scholarly journals Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Molly E. Lauria ◽  
Kevin P. Fiori ◽  
Heidi E. Jones ◽  
Sesso Gbeleou ◽  
Komlan Kenkou ◽  
...  
Keyword(s):  
Public Sector ◽  
Health Service ◽  
Community Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Health Systems Strengthening ◽  
Implementation Study ◽  
Community Based ◽  
Under Five ◽  
Public Sector Health

Abstract Background Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities. Methods The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster. Discussion Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly. Trial registration ClinicalTrials.gov, NCT03694366, registered 3 October 2018

scholarly journals PERILAKU IBU YANG MEMILIKI BALITA DALAM PEMANFAATAN POSYANDU DI KAMPUNG SRI GADING KECAMATAN LUBUK DALAM KABUPATEN SIAK TAHUN 2018

2019 ◽  
Vol 2 (2) ◽  
pp. 50-56
Author(s):  
Andalia Roza ◽  
Multi Safri Atun ◽  
Lora Marlita
Keyword(s):  
Health Behavior ◽  
Community Health ◽  
Random Sampling ◽  
Sampling Technique ◽  
General Knowledge ◽  
Knowledge Level ◽  
Community Based ◽  
Children Under Five ◽  
Research Instrument ◽  
Under Five

ABSTRACT, Posyandu is one form of UKBM (Community Based Health Effort) is best known by the community. Health behavior is a response of a person (organism) to stimuli or objects related to Knowledge (Knowlegde), Attitude (attitude), and action. The purpose of this study is to find out the description of the behavior of mothers who have a toddler in the utilization of posyandu dikampung srigading Kecamatan Lubuk Dalam Siak regency. The type of this research is descriptive by using random sampling technique. The research instrument used questionnaire. Respondents of this research mother who has a toddler in Kampung Sri Gading Kecamatan Lubuk In Siak regency as many as 60 respondents. This study was conducted on June 10 to June 28, 2018. The results of this study in general knowledge level in mothers who have a toddler in the category Good as many as 59 people (98.34%), Enough as much as 1 person (1.67%) and Less as much 0 people (0%). The results of this study in general about attitudes in mothers who have toddlers can be categorized Positive as many as 51 people (85%), Negative as many as 9 people (15%). The results of this study in general about the action on mothers with toddlers can be categorized Good as many as 53 people (88.34%), Not Good as many as 7 people (11.67%). Based on the results of general research on knowledge of mothers who have a toddler in pemgunan posyandu in good category, that is as much as 59 people (98,34). About the attitude of mother who has toddler in posyandu utilization in positive category, that is 51 people (85%). About the actions of mothers who have children under five in the use of posyandu in good category, that is as many as 53 people (88.34%). It is expected that mothers with toddlers to improve the posyandu activities again. Keywords                   : Behavior, Utilization of Posyandu ABSTRAK, Posyandu merupakan salah satu bentuk UKBM (Upaya Kesehatan Bersumberdaya Masyarakat) yang paling dikenal oleh masyarakat.Perilaku kesehatan adalah suatu respon seseorang (organisme) terhadap stimulus atau objek yang berkaitan dengan Pengetahuan (knowlegde), Sikap (attitude), dan tindakan (practice).Tujuan penelitian ini adalah untuk mengetahui gambaran perilaku ibu yang memiliki balita dalam pemanfaatan posyandu dikampung srigading Kecamatan Lubuk Dalam Kabupaten Siak. Jenis penelitian ini adalah deskriptif dengan menggunakan teknik penelitianRandom Sampling. Instrumen penelitian menggunakan kuesioner. Responden penelitian ini Ibu yang memiliki balita di Kampung Sri Gading Kecamatan Lubuk Dalam Kabupaten Siak sebanyak 60 responden. Penelitian ini dilakukan pada tanggal 10 Juni – 28 Juni 2018. Hasil penelitian ini secara umum tingkat pengetahuan pada ibu yang memiliki balita dalam kategori Baik sebanyak 59 orang (98,34%), Cukup sebanyak 1 orang (1,67%) dan Kurang sebanyak 0 orang (0%).Hasil penelitian ini secara umum tentang sikap  pada ibu yang memiliki balita dapat dikategorikan Positif sebanyak 51 orang (85%), Negatif sebanyak 9 orang (15%). Hasil penelitian ini secara umum tentang tindakan  pada ibu yang memiliki balita dapat dikategorikan Baik sebanyak 53 orang (88,34%), Tidak Baik sebanyak 7 orang (11,67%). Berdasarkan hasil penelitian secara umum tentang pengetahuan pada ibu yang memiliki balita dalam pemanfaatn posyandu dalam kategori baik, yaitu sebanyak 59 orang (98,34). Tentang sikap ibu yang memiliki balita dalam pemanfaatan posyandu dalam kategori positif, yaitu sebanyak 51 orang (85%). Tentang tindakan pada ibu yang memiliki balita dalam pemanfaatan posyandu dalam kategori baik, yaitu sebanyak 53 orang (88,34%).Diharapkan kepada ibu yang memiliki balita untuk meningkatkan lagi kegiatan posyandu.  

