Basic Package Health Service (BPHS) Implementation SEHATMANDI Daikondi Project as a partner with MOVE
OCCD implements the Basic Package of Health Service (BPHS) project under Sehatmondi project contracted by the ministry of public health and funded by Word Bank (WB) with partnership of MOVE in Daikondi province. The project started in January 2019 and will end in Jun 2021. Under this project OCCD carries out the following assignments:
Community Based Health Care (CBHC) Program:
Currently OCCD is implementing the main component of BPHS through the Sehatmandi project in Daiknodi province. CBHC is the cornerstone of successful implementation of the BPHS. It provides the context for the most comprehensive interaction between the health system and the communities it serves. Hence OCCD strengthens the components of CBHC system in line with the MoPH/CBHC guideline to improve the CHWs performances. Under the CBHC, OCCD has the following activities:
a) Community Health Worker (CHW) Refresher and initial Training: To maintain and improve CBHC performance, refresher training provides for all current HPs. Based on project work plan 375 HPs will be trained through the life of the project and we provide at least a three-day refresher training twice yearly for the all CHWs. Furthermore, we will provide initial training to the new HPs including dropout CHWs as per the revised curriculum.
b) CHW Monthly Meetings: 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.
c) Health Committees (Shura-e-Sehi): OCCD strengthens existing Shura-e-Sehi and established a well-functioning Shura-e-Sehi at the Health Posts and Health Facility level. We regularly enhance the capacity of Shura-e-Sehi members on communication skill, problem solving, BCC, and supervision.
d) Community Health Shuras: We structured active community health Shuras to support CBHC program and the HFs. 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.
e) Family health action group (FHAG): Family health action group (FHAG) is a mechanism that improves communication and involvement of community in managing and promoting health care to address community needs. The FHAG play important role in improving CHWs performance. The FHAG will help female CHW with outreach activities, appropriate use of curative and preventive care provided by CHW, promote behavioral change for healthy homes and lifestyles, promote the use of health services, inform the CHW on pregnancies, births and sick women and children that need their help. 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.
f) Control of Tuberculosis (TB) at the community level: Our main task is to support and strengthen standardized-course chemotherapy (SCC) and direct observation of treatment (DOTS) at community level. Through the CBHC program, special attention placed on TB diagnosis and referral. Community-based DOTS implements in all HPs through proper equipment, supplies, capacity building and supportive supervision, in close cooperation with HF team. We enhanced the awareness of communities regarding TB transmission, symptoms, & signs, and DOTs by IEC/BCC through the HPs. We maintain improving TB case detection at HPs level. Furthermore, the early diagnosis and prompt treatment of TB cases improved and the process tracked by CHWs that patients complete the regime through close follow up of cases at the communities. Likewise, TB referral improved through collection of sputum in the community at HP level and its transfer to nearest lab facility using available transportation. The OCCD overall community-based TB activities are:
• Referral of family members of TB patients for contact assessment
• Supporting TB patients to complete their treatment under direct observation of CHWs
• All HPs perform case finding activities and refer the suspected cases to those HFs performing sputum smear tests
• Health workers and CHWs training on DOTs protocol
• Implementing DOTs at the community level
• IEC/BCC sessions on stigma reduction and curability of TB patients by CHWs
• Notified each case of active TB in the community and set up a schedule of regular visits to the home to provide medications and observe the patient taking them
• Participate in the domiciliary visits to the TB patients and families and sensitize the community about the importance of the supervised treatment providing health education
g) Community-based nutrition activities: OCCD main focus is on increasing community awareness, and strengthening case management and nutritional surveillance by carrying out the community-based nutrition activities. Through the community-based nutrition activities, we increased community awareness on nutrition and improved case referral to HFs. Furthermore, the CHWs tasked with conducting IEC activities to raise awareness about nutrition, food security, growth monitoring, and malnutrition. The CHWs/FHAGs trained to recognize early signs of malnutrition and refer relevant cases. We implemented the Community-Based Growth Promotion (CBGP) for active case finding of malnutrition through CHWs, FHAGs and shura members in coordination with nearest health facility. As well as the exclusive breastfeeding for all children from birth to age 6 months are promoted through CHWs, LHC members, FHAGs and Mullahs at the community level.
h) Referral System: 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.
i) Supply of CHW’s Kits: Based on our experience, we know that providing adequate kits in a timely manner has a great impact on improving the quality of CBHC program. Thus, OCCD uses the MoPH CBHC guideline to supply the CHWs with necessary of these kits. The CHWs receive these kits in quarterly basis, when they attend to the HFs for monthly meeting. During the supervision activities, we follow with CHWs to make sure proper and rational use of drugs and medical supplies. To avoid stock out of drugs and supplies, the CHS regularly supply the CHWs with necessary items time to time, during supervisory visits.