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Improving Quality of Community Health Programs in Asia and Africa
- 1. Quality Improvement in community health: a multi-country study in Asia and Africa Dr Miriam Taegtmeyer PI, REACHOUT Liverpool School of Tropical Medicine REACHOUT is funded by the European Union 1 12th June 2016
- 2. Six countries, three E’s, close-to- community providers QUITY FFICIENCY FFECTIVENESS
- 3. A platform for research that is… • Working at the interface between community and health systems in a range of contexts • Variety of priority areas including maternal health, SRHR • Working WITH health systems on embedded interventions • Working ON health systems over time
- 4. 5-year approach to our research Context analysis Quality improvement Quality embedding Improved equity, effectiveness and efficiency of CHW services 1. Build capacity in health systems research 2. Identify influence of context, policy and health system 3. Develop and assess interventions 4. Inform evidence based, context appropriate policy making Multiple methods
- 5. How can we improve quality of community health programmes? • Supervision • Community engagement • Referral • Communication and coordination among service providers
- 7. Summary • REACHOUT is a great platform for testing and embedding quality improvement initiatives in community health. • Shifting from project-led to district-led approaches raises complex questions that go beyond health and into politics, people, power • We need context specific understandings of ownership against each stage of the quality assurance cycle for community health.
Editor's Notes
- In 2002 I was working in Kenya, a high prevalence country for HIV, when we started working with community health workers and lay counsellors to develop a door-to-door testing and counselling programme for HIV. Sitting in people’s homes observing testing and counselling taking place reminded me of how a home visit can be an essential part of understanding family circumstances and health. It reminded me of my first home visit as a medical student – the first time I had seen a ‘patient’ outside of a hospital environment and a hospital gown, in a hospital bed that is approached from the patient’s right hand side (always). my first home visit. 2 smoking parents, 3 kids, 1 sofa, 1 TV, no other furniture and an asthma attack. IN homesteads in Kenya too so many things were obvious: bed nets hanging or packed away, one wife or several wives, children, who else lived in the house, someone drunk in a corner, water supply, latrines and so on.
- To maximize the equity, effectiveness and efficiency of CHW services in rural areas and urban slums in six countries: Mozambique, Indonesia, Kenya, Malawi, Bangladesh and Ethiopia. Dimensions of quality that we are interested in
- 4 objectives To build capacity to conduct and use health systems research to improve CHW services. To identify how community context, health policy and interactions with the rest of the health system influence the equity, effectiveness and efficiency of CHW services. To develop and assess interventions with the potential to make improvements to CHW services. To inform evidence-based and context-appropriate policy making for CHW services Strong qualitative consortium Bring together disciplines Innovation in methods round equity to ensure community voices heard
- Inter-country variations in: CHW professionalization and responsibilities Health system structure Burden of disease