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.

The Human Experience of Supporting a Humphrey Fellow

Emily Lanford

USAID ASSIST Project/URC

Beginning on May 1, 2013, the health workforce development (HWD) unit at University Research Company (URC), LLC began its six week sponsorship of Madhavi Dwivedi, a Humphrey Fellow from India whose host was Emory University.  The objective of her work was to identify ways to strengthen the existing engagement tool that is being applied to URC’s Community Support activity in Uganda.   As a part of her work at URC, she conducted a literature review on engagement and influencing factors such as supervision and feedback.  Additionally, Madhvi identified existing M-health initiatives that are cu

Improving uptake and retention of PMTCT services

Rhea Bright

Quality Improvement & Human Resources for Health Advisor, USAID Bureau for Global Health Office of Health Systems
AIMGAPS nurse explains CHSS in Tanzania

An AIMGAPS facility nurse explains the Community Health Systems Strengthening Model (CHSS) to her colleagues during a training session in Iringa, Tanzania, where these nurses are being prepared to serve as community QI coaches for their catchment areas.

Photo by Rhea Bright, URC

Under the USAID Health Care Improvement Project (HCI), my colleagues in Tanzania and I have been working with the Ministry of Health and Social Welfare (MOHSW) and EngenderHealth in the Iringa Region of Tanzania to improve uptake, retention, and the quality of prevention of mother-to-child transmission (PMTCT) of HIV services. Rather than focusing solely on improving care at one point of service along the PMTCT continuum, our improvement efforts looked at improving PMTCT services across the entire continuum of care, from the antenatal period, through the entire breastfeeding period, until the HIV status of the exposed infant is definitively determined at 11 facilities in Iringa.

In order to address the gaps in PMTCT care that were identified at the 11 facilities, a data system was developed, quality improvement (QI) teams were formed, and facility QI teams began to track indicators for various PMTCT services that should be delivered during antenatal care (ANC), labor and delivery as well as in the post-natal/infant follow-up period.  Providers began testing changes at their respective facilities to address areas in need of improvement.  However, we noticed that some indicators improved (i.e. HIV positive pregnant women started on ARV or ART; and definite testing of the HIV exposed infant), while others lagged behind (i.e. early booking for antenatal care (ANC); male partner involvement; exclusive breastfeeding; and infant and child follow-up visits).  After providers tested several different changes at the facility level and saw little to no improvement in those indicators, it became apparent that improvement efforts would need to go beyond the facility.

CHW Regional Meeting | Addis Ababa, Ethiopia, June 19-21, 2012

The USAID-sponsored Community Health Worker (CHW) Regional Meeting held in Addis Ababa, Ethiopia from June 19 to 21, 2012, was attended by over 60 government and nongovernmental (NGO) representatives from six African countries (Ethiopia,...

Uganda| Community Support to Community Health Workers (CHWs)

Date improvement activities began: June, 2012 Aims/objectives: Improve performance of CHW and CHW program by strengthening Community Health System • Explore different community groups, community networks, local government networks, CHWs...

Ethiopia| Community Health Worker (CHW) Collaborative

Date improvement activities began: November, 2011 Aims/objectives: Apply quality improvement methods to improve community health worker (CHW) and community health system performance and productivity Implementation package/interventions:...

Senegal| Community-Based Collaborative

Date improvement activities began: February, 2011 Aims/objectives: Apply IC model to improve evidence based child survival interventions care at community levels (Health Huts) in Senegal. Implementation package/interventions: The...

Improving CHW Program Functionality, Performance, and Engagement: Operations Research Results from Zambia

The United Nations Millennium Project identified the large-scale training and deployment of community health workers (CHWs) as an important strategy to fill the human resources gap and achieve the Millennium Development Goals (MDGs)...

The prevention, treatment and care for HIV/AIDS through the community participation.

Problem: Cultural norms around gender, sexually and substance abuse continue to inhibit HIV prevention,treatment and care in Africa.These norms are so ingrained in the fabric of community life that discussing them is often difficult. The...

Implementing alternative distribution points to rural communities in the Langeberg Sub-district | South Africa

Problem: The Langeberg area is a rural area consisting of five small towns servicing a vast farming community and is situated within the greater Cape Winelands District of the Western Cape of South Africa. The biggest town is Robertson, it...

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