1. The study evaluated a community-based intervention for dengue control in Cuba that strengthened intersectoral coordination and community empowerment. 2. Surveys found that levels of community participation and positive behavioral changes increased more in pilot areas with the coordination and empowerment interventions compared to the control area. 3. Entomological surveillance data showed that the pilot and extension areas achieved lower Breteau indices, indicating greater effectiveness at controlling the Aedes mosquito, compared to the control area over the six-year period.

1. BY-
PRAMOD KUMAR

2. Inter sectoral coordination for
achieving health goals has been accepted
as one of the guiding principles of the
health strategy that was adopted at the
international conference on primary
health care.

3.  INTER:
Inter means with in or it self.
 SECTOR:
Sector refers to the different – different areas or
they may be different organizations.
 COORDINATION:
Coordination is an administrative process which
seeks to bring about unity of purpose in order to
achieve common objectives.

4.  INTER SECTORAL
COORDINATION:
Intersectoral
coordination refers to
the promotion and co-
ordination of the
activities of different
sectors of health care
system to enhance and
to provide a
qualitative services to
community.

5.  There are many governmental departments and
agencies working for people whose activities are
closely linked with health, as health itself is a
multi-sectoral subject that needs-
Clean water
Sanitation
Pollution free environment
Economic conditions
Food production etc.
 Earlier health care system focused more on
’curative’ rather than ‘preventive’ aspects.

6. Collaboration implies a cooperative
situation where two or more participants
have a common goal and where each has
sufficient information as to what others are
going to do to enable him to make correct
decision.
 Collaboration is-
 More participative
 Implies commitment
 Economizes efforts
 Improves quality of work
 Avoid duplication
 Optimizes output

7. Collaboration is a process--- that facilitates
different functionaries and community to work
together for efficient service delivery.
COLLABORATION LEADS -THIRST
T = TIME SAVING
H =HELPS IN BUILDING RAPPORT WITH OTHERS
I =INCREASES EFFICIENCY
R =REDUCES WORKLOAD
S =SHARING OF IDEAS
T =TRUSTWORTHY

8.  To improve vertical
nature of programs.
 To maintain focus on
primary health care.
 To provide
directionality.
 To promote team
work.

9.  INTRA-SECTORAL.
 INTER SECTORAL.

10. 1. AT THE KNOWLEDGE LEVEL:-
 Lack of knowledge of other programmes and goals
of other sectors. Each programme is implemented
in an isolated manner.
For example Health Deptt. may not know the
goals of ICDS programme, which in turn may not
be aware of the goals of RCH programme etc. This
leads to misunderstanding, repetition and
sometimes even contradictions, which affect the
credibility.

11. 2. AT THE ATTITUDINAL LEVEL:-
 The feeling of ‘why should I go, the other
person should come forward’.
 The attitudes are often based on
misconception—coordination means more
work and assuming responsibility for others
work.

12. 3. AT THE PRACTICE LEVEL:-
Lack of knowledge about the mechanisms.
People do not know how to go about it and
how to formalize it. The formal mechanism
such as constitution of Advisory Committees,
Coordination Committees, Task-forces etc.

13. leadership style and willingness.
Health policies and priorities.
Sharing of a common vision and
perspective.
Defining role and responsibilities of
participatory agencies.
Participatory decision making.

14.  Developing informal contacts with involved
groups.
 Learning more about quality of services.
 Spelling out strategies and procedures.
 Conducting joint monitoring and evaluation.
 Taking immediate remedial measures in
solving problems related to
coordination/resource mobilization.

15. Promotion of
nutrition
Agriculture
Education
Social
Welfare/Wo
men and
Child
Development
Panchayats
Animal
Husbandry

16.  Supply of safe water,
 Excreta disposal and refuse disposal,
 Waste water disposal,
 Maternal and child health,
 Family welfare, immunization against
major infectious diseases,
 Prevention and control of locally
endemic diseases, and health education
on prevailing health problems.

