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Geneva, Switzerland, World Health Organization [WHO], 2018. 116 p.The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities. The development of this guideline followed the standardized WHO approach. This entailed a critical analysis of the available evidence, including 16 systematic reviews of the evidence, a stakeholder perception survey to assess feasibility and acceptability of the policy options under consideration, and the deliberations of a Guideline Development Group which comprised representation from policy makers and planners from Member States, experts, labour unions, professional associations and CHWs. Critical to the success of these efforts will be ensuring appropriate labour conditions and opportunities for professional development, as well as creating a health ecosystem in which workers at different levels collaborate to meet health needs. Adapted to context, the guideline is a tool that supports optimizing health policies and systems to achieve significant gains to meet the ambition of universal access to primary health care services.
New York, New York, UNICEF, Program Division, Health Section, Knowledge Management and Implementation Research Unit, 2014 Jul.  p. (Maternal, Newborn and Child Health Working Paper)In addition to a comprehensive literature review, the study used a cross-sectional survey with close- and open-ended questions administered to UNICEF Country Offices and public sector key informants to investigate and map CHW characteristics and activities throughout the region. Responses were received from 20 of the 21 UNICEF Country Offices in the UNICEF East and Southern Africa region in May-June 20013. Data on 37 cadres from across the 20 countries made up of nearly 266,000 CHWs form the basis of this report. This report catalogues the types and characteristics of CHWs, their relationship to the broader health system, the health services they provide and geographic coverage of their work.
Entre Nous. 2009; (68):6-7.The WHO Regional Office for Europe has been promoting family and community health (FCH) interventions since 1992, including biennial meetings for FCH focal points in Member States. Our FCH activities follow a holistic approach, focusing on the health and development of individuals and families across the life course. For sexual and reproductive health (SRH) this means focusing on overall SRH, health of mothers and newborns, children and adolescents, as well as healthy aging. In recent years, the contribution of health systems to improve health has been re-evaluated in many countries. The WHO European Ministerial Conference on Health Systems “Health Systems, Health and Wealth” in Tallinn, June 2008 has discussed the impact of people’s health and economic growth, and has taken stock of recent evidence on effective strategies to improve the performance of health systems. In line with these developments, the WHO Regional Office for Europe held the FCH focal points meeting in Malta, September 2008 with the aim of contributing to the improvement of FCH in a health systems framework.
New York, New York, United Nations Population Fund, HIV/AIDS Branch, . 8 p. (Guidance Brief)This Brief has been developed by the Inter-Agency Task Team (IATT) on HIV and Young People1 to assist United Nations Country Teams (UNCT) and UN Theme Groups on HIV/AIDS in providing guidance to their staffs, governments, development partners, civil society and other implementing partners on community HIV interventions for young people. It is part of a series of seven global Guidance Briefs that focus on HIV prevention, treatment, care and support interventions for young people that can be delivered through different settings and for a range of target groups.
Lancet. 2008 Sep 13; 372(9642):962-71.Primary health care was ratified as the health policy of WHO member states in 1978.(1) Participation in health care was a key principle in the Alma-Ata Declaration. In developing countries, antenatal, delivery, and postnatal experiences for women usually take place in communities rather than health facilities. Strategies to improve maternal and child health should therefore involve the community as a complement to any facility-based component. The fourth article of the Declaration stated that, "people have the right and duty to participate individually and collectively in the planning and implementation of their health care", and the seventh article stated that primary health care "requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care". But is community participation an essential prerequisite for better health outcomes or simply a useful but non-essential companion to the delivery of treatments and preventive health education? Might it be essential only as a transitional strategy: crucial for the poorest and most deprived populations but largely irrelevant once health care systems are established? Or is the failure to incorporate community participation into large-scale primary health care programmes a major reason for why we are failing to achieve Millennium Development Goals (MDGs) 4 and 5 for reduction of maternal and child mortality?
