The Role of CHAs
- 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. 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 2
- 3. 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
- 4. Household and Community Practices 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 4
- 5. 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
- 6. 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 6
- 7. 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.) 7
- 8. 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. 8
- 9. 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. 9
- 10. 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.) 10
- 11. 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. 11
- 12. 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. 12
- 13. Enabling CHA intervention …generate sub-system system integrates pillars, links inputs… outcomes… inputs to impact Integrated service components: …that alter the CHA package of services + climate of CHA emergency referral system Enhanced demand for INTRODUCTION access: services Health workforce: Community …impact on CHA training, deployment and -based services health supervision behavior, and Extended Improved …. Information: range of equity Data collection + feedback tools for services: CHAs Enhanced Promotion/ prevention Health Medicines, Vaccines, etc: Service Supply chain management for Improved Utilization essential commodities for CHAs quality of services: Improve Financing & social protection: Reduced Improved People- Financing of programme + role of centred social wellness Child CHA in expanding protections costs and behavior Improved Leadership & governance: efficiency: maternal CHAs relationship with local Task- survival governance structures & planning shifting
Editor's Notes
- #2: We should make handouts of the interventions…
- #4: Key aspects of RCH: Child growth, development and recognition and management of illness;NutritionWater, sanitation and hygieneReproductive health, including family planning and STI preventionTuberculosis and malaria preventionPregnancy 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
- #14: Introduce a community health agent (CHA) with necessary system supports:To improve access to MNCH services through community-based care and referral systems with a focus on equity To extend the range of MNCH services available, particularly as relates to promotive and preventive servicesTo improve the quality of services through contextually appropriate and people-centered care and improved information on community health status and needsTo increase efficiency of the health system through task-shifting to CHAs