Working with the community to tackle the challenges in access to health care and treatment has become a major focus for governments around the world. Many governments in sub-Saharan Africa are working to train selected community members in the skills required to diagnose, treat and, in serious cases, refer young children suffering from malaria, pneumonia and diarrhoea. This ensures essential health care for the most vulnerable right to their doorstep – bringing skills to the community, reducing the burden on overstretched health facilities and, most importantly of all, saving lives by saving time.
The community based primary health care delivery approach centres around the idea that the most common childhood killers can be readily diagnosed and treated by people within the community, including those with limited education and medical training.
Research has shown that integrated community case management (iCCM) - diagnosing and treating diarrhoea, pneumonia and malaria in children under five at community level, as well as identifying?and referring sick newborns - has the potential to decrease childhood mortality from these three diseases by 60 percent.
In a joint statement released in 2012 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) it is stated that appropriately trained community health workers, who are supported, supervised and provided with a continuous supply of medicines and equipment can identify and appropriately treat children with diarrhoea, pneumonia and malaria.
We have supported ministries of health in many countries, including Mozambique, Uganda, Nigeria, South Sudan and Zambia, to train and equip community health workers to diagnose and treat the three common childhood illnesses or refer sick newborns and severe cases to the nearest health facility. We have been building on this work to test and scale up innovations to address some of the key issues affecting community based health delivery. In South Sudan, we have integrated nutrition into our iCCM programmes, allowing community health workers to address undernutrition as well as common childhood illnesses. We have also expanded our iCCM work to Myanmar, which has the highest child mortality rate in Southeast Asia.
In addition to iCCM, we also work with communities to improve health-seeking behaviour and to change attitudes and perceptions through community dialogues, health clubs and behaviour change initiatives. These strategies have been found to be highly effective in motivating rural communities to identify and address common health challenges that they face on a daily basis.
We also work with communities to improve delivery and uptake of drugs, such as for seasonal malaria chemoprevention and mass drug administration for neglected tropical diseases. Despite these drugs being highly effective and affordable when administered, resistance and misconceptions from the community can often pose a challenge to achieving coverage. By sensitising community members to these strategies through dialogues, health clubs, and through outreach to religious leaders, town criers and mass media, we are able to reach the most vulnerable and remote populations more effectively.
This approach can only be effective and sustainable as part of a wider health systems strengthening approach, however. For this reason, implementing governments need to ensure appropriate policies are in place and that community based health workers are well-trained and equipped, supported by the formal health system and motivated in order to provide high quality care.