Post 00893e : Community Health Planning

POST 00893E : COMMUNITY HEALTH PLANNING Follow-up on Post 00888E 2 March 2006 ___________________________________ This posting contains two contributions. The first is from Robert Steinglass (mailto:[email protected] ) from ImmunizationBasics in the United States. He shares information on another experience with community involvement in health, that of the Uganda national immunization programme, UNEPI. The second contribution is again cross-posted from the network "The Connection" (mailto:[email protected] ). Dr. A.T. SEDDOH (mailto:[email protected]), External Relations and Governing Bodies, WHO AFRO, Brazzaville, Republic of Congo, suggests the following view on the community-based approaches to health with reference to the Nkwanta model. He also informs us of integrated community-based interventions to deliver lifesaving health service in hard-to-reach communities, the ACDS in Africa. ___________________________________ In the same vein as reported in Post 00888E recently on the Ghanaian experience with Community involvement in its own health, let me share with you some information on the Uganda UNEPI experience that many of you may not be aware of. To raise and sustain immunization coverage, the Uganda Ministry of Health, with support from the BASICS Project, elected to pursue the Community Problem Solving and Strategy Development (CPSSD) approach, which is designed to help health workers learn to work with communities, understand community perspectives about immunization services, and encourage community support and participation in immunization delivery. The Ministry produced three documents that summarize the approach, which is consistent with the Reaching Every District (RED) strategy. To access these documents, please go to the ImmunizationBasics site at : http://www.immunizationbasics.jsi.com/Resources_Immunization.htm#Linking There is no direct link for downloading. The documents are the first on top of the list. They have also been added to the list of country programme documents, under Uganda on the TechNet21 site at : http://www.technet21.org/countryprog.html In addition to these Uganda materials listed above, a short description of the program with data showing the success of the intervention in Uganda to lower drop-out rates, and a Powerpoint presentation on the topic can be accessed at the following links. http://www.technet21.org/pdf_file/UgandaCPSSDFinal.pdf http://www.technet21.org/UgandaDropOut.ppt -------------------------------------- "It is exciting to see that the spirit of Alma Ata and the primary health approach is being rekindled and indeed the debate on finding an alternative system for improving human resources for health, given the current precarious levels of health manpower, is now urgent. From that perspective, the piece by Dr. J.K Awoonor is most interesting and sets up a good platform to explore community-based approaches to health. While acknowledging the potential of a Community-based approach to service delivery, I am of the opinion that framework of the model of the Community-based Health Planning and Services (CHPS) initiative discussed requires more detailed review. I have been a keen follower of the CHPS initiative in Ghana which as a concept has a promise but may need further methodological and design clarity. I would focus on a few observations with the hope that the authors might provide further insight to promote experience sharing. First, in their diagnosis, the authors bemoaned the previous affinity for the health system to invest in health facilities but with dwindling human resource levels, there appears to be a reintroduction of the same facilities building philosophy but at a lower level. Secondly with CHPS requiring the production of additional 6000 nurses, the call to increase the production of these new Community health nurses using the facilities that are already used for training general nurses probably does not appreciate enough existing limitations and complexities of health human resource production. Thus a static facilities approach will still face the three challenges of human resources, service delivery policy as well as design, infrastructure and logistics constraints that the CHPS concept faces. The methods for the assessments are not quite clear and the conclusions need further scientific rigour to be globally acceptable. For instance, the assumption that the presence of a BCG scar is a significant proxy for the probability that immunisations will be completed is difficult to accept. The terms "CHPS and non-CHPS zones" pre-supposes a distinct variation in design that is unique and assumes that the particular characteristics of CHPS are significantly exclusive to these zones and in no other areas. Another experiment in Ghana is encapsulated in the Accelerated Child Survival Strategies used in the country's Upper East Region which drew on networks between Communities, community-based volunteers and the existing sub-district and district health system and used the "marginal budgeting bottle-neck tool" developed by UNICEF, WHO and World Bank. I recall the results were quite good between 2001 and 2003. There is definitely a need for clear guidance about the organisation, rules and incentives that best help a health system to achieve its goals within available resources. This, of course, depends on the value of past investments and training programs as well as a systematic rejuvenation of networks ensuring that the existing and new cadres of human resources are custodians of the clients' interest, complemented with communities' own resources - volunteers, private sector, CSOs etc. --------------------------------- Every year nearly 11 million children under age five die from preventable causes, with nearly 5 million of those deaths occurring in sub-Saharan Africa. In order to reach the Millennium Development Goal of a two-thirds reduction in child mortality by 2015, three million child deaths per year will need to be averted in sub-Saharan Africa. Funded by Canadian government, UNICEF developed a pilot project called The Accelerated Child Survival and Development (ACSD) programme that is designed to deliver a package of lifesaving health services to children in hard-to-reach communities. ACSD was initiated in approximately 100 districts within 11 countries in West Africa beginning in 2002. ACSD takes the most effective health interventions for children, newborns and pregnant women and bundles them in an integrated, cost-effective package. Interventions include immunizing children and pregnant women, delivering life-saving micronutrients, encouraging breastfeeding, supplying oral re-hydration salts for diarrhoea and providing bed nets to protect children and women from malaria. After three years of increasing coverage in basic health interventions, UNICEF estimates that child deaths will have dropped by an average of 20 per cent across the 16 districts where the programme was fully implemented, and by 10 per cent where it was partially applied. After analysing what has worked in the pilot programme, UNICEF has set the goal of expanding ACSD to cover many more African children. "We believe that we can reach 60 per cent of children across sub-Saharan Africa by 2009 with these integrated community-based interventions...This will mean saving the lives of an additional one million children every year in that region alone," - UNICEF executive director Ann M. VENEMAN said at the World Health Assembly, 16 May 2005, Geneva, Switzerland. To learn more on ACSD's goals, challenges and solutions visit UNICEF site at: http://www.unicef.org/health/index_childsurvival.html Read "Integrated Approach to Child Survival Achieving Important Results, UNICEF Finds In Several West African Countries, 20% Drop in Death Rates Estimated" at: http://www.fasid.or.jp/oda/pdf/handout_ban2_14.pdf On the subject of ACSD in Ghana, attached please find the document "Ghana's Ministry of Health adopts the UNICEF-supported Accelerated Child Survival and Development approach as a major strategy for scaling up child survival interventions nation-wide and for achieving the child survival MDG" ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[email protected] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de internationale en sant, Canada (http://www.ccisd.org) ______________________________________________________________________________ ##text##