This document discusses community systems strengthening (CSS), which promotes the development and sustainability of communities and community organizations to contribute to long-term health outcomes. CSS aims to improve access to and utilization of health services through increased community engagement in areas like advocacy, health promotion, and home-based care. For communities to effectively impact health, they must have strong, sustainable systems for activities, services, and funding. The core components of CSS systems include enabling environments, community networks, resources and capacity building, community activities, organizational strengthening, and monitoring and evaluation.
EU regulation of health services but what about public health?tamsin.rose
Highlights some of the issues with the planned approach by the EU to regulate healthcare services and social welfare services across Europe. Raises questions about public health and the importance of civil society (NGOs) as service providers and building social capital
EU regulation of health services but what about public health?tamsin.rose
Highlights some of the issues with the planned approach by the EU to regulate healthcare services and social welfare services across Europe. Raises questions about public health and the importance of civil society (NGOs) as service providers and building social capital
This presentation provides insight on how to drive health equity into action at a community level.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
LHINs: Drivers of a More Equitable and Responsive Health System?Wellesley Institute
This presentation provides critical insight on how to achieve a more equitable and responsive health system.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Paul Mikov, MA, Vice President of Institutional Partnerships with Catholic Medical Mission Board shares how CMMB partners with a variety of organizations to deliver care and strengthen health systems, including a program involving care by Catholic nuns.
Peter Yeboah, MPH, MSc, Executive Director of the Christian Health Association of Ghana shares how CHAG works with the Ministry of Health in Ghana to provide health care and addresses challenges and how the organizations works to overcome them.
Community Health Systems Catalog: The One-Stop Shop for Community Healthy Inf...JSI
Over the past few decades, many countries have lacked cohesive community health policies, strategies, and guidelines, resulting in systems that are fragmented, poorly integrated with national health systems, and unable to reach scale. For years, countries have had limited access to global data and evidence to inform community health program design and implementation.
In 2014, APC launched the Community Health Systems Catalog as a resource for 25 countries deemed priority by USAID’s Office of Population and Reproductive Health. Updated in 2016–2017, the CHS Catalog contains information from community health policies, with a focus on community health workers (CHWs) and over 130 community-based interventions.
The CHS Catalog provides an evidence base to inform, strengthen, and harmonize future policy efforts to advance global and national efforts to strengthen community health systems. Specifically, findings help answer key questions about community health policies. For example, which services can CHWs provide? How is community data supposed to be used? What is the community’s role in managing health programs? The CHS Catalog illustrates the breadth and diversity of CHWs – including their various tasks, skills, and characteristics across countries and regions. At the same time, the definition of a CHW still lacks consistency, and greater alignment and clarity of terminology is needed to inform the global conversation on CHWs. Guidance on applying more consistent definitions, such as the forthcoming WHO CHW Guidelines, should provide policymakers, program planners, implementers, and donors with the language to better convey information on best practices, experiences, and lessons in community health.
Presented by Kristen Devlin at the Fifth Global Symposium on Health Systems Research in Liverpool this October.
This presentation provides insight on how to drive health equity into action at a community level.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
LHINs: Drivers of a More Equitable and Responsive Health System?Wellesley Institute
This presentation provides critical insight on how to achieve a more equitable and responsive health system.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Paul Mikov, MA, Vice President of Institutional Partnerships with Catholic Medical Mission Board shares how CMMB partners with a variety of organizations to deliver care and strengthen health systems, including a program involving care by Catholic nuns.
Peter Yeboah, MPH, MSc, Executive Director of the Christian Health Association of Ghana shares how CHAG works with the Ministry of Health in Ghana to provide health care and addresses challenges and how the organizations works to overcome them.
Community Health Systems Catalog: The One-Stop Shop for Community Healthy Inf...JSI
Over the past few decades, many countries have lacked cohesive community health policies, strategies, and guidelines, resulting in systems that are fragmented, poorly integrated with national health systems, and unable to reach scale. For years, countries have had limited access to global data and evidence to inform community health program design and implementation.
In 2014, APC launched the Community Health Systems Catalog as a resource for 25 countries deemed priority by USAID’s Office of Population and Reproductive Health. Updated in 2016–2017, the CHS Catalog contains information from community health policies, with a focus on community health workers (CHWs) and over 130 community-based interventions.