17.  LISTING out the programmes which need joint
efforts.
 IDENTIFYING the areas where coordination is
required.
 KNOWING the categories of health personnel
whose activities should be integrated.
 LOCATING the level of health systems where
joint efforts are needed.
 FORMING coordination committee of members of
district health team which includes all the
middle level supervisors and specialized
functionaries.
 FORMING of operation teams at field level.

18. LISTING THE PROGRAMMES
IDENTIFYING - THE AREAS/ ACTIVITIES
DIFFERENT ORGANIZATIONS AND
AGENCIES
GOOD LOCAL NGOS TO FACILITATE
COMMUNITY’S INVOLVEMENT

19. DEVELOPING AN ACTION PLAN FOR:
 Independent tasks
 Joint tasks
 Sharing of resources
 Field work teams
CREATE INFORMAL FORUM FOR
MEETINGS, ACKNOWLEDGEMENT AND
APPRECIATION OF ALL PARTNERS
EFFORTS IN ACHIEVING THE TARGETS.

20.  Community participation has been identified
as an important means of overcoming sectoral
barriers.
 It is the community and its involvement that
best motivates collaboration between sectors
through the community, health goals can be
linked to and reinforces other goals of well
being.
 It is a long arduous task but results are good
and lasting.

21.  The ranges of activities of community participation
therefore include the following:
 Helping community to analyze their problems and their
causes.
 To identify the needs and prioritize them in a logical
manner. Sometimes felt needs of the community may be
different from the perceived need of the health
professional.
 To plan activities to meet these needs/solve the
problems and to find resources for them.
 To monitor closely the implementation of programmes.
 Last but not the least to own the programme by
assuming full responsibility for its implementation.

22.  MORE achievement at lower cost.
 CATALYST for further development.
 DEVELOPS a sense of ownership and
subsequently responsibility in utilization
and maintenance of health care services.
 INCULCATES self-reliance by enhancing the
use of local indigenous expertise.

23.  Rangabela project, West Bengal
 Comprehensive Rural Development
Project, Jamkhed, Maharashtra
 RUSHA Integrated Health and Community
Development Project, Vallur, Tamil Nadu.

24. Recruitment of
local frontline
health workers.
Working with
local groups.
Working with
NGOs.
Development and
use of simple
indigenous
technologies.
Demand driven
approach rather
than supply
driven approach.

25.  TITLE OF THE STUDY:-
Intersectoral coordination, community
empowerment and dengue prevention: six years
of controlled interventions in Playa Municipality,
Havana, Cuba.
 OBJECTIVE:
To document the process, outcome and
effectiveness of a community-based
intervention for dengue control.

26.  METHODS:
The primary intervention, focused on strengthening
intersectoral coordination, was initiated by
researchers in January 2000 in a pilot area in Playa
municipality, Havana. In August 2002 health
authorities extended the intervention to
neighbouring areas, one of which was selected for
evaluation. In August 2003 a complementary
strategy, focused on community empowerment,
was initiated in half of the pilot area. Longitudinal
process assessment was carried out using document
analysis, interviews and group discussions. Random
population surveys in 1999, 2002 and 2005 assessed
levels of participation and behavioural changes.
Entomological surveillance data from 1999 to 2005
were used to determine effectiveness.

27.  RESULTS:
Mean scores for participation in the pilot area were
1.6, 3.4 and 4.4 at baseline, and 2 years after initiating
intersectoral coordination and intersectoral
coordination plus community empowerment
interventions, respectively. While in the control area
little behavioural change was observed over time,
changes were considerable in the pilot and extension
areas, with 80% of households involved in the
community empowerment intervention showed
adequate behavioural patterns. The pilot and extension
areas attained comparable entomological effectiveness
with significantly lower Breteau indices (BIs) than the
control area. The pilot (sub-) area with the community
empowerment intervention reached BIs below 0.1 that
continued to be significantly lower than the one in the
control area until the end of the study.

28.  CONCLUSION:
The study showed a trend in the levels and
quality of participation, behavioural change and
effectiveness of Aedes control from the routine
activities only over an intervention with
intersectoral coordination to one that combined
intersectoral coordination and community
empowerment approach.