Helping communities to manage disaster risk

This chapter describes how to manage disaster risk and how community-level action is essential when organizing any emergency response action. It outlines the types of hazards that communities face, how they can be reduced and how we can increase the effectiveness and resilience of community health programmes (CHPs) to meet those hazards. It explains how we can train a disaster response team (DRT) and use them and community health workers (CHWs) both to deliver and to help to implement disaster safety messages. It describes in some detail both the types of disaster and ways in which the community can respond and work with others, including government and external providers.

Setting up a family planning and reproductive health programme

This chapter explains the importance of family planning and child spacing from a variety of perspectives. It outlines the difficulty of access to family planning for large numbers of people, and the barriers that exist for its widespread uptake. It describes in some detail the range of contraceptives and their different uses. It describes ways in which supplies can be sold, distributed, and managed at community level. It describes the roles of the family planning provider and community health worker (CHW) and emphasizes the importance of reliable and accessible supplies. The chapter also gives information on sexually transmitted infections (STIs), their causes and types, and how they can best be controlled and treated.

Health teaching and behavioural change

This chapter discusses health information and raising health awareness. It explains how these feed into behavioural change, both in individuals and in communities, as a key to improving health. It describes ways in which behavioural change can be brought about, starting with transformation in our own attitudes. It outlines materials, equipment, and preparations needed to teach and to improve heath at community level. It describes methods of raising health awareness, such as group discussions, personal teaching at the point of need, flashcards, flipcharts, flannel boards, stories and songs, roleplay, drama, puppets, live examples, still images (slides and digital photographs), moving images (video, DVD, and films), CD-ROMs and the Internet, radio, and TV. It finishes with a section on how to measure the impact of health teaching.

Initial tasks

This chapter explores how the community and the health programme can work together in selecting and training appropriate health team members at different levels of expertise. It identifies situations that require caution and understanding, and describes the project cycle. It outlines how to set up a project base, house staff, and identify security needs. It describes options for transport, how transport may be perceived by the local community, and includes questions that should be asked when considering buying a vehicle. It describes methods for ordering supplies, equipment vital to the project, and medicines that should be considered. Finally, it gives a range of ideas on how to fund a project, both from internal and external sources, and provides examples of each.

Working as partners with the community

This chapter explains how to make first contacts with the community. It describes partnership as the basis of all programme stages and explores factors that obstruct partnership. It covers the importance of the facilitator’s role, and discusses various aspects of being a facilitator. It gives a step-by-step approach towards partnering with a community, choosing a project to work on, setting up community meetings. The chapter highlights strategies to avoid pitfalls, and gives examples of working models. It discusses the value of village health committees (VHCs), women’s groups, children’s clubs, and clusters. Finally, it discusses the importance of involving the community as early on as possible, and provides some tips on how to engage community members.

Community-level responses to domestic violence and abuse

This chapter explains the nature and cause of domestic abuse and sexual violence including female genital mutilation/cutting (FGM/C) and summarizes the latest research. It describes ways of engaging men and other perpetrators. The chapter debunks common myths around the topic and gives examples of specific situations. It discusses how to raise awareness at community level to prevent domestic abuse and the principle of ‘do no harm’. The chapter outlines practical steps to implement community-level responses to violence and abuse. It teaches how community members can be informed and aware of local services, some legal backgrounds, and ways of responding appropriately to victims and survivors. It describes ways to pursue justice and reconciliation, including holding to account those in authority, including people of influence, e.g. faith leaders. The chapter elaborates on dealing with specific forms of abuse.

Non-communicable and chronic diseases

This chapter on non-communicable diseases (NCDs) explains how they are now the leading cause of death worldwide, and how their prevention, control, and treatment need to be built into our community health programme. It gives information about physical activity, alcohol moderation, tobacco cessation, and healthy eating, and for each topic uses WHO guidelines as the basis for the advice. The chapter suggests how to raise awareness in the community and ways to integrate the community response with existing services and government health programmes. It details five components for an effective NCD response at the community level—screening, promoting healthy behaviours, advocacy, disease-specific treatments, and interventions. It finishes with ways to monitor and evaluate the programme.

Setting up a community tuberculosis (TB) programme

This chapter describes the recent status, impact, and control of tuberculosis (TB) worldwide through the End TB strategy. It gives examples of how government and civil society programmes can work together, with the roles and tasks of each clearly defined. It gives examples of the many barriers to treatment. The chapter describes current methods of case finding and case holding, existing and new diagnostics, and the treatment of adults and children. It explains the categories for recording cases and of treatment outcomes. It outlines the community and clinic background to managing cases of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, and of co-infection with HIV. It describes the ongoing value of the DOTS strategy (Directly Observed Treatment-short course) and the limited value of the current BCG vaccine. The chapter emphasizes ways to reduce infection such as strict control on tobacco and reducing household smoke.

Drawing up plans

This chapter describes how to draw up a community plan and how to use planning tools within the community, for example, problem trees, a SWOT analysis, and SMART objectives. It describes how to write and use a logical framework (logframe) and provides examples. It covers the importance of establishing village health committees and community action groups, and how using these can assist with engaging the target communities, It also discusses other alternatives to assist in writing proposals, for example, using findings from the participatory appraisal (PA) or a community survey, but also as working programme tools. Finally, it gives practical examples.

Community health as part of the health system

This chapter elaborates on co-operating with others in community health, particularly working with government, aid, and funding organizations. It explores what government is and whether government or the NGO carries out health care more effectively. It discusses how the government and civil society organizations (NGOs and others) can work together for everyone’s benefit. It provides practical guidelines for those working with or for governments, and suggests resources that are available from government health services. It troubleshoots problems faced by agencies, and goes into detail about collaboration between voluntary agencies, the private sector, doctors, traditional health practitioners (THPs), and hospitals. It includes guidelines for working with THPs in the community setting.