The CHS Catalog provides an evidence base to inform, strengthen, and harmonize future policy efforts to advance global and national efforts to strengthen community health systems. Specifically, findings help answer key questions about community health policies. For example, which services can CHWs provide? How is community data supposed to be used? What is the community’s role in managing health programs? The CHS Catalog illustrates the breadth and diversity of CHWs – including their various tasks, skills, and characteristics across countries and regions. At the same time, the definition of a CHW still lacks consistency, and greater alignment and clarity of terminology is needed to inform the global conversation on CHWs. Guidance on applying more consistent definitions, such as the forthcoming WHO CHW Guidelines, should provide policymakers, program planners, implementers, and donors with the language to better convey information on best practices, experiences, and lessons in community health.
Presented by Kristen Devlin at the Fifth Global Symposium on Health Systems Research in Liverpool this October.
Integrating Community Strategy with HIV Programs:A Research Paper Appropriate...Stephen Olubulyera
Integrating Community Strategy with HIV Programs-A Research Paper Appropriate for Turkana County Setting-A review of evidence and implementation strategies
Strengthening Community Capacity for Effective Advocacy: A Strategy Developme...Humentum
Robert Musoke, PATH Uganda; Bernard Byagageire, PATH Uganda; Jennifer Gaberu, PATH Uganda. Presentation made during Humentum's Capacity for Humanity conference, February 2018.
The Power of Community Health Improvement Plans: Building Healthier Futures T...Enterprise Wired
Elements of a Comprehensive Community Health Improvement Plans: 1. Assessment of Community Health Needs 2. Strategic Goal Setting 3. Collaborative Action Planning 4. Implementation and Evaluation
Approaches to understanding community needs, the importance of involving comm...Thomas Owondo
Community involvement in health: “ is a process whereby people, both individually and in groups, exercise their right to play an active and direct role in the development of appropriate health services, in ensuring the conditions for sustained better health and in supporting the empowerment of the community to help development
The five main pillars of maternal, newborn, and child health
Strengthening the health system
Improving the quality of services
Increasing access to services
Improving Healthy Practices with social and behavioral change
Combining global best practices with locally-led solutions.
The capacity-strengthening capabilities demonstrate improving equity and outcomes by directly improving the capacity of local organizations and institutions to deliver health services
Approaches include;
Community Mobilization, Social & Behavior Change
Human-centered design principles to mobilize communities and families for healthier behaviors and care-seeking practices. Central to our behavior change approach, men engaged as clients, partners, and fathers in child health and development.
Engagement of community leaders: through training and capacity-building for community leaders, the development of Community Action Plans (CAP) that identify and address barriers in the community, in order to increase demand for MNCH services
Community Days: semi-annual Community Days that bring different communities together for a day of communication, information, and activities to improve awareness among key target populations of important MNCH services.
Health system strengthening – what is it, how should we assess it, and does i...ReBUILD for Resilience
This presentation was given to the UK's Department for International Development on 30th July 2019.
Comprehensive reviews of health system strengthening interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. In our talk, we will reflect on the process of undertaking such an evidence review for DFID recently (attached again), drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spill-over effects and their contribution to meeting over-arching health system process goals. We will make some initial suggestions about such goals, to reflect the features that characterise a ‘strong health system’. We will highlight current findings on ‘what works’ but also that these are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to re-think evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks and methods can support more coherent HSS investment.
10Where Do We Go From HereLearning ObjectivesAfte.docxpaynetawnya
10
Where Do We Go From Here?
Learning Objectives
After reading this chapter, you should be able to:
• Discuss the importance of collaboration between policy makers and vulnerable populations.
• Explain the community-oriented approach to health care.
• Define the market-oriented approach to health care.
• Specify the role that vulnerable populations should play when developing health care
programs.
• Identify policies (social and economic) for health care reform that will improve health
care services accessibility, cost, and quality.
Courtesy of maigi/fotolia
bur25613_10_c10_259-274.indd 259 11/26/12 2:50 PM
CHAPTER 10
Self-Check
Answer the following questions to the best of your ability.
1. The best way for program administrators to achieve useful program design or
reform is to collaborate with whom?
a. the population they are trying to serve
b. legal counsel
c. government advisors
d. academic researchers
Critical Thinking
Communication can take many different forms. Communication can include everything from formal
town hall meetings to informal conversations between two people. Communication does not necessar-
ily even need to involve talking. Describe three special populations and specify a form of communication
that could be used to gather information on each group.
