community mobilisation and participation in health.ppt

7/29/2019 Community Mobilisation and Participation in Health.ppt

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Definition History CH interventions(Uganda) Evidence Updated Policies and Operational Guidelines VHT good practices VHT Impact Challenges and constraints Improving Linkages with Health System Opportunities and Actions for Impact An example


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A process which people are enabled tobecome actively involved in defining theissues of concern to them, in makingdecisions about factors that affect their lives

and taking action to achieve change.


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1978 Alma Ata declaration Community Based Health Care 1979 District Community Based Health Care

Committees 2001- Village Health Committees 2002-Village Health Teams cooexisting with

diverse community health actors 2009 Ouaga Dougou Declaration

2009 Update of VHT strategy and development ofoperational guidelines for all levels Clear Guidance for All Community Health

Interventions to be implemented via VHT


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Formation of VHT National CoordinatingCommittee

Strengthening of former VHT Secretariat NowKnown as VHT Steering Committee withaddition of Key M o H Program Managers

Formation of VHT Stakeholders Forum

Draft Strategy (update)

Draft Operational Guidelines 2 Members of Staff from HP and

Environmental Health dedicated to VHTS


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Coordination mechanisms Numbers of VHTs

Standard Motivation Package

Selection Criteria for VHTs Basic Functions refined


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Coordination roles and functions defined forall levels

All Community Health Activities via VHT

Requirement for Joint Planning, Review andReporting

Recommendation Resource Pooling

Coordination via DHMT DMO


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Must be selected by the community itself and not imposedby political structures

Should be exemplary, honest and trustworthy andrespected

Want to serve as a volunteer Must be a resident of the village Should be available to perform specified VHT tasks Should be interested in health and development matters Should be a good mobiliser and communicator May already be a CHW TBA, drug distributor or similar Ideally should be able to read and write at least the local

language Political leaders cannot be selected Selection should be gender sensitive


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Basic requirements to carry out VHT function

(Standardised VHT uniform, ID, Standardisedbag and kit using MoH VHT logo. Lunch andtravel allowance whilst carrying out outreachand visits to health centre).

Health worker supervision and mentoring

technical support Activity and performance related incentives Recognition by Authorities and their own

communities- Advocacy and support for VHT to access

Government programs, income generatingschemes and other microfinance and creditschemes

Community reward such as community

digging, seeds, livestock


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VHT BASIC FUNCTIONS

Community Information management, Health Promotion and EducationMobilization of communities for utilization

of health services and health action Simple community case management andfollow up of major killer diseases (Malaria,Diarrhoea, Pneumonia) and emergencies Care of the newborn Distribution of health commodities


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Immunisation

Provision of supplemental vitamin Achildren 6-59 months of age and post-

partum mothers Provision of preventive zinc supplements to

all children 6-59 months of age

Promotion of breastfeeding immediatelyafter birth, exclusive breastfeeding duringthe first 6 months of life, and continuedafter 6 months of age


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Promotion of appropriate complementaryfeeding from 6 months

Promotion of hygiene ( hand-washing), safewater, and sanitation

Promotion of oral rehydration therapy (ORT)and zinc for children with diarrhoea

Promotion of clean delivery Community-based treatment of childhood

pneumonia

Home-based neonatal care, which includespromotion of immediate and exclusivebreastfeeding, promotion of cleanliness,prevention of hypothermia, and diagnosis and

treatment of neonatal sepsis


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Community-based rehabilitation of childrenwith protein-calorie malnutrition via food

supplementation (including rehabilitation ofchildren with severe acute malnutrition byprovision of ready-to-use dry therapeutic foods)

Insecticide-treated bednets (ITNs) in malaria-endemic areas

Indoor residual spraying in malaria-endemicareas

Community-based treatment of malaria Intermittent preventive treatment during

pregnancy (IPTp) of malaria in malaria-endemicareas


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Health Promotion Mobilisation

Outbreak control and surveillance

Nutritional surveillance and monitoring Distribution of commodities and drugs

Community InformationManagement/Documentation

Calculate coverage increases and lives saved


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Tororo - Pit latrine coverage increased from 64% in2003/4 to 85% in 2008/9 community mobilisation and

sensitisation by VHTs Isingiro VHT/CHWs of the Millennium Villages Project

(MVP) through community sensitisation and educationincreased health facility delivery from 12-15% to over

80% Mpigi Unusual Deaths identified by one VHT who had

details of ALL (list of all names and ages addressesdates) facilitating outbreak investigation and causefrom contaminated alcohol to be identified

Mbarara CORPS/VHT Interventions from Jan 2006 toFeb 2009 has contributed to child mortality ratedecline of 37%.

