COMMUNITY SESSION Session Facilitator: Nazo Kureshy (USAID)

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Community Session Overview | Melanie Morrow | MCHIP

Community health activities help countries eliminate preventable child and maternal deaths by
unleashing the power of communities, increasing equity be reaching vulnerable individuals and groups.
MCHIP catalyzed country accomplishments and learning in community health via its country programs,
technical assistance to grantees of the Child Survival and Health Grants Program (CSHGP) and of the
Malaria Communities Program. It also contributed to learning through the development of a guide for
CHW programs at scale and global evidence review on community health. The evidence review found a
large number of technical interventions that can be delivered effectively at community level. It also found
evidence for the effectiveness of four community-based delivery mechanisms: case management, home
visitation, participatory womens groups, and outreach. MCHIP had a wide range of support and learning
through its programming as well. Most of MCHIPs programming effort in communities was devoted to
support for development and scale up of iCCM; support for piloting misoprostol, refinement and
expansion of the Care Group volunteer health worker model, community support of malaria control, the
Health Fertility Study in Sylhet Bangladesh proving the effectiveness of family planning integrated with
MNH, integrated community mobilization for MNH care in the MaMoni Bangladesh project. There was
also learning on a broader set of topics through the operations research portfolio of CSHGP grantees and
other selected topics like community nutrition education and community Kangaroo Mother Care.

Reference Guide: Developing & Strengthening Community Health Worker Programs at Scale| Karen
LeBan|CORE Group

Effective functioning of large-scale Community Health Worker (CHW) programs offers and important
opportunity for improving the health of vulnerable populations. CHWs are not a stop gap measure but a
permanent part of an effective health system. Through consultations with key informants, analysis of the
literature, and reviews of large scale CHW programs, MCHIP facilitated a team of senior writers and
authors to develop a CHW Reference Guide, This looks at the global experience with large-scale CHW
programs. The Guide distinguishes between two levels of CHWs: full-time, paid with formal pre-service
training; and volunteer, part-time workers; both levels are present in most countries. This resource was
developed for policy makers and program leaders as they develop, expand or strengthen large-scale CHW
programs. The guide has 16 chapters divided into four sections that address planning and governance,
human resource issues, relationships to the community and health system, and achieving impact. Twelve
case studies of large-scale CHW programs show how CHW programs have evolved to respond to the local
context in Asia, the Middle East, Africa and South America. The guide is available at www.mchip.net

Egypts SMART Program: Community Health Workers as agents of change| Ali Abdel Mageid | MCHIP

Egypt achieved notable declines in child and maternal mortality in the last two decades; however, there
persistently high levels of newborn mortality and child malnutrition remain. The 2 year SMART project
addressed these problems, emphasizing community approaches. SMART partnered with 112 local
Community Development Associations (CDAs) in six high-need governorates to provide a package of
proven, low-cost interventions during the first 1,000 days of a childs life. Thanks to the work of 1,200
CHWs, SMART achieved notable outcomes. There were substantial increases in womens knowledge of
maternal-newborn danger signs (e.g. knowledge of postpartum danger signs increased from 13% to 61% in
the governorates in Upper Egypt). ANC4 visits and consumption of 90+ IFA tablets increased. While joint
decision-making for use of family planning (FP) increased significantly, use of modern FP decreased in
the governorates of Upper Egypt. This was because of the interruption of commodity supply during the
civil unrest. CDAs made progress on their own sustainability, securing $7.2 million for future health
programming. Despite the unrest and societal changes during project period, the CDAs helped provide
support and local solutions that helped their communities achieve their health goals.

Unleashing the Potential of Communities: MaMonis experience in Bangladesh| Ishtiaq Mannan |
MCHIP Bangladesh

The Government of Bangladesh is committed to engaging communities to enhance the reach and
effectiveness of the health system. The Ministry of Health & Family Welfare established and staffed
13,500 community clinics throughout the country - built on community donated lands, managed by
community representatives, with community support groups. From 2009-2013 the MaMoni project
developed and implemented a model of working with community support groups in Sylhet and Habiganj
districts, linking households to health systems. 13,000 community volunteers worked in 4,000 support
groups, going through repeated cycles of 'identify-plan-act-evaluate' focusing on maternal, newborn,
family planning and nutrition issues. Community volunteers had monthly community microplanning
meetings with MOH&FW health workers. Action plans were fed into public decision making channels.
Service utilization, inequity, and mortality improved significantly. Community SBAs performed 41% of
deliveries, CPR increased 7%. There is evidence maternal mortality fell significantly. Health systems
components like data quality in the health information system improved. CDAs mobilized significant
resources to build clinics and roads and facilitate referral care. Engaging communities unleashes their
potential to mobilize local resources to solve their own problems and improve health system bottlenecks.

Scaling-up Integrated Community Case Management with Integrated Social and Behavior Change
Communication in Rwanda | Melene Kabadege | World Relief Rwanda (CSHGP Grantee)

Kabeho Mwana (Life for a Child) was a USAID-funded Child Survival and Health Grants Program
project (2006-2011) supporting the Ministry of Health of Rwanda to scale-up integrated community case
management (iCCM) for children with malaria, diarrhea, and pneumonia in six of Rwanda's 30 districts,
covering 18% of the countrys population. The project supported implementation of Rwandas national
community health strategy and was a partnership of three international NGOs Concern Worldwide, the
International Rescue Committee and World Relief, along with MOH. More than 13,000 CHWs of
different cadres were active in regular home visits, health promotion, community mobilization, and data
collection. A subset of 6,100 CHWs engaged in iCCM. The project applied principles from the Care Group
model of volunteer organization, organizing CHWs into 660 peer support groups. Children appropriately
treated for fever within 24 hours increased from 20% to 43%; children with pneumonia appropriately
treated went from 0 to 54%. A re-analysis of Demographic and Health Survey data found that the under-
five mortality rate decreased more in districts supported by Kabeho Mwana (55%) compared to non-
project districts (49%). iCCM was scaled up nationally during project period. Rwanda is an example of
national commitment to community health, showing how CHWs can form the basis of integrated service
delivery at household and community levels, essential to ending preventable child and maternal deaths.

Questions and Answers | Nazo Kureshy | USAID Washington