This document outlines the role of Community Health Agents (CHAs) in Tanzania to improve maternal and child health outcomes. The key roles of CHAs are to: 1) Improve household and community practices related to health, 2) Enhance community-based case management of childhood illnesses, and 3) Strengthen the local health system. CHAs will provide health education, monitor pregnancies and newborns, treat common childhood illnesses, and facilitate access to health services. Their work involves improving health behaviors, recognizing illness symptoms, providing initial treatment, and referring severe cases. CHAs will also help strengthen the local health system through community organization, improving data collection, and ensuring access to supplies.

1. 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

2. 2Core Aspects of the CHA RoleImprove household and community practices and capacity to support maternal and child health and child development.2) Enhance community-based case management of childhood illnesses when illness/injury does not require facility attendance.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.Training Module on IMCI and Community IMCI Implementation, MoH Tanzania, 2004

3. Household and Community PracticesRoutine household distribution of key household health “technologies” that prevent illnessInsecticide treated bednets Condoms Oral contraceptives (use of DMPA-Uniject under negotiation with PATH)Soap and hygienic supplies

4. Education and counseling regarding key aspects of reproductive and child healthChild growth, development and management of illnessNutrition (including micronutrient and complementary feeding)Water, sanitation and hygieneReproductive healthHIV/AIDS and STI PreventionTuberculosis and malaria prevention4Household and Community Practices

5. Pregnancy monitoring visits during antenatal periodPromotion of antenatal care and facility-based deliveryCounseling on danger signs of complications, nutrition and post-partum family planningBirth planning and emergency preparationsMonitoring and reminders for net use and IPTp, TT and PMTCT adherenceIdentification and referral for complicationsPromote male active participation and child care and Reproductive Health Household and Community Practices

6. 6Household and Community PracticesPostnatal/partum visits for both mother and newbornCounseling on essential newborn careIdentification and referral for complicationsPromotion of postpartum/natal careIdentification of LBWs using foot sizeFamily planningMonitoring/reminders for early diagnosis of HIV

7. 7Community Case ManagementTraining in CHAs in Integrated Case ManagementAbility integrate disease specific guidelines into a comprehensive and efficient process for attending sick children.

8. Understanding of protocols for assessment for symptoms, and danger signs in sick children.

9. Recognition of less common illnesses or chronic problems that may require clinical care or be managed in community (routine injuries, etc.)8Community Case ManagementRoutine Household Visits to Assess U5 Children for Major SymptomsCough or difficulty breathing, diarrhea, fever, ear problems, bacterial infection, nutritional, immunization and Vitamin A status, etc.

10. Identification of select clinical signs for classification (not diagnosis):

11. Urgent Referral to clinical level of care

12. Initiation of specific treatment using limited number of essential drugs

13. Home treatment, counseling/education of caretakers, including active participation in treatment of children.9Community Case ManagementProvision of complete treatment and follow up to children with uncomplicated illnesses:Malaria – dependent on national supply and scale up of Rapid Diagnostic Tests (RDT); treat with SP and Paracetamol

14. Pneumonia: using ARI timers (detection) and Cotrimoxazole