Introduction
Policy makers and program administrators must realize that there is often a lack of communication between those creating the
programs aimed at vulnerable populations and
the individuals who make up those populations.
Programs won’t be useful if they do not directly
address the needs of the vulnerable in ways that
are accessible to the vulnerable. The best way to
achieve useful program design or reform is to
collaborate with the population you are trying
to serve. Program designers and medical prac-
titioners can learn a lot about the needs of those
they are serving simply by asking them. By hav-
ing conversations with patients and community
leaders, and even by asking patients and patrons
to complete surveys, policy makers, program
administrators, and practitioners gain insight into
the needs and wants of the vulnerable populace.
Only through a coordinated, collaborative effort
to address the serious issues confronting vulner-
able populations can the health and wellness of
said population increase to resemble those who
are not classified as vulnerable.
Courtesy of Digital Vision/Thinkstock
Effective program planning must include
communication between policy makers
and the individuals who make up the
vulnerable populations meant to benefit
from a particular program.
Introduction
bur25613_10_c10_259-274.indd 260 11/26/12 2:50 PM
CHAPTER 10Section 10.1 The Community-Oriented Approach
2. Declarations from those in charge will be useless because ______________.
a. no one will listen
b. there is no food
c. those in charge have not sought the council of the masses
d. those in charge do not care
...
2016 association for community health improvement conference: summary of proc...Innovations2Solutions
The Association for Community Health Improvement (ACHI) held its annual national conference from March 1-3, 2016. The ACHI
is the premier national association for community health, community bene t and healthy communities’ professionals. This year’s conference was held in Baltimore, Maryland, and centered on discussion around the “From Health Care to Healthy Communities” idea.
The event brought together hundreds of community thought leaders, population health experts and community organizations, in sessions of collaborative engagement and learning. Presentations and interactive meetings introduced and critically discussed the latest tools and approaches to population and community health. This summary provides an overview of some of the key themes and takeaways that emerged from the conference.
Ini adalah perbandingan harga obat ARV generik lokal dan ARV generik Import. ARV adalah nama obat yang digunakan bagi terapi Orang terinfeksi HIV (ODHA)
1. COMMUNITY SYSTEMS STRENGTHENING
INFORMATION NOTE
Introduction
Community systems are community-led structures and mechanisms used by community
members and community based organizations and groups to interact, coordinate and
deliver their responses to the challenges and needs affecting their communities.
In the context of health, community systems strengthening (CSS) is therefore an approach
that promotes the development and sustainability of communities and community
organizations and actors, and enables them to contribute to the long-term sustainability of
health and other interventions at community level. The goal is to develop the role of key
populations and communities, and community organizations, networks and other actors, in
the design, delivery, monitoring and evaluation of services and activities aimed at
improving health outcomes.
CSS is a way to improve access to and utilization of formal health services but it is also,
crucially, aimed at increased community engagement (meaningful and effective
involvement as actors as well as recipients) in health and social care, advocacy, health
promotion and health literacy, health monitoring, home-based and community based care
and wider responses to ensure an enabling and supportive environment for such
interventions. This includes direct responses by community actors and also their
engagement in responses of other actors such as public health systems, local and national
governments, private companies and health providers, and cross-sectoral actors such as
education, social protection and welfare systems.
Why is community systems strengthening important?
Community organizations and networks have a unique ability to interact with
affected communities, react to community needs and issues and connect with affected
and vulnerable groups. They provide direct services to communities and advocate for
improved programming and policy environments. This enables them to build community
contributions to health, and to influence the development, reach, implementation
and oversight of public systems and policies.
CSS initiatives are encouraged by the Global Fund with the aim of achieving improved
outcomes for HIV, tuberculosis, malaria and related health challenges. This improvement
in health outcomes can be greatly enhanced through mobilization of key populations
and community networks and an emphasis on strengthening community based and
community led systems for: prevention, treatment, care and support; advocacy; and
development of an enabling and responsive environment.
