Table of Contents
Communities as the Cornerstone of Primary Health Care: Learning, Policy, and Practice
EDITORIALS
- Strength in Diversity: Integrating Community in Primary Health Care to Advance Universal Health Coverage
The supplement highlights a systems approach that recognizes the communities' roles and their interactions with other health system actors to accelerate outcomes and reflect the diversity of the community health ecosystem. Several cross-cutting priorities emerge from the articles, namely coverage, community health financing, policy change, institutionalization, resilience, accountability, community engagement, and whole-of-society efforts.
VIEWPOINTS
- The Untold Story of Community Mobilizers Re-engaging a Disengaged Community During the Endemic Era of India's Polio Eradication Program
Although India's polio eradication program began with a flourish in 1995, gradually, the community disengaged from the program as misinformation about the vaccine spread. Vaccination teams faced abuse and even physical aggression. What caused this break in communication? CORE Group Polio Project's mobilizers had to delve deep to uncover untold stories of why communities were disengaged from the government's polio eradication efforts.
ORIGINAL ARTICLES
- The Community Health Systems Reform Cycle: Strengthening the Integration of Community Health Worker Programs Through an Institutional Reform Perspective
Efforts to scale community health worker programs within primary health care systems in 7 countries illustrated that these efforts are best understood as a complex process of institutional reform. Successful scale up depends on a problem-driven political process; requires that models develop solutions that align with resources, capabilities, and commitments of key stakeholders; and emerges from iterative cycles of learning and improvement.
- Galvanizing Action on Primary Health Care: Analyzing Bottlenecks and Strategies to Strengthen Community Health Systems in West and Central Africa
In West and Central Africa, “leaving no one behind” requires strengthening community health systems by increasing health financing, improving supply chain system, and fostering community ownership and partnerships in all settings. Countries with high child mortality rates should improve service delivery through better integration. Galvanizing context-specific country actions is fundamental to improve primary health care services and move toward universal health coverage.
- Applying the Community Health Worker Coverage and Capacity Tool for Time-Use Modeling for Program Planning in Rwanda and Zanzibar
The C3 Tool supports community health worker (CHW) program planning by making tradeoffs apparent between human resources and the services to be provided at varying levels of population coverage. Governments in Rwanda and Zanzibar used the tool, respectively, to optimize CHW time allocation and to estimate how many CHWs were needed to meet universal health coverage goals.
- Community Health Worker Program Sustainability in Africa: Evidence From Costing, Financing, and Geospatial Analyses in Mali
Understanding specific program costs through efficiency analyses and geospatial targeting allows national stakeholders to make strategic, targeted investments, making the first steps toward sustainability. Costs required for community health worker programs can be reduced without sacrificing quality, and spending can be geographically targeted to optimize service use by rural populations. Results from Mali provide an example for other sub-Saharan African countries.
- Evaluating Vertical Malaria Community Health Worker Programs as Malaria Declines: Learning From Program Evaluations in Honduras and Lao PDR
Community case management by community health workers has substantially reduced malaria across the Greater Mekong Subregion and Central America. To sustain current and achieve further reductions in malaria, surveillance and delivery platforms must be redesigned to ensure their continued use by key populations.
- Measuring Knowledge of Community Health Workers at the Last Mile in Liberia: Feasibility and Results of Clinical Vignette Assessments
We integrated clinical vignettes into routine programmatic supervision to assess community health worker knowledge of integrated community case management in rural Liberia. Results included higher rates of correct diagnosis and lifesaving treatment for uncomplicated disease than for more severe cases, with accurate recognition of danger signs posing a challenge.
- Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
Encouraging local transport programs and transport infrastructure in poorly-resourced communities can help improve community access and strengthen engagement with health systems. Mobilizing community resources and leadership to implement a community-based transport scheme in rural Mozambique to support referrals to health facilities can help improve maternal and child health outcomes.
- Volunteer Community Health and Agriculture Workers Help Reduce Childhood Malnutrition in Tajikistan
Paired agricultural and health interventions led by volunteer community health workers and community agricultural workers through home visits, community events, and peer support groups proved successful in improving nutrition of children and may be applicable in other contexts.
METHODOLOGIES
- Using Human-Centered Design to Adapt Supply Chains and Digital Solutions for Community Health Volunteers in Nomadic Communities of Northern Kenya
Investing the time and effort to use human-centered design (HCD) approaches is beneficial to designing supply chains and digital solutions for complex sociocultural settings. HCD enables users to be engaged in cocreating solutions that address their challenges, are appropriate for their context and capacity, and build local ownership.
FIELD ACTION REPORTS
- Early Lessons From Launching an Innovative Community Health Household Model Across 3 Country Contexts
Community health worker programs can contribute substantively to health systems working to implement universal health coverage, but there is no one-size-fits-all model. Program leaders should anticipate needing to adapt their plans as local realities demand, but lessons learned in other contexts can provide guidance on how to best proceed.
- Learnings From a Pilot Study to Strengthen Primary Health Care Services: The Community-Clinic-Centered Health Service Model in Barishal District, Bangladesh
The community-clinic-centered health service model piloted in Bangladesh strengthened community and local government engagement, harmonized the work of different community health worker cadres, and improved client satisfaction. The approach has the potential to strengthen the delivery of close-to-community primary health care services and accelerate progress toward achieving universal health coverage.
COMMENTARIES
Community health workers play a critical role in providing both essential health services and pandemic response. Community health demonstrates a strong return on investment, but funding for this sector is limited and fragmented. Understanding the underlying costs of a community health system is crucial for both planning and policy; the data demonstrate a strong investment case.
Liberia's community health program went from concept to nationwide scale in 4 years due to the Liberian Government's vision and its partnership with implementing organizations and donors. The next community health policy will tackle the unfinished agenda related to quality, resilience, and sustainability. Liberia's experience offers valuable lessons for innovating, and institutionalizing a compensated, effective cadre of community health assistants.
The process of institutionalizing community health services in Kenya required strong leadership by the Ministry of Health, effective coordination and support of stakeholders, and alignment of community health with the political priorities at the national and decentralized government levels to facilitate adequate prioritization and financing of the community health strategy.