London, United Kingdom, ACF International Network, . 80 p. (Hunger Watch Publication)This report documents the findings of Local Voices, a six month qualitative research project that provided HIV orphans, vulnerable children and their carers with the opportunity to discuss and document the difficulties they face providing food, water and healthcare for their families. Through meetings, detailed interviews and discussions the project initiated and developed an ongoing dialogue with 20 families in four areas of the Kitwe district in the Copperbelt province of Zambia: Chimwemwe, Kwacha, Chipata and Zamtan. The discourse that developed over the course of the project has given Action Against Hunger (ACF-UK) and CINDI insight in two key areas. Firstly, the research has added a household perspective to existing ideas and analysis of food security in an HIV/AIDS context. Secondly, the project highlights the knowledge and learning that can be gained when people living with a positive HIV diagnosis are seen as 'experts' and their experiences are used to help identify and address the problems they face. Through the voices of the project's participants, the testimonies and images that are the core of this document explore the social and economic impact HIV/AIDS has on families affected by the disease. ACF-UK and CINDI pioneered this work because we believe HIV/AIDS can no longer be seen as just a medical issue. Within this report we demonstrate that HIV/AIDS has a direct impact on the economic and social well-being of both households and communities; and as such it must be tackled using an integrated approach where food, livelihoods and social protection are highlighted as solutions alongside access to medical care. This report opens with statistics that outline current rates of HIV/AIDS and poverty in Zambia, focusing specifically on the Copperbelt province and the Kitwe district. The testimonies that form the centrepiece of this report are introduced by a summary of the key social and economic issues that HIV orphans, vulnerable children and their carers face, together with a synopsis of government and community based organisation (CBO) responses. These topics have been selected as they cover the core issues that were raised during the Local Voices project. The document ends with a brief conclusion and the report recommendations.
New York, New York, UNICEF, 2008 May. 54 p.Every year, the United Nations Children's Fund (UNICEF) publishes The State of the World's Children, the most comprehensive and authoritative report on the world's youngest citizens. The State of the World's Children 2008, published in January 2008, examines the global realities of maternal and child survival and the prospects for meeting the health-related Millennium Development Goals (MDGs) - the targets set by the world community in 2000 for eradicating poverty, reducing child and maternal mortality, combating disease, ensuring environmental sustainability and providing access to affordable medicines in developing countries. This year, UNICEF is also publishing the inaugural edition of The State of Africa's Children. This volume and other forthcoming regional editions complement The State of the World's Children 2008, sharpening from a worldwide to a regional perspective the global report's focus on trends in child survival and health, and outlining possible solutions - by means of programmes, policies and partnerships - to accelerate progress in meeting the Millennium Development Goals. (excerpt)
Decentralising HIV M&E in Africa. Country experiences and implementation options in building and sustaining sub-national HIV M&E systems, in the context of local government reforms and decentralised HIV responses.
Washington, D.C., World Bank, Global HIV / AIDS Program, 2007 Aug. 10 p. (HIV / AIDS M&E -- Getting Results)In operationalising the 3rd of the Three Ones - One HIV M&E system, a growing number of countries in Africa are opting to decentralise their national HIV monitoring and evaluation (M&E) systems. This decentralization is primarily driven by other decentralisation processes happening within government, and by the fact that the HIV response itself is changing towards less centralized intervention and increased community ownership. Decentralisation of national HIV M&E systems is an arduous and resource intensive process, but experience has shown that it is essential to decentralise M&E functions as HIV services are rolled out. This note summarizes the experience of countries that are decentralizing their national HIV M&E systems and describes how it can be done. It defines decentralization, discusses the rationale and benefits of decentralizing the HIV response, and key factors to take into account when doing so. Decentralizing the HIV M&E system is linked to decentralizing the HIV response. The note describes how each of the 12 components of a HIV M&E system can be decentralized, with country examples. (author's)
Community-based management of severe acute malnutrition. A joint statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund.