Apac - 93% coverage IRS by VHTs, as a result, MalariaOPD attendance reduced from 78% to 53%


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Empowering DHMT to coordinate partners

Building the necessary linkages ( VHT-Community-Health Centres, Cross Sectoral)

Ensuring Necessary requirements forimplementation (Learning from past experience

with Homopak) Health Workers reinforcing messages and being

a good example to community

Failure to deliver minimum referral services by

HCs Integration of established CHWs into VHT


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Use Evidence and prioritise activities andinterventions based on epidemiology andcommunity perceptions of need

Linking VHTs: Establish and maintain Necessary

linkages with formal health system1. With nearest Health Centre

2. With outreach activities

3. With other community structures and players

Acknowledge good performance and impact

Document actions collate data and show impact


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Good OrganisationVHTs Linked to nearest HC

List on wall Register of VHTs

Roster for individual VHT once per month enablingsupervision/ supplies/ on job training mentoring

Health centre or out reach

VHT stay and assist queues/ registering/ weighing/Muac/OP ANC Nutritional clinics / Health educationtalks etc

Empowering, Motivation builds good relationship andincreases knowledge and skills and frees up HW totreat sick

Monthly and quarterly meetings

Competitions and prizes

Radio programs


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Mbarara linkage between ALL health training

schools including laboratory andcommunities via VHT/CORP

Makerere linkages Medical School andCommunity and School of Public Health

Yumbe - Clean Village and bestVHTcompetitions were organised and throughhealth promotion talks by VHTs, cleanestvillage won a plaque plus a borehole (CAO);

VHTs are given priority for functional adultliteracy FAL classes; Linkages agriculture and forestry tree

planting


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When do we carry out postnatal check for Mother?

For newborn?


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Home visitsReferral for danger

signs


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Need good linkages Not enough to improve community andknowledge if not matched with

minimum standards at Health Centre Need health workers Presence,Knowledge Skills and Basic

Equipment/Drugs to have Impact Why PNC When PNC What PNC


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If these in place then maximal impact possible(decrease of up to 79% in early neonatal

mortality) WHO and UNICEF recommend that care be

provided by a skilled attendant during andimmediately after birth irrespective of where

the birth takes place. Women who give birth in a health facility and

their newborns should be assessed forproblems and given a specific date to returnfor further postnatal care, even if everything isgoing well, and advised to return immediatelyif any danger Signs


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The recommendation for womenwho givebirth at home without skilled care, and wherecontinuous professional care cannot be

assured, is that they should seek postnatalcare as soon as possible after birth

Postnatal home care by community healthworkers (VHTs) should be linked to the healthsystem and the full continuum of care. Healthservices should try to bring postnatal care asclose as possible to the home and the family.

Gaps in services including skilled attendance atbirth and treatment of newborn illness need tobe addressed as part of a programmaticapproach.


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Live birth Abaana abazairwe bahureire nibangahi?

Ebiro byokuzarwa Date Eiziina ryanyineka Headof the household HospitalOmwirwariro OtherAhandi

Abaana abafiire kuruga aha mwaana owazarwa kuhika ahawemyaka etano nibangahi? Deaths from birth to

five years

Abaa

na abazirwe bafiire nibangahi? Omwaana owazarwa atarireho, atitsye nakakye nari atehindwire still birth

Ebiro byokuzarwa birth

date

Neiziina ryanyineka Head of

the household

Hospital

Omwirwariro

Other

Ahandi

Ebikozirwe Activity Number Omuhendo gwebikozirwe

Home visits made Mutayayire amaka angahi?

How many Health talks Emishomo yoona

eyebyamagara eyimushomeise?

Emyaka eyiyaferireho years

that death occured

Eiziina ryanyineka Head

of the household

Hospital

Omwirwariro

Other

Ahandi

Omuruka Parish_________________ Ekyaro Village_____________________Date Ebiro

byokwezi____ /____ /_____ Abahereza: CORPs

_______________________Na and_________________________Na and____________________

community mobilisation and participation in health.ppt

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