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Title Page Empowerment and Ownership: A checklist to Sustain Community Health Workers Dr. Chidi Ukandu Dr. Elvira Beracochea MIDEGO-Nigeria MIDEGO, Inc. Director Presidentchidi@midego.com email@example.com
Opportunity in Nigeria• Population: Est. 170 million• Physician Density: 0.4/1000 people• Nurses & Midwives Density: 1.6/1000 people• Community Health Workers Density: 0.1/1000 people• Life expectancy: 52 years• Infant Mortality Rate: 74/1000 live births• Maternal mortality: 630 deaths/100,000 live births• Health system ranked 187 out of 191 countries by WHO in 2000
Community Health Workers & Healthcare Systems• The use of CHW has been identified as one strategy to address the growing shortage of health workers in low income countries• Robust evidence exists that CHWs can undertake actions that lead to improved health outcomes• Although they can implement effective interventions the quality of health services they provide is sometimes poor• For CHWs to make an effective contribution they must be carefully selected and appropriately trained and supervised and linked to supporting facility and made to feel “proud of their contribution” to the community and competent
Creating Empowerment and Ownerrship• Participate in the design, implementation and evaluation of the programs they implement• Participate in the tracking of their own improvement and help them to account for their own achievements
Community Health Workers in Nigeria• CHO• CHEW• CBHV• TBAs• CDIs• Home based HIV care givers• Ward and Village Development Committees and Local Leaders
Country led developmentprogramme starting with 10 items 1. Hand washing 2. Antenatal, delivery/Postnatal Care 3. Use of bednets 4. Exclusive breast feeding 5. Appropriate nutrition 6. Routine immunization 7. Birth spacing and family planning 8. Malaria prevention 9. Diarrhea and ORS 10. Smoking cessation
Empowering CHWs to take action using a simple tool: the checklist• A simple list of tasks to achieve a defined quality objective• Can be carried around by CHWs• Allows for consistency in delivery of care• Prevents “action paralysis” due to overwhelming challenges• Participatory and requires minimal training• Can be deployed rapidly
Sample checklist for hand washing1. Smile and greet “guest”2. Introduce yourself3. Explain to guest why hand washing is important – very powerful for preventing diseases4. Ask if guest can easily get access to clean water and soap5. If no, explore possible sources for getting access to clean water with guest6. If yes, now explain the process the guest shall take to start implementing hand washing immediately7. Demonstrate correct hand washing8. Have guest repeat procedure,9. Have guest invite others in HH to wash hands10.Set another date to meet with guest to evaluate progress11.Thank guest for his/her time
Steps to be Developed by the CHW1. Find a source of clean water for washing near the bathroom and kitchen at home. At work, have a source of clean water near every patient examination area. If you do not have a faucet, use a plastic bottle or bucket with a ladle to save water2. Find soap and a clean cloth or towel to dry your hands3. Pour water on both hands4. Use soap to form a good amount of foam and rub palms, back of hands and in between fingers while counting slowly up to 20.5. Rinse both hands with water6. Inspect your hands and the hand of children after washing to ensure hands are clean and whether you need cut nails if long or there is dirt underneath.7. Repeat if not clean.
Measuring Effectiveness: The Weekly Scorecard1. Number of children born2. Number of children who are exclusively breastfed3. Number of children with adequate weight for age4. Number of pregnant women5. Number of pregnant women who have at least had one ANC visit6. Number of immunized children7. Number of people diagnosed with Malaria8. Number of cases of diarrhea9. Number of people who smoke
Next Steps• Raise U$100,000 to implement and evaluate the project• Scale up the project into a statewide and national program