Transcript Community Involvement in
CDI Module 3: The Value of Community Involvement
… and its role in community and home management of malaria ©Jhpiego Corporation The Johns Hopkins University
A Training Program on Community Directed Intervention (CDI) to Improve Access to Essential Health Services
Module 3 Objectives
By the end of this module, learners will: Identify and define community structures Define community participation Explain the value and benefit of community participation and involvement in health programs Identify the various volunteer community health agents and their roles Describe the community social and economic factors that affect health List community resource people who can be involved in malaria control
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Home and Community Management
Although this module uses malaria as an example, we can apply the principles to management of other health problems common in the home and community Please suggest other common problems that are amenable to home management
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Why Community Involvement?
Health is produced at home and in the community.
Health depends upon: – What people do or fail to do In many countries the National Malaria Control Program (NMCP) strategic plan is directed at improving case management of malaria at the home and community levels Home management of malaria (HMM) is an important strategy because it provides access to pre-packed, quality, anti-malarial medicines within 24 hours of the onset of fever This strategy is designed to use a network of community resource persons
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What Is a Community?
A group of people living in the same defined area —sharing basic values, organization and interests (Rifkin et al. 1988) An informally organized social entity, which is characterized by a sense of identity (White 1982) A population, which is geographically focused, but which also exists as a discrete social entity, with a local collective identity and corporate purpose (Manderson et al. 1992)
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Why Is Community Valuable for Health Service Delivery?
A community is:
An operational area
for delivering a minimum health care package
Designed to mobilize political commitment
to health service delivery as a requisite for social development
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Larger and Smaller Arrangements of Community
Sometimes the health service may group smaller communities to make it easier to deliver services For example, a ward or sub-district m catchment area of a health center and serve many communities ay be the Communities themselves may be composed of smaller units (like blocks, neighborhoods and kindreds/clans) We need to learn from the communities how they are divided and subdivided, and use this information to foster maximum involvement How are communities organized in your area?
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What Constitutes Participation?
Active involvement of the local population in the decision-making
for —and implementation of— development projects
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What Constitutes Participation? (continued)
The community determines collective needs and priorities,
and
assumes responsibility for these decisions
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Role in Participation
The community’s role includes: Formulating a health program Enabling its residents to understand and make informed choices Reconciling outside objectives with community priorities
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Why Participation?
Participation (assumptions): Increases program acceptance and ownership Ensures that programs meet local needs May reduce costs using local resources Uses local/familiar organizations and problem-solving mechanisms —and is more efficient Some examples follow
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Village Health Workers (VHWs) Promoting Filters
Product, price, place and promotion organized by VHWs
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20 15 10 5 0 45 40 35 30 25 Effects of Participation
Guinea worm filter sales are better where village selected health workers take part Communities select their VHWs and usually respect them
VHW sold VHW advised No VHW 13
Community Involvement in …
Water Supply Improvements
Raising money Helping dig Dedicating the well Supervising use and maintenance
Community involvement
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Community Involvement in …
Well Construction
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Participation in Water Supply Project 70 60 50 40 30 20 10 0
Multiplier effect on immunization participation
Indonesia Togo Participatory Non participatory No project 16
Community-Managed Essential Drugs
VHWs, selected by the community , buy and maintain village drug stocks
70 60 50 40 30 20 10 0 64 35 7 1 % buy stock Community Controlled Mean times buy LGA Controlled 17
Community Problem-Solving Above: Community Action Cycle: Save the Children Discuss community involvement efforts you have seen 18
Participatory Approach for Improving MCH
Save the Children worked in Bolivia to help women’s groups plan their own program
140 120 100 80 60 40 20 0 P er in at al M or ta lit y C o nt ra ce pt iv e U se TT C o ve ra ge A N C v is it Tr ai ne d A tt en da nt In iti at e B F Baseline Follow-up 19
Rationale and Scientific Basis for HMM
It is widely acknowledged that access to appropriate and effective treatment of malaria should be provided within 24 hours of onset of symptoms Any strategy to accomplish this should take into account: The rural population Inadequate coverage of the population by the health system Poor terrain and road networks in malaria-endemic areas
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Community Involvement Addresses the Access Gap HMM is designed to address the access gap
HMM: Is designed to enable communities and homes to serve as the first “hospital” Relies upon the community and the services offered by the formal and informal private health sectors Is an integral part of malaria case management within the overall Roll Back Malaria (RBM) strategy
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Who Are Community Agents?
Community agents: Are volunteers selected by their own communities to perform basic health and educational duties May be called by many names, but the concept is the same Community-directed distributors (CDDs) Role model caregivers (RMCGs) Community-integrated managers of childhood illness (CIMCI) Community health workers (CHWs)/village health workers (VHWs) Community-oriented resource persons (CORPs)
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Community Management
Community agents promote HMM The HMM strategy has the potential to ensure effective case management for non-immune people at risk of malaria (such as children under five years of age in high malaria transmission areas) HMM may also be applicable to adults in low and moderate malaria transmission areas. In this population, the disease could advance rapidly to severe malaria, especially during epidemics
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Malaria Is Often Managed in the Home and Community
In many countries self-treatment is often the most common form of treatment, though it is often not appropriate In communities, first-line malaria treatment medicines are bought from patent medicine vendors Usually diagnosis and treatment of malaria is done at home by family members S uch treatment is frequently done on a “
wait and see”
basis, which leads to delays in care and possible complications
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Factors That Affect Malaria Treatment
Non-affordability of anti-malaria drugs Inappropriate health-seeking behavior Inadequate health care infrastructures Unapproved malaria drugs found in clinics and shops Non-compliance with drug regimens Poor communication between clients and providers
Trained community agents can address these factors
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Communities Can Also Prevent
Trained community-based workers and community leaders can:
Mobilize/sensitize the communities
on the value of antenatal care (ANC), the risk of malaria in pregnancy, the concept and rationale for intermittent preventive treatment in pregnancy (IPTp)
Promote
other control measures, especially use of
long-lasting insecticide-treated nets (LLINs)/insecticide-treated nets (ITNs)
Refer pregnant women
level of care promptly to the appropriate Encourage the community to accept and
use IPTp 26
Involving Local Resource People TBA in Nigeria volunteers as a CDD 27
Local Resource People
Local resource people understand the cultural, social and economic realities of their own communities These people can serve as volunteers and opinion leaders to promote malaria control. They include: Traditional birth attendants (TBAs) Religious leaders Teachers Local chiefs
Can you name others?
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Community Resource People like TBAs Can Aid Malaria/Disease Prevention
TBAs in in several Nigeria communities volunteer to distribute LLINs and provide IPTp
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With Community Participation, What Might Your Country Be Like without Malaria?
Decreased morbidity, leading to
fewer clinic visits
and
fewer hospital admissions Increased health resources
for other diseases
Decreased mortality
infant, childhood and maternal (deaths)
Increased life expectancy Reduced absenteeism
from school and work
Increased work productivity
everyone and more food for
Improved
national
economy 30
Summary and Conclusions
Community
represents a vital missing link in malaria control efforts Communities can mobilize members and resources for effective malaria control efforts Community involvement can strengthen facility and community linkages Community agents can address and reduce the factors that impede malaria control efforts Comments and Questions?
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