Community Health

Community Health System

As the complex needs of people facing the double burden of health issues and socio-economic difficulties are increasingly identified and addressed, the importance of community-level health and social services is magnified. Improvement methods can be applied at the community level to address the quality and coverage of health and social welfare services, strengthen linkages between the community and the health system, and enhance the capacity of existing groups and networks to affect health issues in their own communities. 

A particular area of focus for improvement in community health is to strengthen the effectiveness and sustainability of programs that rely on community health workers (CHWs). Due to large catchment areas and numbers of households they are expected to cover, CHWs are frequently inadequate to provide services to all households needing them.  Although CHWs are usually linked to facilities, facility health care teams often do not have the time or capacity to address the challenges facing CHWs. Leveraging existing networks and indigenous structures to work together to improve the health of community members can improve CHWs’ acceptance, morale, and performance.

Community-Based Maternal Health Care: Meeting Women Where They Are

ICHC Blog Series

This post is part of the Institutionalizing Community Health Conference blog series.

By: Sarah Hodin Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Mother and newborn in Ghana. (Courtesy of Kate Holt/Jhpiego)

Transforming the Community Health Landscape: From Alma Ata to the Institutionalizing Community Health Conference

ICHC Blog Series

This post is part of the Institutionalizing Community Health Conference blog series.

By: Nazo Kureshy, Community Health Team Leader, USAID and Jerome Pfaffmann Zambruni, Health Specialist / Child Health Unit, UNICEF

Quality improvement— a game changer for Kenya

Bill Okaka

Knowledge Management & Communications Officer, ASSIST Kenya

After the promulgation of the Kenyan constitution in 2010, the Right to Health by all Kenyans cannot be refuted. Fatuma Abdullahi, a practicing nurse, is the institutional memory of the unfolding of events in the northern frontier semi-arid regions of Kenya. Her three decades of facility and community work has been characterized by:

  • low utilization of health services (even in situations where access wasn’t a problem due to short distances)
  • high neonatal and maternal mortality (the region scores a Maternal Mortality Ratio of 790/ 100,000 live birth), and
  • low financial resource ploughing by national and county governments (compared to resource envelop received vis-à-vis the vastness of the region).

Avoiding the word “HIV” to bring women in for testing – a good strategy?

Kim Ethier Stover

Senior Improvement Advisor, USAID ASSIST Project/URC

I recently took a trip to Mozambique to gather learning around the Partnership for HIV-Free Survival's (PHFS) Community Demonstration Project, led by ASSIST. In Gaza Province in Mozambique, we worked with three health facilities, Licilo, Chissano, and Incaia, and their catchment communities. I had the opportunity to meet with community groups participating in the project, bairro (community) improvement teams and Health Committees, consisting of bairro improvement team representatives, at the Health Centers.

A health worker's perspective on improving PMTCT services through a community-based system in Mozambique

Percina Paulo Mathe

Maternal and Child Health Nurse, Licilo Health Post/Mozambique

The following blog is written by Percina Paulo Mathe, a health worker in Mozambique,and was originally published in January. ASSIST is highlighting Percina's story as as part of World Health Worker Week (April 6-10). The original Portuguese entry is below the English translation.

My name is Percina Paulo Mathe, I’m a 32-year-old maternal and child health nurse in Licilo in Gaza Province, Mozambique.

After my training on PMTCT, I found it was hard to apply it in my community because there were many barriers to the community approach. For example, often all the information about a patient stayed within the hospital without being passed on to those in their own community or neighborhood who could support the patient. Language was also a barrier; sometimes topics were not explained in the hospital in the same terms as in the community, whereas using a common language would increase what is truly understood by the patient and the community, taking into account the rumors that exist in the community.  For me such incomplete communication was like trying to fight a poisonous tree by just cutting off some branches; leaving the trunk and the roots means that when the rain comes, the tree will just grow back.

Le travail du centre de santé de Kinyami au niveau communautaire

Cyriaque Bimenyimana

Nurse, Kinyami Health Center, Burundi

Propos recueillis par Bède Matituye

Je suis Cyriaque Bimenyimana, titulaire du centre de santé de Kinyami, district sanitaire Giteranyi en province de Muyinga. J’avais participé, en décembre 2013 à une formation sur comment renforcer le système de santé communautaire organisée par le Ministère de la Santé et University Research Co. Y ont également participé un des chefs collinaires, un animateur communautaire et un responsable d’une association locale. Nous avions été invités pour notre formation car notre centre de santé ne faisait pas partie des sites pilotes retenus pour le système de santé communautaire. Au retour de la formation, nous avons pris la décision nous-mêmes d’initier certaines activités pour renforcer notre système de santé communautaire.

Love thy neighbor: Tanzanian communities mobilize their own for HIV testing and care

Kate Fatta

Improvement Advisor for Knowledge Management, USAID ASSIST Project/URC

“I’ve always heard people talk about ‘community engagement’ and ‘community mobilization’, now I see, this is the real way to do it,” said Regina, the District Home-Based Care (HBC) Coordinator of Muheza, while meeting with the community improvement team in Kwemsala. This comment struck me when she said it, and now, weeks later, I continue to think about it and the work that I saw when I visited communities involved in the Tanzania Community Linkages activity in the Tanga Region.

MaNHEP – Testing changes at the community level

Kim Ethier Stover

Senior Improvement Advisor, USAID ASSIST Project/URC

In previous blog posts I mentioned that when I began working on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), I had to shift my thinking from facility-level improvement to the community level.  To begin with, we set up community-level quality improvement teams and trained them. Then, it was time to get to the business of improving care.