need to know the additional resource requirements for IMCI before its actual implementation so that appropriate levels and combinations of personnel and drugs can be allocated. [abstract]

This paper describes three examples of human resource development in community-driven HIV/AIDS programmes. The basic proposition is that acknowledgement, inclusion of and support for community based health initiatives is necessary to understand fully where health action is occurring and where potential for expansion lies. The paper calls for an expanded definition of health systems encompassing work being carried out by communities who are at the frontline in responding to the HIV/AIDS epidemic. Health care workers live in communities, and communities are providing health care.

Using incentives and disincentives to direct individuals’ energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas.

An editorial arguing for expanding the professional category of the formal health care workers to include home-based informal caregivers, political community leaders, shop vendors of health products, and traditional health practitioners. The editorial further notes that formal health workers can become informal health workers when operating outside the rules of the health system.

This research sheds light on the nature, design and provision of institutional services for providing training to the premier community health service providers in the public sector in Bangladesh. Virtually no major study exists on the training of the FWVs in the country. The methodology of the research mainly consists of a personal interview and questionnaire survey, covering the concerned trainers and officials of the major public health administration and training institutions of the country, including the National Institute of Population Research and Training, the Family Planning Directorate and the Family Welfare Visitors’ Training Institute.

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

This study explored the factors that motivate lay volunteers to join tuberculosis (TB) control programmes in high burden but resource-limited settings. [adapted from abstract]

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 paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces.