Empowering Communities to serve themselves for improved health status

Empowering Communities to serve themselves for improved health status JKT Ajiboye, Adviser, Community Mobilization and Communication - COMPASS Project Abuja 12 th January 2009

COMPASS: Providing quality social sector services to the people!

5 year- community-driven-USAID –Funded project (2004- 2009)

Largest integrated health and education project in Africa

Being implemented in 51 Local Government Areas in Bauchi, Kano, Lagos and Nassarawa states and the Federal Capital Territory, Abuja.

9 implementing partners (including 4 Nigerian partners) led by Pathfinder International

3 key technical areas: Reproductive Health/ Family Planning, Basic Education and Child Survival and a set of key cross-cutting activities including Community Mobilization & Communication .

Vision & Goal

Vision: To create an environment in which all Nigerians are involved in learning, planning and action to improve health and education in their communities. At the end of the project, communities will be powerful advocates regularly influencing local health and education initiatives.

Goal: By 2009, COMPASS will have improved the health and education status of 23 million Nigerians in the four states (Bauchi, Kano, Lagos, Nasarawa) and the Federal Capital Territory of Nigeria

COMPASS Project States

Lagos

Nasarawa

Bauchi

FCT (Abuja)

Kano

Health Indicators at Baseline (Measure Evaluation, 2005)) Current Use of FP ANC Visits Skilled Assisted Delivery DPT 3 Coverage Vit A Coverage Under 5 Sleeping Under LLIN/ITN Bauchi 2.3% 26.7% 19% NA NA NA FCT 10.0% 41.3% 44.3% NA NA NA Kano 1.2% 18.1% 19% 1.3% 6.5% 1.1% Lagos 14.1% 39.2% 44.5% 21.3% 37.0% 3.3% Nasarawa 7.8% 27.1% 21.7% 3.7% 36.1% 7.5% All States 9.0% 30.9% 32.6% 12.1% 23.2% 2.8%

What do we want to happen ?

All children immunized

All service providers demonstrate good interpersonal relationships with their clients

All children under 5 and pregnant women sleep consistently under ITNs/LLINs…

All…

All…

Good quality of services

A positive, long term and sustainable change

How do we get there?

Constitute a Health Team made up of:

Households plus

Community plus

Government

That has a SHARED Vision

Households are the primary producers of health Households Government Community Global Driving Forces

COMPASS Definition of Community

Group of people within a defined geographical locality using common social services.

Defined around an integrated, functional primary health care (PHC) center

Health Post  Community Defined as Catchment area

Community Action Cycle (CAC) as a core approach .

Simple steps community members can follow to identify and analyze health problems, identify solutions, set priorities, develop action plans, take action to improve the situation. review progress to either adjust their actions or identify other problems

Phases of Community Action Cycle (CAC) Prepare to mobilize Prepare to scale up Act together Organize the Community for action Explore the Issues and set priorities Plan together Evaluate together

Community Coalitions (CCs)

At End of a CAC Process, a Community Coalition (CC) is formed at the community level

A CC is made up of all interested groups within a community: Community-based organizations, Parent-Teacher Association, women groups, youth groups, associations, Quality Improvement Teams (QITs), etc.

Functions of Community Coalitions

Community Education & Mobilization

Advocacy

Oversight, Accountability & Coordination

Funds raising and Resource Leveraging

Empowering other CCs

Partnership Defined Quality (PDQ)

PDQ is a specific methodology

to involve health service providers and

community members working together

to improve quality of Education and Health using CAC as an approach

It facilitates the process of building partnership between Providers (Health and Education) and community members through formation a Quality Improvement Team (QIT) at the facility level

Getting Started Introduce Concept Build support (MOH, HW, Community) Explore Quality Health Worker View Teachers view Explore Quality Community View Workshop Bridging the Gap: Problem & Solutions Quality Improvement Team Community Health Workers Teachers “ System” Step 1 Step 2 Step 3 Step 4 The PDQ Process Working for Change: Mobilization/Advocacy/Monitoring

Reach of the CCs/QITs

215 CCs and 731 QITs formed as of December 2008

Average of 10 associations per coalition and 25 members per association

CCs are reaching more than 51,000 association members who then potentially reach out to the population at large

LGA Forums: Giving Voice to the People

Consist of a network of CCs in a LGA

Address issues that cannot be solved at the community level

Conduct advocacy and fundraising

Accomplishments - Impact

Assessment has shown significant differences between CC and non-CC health facilities in RI, FP, ANC, facility deliveries

Community perceives changes:

Increased utilization of services

Changes in attitudes towards routine immunization, polio, FP, ANC and facility deliveries.

Advocacy for LGA support for infrastructure, additional personnel, water, implementation of policies etc.

Accomplishments - Monetary

COMPASS-supported communities leveraged more than $1 million last year.

This money has been used for a wide variety of infrastructure activities: construction of new

primary health facilities and schools, renovation

of existing facilities, toilet construction, electrification, digging boreholes for water, and provision of equipment and supplies.

In cases where COMPASS was supporting the

renovation of facilities but funding was limited, the CCs/QITs provided matching funds to complete the job.

More Accomplishments – Non-Monetary

Sensitization through both women and men on polio, RI, ANC, FP and facility deliveries

Improved provider / community relations – Improved attitude, working together to solve problems

Supervision and monitoring of facility activities and renovations

Community labor contributions – renovations, sanitation

CC Members describing their Experiences

CC Members now believe in themselves!

“ We used to think that we cannot help ourselves when it comes to health.

All we used to do was to go to the clinic and ask a nurse to write medicine for our sickness, but now we don’t only go to them to write medicine but can also clean the environment and do other things to see that our clinic is better.

We don’t have to wait for the Government for everything. There are some things we can do ourselves” (Community member, Bauchi State)

A new spirit…

“ Most of us are retired, but not tired....and even when COMPASS leaves we will continue working for our families, our children and our grand children.

We are building a PHC in Agodo so that they can have access to health services without having to travel to another PHC“ - Chairman of Egbe-Idimu CC - Lagos state

Challenges…

How to keep a coalition together long enough to accomplish its goals?

How Should leaders be selected? What will be their terms of office? How will they stay accountable to the membership?

How to avoid conflicts?

How to fund their action plans?

Lessons learned

Involving community members in taking decisions made them to see themselves as true stakeholders and owners of the project

COMPASS’ rigorous denial of financial and material support for CC and QIT operating costs has led to a significant increase in community responsibility for their own activities.