Global Fund Information Note: Community Systems Strengthening (July 2011) 1
2. In order to have real impact on health outcomes, however, community organizations and
actors must have effective and sustainable systems in place to support their activities and
services. This includes a strong focus on capacity building, including human and financial
resources to enable community actors to play a full and effective role alongside health and
social welfare systems. CSS is a means to prioritize adequate and sustainable funds for
specific operational activities and services and, crucially, core funding to ensure
organizational stability as a platform for operations and for networking, partnership and
coordination with others. CSS does not refer to daily programmatic activities that
communities implement such as condom distribution, bed net distribution or provision of
directly observed treatment to TB patients. CSS is in addition to these daily activities and
is about strengthening the systems needed for communities to meaningfully contribute to
these programmatic activities.
Core components of community systems
All of the following core components are essential for creating functional, effective
community systems and enabling them to fulfill their role of contributing to improved
health outcomes.
1. Enabling environments and advocacy – including community engagement and advocacy
for improving the policy, legal and governance environments, and affecting the social
determinants of health.
FOR EXAMPLE: Mobilization of key populations and community networks to engage in
campaigns and solidarity movements.
2. Community networks, linkages, partnerships and coordination – enabling effective
activities, service delivery and advocacy, maximizing resources and impacts, and
coordinated, collaborative working.
FOR EXAMPLE: Networking and partnership development between community and other
actors, for access to services, particularly for the most affected population groups.
3. Resources and capacity building – including human resources with appropriate personal,
technical & organizational capacities, financing (including operational and core funding)
and material resources (infrastructure, information and essential medical & other
commodities & technologies).
FOR EXAMPLE: Capacity building for financial management, book-keeping, accounting,
reporting, use of bank accounts, acquisition and use of accounting software;
4. Community activities and service delivery – accessible to all who need them, evidence-
informed and based on community assessment of resources and needs.
FOR EXAMPLE: Mapping community health & social support services and their accessibility
to end users.
5. Organizational and leadership strengthening - including management, accountability and
leadership for organizations and community systems.
FOR EXAMPLE: Increasing transparency and accountability through meetings with
stakeholders and community members.
6. Monitoring & evaluation and planning - including M&E systems, situation assessment,
evidence-building and research, learning, planning and knowledge management.
FOR EXAMPLE: Developing capacity for data analysis, identifying and documenting key
information and lessons learned.
Global Fund Information Note: Community Systems Strengthening (July 2011) 2
3. The Community Systems Strengthening Framework provides a detailed description of the
CSS rationale and the core components. The definition and scope of CSS will continue to be
revisited and modified in the light of experience and lessons learned from implementation.
The Framework contains examples of activities under each component, and recommended
service delivery areas for building or strengthening community systems. The Framework
also provides guidance on the steps required to build or strengthen a system for CSS
interventions. It includes a number of recommended CSS indicators with detailed
definitions for each of them. These indicators have been developed in consultation with
technical partners and civil society representatives. They are designed to enable
measurement of progress in community systems strengthening over time.
How community systems strengthening can be integrated into Global Fund proposals
The Global Fund encourages applicants to include CSS interventions routinely in proposals,
wherever relevant for improving health outcomes. The proposal form and guidelines have
been revised to reflect the increased importance of CSS within proposals to the Global
Fund.
In preparation for completing the proposal form, applicants will need to work closely with
community organizations and actors to identify which community system strengthening
interventions need to be funded, based on analysis of existing resources and the gaps and
weaknesses that need to be addressed. It is also important to show clearly how systems
will be strengthened by interventions and thus ensure that CSS funding will be
appropriately targeted.
Applicants are encouraged to consider CSS as an integral part of assessments of disease
programs and health systems, ensuring that they identify those areas where full
involvement of the community is needed to improve a) the scope and quality of service
delivery, particularly for those hardest to reach, b) the scope and quality of interventions
to create and sustain an enabling environment, and c) evidence-based policies, planning
and implementation.
Requests for funding of CSS-related interventions can be included either in a disease
proposal or under the common GAVI Global Fund HSS proposal form. The set of CSS
interventions that are included in an HIV, TB or malaria proposal should focus on the
disease, and may also in addition include broader community systems strengthening
interventions.
It is important to focus on aspects related to strengthening community systems in the
context of service delivery, advocacy and enabling environment for the three diseases.