Geneva, Switzerland, WHO, 2007 May. 7 p.Severe acute malnutrition remains a major killer of children under five years of age. Until recently, treatment has been restricted to facility-based approaches, greatly limiting its coverage and impact. New evidence suggests, however, that large numbers of children with severe acute malnutrition can be treated in their communities without being admitted to a health facility or a therapeutic feeding centre. The community-based approach involves timely detection of severe acute malnutrition in the community and provision of treatment for those without medical complications with ready-to-use therapeutic foods or other nutrient-dense foods at home. If properly combined with a facility-based approach for those malnourished children with medical complications and implemented on a large scale, community-based management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children. (excerpt)
Journal of Health, Population and Nutrition. 2006 Dec; 24(4):377-379.A new target-universal access to reproductive health by 2015-was endorsed in October 2006 under Millennium Development Goal 5 (MDG 5) to improve maternal health. And while the international reproductive health community could finally celebrate this official recognition of reproductive health on "centre stage of international efforts to defeat poverty and preventable illness" (1), the field reality is far from the target. What does it take to improve sexual and reproductive healthcare practices, including self-care practices at the home and use of services? Generated by a call for papers on these topics, this issue of the Journal contains selected papers describing current practices, examining specific barriers to improved practices, and providing results of interventions aimed at improving self-care practices or use of services. Most practices described relate to improving maternal and newborn* health or care; only two articles provide information on practices in other sexual and reproductive health areas-one on male sexuality and another on women with HIV/AIDS. No papers were received concerning care-seeking for family planning, menstrual regulation, or abortion care-a red flag perhaps signaling the marginalization of these topics in the current day. (excerpt)
Journal of Nutrition. 2007 Feb; 137(2):484-487.The Baby-Friendly Hospital Initiative (BFHI) is the translational tool developed by WHO and UNICEF to promote breastfeeding (BF) in maternity wards worldwide. BFHI was officially launched in the 1980s based on a ''common sense'' approach. Since then, research conducted in Latin America has shown that BFHI is highly cost-effective. BF trends over the past 2 decades strongly suggest that BFHI has had a global impact on BF outcomes. The 10th step of BFHI related to community-based BF promotion is one of the most challenging ones to address. Randomized controlled trials conducted in the Americas, Asia, and sub-Saharan Africa indicate that peer counseling is a very efficacious tool for increasing EBF rates. Low-cost rapid-response monitoring systems are needed to monitor the proper implementation and administration of BFHI steps following an evidence-based approach. This approach is essential for reenergizing the BFHI worldwide. (author's)
A healthy partnership -- a case study of the MOH contract to KHANA for disbursement of World Bank funds for HIV / AIDS in Cambodia.
[Brighton, England], International HIV / AIDS Alliance, 2005 Mar. 12 p.In 1998, the Cambodian Ministry of Health was experiencing difficulties in disbursing World Bank funds earmarked for local NGOs/CBOs, and in 1999, contracted Khana to manage the disbursement process. Given the scarcity of documented successful government-NGO/CBO disbursement initiatives, the Alliance commissioned a case study of this mechanism of making World Bank funds more accessible to civil society organisations. This report of the case study outlines the background and context to adopting the disbursement mechanism, explains the selection of the disbursing agency and the process of contract negotiation, details the nature and quantity of the disbursement, and identifies the strengths, weaknesses and lessons learned from this model. (excerpt)
Adolescence Education Newsletter. 2004 Dec; 7(2):19-20.For three years (2001-2003), the approach was pilot-tested in two sites (Kamasakit, Dallah Township and Sarmalauk, Nyaungdone Township), giving rise to a number of communityoperated youth centres. The lessons from these pilot tests were described in a new publication by the UNFPA Country Technical Services Team in Bangkok: The crucial support of community leaders was key to the community-based approach. Advocacy was carried out in the initial stage of implementation with activities targeting both national and local leaders and influencers. Activities were implemented regularly in the form of meetings, orientation and training sessions, participatory training workshops and site visits from high-level officials. (excerpt)
