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.

Improving Female Involvement in Voluntary Medical Male Circumcision in Uganda

The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project in Uganda has been working collaboratively with 10 implementing partners (IPs) to carry out voluntary medical male circumcision (VMMC) for HIV prevention programs since 2013. ASSIST’s objective was to build capacity of IP, district and health facility staff to improve the quality and safety of voluntary medical male circumcision services in Uganda. Initially, 30 health facilities were involved and progressively the activity was scaled up to additional health facilities. There were 19 health facilities in the first wave and 33 in the second.

VMMC faces some challenges such as demand creation for services, adherence to six weeks abstinence after circumcision, return for post-operative review, and use of other HIV prevention methods after VMMC. Literature has shown that female involvement in VMMC can play a large role in addressing these challenges so QI teams set about to increase female partner involvement in VMMC.

The tested changes section of this change package provide guidance to health facility teams on improving female involvement in VMMC, the authors recommend that to improve female involvement in VMMC, health unit teams should implement changes under the following four aims below, which were determined based on the gaps found to affect female involvement in VMMC at the health facilities:

  • Improving the competence of health providers to provide adequate and consistent information/messages on involving women in VMMC
  • Promoting the provision of female friendly services during VMMC services
  • Focus on community sensitization and mobilization on involving women in VMMC
  • Improving data capture of female participation in VMMC

Brindando apoyo psicoemocional a madres y estimulacion a ninos afectados por sindrome congenito asociado al virus del Zika

El Hospital General del Sur (HGS), con sede en la ciudad de Choluteca y la Región Departamental de Choluteca, inauguró en noviembre del 2017 una clínica de manejo integral para niños con microcefalia, que surgió con el propósito de dar seguimiento integral y niños afectados por síndrome congénito asociado al Zika (SCaZ) de su área de influencia.

El Proyecto ASSIST de USAID ha brindado asistencia técnica a los equipos de profesionales de la Región de Salud, al hospital y a los establecimientos de salud para implementar actividades de capacitación en Zika, organizar equipos de mejoramiento de la atención y dar seguimiento a niños afectados por SCaZ, a fin de que reciban las atenciones que les corresponda acorde a los lineamientos de la SESAL.

El presente estudio de caso describe el proceso llevado a cabo para la implementación de la clínica destinada a brindar atención integral a los niños afectados por el síndrome congénito de Zika en el área de influencia de la Región de Salud de Choluteca, así como brindar apoyo psicoemocional a las madres y familiares de estos niños.

Leer el estudio de caso.

Hospital General del Sur (HGS), based in the city of Choluteca and the Departmental Region of Choluteca, introduced a comprehensive management clinic for children with microcephaly in November 2017, which emerged with the purpose of providing comprehensive monitoring and affected children for congenital syndrome associated with Zika (SCaZ) in its area of ​​influence.

The USAID ASSIST Project has provided technical assistance to teams of professionals from the Health Region, the hospital and health facilities to implement training activities in Zika, to organize teams to improve care and monitor children affected by Zika (SCaZ), so that they receive attention according to the guidelines of the MOH.

This case study describes the process carried out for the implementation of the clinic aimed at providing comprehensive care to children affected by the congenital Zika syndrome in the area of ​​influence of the Choluteca Health Region, as well as providing psycho-emotional support to the mothers and relatives of these children.

Survive & Thrive Final Report

Demonstrated that training is not enough and that quality improvement approaches are essential to sustain quality care for mothers and newborns in low-resource settings, the Survive & Thrive Final Report highlights the efforts that partners shared through developing tools and resources.

A breakthrough contribution of the Global Development Alliances (GDA) was its development of a practical approach to engage frontline health workers in improving quality of maternal and newborn care.  The GDA’s Improving Care of Mothers and Babies guide, developed by the USAID ASSIST Project and the American Academy of Pediatrics, breaks down the process of improvement in clear steps that providers can follow to plan, test, implement, continuously assess, and sustain process changes to deliver care in the best way possible for the setting. The guide, which has been translated to French and Spanish, is a critical resource to ensure care is optimized once providers have been trained.   

An equally important component of the GDA was to ensure that quality improvement (QI) is part of the implementation and long-term sustainability of maternal and newborn care. The Improving Care of Mothers and Babies: A guide for improvement teams, includes information and tools to facilitate implementation of quality improvement activities at the facility level.  The Guide outlines the process of improvement step-by-step, helping providers plan, test, implement, continuously assess and sustain interventions that enable care to be delivered in the best way possible.  Improving Care of Mothers and Babies can guide those new to improvement methodologies, as well as provide further support to those who have experience implementing and managing improvement projects.  It can be used by a leader or facilitator to help others learn about improvement in both clinical and workshop settings and can also be used as a self-study manual by improvement teams and individuals.

Download Survive & Thrive Final Report

Dando respuesta a los asuntos de género para mejorar los resultados en la atención en salud relacionada con el Zika

Este documento proporciona información sobre los problemas relacionados con el género en relación con la atención médica relacionada con el Zika.

Resalta los principales problemas:

• Roles y valores relacionados con el género
• Acceso limitado y / o control sobre educación sexual, anticonceptivos y otros servicios de salud reproductiva
• La falta de poder de las mujeres para negociar el uso de anticonceptivos (incluidos los condones)
• Estigma que lleva al abandono de la madre y el niño

Version en español

Responding to Gender Issues to Improve Outcomes in Zika-related Health Care

This document provides information on the issues surrounding gender with regards to Zika- related health care.

It highlights the main issues:

• Gender-related roles and values
• Limited access to and/or control over sexuality education, contraceptives, and other reproductive health services
• Women’s lack of power to negotiate contraceptive use (including condoms)
• Stigma leading to mother and child abandonment

English Version


Privacy, a companion of choice and swift referrals; the key to improve mothers' experience of care

Since March 2017, the Ministry of Health in Uganda, in collaboration with USAID ASSIST Project has been working to improve the experience of care for mothers delivering their babies in health facilities. The focus was on 15 health facilities in the two districts of Gulu and Nwoya in Northern Uganda. Through exit-interviews with mothers who had delivered both in the hospital and at home, health facilities were able to identify areas to specifially improve the experience of care.

Mary Atim Ladwong, a midwife in Anaka hospital, and Lilly Grace Ayamo, a clinical officer in Koch Goma Health Centre IV, share what steps they took to improve experience of care, and how it affected their work.

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Improving postpartum care in a large hospital in New Delhi, India

Despite recent progress, the maternal mortality ratio (MMR) in India remains high at 174 per 100 000 live births. Bhagwan Mahavir Hospital (BMH) is a secondary level hospital in New Delhi. In 2013, five women died in BMH’s postpartum ward. In January 2014, a United States Agency for International Development-funded team met with BMH staff to help improve their system for providing postpartum care to prevent maternal deaths. The hospital staff formed a quality improvement (QI) team and, between January and December 2014, collected data, conducted root cause analyses to understand why postpartum women were dying and tested and adapted small-scale changes using plan-do-study-act cycles to delivery safer postpartum care. Changes included reorganising the ward to reduce the time it took nurses to assess women and educating women and their relatives about common danger signs. The changes led to an increase in the number of women who were identified with complications from two out of 1667 deliveries (0.12%) between January and May 2014 to 74 out of 3336 deliveries (2.2%) between July and December 2014. There were no deaths on the postpartum ward in 2014 compared with five deaths in 2013 but the reduction was not sustained after the hospital started accepting sick patients from other hospitals in 2015. QI approaches can improve the efficiency of care and contribute to improved outcomes. Additional strategies are required to sustain improvements.

Improving postpartum care in a large hospital in New Delhi, India