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COMMUNITY SYSTEMS STRENGTHENING

Keynote address by

PROF MIRIAM K. WERE

ON THE OCCASION OF THE AMREF HEALTH AFRICA

INTERNATIONAL CONFERENCE, 2014NAIROBI, KENYA

24th – 26th NOVEMBER, 2014

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1. CENTRALITY OF COMMUNITIES IN THE WORK OF

AMREF HEALTH AFRICA

AMREF AFRICA’s 10 year strategy is entitled:

“PUTTING AFRICAN COMMUNITIES FIRST: ENHANCING CAPACITY AND PARTICIPATION TO CLOSE THE GAP IN HEALTH SYSTEMS.” The first point I want to make is to congratulate

AMREF for recognizing the importance of communities in health promotion, prevention of disease and in health services delivery since the 1970’s

These congratulations are doubled by the increasing focus on communities in the first three year business plan (2010 – 2014) and in the second one (March 2014 – Feb 2018)

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1.2 VisionHealthy people living good quality lives in robust and vibrant communities that make up healthy and vibrant Counties all over the nation resulting in a healthy Nation overall.

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1.3 MissionTo promote the Community health approach as the modality for social transformation for development from the community level by establishing equitable, effective and efficient Community Health Services in Community Health Units all over a nation.

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2. WHY IS THE COMMUNITY APPROACH SO IMPORTANT FOR AFRICA?

If it doesn’t happen in the community, it just doesn't happen!

If it happens in the communities it happens in the nation.

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Specifically the community approach is crucial because:-

2.1 It brings health services closer to mothers and children who are the most vulnerable and who need them the most.

2.2 Communicable disease reduction from community based action e.g. construction and use of latrines, participation in immunisation and community based first line care reduces the disease burden

2.3 Better management & prevention of non-communicable diseases and their reduction takes place through Community Dialogue Days that leads to internalization of how non-communicable diseases can be prevented through appropriate lifestyles that get adopted by the community which is much stronger than individuals changing alone.

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2.6Improved quality of care at health facilities-–especially for non communicable/chronic diseases-- as decongestion occurs at health facilities both in outpatient and inpatient services.

2.7Containment & even reduction of financial cost to health sector from reduced and reducing disease burden because of disease prevention and health promotion through empowered communities as well as more effective and efficient organisation of health services aided by decongestion of health facilities.

2.4 Adoption of community norms that promote health and prevent disease occur from participation in monthly Community Dialogue Days/Events and quarterly Community Action Days/Events.

2.5 Possibility is enhanced for achieving universal health coverage through establishment of Community Health Services since coverage with health services at facilities alone is still less than 50% in most of Africa.

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3. COMMUNITY SYSTEMS STRENGTHENING

3.1 First crucial step in Community Health Systems Strengthening is Formal recognition of the community level as part of the national health system e.g.1. Ethiopia’s Health Extension Program (HEP)2. Ghana’s Community-Based Health Planning &

Services (CHPS)3. Kenya’s Community Health Strategy/Services (CHS)

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3.2 Deliberate commitment to Processes for peoples’ participation, involvement and Empowerment through:-

Establishing/Strengthening structures to facilitate this;

Deliberate hope &confidence building process; Sharing in decision-making including what

the people see as their priority health problems

Raising awareness on the social and physical determinants of health that must also be addressed.

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3.3 Having clarity on the Key Steps In Establishing

Community-level Health Work:

1) Financing of Community Health Services;

2) Clarity on what constitutes a Community Health Unit;

3) Clarity on who provides Community Leadership &

Governance

4) Clarity on mechanism of motivation and retention of

the Community Health workforce

5) Recruitment and Training of Community Health

Workforce;

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6. The Community Entry Process &clarification of

interaction between health workforce and the

Community Health Unit;

7. Clarity on mechanisms for strengthening the

Interface/Linkage of the Community Level with

Health Facilities;

8. Clarity on mechanisms for supportive supervision for

Community Based Health Services;

9. Monitoring and evaluation for Community Health

Services:

10.Partnership in support of Community Health

Services ;

11.Role of Multi-Sectoral Approach in Advocacy and

Communication;

12.High Impact Interventions for Community Health

Services .

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3.4 The WHO Framework for the Community Health System

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4. COMPONENTS OF COMMUNITY HEALTH SYSTEMS

STRENGTHENING. The six building blocks for health systems strengthening can be applied to the community level as a means of gaining clarity in what needs to be strengthened. THE BUILDING BLOCK

EXAMPLES ISSUES TO BE ADDRESSED IN STRENGTHENING

1. Community level Leadership/Governance

Community Health Committees

Specifics of:- Roles &

responsibilities Criteria for

selection Training modules

2. Community Level Health Workforce

Ethiopia’s Health Extension Workers (HEW)

Ghana’s Community Health Officer (CHO)

Kenya’s Community Health Assistant (CHA)

Roles and responsibilities

Basis for selection for training

Training curriculum Volunteers to work

with the health workers & their training

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THE BUILDING BLOCK

EXAMPLES ISSUES TO BE ADDRESSED IN STRENGTHENING

3. a) Information   

Community health information tools

What information is to be collected

How to be collected

How to be usedb) Research Determination of

workload for community health personnel.

 

4. Services to be delivered

--Organisation of Health Education sessions Treatment of

malaria? Treatment of

pneumonia? Child birth? etc.

What each of these entails

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THE BUILDING BLOCK

EXAMPLES ISSUES TO BE ADDRESSED IN STRENGTHENING

5. Community level medical products and technologies

Kenya’s CHA Medical Kits Items for prevention

e.g. contraceptives Items for

diagnostics e.g Rapid Diagnostic Test (RDT) for Malaria

Items for treatment e.g. antimalarial items

 

 

6. Community-Level Health financing

From the national budget

From income generating activities

From development partners

The various expenditure items to which the finances go at the community level

Performance-Based Financing/payment of

5. IN CONCLUSION

The more a country in Africa makes the community level the FOUNDATION of the health system through successful implementation of Community Health Service, the more progress is made towards a healthy population with positive health indices.

If it doesn’t happen in the communities it just doesn’t happen in the nation.

If it happens in the communities it happens in the nation.

16THANK YOU VERY MUCH FOR YOUR KIND ATTENTION