UN Chronicle. 2005 Dec;  p..Afghan women have one of the world's highest maternal mortality rates. They face many obstacles when it comes to accessing health care: most are rural and do not live close to or cannot access medical facilities, if the need arises. The few existing facilities do not necessarily specialize in obstetric and gynaecological care and cannot always offer quality care. Many Afghan families do not recognize signs of complication during pregnancy and delivery, and may not seek medical attention soon enough to save the lives of mothers and babies. Also ongoing insecurity and cultural norms in the country often keep women from leaving the house to seek urgently needed medical care. Because of cultural pressures, families are reluctant to present women to male doctors, and few female doctors are trained to meet the overwhelming medical needs of women; these conditions constitute a death sentence for thousands of women each year. It is estimated that about 25 per cent of Afghan children die before their fifth birthday from mostly preventable illnesses. The World Health Organization reports that children in Afghanistan are particularly at risk of dying from diarrhoeal diseases that, according to surveys, result in 20 to 40 per cent of all deaths of children under five--an estimated 85,000 children per year. Diarrhoea is also a significant cause of malnutrition, which is a major contributing factor in children's death from other diseases. (excerpt)
Geneva, Switzerland, UNAIDS, 1997 Apr.  p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)UNAIDS understands a "mobilized community" to have most or all of the following characteristics: members are aware -- in a detailed and realistic way -- of their individual and collective vulnerability to HIV/AIDS; members are motivated to do something about this vulnerability; members have practical knowledge of the different options they can take to reduce their vulnerability; members take action within their capability, applying their own strengths and investing their own resources -- including money, labour, materials or whatever else they have to contribute; members participate in decision-making on what actions to take, evaluate the results, and take responsibility for both success and failure; the community seeks outside assistance and cooperation when needed. (excerpt)
Evaluation of a community level nutrition information system for action in a rural community of Zaria, northern Nigeria.
Annals of African Medicine. 2004; 3(3):120-125.The aim was to improve evidence-based action at the community level, UNICEF developed a nutrition information management strategy called Community Level Nutrition Information System for Action (COLNISA). It uses a participatory cycle of assessment, analysis and action to solve nutritional and health related problems. Structured questionnaires were administered to mothers with children under the age of five in 67 households before intervention and 24 months later. Showed statistically significant changes in maternal literacy [7(10%) vs. 24(36%)] and engagement in income generating activities [17(26%) vs. 54(81%)]. Similarly, the proportion of mothers attending antenatal care during pregnancy increased almost six-fold [7(10%) vs. 40(59%)]. Significant improvements were also observed in mothers' knowledge of exclusive breastfeeding [21(32%) vs. 62(93%)], practices of complementary feeding [11(16%) vs. 39(58%)] and oral rehydration therapy [16(24%) vs. 47(70%)]. Furthermore, there were significant increases in the proportion of under fives that were growth monitored [4(5%) vs. 46(83%)] and fully immunized [7(10%) vs. 22(33%)]. Conversely, there was a reduction in the proportion of stunted, wasted and underweight children [51(77%), 11(17%) and 41(61%)] vs. [50(75%), 8(12%) and 33(49%)]. The changes in nutritional indices were however, not statistically significant. This study shows that the COLNISA strategy has a positive impact on basic social, health and nutritional indices and engenders community participation. A controlled trial is however advocated before its wholesale application. (author's)
Adolescence Education Newsletter. 2004 Jun; 7(1):18-19.The Adolescent Reproductive Health Toolkit will soon assist local service providers and health educators in putting up youth-friendly service centres in Viet Nam. This pioneering project hopes to cater to the 24 million Vietnamese youth facing serious problems on reproductive health and population education, but lack access to appropriate information and youth-friendly services. Since February 2004, RHIYA in Viet Nam has already implemented innovative initiatives such as street theatres and "condom cafés" to increase the effectiveness of behaviour change communication (BCC) among adolescents and youth. Now on its second phase, the newly established RHIYA Viet Nam is actively working on the completion of the ARH Toolkit, which will be a "how-to" guide for local institutions or organizations that want to establish youth-friendly service centres in the community. Specifically, the Toolkit will outline principles on how to establish, manage, market and monitor programmes that provide youth-friendly reproductive health information, education and counselling, and support clinical services for adolescents and youths in both urban and rural areas of Viet Nam. (excerpt)
