Community Approaches

to Child Health

Why Community Approaches?

• To reach unreached families

• To mobilize additional resources and partners (including communities and families themselves)

• To especially strengthen preventive approaches

Careseeking And Sources of Care - Bangladesh, 2000

12%4%

1%3%

3%

40%

NO37% Yes

63%

Untrained Traditional CHW

Other Facility Private Doctor

Source: IMCI Multi-Country Evaluation Bangladesh, 2000

1st source of care sought

Home Treatment and Proportion of Children with Severe Dehydration - Haiti, 1983

3

22

0

5

10

15

20

25

Yes No

Fluid Therapy at Home

Pe

r c

en

t S

ev

ere

ly

De

hyd

rate

d

Examples - Community Approaches at Scale

• Indonesia - Posyandus

• Bangladesh - BRAC ORT

• Nepal - Vitamin A & pneumonia treatment

• Madagascar - Immunization, Nutrition, Safe Water, “Community IMCI”

• Bamako Initiative

Global Programming Efforts for Community Approaches at Scale

• Community Based Delivery of family planning

• “Community IMCI”

• Roll Back Malaria (“the home is the first hospital”)

• Child Health Days (vitamin A plus)

• “Sustainable Outreach” (immunization)

WELL

Promotion/Prevention Behaviors

• Feeding• Hygiene• Bednets, etc.

• Support Groups (Women’s, schools, religious, etc.)

• Information• Resources• Support for key inputs

(Bednet redipping, water, etc.)

• Organization for outreach(Immunization, micronutrients, etc.)

• Outreach • Assessment (Nutrition status)

• Information & counselling• Immunization, micronutrients

ILL• Recognition• Home care• Care seeking• Continued care• Referral acceptance

• Information• Support for referral

(Transport, emergency funds, etc.)• Drugs and supplies

(Community Pharmacies, private sector, CHWs, etc.)

• Treatment

• Treatment• Referral• Counselling (continued care)

• “Counter-referral”

HO

ME

CO

MM

UN

ITY

FA

CIL

ITY

Taking Community Approachesto Scale

• Focus on key outcomes (not prescribed processes)

• Build on what’s there - NGOs, community- based programs

• Engage partners

• Develop policy and resource commitment (part of national strategy)

Country Program Examples -Key Questions

• Why a community approach?

• How does the program work?

• What is the role of government (national, district, local), NGOs, others?

• What have been key challenges and constraints?

• Is it working?

Key Behaviors Related to Major Causes of Infant and Child Mortality

• Newborn care

• Breastfeeding

• Appropriate feeding

• Micronutrient intake

• Immunization

• Handwashing &

Hygiene

• Bednets

• Recognizing illness

• Appropriate home care

• Danger signs & indications

for care seeking

• Seeking appropriate

care (including care

delivered in the

community)

• Accepting referral

Promotion of Health/ Prevention of Illness

Illness Recognition, Home Care & Care Seeking