OCCD is implementing the main component of BPHS which is responsible for building the capacity of community health workers through the existing health post (HP) and health facilities health Shuras, HP Shuras and Family Health Action groups. OCCD emphasizes on improving the CBHC system. OCCD improved the four functions of CBHC in the province and focused on:
- Providing community case management of priority and common health problems
- Referring serious and emergency conditions to the health facilities;
- Promoting the appropriate use of preventive and curative service at the health facility and community level
- Promoting behavior changes and healthy lifestyles in household and the community.
- Through the CBHC, OCCD leads the following activities:
- Conducting CHW refresher and initial trainings
- Expanding health coverage through establishing new HPs and FHs Shuras
- Structuring and re- structure Community Health Shuras
- Establishing and training Femalely Health Action Group
- Strengthening referral system
CHW Refresher and initial Training: To maintain and improve CBHC performance, a total 202 new CHWs will be trained during the life of project. During the first two years of the project (2015/2016) OCCD enabled to train 132 CHWs (Male and Female) As well as refresher training, conducted for all CHWs (1200) as it is planned in project annual plans.We provided at least a three-day refresher training twice yearly for the all CHWs. The training plan made after a TNA at the beginning of each year. We considered the job description of CHWs, the gap of knowledge and skills in their performance, health need of the community and feedback from supervisory visits, to prepare the training plan. These training sessions conducted in the HFs and we emphasized on improving the skill through practical work by participants. This will provide the chance for CHWs to learn the knowledge and practice the skills under supervision and experienced health worker and trainer.
All CHWs are attending once a month to their related health facilities for a refresher session. This session provides an opportunity for CHWs to exchange knowledge and practices, submit their monthly reports, receive necessary feedback on their referrals, discuss about some challenges and difficulties cases they managed during the month and discuss about the main health problems of their communities and possible solutions.
There are 734 active community health Shuras to support CBHC program and 63 health Shuras to support the HFs. Among this figure 97 female Shura that meet separately. Establishing female health Shura has shown great success in implementing of the project and it enabled us to achieve our targets. First we involved the religious leaders and most influential male members of the community understand about the CBHC program and supported it. As well we involved female health workers in the program to identify the most respectable women in the villages to get their support in detecting and gathering of a group of dedicated women to establish a female health Shura. These Shuras oriented about CBHC program and requirement and expectation of the program from Shuras. The Shuras meets at least once a month and in each meeting, they discuss on a priority health problem of the community and propose appropriate solutions. The maternal and child health topics are the first priority in health community Shura meetings. The community male and female health Shuras involve the male in reproductive health to improve the decision making and women empowerment in health care seeking. To advocate for the role of the CHWs among their people and create demand for utilization of their services, we added an agenda regarding this topic in each Shuras meetings. Conducing training and exchange visit from model Shuras are the approaches that we use for the capacity building of Shuras members. We use the monthly meetings as an opportunity to train the health Shura members and improve their capacity.
According to CBHC plan, we brought together a group of women in the catchment area of health post to talk about their past experiences in pregnancy related health problems, delivery and caring of newborns. The FHAG lead by an experience CHW or health workers. Each woman in the group express her past experiences and talk about the problems she faced. Through this we enabled to disseminate the knowledge and experience among women.
OCCD have a functional referral system, from HP to health facilities level CHWs are the key personnel in this level. Early recognition of danger signs among children and women; ability to communicate the issue to the families; and refer them to appropriate referral center are among the main activities they will do. Each HFs have a system to collect referral cards from CHWs, and give them a feedback during the CHW refresher session. During dialogue with community, we use the real-life scenarios for maternal and child death cases, as a case study method, to emphasize the role of timely referral and its importance in death prevention. Through participatory approaches with communities we found innovative and feasible strategies which are locally feasible and acceptable