UN Chronicle. 1989 Sep; 26(3): p..Pedro never wanted to be a shoeshine boy. He dreamt of becoming a doctor, but his family did not have enough money to feed him, let alone educate him. He left school at the age of eight to work on the street and soon ended up living there. Now 12, Pedro shines shoes in the daytime and sleeps in a park with other street kids at night. He does not think about becoming a doctor anymore; he concentrates on survival. Pedro is not alone. Although no firm statistics are available, the 1989 UNICEF annual report estimates that as many as 100 million children live on the streets of the world's big cities. Their number has risen dramatically in the past decade, as the world recession, the debt crisis, and civil strife in Latin America, Africa and Asia, pushed many rural families into already crowded urban slums throughout the third world. (excerpt)
Chinese Primary Health Care. 2000; 14(9):11-14.To set up the research priorities for the broader reproductive health programmes, the World Health Organization (WHO) has given a high priority to planning and programming for reproductive health, which aims at improvement of the delivery of reproductive health services. In 1998, with a financing support by Ford Foundation, the Foreign Loan Office of the China Ministry of Health (MoH) initiated a program in poor rural areas of China entitled reproductive health improvement project (RHIP) in 4 of the 71 World Bank/MoH of China "Health VIII Project" Counties. This paper reports the approaches and entry points of RHIP: (1) Participatory planning; (2) Operations research; and (3) Listening to women's voice at the rural communities. It is expected that these approaches and entry points will be useful for improvement of reproductive health services in other rural areas of China. (author's)
Strategy to involve rural workers in the fight against HIV / AIDS through community mobilisation programs. Draft for review.
[Unpublished] 2000 May 1. 58 p.The Rural HIV/AIDS Initiatives (RAIDS) is a contribution of the rural sector to the Bank’s multisectoral effort designated as AIDS Campaign Team (ACT- Africa) launched in 1999. Starting in 1998, RAIDS attempted to involve rural communities in HIV/AIDS prevention and mitigation through rural frontline workers especially extension workers and/or local RAIDS consultants in Benin, Burkina Faso, Cameroon, Chad, Cote d’Ivoire, Guinea, Malawi, Niger and Nigeria. RAIDS commissioned a team of consultants from the Royal Tropical Institute (KIT) and Tanzania Netherlands Support for AIDS (TANESA) to review rural AIDS activities in SSA and to develop a framework of strategies to involve rural workers and rural communities in HIV/AIDS prevention and mitigation efforts. This report is the outcome of their work, and is based on literature review, field visits and KIT/TANESA’s experience on district level approach to HIV/AID prevention and mitigation in Africa. (excerpt)
Reaching communities for child health and nutrition: a proposed implementation framework for HH/C IMCI.
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 2001.  p. (USAID Contract No. HRN-C-00-99-00007-00; USAID Contract No. FAO-A-00-98-00030-00)The Household and Community component of IMCI (Integrated Management of Childhood Illness) was officially launched as an essential component of the IMCI strategy at the First IMCI Global Review and Coordination Meeting in September 1997. Participants recognized that improving the quality of care at health facilities would not by itself be effective in realizing significant reductions in childhood mortality and morbidity because numerous caretakers do not seek care at facilities. Since that first meeting, several efforts were undertaken to strengthen interagency collaboration for promoting and implementing community approaches to child health and nutrition. (excerpt)
Indian Journal of Community Medicine. 2002 Jul-Sep; 27(3): p..Health systems have undergone overlapping generations of reforms in the past 100 years, including the founding of national health care systems and extension of social insurance schemes. Subsequently to realize the goal of "Health for all" the system of primary health care was adopted the world over. The system of primary health care paid too little attention to the people's demand for health care and it concentrated exclusively on the perceived needs. In the past decade or so there has been gradual shift of vision towards what WHO calls the "New Universalism" high quality delivery of essential care, defined mostly by criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor. (excerpt)
