Community Based Health Care (CBHC)
OCCD as a community- based development organization has successful experience of implementing Community Based Health Care program as integral part of Basic Package of Health Services (BPHS) in several part of Afghanistan. As a national NGO, OCCD remained closer to the community, worked with them and provided timely response to their needs and obtained their trust. This has further enhanced the organization’s capacity to work in challengeable areas. OCCD is well experienced in provision of CBHC and educating and deploying community health workers such as community midwives and community health nurses. OCCD has expanded the coverage of BPHS through training and supporting CHWs and FHAGs in remote areas; establishing female health Shuras at both HF and HP levels. Improving referral activities has been the core objective of the OCCD’s CBHC activities through CHWs and FHAGs. They trained on detecting and timely referral of diseases requiring specialized care. OCCD believes that its past experience of extending coverage of health services through CBHC activities and improving of quality of health care through building required capacities in HFs as well as community are the main assets for the organization that enable the organization to undertake any challenges and come up with significant accomplishments.
Community Based Health Care Activities:
OCCD implemented the main component of BPHS which was 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 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 community level
- Promoting behavior changes and healthy lifestyles in household and the community.
Through the CBHC, OCCD leaded the following activities:
- 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 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 provided the chance for CHWs to learn the knowledge and practice the skills under supervision and experienced health worker and trainer.
- CHW Monthly Meetings: All CHWs attended once a month to their related health facilities for a refresher session. This session provided 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.
- Community Health Shuras: There were 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.
- Family Health Action Group (FHAG): 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 FHAGs 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.
- Control of Tuberculosis (TB) at the community level: Our main task was 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 implemented 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 maintained improving TB case detection at HPs level. Furthermore, the early diagnosis and prompt treatment of TB cases were improved and the process tracked by CHWs that patients complete the regime through close follow up of cases at the communities. The OCCD overall community-based TB activities were:
- 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
- Community-Based Nutrition Activities: OCCD main focus was 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 were promoted through CHWs, LHC members, FHAGs and Mullahs at the community level.
- Referral System: OCCD had a functional referral system, from HP to health facilities level CHWs were 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 had a system to collect referral cards from CHWs, and give them a feedback during the CHW refresher session.
Dissemination of Health Messages through FM Radio:
The media is an important ally in any public health situation. It serves the role of being a source of correct information as well as an advocate for correct health behaviors. The local media plays a vital role as the link between health workers and the larger public. The mass media helps health workers expand their audience reach when this channel is in the form of the radio. It is an effective way to persuade target audience to adopt new behaviors or remind them of critical information. In order to disseminate information about the health messages to the wider public, OCCD coordinated with related department at the provincial level and oriented them regarding the importance of health education. The health message dissemination purpose was, to increase the awareness of the community on health preventive and promote measures which covers the whole province. These messages broadcasted through the FM Radio and including the key messages which was endorsed by MoPH. Besides informing the public about disease and where to seek help, they also have been kept the public update about health events and specially on NIDs campaigns. The overall objective of these project was to decrease maternal and child mortality through the increasing and raising health awareness of the society and empower rural populations to fight major cause of maternal and infant mortalities. The main topics focused on:
- Family Planning
- Communicable disease (TB, HIV, Hepatitis, Malaria)
- b) Exclusive Breastfeeding;
- c) Reproductive Health
- d) Health Care Seeking Behavior
- e) Immunization.