Because CSS particularly focuses on affected communities, CSS interventions should be
harmonized across the three disease components whenever possible and overlap should be
avoided at all cost. This means that HIV, TB and malaria programs need to coordinate their
efforts, avoid duplication and ensure that CSS interventions for the different diseases are
complementary to each other at community level. Secondly, since the Global Fund works
with a system of performance based funding it is important that a limited number of CSS
indicators are carefully chosen as a basis for regular reporting to inform disbursement
decisions.
The CSS Framework needs to be read alongside the Gender Strategy and the Sexual
Orientation and Gender Identities Strategy as CSS is a strong tool through which key
affected populations can be strengthened to maximize their contribution to HIV,TB and
malaria.
Global Fund Information Note: Community Systems Strengthening (July 2011) 3
4. Terminology
The following terms may be useful for applicants who may be considering the inclusion of
interventions related to CSS in their proposal:
Community is a widely used term that has no single or fixed definition. Broadly,
communities are formed by people who are connected to each other in distinct and
varied ways. Communities are diverse and dynamic, and one person may be part of
more than one community. Community members may be connected by living in the
same area or by shared experiences, health and other challenges, living situations,
culture, religion, identity or values.
Key populations, people or communities indicate those who are most vulnerable to
and affected by conditions such as malaria, tuberculosis and HIV and are the most
often marginalized and have the greatest difficulty in achieving their rights to
health. This includes children, youth and adults affected by specific diseases such
as HIV, tuberculosis or malaria; women and girls; men who have sex with men;
injecting and other drug users; sex workers; people living in poverty; street
children and out-of-school youth; prisoners; migrants and migrant laborers; people
in conflict and post-conflict situations; refugees and displaced persons.
Community based organizations (CBOs) are those organizations that have arisen
within a community in response to particular needs or challenges and are locally
organized by community members. Non-governmental organizations (NGOs) are
generally legal entities, for example registered with local or national authorities;
they may be operative only at community level or may also operate or be part of a
larger NGO at national, regional and international levels.
Community organizations and actors are all those who act at community level to
deliver community based services and activities and promote improved practice and
policies. This includes many civil society organizations, groups and individuals that
work with communities, particularly community based organizations (CBOs), non-
governmental organizations (NGOs) and faith-based organizations (FBOs) and
networks or associations of people affected by particular challenges such as HIV,
tuberculosis and malaria. It also includes those public or private sector actors that
work in partnerships with civil society to support community based service delivery,
for example local government authorities, community entrepreneurs and co-
operatives.
Civil society organizations (CSOs) include not only community organizations and
actors but also other non-governmental, non-commercial organizations, such as
those working on public policies, processes and resource mobilization at national,
regional or global levels.
Global Fund Information Note: Community Systems Strengthening (July 2011) 4
5. Further Reading / Useful Resources
Civil Society Action Team (CSAT) http://www.icaso.org/csat.html
Roll Back Malaria Toolbox http://www.rollbackmalaria.org/toolbox/index.html
Stop-TB - Technical Assistance Mechanism (TEAM)
http://www.stoptb.org/countries/tbteam/default.asp
Community involvement in rolling back malaria; Roll Back Malaria / WHO 2002
http://www.rollbackmalaria.org/cmc_upload/0/000/016/247/community_involvem
ent.pdf
Community involvement in tuberculosis care and prevention: Guiding principles and
recommendations based on a WHO review; WHO 2008
http://www.stoptb.org/wg/tb_hiv/assets/documents/9789241596404_eng.pdf
Global Fund Monitoring and Evaluation Guidelines and Tools:
http://www.theglobalfund.org/en/me/documents/
Malaria control, community systems strengthening and community-owned response:
Malaria Control (MC) and Community Systems Strengthening (CSS) Consultation,
Geneva, 23-25 March 2009;
http://www.rollbackmalaria.org/docs/events/2009/Malaria-
control_CSS_community-owned-responseGF9guidelines.pdf
Supporting community based responses to AIDS: A guidance tool for including
Community Systems Strengthening in Global Fund proposals; UNAIDS, January 2009;
http://data.unaids.org/pub/Manual/2009/20090218_jc1667_css_guidance_tool_en.
pdf
WHO community directed interventions for major health problems in Africa: A
multicountry study; WHO 2008 http://apps.who.int/tdr/svc/publications/tdr-
research-publications/community-directed-interventions-health-problems
Global Fund Information Note: Community Systems Strengthening (July 2011) 5