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.

Listening to the voices of community health workers

Donna Bjerregaard

Senior Technical Advisor, Initiatives Inc.

In 1505, the Polish Parliament stated, "Nothing new without the common consent." Today we understand that ‘nothing about us without us’ is the rallying cry for inclusion and change.    

Community improvers impress district and national officials in Mahalapye, Botswana

Cecil Haverkamp

Chief of Party, Botswana, USAID ASSIST/URC


Participants in a Community Improvement Learning Session in Botswana. Photo by URC.

Strengthening HIV linkage and retention through improved community/facility collaboration in Palla Road, Botswana

This ASSIST case study describes how the community improvement team in Palla Road village worked with facility staff to figure out how to leverage existing community platforms and resources to locate patients who were lost to follow-up (LTFU) and return to HIV care at the local facility.

Using Collaborative Improvement to Enhance Postpartum Family Planning in Niger

The report describes the ASSIST project intervention in 16 facilities in Niger that led to an improvement in postpartum family planning (PPFP) quality and uptake, and adherence with selected FP methods of choice. The intervention, which happened over a period of eight months, also contributed to the reduction of unmet FP need and achieving healthy timing and spacing of pregnancies (HTSP).

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).

Integrating Nutrition Services in HIV and TB Care in Mindolo I Clinic in Kitwe, Zambia

With support from the United States Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), health care workers in Kitwe District are improving the quality of nutrition assessment, counseling, and support (NACS). NACS services were not being implemented as part of the daily clinic process, despite health workers being trained in NACS and receiving the necessary tools and job aids.

The Mixed Nature of Incentives of Community Health Workers: Lessons from a Qualitative Study in Two Districts in India

This article, published in Frontiers in Public Health, examines the role that incentives play in motivating community health workers (CHWs) and in family dynamics that affect CHW performance. In India, accredited social health activists (ASHAs) are female CHWs who provide a range of services. This study interviewed 49 ASHAs in two districts in India and at least one family member (a husband, mother-in-law, sister-in-law, or son) to explore the role of family, community, and health system in supporting ASHAs in their work.

USAID ASSIST Project Annual Performance Monitoring Report FY15

This annual report for the USAID ASSIST Project summarizes the project's accomplishments and results in FY15 supporting the application of modern improvement methods by host country providers and managers in USAID-assisted countries. During FY15, USAID ASSIST provided assistance in 23 countries through field and core funding.

FY15 Results:

Increasing institutional deliveries through improving community-facility linkages in Mewat, Haryana State, India

Empowering communities and frontline health workers to use quality improvement (QI) methods to achieve better antenatal and intrapartum care, the USAID ASSIST Project supported a community QI team in Mewat, Haryana. The team observed that fewer than 20 percent of pregnant women in Salaheri village had institutional deliveries due to rumours that male doctors delivered babies and staff did not treat patients well. The QI team addressed these issues during regular home visits by frontline workers, leading to some improvement.

Partnership for HIV-Free Survival Community Demonstration Project in Gaza, Mozambique

Beginning in late 2013, the USAID ASSIST Project began to provide technical support for community-level improvement of elimination of mother-to-child transmission (EMTCT) services to the Ministry of Health of Mozambique as part of the PEPFAR-funded Partnership for HIV-Free Survival (PHFS). The project took place in Bilene District in Gaza, Province in three health centers (Licilo, Chissano and Incaia) and their associated catchment areas which included 15, 11 and 13 bairros (communities) respectively. The goal of the PHFS Community Demonstration Project was to contribute to EMTCT through increased community awareness, improved community-facility linkages, and increased access to services for pregnant women. The project focused on increasing the number of pregnant women identified by the community who sought antenatal care (ANC) at the health center and who were tested for HIV. This demonstration project employed the community health system strengthening model to improve the quality of PHFS services at the community level.

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