Transcript Slide 1
Introduction • Elaine Rossi of JSI and Catherine O’Brien of The Manoff Group presented the following at the Global Health Council Conference, May 2008. • The project has had remarkable success in community mobilization for health in Djibouti. • PESCE is funded by USAID and implemented by JSI. The Manoff Group is a subcontractor, responsible for behavior change communication and community mobilization. From Five Villages to a National Policy: Community Mobilization in Djibouti Dr. Stanislas Nebie, Chief of Party, PESCE, JSI Dr. Chehem Watta, Senior Advisor, Ministry of Health, Djibouti Dekha Hadi, Social Mobilization Assistant, PESCE Catherine O’Brien, Senior Technical Advisor, The Manoff Group Elaine Rossi, Senior Technical Advisor, JSI Expanded Coverage of Essential Health Services in Djibouti Project (PECSE) The authors’ views expressed in this publication do not necessarily reflect the views of the US Agency for International Development or the US Government. Country Context: 2004 • Population: ~800,000 • Size of US state of Massachusetts • Life expectancy: ~46 yrs • Infant mortality: 103 per 1,000 live births (2002) • Under-5 mortality: 121 per 1,000 live births (2002) • Maternal mortality: 650 per 100,000 live births (2002) • Malnutrition, malaria, TB all pose great risks Health System Context: 2004 • Weak infrastructure • Unreliable health statistics and poor health knowledge • No community mobilization for health! • MOH health sector reform strategy aims to increase access to health care through decentralization, prevention, and primary care Poor infrastructure Poor water source in Gourabouss: 2005 As Eyla clinic beds: 2005 Resource Scarcity Water struggle in Dorra: April 2005 PECSE Project • 2004–2008 • Expand access to health services – Rehabilitate health facilities – Train health care providers – Establish health management information system – Mobilize communities – Focus on rural areas Sagalou Health committee members, April 2006. The Health Committee President is seated on the left. Community Mobilization: Challenges • No community mobilization existed before in the health sector • MOH not receptive to idea • Health infrastructure in terrible condition • Nomadic populations; refugees • Difficult physical environment Laying the Groundwork • “Back to Basics” • Not ready for BCC • Pilot program in 5 sites in 2005 • Very basic community mobilization PECSE and MOH staff in discussion with Goubetto community chief in 2005, when negotiating the establishment of a health committee Community Mobilization Pilot Approach • Health Post Health Committee community members forging links to improve services • Community health volunteer is the link between community and health post staff Daley Aff Community volunteers: Jan 2006 Involving the MOH • PECSE cultivated excellent relations with MOH, UNICEF, WHO, NGOs, and others • Study tour to Ethiopia and Madagascar • Consensus on community mobilization emerged after study tour • MOH interested in replicating model Djibouti health committee members and nurses during the study tour in Madagascar, 2005 Scaling Up • 5 pilot sites 23 health posts • Each post linked to health committee • Each committee has men and women • 4 or 5 community volunteers (at least 2 female) per community Gallamo community leader giving working tools to a volunteer: May 2006 Training and Supervision • Training-of-trainer workshops nationwide for community health volunteers • Health education activities • Joint supervision by MOH and PECSE Dorra female health volunteer receiving a loud speaker for community mobilization: August 2006 Training Work plan development during the Tadjoura district volunteers training: June 2006 Community trainer during Arta health committee members training: May 2006 Supervision Randa village volunteers during supervision: Sept 2006 Gourabouss community volunteers during a supervision session: Aug 2006 Mobilization at work • PECSE carried out MOH priorities • Emergency immunization campaigns – Polio in 2005: Health Committees and Volunteers proved themselves – Cholera in 2006: further validation • Volunteers and committees trained in prevention and symptoms • Volunteers spread messages and identified cases for nurses to treat • Avian influenza preparedness Additional Activities • MOH requested urban community mobilization work • Flipchart produced covering 9 health themes for nationwide distribution • Mobile caravan performed skits • Radio spots Mobile theater group performing a skit Flip Chart Preparation Nutrition for a nursing mother Tadjoura district volunteers and community members training in flip chart utilization: Feb 2006 When to take a child to the health post Infrastructure Rehabilitation Medical waste situation in 2005 Solar pump installation in Assamo Incinerator now available in the 23 project sites for medical waste management Drilled well in 2008 Infrastructure Rehabilitation Alaili-Dada Clinic 2004 2005 Medeho clinic toilet National Community Mobilization Strategy • After study tour, MOH formed committee on social mobilization for health policy • PECSE provided framework for policy • National Policy promulgated in 2006! – Validated role of Community Health Volunteers and Health Committees – Created new MOH cadre of Health Aides based on Ethiopian model A major step forward Ass-Eyla health committee members showing their certificates of recognition with pride: April 2008 • By late 2006 utilization rates rose for prenatal care and immunization • Contributed to positive national results: Results 2002 2006 Infant Mortality 103 67 121 94 (per 1000 live births) Under-5 Mortality The Project social mobilization assistant with the Gallamo female volunteer ‘s child: 2006 (per 1000 live births) CPR 12% 18% Results: Deliveries Proportion of Deliveries in PECSE intervention health facilities 70 60 Percentage 50 2004 40 2005 2006 30 2007 20 10 0 Alisabieh Arta Dikhil Obock PECSE district Tadjourah Average Results: Antenatal Care Antenatal Care: at least one visit (2004-2007) 2800 2550 2050 2004 1800 2005 1550 2006 2007 1300 1050 800 550 300 Months D EC V N O T O C SE PT AU G JU LY JU N AY M AP R AR M FE B 50 JA N Number 2300 Thanks to a great team Minister of Health and Project COP at Knighthood Ceremony for COP, May 2008 Community Mobilization Team: May 2008