Introducing Community Health Agents to accelerate achievement of MDGs 4 and 5

in Tanzania:

The Connect Project

The Role of the CHA intervention in Community-based Primary Health Care

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Core Aspects of the CHA Role

1) Improve household and community practices and capacity to support maternal and child health and child development.

2) Enhance community-based case management of childhood illnesses when illness/injury does not require facility attendance.

3) Strengthen the health system by way of facilitating accessibility of drugs and supplies where needed, improving organization of work from the community-level up, including monitoring, supervision and referral.

Training Module on IMCI and Community IMCI Implementation, MoH Tanzania, 2004

Household and Community Practices

Routine household distribution of key household health “technologies” that prevent illness• Insecticide treated bednets • Condoms • Oral contraceptives (use of DMPA-Uniject under

negotiation with PATH)• Soap and hygienic supplies

Education and counseling regarding key aspects of reproductive and child health• Child growth, development and management

of illness• Nutrition (including micronutrient and

complementary feeding)• Water, sanitation and hygiene• Reproductive health• HIV/AIDS and STI Prevention• Tuberculosis and malaria prevention

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Household and Community Practices

Pregnancy monitoring visits during antenatal period

• Promotion of antenatal care and facility-based delivery• Counseling on danger signs of complications, nutrition

and post-partum family planning• Birth planning and emergency preparations• Monitoring and reminders for net use and IPTp, TT and

PMTCT adherence• Identification and referral for complications• Promote male active participation and child care and

Reproductive Health

Household and Community Practices

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Household and Community Practices

Postnatal/partum visits for both mother and newborn

• Counseling on essential newborn care• Identification and referral for complications• Promotion of postpartum/natal care• Identification of LBWs using foot size• Family planning• Monitoring/reminders for early diagnosis of HIV

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Community Case Management

Training in CHAs in Integrated Case Management

• Ability integrate disease specific guidelines into a comprehensive and efficient process for attending sick children.

• Understanding of protocols for assessment for symptoms, and danger signs in sick children.

• Recognition of less common illnesses or chronic problems that may require clinical care or be managed in community (routine injuries, etc.)

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Community Case Management

Routine Household Visits to Assess U5 Children for Major Symptoms

• Cough or difficulty breathing, diarrhea, fever, ear problems, bacterial infection, nutritional, immunization and Vitamin A status, etc.

• Identification of select clinical signs for classification (not diagnosis):

• Urgent Referral to clinical level of care

• Initiation of specific treatment using limited number of essential drugs

• Home treatment, counseling/education of caretakers, including active participation in treatment of children.

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Community Case Management

Provision of complete treatment and follow up to children with uncomplicated illnesses:

• Malaria – dependent on national supply and scale up of Rapid Diagnostic Tests (RDT); treat with SP and Paracetamol

• Pneumonia: using ARI timers (detection) and Cotrimoxazole

• Diarrhea: Oral Rehydration Therapy with zinc and extra fluids.

• Malnutrition: Increased breasfeeding, extra feeds (if on complementary feeding.

• Referral to facility when appropriate.

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Local Health System Strengthening

Facilitate Access to Additional Support and Financing Mechanisms:

• Community mobilization for enrollment in National Health Insurance/Community Health Funds

• Education and identification of households eligible for fee exemptions, facilitate their acquisition of CHF cards and care-seeking support.

• Identification of vulnerable households and facilitate access to additional support services (e.g. families affected by disability, aging household members, chronic illness, poor water and sanitation, etc.)

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Local Health System Strengthening

Linking district-level and village planning and organization:

• Provide organizational support with facility management and village health committees.

• Represent and encourage involvement of village health committees for immunization, Vitamin A, ANC, and reproductive health community outreach.

• Develop and sustain emergency referral mechanisms.

• Communicate district and village health agenda to the community and ensure accountability

• Participate in maternal and newborn death audits.

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Local Health System Strengthening

Improve quality of data on community health information and reporting mechanisms:

• Training and follow up support to facility-based supervisors for supportive supervision of the CHA.

• Facilitate the CHA collection, management and utilization of health data for decision-making.

• Identify and address bottlenecks in the supply chain of essential drugs and commodities and integrate the community into that process.

• Reports summary information to village health committees, encourages communities to advocate for health rights to decision makers.

Improve Child and

maternalsurvival

Information:Data collection + feedback tools for

CHAs

Medicines, Vaccines, etc:Supply chain management for

essential commodities for CHAs

Financing & social protection:Financing of programme + role of

CHA in expanding protections

Leadership & governance:CHAs relationship with local

governance structures & planning

Improved equity

Reduced social costs

Improved efficiency:

Task-shifting

…that alter the climate of

demand for services

Enhanced Health

Service Utilization

Enhanced access:

Community-based

services

Health workforce:CHA training, deployment and

supervision

Improved quality of services:People-centred

Extended range of services:

Promotion/ prevention

…generate system

outcomes…Integrated service components:

CHA package of services + emergency referral system

Enabling sub-system

inputs…

…impact on health

behavior, and ….

CHA intervention integrates pillars, links

inputs to impact

Improved wellness behavior

CHA INTRODUCTION