Working with communities to increase the use of health services: an experience from Togo, West Africa

A project in Togo, West Africa, demonstrated that motivated and skilled district health teams can increase community involvement in promoting positive health behavior. Village health committees, village volunteers, health workers, itinerant health agents, and school teachers collaborated with district health personnel in village-wide efforts to increase the use of health services targeted to children under 5 years of age. The project also demonstrated that in areas where health services are accessible, high levels of service utilization can be achieved by villages through a combination of strategies that rely on person-to-person and group methods of communication. Village-level educational programs, which included theater, storytelling, patient education at health facilities, and child-to-child activities in schools contributed to improvements in immunization coverage levels in children 12-23 months of age after less than one year following the educational intervention. The major factors responsible for the success of the project are summarized,and issues related to project replication and diffusion are discussed."Health Education"--cover.Bibliography: p. 15-16

Controlling malaria in Francophone Africa: taking the initiative : a series of papers on the ACSI-CCCD Malaria Initiative

edited by Joseph F. Naimoli and Phuc Nguyen-Dinh."Malaria"--cover.Includes bibliographic references.United States Agency for International Development, Africa Regional Project 698-042

Do we have the right models for scaling up health services to achieve the Millennium Development Goals?

There is widespread agreement on the need for scaling up in the health sector to achieve the Millennium Development Goals (MDGs). But many countries are not on track to reach the MDG targets. The dominant approach used by global health initiatives promotes uniform interventions and targets, assuming that specific technical interventions tested in one country can be replicated across countries to rapidly expand coverage. Yet countries scale up health services and progress against the MDGs at very different rates. Global health initiatives need to take advantage of what has been learned about scaling up.UKai

Integrating community health assistant- driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: Mapping key actors, points of integration, and conditions shaping the process

Introduction: Although large scale public sector community health worker programs have been key in providing sexual and reproductive health (SRH) services in low- and middle-income countries, their integration process into community health systems is not well understood. This study aimed to identify the conditions and strategies through which Community Health Assistants (CHAs) gained entry and acceptability into community health systems to provide SRH services to youth in Zambia. The country’s CHA program was launched in 2010. Methodology: A phenomenological design was conducted in Nyimba district. All nine CHAs deployed in Nyimba district were interviewed in-depth on their experiences of navigating the introduction of SRH services for youth in community settings, and the data obtained analyzed thematically. Results: In delivering SRH services targeting youth, CHAs worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders. CHAs delivered SRH education and services in health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and they also worked to build relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. CHAs used their existing social networks to deliver SRH services to adolescents. By embedding the provision of information about SRH into general life skills at community level, the topic’s sensitivity was reduced and its acceptability was enhanced. Further, support from community leaders towards CHA-driven services promoted the legitimacy of providing SRH for youth. Factors limiting the acceptability of CHA services included the taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits

Implementing health system strengthening projects at USAID: Findings from five cases using an integrated framework

Evidence on the implementation of health systems strengthening (HSS) interventions is scarce. Donors need this information to prioritise investments and lobby for continued financial support. To develop a deeper understanding of the implementation dynamics of robust HSS interventions, we retrospectively compared five USAID-supported projects in the Dominican Republic, Ethiopia, Kazakhstan, Rwanda, and Zambia. A document review and key informant interviews (n = 44) were conducted, coded, and analysed in each of the five cases using an integrated implementation framework. The framework was organised by four phases of implementation. For the pre-condition phase, data-driven HSS interventions were nested in a range of political contexts and with differing levels of financial support. In pre-implementation, cases relied on diverse teams that created a data-informed, inclusive, and transparent project ethos for implementation. Implementation was located at multiple tiers of the health system, used interventions as catalysts for government initiatives, supported governance/accountability initiatives, and responded nimbly to contextual changes in the implementation climate. There was less evidence of maintenance and evolution but all cases were designed with an eye towards sustainability. This research yields important insights about the dynamics of HSS, identifying ways donors can better support countries to achieve universal health coverage