As part of shaping the learning agenda for Community Health (CH) in our CoP, in March 2018 we initiated discussion on defining and refining the community health framework. To stimulate a debate we shared with you a framework produced by UNICEF.
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The framework helped us to visualise different actors and facilitators in the canvas of CH. In the framework to the left there were the community networks, which included several supportive pillars like social networks and community groups, which often act as immediate support to the caretaker, followed by the legal, education and local governance within which a community functions. The frontline workers are the first line of linkage between the caretaker and the primary level of care and subsequently linked to the higher service delivery chain, which is represented in the right of the diagram. In order to have a functional community networks and health service delivery, several enabling policies were also needed, which was also listed in the framework.
We sought your opinion if there were any missing elements in the framework and which blocks and policies we need to prioritise to further explore in this year. Your feedback has helped us to revisit the framework and make it more comprehensive and based on the priority areas identified we will engage with you for continuous learning.
Refining the framework:
The framework can be adapted and be used beyond child survival, growth and development, as Community health is the foundation of a strong primary health care system. There are few suggestions for making it more comprehensive by encompassing both the community and service delivery networks:
Strengthening the Community / Social / family networks:
- Family needs to be added as the first support structure along with mother. This will enable to adapt the framework beyond child health.
- Emphasis needs to be provided for faith institutions and belief systems as part of social networks.
- Similarly community leadership structure and informal providers need to be recognized and brought under the framework.
The opinion is voiced by one of the expert- “Health workers should not be seen as the main organizer of social networks to create a community-based care environment for the benefit of the general population, marginalized groups and vulnerable people in particular” (sic). The members emphasised the need for self-determination and self-empowerment of the population in the choice and implementation of health care activities. The community health system should encompass the emergence of initiatives and innovations by the communities themselves for their health needs.
Strengthening the service delivery networks and enabling policies:
But at the same time one cannot ignore the service delivery chain where the community health worker (CHW) is the first contact point. Experts have mentioned that the CHW’s are the pillar for any community system and one needs to explore areas like the profile of CHW, level of education, the training needs, data collection and efficient reporting system, payment mechanisms and usage of new technologies.
- Coordination and supervision by the health managers needs to be emphasised in the system.
- In terms of enabling policies, one needs to explore food security, nutrition policies by exploring the gaps in the agricultural sector. But all policies can succeed if there is ‘enabling environment’ in which they are implemented.
With regard to circles in the framework, contributors note that priority should be given to local governance structures, social networks, community health workers and front-line interventions. New technologies, governance, payment mechanisms, social responsibility, quality of care, pharmaceuticals and civil society have been identified as key elements to support policies. One area that the members have emphasised in overall functioning the community health system is the role of the community, which is well aware of their roles and responsibilities. One now has to explore approaches that guarantees people’s support
The discussions on the conceptual framework of community health systems has thus made it possible to identify number of issues on which CoP members has agreed. Over the next one year we can further strengthen our understanding what will be key driver for community health – the community networks or the health service delivery or could there be a third possible way? Following thematic areas we have identified which we would focus this year and the other thematic area and new areas that will evolve we will carry forward for the subsequent year:
- Social network including family
- Role of local governance
- Interventions for CHWs
The idea of a collaborative south-south learning’s we will try to accomplish through country specific best practices, case- studies, blogs, discussion, webinar, a session in conference. But we would very much like to hear your suggestions how best you want to engage, so kindly send your feedback.