POST 907E : COMMUNITY HEALTH PLANNING

POST 907E : COMMUNITY HEALTH PLANNING Follow-up on Posts 00888E and 00893E 4 April 2006 _____________________________________________________________ Robert Steinglass (mailto:[email protected]) from the United States draws our attention to another experience of community participation, involving Village Development Committees in the Parsa district of Nepal, then supported by the BASICS Project, to implement the RED strategy. At the following link, you can access a short five-page document (33K), written by Hari Krishna Shaw and Mizan Siddiqi published in 2004. Http://www.technet21.org/pdf_file/NepalRED-VDC.pdf or at http://www.technet21.org/Countryprog.html This document describes the activities and achievements of an effective approach used in Nepal to involve community leaders and local health workers, volunteers, and organizations in tracking children who had dropped out or not started their basic immunizations, and motivating their caregivers. The programme had developed a recall system using reminder slips. A translated example of this slip is temporarily hosted on the website. You can download it from : http://www.technet21.org/DropOutSlipNepal04.xls In societies majoritarily illiterate, one can wonder how effective could this system be. There is no available evaluation studies of recall systems in developing countries. Maybe some members would be aware of any such evaluation? Three elements are highlighted in the analysis : Monitoring of the DPT1/DPT3 drop-out rates at the health facility level. Health staff/Villagers Meetings Community support to routine vaccination. Concerning the drop-out rate monitoring, Robert also sends a piece extracted from a Question/answers corner on the IMMUNIZATIONBasics website. This one discusses strategies for drop-out rate reduction. _________________________________ Question from a post-graduate student in Uganda: What are the strategies of reducing immunisation drop-out in Africa? Response: Thank you for your question on reducing immunization drop-out. This is not a simple question, as the appropriate response will not be the same in every location. The general approach, however, would be to try to (1) Observe services and talk to health staff and families to learn the nature and level of drop-out and the main causes, and (2) Take appropriate steps to address the major causes in your particular situation. You can obtain a general idea of drop-out levels by comparing the number of DPT1 and DPT3 vaccinations each month and over the year. You can also measure drop-out of those who are initially accessing health services but not returning by comparing BCG and measles (or DPT3) vaccinations. Finally, it is useful to look at data to determine between which doses the drop-out is occurring. In some places, often those with better services and higher coverage, the biggest drop-out is between DPT3 and measles – usually due to punctual receipt of DPT3 followed by a long interval before measles can be given. In this case, there may be a need to provide special reminders or messages at the DPT3 contact. Questions you can then ask to determine the causes of drop-out include: • Are services available, reliable, and provided as scheduled? • Are the days and times when vaccination is offered appropriate for the population, e.g. are vaccinations offered at times when many people are busy growing food or doing other essential tasks? • Have there been stockouts or logistics problems (e.g. no fuel for transport of the vaccines or health staff)? • Are there physical access problems (large distances, impassible roads)? • Are there practical problems (people must work full-time in the fields at certain times of the year)? • Are there constraints (e.g., mothers need their husbands' permission to go for services; people strongly trust traditional practitioners and mistrust “modernâ€