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Implementing the Community strategy for primary health care: key lessons for Africa

Prof. Anthony K. MbonyeDirector Health Services, Ministry of Health Uganda/School of Public Health Makerere University-Kampala.

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• The underlying idea is that the involvement by ordinary citizens and civil society organizations will lead to increase in accountability .

• Empowering communities and service users is also embedded in the Primary Health Care concept - Alma Ata Declaration of 1978

• The Ottawa Charter for Health Promotion of 1986.

Why community health strategies?

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• Poor access to health based interventions eg four visits of Antenatal care, 52%, skilled attendance at delivery 60%, access to two doses of IPTp 26%, postnatal care 25%

• Poor access to HIV testing, ART, stock-out of laboratory supplies etc

• Health system bottlenecks: inadequate staffing, inadequate skills, stock-out of essential commodities, rude health workers, absenteeism, poor motivation and pay, poor infrastructure

Why community health strategies?

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Evidence on Community Delivery of IPTp for malaria

Uganda(Mbonye 2007)

Faso(Ouedraogo

2010)

Uganda(Ndyomugenyi

2009)

• Community sensitization• Training of community

resource persons• SP delivery by Dug Shop

Vendors, TBAs, CRHMs

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1 • Increase IPTp-2 68% verses 40% in control

• Increase ANC attendance

• Health education messaging

• SP delivery by community drug distributors

• Increase IPTp2: Intervention 68% verses 40% control

• ANC attendance was maintained

• Community delivery• Outreach delivery

• Increase IPTp2: Intervention 83% verses 46% control

• ANC attendance was maintained

Malawi(Msyamboza

2009)

• Training community health workers

• SP delivery

• Increase IPTp:2 68% verses 40% in control

• ANC attendance reduced

Studies SP delivery methods

Results

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Challenges of community based strategies

Policy

• Current policies prioritize health facility mode of delivery

• Most funding priorities are clinic based, less on prevention

Community Acceptance

• Communities may not accept community health based interventions

Motivation of community

workers

• Most community health programs are voluntary leading to high levels of attrition

• Inadequate supervision and mentoring

Data collection• Community data not integrated into HMIS

• Inadequate research

Commodities• Frequent stock-outs of life saving commodities

• Poor logistic management system

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Key Lessons for Africa

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• Revise policies, guidelines and curriculum to support community delivery of key interventions targeting vulnerable groups (women and children)

• Leverage existing funding opportunities and projects (Global Fund, GAVI) to obtain resources to scale up community health interventions

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• Design appropriate messages to support acceptance of community based interventions

• Integrate community data into national HMIS system to enhance monitoring and evaluation

• Support implementation research to identify best modalities to support community based interventions

Key Lessons for Africa

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• Design models for supervision and mentoring for community based interventions

• Design models of motivation and retention of community health workers

• Share best practices and lessons learned between countries

Key Lessons for Africa

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ENDThank you