Mallika Raghavan is Senior Government Engagement and Policy Officer (Health Investment & Policy) at Last Mile Health (New York, USA). She gives her views in an interview by Rachael Tembo.  

RT: Can you say a few words about the underlying project for this workshop?

MR: In March 2017, USAID, UNICEF & Bill and Melinda Gates Foundation came together to host the Institutionalizing Community Health Conference (ICHC) in Johannesburg, South Africa. At that time, over 25 different countries delegations came together to reaffirm their commitment to primary health care and to institutionalize community heath. From that conference, there was a lot of momentum and excitement generated, especially with the upcoming 40^th anniversary of Alma Ata this year.

Simultaneously, USAID in partnership with UNICEF has made direct investments with 7 specific partners alongside Ministries of Health in Bangladesh, Mali, Uganda, Haiti, Kenya, Liberia and DRC. The intent behind this investment was to bring together actors across the health system with governments leading alongside the partner organization, USAID and UNICEF to align towards targeted efforts to institutionalize community health.  While each country’s project is contextually diverse, there is a wealth of knowledge and learning being generated that is highly influential to leverage. 

Through this investment, Last Mile Health will be supporting capturing learning across the 7 country investment with a specific lens towards policy and advocacy efforts for the scale and institutionalization of frontline health work programs. This learning will be elevated to support in country governmental and global advocacy efforts around best practices and design in community health programming. 

RT: What is the role of Last Mile Health in the whole process?

MR: Last Mile Health (LMH) was fortunate to be a recipient of the Integrating Community Health award in Liberia in 2016. We had a lot of success in supporting the government to launch and scale the National Community Health Assistant Program (NCHAP). Building on our success alongside the Ministry of Health, we will now apply those broader policy and advocacy efforts towards a global effort with USAID and UNICEF, supported by the Bill & Melinda Gates Foundation called “Policy and Advocacy to Scale Frontline Delivery”. Over the course of the next three years, we will be working with the 7 ICH countries to collect, package and disseminate best practices, tools and processes around Integrating Community Health platform. This work will be disseminated to different audiences, including governments in respective countries as well as through other platforms for advocacy such as the   Primary Health Care Global Strategy Group (PHCGSG), Community Health-Community of Practice, Community Health Academy in support of WHO CHW guidelines and the CHW hub. We will also support global advocacy events where Primary Health Care and CHW Programming can be leveraged such as Alma Ata and the World Health Assembly.

These 7 ICH countries are all working together on a shared goal to support governments to institutionalise community health but the scope of their work is very context dependent, based on the priorities of each country. These investments are helping to strengthen those systems and support governments to think long term about the goals to strengthen those community health care systems in their countries.

RT: Why is it important to harmonise the performance metrics for the ICH partners?

MR: Harmonizing and defining strong performance metrics is critically important to ensure we are designing CHW programming that is not only measuring service delivery, but is focusing on how we implement services that are of high service delivery quality.  Having metrics to measure performance of community health programs and community health workers themselves is also essential to generate data which can be packaged in strategic ways to support and strengthen programs. We are grateful and excited by the work Population Council will be doing under this investment to move this process forward globally.

RT: Can you share some of the successes in advocacy work and policy changes in these 7 ICH countries?

MR: Sure, I think often the process and tactics of successful advocacy for community health systems is not adequately captured. We don’t have a lot of information on how these processes work. Design of CHW programs is a critical element, but it’s equally important to understand who are the key decision makers, how are they involved in institutionalization efforts, how are they empowered and equipped with the tools they need to reform?

Through this work, we are beginning to see a number of successes and best practices to share and disseminate. For example, in Liberia after the Ebola outbreak, Former President Madame Ellen Johnson Sirleaf was a true champion and advocate for the National Community Health Assistant Program. She had a vision to launch and scale up a government run community health worker program to ensure that every rural community more than 5 km from a health facility has a Community Health Assistant. In Mali as another example, we are learning about the role of civil society actors who serve as a critical advocacy network alongside and within the Ministry of Health. In Kenya, we have learned about de-centralized level ownership and management of community health programming. These are just a few snapshots of how advocacy is critical at all levels of a health system- from leadership at the Presidential level to grassroots efforts through Civil Society Organizations and community based actors.

RT: What are the next steps from this meeting?

MR: This convening in South Africa allowed the beginning of a valuable exchange of ideas and opportunities. Our team has been able to build strong relationships with the 7 country teams, including better understanding where particular policy and advocacy opportunities currently are, as well as potential bottlenecks within each country. We will be working in close partnership with each of the 7 ICH countries to better understand their goals and efforts around governance and management, supply chain, community engagement, civil society, health information. We will be supporting the packaging of different tools and processes and demonstrating what systems level thinking can look like.  We are grateful and excited for the opportunity to amplify the Integrating Community Health investment alongside Ministries of Health, USAID and UNICEF and look forward to collaborating with stakeholders to increase global advocacy around CHW programming and best practices in institutionalization.