1

The Strength of the Community: A Foundation for

Healthcare Delivery

Ram Shrestha, D.Sc.(hon) and Rhea Bright, MPHUniversity Research Co., LLC

Health Service Structure

Health Post

CHW

Ram Shrestha

CHW

Approach – Community Health Worker

Ram Shrestha

Current Situation of Community Health Workers

Ram Shrestha

SUPPORT TO COMMUNITY HEALTH WORKERS

Ram Shrestha

What is a Community System?

Schools

Religious Community

Women’s Group

Local Health Clinic

$

Credit & SavingsGroup

Local Government

Community Health System

Community Committee

Ram Shrestha

How does a Community System Function?

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Ram Shrestha

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Ram Shrestha

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Ram Shrestha

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Ram Shrestha

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Ram Shrestha

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Ram Shrestha

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

Community Health System

Community QI

Ram Shrestha

Name of Group Member

# and names of pregnant women identified

# and names of postpartumwomen identified

# and names of < 5 children

# and names FP user

1. Example

Name 1: _____Name 2: _____

2.

3.

4.

Total

Community Group Monthly Health Data Record

2014

Name of Community Group: Women’s Group

Village: Luboga

Month & Year: February 2014

District: Kishapu

Schools

Religious Community

Women’s

Group

Local Health Clinic

$Savings & Credit Group

Local Government

CHW

Community Health System

Ram Shrestha

What is an Improvement?

What is an improvement?

Where You are?

Where do you want to be in one year?

This is a gap

20 pregnant women

200 pregnant women

2% exposed infants receiving HIV test

90% exposed infants tested for HIV

Change Ideas for Improvement

10 % of pregnant women participate in ANC services100% of pregnant women should participate in ANC services

QI Team met and discussedChange Idea Proposed- Awareness- TV spotsTwo weeks later: Measured – 20% women received ANC servicesImprovement but not 100%

QI Team met and discussedChange Idea Proposed- Awareness- TV Spots and individual counselingTwo weeks later: Measured – 50% women received ANC services Improvement but not 100%

QI Team met and discussedChange Idea Proposed- Awareness- TV Spots, individual counseling and family counselingTwo weeks later: Measured – 80% women received ANC servicesImprovement but not 100%

QI Team met and discussedChange Idea Proposed- Awareness- Radio SpotsTwo weeks later: Measured – 10% women received ANC servicesNo Improvement

LS Learning Session LS

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

Situation Analysis

Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching

Harvest Dissemination meeting

3rd month

6th

month9th

month12th month

1st month

Community QI Implementation ActivitiesTimeline

Ram Shrestha

Community Group Orientation

Coaches Orientation

2-3 months

Coaches Orientation: Training facility nurses to serve as community QI coaches, Iringa, Tanzania

LS Learning Session LS

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

Situation Analysis

Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching

Harvest Dissemination meeting

3rd month

6th

month9th

month12th month

1st month

Community QI Implementation ActivitiesTimeline

Ram Shrestha

Community Group Orientation

Coaches Orientation

2-3 months

LS Learning Session LS

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

QI m

Situation Analysis

Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching Coaching

Harvest Dissemination meeting

3rd month

6th

month9th

month12th month

1st month

Community QI Implementation ActivitiesTimeline

Ram Shrestha

Community Group Orientation

Coaches Orientation

2-3 months

Community QI Team, Buikwe, Uganda

Changes Tested to identify patients on ART in the community

-Home to Home visits.

- PHA group reps reach out to membership

- Patient to patient linkages- HWs link patients to VHTs- VHTs participate in HF

activities- Local Chiefs mobilize

community to identify VHTs

- Discuss HIV in women group meetings

Above Figure shows that the total number of patients on ART identified in the community increased from 15 to 257 patients in June and September 2012 respectively.

The improvement was almost two fold when VHTs worked in a system than when working alone.

Identification of patients on ART in the community

Improved number of pregnant women receiving ANC

Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-120

50

100

150

200

250

300

Number of pregnant women identified by QI team and received ANC services at Health Post, Illu District

No of preg women who received ANC

No of preg women identi-fied by QI team

Changes TestedHome visit- Mobilize Gare- Mobilize Iddir- Mobilize Religious leaders

QI team formed 72%

86%

% of pregnant women tested for HIV increased from 72% in Oct. 2011 to 86% by June 2012

Exercise

11/1/2013 12/1/2013 1/1/2014 2/1/20140

10

20

30

40

50

60

70

80

90

100

60

75

90 89

1115

36

48

Closing the gap: making sure that children <5 with fever are seen at the health facility

Total <5 with fever <5 w/ fever seen at facility

Nu

mb

er

of

child

ren

<5

82%

46%

80%

60%

Use of local materials to present Improvement in quality of services