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], Regional Task Force on Drug Use and HIV Vulnerability, .  p.In 1997 the Task Force on Drug Use and HIV Vulnerability commenced its operation in Bangkok. It immediately identified the lack of information concerning HIV/AIDS among drug users in the Asia region across three broad thematic areas: insufficient epidemiological data; limited knowledge within the region on policies related to drug use and HIV/AIDS; and, inadequate documentation and dissemination of good interventions. Subsequent to these observations, UN organisations and their partners have undertaken much work in order to fill this vacuum. The Asian Harm Reduction Network, along with other partners, has published two editions of the “Hidden Epidemic”, that provides details on the status of the HIV/AIDS epidemics among drug users in the countries of the region. In October 2000, the Task Force itself published the report “Drug Use and HIV Vulnerability: Policy Research Study in Asia”. These two publications have concisely addressed the issues of epidemiology and policy. This current publication “Preventing HIV/AIDS Among Drug Users: Case Studies from Asia”, addresses the third important area, the dissemination of good practices on HIV/AIDS prevention and care interventions among drug users. Emphasis is laid on addressing the practical aspects of how to do it. Each of the studies has been arranged in a format to promote the reader’s further consideration of the issues such that they might be replicated and adapted to their own particular context and needs. The case studies describe a variety of interventions, focusing on HIV/AIDS vulnerability and demand reduction, outreach interventions (including the provision of clean needles and syringes), condoms and counseling, institutional treatment, care and support, substitution therapy and advocacy. They also reflect a recurrent strategic theme that single isolated interventions are unlikely to be effective unless they are integrated within a comprehensive approach. While we are familiar with all the elements of a comprehensive approach and, as the case studies indicate, there is indeed practical experience on how to best proceed, the challenge remains as to how to scale up such interventions to a level commensurate with the scale of HIV/AIDS epidemics among drug users. (excerpt)
Listening to those working with communities in Africa, Asia, and Latin America to achieve the UN goals for water and sanitation.
Geneva, Switzerland, WSSCC, . 80 p.The traditional top-down methods for providing water and sanitation services in poor communities of the developing world have not been successful in reaching out to all. Despite decades of effort and billions of dollars, 1 billion people still lack safe water and almost 2.5 billion lack safe sanitation. The time has therefore come to re-orient national and international efforts in support of a different approach. ‘LISTENING’ is about that new approach. It is an approach which has learnt from the failures of the past and begun to achieve well-documented successes of its own. But it is an approach that is not yet universally accepted because of the many vested interests that stand in its way. In brief, decentralisation and empowerment of people and communities to enable them to take more control of their own lives and to support them in achieving their own development goals must be the method and the aim. But this does not mean that the responsibility to mobilise additional resources for the poor, and to create an enabling environment within which they can move forward, should be abandoned. In fact the responsibility for initiating and supporting community-led approaches means an even greater and more demanding role for government. ‘LISTENING’ attempts to bring these lessons – through the voices of many of those who have been most closely involved – to a wider international audience. (excerpt)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2002. 28 p. (WHO/FCH/CAH/02.23)Although the past 15 years have seen a decline in child mortality due to pneumonia, it remains a very important cause of death in developing countries. In Africa in particular, pneumonia and malaria are by far the most important causes of death for children under 5. The overall aim of this meeting was to help to define practical community approaches which could deliver a rapid reduction in this preventable mortality. WHO has developed and supported the use of case management of pneumonia through the ARI Programme and later as a part of IMCI. The main focus for these initiatives has been the health facility, although much of the demonstration of the efficacy of the clinical interventions was carried out at community level, using community health workers. IMCI uses the same clinical methodology. Although IMCI stresses the promotion of care-seeking by families with sick children, in general, the clinical management of such children is offered at the first level health facility. The importance of providing care without delay for children with malaria has led to the development and introduction, so far on a small scale, of interventions based in the community, either through a community health worker or directly by families, who are provided with packs of antimalarials. These two diseases in childhood, pneumonia and malaria, have major overlaps in terms of clinical presentation, the requirements for their effective management and the feasibility of providing standardised care in the community. Technically sound and operationally manageable community interventions that tackled both conditions would offer a most valuable tool for use in the reduction in child mortality in developing countries. (excerpt)