Key aspects of RCH: Child growth, development and recognition and management of illness;NutritionWater, sanitation and hygieneReproductive health, including family planning and STI preventionTuberculosis and malaria preventionPregnancy monitoring visits during antenatal period:Promotion of antenatal care and facility-based delivery Counseling on danger signs of complications, nutrition and post-partum family planning Birth planning and emergency preparations Monitoring and reminders for net use and IPTp, TT and PMTCT adherence Identification and referral for complications
Introduce a community health agent (CHA) with necessary system supports:To improve access to MNCH services through community-based care and referral systems with a focus on equity To extend the range of MNCH services available, particularly as relates to promotive and preventive servicesTo improve the quality of services through contextually appropriate and people-centered care and improved information on community health status and needsTo increase efficiency of the health system through task-shifting to CHAs
Cha role presentation (october, 2010)
Introducing Community Health Agents to accelerate achievement of MDGs 4 and 5 in Tanzania:The Connect Project The Role of the CHA intervention in Community-based Primary Health Care<br />
2<br />Core Aspects of the CHA Role<br />Improve household and community practices and capacity to support maternal and child health and child development.<br />2) Enhance community-based case management of childhood illnesses when illness/injury does not require facility attendance.<br />3) Strengthen the health system by way of facilitating accessibility of drugs and supplies where needed, improving organization of work from the community-level up, including monitoring, supervision and referral.<br />Training Module on IMCI and Community IMCI Implementation, MoH Tanzania, 2004<br />
Household and Community Practices<br />Routine household distribution of key household health “technologies” that prevent illness<br />Insecticide treated bednets <br />Condoms <br />Oral contraceptives (use of DMPA-Uniject under negotiation with PATH)<br />Soap and hygienic supplies<br />
Education and counseling regarding key aspects of reproductive and child health<br />Child growth, development and management of illness<br />Nutrition (including micronutrient and complementary feeding)<br />Water, sanitation and hygiene<br />Reproductive health<br />HIV/AIDS and STI Prevention<br />Tuberculosis and malaria prevention<br />4<br />Household and Community Practices<br />
Pregnancy monitoring visits during antenatal period<br />Promotion of antenatal care and facility-based delivery<br />Counseling on danger signs of complications, nutrition and post-partum family planning<br />Birth planning and emergency preparations<br />Monitoring and reminders for net use and IPTp, TT and PMTCT adherence<br />Identification and referral for complications<br />Promote male active participation and child care and Reproductive Health <br />Household and Community Practices<br />
6<br />Household and Community Practices<br />Postnatal/partum visits for both mother and newborn<br />Counseling on essential newborn care<br />Identification and referral for complications<br />Promotion of postpartum/natal care<br />Identification of LBWs using foot size<br />Family planning<br />Monitoring/reminders for early diagnosis of HIV<br />
7<br />Community Case Management<br />Training in CHAs in Integrated Case Management<br /><ul><li>Ability integrate disease specific guidelines into a comprehensive and efficient process for attending sick children.
Understanding of protocols for assessment for symptoms, and danger signs in sick children.
Recognition of less common illnesses or chronic problems that may require clinical care or be managed in community (routine injuries, etc.)</li></li></ul><li>8<br />Community Case Management<br />Routine Household Visits to Assess U5 Children for Major Symptoms<br /><ul><li>Cough or difficulty breathing, diarrhea, fever, ear problems, bacterial infection, nutritional, immunization and Vitamin A status, etc.
Identification of select clinical signs for classification (not diagnosis):
Initiation of specific treatment using limited number of essential drugs
Home treatment, counseling/education of caretakers, including active participation in treatment of children.</li></li></ul><li>9<br />Community Case Management<br />Provision of complete treatment and follow up to children with uncomplicated illnesses:<br /><ul><li>Malaria – dependent on national supply and scale up of Rapid Diagnostic Tests (RDT); treat with SP and Paracetamol
Pneumonia: using ARI timers (detection) and Cotrimoxazole
Diarrhea: Oral Rehydration Therapy with zinc and extra fluids.
Malnutrition: Increased breasfeeding, extra feeds (if on complementary feeding.
Referral to facility when appropriate.</li></li></ul><li>10<br />Local Health System Strengthening<br />Facilitate Access to Additional Support and Financing Mechanisms:<br /><ul><li>Community mobilization for enrollment in National Health Insurance/Community Health Funds
Education and identification of households eligible for fee exemptions, facilitate their acquisition of CHF cards and care-seeking support.
Identification of vulnerable households and facilitate access to additional support services (e.g. families affected by disability, aging household members, chronic illness, poor water and sanitation, etc.)</li></li></ul><li>11<br />Local Health System Strengthening<br />Linking district-level and village planning and organization:<br /><ul><li>Provide organizational support with facility management and village health committees.
Represent and encourage involvement of village health committees for immunization, Vitamin A, ANC, and reproductive health community outreach.
Develop and sustain emergency referral mechanisms.
Communicate district and village health agenda to the community and ensure accountability
Participate in maternal and newborn death audits.</li></li></ul><li>12<br />Local Health System Strengthening<br />Improve quality of data on community health information and reporting mechanisms:<br /><ul><li>Training and follow up support to facility-based supervisors for supportive supervision of the CHA.
Facilitate the CHA collection, management and utilization of health data for decision-making.
Identify and address bottlenecks in the supply chain of essential drugs and commodities and integrate the community into that process.
Reports summary information to village health committees, encourages communities to advocate for health rights to decision makers.</li></li></ul><li>
14<br />Coming Up…<br /><ul><li>Who are our CHAs? Recruitment, selection and lessons learned so far.