Strategies for implementing community-based primary health care (CBPHC) programs focus on community collaboration, intervention delivery, and health systems strengthening. Key strategies include forming community health worker programs and women's groups, conducting home visits and outreach, and strengthening drug supply and the referral system. Successful strategies in one program included active case finding, testing and treating malaria in homes, follow-up visits, connecting women to prenatal care, removing user fees, and having one community health worker per 2,800 people to facilitate rapid referrals, which helped contribute to a decline in under-5 mortality.

1. Strategies

2. Overview of CBPHC strategies
• Strategies for implementing community-based
interventions have received less attention in the peer-
reviewed literature than the interventions themselves
•
• “Unless services reach those in need, even the best-
conceived primary health and nutrition care programs can
obviously have little impact on mortality. Thus, … the
development of plans for getting services to the people is
as important as are decisions concerning which services
should be offered.”1
– Gwatkin, Wray and Wilcox, 1980 (Can Health and Nutrition
Inteventions Make a Difference?)

3. Strategy 1: Community collaboration
• Formation of or collaboration with village health
communities, engagement with community leaders,
mobilization of the community, engagement with religious
leaders or with community-based organizations
• Formation of community groups; women’s empowerment;
training/education of mothers; formation of, management
of, or collaboration with micro-credit programs
• Community selection of CHWs, community support/
supervision of CHW activities,
• Engagement with planning or evaluation of CBPHC program
• Engagement of fathers
• Engagement of drug sellers

4. Strategy 2: Intervention delivery
• Home visits (routine visits of all homes, targeted visits
depending on age group, visits to sick children, etc.)
• Community case management (management of
childhood illness in the community (classification of
seriousness, recognition of cases in need of referral,
management of cases if appropriate)
• Participatory women’s groups (Participatory Learning
and Action Groups, Care Groups, etc.)
• Outreach visits by mobile teams (very little research
evidence on this though it is a major modality of
service delivery)

5. Strategy 3: Health systems
strengthening
• Strengthening logistical support/drug supply
for community-level workers
• Strengthening of supervision of community-
level workers
• Training of providers at peripheral health
facilities
• Strengthening of quality of care at peripheral
health facilities
• Strengthening of referral system

6. Strategies (cont.)

7. Community involvement
(702 reports)
• Planning: 25% highly or moderately
involved
• Implementation: 67%
• Evaluation: 23%

8. PLOS One 2013

9. Strategies used
• Active door-to-door case finding
• Search for 16 danger signs
• RDT to diagnose and treat malaria in the home
• Follow-up of treated patients at 24 and 48 hours
• Connecting pregnant women with prenatal care
and birthing services
• Removal of user fees

10. Strategies used (cont.)
• 1 CHW per 2,800 people (560 children)
• Rapid referral of sick children (via community
mobilization)
• Also program of micro-credit and community
empowerment (with trained Community
Organizers)

11. Decline in under-5 mortality