Strengthening the Building Blocks of Health Systems Doing Better, Reaching More -- Tall

1. Evolution of Equity
Senegal’s Community Health
Interventions
Dr. Aida Tall
ChildFund Senegal
USAID Neema

2. Senegal’s Health Context
• Significant progress in SRMNIA - Reproductive,
maternal, neonatal, infant, and
adolescent/youth health
• Yet notable challenges persist:
– Unequal access to health structures and
services based on location (rural versus urban)
– Insufficient coverage at the community level,
specifically of high impact interventions
– Important disparities regarding gender and age

3. Supporting Strengthening of Senegal's Health System
Neema
2006-2011 2011-2016 2016-2021

4. Key Accomplishments
Expansion of geographic
coverage of interventions
Strengthened service
delivery
Institutionalization of
community health services

5. 0
500
1000
1500
2000
2500
3000
3500
4000
Régions Districts Health huts Health sites
13 65
1620 1676
14 76
2190
3594
PSSCI PSSC II
Expansion of Geographic Coverage of
Interventions

6. 6
Strengthened Service Delivery
Standardization of service
packages
Elaboration and
standardization of tools for
implementation, training,
M&E, data management, and
SBCC
Training and ongoing
supervision of 25,998
community health volunteers
Innovative strategies:
• Integrated Home Visiting Strategy (VADI)
• Community Alert Committees (CVAC) for maternal
and neonatal health
• Health Hut Management Sustainability Strategy
• CBO strategy
• Post-partum hemorrhage prevention
• Injectable contraceptives

7. 7
Institutionalization of Community
Health Services
Development of strategic documents including:
• National Policy of Community Health
• National Strategic Plan of Community Health
• Guides for Norms and Procedures in Community Health
• Regional and Local Plans for Community Health
Motivation for community
health volunteers (CHV ):
• Organization of CHVs in
associations at district and
regional levels
• Continued training
• Creation and distribution of
volunteer identification
badges
• Organization of local and
regional recognition days for
CHVs
National mapping of services,
infrastructure and community
health actors

8. How can we
do better
prioritizing attention to
gender and youth
in our health systems
strengthening work?

9. Community Focus on Gender & Youth
• Access to health services for the most vulnerable
– Infants 0-5 years old, pregnant women, mothers and newborns,
and communities living far from existing health services or remote
communities
• Autonomy in health-decision making for women
• Use of community framework to encourage positive
behavior change around gender
• Involvement of men
• Needs of adolescents and youth at forefront of
interventions

10. 10
Neema: Prestation de Services Intégrés
et Adoption de Comportements Sains
Programme Santé de l’USAID 2016-2021
IntraHealth International (Prime)
ChildFund International Marie Stopes International
JHU-CCP Helen Keller International
Reseau Siggil Jiggen Alliance Nationale Contre le SIDA
ideas42
Purpose: Ensure health services are sustainably improved and effectively
utilized to reduce maternal, neonatal, and child mortality and morbidity and
contribute to an AIDS-free generation.
Objective 1: Increase access to quality priority services and products in the
public sector
Objective 2: Increased adoption of healthy behaviors

11. Neema’s Community-Level Interventions
Quality Improvement Approach for
Community Service Delivery
• Fill gaps in FP and prevention of post-
partum hemorrhage interventions
• Revised Integrated Home Visiting strategy
• Integrated approach for care
• Adapted package of community services
for adolescents and youth
• Newborn-specific care
• Expansion of service package in health
sites
• Creation of new health huts and sites
• Coaching health agents on community
interventions
• Strengthen the strategy of mobile
midwives
Participatory Approaches to Scale Up
Sustainable Interventions and Community
Ownership
• Revised Strategy of Sustaining
Management of Health Huts
• Development of Community Scorecard
to ensure strategies meet community
needs
• Community Action Cycle for GBV -
Early Marriage/Pregnancy
• Training of local government members
and management committees
• Revised strategy for Community Watch
Committees for maternal and newborn
health

12. Neema’s Key Community-Level Gender &
Youth Activities
• Tool & Training Revision:
– VADI
– CVAC
• Community Action Cycle GBV
Early Marriage/Pregnancy

13. CVAC Strategy
Revision
• Selection of men and
adolescent/youth to act as peer
educators
o Youth: prevention, rapid
orientation, and support
monitoring of early
pregnancy
o Men: provide information
and support to husbands;
advocate for resource
mobilization
• Targeting of pregnant youth,
single mothers, newly married
COMMUNITY WATCH COMMITTEES (CVAC)
• Early identification and personalized
monitoring of pregnant women, mothers,
and newborns to improve the utilization
of health services at both the community
and health structure level.
• Community focal points engaged in
mobilizing resources for promoting
maternal and newborn health.
• 84% coverage within project area
• Tools:
• Implementation Guide
• Training Manual
• Data Management Tools

14. VADI Strategy
INTEGRATED HOME VISITING (VADI)
• Home visiting for target populations
• Address other targeted needs within
households
• 71% coverage within project area
• Tools :
• Home visiting guide with 8
components
• Implementation Guide
• Training Manual
• Home Visitor Notebook
Revision
One new task for all integrated home visits :
coaching on parent/adolescent
communication.
Themes for adolescent/parent
communication on ASRH
• Key changes that occur during
adolescence
• Importance of hygiene measures for
youth
• Effectiveness of communication between
parents/parental figures and adolescents
to prevent risky behaviors
• Availability of ASRH services at the
community level

15. Community Action Cycle: Early
Marriage/Pregnancy
• Objectives:
– Encourage and strengthen community reflection on gender based
violence, specifically early marriage and early pregnancy
– Organize community mobilization to prevent early marriage and
pregnancy to improve and target the offer of services at the
community level
• Intervention sites: 518 communities in 29 districts
• 5 proposed groups:
– Grandmothers
– Mother
– Adolescent girls (10-14 years old)
– Male and female youth (15-18 years old)
– Male heads of household

16. Conclusion
• We are building on our years of experience in
Senegal, deepening our interventions, and
reaching more vulnerable populations
Dr. Aida Tall, ChildFund Senegal, Neema Project
atall@childfund.org
Merci!