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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
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Core Aspects of the CHA Role
1) Improve 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
Household and Community Practices
Routine household distribution of key household health “technologies” that prevent illness• Insecticide treated bednets • Condoms • Oral contraceptives (use of DMPA-Uniject under
negotiation with PATH)• Soap and hygienic supplies
Education and counseling regarding key aspects of reproductive and child health• Child growth, development and management
of illness• Nutrition (including micronutrient and
complementary feeding)• Water, sanitation and hygiene• Reproductive health• HIV/AIDS and STI Prevention• Tuberculosis and malaria prevention
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Household and Community Practices
Pregnancy 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• Promote male active participation and child care and
Reproductive Health
Household and Community Practices
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Household and Community Practices
Postnatal/partum visits for both mother and newborn
• Counseling on essential newborn care• Identification and referral for complications• Promotion of postpartum/natal care• Identification of LBWs using foot size• Family planning• Monitoring/reminders for early diagnosis of HIV
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Community Case Management
Training in CHAs in Integrated Case Management
• 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.)
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Community Case Management
Routine Household Visits to Assess U5 Children for Major Symptoms
• 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):
• Urgent Referral to clinical level of care
• Initiation of specific treatment using limited number of essential drugs
• Home treatment, counseling/education of caretakers, including active participation in treatment of children.
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Community Case Management
Provision 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
• 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.
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Local Health System Strengthening
Facilitate Access to Additional Support and Financing Mechanisms:
• 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.)
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Local Health System Strengthening
Linking district-level and village planning and organization:
• 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.
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Local Health System Strengthening
Improve quality of data on community health information and reporting mechanisms:
• 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.
Improve Child and
maternalsurvival
Information:Data collection + feedback tools for
CHAs
Medicines, Vaccines, etc:Supply chain management for
essential commodities for CHAs
Financing & social protection:Financing of programme + role of
CHA in expanding protections
Leadership & governance:CHAs relationship with local
governance structures & planning
Improved equity
Reduced social costs
Improved efficiency:
Task-shifting
…that alter the climate of
demand for services
Enhanced Health
Service Utilization
Enhanced access:
Community-based
services
Health workforce:CHA training, deployment and
supervision
Improved quality of services:People-centred
Extended range of services:
Promotion/ prevention
…generate system
outcomes…Integrated service components:
CHA package of services + emergency referral system
Enabling sub-system
inputs…
…impact on health
behavior, and ….
CHA intervention integrates pillars, links
inputs to impact
Improved wellness behavior
CHA INTRODUCTION
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