COMMUNITY SYSTEMS STRENGTHENING
Keynote address by
PROF MIRIAM K. WERE
ON THE OCCASION OF
THE AMREF HEALTH AFRICA
INTERNATIONAL CONFERENCE, 2014
NAIROBI, KENYA
24th – 26th NOVEMBER, 2014
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1. CENTRALITY OF COMMUNITIES IN THE WORK OF
AMREF HEALTH AFRICA
AMREF AFRICA’s 10 year strategy is entitled:
“PUTTING AFRICAN COMMUNITIES FIRST: ENHANCING
CAPACITY AND PARTICIPATION TO CLOSE THE GAP IN HEALTH
SYSTEMS.”
 The first point I want to make is to congratulate AMREF for
recognizing the importance of communities in health
promotion, prevention of disease and in health services
delivery since the 1970’s
 These congratulations are doubled by the increasing focus
on communities in the first three year business plan (2010 –
2014) and in the second one (March 2014 – Feb 2018)
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1.2 Vision
Healthy people
living good quality
lives in robust and
vibrant
communities that
make up healthy
and vibrant
Counties all over
the nation
resulting in a
healthy Nation
overall.
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1.3 Mission
To
promote
the
Community
health
approach
as
the
modality for social
transformation
for
development from the
community level by
establishing equitable,
effective and efficient
Community
Health
Services in Community
Health Units all over a
nation.
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2. WHY IS THE COMMUNITY APPROACH
SO IMPORTANT FOR AFRICA?
If it doesn’t happen in the community, it just doesn't happen!
If it happens in the communities it happens in the nation.
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Specifically the community approach is crucial
because:2.1 It brings health services closer to mothers
and children who are the most vulnerable
and who need them the most.
2.2
Communicable disease reduction from
community
based
action
e.g.
construction and use of latrines,
participation in immunisation and
community based first line care reduces
the disease burden
2.3 Better management & prevention of noncommunicable
diseases and
their
reduction takes place through Community
Dialogue Days that leads to internalization
of how non-communicable diseases can
be prevented through appropriate
lifestyles that get adopted by the
community which is much stronger than
individuals changing alone.
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2.4 Adoption of community norms
that promote health and prevent
disease occur from participation in
monthly Community Dialogue
Days/Events
and
quarterly
Community Action Days/Events.
2.5 Possibility is enhanced for
achieving
universal
health
coverage through establishment
of Community Health Services
since coverage with health
services at facilities alone is still
less than 50% in most of Africa.
2.6 Improved quality of care at health facilities-–especially for non
communicable/chronic diseases-- as decongestion occurs at health facilities
both in outpatient and inpatient services.
2.7 Containment & even reduction of financial cost to health sector from
reduced and reducing disease burden because of disease prevention and
health promotion through empowered communities as well as more
effective and efficient organisation of health services aided by
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3. COMMUNITY SYSTEMS STRENGTHENING
3.1 First crucial step in Community Health Systems Strengthening is
Formal recognition of the community level as part of the national
health system e.g.
1. Ethiopia’s Health Extension Program (HEP)
2. Ghana’s Community-Based Health Planning & Services (CHPS)
3. Kenya’s Community Health Strategy/Services (CHS)
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3.2
Deliberate commitment to Processes for peoples’
participation, involvement and Empowerment through: Establishing/Strengthening structures to facilitate this;
 Deliberate hope &confidence building process;
 Sharing in decision-making including what the people
see as their priority health problems
 Raising awareness on the social and physical
determinants of health that must also be addressed.
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3.3 Having clarity on the Key Steps In Establishing Community-level
Health Work:
1) Financing of Community Health Services;
2) Clarity on what constitutes a Community Health Unit;
3) Clarity on who provides Community Leadership & Governance
4) Clarity on mechanism of motivation and retention of the
Community Health workforce
5) Recruitment and Training of Community Health Workforce;
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6. The Community Entry Process &clarification of
interaction
between health workforce and the Community Health Unit;
7. Clarity on mechanisms for strengthening the Interface/Linkage
of the Community Level with Health Facilities;
8. Clarity on mechanisms for supportive supervision for
Community Based Health Services;
9. Monitoring and evaluation for Community Health Services:
10. Partnership in support of Community Health Services ;
11. Role
of
Multi-Sectoral
Approach
in
Advocacy
and
Communication;
12. High Impact Interventions for Community Health Services .
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3.4 The WHO Framework for the Community Health System
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4. COMPONENTS OF
COMMUNITY HEALTH SYSTEMS STRENGTHENING.
The six building blocks for health systems strengthening can be
applied to the community level as a means of gaining clarity in
what needs to be strengthened.
THE BUILDING BLOCK
EXAMPLES
1. Community level
Leadership/Governance
Community Health
Committees
2. Community Level Health  Ethiopia’s Health
Workforce
Extension Workers
(HEW)
 Ghana’s Community
Health Officer (CHO)
 Kenya’s Community
Health Assistant (CHA)
ISSUES TO BE ADDRESSED
IN STRENGTHENING
Specifics of: Roles & responsibilities
 Criteria for selection
 Training modules
 Roles and
responsibilities
 Basis for selection for
training
 Training curriculum
 Volunteers to work
with the health workers
& their training
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THE BUILDING BLOCK
EXAMPLES
3. a) Information
Community health
information tools
b) Research
4. Services to be
delivered
ISSUES TO BE
ADDRESSED IN
STRENGTHENING
 What information is to
be collected
 How to be collected
 How to be used
Determination of
workload for community
health personnel.
--Organisation of Health  What each of these
Education sessions
entails
 Treatment of malaria?
 Treatment of
pneumonia?
 Child birth? etc.
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THE BUILDING BLOCK
EXAMPLES
5. Community level medical Kenya’s CHA Medical Kits
products and
 Items for prevention
technologies
e.g. contraceptives
 Items for diagnostics e.g
Rapid Diagnostic Test
(RDT) for Malaria
 Items for treatment e.g.
antimalarial items
6. Community-Level Health
financing
ISSUES TO BE ADDRESSED
IN STRENGTHENING

 From the national
 The various expenditure
budget
items to which the
 From income generating
finances go at the
activities
community level
 From development
 Performance-Based
partners
Financing/payment of
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5. IN CONCLUSION

The more a country in Africa makes the community level the FOUNDATION of
the health system through successful implementation of Community Health
Service, the more progress is made towards a healthy population with positive
health indices.
 If it doesn’t happen in the communities it just doesn’t happen in the nation.
 If it happens in the communities it happens in the nation.
THANK YOU VERY MUCH FOR YOUR KIND ATTENTION
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