scholarly journals Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all

2019 ◽  
Vol 3 (Suppl 3) ◽  
pp. e001384 ◽  
Author(s):  
Emma Sacks ◽  
Melanie Morrow ◽  
William T Story ◽  
Katharine D Shelley ◽  
D Shanklin ◽  
...  
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Health Sector ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Health It ◽  
The Sustainable Development ◽  
Health Goals ◽  
Effective Community ◽  
Community Roles

Achieving ambitious health goals—from the Every Woman Every Child strategy to the health targets of the sustainable development goals to the renewed promise of Alma-Ata of ‘health for all’—necessitates strong, functional and inclusive health systems. Improving and sustaining community health is integral to overall health systems strengthening efforts. However, while health systems and community health are conceptually and operationally related, the guidance informing health systems policymakers and financiers—particularly the well-known WHO ‘building blocks’ framework—only indirectly addresses the foundational elements necessary for effective community health. Although community-inclusive and community-led strategies may be more difficult, complex, and require more widespread resources than facility-based strategies, their exclusion from health systems frameworks leads to insufficient attention to elements that need ex-ante efforts and investments to set community health effectively within systems. This paper suggests an expansion of the WHO building blocks, starting with the recognition of the essential determinants of the production of health. It presents an expanded framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organising and mobilising social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognises societal partnerships as critical links to the public health sector. This framework makes explicit the oft-neglected investment needs for community health and aims to inform efforts to situate community health within national health systems and global guidance to achieve health for all.

scholarly journals Towards universal health coverage: what are the system requirements for effective large-scale community health worker programmes?

2019 ◽  
Vol 4 (Suppl 9) ◽  
pp. e001046 ◽  
Author(s):  
Uta Lehmann ◽  
Nana A Y Twum-Danso ◽  
Jennifer Nyoni
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Large Scale ◽  
Scale Up ◽  
Health Systems Strengthening ◽  
Local Context ◽  
Extensive Literature ◽  
Health Coverage ◽  
Universal Health

Against the background of efforts to strengthen health systems for universal health coverage and health equity, many African countries have been relying on lay members of the community, often referred to as community health workers (CHWs), to deliver primary healthcare services. Growing demand and great variability in definitions, roles, governance and funding of CHWs have prompted the need to revisit CHW programmes and provide guidance on the implementation of successful programmes at scale. Drawing on the synthesised evidence from two extensive literature reviews, this article determines foundational elements of functioning CHW programmes, focusing in particular on the systems requirements of large-scale programmes. It makes recommendations for the effective development of large-scale CHW programmes. The key foundational elements of successful CHW programmes identified are (1) embeddedness, connectivity and integration into the larger system of healthcare service delivery; (2) cadre differentiation and role clarity in order to maintain clear scopes of work and accountability; (3) sound programme design based on local contextual factors and effective people management; and (4) ongoing monitoring, learning and adapting based on accurate and timely local data in order to ensure optimal fit to local context since one size does not fit all. We conclude that CHWs are an investment in health systems strengthening and community resilience with enormous potential for contributing to universal health coverage and the sustainable development goals if well designed and managed. While the evidence base is uneven and mixed, it provides extensive insight and knowledge to strengthen, scale up and sustain CHW programmes throughout Africa.

scholarly journals Understanding the structure of a country’s health service providers for defence health engagement

2020 ◽  
pp. bmjmilitary-2020-001502
Author(s):  
Martin Bricknell ◽  
S Hinrichs-Krapels ◽  
S Ismail ◽  
R Sullivan
Keyword(s):  
Health Service ◽  
Health Systems ◽  
Service Providers ◽  
Building Blocks ◽  
Crisis Response ◽  
Health Systems Strengthening ◽  
Health Providers ◽  
Healthcare Provision ◽  
Holistic View ◽  
Health Service Providers

There are a variety of structural and systems frameworks for describing the building blocks of country’s public health and health systems. In this paper, we propose a conceptual framework for a holistic view of a country’s health service providers in order to inform the plan for Defence Health Engagement activities with partner countries. This includes all potential government ministries involved in healthcare provision, the independent, private sector and the non-government organisation/charity sector. The framework provides a visualisation to support the analysis of a country’s health services providers. We propose that recognising and analysing the different contributions of all these national health providers is essential for understanding the wider political economy of a nation’s health systems. This can inform a plan of Defence Health Engagement for capacity building in crisis response, development and health systems strengthening.

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